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Rocky  Mountain  Medical  Journal 

Official  Journal 

of 

The  Colorado  State  Medical  Society 
The  Montana  State  Medical  Association 
The  New  Mexico  Medical  Society 
The  Utah  State  Medical  As  sociation 
The  Wyoming  State  Medical  Society 
The  Colorado  Hospital  Association 
The  Rocky  Mountain  Medical  Conference 

VOLUME  XLVI 
January  to  December,  1949 


EDITORIAL  BOARD 

Lyman  W.  Mason,  M.D.,  Associate  Editor  for  Colorado  and  Chairman  of 
Editorial  Board,  1214  Republic  Bldg.,  Denver 

Douglas  W.  Macomber,  M.D.,  Scientific  Editor,  1820  Gilpin  St.,  Denver 

Raymond  P.  Peterson,  M.D.,  Scientific  Editor  for  Montana,  Murray  Clinic, 

Butte 

Herbert  T.  Caraway,  M.D.,  Associate  Editor  for  Montana,  1 15  North  28th  St., 

Billings 

Carl  H.  Gellenthien,  M.D.,  Scientific  Editor  for  New  Mexico, 
Valmora  Sanatorium,  Valmora 

H.  L.  January,  M.D.,  Associate  Editor  for  New  Mexico,  First  National  Bank 

Bldg.,  Albuquerque 

R.  P.  Middleton,  M.D.,  Scientific  Editor  for  Utah,  Boston  Bldg.,  Salt  Lake  City 

W.  H.  Tibbals,  Associate  Editor  for  Utah,  316  Atlas  Bldg.,  Salt  Lake  City 

Earl  Whedon,  M.D.,  Scientific  Editor  for  Wyoming,  304  South  Main  St., 

Sheridan 

Arthur  Abbey,  Associate  Editor  for  Wyoming,  Box  897,  Cheyenne 

Roy  R.  Anderson,  Editor  for  Colorado  Hospital  Association,  Presbyterian 

Haspital,  Denver 

Harvey  T.  Sethman,  Managing  Editor,  835  Republic  Bldg.,  Denver 


I 


Press 
of  the 

Western  Newspaper  Union 


Psychological  Factors  in  Everyday  Practice — 
O.  Spurgeon  English,  Philadelphia. 

Current  Therapeutic  Procedures  in  Coronary 
Disease — William  S.  Middleton,  Madison,  Wis- 
consin. 


^ _4i;MOCHRO]v/[ATOSIS  WiTH  ApLASTIC  OR  REFRACTORY 

— Eugene  Hildebrand,  F.  H.  Crago  and 
A.  Layne,  Great  Falls. 

Invers^n  of  the  Uterus — Raymond  Mundt, 
npoint.  New  Mexico. 

"noma  of  the  Skin— T/ioma.s  K.  Mahan, 
rand  Junction. 

Malignancy  Records — Claude  L.  Shields.  Salt 
Lake  City.  ■/’  •’ 

(For  Complete  Table  of  Corit‘(m(nf‘ 

Turn  the  First  Pagei'^,^'‘ 


25c  Per  Copy 


$2.50  Per  Year 


criteria  in 


syphilotherapy 


MAPHARSEN 


PARKE,  DAY 


-XyC; 


“Therefore,  more  than  in  any  other  disease,  it  is  necessary  in  the 
treatment  of  an  individual  patient  with  syphilis  to  follow  a thera- 
peutic regimen  which,  after  long-term  study  in  large  series  of 
patients,  has  been  established  as  satisfactory  for  the  particular 
type  of  syphilis  under  consideration.”* 


<jm  4)£ /im 


long-term  study 

more  than  a decade  of  clinical  evaluation. 


large  series  of  patients 

over  two  hundred  million  injections  already  administered. 


satisfactory 

high  therapeutic  effectiveness  with  notable  safety  in  causing  dis- 
appearance of  spirochetes,  healing  of  lesions  and  reversal  of  sero- 
positivity  in  a large  percentage  of  cases. 


MAPHARSEN  ( oxophenarsine  hydrochloride,  P.  D.  & Co.)  is  supplied  in 
single  dose  ampoules  of  0.04  Gm.  and  0.06  Gm.,  boxes  of  10,  and  in  mul- 
tiple dose  ampoules  of  0.6  Gm.  in  boxes  of  10. 

*Cecil,  R.  A.:  A Textbook  of  Medicine.  Philadelphia,  W.  B.  Saunders  Co.,  1947,  p.  370. 


APR  1 2 195a 


N 


E TV 


<:MdealSv!^mi 

. . . Designed  by  a former  Government  expert 

Simplified  Bookkeeping  System  and  Income 
Tax  Record 


Special 

Book 

for 

Doctors 

and 

Dentists 


Loose-Leaf  Book — Actual  Size  9'/2*^'/i  Inchoi 


Easy,  inexpensive  bookkeeping — no  experience 
required.  Facilitates  preparation  of  Income  Fax 
Reports.  One  loose-leaf  book  does  it  all.  In- 
cludes Bulletin  and  Advisory  Services.  Meets 
all  federal  and  state  tax  requirements. 

D-size,  $5;  E-size,  $3.50;  F-size,  $2  postpaid, 
each  complete.  2%  tax  in  Colorado.  Mail  or 
phone  orders;  use  charge  account. 

STATIONERY  CO.  yl 

KEystone  0241 

1641  California  St.  Denver  2,  Colorado 


Qea.  (1. 

Orthopedic  Brace 
and  Appliance  Co. 

1628  Court  Place  MAin  3026 

Write  for  Measuring  Chart 


Table  of  Contents 

VOLUME  46  NUMBER  1 

JANUARY,  1949 

Page 


Editorials 

This  Is  Worth  Memorizing 17 

Total  Socialization  in  England 17 

American  War  Hospitals  in  England 19 

Silhouettes  From  the  A.M.A.  House  of 
Delegates  19 

Correspondence  20 

4- 


Original  Articles 

Psychological  Factors  in  Everyday  Prac- 
tice, O.  Spurgeon  English 21 

Current  Therapeutic  Procedures  in  Coron- 
ary Disease,  William  S.  Middleton 27 

Hemochromatosis  With  Aplastic  or  Re- 
factory Anemia,  Eugene  Hildebrand,  F. 

H.  Crago  and  John  A.  Layne 32 

Inversion  of  the  Uterus,  Raymond  Mundt..  36 

Carcinoma  of  the  Skin,  Thomas  K.  Mahan  38 

Malignancy  Records.  Claude  L.  Shields 43 

■f 


Organization 


Colorado 

Colorado  Demands  Action  by  A.M.A. ! 48 

Report  of  Delegates  to  A.M.A.  Regarding 

Interim  Session 50 

Preliminary  Program  National  Confer- 
ence on  Medical  Service 52 

Dr.  Sudan  Hails  His  Successor 54 

Obituaries  54 

Denver  Children’s  Hospital  Summer 

Clinics  56 

Auxiliary  56 

Colorado  Medical  School  Notes 58 

Utah 

Obituaries  58 

Medical  School  Notes 60 

Wyoming 

The  1949  Meeting 60 

Natrona  County  Medical  Society  Elec- 
tions   60 


4- 


Colorado  Hospital  Association 62 

Tuberculosis  Abstracts  66 

The  Book  Comer 70 


2 


Rocky  Mountain  Medical  Journal 


R.  J.  Reynolds  Tobacco  Co.,  Winston-Salem,  N.  C. 

4cc«rdmg  t@  a Nationwide  surveys 

MORE  DOCTORS  SMOKE 
CAMELS  THAN  ANY 
OTHER  CIOARETTE 

Doctors  smoke  for  pleasure,  too!  And  when 
three  leading  independent  research  organiza- 
tions asked  113,597  doctors  what  cigarette  they 
smoked,  the  brand  named  most  was  Camel! 


Test  for  yourself 
what  throat  specialists 
reported  when  a 30-day 
smoking  test  revealed: 


NO  THROAT 
IRRITATION 

due  to  smoking 

CAMELS!" 


MAKE  YOUR  OWN  30- 
DAY  CAMEL  MILDNESS 
TEST.  Smoke  Camels,  and 
only  Camels,  for  30  days. 
Prove  for  yourself  how  mild 
Camels  are! 

Hundreds  of  men  and 
women,  from  coast  to  coast, 
recently  made  a similar  test. 
They  smoked  an  average  of 
one  to  two  packs  of  Camels  a 
day  for  30  days.  Their  throats 
were  carefully  examined  by 
throat  specialists.  And  after  a 
total  of  2470  examinations  — 
these  throat  specialists  re- 
ported "not  one  single  case  of 
throat  irritation  due  to  smok- 
ing Camels!” 

But  prove  it  yourself ...  in 
your  "T-Zone”  (T  for  Taste 
and  T for  Throat).  Let  YOUR 
OWN  TASTE  tell  you  about 
the  rich,  full  flavor  of  Camel’s 
choice  tobaccos.  Let  YOUR 
OWN  THROAT  give  the 
go.od  news  of  Camel’s  cool, 
cool  mildness. 


for  January,  1949 


3 


ROCKY  MOUNTAIN  MEDICAL  JOURNAL 

Tit/«  Registered,  U.S.  Patent  Office 
Publication  Office: 

835  Republic  Building  (1612  Tremont  Place),  Denver  2,  Colorado 
Telephone  C Kerry  5521. 

EDITORIAL  BOARD 

Colorado:  Douglas  W.  Macomber,  M.D.,  Scientific  Editor,  1820  Gilpin  St.,  Denver;  Lyman  W.  Mason, 
M.D.,  Associate  Editor,  1214  Republic  Bldg.,  Denver,  (Chairman  of  Editorial  Board). 

Montana:  Raymond  F.  Peterson,  M.D.,,  Scientific  Editor,  Butte,  Mont.;  Herbert  T.  Caraway,  M.D., 
Associate  Editor,  Billings,  Mont. 

New  Mexico:  Carl  H.  Gellenthein,  M.D.,  Scientific  Editor,  Valmora,  New  Mexico;  Harold  L.  Janu- 
ary, M.D.,  Associate  Editor,  First  National  Bank  Bldg.,  Albuquerque,  New  Mexico. 

Utah:  Richard  P.  Middleton,  M.D.,  Scientific  Editor,  Boston  Bldg.,  Salt  Lake  City;  W.  H.  Tibbals, 
Associate  Editor,  316  Atlas  Bldg.,  Salt  Lake  City. 

Wyoming:  Earl  Whedon,  M.D.,  Scientific  Editor,  Sheridan;  Arthur  R.  Abbey,  Associate  Editor,  P.O. 
Box  897,  Cheyenne. 

Hospital  Assn.:  B.  B.  Jsita,  M.D.,  Editor,  230  Metropolitan  Bldg.,  Denver. 


Managing  Editor:  Harvey  T.  Sethman,  835  Republic  Bldg.,  Denver. 
Business  Manager:  Helen  Kearney,  835  Republic  Bldg.,  Denver. 


Ownerahip  and  Sponaorahipt  The  Rocky  Mountain 
Medical  Journal  is  owned  by  the  Colorado  State 
Medical  Society  and  is  published  monthly  as  a non- 
profit enterprise  for  the  mutual  benefit  of  the  or- 
ganizations which  Jointly  sponsor  it.  It  is  published 
under  the  direction  of  the  Board  of  Trustees  of  the 
Colorado  State  Medical  Society,  assisted  by  an  Edi- 
torial Board  representing:  the  sponsoring  organiza- 
tions. It  is  the  Official  Journal  of  the  Colorado  State 
Medical  Society,  the  Montana  State  Medical  Associa- 
tion, the  New  Mexico  Medical  Society,  the  Utah 
State  Medical  Association,  the  Wyoming  State  Medi- 
cal Society,  the  Rocky  Mountain  Medical  Conference, 
and  the  Colorado  Hospital  Association. 

Manascrlptst  Scientific  Articles,  Case  Rei>orts,  etc., 
from  any  state  for  which  this  is  the  Official  Journal 
should  be  submitted  to  the  Scientific  Editor  for  that 
state  as  named  in  the  Editorial  Board,  above.  Other 
material  from  any  participating  state  should  be  sub- 
mitted to  the  Associate  Editor  for  that  state  as 
named  above.  Manuscripts  from  outside  the  Rocky 
Mountain  area  should  be  sent  direct  to  the  Journal 
office.  Manuscripts  must  be  typewritten,  double  or 
triple  spaced,  using  only  one  side  of  each  sheet.  It 
is  the  policy  of  this  Journal  to  omit  bibliographies. 


Adverttaingi  National  representatives:  The  Coop- 
erative Medical  Advertising  Bureau,  535  North  Dear- 
born Street,  Chicago  10,  111.  Local  advertising  from 
firms  in  the  Rocky  Mountain  area  should  be  submit- 
ted to  the  Associate  Editor  of  the  appropriate  state 
or  to  the  Journal  office.  Advertising  forms  close  on 
the  20th  of  the  month  preceding  publication;  allow 
ten  days  additional  to  insure  submitting  proofs  for 
approval. 

Sabscrlption : |2.50  per  year  in  advance,  postpaid  in 
the  United  States  and  its  possessions;  single  copy, 
25  cents  plus  postage.  Subscription  is  included  in 
medical  society  dues  of  sponsoring  state  medical 
organizations. 

Copyright!  This  Journal  is  copyright,  1949,  by  the 
Colorado  State  Medical  Society.  Requests  for  permis- 
sion to  reproduce  anything  from  the  columns  of  this 
Journal  should  be  addressed  to  the  Journal  office. 

Second  Clns*  Hatter:  Entered  as  second  class  mat- 
ter Jan.  22,  1906,  at  the  Postoffice  at  Denver,  Colo., 
under  the  Act  of  Congress  of  March  3,  1879.  Accepted 
for  mailing  at  special  rates  of  postage  provided  for 
in  Section  1103,  Act  of  Oct.  3,  1917 ; authorised  July 
17,  1918. 


Essential  Automobiles  Given  Prioritjr — We  Recommend 

CAPITAL  CHiVROLET  COMPANY 

Featuring  COMPLETE  REPAIR  SERVICE — Including  Body,  Fender  and  Paint  Work 

CAPITAL  CHEVROLET  COMPANY 

Phone:  TAbor  5191  13th  Ave.  at  Broadway  to  Lincoln  Denver,  Colo. 


Don't  miss  important  telephone  calls 


Let  us  act  as  your  secreta^  while  you  are  away,  day  or  night: 
our  kindly  voice  conscientiously  tends  your  telephone  business, 
accurately  reports  to  you  when  you  return. 


Telephone  ANSWERING  Service  call  Atpine  mm 


Cambridge  Dairy  Grade  “A”  Milk  Is  Produced  and  Processed  at  690  S.  Colo.  Blvd. 

We  do  not  handle  Shipped-in  Milk  produced  Where?  How  and  by  Whom?  Doctors  know  the  difference 
Now  Homogenized  Vitamin  D Milk  is  available  for  baby  feeding  and  family  use. 

We  Invite  Your  Inspection  and  Appreciate  Your  Recommendation. 


INC. 


New  York  13,  N.  Y.  Windsor,  Ont. 


1.  Follis,  R.  H.,  Jackson,  D.,  Eliot,  M.  M.,  and  Park,  E.  h.  : Am:  Jour. 
Dis.  Child.,  66:1,  July,  1943. 

2.  Stearns,  Q.:Jour.  Lancet,  63:344,  Nov.,  1943. 


Throughout  the 


years . . . 


From  birth  to  at  least  the  age  of  14  years, 

investigators  now  agree  children  are 
susceptible  to  rickets,  with  scarcely 
diminished  frequency.’ 


The  critical  periods  of  active  skeletal 
growth  are  found  in  infancy  and  childhood, 
lasting  through  at  least  the  years 
just  preceding  puberty.' 


DRISDOL,  trademark  reg.  U.  S.  & panada 
CARTOSE,  trademark  reg.  U.  S.  & Canada 


ODORLESS  . . .TASTELESS  . . . ECONOMICAL 
Average  dose  for  infants  2 drops, 
for  children  4 to  6 drops,  in  milk. 


Throughout  these  formative  years  patient  cooperation 
assuring  an  adequate  vitamin  D intake  is  readily 
obtained  by  the  use  of 


WINTHROP-STEARNS 


SPECIFICALLY  DESIGNED  FOR  INFANT  FEEDING 
Less  FERMENTATION 
LESS  DIGESTIVE  DISTURBANCES 

CARTOSE® 

MIXED  CARBOHYDRATES 

IN  EASY-TO-USE  LIQUID  FORM 
Compatible  with  all  milk  formulas 
Bottles  of  16  fl.  oz.  Write  for  Formula  Blanks 


THE  COLORADO  STATE  MEDICAL  SOCIETY 

Next  Annual  Session:  Shirley-Savoy  Hotel,  Denver;  Sept.  20,  21,  22,  23,  1949 


OFFICERS 

Terms  of  Officers  and  Committees  expire  at  the  Annual  Session 
in  the  year  Indicated.  Where  no  year  is  indicated,  the  term 
is  for  one  year  only  and  expires  at  the  1949  Annual  Session. 

President:  Casper  F.  Hegner,  Denver. 

President-elect:  Fred  A.  Humphrey,  Fort  Collins. 

Vice  President:  Lester  L.  Ward,  Pueblo. 

Constitutional  Secretary  (three  years) : George  B.  Buck,  Denver,  1951. 
Treasurer  (three  years):  George  C.  Shivers,  Colorado  Springs,  1950. 

Additional  Trustees  (three  years);  Ervin  A.  Hinds,  Denver.  1949;  E.  H. 
Munro,  Grand  Jurction,  1949;  S.  P.  Newman,  Denver,  1950;  Claude  D. 
Bonham,  Boulder,  1951. 

(The  above  nine  officers  compose  the  Board  of  Trustees  of  which  Dr. 
Ervin  A.  Hinds  is  the  1948-1949  Chairman.) 

Board  of  Councilors  (three  years):  District  No.  1;  Clemens  F.  Eaklns, 
Brush,  1951:  No.  2;  Ella  A.  Mead,  Greeley,  1951;  No.  3:  L.  G.  Crosby. 
Denver,  1951:  No.  4:  banning  E.  Likes,  Lamar,  1950:  No.  5:  Guy  H. 
Hopkins.  Pueblo,  1950:  No.  6:  Lester  E.  Thompson,  Salida,  1950;  No.  7: 
A.  L.  Burnett,  Durango,  1949:  No.  8:  Lawrence  L.  Hick,  Delta,  1949; 
No.  9:  W.  W.  Sloan,  Hayden,  1949  (Chairman  of  Board  for  1948-49). 

Board  of  Supervisors  (two  years):  A.  B.  Gjelium,  Del  Norte,  1949:  L.  W. 
Lloyd,  Durango,  1949:  B.  0.  Howlett,  Golden,  1949;  Scott  A.  Gale, 
Pueblo,  1949:  L.  D.  Dickey,  Fort  Collins,  1949:  N.  A.  Madler,  Greeley, 
1949  (Chairman  of  Board  for  1948-49);  L.  D.  Buchanan,  Wray,  1960; 
W.  F.  Deal,  Craig,  1950:  G.  C.  Cary,  Grand  Junction,  1950:  W.  A. 
Campbell,  Colorado  Springs,  1950:  Balph  S.  Johnston,  Sr.,  La  Junta, 
1950:  William  A.  Liggett,  Denver,  1950. 

Delegates  to  American  Medical  Association  (two  years):  George  A.  Unfug, 
Pueblo,  1949  (Alternate:  Herman  C.  Graves,  Grand  Junction,  1949); 
William  H.  Halley.  Denver,  1960  (Alternate:  Kenneth  C.  Sawyer,  Denver, 
1950). 

Foundation  Advocate:  Walter  W.  Klnc,  Denvv. 

Executive  Office  Staff:  Mr.  Harvey  T.  Sethman,  Executive  Secretary: 
Miss  Helen  Kearney,  Assistant  Executive  Secretary;  llr.  Evan  A.  Edwards, 
Field  Secretary;  Miss  Mary  E.  McDonald,  Committee  Secretary;  835  Be- 
publlc  Building,  Denver  2,  Colo.,  Telephone  CHerry  5521. 

General  Counsel:  Mr.  J.  Peter  Nordlund,  Attorney-at-Law,  Denver. 

STANDING  COBIMITTEES 

Credentials:  George  B.  Buck,  Denver,  Chairman,  ex-officio;  others  to 
be  appointed. 

Public  Policy:  Kenneth  C.  Sawyer,  Denver,  Chairman;  McKlnnle  L. 
Phelps.  Denver,  Vice  Chairman;  John  S.  Bouslog,  Denver;  F.  B.  Calhoun, 
Denver;  Frank  B.  McGlone,  Denver;  T.  M.  Bogers,  Sterling;  Sidney  An- 
derson, Alamosa;  Bichard  L.  Davis,  La  Junta;  Herman  C.  Graves.  Grand 
Junction;  John  L.  McDonald.  Colorado  Springs:  Lawrence  D.  Dickey,  Fort 
ColUns;  George  E.  Bice,  Pueblo;  John  D.  OUlaspie,  Boulder.  Ex-officio 

members:  Casper  F.  Hegner,  President;  Fred  A.  Humphrey,  President-elect; 

George  B.  Buck,  Constitutional  Secretary. 

Sub-Committee  on  Legislation:  H.  I.  Barnard,  Denver,  Chairman;  others 
to  be  appointed. 

Health  Education  (two  years):  A.  C.  Sudan.  Denver,  Chairman,  1949; 

J.  D.  Bartholomew,  Boulder,  1949;  B.  J.  Savage,  Denver,  1949;  B.  T. 
Porter,  Greeley.  1949;  Bobert  B.  Bradshaw,  Alamosa,  1949;  L.  W.  Bortree, 
(k)lorado  Springs,  1950;  F.  0.  Bobertson,  Denver,  1950.;  J.  L.  Sadler,  Port 
Collins,  1950;  Harold  T.  Low,  Pueblo,  1950;  John  H.  Amesse,  Denver, 
1950;  E.  H.  Munro,  Grand  Junction,  1950. 

Scientific  Work:  W.  B.  Condon,  Denver,  Chairman;  Bobert  S.  Liggett, 

Karl  F.  Arndt,  Frank  T.  Joyce,  Marshall  G.  Nims,  Vincent  G.  Cedar- 

blade,  all  of  Denver. 

Sub-Committee  on  Scientific  Exhibits:  Frank  C.  Campbell,  Chairman; 
Nolle  Mumey,  Edgar  W.  Barber,  B.  W.  Vines,  all  of  Denver. 

Arrangements:  To  be  appointed. 

Medicolegal  (two  years):  B.  W.  Arndt,  1950,  Chairman;  George  B. 
Packard,  Jr.,  1950;  K.  D.  A.  Allen,  1950;  C.  S.  Bluemel,  1949;  all  of 
Denver.  Two  others  to  be  appointed. 

Medical  Education  and  Hospitals:  George  F.  Wollgast,  Denver,  Chairman; 
W.  W.  Sloan.  Hayden:  F.  B.  Pingrey,  Durango;  E.  B.  Mugrage,  Denver; 
D.  W.  McCarty,  Longmont:  A.  E.  Lubchenco,  Denver. 

Library  and  Medical  Literature:  A.  J.  Markley,  Denver,  Chairman;  T.  E 
Beyer,  Denver;  J.  J.  Connor,  Delta;  H.  Dumont  Clark,  Denver. 

Medical  Service  Plans;  F.  H.  Good,  Denver,  Chairman;  C.  E.  Honstein, 
Port  Collins;  James  B.  Blair,  Denver;  Vernon  L.  Bolton,  (kilorado  Springs; 
Scott  A.  Gale,  Pueblo;  John  A.  Weaver,  Jr.,  Greeley;  John  E.  Hyland, 
Monte  Vista;  Thomas  K.  Mahan,  Grand  Junction. 

Necrology:  W.  H.  Wilson,  Denver,  Chairman. 

PUBLIC  HEALTH  COMMITTEES 

General  Committee  on  Public  Health:  Consists  of  the  chairmen  of  the 
following  eleven  public  health  subcommittees,  presided  over  by  Bobert  W. 
Dickson,  Denver,  as  General  Cbairman. 

Cancer  Control:  J.  C.  Mendenhall,  Denver,  Cbairman;  John  B.  Grow, 
Denver;  S.  W.  Holley,  Greeley:  T.  Leon  Howard,  Denver;  James  B.  Mc- 
Naught,  Denver;  Eoger  G.  Howlett,  Golden:  James  W.  McMullen,  Colorado 
Springs;  James  E.  Donnelly,  Trinidad;  Lanning  E.  Likes,  Lamar;  Thomas 

K.  Jlahan.  Grand  Junction. 


Crippled  Children:  I.  E.  Hendryson,  Denver.  Chairman:  Mary  L.  Moore, 
Grand  Junction;  Bichard  H.  Mellen,  Colorado  Springs;  Sidney  B.  Bland- 
ford,  Jr.,  Denver;  Paul  B,  Hildebrand,  Brush;  Samuel  P.  Newman,  Denver. 

Industrial  Health;  B.  F.  Bell,  Loiivlers.  Chairman;  A.  B.  Woodbume, 
Denver;  Vincent  F.  Kelly,  Leadville;  D.  W.  Boyer,  Pueblo;  H.  G.  Harvey,  Jr.. 
Denver:  Bobert  Woodruff,  Denver;  Frank  J.  McDonough,  Grand  Junction. 

Local  Health  Units:  Monroe  B.  Tyler,  Denver,  Chairman;  Harold  E 
Haymond.  Greeley;  B.  B.  Richards.  Fort  Morgan:  Nicholas  S.  Saliba,  Wal- 
senburg;  Marvel  L.  Crawford,  Steamboat  Springs;  R.  Sherwln  Johnston,  Jr., 
La  Junta. 

Maternal  and  Child  Health:  John  R.  Evans,  Denver,  Chairman;  Joseph 
H.  Lyday.  Denver;  John  M.  Nelson,  Denver:  Tracy  D.  Peppers,  Greeley: 
J.  H.  Woodbridge,  Pueblo;  M.  E.  Snyder,  Colorado  Springs. 

Mental  Hygiene:  Bradford  Murphey,  Denver,  Chairman;  E.  James  Brady, 
Colorado  Springs;  Frank  H.  Zimmerman,  Pueblo:  Paul  A.  Draper,  Colorado 
Springs;  J.  P.  Hilton,  C.  S.  Bluemel,  John  M.  Lyon,  G.  H.  AsUey,  Lewis 
C.  Overholt,  Clarke  H.  Barnacle,  Harold  R.  Carter,  all  of  Denver. 

Milk  Control;  George  W.  Stiles,  Denver,  Chairman;  Max  M.  Glnsburg, 
Denver;  N.  J.  Miller,  D.V.M.,  Eaton;  Millard  F.  Schafer,  Colorado  Springs; 
Robert  W.  Vines,  Denver;  Mr.  Wendell  Vincent,  Denver. 

New  Hospital  Construction:  D.  R.  Collier,  Wheatridge,  Chairman; 
Henry  M.  Powell,  Colorado  Springs;  Mr.  John  R.  Peterson,  Fort  Collins; 
Florence  B.  Sabin,  Denver;  Herbert  A.  Black,  Pueblo. 

Public  Water  Supplies:  E.  I.  Dobos,  Denver,  Chairman;  Robert  Barnard, 
Eagle;  William  C.  Shontz,  San  Luis;  Carl  W.  Maynard,  Pueblo;  W.  B. 
Crouch,  Colorado  Springs;  H.  D.  Palmer,  Denver;  E.  Robert  Orr,  Fnilta. 

Tuberculosis  Control:  John  I.  Zarit,  Denver,  Chairman;  W.  J.  Hlnzel- 
man,  Greeley;  H.  M.  Van  Der  Schouw,  Wheatridge:  John  P.  McGraw,  Pueblo; 
Arthur  Rest,  Denver;  H.  Calvin  Fisher,  Denver;  T.  D.  (hinningham,  Denver. 

Venereal  Disease  Control:  Sam  W.  Downing,  Denver,  Cbairman;  Paul  B. 
Stidham,  Grand  Junction;  H.  E.  Coakley,  Pueblo;  D.  E.  Newland,  Denver: 
Joseph  H.  Patterson,  Denver.  James  R.  McDowell,  Denver. 


SPECIAL  COMMITTTES 

Rocky  Mountain  Medical  Conference  (five  years):  L.  Clark  Hepp,  Denver, 
1953;  G.  P.  Lingenfelter,  Denver,  1952,  Chairman;  Ward  Darley,  Denver, 
1951;  L.  W.  Bortree,  Colorado  Springs,  1950;  George  H.  Gillen,  Denver, 
1949. 

Advisory  to  Auxiliary:  Fred  A,  Humphrey,  Fort  Collins,  Chairman;  Ervin 
A.  Hinds,  George  R.  Buck,  Denver. 

Midwinter  Clinics:  Samuel  B.  Childs,  Jr.,  Chairman;  Raymond  C.  Chat- 
field,  E.  L.  Binkley.  Jr.,  A.  J.  Kauvar,  Terry  J.  Gromer,  aU  of  Denver. 

Rehabilitation:  W.  W.  Haggart,  Denver,  Chairman;  Atha  Thomas,  Den- 
ver; Lawrence  T.  Brown,  Denver;  J.  E.  A.  ConneU,  Pueblo:  Thad  P.  Sears, 
Ft.  Logan;  Kenneth  C.  Sawyer,  McKlnnle  L.  Phelps,  (leorge  B.  Buck, 
Bradford  Murphey.  all  of  Denver. 

Advisory  to  the  Goodwill  Industries’  Rehabilitation  Program:  Lewie  C. 
Overholt,  Chairman;  William  H.  Halley,  Maurice  Katzman,  Terry  J. 
Gromer.  Lorenz  W.  Frank,  William  B.  Lipscomb.  Irvin  E.  Hembrson, 
all  of  Denver. 

Rural  Hdalth  Commission:  Leonard  N.  Myers,  Cheyenne  Wells,  Chairman; 

V.  V.  Anderson,  Del  Norte;  James  S.  Orr,  Fruita;  Keith  F.  Krausniek, 
Lamar;  Robert  M.  Lee,  Fort  Collins.  Ex-offlcio  member;  Fred  A.  Hum- 
phrey, Fort  Collins. 

Medical  Disaster  Commission;  Foster  Matchett,  Denver,  Chairman;  Karl 
Arndt,  Denver,  Secretary;  Mark  S.  Donovan,  Harry  C.  Hughes,  Adolph  J. 
Kafka,  Roderick  J.  McDonald,  William  F.  Stanck,  Henry  Swan,  Karl  F. 
Sunderland,  all  of  Denver;  Lawrence  W.  Holden,  Boulder;  Richard  H. 
Mellen,  Colorado  Springs;  Richard  H.  Altmix,  Englewood;  Jacob  0.  Hall, 
Estes  Park;  Thad  P.  Sears,  Fort  Logan;  Donald  E.  Cowen,  Fort  Morgan; 
Kenneth  E.  Prescott,  Grand  Junction;  Walter  A.  Seboen,  Greeley;  David 

W.  McCarty,  Longmont:  David  W.  Boyer,  Pueblo;  J.  G.  Espey,  Craig;  Leo 
W.  Lloyd,  Durango;  Keith  F.  Krausniek,  Lamar;  Bobert  M.  Lee,  Ft.  Col- 
lins; George  H.  Lord,  Aurora;  J.  Gordon  Hedrick,  Wray;  James  P.  Bigg, 
Grand  Junction.  ■ 

Lay  Organization  Standards:  George  R.  Buck,  Fredrick  H.  Good,  Ken- 
neth C.  Sawyer,  Frank  B.  McGlone,  T.  D.  Cunningham,  Bradford  Murphey, 
Casper  F.  Hegner,  John  S.  Bouslog,  all  of  Denver. 

Study  of  Child  Welfare  Clinics:  Balph  H.  Verploeg,  .Denver,  Chairman; 
J.  W.  White,  Pueblo'  Jackson  L.  Sadler,  Fort  Collins;  L.  E.  Maurer, 
Boulder;  Haney  M.  Tupper,  Grand  Junction;  Harvey  S.  Rusk,  Pueblo. 

Liaison  to  Colorado  State  Nurses  Association:  John  B.  Evans,  Samuel  P. 
Newman,  Denver. 

Liaison  to  Colorado  Bv  Association;  W.  S.  Dennis,  Chairman;  A.  C. 
Sudan,  R.  W.  Arndt,  aU  of  Denver. 

Medical-Dental  Liaison:  Guy  W.  Smith,  Denver,  Chairman;  George  E 
Warner,  Denver;  Calvin  N.  Caldwell,  Pueblo. 

Representative  to  Rocky  Mountain  Radio  Council:  William  E.  Hay, 
Denver;  (Alternate:  Chauncey  A.  Hager,  Denver). 

Representative  to  Belle  Bonfils  Memorial  Blood  Bank:  0.  S.  Pbilpott, 
Denver. 

Representatives  to  Liaison  Council  on  Graduate  Education  (two  years) : 

L.  R.  Safarik,  Denver,  1949;  Harold  I.  Goldman,  Denver,  1950. 

Delegate  to  Colorado  Interprofessional  Council  (five  years):  K.  D.  A. 
.Allen,  Denver,  1949;  (Alternate:  Carl  A.  McLauthlin,  Denver,  1949). 


6 


Rocky  Mountain  Medical  Journal 


Today,  there  is  a wealth  of  clinical  evidence  supporting 
the  use  of  Meonine  as  a supplement  to  the  protein-rich 
diet  usually  prescribed  for  liver  damage  associated  with 
malnutrition,  pregnancy,  allergy,  certain  chemical  poi- 
sons, and  alcoholism. 

Typical  of  this  evidence  is  a Beams-Endicott  paper*.  The 
authors  reported  that  a methionine  supplement  seemed  to 
cause  regeneration  of  the  liver  parenchyma,  in  cirrhotic 
patients,  irrespective  of  the  amount  of  protein  and  vitamins 
in  the  diet. 

Complete  bibliography  on  request.  Meonine  is  supplied 
in  0.5  gram  tablets.  Wyeth,  Philadelphia,  Pa. 

*Beam8,  A.  J.,  and  Endicott,  £.  T.,  Histologic  changes  in  the  livers  of  patients 
with  cirrhosis  treated  with  methionine.  Gastroenterology  9:718-735  (Dec.)  1947. 


MEONINE 

for  liver  damage 

(dl-Mefhionine  Wyefh) 


7 


for  January,  1949 


7 


MONTANA  STATE  MEDICAL  ASSOCIATION 


OFFICERS 

Terms  of  Officers  and  Committees  expire  at  the  Annual  Session 
in  the  year  indicated.  Where  no  year  is  Indicated,  the  term  is 
for  one  year  only  and  expires  at  1949  Annual  Session. 

President:  Thomas  L.  Hawkins,  Helena. 

President-elect:  Thomas  F.  Walker.  Great  Falls. 

Vice-President:  R.  G.  Johnson,  Harlowton. 

Secretary-Treasurer:  Herbert  T.  Caraway,  Billings. 

Delegate  to  American  Medical  Association:  Raymond  F.  Peterson,  Butte, 
1950:  Alternate.  Thomas  B.  Moore,  Kalispell,  1950. 


STANDING  COMMITTEES 

Executive  Committee:  T.  L.  Hawkins,  Helena,  Chairman;  T.  F.  Walker. 
Great  Falls;  H.  T.  Caraway,  Billings;  L.  W.  Allard,  BlUings;  M.  A. 

ShilUngton,  Glendive. 

Economics  Committee:  J.  C.  Shields,  Butte,  Chairman;  C.  P.  Brooke.  St 
Ignatius:  R.  B.  Durnin,  Great  Falls;  Leland  G.  Russell,  Billings;  S.  D. 

Whetstone,  Cut  Bank. 

Legislative  Committee:  J.  M.  FUnn,  Helena,  Chairman;  F.  D.  Hurd, 

Gnat  Falls;  P.  E.  Kane,  Butte;  J.  C.  MacGregor,  Great  FaUs;  Claude 

M.  Mears,  Helena. 

Necrology  and  History  of  Medicine  Committee:  L.  W.  Brewer,  Missoula, 
Chairman;  I.  J.  Bridenstine.  Missoula;  J.  H.  Irwin,  Great  Falls;  Claude 
M.  Mears.  Helena'  J.  P.  Ritchey,  Missoula. 

Public  Relations  Committee:  H.  W.  Gregg,  Butte,  Chairman;  W.  L.  DuBois, 
Cut  Bank;  R.  V.  Morledge,  Billings ; W.  H.  Stephan,  Dillon;  Dora  Walker, 
Great  Falls. 

Legal  Affairs  and  Malpractice  Committee:  J.  C.  MacGregor,  Great  Falls, 
Chairman;  Raymond  Eck,  Lewistown;  W.  E.  Harris,  Livingston;  John  E. 
Hynes,  Billings;  R.  D.  Knapp,  Wolf  Point. 

Program  Committee:  C.  H.  Fredrickson,  Missoula,  Chairman;  H.  T. 
Caraway,  Biliings'  H.  W.  Gregg,  Butte;  J.  J.  McCabe,  Helena;  E.  S. 
Murphy,  Missoula. 

Interprofessional  Relationship  Committee:  L.  W.  AUard,  Billings,  Chair- 
man: C.  R.  Canty,  Butte;  S.  A.  Cooney,  Helena;  S.  N.  Preston,  Missoula; 
F.  I.  Sabo,  Bozeman. 


Nominating  Committee:  H.  H.  James,  Butte,  Chairman;  E.  L.  Anderson, 
Fort  Benton;  R.  D.  Harper,  Sidney;  J.  J.  Make,  Anaconda;  W.  R.  Mc- 
Elwee,  Townsend. 

Auditing  Committee:  E.  H.  Lindstrom,  Helena,  Chairman;  F.  H.  Crago, 
Great  Falls;  R.  D.  Harper,  Sidney;  G.  W.  Setzer,  Malta;  R.  0.  Johnson, 
Harlowton. 

Cancer  Committee;  Mary  E.  Martin,  Billings,  Chairman;  W.  F.  Caeb- 
more,  Helena;  C.  H.  Fredrickson,  Missoula;  B.  F.  Peterson,  Butte;  W.  C. 
Robinson,  Shelby. 

Maternal  and  Child  Welfare  Committee:  F.  L.  McPball,  Great  FaUs, 
Chairman;  L.  W.  Brewer,  Missoula;  P.  L.  Eneboe,  Bozeman;  Maude  M. 
Gerdes,  Billings:  D.  L.  Gillespie,  Butte;  A.  L.  Gleason,  Great  Falls;  E.  L. 
Hall,  Great  FaUs;  D.  S.  MacKenzie,  Jr.,  Havre;  R.  E.  Mattison,  Billings; 
0.  M.  Moore,  Helena;  F.  W.  Paul,  Kalispell;  C.  W.  Pemberton,  Butte; 
S.  N.  Preston,  Missoula;  A.  E.  Rltt,  Great  Falls. 

Tuberculosis  Committee;  F.  I.  Terrill,  Galen,  Chairman;  C.  B.  Craft, 
Bozeman;  E.  A.  Dolan,  Anaconda;  A.  R.  Kintner,  Missoula;  J.  A.  Layne, 
Great  Falls. 

Fracture  and  Orthopedic  Committee;  J.  K.  Colman,  Butte,  Chairman;  L.  C. 
Allard,  Billings;  W.  H.  Hagen,  BilUngs;  S.  L.  Odgers,  Butte;  J.  C.  Wol- 
gamot.  Great  Falls. 

Rural  Health  Committee:  B.  C.  Farrand,  Jordan,  Chairman;  R.  A. 
Benke,  KaUspeli;  W.  A.  Lacey,  Havre;  W.  G.  Tanglin,  Poison;  J.  H. 
Williams.  Culbertson. 

Industrial  Welfare  Committee:  R.  B.  Richardson,  Great  Falls,  Chairman; 
M.  A.  Gold,  Butte:  P.  E.  Logan,  Great  Falls;  D.  S.  MacKenzie,  Jr.,  Havre; 
R.  E.  Walker,  Livingston. 

Rheumatic  Fever  and  Heart  Committee:  F.  R.  Schemm,  Great  FaUs, 
Chairman;  D.  T.  Berg,  Helena;  H.  W.  Gregg,  Butte;  A.  R.  Kintner,  Mis- 
soula; P.  E.  Logan,  Great  Falls;  F.  H.  Lowe,  Missoula;  J.  J.  Malee, 
Anaconda;  0.  M.  Moore,  Helena;  H.  W.  Power,  Conrad;  R.  E.  SmaUey, 
BilUngs. 

SPECIAL  COMMITTEES 

Emergency  Medical  Service  Committee:  R.  F.  Peterson,  Butte,  Chairman; 
Paul  J.  Gans,  Lewistown;  J.  J.  McCabe,  Heletu;  S.  A.  Olson,  Glendive; 
L.  G.  Russell,  Billings. 

lAB  Fee  Schedule  Committee:  H.  H.  James,  Butte,  Chairman;  E.  H. 
Lindstrom,  Helena;  J.  J.  Malee,  Anaconda;  D.  S.  McKenzie,  Jr.,  Havre; 
F.  K.  Waniata,  Great  FaUs. 


Collection 

Accounts 

All  reports  show  a trend  toward  slower  and  harder  collections  in  the 
months  ahead. 

At  the  first  sign  of  neglect  you  will  save  money  if  they  are  turned  over 
to  us  for  collection. 

Comparison  of  collection  results,  backed  by  35  years  of  experience,  proves 
you  obtain  greater  results  at  less  cost,  when  you  list  your  accounts 

with 

The  American  Medical  and  De 

Suite  524,  810  14th  St.  TAbor  2331 

intal  Association 

Denver,  Colorado 

8 


Rocky  Mountain  Medical  Journal 


: only  2 or  3 drops 


PRIVINE  0.05% 


a distinguished  nasal 

vasoconstrictor 


HIGHLY  POTENT:  Prompt,  complete  relief  from  nasal  congestion  and  hyper- 
secretion usually  results  from  only  2 or  3 drops  of  Privine 
hydrochloride  0.05%.  Each  application  provides  2 to 
6 hours  of  nasal  comfort. 

BLAND.  NON-IRRITATING:  Privine  is  prepared  in  an  isotonic  aqueous  solution  buf- 
fered to  a pH  of  6.2  to  6.3.  Artificial  differences  in 
osmotic  pressure  between  solution  and  epithelium  are 
avoided.  Thus,  stinging  and  burning  usually  are  absent. 

Privine  is  generally  free  of  systemic  effect.  The  occa- 
sional sedative  effect  that  may  be  noted  in  infants  and 
young  children  is  usually  due  to  gross  overdosage.  Since 
there  is  no  central  nervous  stimulation,  Privine  may  be 
applied  before  retiring  with  no  resultant  interference 
with  restful  sleep. 


Privine:  0.05%  in  i-ounce  dropper  bottles  and  i-pint  bottles; 
0.1%  strength  reserved  for  office  procedures,  in  i-pint  bottles  only. 


PHARMACEUTICAL  PRODUCTS,  INC.,  SUMMIT.  NEW  lERSEY 


PRIVINE  (brand  of  naphazoline) — Trade  Mark  Reg.  U.  S.  Pat.  Off.  ‘2/1424M 


for  January,  1949 


9 


NEW  MEXICO  MEDICAL  SOCIETY 


OFFICERS  — 1948-1949 

President:  P.  L.  Travers,  Santa  Fe. 

President-Elect:  J.  W.  Hannett,  Albuquerque. 

Vice  President:  I.  J.  Marshall,  Roswell. 

Secretary-Treasurer:  H.  L.  January,  Albuquerque. 

Councilors  (3  years):  W.  D.  Dabbs,  Clovis;  A.  C.  Shuler,  Carlsbad. 
Councilors  (2  years):  K.  0.  Brown.  Santa  Fe;  C.  H.  Gellenthlen,  Valmora. 
Councilors  (1  year):  Carl  Mulliy,  Albuquerque;  L.  S.  Evans,  Las  Cruces. 

COMMITTEES  — 1948-1949 

Basic  Science:  W.  E.  Nlssen,  Albuquerque,  Chairman;  Le  Grand  Ward, 
Santa  Fe;  Vincent  Accardl,  Gallup. 

Rural  Medical  Service:  M.  D.  Moran,  Farmington,  Chairman;  W.  B. 
Cantrell,  Hot  Springs;  Stuart  W.  Adler,  Albuquerque. 

Cancer:  Murray  M.  Friedman,  Santa  Fe,  Chairman:  Van  A.  Odle,  Boswell; 
J.  B.  Van  Atta,  Albuquerque;  J.  W.  Grossman,  Albuquerque:  B.  W.  Maher, 
Albuquerque.  ^ 


Venereal  Disease  Control:  Sam  Jelso,  Albuquerque,  Chairman;  V.  B. 
Berchtold,  Santa  Fe;  L.  M.  Miles,  Albuquerque;  L.  S.  Evans,  Las  Cruces; 
H.  L.  January,  Albuquerque. 

Legislative:  Albert  Lathrop,  Santa  Fe,  Chairman;  W.  0.  Connor,  Albu- 
querque; W.  R.  Lovelace,  II,  Albuquerque;  Walter  A.  Staiir,  Las  Vegas; 
George  S.  Morrison,  Roswell;  R.  0.  Brown,  Santa  Fe. 

Public  Relations;  D.  A.  McKinnon,  Jr.,  Albuquerque,  Chairman;  James 
L.  McCrory,  Santa  Fe;  H.  M.  Mortimer,  Las  Vegas;  Frank  W.  Parker,  Jr., 
Gallup. 

Tuberculosis:  R.  0.  Brown,  Santa  Fe,  Chairman;  C.  H.  Gellenthlen, 
Valmora;  D.  0.  Shields,  Albuquerque;  H.  S.  A.  Alexander,  Santa  Fe. 

Advisory  Committee  on  Ins.  Compensation:  Eugene  W.  Flske,  Sants  Fe, 
Chairman;  John  F.  Conway,  Clovis;  A.  C.  Shuler,  Carlsbad;  B.  E.  Forbls, 
Albuquerque. 

Committee  on  National  Emergency  Medical  Service:  A.  E.  Reymont,  Santa 
Fe,  Chairman;  C.  M.  Thompson,  Albuquerque;  L.  G.  Bice,  Albuquerque; 
Walter  A.  Stark,  Las  Vegas. 


Ocuiist  f^reicription  Service  ^xciuiiveii^ 

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CO. 

Dispensing  Opticians 

AComa  261 T 

228  16th  Street,  Denver,  Colo. 

These  fine  Dairy  Cattle,  a portion  of  City  Park’s  large  herd  of  Guernsey  and  Holstein 
cows,  are  scientifically  fed  and  cared  for,  continuously  tested  by  competent  veterin- 
arians. Only  through  such  precise  watchfulness  does  City  Park  Milk  receive  Grade 
“A”  designation  which  it  enjoys.  Choose  City  Park’s  regular  Grade  “A”  Pasteurized 
or  Homogenized  milk  today  — notice  the  particularly  clean,  fresh  flavor. 


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10 


Rocky  Mountain  Medical  Journal 


• • 


safe  contra 


lt\® 


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ilfOUf 


THE  UTAH  STATE  MEDICAL  ASSOCIATION 


OETICERS  1»48-1949 
President:  0.  A.  OgHvle,  Salt  Lake  City. 

President-elect;  C.  H.  Jenson,  Ogden. 

Past  President:  J.  C.  Hubbard.  Price. 

Honorary  President:  0.  W.  French,  Coalville. 

First  Vice  President:  J.  G.  McQuarrie,  Richfield. 

Second  Vice  President;  Ezra  Cragun,  Lewi.ston. 

Third  Vice  President:  R.  W.  Farnsworth.  Cedar  City. 

Secretary:  Ray  T.  Woolsey,  Salt  Lake  City. 

Executive  Secretary:  Mr.  W.  H.  Tibbals,  Salt  Lake  City. 

Treasurer:  L.  B.  White,  Salt  Lake  City. 

Councilor  First  District:  J.  G.  Olson.  Ogden. 

Councilor  Second  District:  V.  L.  Rees.  Salt  Lake  City. 

Councilor  Third  District;  L.  W.  Oaks.  Provo. 

Delegate  to  A.M.A.,  1948:  James  P.  Kerby.  Salt  Lake  City. 

Altirnate  Delegate  to  A.M.A..  1948:  J.  J.  Weight.  Provo. 

Editor  of  the  Utah  Section  of  the  Rocky  Mounnain  Medical  Journal: 
R.  P.  Middleton,  Salt  Lake  City. 

STANDING  COMMITTEES 
Rocky  Mountain  Medical  Conference  Continuing  Committee:  R.  P.  Mid- 
dleton, Chairman,  Salt  Lake  City,  1949;  K.  B.  Castleton,  Salt  Lake  City, 
1950;  Clark  Rich,  Ogden,  1951;  Noall  Z.  Tanner,  Layton,  1952;  T.  B. 
Seager,  Vernal,  1953. 

Scientific  Program  Committee;  Ray  T.  Woolsey,  Chairman,  Salt  Lake 
City;  Drew  M.  Peterson,  Ogden;  Stanley  N.  Clark,  Provo;  P.  M.  Howard, 
Salt  Lake  City;  V.  P.  White,  Salt  Lake  City;  L.  V.  Broadbent,  Cedar 
City:  Paul  A.  Pemberton.  Salt  Lake  City. 

Public  Policy  and  Legislation  Committee:  F.  R.  King,  Chairman,  Price, 
1951;  Jesse  J.  Weight,  Provo,  1949;  M,  L.  Crandall,  Salt  Lake  City, 
1949;  V.  L.  Stevenson,  Salt  Lake  City,  1949;  N.  F.  Hicken,  Salt  Lake 
City.  1950:  Omar  Budge,  Logan,  1950;  John  Coletti,  Salt  Lake  City,  1950; 
W.  B.  West,  Ogden,  1951:  R.  V.  Larson.  Roosevelt,  1951. 

Medical  Defense  Committee:  W.  J.  Thomson,  Chairman,  Ogden,  1949; 
R.  W.  Owens,  Salt  Lake  City,  1949;  J.  L.  Hansen,  Vernal,  1949;  Homer 
Smith.  Salt  Lake  City,  1950;  L.  N.  Ossman,  Sait  Lake  City,  1950;  Erwin 

D.  Zeman,  Ogden.  1950;  Charles  W.  Woodruff,  Salt  Lake  City,  1951; 

James  Westwood,  Provo.  1951:  L.  H.  Merrill,  Hiawatha,  1951. 

Medical  Education  and  Hospitals  Committee:  I.  Bruce  McQuarrie,  Chair- 
man, Ogden.  1949;  L.  J.  Paul.  Salt  Lake  City,  1949;  0.  A.  Ogilvie, 
Salt  Lake  City,  1949;  G.  G.  Richards,  Salt  Lake  City,  1950;  Bay  T. 
Woolsey,  Salt  Lake  City,  1950;  T.  E.  Robinson,  Salt  Lake  City,  1950; 

Seth  E.  Smoot,  Provo.  1951;  George  H.  Curtis.  Salt  Lake  City,  1951; 

R.  0.  Porter.  Logan,  1951:  R.  H.  Young,  Ex-Officio.  Salt  Lake  City. 

Medical  Economics  Committee;  Russell  Smith.  Chairman,  Provo,  1949; 
A.  R.  Denman,  Helper.  1949;  W.  T.  Ward.  Salt  Lake  City,  1950:  W.  R. 
Merrill,  Brigham  City.  1951:  Ralph  Pendleton,  Salt  Lake  City,  1951. 


Public  Health  Committee:  John  R.  Bourne,  Chairman,  Roosevelt,  1949; 
F.  D.  Spencer.  Salt  Lake  City,  1950;  Ralph  ElUs,  Ogden,  1951. 

Military  Affairs  and  National  Emergency  Committee:  Chrles  Woodruff, 
Chairman.  Salt  Lake  City;  L.  J.  Paul,  Salt  Lake  City;  Mazel  Skolfield, 
Salt  Lake  City;  W.  M.  Gorishek,  Standardville  L.  R.  Cullimore,  Orem; 
Ray  H.  Barton,  Magna:  D.  T.  Madson,  Price;  Riley  G.  Clark,  Provo; 
Willis  Hayward,  Logan;  Dean  Tanner,  Ogden. 

Tuberculosis  and  Cardiovascular  Diseases  Committee:  Elmer  M.  Kil- 
patrick, Chairman,  Salt  Lake  City;  Ray  Rumel,  Salt  Lake  City;  D.  0.  N. 
Lindberg,  Ogden;  W,  C.  Walker,  Salt  Lake  City;  Donald  M.  Moore,  Ogden; 
Don  C.  Merrill.  Provo. 

Cancer  Committee:  0,  A.  Ogilvie.  Chairman,  Salt  Lake  City:  S.  W. 
Fennemore,  Price;  E.  D.  Zeman,  Ogden;  W.  G.  Noble.  Richmond;  Harold 
Austin,  Provo;  Stanley  G,  Rees,  Gunnison;  Paul  K.  Edmunds,  Cedar  City; 
F.  G.  EskeLson,  Vernal;  K.  B.  Castleton,  Salt  Lake  City. 

Fracture  Committee:  A.  M.  Okelberry,  Chairman,  Salt  Lake  City;  Clark 
Rich.  Ogden;  Roy  H,  Robinson,  Kenilworth;  S.  M.  Budge,  Logan;  Norman 
R.  Beck,  Salt  l.ake  City;  Louis  Perry,  Ogden;  J.  G.  McQuarrie,  Richfield; 
D.  C.  Evans,  Fillmore. 

Necrology  Committee:  W.  T.  Hosier,  Chairman,  Provo;  L.  A.  Stevenson, 
Salt  Lake  City:  Jos.  A.  Phipps,  Salt  Lake  City. 

Industrial  Health  Committee:  Paul  S.  Richards,  Chairman,  Bingham 
Canyon;  L.  J.  Tauter,  Salt  Lake  City;  Frank  Gorishek,  Helper;  Byron  Daynes, 
Salt  Lake  City;  E.  B.  Kuhe,  Salt  Lake  City;  D.  C.  Barker,  Ogden. 

Advisory  Committee  to  the  Woman’s  Auxiliary:  Vernal  Johnson,  Chair- 
man, Ogden:  0.  P.  Heninger,  Provo;  L.  G.  Moench,  Salt  Lake  City;  James 

K.  Palmer,  Salt  Lake  City. 

Public  Relations  Committee:  R.  P.  Middleton,  Chairman,  Salt  Lake  City; 
Louis  P.  Matthei,  Ogden;  R.  W.  Farnsworth,  Cedar  City;  Quinn  A.  Whit- 
ing, Price;  Clyde  J.  Daines,  Logan;  Ray  E.  Spendlove,  Vernal:  H.  L 
Goodwin,  Salt  Lake  City;  Gilhert  Wright,  Salt  Lake  City;  Roy  B.  Hammond, 
Provo. 

Inter-Professional  Committee:  J.  Leroy  KimbaU,  Chairman,  Salt  Lake 

City;  C.  C.  Hetzel,  Jr.,  Ogden;  T.  E.  Bauman,  Park  City;  Paul  Clayton, 
Salt  Lake  City;  Ralph  G.  Rigby,  Salt  Lake  City. 

Mental  Hygiene  Committee:  Roy  A.  Darke,  Chairman,  Salt  Lake  City: 

L.  G.  Moench,  Salt  Lake  City;  Wm.  D.  Pace,  Salt  Lake  City;  George  Cochran. 
Salt  Lake  City;  E.  L.  Weimers,  Provo. 

Fee  Schedule  Committee;  K.  B.  Castleton,  Chairman,  Salt  Lake  City; 

Howard  K.  Belnap,  Ogden;  J.  E.  Trowbridge.  Bountifid;  U.  R.  Bryner, 

Salt  Lake  City;  W.  Leroy  Smith,  Salt  Lake  City;  J.  R.  Wherritt,  Heber 
City;  0.  W.  Budge,  Logan. 

Special  Committee  to  Study  Dues:  H.  R.  Reichman,  Chairman,  Salt 

Lake  City:  Eliot  Snow.  Salt  Lake  City:  Ezra  Cragun,  Lewiston. 

Rural  Health  Committee:  J.  J.  Weight,  Chairman,  Provo;  J.  G.  McQuarrie, 
Richfield;  J.  P.  Burgess,  Hyrum;  Noall  Z.  Tanner,  Layton.  . 


i^etter  ^iow*ri  at  l^eaAonaLft  prices 

^^enuet  Oxt^^en  ^nc. 

“Orders  Delivered  to  Any  City  by 
Guaranteed  Service” 

Corner  10th  and  Lawrence  Sts. 
TAbor  5138 

Special  attention  given  to  floral  tributes 
Also  Hospital  Flowers 

Medical  Gas  Division 

MEDICAL  OXYGEN 

Call  KEy stone  5106 

CARBON  DIOXIDE-OXYGEN 
MIXTURES 

'Park  floral  C'o  Sfor^ 

AVIATORS’  BREATHING  OXYGEN 
WATER  COMPRESSED  NITROGEN 

WATER  COMPRESSED  AIR 

1643  Broadway  Denver,  Colo.  ^ 

Twenty -Four  Hour  Service 

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ILLU5TRATOR5-DESIGNERS 


PHOTO 

ENGRAVERS 


12 


Rocky  Mountain  Medical  Journal 


NEO'IOPAX  is  available  as  a 
stable,  crystal-clear  solution  of  disodium 
N-methyl-3,  5-diiodo-chelidamate  in  10,  20  and 
30  cc.  ampuls  of  50%  concentration  and  in 
10  and  20  cc.  ampuls  of  75%  concentration. 

Boxes  of  1,  5 and  20  ampuls. 

BIBLIOGRAPHY : I.  Simon  S.:  J.A.M.A.  138:127,  1948. 
2.  Pearman,  R.  O.:  New  England  J.  Med.  228:507,  1943.  3.  Kearns,  W.  M., 
Hefke,  H.,  and  Morton,  S.  A.:  J.  Urol.  56:392,  1946 

CORPORATION  . BLOOMFIELD,  NEW  JERSEY 

IN  CANADA,  SCHERINC  CORPORATION  LIMITED,  MONTREAL 


NEO-IOPAX 

(BRAND  OF  SODIUM  I O D O M ETH A M ATE  ) 


Its  optimal  radiopacity  produces  clear 
delineation  of  the  urinary  tract  permitting 
diagnostic  interpretations  to  be  made  confidently. 

NEO-IOPAX  IS  SAFE.  Its  un- 
blemished recoi'd^— more  than  fifteen  years  of 
effective  urinary  tract  visualization  without  a 
single  fatality  reported  in  the  literature  — xema.ms 
to  be  equalled.^  Administered  intravenously, 
using  proper  technic,  Neo-Iopax  is 
remarkably  free  from  even  minor  side-effects.^’® 


accurate, 

safe 

urography 

UJI”:  =■  NEO-IOPAX  * IS  ACCURATE. 


NEO-IOPAX 


THE  WYOMING  STATE  MEDICAL  SOCIETY 


OFFICERS 


President:  George  E.  Baker,  Casper. 

President-Elect:  DeWitt  Dominick,  Cody. 

Vice  President:  K.  E.  Krueger,  Ro^  Springs. 

Treasurer:  P.  M.  Schunk,  Sheridan. 

Corresponding  Secretary:  George  H.  Phelps,  Cheyenne. 

Delegate  A.M.A.:  R.  H.  Reeve,  Casper. 

Alternate  Delegate  A.M.A.:  W.  A.  Buntea,  Cheyenne. 

Executive  Secretary:  Mr.  Arthur  Ahbey,  Cheyenne. 

COMMITTEES 

Rocky  Mountain  Medical  Conference:  Earl  Whedon,  Chairman,  Sheridan; 
George  N.  Phelps,  Cheyenne;  H.  L.  Harvey,  Casper;  C.  W.  Jeffrey,  Rawlins; 

L.  W.  Storey,  Laramie. 

Syphilis  Committee:  N.  E.  Morad,  Chairman,  Casper:  G.  M.  Groshart, 
Worland;  L.  H.  Wilmoth,  Lander;  L.  G.  Booth,  Sheridan:  F.  H.  Halgler, 
Midwest. 

Cancer  Committee:  Earl  Whedon,  Chairman,  Sheridan;  John  Gramllch, 
Cheyenne;  DeWitt  Dominick,  Cody;  J.  R.  Newman,  Kemmerer;  E.  W.  New- 
man, Cheyenne, 

Medical  Economics  Committee:  C,  L.  Rogers,  Chairman,  Sheridan;  Nels 
A.  Vicklund,  Thermopolls;  R.  A,  Corbett,  Saratoga;  G.  R.  James,  Casper; 

S.  S.  Hellewell,  Evanston. 

Fracture  Committee:  Philip  Teal,  Chairman,  Cheyenne;  Silva  J.  Giovale, 
Cheyenne;  Robert  V,  Batterton,  Rawlins;  Lowell  D,  Kattenhorn,  Powell; 
Joseph  E,  Hoadley,  Gillette, 

Medical  Defense  Committee:  George  Baker,  Chairman,  Casper;  Andrew 
Bunten,  Cheyenne;  E,  W,  DeKay,  Laramie, 

Councillors;  Earl  Whedon,  Chairman,  Sheridan:  R.  J,  Boesel,  Cheyenne; 
E,  W,  DeKay,  Laramie;  George  Baker,  President,  Casper;  George  Phelps, 
Secretary,  Cheyenne, 

Advisory  to  Woman’s  Auxiliary:  John  R.  Bunch,  Chairman,  Laramie; 
Virgil  L,  Thorpe,  Newcastle;  H.  J.  Aldrich,  Sheridan;  G.  B.  Savory,  Chey- 
enne. 

Advisory  to  Workmen’s  Compensation  Department:  J.  D.  Shingle,  Chair- 
man, Cheyenne;  G.  H.  Phelps,  Cheyenne;  W.  A.  Bunten,  Cheyenne;  R.  H. 
Reeve,  Casper;  Albert  T,  Sudman,  Green  River;  P,  M.  Schunk,  Sheridan.  * 


Industrial  Health  Committee:  K.  E,  Krueger,  Chairman,  Bock  Springs; 
Willard  Pennoyer,  Cheyenne;  Thomas  B,  Croft,  Lovell;  Eugene  Pelton, 
Laramie. 

Veterans’  Affairs  and  Military  Service  Committee:  A.  J.  AUegretti,  Chair- 
man, Cheyenne:  Jack  Rowlett,  Laramie;  Everett  Ellis,  Cheyenne;  Bernard 
Sullivan,  Laramie;  G.  W,  Koford,  Cheyenne;  Bernard  Stack,  Thermopolls; 
J.  W.  Sampson,  Sheridan;  DeWitt  Dominick,  Cody;  Paul  B.  Holtz,  Lander; 
George  E,  Baker,  President,  Casper;  George  Phelps,  Secretary,  Cheyenne. 

Blue  Cross  Hospital  Committee:  B.  I.  Williams,  Chairman,  Cheyenne,  1950; 
W.  A.  Bunten,  Cheyenne,  1949;  E,  W,  DeKay,  Laramie,  1951;  Cedric 
Jones,  Cody,  1952, 

Public  Policy  and  Legislation:  George  Phelps,  Chairman,  Cheyenne: 

Andrew  Bunten,  Cheyenne;  George  Baker,  President,  Casper;  G.  W,  Koford, 
Cheyenne;  E.  W.  DeKay,  Laramie;  G.  W.  Henderson,  Casper. 

National  Physicians  Committee:  George  Phelps,  Chairman,  Cheyenne; 

Andrew  Bunten,  Treasurer,  Cheyenne;  E,  W.  DeKay,  Laramie;  George  Baker, 
Casper, 

Poliomyelitis  Committee:  H.  L.  Harvey,  Chairman,  Casper:  N.  A.  Vicklund, 
Thermopolls:  Leo  Keenan,  Torrington;  DeWitt  Dominick,  Cody;  Philip  Teal, 
Cheyenne;  Franklin  Yoder,  Cheyenne;  F,  A.  Mills,  Rawlins. 

State  Institutions  Advisory  Committee:  J.  F.  Whalen,  Chairman,  Evans- 
ton; George  Phelps,  Cheyenne;  C,  W,  Jeffrey,  Rawlins;  Earl  Whedon,  Sheri- 
dan; G,  M,  Groshart,  Worland;  R.  H,  Kanable,  Basin, 

Necrology  Committee:  Earl  Whedon,  Chairman,  Sheridan;  John  B. 
Krahl,  Torrington;  Franklin  Yoder,  Cheyenne. 

Rural  Hdaith  Committee:  Paul  Holtz,  Chairman,  Lander;  Andrew  Bun- 
ten, Cheyenne:  Samuel  Worthen,  Afton;  Wm.  K,  Rosene,  Wheatland;  Claude 
Raffl,  Basin. 

Public  Health  Department  Liaison  Committee:  E.  C,  Ridgeway,  Chair- 
man, Cody;  R.  P.  Fitzgerald,  Casper;  R.  V.  Batterton,  BawUns;  J.  W. 
Sampson,  Sheridan;  B,  C.  Stratton,  Green  River;  WiUard  Pennoyer, 

Cheyenne, 

Child  Health  Committee:  Paul  W.  Emerson,  Chairman,  Cheyenne;  John 
Gramllch,  Cheyenne:  Thomas  Croft,  Lovell;  Bernard  Sullivan,  Laramie; 

Paul  R,  Holtz,  Lander;  Geo,  E.  Baker,  Casper;  A,  R,  Abbey,  Cheyenne. 

Council  on  National  Emergency  Medidal  Service:  George  H.  PheBm. 
Chairman,  Cheyenne;  R.  H.  Reeve,  Casper;  DeWitt  Dominick,  Cody;  E,  W. 
DeKay,  Laramie;  K,  S,  Kruegeri  Rock  Springs;  P.  M.  Schunk,  Sheridan. 


COLORADO  HOSPITAL  ASSOCIATION 


OFFIC/EmS 

President:  Frank  G.  Palladlno,  Community  Hospital,  Boulder. 
President-Elect:  Walter  G.  Christie,  Presbyterian  Hospital,  Denver. 

Vico  President:  Hubert  W.  Hughes,  St.  Anthony  Hospital,  Denver. 
Treasurer:  Sister  Mary  Thomas,  Mercy  Hospital,  Denver. 

Executive  Secretary:  B.  B.  Jaffa,  M.D.,  Denver. 

Trustees:  Roy  B.  Prangley,  SL  Luke's  Hospital,  Denver  (1949);  James 
P.  Dixon,  M.D.,  Denver  General  Hospital,  Denver  (1949);  Louis  Llswood, 
National  Jewish  Hospital,  Denver  (1950);  DeMoss  Taliaferro,  Children’s 
Hospital,  Denver  (1950);  Roy  R.  Anderson,  Presbyterian  Hospital,  Denver 
(1951):  Rev.  Allen  H.  Erb,  Mennonite  Hospital,  La  Junta,  Colo.  (1951). 

Delegate  to  the  American  Hospital  Association:  Herbert  A.  Black,  M.D., 
Parkview  Hospital,  Pueblo. 

Alternate:  Msgr.  John  R.  Mulroy,  Catholic  Hospitals,  Denver. 

STANDING  COMMITTEES 
Auditing:  Ben  M.  Blumberg,  Chairman,  (1948),  General  Bose  Me- 
morial Hospital,  Denver;  M.  A.  Moritz  (1949),  Denver  General  Hospital, 
Denver;  B.  W.  Pontow  (1950),  Colorado  General  Hospital,  Denver. 

IhNistitutlon  and  Roles;  Samuel  S.  Golden,  M.D.,  Chairman,  Beth  Israel 
Hospital,  Denver;  Henry  B.  Hill,  Weld  County  Hospital,  Greeley;  Sister 
H.  Johanna,  Sacred  Heart  Hosplt^,  Lamar. 

Legislative:  Msgr.  John  R.  Mulroy,  Chairman,  Catholic  Hospitals,  Denver; 
DeMoss  Taliaferro,  Children’s  Hospital,  Denver;  Carl  Ph.  Sebwalb,  Denver; 
Robert  C.  Kniffen,  Colorado  General  Hospital,  Denver;  Herbert  A.  Black, 
H.D.,  Parkview  Hospital,  Pueblo. 

Membenhip;  Leo  W.  Beifel,  Chairman,  St.  Vraln  Hospital,  Longmont; 
B.  B.  Jaffa,  M.D.,  Denver. 

Nominating:  Herbert  A.  Black,  M.D.,  Chairman,  (1948),  Parkview 
Hoopltal,  Pueblo;  John  C.  ShuU,  (1949),  Porter  Sanitarium  and  Hospital. 
Denver;  Hubert  W.  Hughes,  (1950),  St.  Anthony  Hospital,  Denver. 


Program;  Boy  B.  Prangley,  Chairman,  SL  Luke’s  Hospital,  Denver;  B.  B 
Jaffa,  M.D.,  Denver. 

Nursing  and  Public  Education:  DeMoss  Taliaferro,  Children’s  HosplUL 
Denver;  Sister  M.  Louis,  St.  Anthony  Hospital,  Denver;  Miss  Merle  Love, 
R.N.,  Presbyterian  Hospital,  Denver;  Sister  Maria  Graria,  B.N.,  Gloekner 
Sanatorium,  Colorado  Springs;  Frank  G.  Palladlno,  Community  Hospital, 
Boulder. 

Resolutions;  S.  Russ  Denzler,  Chairman,  Colorado  Hospital,  Canon  City; 
Carl  Ph.  Sebwalb,  Denver;  Walter  0.  Christie,  Prebyterian  Hospital.  Denver. 

SPECIAL.  COMBII’TTEES 

Public  Relations:  John  C.  Shull,  Chairman,  Porter  Sanitarium  and  Hos- 
pital, Denver;  James  P.  Dixon,  M.D.,  Denver  General  Hospital,  Denver; 
Sister  Mary  Luitgard,  St.  Thomas  More  Hospital,  Canon  City. 

Rates  and  Charges:  Hubert  W.  Hughes,  Chairman,  SL  Anthony  Hos- 
pital, Denver;  Walter  G.  Christie,  Presbyterian  Ht^pltal,  Denver;  Ben  M. 
Blumberg,  General  Rose  Memorial  Hospital,  Denver;  Msgr.  John  & Mulroy, 
Catholic  Hospitals,  Denver;  Leo  W.  Beifel,  St.  Vraln  Hospital,  laingmont; 
Roy  R.  Prangley,  St.  Luke’s  Hospital,  Denver;  DeMoss  Taliaferro,  Chlldrcn’c 
Hospital,  Denver. 

Hospital  Survey  and  Planning:  James  H.  Walker,  Chairman,  Good  Sa- 
maritan Hospital,  Sterling;  Arthur  A.  Fisher,  Architect,  Denver;  B.  B. 
Jaffa,  M.D.,  Denver. 

State  Board  of  Health  Advisory:  Msgr.  John  B.  Mulroy,  Chairman,  Catho- 
lic Hospitals,  Denver;  DeMoss  Taliaferro,  Children’s  Hospital,  Denver;  B.  B. 
Jaffa,  M.D.,  Denver. 

Delegate  to  Colorado  Inter-Professional  Council:  Hubert  W.  Hughes,  SL 
Anthony  Hospital,  Denver. 

Representatives  to  Liaison  Connell  on  Cradoato  Education:  Boy  B. 
Prangley,  St.  Luke’s  Hospital,  Denver;  Frank  G.  PaUadioo,  Community 
Hospital,  Boulder. 


A 


id  Speed  in  ^redcription 


eruice 


ccurac^  ana  ^peea  in  i"  reAcrip 

DORR  OPTICAL  COMPANY 


421  16th  Street 


Denver,  Colorado 


KEystone  5511 


14 


Rocky  Moumtaim  l^feoxcAL  Journal 


Zke  Jmportame  of  Protein  M^^uacy 
Jn  'Diabetes  Ji^ititus 

It  appears  in  the  light  of  recent  experience  that  the  daily  protein 
requirement  of  the  diabetic  has  been  underestimated  and  calls  for 
an  upward  revision. 

The  success  obtained  in  diabetic  retinopathy  from  the  use  of  high 
protein  diets  emphasizes  the  deleterious  possibilities  of  hypoalbumin- 
emia  in  this  metabolic  disease. 

In  view  of  the  excellent  results  observed  from  a high  protein  intake, 
in  many  forms  of  hepatic  disease,  a dietary  rich  in  protein  is  suggested 
as  a therapeutic  measure  in  the  management  of  liver  enlargement, 
one  of  the  frequent  complications  of  diabetes.^  Since  impaired  liver 
function  reduces  the  efficacy  of  insulin,  prevention  of  liver  enlarge- 
ment by  a liberal  allowance  of  protein  in  the  daily  diet  of  the  dia- 
betic appears  an  important  factor  in  the  control  of  this  disease.  With 
an  estimated  2,000,000  diabetics  in  the  United  States^  every  benefit 
achieved  in  this  field  makes  itself  felt  on  a truly  large  scale. 

Meat  is  an  outstanding  source  of  protein  in  the  dietary  of  the 
patient  with  diabetes  mellitus  for  these  reasons:  It  is  notably  rich  in 
protein,  from  17  to  20  per  cent  of  its  uncooked,  and  from  25  to  30 
per  cent  of  its  cooked  weight.  The  protein  of  meat,  regardless  of  cut 
or  kind,  whether  fresh,  cured,  or  canned,  is  biologically  complete. 
All  meat  is  of  excellent  digestibility — from  96  to  98  per  cent.  Fur- 
thermore, meat  ranks  with  the  best  sources  of  B vitamins,  potassium 
and  phosphorus,  all  of  which  are  essential  factors  in  the  metabolism 
of  carbohydrate. 

^Nutrition  in  Diabetes,  Nutrition  Rev.  6:257  (Sept.)  1948. 

^Diabetes  and  Arteriosclerosis  in  Youth,  Editorial,  J.A.M.A.  135:1074 
(Dec.  20)  1947. 


The  Seal  of  Acceptance  denotes  that  the  nutri- 
tional statements  made  in  this  advertisement 
are  acceptable  to  the  Council  on  Foods  and 
Nutrition  of  the  American  Medical  Association. 

American  Meat  Institute 

Main  Office,  Chicago -,..Vieitiberf  Ihroughciut  tt'e  United  States 


for  January,  1949 


15 


HSI 


^WaViirted  supetiof  ^ 


The  incidence  of  mild  protein  deficiencies  in 
children,  predisposing  toward  infections  and 
edema,  is  reported'-^  much  greater  than 
generally  realized.  Infant  and  adolescent 
requirements— not  only  for  tissue  repair 
and  maintenance,  but  also  for  growth— 
are  much  higher  than  in  adulthood.^  To 
insure  adequate  protein  intake  in  infancy, 
Dkyco  — Borden's  high-protein  infant  food 
— is  ideally  suited  as  a basis  for  formula 
building.  It  furnishes  all  the  essential 
amino  acids.  Its  low  fat  content  minimizes 
gastro-intestinal  upsets  due  to  fat  intolerance, 
while  its  intermediate  carbohydrate  content 
lends  itself  for  prescription  with  or  without  added 
carbohydrate.  Quickly  soluble  in  cold  or  warm 
water,  Dryco  contains  adequate  vitamins 
A.  B|,  B^  and  D,  plus  essential  milk  minerals. 

R*f«r«ncM:  1.  Dodd.  K.and  Minot,  A.  S.;  /.  Pediat.,  8:442, 1936. 

a.  Dodd.  K.  and  Minot.  A.  S.:  /.  Pediat.,  8:452, 1936. 
3.  Sahyun,  M.s  Am.  J.  Dig.  Dis.,  13:59,  1946. 

BORDEN’S  PRESCRIPTION  PRODUCTS  DIVISION 

350  Madison  Avenue,  New  York  17,  N.  Y. 

fn  Canada  writa  The  Borden  Company,  Limited 
Spadina  Crescent,  Toronfo. 

DRYCO  is  made  from  spray-dried, 
pasteurized,  superior  quality  whole 
milk  and  skim  milk.  Provides 
2500  U.S.P.  units  vitamin  A 
and  400  U.S.P.  units  vitamin 
D per  reconstituted  quart. 
Supplies  3IV2  calories  per 
tablespoon.  Available 
at  all  drug  stores  in  I 
and  It/z  lb.  cans. 


16 


Rocky  Mountain  Medical  Journal 


Complete  Therapy  for  Pernicious  Anemia 


Potent  liver  extract  is  the  only  substance  which  has  been  proved  to 
provide  complete  therapy  for  macrocytic  anemias.  The  concentration  of 
all  Lilly  liver  extracts  is  such  that  the  amounts  contained  in  the 
recommended  daily  dose  will,  in  the  average  uncomplicated  case  of 
pernicious  anemia  in  relapse,  produce  a standard  reticulocyte  response 
and  cause  the  red-blood-cell  count  to  return  to  normal  within  a period  of 
sixty  days.  This  standardization  is  in  accordance  with  the 
recommendations  of  the  United  States  Pharmacopoeia  Anti-Anemia 
Preparations  Advisory  Board. 

Lilly  injectable  liver  extract  preparations  include — 

Liver  Extract  Solution,  Crude,  Lilly,  in  strengths  of  1 and  2 
injectable  U.S.P.  units  per  cc. 

Liver  Extract  Solution,  Purified,  Lilly,  in  strengths  of  5,  10,  and 
15  injectable  U.S.P.  units  per  cc. 


ELI  LILLY  AND  COMPANY,  INDIANAPOLIS  6,  INDIANA,  U.S.A, 


FramabU  reprints  of  this  illustration  are  available 

THE  MEN  RESPONSIBLE  FOR 
MRS.  BROWN'S  BLOOD  COUNT 


You,  the  physician,  are  ultimately  responsible  for  the 
successful  management  of  patients  afflicted  with 
pernicious  anemia.  You  and  your  assistants  carefully  determine  the 
patient’s  response  to  measured  doses  of  liver  extract,  but  back 
of  that  is  the  responsibility  of  the  men  who  make  the  product. 

It  is  reassuring  to  both  physician  and  patient  to  know  that  the 
liver  extract  employed  has  met  exacting  standards  before  release. 

Fresh  frozen  liver  is  handled  in  abattoirs  according  to  Lilly 
specifications  and  is  checked  by  skilled  Lilly  inspectors  before 
acceptance.  The  frozen  liver  is  then  ground  and  extracted  in  equip- 
ment designed  by  Lilly  engineers.  Lilly  liver  extracts,  whether 
for  parenteral  or  oral  administration,  are  assayed  on  hospitalized 
pernicious  anemia  patients  in  relapse  by  clinicians  experienced 
in  hematology.  Thus,  from  the  grinding  of  the  frozen  liver 
to  the  final  packaging  and  inspection,  the  production  of  Lilly  liver 
products  is  supervised  by  competent  specialists.  They,  too,  feel 
deeply  their  responsibility  for  Mrs.  Brown’s  blood  count. 


LILLY  SPECIALISTS  SERVE  THE  MEDICAL  PROFESSION 


SRocky 

Colorado 
Montana 
New  Mexico 
Utah 
Wyoming 


JANUARY 

1949 


y\/lountaLn 

yvledical  Journal 

E-ditorial ^ 


This  Is  Worth 
Memorizing! 

p\R.  ANTHONY  B.  DIEPENBROCK  of 
San  Francisco  recently  wrote  to  an 
officer  of  the  American  Medical  Associa- 
tion. He  stated  that  in  this  day  and  age 
when  everybody  is  talking  himself  hoarse 
about  medical  plans  and  programs,  he  would 
like  to  offer  his  own  13-point  program  which 
“might  be  interesting  to  our  colleagues.” 
The  letter  has  already  been  widely  quoted, 
but  without  further  explanation  we  present 
Dr.  Diepenbrock’s  “program”  in  full: 

1.  Continue  to  sit  on  your  fat  derriere  and  do 
nothing. 

2.  Be  apathetic  and,  like  5,000,000  registered 
Republican  voters  who  failed  to  vote,  do  not 
bother  to  make  your  opinion  known.  If  you 
think,  as  they  did,  that  your  opinion  or  your 
vote  is  not  worth  anything,  the  opposition  will 
agree  with  you  and  act  accordingly,  as  they 
have. 

3.  Write  an  occasional  letter  to  your  Congress- 
man, tell  him  off,  and  then  explain  proudly 
to  the  interns  in  the  surgical  dressing  rooms 
how  smart  you  are  and  what  a stinker  your 
Congressman  is. 

4.  Tell  everybody  you  see  that  the  gag  is  up, 
and  we  might  as  well  prepare  for  the  inevitable. 

5.  Moan  and  groan  and  issue  explosive  and 
unprintable  epitheths. 

6.  Refer  to  your  medical  leadership  as  a group 
of  impotent,  ineffective  and  bumbling  igno- 
ramuses. 

7.  Make  speeches  before  sympathetic  lay  au- 
diences, and  concert  those  who  already  believe  in 
free  enterprise. 

8.  Don’t  bother  to  tell  your  county  society 
heads,  your  state  society  heads,  or  your  national 
association  heads  what  you  want  them  to  do. 
Expect  them  to  find  a way  for  you  without  your 
guidance. 

9.  Scream  about  high  medical  society  dues  and 
forget  that  our  friends  in  the  trades  union  de- 
mand many  times  what  we  pay:  in  other  words, 
make  the  situation  as  difficult  as  possible,  then 
grumble  about  it. 


10.  Oppose  any  program  developed  by  the 
majority  of  your  colleagues  because  it  demon- 
strates your  superior  wit  and  your  general 
greatness. 

11.  Remain  superbly  and  learnedly  dignified 
when  Joe  Doakes  asks  why  you  oppose  state 
medicine.  Brush  him  aside  with  any  insult 
you  can  think  of.  Joe  will  like  you  for  that. 

12.  Don’t  bother  to  use  the  selling  methods 
which  actually  bring  messages  before  the  public. 
Continue  to  depend  on  occasional  radio  feature 
programs.  Billboard  advertising,  newspaper  ad- 
vertising, national  magazine  advertising,  radio 
advertising  and,  above  all,  continuous  and  daily 
radio  spot  programs  over  national  hookups  and 
all  such  like  are  too  commercial,  too  trouble- 
some, too  expensive  and  too  undignified:  don’t 
use  them. 

13.  Above  all,  disregard  the  “little  guy” — the 
one  with  a vote.  Tell  him  nothing;  push  him 
around.  He  doesn’t  know  anything  anyhow. 

V <4  ^ 

T otal  Socialization 
In  England 

A TOUR  of  the  United  States  has  recently 
been  completed  by  Sir  Archibald  Mc- 
Indoe,  the  English  surgeon.  He  has  made  a 
number  of  talks  to  various  groups  regarding 
the  status  of  medical  practice  in  England. 
He  states  that  there  is  much  misapprehen- 
sion regarding  England  among  the  doctors  of 
America.  Furthermore,  after  considerable 
observation  and  thought,  he  is  not  sure  that 
the  calamity  of  state  medicine  is  far  off  in 
this  country. 

England  differs  politically  from  the 
United  States.  During  the  past  twenty 
years  she  has  developed  a third  party,  the 
Socialist.  It  started  as  the  Fabian  Society 
which  now  has  come  to  rule  England.  The 
Society  intends  to  nationalize  England’s  re- 
sources, labor,  and  production.  England 
and  her  people  have  respect  for  law,  order, 
and  political  authority.  We  in  America 
have  less  regard  for  the  latter.  England 


for  January,  1949 


17 


is  financially  broke  and  must  find  a way 
of  paying  for  what  she  needs;  at  least  one- 
half  of  the  populace  must  be  fed  from  out- 
side resources.  Her  present  social  security 
program  intends  that  every  individual  in 
the  country  shall  be  entitled  to  freedom 
and  want  from  womb  to  tomb.  This  plan 
is  expressed  in  three  ways — unemployment 
and  old  age  insurance,  abolishment  of  in- 
dustrial injuries  compensation,  and  state 
control  of  all  hospitals  (except  the  teach- 
ing institutions) . 

The  doctors  of  England  were  given  a 
plan  of  panel  practice  in  keeping  with  the 
above,  for  the  simple  reason  that  they  did 
not  submit  a plan  of  their  own.  (A.M.A. 
please  note!)  A hostile  people,  the  press, 
and  the  House  of  Commons  resented  what 
they  interpreted,  rightly  or  wrongly,  as  un- 
fair or  selfish  financial  ambition  on  the 
part  of  the  doctors.  Ninety  per  cent  of  the 
doctors  voted  against  the  plan,  but  there 
was  no  alternative  to  its  acceptance.  They 
were  told  that  they  did  not  have  to  go  in, 
but  each  was  at  liberty  to  make  his  living, 
if  he  could,  out  of  the  five  per  cent  of 
people  who  did  not  accept  or  were  not 
entitled  to  “free”  medical  care.  Obviously 
very  few  physicians  could  afford  to  take 
such  a risky  gamble  with  essentially  every 
wage-earner  and  his  family  entitled  to  medi- 
cal care  in  return  for  compulsory  with- 
holding of  the  equivalent  of  one  dollar 
and  a half  from  his  earnings.  For  this 
premium,  he  is  entitled  to  old  age  benefits, 
medical  and  hospital  care,  industrial  acci- 
dent coverage  and  prosthesis — even  includ- 
ing eye  glasses. 

The  doctors  were  offered  what  appeared 
to  be  a fairly  attractive  proposition;  ap- 
parently luscious  bait  was  placed  in  the 
trap  to  gain  their  cooperation,  if  not  their 
enthusiasm.  The  physician  ultimately,  after 
his  useful  professional  life,  receives  a pen- 
sion which  is  two-thirds  of  the  average  in- 
come of  the  last  three  years  of  his  practice. 
This  pension  does  not  die  with  him,  if 
his  wife  survives,  but  is  concluded  with 
her  death.  The  doctor  is  still  entitled  to 
earn  all  that  his  inclination  and  physical 
stamina  will  permit.  But,  as  with  any  other 
Englishman,  he  cannot  keep  more  than 

18 


3,200  pounds  (approximately  $12,000),  for 
the  government  takes  all  beyond  that. 

The  medical  profession  of  England  is  mak- 
ing the  best  of  it  and  for  the  most  part 
seems  to  have  resigned  itself  to  making  the 
plan  succeed  if  it  is  within  its  power  to 
do  so.  Most  of  the  doctors  are  carrying 
on  with  the  well-known  British  stoicism. 
The  doctors  who  are  wise,  and  also  able, 
are  not  rupturing  their  arteries  and  dilating 
their  hearts  seeking  a greater  income  for 
their  King.  Many  have  relaxed  and  are 
taking  a few  months  off  each  year.  They 
seem  not  to  worry  too  much.  They  go  home 
and  rest,  at  times  when  we  American  doctors 
would  be  inclined  to  return  to  the  office 
or  the  hospital. 

Regarding  their  philosophy,  perhaps  the 
English  doctors  have  something.  We  know 
what  political  medicine  would  do  to  our 
patients,  to  the  whole  public,  and  to  medical 
progress  in  the  United  States.  We  must 
fight  it,  and  the  outcome  of  the  battle  is 
not  yet  fully  determined.  There  may  yet 
be  time  to  convince  the  American  people 
and  the  American  Congress  that  freedom 
is  worth  preserving.  Nevertheless,  whether 
we  and  those  still-too-few  people  who  know 
the  facts  win  or  lose  the  struggle,  we  doctors 
would  do  well  to  save  our  coronaries,  enjoy 
life  like  human  beings  as  we  go  along  and 
live,  and  live  longer. 

^ ^ 

American  War  Hospitals 
In  England 

A PPROXIMATELY  one  hunderd  hospi- 
tals  were  set  up  in  England  by  the 
United  States  during  World  War  II  for  the 
use  of  our  armed  forces.  Some  were  in 
spacious  manor  houses,  material  surviving 
evidence  of  a fabulous  way  of  life  which 
has  passed;  others  were  composed  entirely 
of  temporary,  ten  to  twenty-five  year,  struc- 
tures; a few  were  of  good  and  permanent 
construction,  to  be  turned  over  to  the  Eng- 
lish for  perpetual  use  of  communities  sorely 
in  need  of  augmented  hospital  facilities.  In 
this  way  the  old  lend-lease  balance  was 
titlted  a bit  toward  the  right,  as  if  it  made 
any  difference. 

One  of  the  prominent  American  hospitals 
in  England  was  the  Churchill  Hospital  at 

Rocky  Mountain  Medical  Journal 


Oxford.  Statistics  are  not  available  to  us, 
but  it  may  be  that  more  Americans  visited 
Oxford  than  any  English  city  other  than 
London,  It  was  a favorite  spot  for  mili- 
tary personnel  on  leave,  as  were  Canter- 
bury, Cambridge,  Stratford-on-Avon,  Ches- 
ter, Edinburgh,  among  a number  of  others. 
Oxford  was  sought  for  its  educational  re- 
sources, historical  significance,  and  for  its 
beauty.  Many  medical  conferences  were 
held  at  Churchill  Hospital,  and  facilities  of 
Radcliffe  Infirmary,  Oxford  Medical  School 
and  other  institutions  were  available  for 
educational  pursuits.  Hospitality  of  the 
faculty  and  others  toward  Americans  made 
excursions  to  Oxford  double  attractive  in 
contrast  to  the  toils  of  war. 

At  hand  is  a recent  clipping  from  an 
Oxford  newspaper  which  would  interest  the 
hundreds  of  American  doctors  and  nurses 
who  served  or  attended  the  Churchill  Hos- 
pital. It  is  entitled  “New  Maternity  Home 
— Oxford  40-Bed  Block.”  The  new  block 
has  been  converted  from  a section  of  the 
hospital  as  the  Americans  left  it  and  it  is 
anticipated  that  it  will  accommodate  at 
least  a thousand  maternity  cases  annually. 
In  conjunction  with  the  Radcliffe,  it  pro- 
vides also  a school  of  midwifery.  Inci- 
dentally, midwifery  is  a prominent  part  of 
medical  service  in  Britain— and  the  mid- 
wives’ morbidity  and  mortality  statistics  are 
not  bad.  Probably  they  call  for  medical 
help  in  time  when  they  need  it,  but  at 
any  rate  midwifery  serves  well  a crying 
need  in  that  country.  They  are  proud  of 
their  ultra-modern  converted  American  hos- 
pital. We  should  be  interested  in  the  dis- 
position of  the  other  similar  structures 
after  we  cleared  out  and  returned  the 
island  to  those  who  were  glad  to  get  it 
back. 

Oxford  was  peculiarly  free  from  air  raids 
— and,  as  far  as  we  know,  so  was  Heidel- 
burg.  It  was  common  belief  at  the  time 
that  Hitler  had  relations,  or  at  least  friends, 
among  the  large  headed,  bespectacled,  hol- 
low-chested eccentrics  who  frequent  edu- 
cational centers,  especially  in  the  Old  World. 
Some  sort  of  a “deal”  was  thought  to  pre- 
vail for  mutual  protection  of  these  educa- 
tional centers  and  their  contents — not  books. 


but  rather  nazis,  communists,  fifth  column- 
ists. But  perhaps  it  was  only  army  grape- 
vine, the  most  facile  of  all  communication 
media,  or  maybe  simply  a strange  coinci- 
dence. 


SILHOUETTES 

from  the  A.M.A.  House  of  Delegates 


At  the  Interim  Meeting  of  the  American  Medi- 
cal Association  in  St.  Louis  the  House  of  Dele- 
gates voted,  unanimously,  to  levy  an  assessment 
of  twenty-five  dollars  on  each  member  of  the 
association.  It  is  important  to  emphasize  that 
this  action  was  taken  by  the  House  of  Delegates. 
It  is  equally  important  to  realize  that  the  sug- 
gestion that  this  assessment  be  levied  came  from 
the  delegates  of  several  states  and  did  not  origi- 
nate with  the  Board  of  Trustees  or  with  any 
council  or  committee  of  the  association.  It  was 
the  thought  and  the  action  of  the  House  of  Dele- 
gates— ^your  representatives  in  the  structure  of 
our  association. 

The  purpose  of  this  levy  is,  briefly,  to  carry 
to  the  public  through  the  newspapers  of  the 
United  States  factual  data  concerning  the  ac- 
complishments, the  activities  and  the  objectives 
of  the  medical  profession.  It  is  designed  to  tell 
the  whole  truth  to  all  of  the  people.  And  that 
should  be  a great  treat  for  all  of  the  people. 
The  management  of  this  program  must,  of  neces- 
sity, be  vested  in  our  administrative  body — the 
Board  of  Trustees. 

The  wishful  thinkers  are  vocal  and  in  print. 
They  are  predicting  failure  to  collect  this  assess- 
ment. They  prophesy  that  the  American  Medi- 
cal Association  will  be  “split  down  the  middle.” 
That’s  what  they  think.  Let’s  show  ’em! 

Twenty -five  dollars  is  (as  those  two  fine  yoimg 
American  boys  who  shovel  our  snow  say)  “some 
lettuce.”  Consider  the  barter  value  of  twenty- 
five  dollars:  It  will  purchase  three  orchids  or 
a pair  of  shoes  for  your  wife,  or  two  to  four 
neckties,  or  one-half  to  one  hat  for  your  daugh- 
ter, or  a minimum  amount  of  feminine  unmen- 
tionables, or  three  and  one-half  bottles  of  Johnny 
Walker  or  Old  Granddad. 

But,  it  will  purchase,  also,  professional  dignity 
and  security,  spiritual  integrity,  intellectual  in- 
dependence, freedom  in  thought,  action,  ambi- 
tion and  achievement,  and  a decent  disregard 
of  sob  sisters,  pot  boilers,  pseudo  political  up- 
lifters,  the  lap  dogs  of  foreign  ideologies  and 
other  emotional  tripe. 

The  defeatist  attitude  has  been  abroad  in  orxr 
profession  these  last  two  months.  “What’s  the 
use”  and  “you  cannot  beat  the  government” 


for  January,  1949 


19 


These  mental  (?)  reactions  are  normal  and, 
therefore,  not  impressive.  It  is  our  duty  to  help 
the  people  and  the  government.  What  is  this 
mythical  and  fearsome  entity  “government”? 
Government  is  you  and  you  and  you  and  Luke 
McGluke  on  the  street  corner  and  under  the 
viaduct.  None  other. 

Our  short,  stormy  but  magnificent  history  as 
a nation  is  littered  with  the  unembahned  mum- 
mies of  defeatist  thought.  The  Great  American 
Desert,  that  pitiful  backwoodsman  Lincoln,  those 
deluded  Wright  Brothers  at  Kitty  Hawk,  Morse, 
Steinmetz,  Henry  Ford,  and  back  yonder  a fel- 
low called  John  Paul  Jones.  When  ordered  to 
“strike  colors”  on  his  battered  and  sinking  ship, 
John  Paul  Jones  rephed,  “We  have  just  begim 
to  fight!”  Here  is  the  lesson  of  history.  To 
your  battle  stations,  gentlemen.  Give  us  youth 
and  vision  or  give  us  testosterone. 

Thoughts  of  a Maverick 

Is  there  not,  in  the  administrative  bodies  of 
our  association,  a place  for  that  dynamic,  fair- 
minded,  outspoken  gentleman.  Dr.  Paul  R.  Haw- 
ley? Or  do  we  save  the  chaff  and  throw  away 
the  grain?  * • ♦ 

With  an  expanding  program,  certain  voluble 
editors  will  find  need  for  several  more  ghost 
writers.  * • * 

Colorado  introduced  a resolution  on  behalf  of 
and  with  the  verbal  concurrence  of  the  delegates 
of  fourteen  additional  states.  The  Speaker,  at 
the  end  of  the  session,  requested  that  such  antics 
^ be  avoided  in  the  future.  This  smells  more  like 
Chicago  than  Philadelphia — a sort  of  childish 
gasp  of  a failing  bureaucrat. 

WILLIAM  H.  HALLEY,  M.D. 


Correspondence 


Editor’s  Note:  The  lollowinff  letter,  received  by 
Dr.  C.  F.  Hegner,  President  of  the  Colorado  State 
Medical  Society,  is  published  with  the  permission  of 
both  writer  and  Dr.  Hegner. 

Walsenburg,  Colo., 
November  13,  1948. 

Dear  Dr.  Hegner; 

This  is  still  America  or  I wouldn’t  be  writing 
to  you  in  this  way. 

I am  greatly  concerned  over  socialized  medi- 
cine, which  President  Truman  will  try  to  force 
on  the  public.  Of  course  such  a program  will 
mean  that  the  government  has  control  of  our 
bodies  and  our  minds.  It  will  mean  loss  of 
personal  freedom  and  regimentation  in  its  highest 
form.  It  will  mean  the  government  will  set 
itself  up  as  a welfare  state.  It  will  be  bad  for 


the  people  but  it  will  also  be  tragic  for  you 
physicians. 

You  are  not  organized  as  a union  and  I hope 
that  you  never  will  be.  Still,  you  have  your 
county,  state  and  other  organizations.  Trucksters, 
railroad  men,  telephone  operators  and  clerks  and 
others  get  their  way  by  striking.  Can  you  not, 
through  your  county  organizations,  state  organi- 
zations, etc.,  make  such  an  organized  protest  of 
refusal  that  you  can  save  America  and  your- 
selves? 

Doctors  are  ethical,  but  the  cause  seems  great 
enough  for  doctors  to  fight. 

This  does  not  call  for  an  answer,  but  I sin- 
cerely hope  that  you  doctors  can  keep  America 
free.  There  are  two  months  left. 

Very  sincerely, 

MRS.  K.  L.  B. 

In  the  opinion  of  the  Editor,  this  letter  does  deserve 
an  answer,  and  in  Dr.  Halley’s  “Silhouettes,”  above, 
one  form  of  reply  is  plainly  indicated. 


To  the  Editor: 

For  the  benefit  of  the  members  of  the  five 
constituent  State  Medical  Societies  served  by 
the  Rocky  Mountain  Medical  Journal,  I refer 
to  the  following  incident  which  I recently  ex- 
perienced at  the  Palmer  House  in  Chicago. 

On  June  16,  1948,  I handed  to  the  doorman 
at  the  Palmer  House  a suitcase  for  checking 
until  after  a meeting  then  in  progress  in  that 
hotel.  I was  given  a numbered  baggage  check. 
On  claiming  the  bag  in  the  late  afternoon  I 
was  advised  it  was  lost.  After  two  days  of 
patient  waiting  I demanded  a search  for  same 
since  I had  pointed  out  an  identical  bag  and 
my  name  was  on  an  attached  tag.  Nine  days 
later — Jime  25 — the  bag  was  found  in  one  of 
the  hotel  rooms.  Since  this  bag  contained 
everything  not  on  my  person  and  including 
memos  and  correspondence  necessary  to  certain 
arranged-for  professional  and  business  confer- 
ences, the  value  of  the  trip  was  seriously  re- 
duced. Substantial  purchases  of  toilet  articles 
and  clothing  in  order  to  remain  through  the 
meeting  were  required. 

The  hotel  passed  the  matter  of  responsibility 
on  to  an  insurance  carrier  which  claims  all  re- 
sponsibility is  limited  to  $50.00  because  of  the 
following  which  appears  on  the  back  of  the 
baggage  check  given  me:  “The  property  checked 
hereunder  is  accepted  only  upon  the  following 
conditions:  (1)  the  hotel’s  liability  is  limited, 
pursuant  to  Illinois  statutes, ' to  the  following 
amounts;  Valises,  traveling  cases  and  contents — 
$50.00.  Boxes,  parcels  or  packages  and  contents 
— $10.00.”  However,  to  date  the  insurance  com- 
pany “decline  to  make  a voluntary  payment” 
of  my  claim. 

If  the  reader  is  in  the  habit  of  carefully  noting 
the  printed  matter  on  the  back  of  a baggage 
check  given  by  a hotel — especially  when  hurry- 
ing to  get  to  a meeting  then  in  progress — this 
warning  is  unnecessary,  but  it  would  be  wise 
before  placing  baggage  in  the  custody  of  any 
hotel  to  determine  the  value  of  the  case  and 
contents  in  view  of  the  law  under  which  the 
hotel  limits  its  responsibility. 

C.  T.  BURNETT,  M.D. 

Denver. 


20 


Rocky  Mountain  Medical  Journal 


Original  Articles 


PSYCHOLOGICAL  FACTORS  IN  EVERYDAY  PRACTICE* 

O.  SPURGEON  ENGLISH,  M.D. 

PHILADELPHIA,  PENNSYLVANIA 


This  paper  is  presented  with  misgiving, 
since  as  a psychiatrist  becomes  aware  of 
many  things  which  cause  people  emotional 
distress  and  places  them  before  his  col- 
leagues, he  may  seem  to  be  criticizing  his 
colleagues  for  these  things  are  too  often 
overlooked,  or  perhaps  we  simply  pamper 
human  beings  in  general.  However,  you 
are  aware*  that  civilization  has  growing 
pains;  technocracy  has  cured  many  which 
came  from  long  hours  of  laborious  work; 
medicine  and  surgery  have  cured  some  due 
to  macroscopic  and  microscopic  pathology 
of  the  soma.  Psychiatry  has  become  aware 
of  microscopic  stresses  within  the  psyche 
which  add  up  to  unhappiness,  inefficiency 
and  illness — and  it  is  these,  encountered  in 
daily  practice,  which  are  under  discussion. 
We  are  coming  to  know  more  about  people 
and  what  hurts  them  in  the  mind,  and  this 
must  become  general  knowledge  and  be 
spread  by  the  doctor.  The  doctor  always 
has  been  a great  teacher  and  this  role  is 
becoming  more  important  all  the  time,  es- 
pecially in  teaching  man  about  himself. 

One  fact  of  interest  which  has  assumed 
great  importance  in  medicine  within  the 
past  fifty  years  is  that  we  begin  life  as 
children  and  grow  up  with  difficulty.  One 
patient  said,  “I  never  really  grew  up.  I 
only  grew  older.”  At  any  rate,  we  grow  up 
only  relatively  well,  since  to  grow  up  or  to 
mature  emotionally  means  to  be  able  to 
endure  stresses  and  distresses  while  assum- 
ing responsibilities,  and  to  work  happily 
and  enjoy  communion  with  our  fellow  man. 
To  be  able  to  do  these  things  guarantees 
freedom  from  disease  syndromes  classed  as 
psychoneuroses  and  psychosomatic  condi- 
tions. But  this  must  be  difficult  to  accom- 
plish, since  after  centuries  of  living  we  have 

‘Presented  at  the  Fifty-second  Annual  Meeting  of 
the  Utah  State  Medical  Association,  September  11. 
1947.  From  the  Temple  University  Medical  School. 


more  social  problems  in  the  world  today 
than  ever  before,  and  people  are  concerned 
that  the  highly  developed  mind  of  man  will 
not  settle  them  but  instead  will  proceed  to 
destroy  themselves  and  every  good  thing  on 
earth. 

Dependency 

As  we  study  human  personality,  we  find 
that  passive  state  of  childhood,  with  em- 
phasis on  being  cared  for,  has  a powerful 
pull  upon  the  individual  child.  Parents  and 
teachers  attempt  to  combat  it  by  appeal, 
rewards,  reminders,  cajolery,  sternness  and 
punishment.  Some  parents  or  parent  sub- 
stitutes succeed  in  creating  a responsible, 
diligent  individual  whose  hold  upon  life  and 
enjoyment  of  things  in  it  is  so  great  he  is 
practically  never  tempted  to  inertia  or  the 
questionable  pleasures  of  dependency,  con- 
tinued idleness,  being  cared  for  through  hos- 
pitalization, remaining  at  home  because  of 
symptoms,  or  prolonging  convalescent  time 
from  illness  or  operation.  However,  an  ap- 
palling number  of  people  do  not  succeed  in 
avoiding  these  conditions  during  their  life- 
time. 

Training  of  physicians  for  years  over- 
looked an  important  observation  — that 
man’s  physiology  is  trained  to  responsibility 
along  with  man  himself.  Man  must  learn 
to  eat  as  well  as  learn  the  alphabet;  he  must 
learn  to  control  the  lower  bowel  and  blad- 
der as  well  as  learn  the  multiplication 
table;  he  must  learn  to  control  his  heart 
rate  under  conditions  of  danger  and  re- 
sponsibility, and  he  must  learn  how  to  with- 
draw from  life  at  periodic  intervals  in  sleep 
in  order  to  effect  necessary  rest  and  repair. 
While  these  physiological  phenomena  have 
certain  automaticity,  they  are  not  complete- 
ly so,  and  the  learned  component  is  impor- 
tant in  maintaining  health. 

Furthermore,  what  we  have  glibly  re- 


fer January,  1949 


21 


ferred  to  as  instinct — that  which  was  in- 
born and  needed  no  learning — is  not  neces- 
sarily serving  us  in  a complex  world.  We 
refer  to  the  fact  that  mothers  know  how  to 
I ear  their  young.  They  did  a good  job 
when  home  and  child  rearing  was  the  cen- 
tral focal  point  of  their  lives,  but  the  time 
has  come  when  their  interests  are  more 
scattered  and  being  the  teachers  of  a well- 
ordered  mind  which  included  a well-inte- 
grated and  functioning  physiology  is  no 
longer  their  first  love  and  concern  in  an 
increasing  number  of  instances.  It  is  an 
increasingly  important  part  of  the  physi- 
cian’s job  to  teach  them  the  importance  of 
this  role  as  well  as  to  equip  himself  to  re- 
pair damage  wrought  by  ignorance  or  neg- 
lect of  the  human  being’s  basic  needs  for 
health. 

The  discomforts  of  being  young,  of  being 
a child,  of  being  dependent,  are  many  and 
continuous.  Children  are  sick  and  tired  and 
cry  with  distress  many  times  when  they 
have  no  broken  bones,  no  bruised  tissues, 
no  fever,  and  no  invasion  with  organisms. 

The  “dis-ease”  which  comes  from  merely 
being  alive  and  needs  the  sunny  smile  of 
friendship,  the  soothing  breeze  of  satisfac- 
tions of  hungers  and  the  invigorating  air 
of  approval  for  effort  needs  ministering  to 
in  the  home,  and  if  it  isn’t  there,  the  one 
who  misses  it  will  visit  health  resorts,  doc- 
tors’ offices,  or  clinics  for  it — often  futilely. 
This  is  because  sometimes  the  defect  in 
emotional  structure  between  neurology  and 
physiology  is  so  great  it  cannot  be  replaced, 
no  matter  how  well  understood.  But  in 
many  instances  it  is  replaceable  and  fails 
to  be  replaced  because  it  is  not  understood. 

This  may  sound  to  some  like  theorizing 
or  philosophizing,  but  actually  these  are  ob- 
servations which  have  been  proved  and  can 
be  proved  again  and  again. 

If  a mother  is  coming  home  from  market 
with  both  arms  l^aden  and  leading  the  dog 
and  her  child  of  three  is  too  tired  to  go  on, 
sits  down  until  he  is  carried,  one  may  think 
it  is  annoying  or  cute,  depending  upon  the 
mood  one  is  in.  But  when  a valuable  em- 
ployee feels  the  same  way  when  his  em- 


ployer needs  his  service,  it  becomes  a com- 
plex problem  in  diagnosis  and  treatment; 
it  may  involve  the  lives  of  many  people, 
much  money  and  wasted  energy. 

This  is  why  the  doctor  of  today  needs  to 
know  much  about  that  intangible  but  pow- 
erful force  operating  between  the  neuro- 
logical and  physiological  structure.  We  call 
this  force  the  personality.  It  needs  more 
than  the  common  sense,  we  are  often  so 
proud  of,  to  understand  its  workings.  It 
takes  uncommon  sense  to  know  its  many 
ramifications  and  manifestations. 

A man,  aged  46,  complained  of  gastro- 
intestinal symptoms  in  January,  1947.  He 
was  operated  upon  for  removal  of  the  ap- 
pendix and  drainage  of  the  gallbladder.  He 
was  told  they  “had  never  seen  a worse  ap- 
pendix,” and  even  though  there  were  no 
complications  and  he  made  an  uneventful 
recovery,  his  family  doctor  told  him,  “You 
shouldn’t  go  to  work  for  six  months.”  He 
had  been  a stationary  engineer  for  seven- 
teen years,  and  after  three  months’  idleness 
he  began  to  have  pain  in  the  back,  pain  in 
left  side  of  head,  and  began  to  feel  shaky 
and  dreaded  to  lose  his  mind.  He  has  been 
out  of  work  eight  months  and  shows  no  in- 
tention of  returning  to  it  until  he  feels 
completely  comfortable.  His  wife  has  had 
to  go  to  work  to  support  him  and  their 
daughter.  Careful  study  has  shown  no  dis- 
ease, but  he  is  determined  that  he  can’t  go 
to  work  until  he  is  made  well.  More  history 
revealed  that  at  the  age  of  27  he  had  had 
a “nervous  breakdown”  with  fatigue  and 
gastro-intestinal  symptoms  and  insomnia, 
and  a specialist  had  told  him  his  job  was 
“too  big  for  him.”  He  changed  jobs  and 
improved,  but  always  after  that  when  under 
stress  he  would  get  various  body  aches  and 
pains  and  some  indigestion.  If  these  emo- 
tional factors  of  his  earlier  history  had  been 
understood,  it  would  have  been  clear  that 
to  suggest  six  months’  rest  for  this  man  was 
playing  into  the  hands  of  his  dependency 
and  might  bring  about  reactivation  of  old 
illnesses.  A prolonged  convalescence  can  be 
as  harmful  to  efficiency  as  that  prolonged 
period  back  of  the  lines  was  for  the  patient 
during  the  war.  The  psyche  should  be 


22 


Rocky  Mountain  Medical  Journal 


evaluated  pre-operatively  just  as  is  now 
done  with  heart,  lung,  and  kidney. 

Evaluating  the  Presenting  Symptom 

Behind  the  symptoms  presented  to  the 
doctor  there  may  lie  a great  need  to  be  un- 
derstood regarding  some  emotional  pain  or 
distress.  The  presenting  symptom  is  mere- 
ly the  bridge  over  which  the  patient  tries 
to  walk  in  gaining  rapport  with  the  wise 
and  understanding  person  that  the  physician 
is  supposed  to  be.  A patient  once  said,  “It 
is  harder  to  bear  the  suffering  of  grown-up 
children  like  us  patients  than  the  suffering 
of  little  children.”  Such  a statement  could 
be  regarded  in  different  ways.  It  is  true 
we  expect  mental  suffering  from  children 
and  not  from  adults.  But  the  truth  of  the 
matter  probably  is  that  not  many  of  us  can 
stand  much  suffering  of  any  kind  in  other 
people,  nor  do  we  know  very  much  about 
what  to  say  or  do  about  it.  At  the  present 
stage  of  our  civilization,  children  have  to 
endure  or  repress  a great  deal  of  suffering 
because  neither  its  cause  nor  effect  is  un- 
derstood. When  the  adult  suffers  he  may 
be  more  insistent  and  hence  harder  to  avoid 
or  be  put  off.  Moreover,  we  are  more  baf- 
fled by  suffering  we  cannot  understand  and 
alleviate.  If  we  do  not  understand  and  al- 
leviate the  suffering  of  children  when  it  is 
simple,  we  aren’t  likely  to  do  any  better 
with  that  of  adults  when  time  has  made  it 
much  more  complex. 

Understanding  the  Tendency  to  Act 
Childishly  (Regression) 

Patients  cooperate  better  if  they  feel  their 
doctor  knows  human  nature  and  accepts  it 
philosophically.  One  patient  who  suffered 
from  fatigue  said,  “I’d  like  to  go  to  bed  in  a 
nice  hospital  for  six  months  and  have  the 
doctors  and  nurses  very  solicitous  of  me; 
to  have  them  bring  me  my  meals  on  a tray 
and  to  have  my  friends  call  on  me,  bringing 
me  flowers  and  presents.  But  I’d  die  rather 
than  admit  that  to  a soul  I know.”  In  this 
statement  we  see  clearly  the  desire  to  re- 
gress to  a childish  state  of  living.  If  we  ac- 
cept this  confused  attitude,  does  this  mean 
the  patient  is  going  to  lie  down  on  the  job — 
just  because  we  admit  we  understand?  Not 


at  all.  Enough  insight  and  honesty  alone 
are  present  to  keep  her  from  it,  and  to  be 
aware  of  and  sympathetic  to  her  wish  puts 
us  in  a position  to  offer  some  encouraging 
support  that  will  be  helpful.  In  passing,  we 
might  say  that  many  patients  are  actually 
doing  what  this  woman  only  admitted  she 
would  like  to  do.  The  regressive  forces 
have  been  stronger  and  produced  enough 
symtomatology  and  incapacitation  to  put 
them  in  the  hospital  bed  with  some  symp- 
tom or  group  of  symptoms.  To  their  credit, 
it  must  be  said  that  they  do  not  understand 
their  wish,  or  wishes,  but  if  they  are  to  be 
made  well  and  remain  so  we  must  under- 
stand their  wishes  to  be  dependent  and 
cared  for,  and  help  them  avoid  becoming 
victims  to  their  emotions  through  illness. 

The  practice  of  medicine  requires  sociolog- 
ical knowledge  as  well  as  all  the  other 
diagnostic  therapeutic  technics.  We  must 
understand  and  help  them  not  only  because 
our  job  is  to  understand  and  cure  ill  people, 
but  also  because  the  whole  world  must  un- 
derstand itself  if  we  are  to  make  any  head- 
way with  the  many  causes  of  human  un- 
happiness, strife  and  impediments  to  prog- 
ress, such  as  broken  homes  and  marriages, 
industrial  strife,  class  and  racial  struggles, 
delinquency  and  war.  The  forces  which 
make  the  individual  sick  make  society  sick, 
and  vice  versa,  and  changes  won’t  come  if 
knowledge  of  human  nature  remains  in  the 
hands  of  a few.  Knowledge  of  self,  i.e., 
knowledge  of  the  working  of  our  emotions 
and  ideas  which  implement  them,  must  be- 
come the  property  of  everyone.  The  doctor 
is  the  logical  one  to  do  a great  deal  of 
teaching  about  it.  He  has  prestige;  he  has 
centuries  of  reputation  of  having  worked 
for  the  public  good;  he  is  regarded  as  a 
scientist.  The  ill  man  has  much  to  gain 
personally  from  listening.  Moreover,  who 
is  more  interested  in  the  problem  of  cre- 
ating better  adjusted  human  beings  unless 
it  be  the  clergyman?  And  who  has  better 
access  to  human  beings  than  the  doctors? 

Sharing  a Distressing  Siutation 

A woman  of  35  recently  arrived  from 
Puerto  Rico,  entered  the  hospital  for  pain 
in  the  lower  abdomen  and  back.  She  was 


for  January,  1949 


23 


a well-educated  woman  married  to  a man 
not  only  less  well-educated  but  emotionally 
and  imaginatively  more  obtuse.  She  bore 
him  three  children,  the  last  one  being  def- 
initely unwanted  and  she  had  made  sev- 
eral tries  at  abortion.  Coincident  with  the 
birth  of  the  third  child,  she  became  frigid 
and  began  to  have  pain  in  the  lower  back 
and  abdomen.  In  efforts  to  remove  the 
pain  she  had  appendectomy,  hysterectomy 
and  oophorectomy.  She  and  her  husband 
became  more  estranged  and  she  became  on 
increasingly  poor  terms  with  his  family. 

She  left  the  country,  leaving  the  children 
with  the  grandparents,  and  came  to  the 
States  looking  for  work  and  a solution  to 
her  problem.  But  she  missed  her  children 
and  familiar  surroundings  and  was  unhappy 
here  and  the  pain  was  worse.  All  physical 
findings  were  negative.  She  said,  “I’ve 
had  an  unhappy  past  and  I see  nothing  in 
the  future.”  She  was  going  back  to  Puerto 
Rico  to  a husband  and  family  situation  full 
of  distress,  but  it  seemed  a little  better 
than  staying  in  a new  country  in  unfamiliar 
surroundings  away  from  the  children. 

She  needed  a doctor  who  was  not  intent 
on  taking  away  the  pain  immediately.  He 
needed  to  be  able  to  let  her  have  it  for 
awhile — to  share  it  with  her,  perhaps  even 
in  the  beginning  to  have  her  subtly  re- 
proach him  for  his  lack  of  skill  as  a doctor — 
while  he  explained  to  her  the  way  the  body 
absorbs  pain  from  the  mind,  and  who  would 
encourage  her  to  do  the  best  she  could  in 
spite  of  pain  and  make  as  much  peace  as 
she  could  with  unfriendly  relatives.  She 
found  such  a doctor;  in  fact,  one  who  spoke 
her  native  tongue,  and  made  rapid  improve- 
ment, and  said,  “If  I could  find  a doctor  hke 
you  when  I go  home,  I feel  sure  I could 
stay  well  enough  to  carry  on.”  There 
seems  no  question  but  what  we  must  train 
medical  students  to  avoid  the  conviction 
that  they  must  cure  a patient  completely 
and  quickly  so  that  they  'do  not  have  to  see 
him  for  a long  time,  else  their  ability  as 
physicians  is  open  to  question.  We  need  to 
have  more  of  the  philosphoy  of  the  good 
parent  who,  while  he  does  not  encourage 
dependency,  neither  does  he  shake  off  those 


whd  need  him  too  forcibly,  and  so  soon  that 
they  have  not  been  properly  strengthened. 

The  Danger  of  Efforts  at  Quick 
Symptom  Removal 

The  pressure  upon  the  doctor  to  relieve  a 
symptom  quickly  is  not  as  great  as  he  often 
believes.  Patients  will  endure  symptoms 
a long  time,  as  we  know,  both  from  their 
history  and  from  the  discovery  in  many 
cases  of  serious  pathology  which  they  have 
been  ignoring.  While  it  is  true  that  most 
patients  want  relief  when  they  consult  a 
physician,  they  will  be  patient  if  told  that 
the  cure  takes  time  and  that  there  is  no 
specific  drug  or  operation  which  will  bring 
quick  cure  for  their  condition.  The  urge  to 
give  quick  relief  to  a condition  which  is  due 
to  personal  conflict  with  the  individual, 
either  with  his  conscience  or  his  environ- 
ment, has  led  to  the  injurious  use  of  seda- 
tives, electroshock,  glandular  therapy,  ton- 
ics, vitamins,  injections  of  iron  and  other 
preparations,  when  no  proved  indication  for 
their  use  exists.  The  good  results,  when 
they  occur,  must  then  be  due  usually  to 
suggestion;  but  when  relapse  occurs,  as  in- 
evitably it  does,  the  effect  is  never  as  good 
in  subsequent  treatment.  It  is  then  more 
difficult  to  switch  to  a psychotherapeutic 
approach  than  it  would  have  been  to  begin 
such  at  the  first  visit.  In  comparison,  one 
must  admit  that  relapses  occur  after  psy- 
chotherapeutic treatment  also,  but  the  re- 
sumption of  treatment  by  this  means  gives 
results,  while  the  effect  of  non-specific 
suggestive  medications  has  worn  off.  More- 
over, one  has  an  enlightened  patient  to  deal 
with  who  does  not  mind  the  challenge  of 
going  to  work  upon  himself,  and  making 
that  effort  to  get  interested  in  the  world 
outside  of  himself  again.  One  very  impor- 
tant ally  on  the  side  of  the  psychotherapeu- 
tic approach  is  that  everyone  wants  to  live 
more  interestingly  and  more  constructively. 
Finally,  there  is  the  fact  that  the  patient  is 
doing  his  share  in  the  therapy,  instead  of 
just  saying  reproachfully  and  dependency, 
“Doctor,  your  last  medicine  doesn’t  help  me. 
What  are  you  going  to  do  now?” 

An  example  of  this  is  a married  woman, 
aged  29,  with  two  children,  who  developed 


24 


Rocky  Mountain  Medical  Journal 


fears  of  dying,  accompanied  by  palpitation, 
shortness  of  breath,  weakness  and  dizziness. 
She  had  been  brought  up  in  a home  with 
a mother  who  suffered  from  depression  of 
spirits,  irritability,  and  many  physical  com- 
plaints and  was  prone  to  nag  and  forbid. 
The  patient  was  freed  from  this  dull  ex- 
istence momentarily  before  marriage,  but 
following  marriage  in  the  early  twenties, 
and  being  confined  to  the  house  by  two 
children,  the  resentment  and  depression  she 
had  accumulated  through  so  many  years’ 
contact  with  a neurotic  mother  asserted  it- 
self and  she  developed  symptoms.  We  ex- 
plained the  origin  of  such  symptoms,  as- 
sured her  as  to  their  harmlessness  and 
urged  her  to  try  to  get  out  of  the  home  and 
live  a little.  She  at  first  hopelessly  said 
she  couldn’t  get  anyone  to  stay  with  the 
children,  but  by  our  emphasizing  this  move 
as  not  just  a luxury  but  the  necessary  es- 
sence of  her  therapy,  she  and  her  husband 
made  arrangements  for  the  children,  ven- 
tured forth  to  parties,  dancing,  bowling 
and  skating.  She  became  symptom  free, 
quite  rapidly  in  a three-month  period,  and 
remained  so  for  one  and  a half  years,  out 
of  contact  with  medical  care.  Then  one  day 
she  got  a return  of  symptoms  again  quite 
suddenly  and  returned,  and  it  was  plain  in 
a few  moments  of  conversation  that  she  had 
let  her  outside  life  drop  and  was  back  living 
the  same  dull,  uninspired,  unsociable  life 
her  mother  had  lived.  She  said,  “I  gradually 
got  back  in  a rut  again  without  realizing 
it.”  With  a few  instructions  she  was  again 
symptom  free  in  three  weeks,  this  time  as  a 
result  of  again  putting  into  effect  what  she 
had  learned  the  first  time.  She  said,  “i 
don’t  think  I’ll  forget  so  soon  this  time.”  Her 
husband  was  told,  “If  you  want  to  keep 
your  wife  welf,  go  out  with  her  periodically 
where  she  can  enjoy  herself  and  thereby 
give  her  something  pleasant  to  think  about 
for  a few  days  which  will  help  neutralize 
the  bleakness  of  her  childhood  which  now 
floods  her  mind  and  threatens  to  overcome 
her.”  He  understood  and  has  kept  it  up.  In 
passing,  we  might  remark  that  an  under- 
standing and  cooperative  spouse  is  a great 
asset  in  psychotherapy. 


Symptoms  arising  from  faulty  attitudes 
toward  life  require  specific  treatment  for 
their  personality  reactions.  To  treat  un- 
specifically  is  to  foster  invalidism  with 
fixed  symptoms  which  may  eventually  be- 
come resistant  to  psychotherapy  because  the 
faulty  personality  pattern  has  become  too 
firmly  set. 

Finally,  in  closing,  a word  or  two  about 
watching  carefully  our  own  beliefs  and 
prejudices  and  asking  ourselves  every  now 
and  then  whether  we  are  really  rendering 
the  right  decisions  for  our  patients,  or 
whether  we  are  applying  worn-out  con- 
cepts, exercising  a personal  prejudice,  or 
being  too  hurried  or  too  indifferent 
to  find  out  the  patient’s  real  wish  or 
to  discuss  the  matter  with  him  in  a 
manner  that  will  fit  his  problem.  One 
doctor  says,  for  example,  “No  mother  should 
have  the  care  of  her  own  child.  At  birth 
it  should  be  handed  over  to  a nurse  to  care 
for.  The  mother  is  emotionally  too  wrapped 
up  in  the  child  to  be  good  for  it.”  A mother 
said,  “I  had  to  beg  my  doctor  to  let  me  nurse 
my  baby  and  finally  he  gave  in.”  A woman 
whose  child  needed  a transfusion  asked  to 
have  an  explanation  of  what  this  entailed 
for  her  and  the  child,  and  the  doctor  im- 
patiently said,  “I  know  how  to  give  a trans- 
fusion. Don’t  you  trust  me?”  The  mother 
was  offended,  went  through  with  the  trans- 
fusion and  then  crossed  this  doctor  off  her 
list  for  any  future  service  to  her  family,  as 
she  said,  “No  one  had  ever  had  a trans- 
fusion in  our  family.  Naturally,  one  wants 
to  know  what  that  means  in  terms  of  time 
and  discomfort.  I can’t  say,  ‘You’re  won- 
derful, Doctor,  everything  you  do  is  all 
right,’  even  though  that  seems  to  be  what 
he  wants.”  People  want  to  know  and  are 
entitled  to  know  more  about  these  things 
than  in  the  old  days  of  secrecy  about  what 
was  done  for  illness.  This  woman’s  reac- 
tion represents  a growing  trend  of  thinking 
in  the  minds  of  a more  enlightened  public, 
which  doctors  must  be  aware  of  and  meet. 

Some  doctors  have  acquired  an  undue 
anxiety  about  the  prescription  of  sedatives, 
seeing  in  every  patient  a potential  addict. 
They  refrain  from  giving  a sedative  or 


for  January,  1949 


25 


hypnotic  the  first  night  in  the  hospital  or 
before  an  operation  because  of  this  belief, 
and  the  patient  spends  several  uncomfort- 
able hours  unnecessarily  while  his  good-will 
toward  the  hospital  and  doctor  are  put  to  a 
strain.  If  the  patient  needs  a laxative,  he 
may  appreciate  being  asked  which  one  he 
customarily  uses,  if  any,  and  the  amount, 
and  be  prescribed  the  same,  instead  of  a 
blanket  dosage  for  every  one  of  some  favor- 
ite drug  favored  by  the  physician  which 
may  turn  out  to  be  too  much  or  too  little. 

A patient  recently  said,  “I  like  Dr.  Jones, 
but  I feel  he  is  too  busy  for  me.  I went  in 
with  a hundred  questions  but  I had  only 
two  minutes  of  his  time  and  couldn’t  get 
any  satisfaction.”  Now,  when  the  doctor  is 
busy  and  patients  would  like  to  discuss  their 
illness  at  length,  a successful  comprise  may 
be  to  recognize  the  need  and  say,  “I  can’t 
discuss  your  illness  to  the  extent  you  would 
hke,  but  I’ll  answer  your  three  most  im- 
portant questions  today  if  you  will  put  them 
briefly  and  concisely  and  take  up  more  with 
you  next  time.”  It  would  often  turn  out 
that  the  patients  won’t  have  three  questions 
but  if  they  have  more  they  still  have  gained 
considerable  satisfaction  from  having  the 
three  most  important  ones  answered. 

Then,  there  is  the  physician  who  feels 
that  no  patient  should  be  told  he  has  in- 
curable disease  and  the  others  who  feel  the 
patient  should  always  be  told  he  has  an 
incurable  disease.  It  would  seem  that  a 
middle  road  is  the  only  rational  one.  Some 
want  to  know  the  truth  about  their  illness, 
can  cope  entirely  adequately  with  the  news 
and  certainly  deserve  to  be  told  and  may 
attend  to  some  very  important  things  when 
told,  as  well  as  make  the  best  use  of  their 
remaining  time  in  life.  Others  do  not  want 
to  be  told,  could  not  well  stand  to  be  told, 
would  live  their  remaining  days  miserably 
if  told,  and  if  such  is  the  case,  they  can  well 
be  left  in  ignorance,  with  only  the  other 
family  members  being  informed  of  the  true 
state  of  affairs. 

The  doctor  has  shaved  off  his  beard  and 
laid  aside  his  long-tailed  coat,  but  he  still 
has  the  respect  of  the  public.  Yet  he  must 
keep  it — and  we  submit  that  to  do  so  he 


must  replace  the  austerity  with  a greater 
knowledge  of  how  human  personality  func- 
tions. We  must  find  out  what  human  beings 
need  and  try  to  discover  in  what  degree 
helping  them  to  get  what  they  want  and 
need  is  important  for  their  welfare.  We  are 
finding  out  that  lessening  emotional  tur- 
moil and  promoting  serenity  as  far  as  pos- 
sible is  not  a luxury  for  the  human  race, 
but  a necessity.  Since  the  doctor  is  one  of 
the  foremost  leaders  in  human  welfare,  the 
application  of  knowledge  of  the  emotions  is 
an  increasingly  important  part  of  his  arma- 
mentarium. 

In  fact,  as  we  learn  more  about  how  peo- 
ple can  get  along  with  less  unhappiness  and 
conflict,  the  psychiatrist  would  like  to  make 
every  colleague  an  ally  in  an  effort  to  re- 
duce in  size  that  vast  reservoir  called  the 
unconscious  mind.  The  doctor  works 
through  his  colleagues  and  the  colleagues 
work  through  the  adult  patient  and  they  in 
turn  through  the  children.  Finally,  the 
speed  of  increased  knowledge  is  rapid  if  we, 
as  doctors,  earnestly  assume  our  teaching 
as  well  as  our  healing  role. 


POSTGRADUATE  COURSE  IN 
ENDOCRINOLOGY 

The  Postgraduate  Committee  of  the  Associa- 
tion for  the  Study  of  Internal  Secretions,  under 
authority  of  its  Council,  announces  a course  of 
lectures  and  demonstrations  in  Clinical  Endo- 
crinology to  be  held  in  Oklahoma  City  at  the 
Skirvin  Hotel,  February  21  to  26,  1949,  inclusive. 
The  faculty  will  consist  of  prominent  investi- 
gators and  clinical  endocrinologists  in  the  va- 
rious branches  of  the  medical  sciences  in  the 
United  States  and  Canada.  This  course  will  be 
a practical  one  of  interest  and  value  to  both 
the  general  practitioner  and  the  speciahst.  A 
fee  of  $100  will  be  charged  for  the  entire  course 
and  the  attendance  will  be  limited  to  100.  Reg- 
istration will  be  in  order  of  checks  received. 
Should  there  be  an  insufficient  number  of  ap- 
plicants to  warrant  the  course,  the  registration 
fee  will  be  immediately  refunded  in  full.  Please 
forward  application  on  your  letterhead,  together 
with  your  check  payable  to  the  Association  for 
the  Study  of  Internal  Secretions,  to  Henry  H. 
Turner,  M.D.,  Chairman  of  the  Postgraduate 
Committee,  1200  North  Walker  Street,  Oklahoma 
City  3,  Oklahoma.  Due  to  other  meetings  being 
held  in  Oklahoma  City  at  the  time  of  this  as- 
sembly, satisfactory  hotel  accommodations  will 
be  difficult  to  procure  on  short  notice;  there- 
fore, it  is  suggested  that  all  applicants  make 
their  reservations  early,  directly  with  hotels  of 
their  choice.  Some  of  the  better  downtown  hotels 
in  Oklahoma  City,  listed  according  to  their 
proximity  to  the  Skirvin  are:  Skirvin  Tower, 
Huckins,  Wells-Roberts,  Biltmore  and  Black. 


26 


Rocky  Mountain  Medical  Journal 


CURRENT  THERAPEUTIC  PROCEDURES  IN  CORONARY  DISEASE* 

WILLIAM  S.  MIDDLETON,  M.D. 

MADISON,  WISCONSIN 


Much  of  the  present  knowledge  of  coro- 
nary disease  stems  from  the  clinical  studies 
of  contemporary  clinicians.  Among  them 
George  Dock  and  James  B.  Herrick  in  the 
United  States  and  John  Parkinson  in  Eng- 
land deserve  especial  notice.  Within  the 
span  of  an  active  career  Herrick  has  per- 
force preached  first  a need  for  diagnostic 
consciousness  of  coronary  thrombosis  and 
then  the  necessity  of  greater  critical  judg- 
ment. Errors  of  commission  are  exceeding 
errors  of  omission  in  its  diagnosis.  In  press- 
ing his  thesis  he  cited  some  twenty-eight 
conditions  that  were  mistaken  for  coronary 
occlusion.  Perhaps  selfish  abstraction  has 
led  the  medical  profession  to  serious  con- 
cern in  the  prospect  of  an  unusually  high 
incidence  of  this  vascular  accident  among  its 
own  members.  For  a time  Levine  and 
Hindle  allayed  this  fear  by  adducing  evi- 
dence that  there  is  no  such  differential  be- 
tween the  physicians  and  the  general  popu- 
lation, even  though  coronary-artery  disease 
is  the  most  frequent  cause  of  death  among 
doctors.  Dublin  and  Spiegelman  in  a careful 
analysis  of  the  situation,  however,  deter- 
mined that  the  death  rate  of  male  physi- 
cians from  coronary  disease  is  one  and 
four-fifths  times  that  of  white  males  of  the 
same  ages  in  the  general  population. 

With  a clarification  of  diagnostic  criteria 
interest  next  centered  upon  the  prognosis  of 
coronary  thrombosis.  This  knowledge 
opened  the  door  to  logical  therapy.  With 
this  shifting  emphasis  came  renewed  at- 
tention to  the  underlying  anatomy  and 
physiology  of  the  coronary  circulation.  The 
old  Weigert-Cohnheim  controversy  over  the 
fundamental  nature  of  the  arterial  termina- 
tions has  resolved  itself  long  since  by  the 
demonstration  of  anastomoses.  These  con- 
necting channels  vary  in  size  and  ap- 
parently become  functional  only  when  the 
demand  arises  upon  interference  with  the 
lumen  of  a normally  responsible  vessel. 

’From  The  Department  of  Medicine,  University  of 
Wisconsin  Medical  School.  Read  before  the  Fifty- 
second  Annual  Meeting-,  Utah  State  Medical  Associa- 
tion, September  11,  1947. 


Such  arterial  communications  may  be  (a) 
intercoronary,  (b)  through  the  vessels  of 
Thebesius,  (c)  by  way  of  the  arteriae  telae 
adiposae  or  (d)  through  vessels  in  pericar- 
dial synechiae.  The  sympathetic  nerves  sup- 
ply vasodilator  fibres  to  the  coronary  arter- 
ies, whereas  vasoconstriction  is  effected 
through  the  vagi.  The  coronary  arteries  may 
be  the  seat  of  any  disease  to  which  the  gen- 
eral vascular  bed  is  heir.  Early  in  the  in- 
flammation or  degeneration  of  a vascular 
tube  the  responses  to  any  stimulus  are  ex- 
cessive. Beyond  the  capacity  to  respond  to 
such  stimuli  the  artery  may  anatomically 
represent  a rigid  or  an  occluded  tube. 

To  simplify  the  discussion,  coronary 
sclerosis  with  resultant  thrombosis  may  be 
taken  as  the  type.  Obviously  there  are 
many  other  diseases  affecting  the  coronary 
system.  Independently  arteriosclerosis  may 
lead  to  narrowing  and  occlusion  of  coronary 
arterial  branches.  The  customary  result  of 
such  gradual  nutritional  encroachment  is 
myocardial  fibrosis.  In  this  light  coronary 
thrombosis  on  an  arteriosclerotic  basis  can 
never  be  acute  in  its  pathologic  background. 
Furthermore,  the  pathologic  outcome  of 
coronary  thrombosis  depends  on  the  size 
and  importance  of  the  vessel  occluded,  the 
adequacy  of  anastomoses  and  the  time  fac- 
tor in  the  ultimate  complete  obstruction. 
Smaller,  less  vital  vessels  may  be  occluded 
without  serious  consequence,  provided  there 
be  adequate  collateral  arterial  support  and 
time  to  bring  it  into  effective  play.  If  these 
several  factors  be  not  favorable  and  myo- 
cardial nutrition  fail,  infarction  ensues.  Le- 
vine has  divided  the  periods  of  pathologic 
events  subsequent  to  coronary  thrombosis 
on  rather  arbitrary  but  highly  practical 
grounds.  Anemia,  edema  and  hemorrhagic 
extravasation  dominate  the  histologic  pic- 
ture for  the  first  three  or  four  days.  Necro- 
sis comes  to  the  fore  from  the  fourth  day 
to  the  end  of  the  third  week.  Fibrosis  is 
inconspicuous  early  and  does  not  take  a 
prominent  place  until  after  the  third  week. 


for  January,  1949 


27 


Its  reparative  role  is  rarely  adequate  until 
the  fifth  or  sixth  weeks.  Deviations  from 
such  a formula  will  be  frequent,  but  they 
do  not  detract  from  its  broad  application. 
Dependent  upon  the  ischemia  of  the  epi- 
cardium  and  endocardium  adjacent  to  the 
myocardial  infarct  reactive  inflammation 
of  these  serous  membranes  may  be  antici- 
pated. The  pericardial  reaction  proceeds 
from  sero-fibrinous  to  fibrous  stages.  As 
indicated,  through  such  adhesions  a poten- 
tial source  of  improved  nutrition  may  come. 
The  approximation  of  the  pericardial  layers 
and  their  sealing  may  further  act  as  an  ef- 
fective “blowout”  patch.  Within  the  cham- 
bers of  the  heart  at  the  site  of  the  infarction 
mural  thrombi  may  occur.  Particularly  is 
such  thrombosis  prominent  in  aneurysms  of 
the  heart  incident  to  myocardial  infarction. 
These  intracardiac  thrombi  carry  an  ever- 
present threat  of  remote  embolism.  On  the 
other  hand  it  is  conceivable  that  they  serve 
an  “anti-leak”  function  similar  to  “fillers” 
in  the  inner  tubes  of  pneumatic  tires. 

Translated  into  the  clinical  course  these 
pathologic  processes  find  expression  in  sev- 
eral manners.  The  gradual  encroachment 
of  arteriosclerosis  upon  the  myocardial  nu- 
trition leads  to  symptoms  that  are  best  con- 
sidered as  coronary  insufficiency.  The  most 
widely  recognized  among  these  is  angina 
pectoris.  This  symptom  takes  on  a more 
ominous  portent  when  the  precipitating 
cause  from  a physical  standpoint  becomes 
decreasingly  less  and  then  assumes  the 
characterization  of  angina  of  decubitus.  Just 
as  significant  of  coronary  insufficiency  is 
indigestion  on  effort  after  eating.  Heberden 
clearly  appreciated  this  relationship  in  an- 
gina pectoris,  since  he  wrote,  “They  who  are 
afflicted  with  it,  are  seized  while  they  are 
walking  (more  especially  if  it  be  up  hill, 
and  soon  after  eating)  with  a painful  and 
most  disagreeable  sensation  in  the  breast.” 
Dyspnea  removed  from  the  effort  and  un- 
explained weakness  are  less  definite  symp- 
toms from  this  cause;  but  they  must  be  con- 
sidered in  the  composite  picture  of  coronary 
insufficiency.  In  gradual  myocardial  fi- 
brosis from  coronary  sclerosis  congestive 
failure  ultimately  eventuates  in  most  sub- 


jects. Immediate  death  upon  coronary  oc- 
clusion depends  upon  some  serious  inter- 
ference with  conduction.  Surviving  this 
immediate  threat  the  second  danger,  namely 
that  of  rupture  of  the  heart,  may  be  en- 
countered from  the  third  day  to  the  end  of 
the  third  week  after  the  occlusion.  A con- 
siderable number  of  patients  with  acute 
coronary  occlusion  and  myocardial  infarc- 
tion under  my  care  have  died  from  this  on 
the  fifth  day.  This  experience  has  not  been 
an  isolated  one.  Embolism  from  mural 
thrombosis  may  usually  be  expected  before 
the  fourteenth  day.  In  the  experience  of  the 
State  of  Wisconsin  General  Hospital  the 
greatest  mortality  from  coronary  thrombo- 
sis is  incident  to  delayed  cardiac  failure. 
Obviously  this  picture  is  in  some  measure 
colored  by  the  exclusion  of  the  group  of 
early  fatalities. 

With  this  background  the  therapeutic  at- 
tack may  be  more  clearly  ordered.  The 
prophylactic  approach  to  the  degenerative 
diseases  is  not  well  defined.  Obviously  un- 
derlying constitutional  states,  such  as  dia- 
betes mellitus  and  hypertension,  should  re- 
ceive appropriate  attention.  In  the  major- 
ity of  individuals  arteriosclerosis  is  an  in- 
cidental finding  and  general  hygienic 
measures  alone  prevail.  Among  these, 
mental  and  psychological  equilbrium  are 
more  important  than  physical  protection. 
Tobacco  should  be  interdicted  by  reason  of 
its  vasospastic  effect.  While  this  action 
may  represent  an  individual  idiosyncrasy, 
its  elimination  is  still  justified.  Tea  and 
coffee  have  no  contraindication  if  used  in 
moderation.  Alcoholic  beverages  in  small 
amount  need  not  be  denied,  if  the  patient 
be  in  the  habit  of  their  reasonable  use.  In- 
deed, they  have  the  incidental  property  of 
vasodilatation.  The  diet  requires  especial 
notice.  Arteriosclerosis  is  singularly  prev- 
alent in  obese  individuals.  Experimental 
and  clinical  evidence  supports  a cholesterol 
fault  of  metabolism  in  the  etiology  of  ar- 
teriosclerosis. Beyond  a peradventure 
weight  reduction  is  a prime  indication  in 
obese  subjects  with  arteriosclerosis.  Fur- 
ther, the  diet  for  all  potential  or  established 
coronary  patients  must  take  the  factor  of 


28 


Rocky  Mountain  Medical  Journal 


cholesterol  sources  under  advisement.  Let 
it  be  borne  in  mind,  however,  that  the 
demonstrability  of  vascular  change  of  this 
order  is  proof  of  their  irreversibility.  The 
prophylaxis  should  anticipate  this  point. 
Perhaps  Osier’s  admonition  should  be  ex- 
tended to  the  choice  of  one’s  grandparents, 
for  there  is  a vascular  pattern  among  fami- 
lies. Whether  this  circumstance  depends 
upon  environment  or  heredity  remains  to 
be  proved. 

From  the  standpoint  of  the  active  therapy 
of  coronary  sclerosis  the  xanthin  deriva- 
tives have  been  widely  recommended.  Their 
usefulness  has  been  questioned  in  some 
quarters,  but  experimental  evidence  and 
clinical  experience  justify  the  use  of  theo- 
phyllin  0.1  to  0.2  gram  (IVz  to  3 grains), 
three  times  a day.  Mild  sedation,  such  as 
phenobarbital  0.015  to  0.030  gram  (V4  to  V2 
grain)  three  times  a day,  may  supplement 
psychotherapy  and  advice  in  affording  re- 
laxation. Nitroglycerin  and  the  nitrites  have 
their  traditional  position  in  the  treatment 
of  angina.  The  results  from  androgens  have 
not  justified  the  early  optimism  that  at- 
tended their  use.  Among  the  measures  ad- 
\dsed  for  the  reduction  of  the  circulatory  re- 
‘ quirement  the  most  radical  was  total  thy- 
i roidectomy.  Its  unphysiologic  principles 
should  have  condemned  this  procedure  a 
j priori.  More  recently  thiouracil  and  propyl- 
jj  thiouracil  have  been  proposed  with  the  same 
I design.  They  have  the  virtue  of  simplicity, 
I control,  and  reversibility.  Further  trial  of 
i these  drugs  is  necessary  to  establish  their 
I availability  in  coronary  insufficiency.  When 
cardiac  failure  becomes  the  dominant  ex- 
I pression  of  coronary  sclerosis,  appropriate 
. measures  of  physical  rest,  diet,  digitalis  and 
; other  details  of  cardiac  support  will  be  in- 
voked. 

With  the  warning  of  the  symptoms  and 
signs  of  coronary  insufficiency  frank  coro- 
; nary  thrombosis  may  be  postponed  or 
i j averted.  On  the  other  hand  this  accident 
I in  all  of  its  classical  features  may  occur 
I without  premonitory  signals  of  distress, 
i Conversely  the  atypical  and  silent  forms 
! may  baffle  the  most  astute  diagnostician. 
The  therapeutic  targets  are  specific,  namely, 

for  January,  1949 


control  of  pain  and  hypoxia,  sedation,  pro- 
tection of  the  myocardium,  improvement  of 
the  coronary  blood  flow,  prevention  of  em- 
bolism and  of  propagation  of  the  thrombus, 
preservation  or  restoration  of  normal  con- 
duction and  maintenance  of  minute  volume 
output  of  the  heart  (control  of  cardiac  de- 
compensation). Absolute  bed  rest,  with 
mental  as  well  as  physical  relaxation,  is  the 
first  indication  in  the  treatment  of  acute 
coronary  occlusion.  Ordinary  sedatives  and 
analgesics  do  not  suffice  to  meet  this  de- 
mand. Morphine  sulfate  (0.015  gram  — 14 
grain)  should  be  given  intravenously.  The 
hypodermic  route  will  require  several  times 
this  dose  without  an  assurance  of  satisfac- 
tory results.  The  repetition  of  morphine 
will  depend  upon  the  effective  control  of 
mental  unrest  and  pain.  Since  papaverin 
alone  of  the  alkaloids  of  opium  gives  smooth 
muscle  relaxation,  it  has  been  recommended 
in  place  of  morphine  in  this  connection.  The 
earlier  dosage  (0.030  to  0.060  gram)  did  not 
give  adequate  control,  but  the  more  recently 
advised  0.060  to  0.2  gram  (1  to  3 grains) 
doses,  intravenously,  have  been  efficacious. 
Oxygen  has  been  one  of  the  most  satisfac- 
tory agents  for  the  control  of  the  pain  of 
coronary  occlusion.  At  the  same  time 
dyspnea  and  systemic  hypoxia  are  com- 
batted. The  approved  dosage  is  6 liters  per 
minute  by  the  oro-pharyngeal  route  until 
equilibrium  is  established.  Thereupon  the 
flow  may  be  reduced  to  4 liters  per  minute. 
As  a rule  in  the  State  of  Wisconsin  General 
Hospital  oxygen  is  administered  routinely 
at  levels  of  4 to  6 liters  per  minute  for  the 
first  fifteen  days  to  three  weeks  after  cor- 
onary thrombosis.  The  philosophy  of  this 
procedure  lies  in  the  histologic  evidence  of 
the  curve  of  myocardial  necrosis.  A much 
more  extended  experience  will  be  required 
to  establish  the  validity  of  this  position. 
Practically  most  of  the  patients  are  much 
more  comfortable;  but  the  question  is  not 
susceptible  of  experimental  resolution  since 
the  general  vascular  picture  in  the  coronary 
arterial  system  cannot  be  duplicated  in  ani- 
mals. Attendant  upon  vascular  occlusion 
are  waves  of  nerve  impulses.  The  vagal  re- 
sponse leads  to  vasoconstriction.  To  block 


29 


this  possible  contribution  to  coronary  im- 
pairment atropine  has  been  used.  The  recom- 
mended dose  of  0.001  gram  (1/60  grain)  is 
precariously  close  to  the  level  for  vagal 
release.  If  it  be  repeated  as  recommended, 
serious  tachycardia  may  occur.  Aminophyl- 
lin  (0.5  gram)  intravenously  is  advised  early 
in  the  course  of  coronary  thrombosis.  Later 
it  may  be  given  by  mouth  in  doses  of  0.1  to 
0.2  gram  (IVa  to  3 grains)  three  times  a day. 

The  incidence  of  embolism,  remote  throm- 
bosis and  the  propagation  of  a coronary 
thrombus  has  been  variously  estimated  at 
from  10  to  35  per  cent.  Certainly  these 
thrombo-embolic  complications  of  coronary 
occlusion  constitute  a considerable  problem. 
With  the  availability  of  anticoagulant  agents 
a clinical  attack  has  been  made.  Peters, 
Guyther  and  Brambel  reported  a controlled 
series  of  patients  with  coronary  thrombosis 
treated  with  dicumarol.  Embolic  phenom- 
ena were  reduced  to  one-eighth  and  the  mor- 
tality to  one-fifth  of  the  untreated  group. 
In  general  the  extending  experience  has 
confirmed  this  report.  Meyer,  Bingham  and 
Axelrod  recommended  5 mgm.  of  dicumarol 
per  kilo  as  an  initial  dose  by  mouth  and  1.5 
mgm.  per  kilo  sufficiently  frequently  to 
keep  the  prothrombin  level  between  25  and 
35  per  cent.  Subsequently  the  general  rule 
has  made  300  mgm.  of  dicumarol  the  first 
dose.  If  the  prothrombin  percentage  is 
above  20  per  cent  on  the  succeeding  day, 
200  mgm.  is  given.  If  the  value  is  below  20 
per  cent,  no  dicumarol  is  given  on  the  sec- 
ond day.  If  the  curve  of  decline  of  pro- 
thrombin has  been  slow  the  dose  of  dicu- 
marol is  increased.  If  rapid,  the  subsequent 
doses  should  be  decreased  or  the  interval 
lengthened.  This  anticoagulant  therapy 
should  be  continued  through  the  period  of 
bedfastness  in  patients  with  coronary 
thrombosis.  The  technical  difficulties  in  the 
laboratory  control  of  dicumarol  effect  by 
repeated  prothrombin  determinations,  in  the 
judgment  of  some  clinicians,  outweigh  the 
advantage  of  an  effective  anti-coagulant 
that  can  be  administered  by  mouth.  Its  oc- 
casional hazard  in  hemorrhage  can  be  con- 
trolled by  transfusion  of  fresh  whole  blood 
or  more  specifically  by  the  intravenous  in- 


jection of  40  to  60  mgm.  of  synthetic  vi- 
tamin K. 

Since  the  initiation  of  the  depression  of 
prothrombin  is  delayed  for  twenty-four  to 
forty-eight  hours  after  the  oral  administra- 
tion of  dicumarol,  the  support  of  promptly 
acting  heparin  has  been  evoked  in  conjoint 
therapy.  Given  intravenously,  heparin 
leads  to  an  immediate  prolongation  of  the 
clotting  time  (10  minutes)  and  its  effect  is 
lost  within  two  or  three  hours.  Hence  hepa- 
rin may  be  used  to  initiate  anti-coagulant 
therapy  in  the  prospect  of  a continuation  of 
this  basic  action  by  dicumarol.  The  ad- 
vised dose  of  heparin  for  intravenous  use 
is  50  mgm.  every  four  hours.  Continuous 
intravenous  drip  methods  are  too  difficult 
for  a wide  acceptance.  The  therapeutic  ob- 
jective is  a prolongation  of  clotting  at  least 
twice  normal  time  (to  12  or  15  minutes). 
This  plan  presupposes  the  discontinuance  of 
heparin  as  soon  as  the  prothrombin  falls  to 
30  per  cent  under  the  concurrently  ad- 
ministered dicumarol.  Loewe  and  Rosen- 
thal’s suggestion  of  Pitkin’s  menstruum  as  a 
vehicle  for  heparin  permits  deep  subcuta- 
neous injection  and  prolonged  therapeutic 
action  through  slow  absorption.  The  effect 
of  a single  subcutaneous  injection  will  last 
for  eighteen  to  forty-eight  hours.  Hence  it 
offers  the  prospect  of  a more  easily  con- 
trolled anti-coagulant  for  long  continued 
use  in  coronary  thrombosis.  Much  wider 
experience  in  its  use  is  required  before 
heparin  in  Pitkin’s  menstruum  will  replace 
dicumarol.  The  antidote  for  heparin  is 
protamine.  Multiple  transfusions  of  fresh 
blood  are  likewise  efficacious. 

The  diet  of  a patient  subsequent  to  coron- 
ary thrombosis  requires  especial  attention. 
Early,  especially  if  the  stomach  be  unre- 
tentive,  parenteral  fluids  should  be  ad- 
administered.  To  avoid  the  risk  of  right 
heart  embarrassment,  isotonic  solution  of 
glucose  is  preferred.  Five  hundred  cubic 
centimeters  of  5 per  cent  glucose  may  be 
given  slowly  by  the  intravenous  route  three 
times  a day.  Although  the  caloric  value  of 
this  nutrient  source  is  small,  it  represents 
rapidly  available  energy  for  the  lamed  myo- 
cardium. Food  by  mouth  should  be  offered 


30 


Rocky  Mountain  Medical  Journal 


in  small  quantities,  preferably  in  five  small 
rather  than  the  customary  three  average 
meals.  To  observe  the  above  implied  indica- 
tion an  adequate  carbohydrate  intake 
should  be  especially  preserved.  Should 
edema  be  a presenting  manifestation,  low 
sodium  intake  will  become  a prime  indica- 
tion. The  patient  on  low  sodium  may  take 
fluids  as  he  desires.  Mercurial  diuretics 
with  or  without  preparatory  ammonium 
chloride  may  later  be  required. 

Although  most  of  the  contraindications  to 
digitalis  are  theoretical,  it  should  be  re- 
served for  frank  or  impending  decompensa- 
tion. Rarely  will  these  indications  require 
rapid  digitalization.  As  a rule  the  course 
may  be  planned  with  a three-day  objective 
of  therapeutic  action.  Cardiac  arrhythmias 
are  potential  sources  of  serious  danger  in 
coronary  thrombosis.  Nevertheless  the  pro- 
phylactic use  of  quinidine  has  not  seemed 
justified.  A small  minority  of  these  pa- 
tients experience  such  faults  of  conduction 
and  the  action  of  quinidine  is  so  rapid  (10 
to  15  minutes  by  the  oral  route)  that  little 
added  hazard  exists  in  its  deferment  until 
the  development  of  the  arrhythmia.  A fixed 
formula  for  its  administration  has  proved 
especially  useful.  Bearing  in  mind  the  fact 
that  the  action  of  quinidine  is  exerted  for 
only  two  hours,  the  pattern  is: 

a.  Quinidine  sulfate  130  mgm.  (2  grains) ; 
repeated  in  two  hours  as  a test  for  quinine 
idiosyncrasy,  b.  Quinidine  sulfate  260  mgm. 
(4  grains)  every  two  hours  day  and  night 
for  thirty-six  hours,  or  until  the  normal 
sinus  rhythm  is  restored,  if  it  be  before  that 
period.  Experience  has  proved  that  con- 
tinuance of  these  doses  beyond  thirty-six 
hours  is  usually  unavailing,  c.  Maintenance 
levels  are  established  first  by  reducing  the 
individual  dose  and  then  by  lengthening  the 
interval.  Usually  complete  withdrawal  is 
possible;  but  a gradual  reduction  after  the 
suggested  plan  makes  it  possible  to  retrace 
one  step  at  a time  rather  than  to  repeat  the 
entire  course  of  quinidine  in  event  of  an 
escape  from  therapeutic  control. 

Surgery  has  made  material  contributions 
to  the  treatment  of  coronary  disease.  In 
general  most  of  the  surgical  procedures 


coronary  circulation  through  new  pericar- 
dial sources.  Thorel  established  the  exist- 
have  evolved  from  attempts  to  improve  the 
ence  of  fresh  blood  supply  in  pericardial 
adhesions.  Beck  pursued  this  approach  by 
suturing  the  pectoralis  major  to  the  epi- 
cardium.  O’Shaughnessy  brought  the  omen- 
tum through  the  diaphragm  for  the  same 
purpose.  Subsequent  suggestions  have  in- 
cluded a series  of  measures  to  create  arti- 
ficial synechiae  between  the  layers  of  the 
pericardium.  Divergent  from  this  plan  have 
been  Fauteux’s  direct  attacks  upon  the 
coronary  system.  By  the  application  of  the 
Leriche  principle  of  periarterial  sympathec- 
tomy to  the  coronary  artery  and  simulta- 
neous ligation  of  the  great  cardiac  vein  he 
has  shown  a distinct  circulatory  advantage 
to  the  myocardium  of  experimental  ani- 
mals. Carried  over  into  clinical  experience 
the  results  have  been  promising;  but  a much 
wider  application  of  the  method  will  be  re- 
quired to  establish  its  place  in  practice. 
Most  recently  Vineberg  and  Jewett  have 
suggested  transplantation  of  the  internal 
mammary  artery  into  the  wall  of  the  left 
ventricle  for  the  purpose  of  improving  its 
nutrition.  These  experimental  studies  have 
not  yet  been  supported  by  clinical  trial,  but 
new  vascular  channels  have  appeared  in  the 
myocardium  of  dogs  after  the  transplant. 
Attempts  to  transfer  the  prospects  of  any 
operative  procedure  from  the  experimental 
animal  to  the  human  subject  with  coronary 
disease  must  always  take  into  account  the 
usual  widespread  vascular  handicap  in  the 
latter.  Until  it  is  possible  to  duplicate  this 
condition  in  animals  and  from  that  baseline 
to  induce  coronary  occlusion,  the  clinical 
projection  and  application  of  experimental 
studies  will  be  presumptive  and  the  results 
relatively  fortuitous. 

The  convalescence  from  a coronary  acci- 
dent is  frequently  tedious.  Recognizing 
every  grade  of  myocardial  handicap,  minor 
episodes  admittedly  escape  notice  or  pro- 
gress to  an  uneventful  convalescence  with- 
out unusual  protection.  On  the  other  hand, 
serious  degrees  of  disability  to  fatality  may 
succeed  initially  inconsequential  manifesta- 
tions. The  prognosis  of  coronary  thrombo- 


jor  January,  1949 


31 


sis  is  beset  by  many  pitfalls.  Accordingly- 
conservatism  is  the  best  policy.  Physical 
rest  in  bed  must  be  enjoined  for  six  weeks 
in  the  average  subject.  Compromises  in  the 
reduction  of  this  period  may  be  made  in 
the  victims  of  lesser  attacks  under  carefully 
controlled  conditions.  Conversely,  a certain 
number  with  severe  reactions  must  remain 
in  bed  for  several  months  to  insure  the  es- 
tablishment of  a maximal  collateral  circu- 
lation and  myocardial  reserve.  Physical  in- 
activity can  be  carried  to  inordinate  ex- 
tremes. The  period  of  recuperation  may  be 
reached  when  carefully  graduated  exercise 
becomes  the  key  to  more  adequate  myocar- 
dial recovery.  Mental  rest  must  likewise 
be  insured.  Detachment  from  business  and 
family  cares  is  essential.  Tobacco  in  all 
forms  must  be  eschewed  by  reason  of  its 
vasoconstrictor  influence.  Although  this  ef- 
fect is  much  more  profound  in  some  indi- 
viduals than  in  others,  it  is  the  safest  plan 
to  generalize.  Alcohol,  tea,  and  coffee  have 
a vasodilator  effect  and  may  be  used  in 
moderation.  With  freedom  from  symptoms 


of  coronary  insufficiency  and  an  improve- 
ment in  myocardial  reserve  will  come  in- 
creasing ' interest  in  mental  and  physical 
outlets.  This  period  carries  a grave  re- 
sponsibility for  the  physician.  Whereas  up 
to  this  point  the  patient  has  been  pro- 
tected from  a real  knowledge  of  the  exact 
conditions,  now  the  physician  must  make 
him  a partner  in  the  ultimate  plan  of  cam- 
paign. The  anatomic,  physiologic,  and 
pathologic  factors  in  the  situation  are  out- 
lined in  principle.  The  coronary  handicap 
is  cited,  usually  somewhat  on  the  optimis- 
tic side.  The  myocardial  reserve  is  dis- 
cussed as  an  element  which  may  be  spent 
extravagantly  or  protected  by  judicious  liv- 
ing. Always  the  patient  must  be  informed 
of  the  penalty  of  probable  invalidism  inci- 
dent to  wasteful  expenditure  of  this  reserve. 
Conversely,  the  prospect  of  years  of  com- 
fortable useful  living  under  careful  control 
should  leave  no  doubt  in  his  mind  as  to  the 
physician’s  position;  but  such  conferences 
must  be  sympathetically  realistic.  As  Long- 
cope  said,  “Why  ward  off  death  if  in  the 
attempt  we  kill  living?” 


HEMOCHROMATOSIS  WITH  APLASTIC  OR  REFRACTORY 

ANEMIA* 

EUGENE  HILDEBRAND,  M.D.,  F.  H.  CRAGO,  M.D.,  and  JOHN  A.  LAYNE,  M.D. 

GREAT  FALLS,  MONTANA 


Severe  anemia  is  an  uncommon  finding  in 
hemochromatosis.  However,  six  cases  of 
aplastic  or  refractory  anemia  accompanying 
hemochromatosis  have  been  reported’  - ^ 
Dive  of  these  six  cases  had  a cellular  bone 
marrow,  of  the  type  sometimes  referred  to 
as  “pseudoplastic  anemia.”  We  are  report- 
ing this  case  in  order  to  add  one  more  to 
the  previously  reported  five  cases  with  a 
cellular  bone  marrow,  and  also  for  the  pur- 
pose of  recalling  Mallory’s  views  about  the 
role  of  copper  poisoning  in  the  etiology  of 
hemochromatosis. 

REPORT  OF  CASE 

History:  C.  N.,  a 50-year-old  male,  was  first 
seen  by  Dr.  F.  R.  Schemm  in  June,  1944,  because 
of  weakness  of  a degree  which  interfered  with 

♦Presented  in  part  before  the  Mid-Western  Sec- 
tion of  the  American  Federation  for  Clinical  Re- 
search, in  Chicago,  on  October  30,  1947.  From  the 
Departments  of  Medicine  and  Pathology,  Great  Falls 
Clinic,  Great  Falls,  Montana. 


his  occupation.  He  had  been  treated  elsewhere 
during  the  preceding  eight  months  because  of 
anemia,  receiving  ferrous  sulfate  orally  and  liver 
extract  intramuscularly.  His  previous  health  had 
been  good.  His  mother  died  in  1919  of  what  was 
diagnosed  as  pernicious  anemia. 

He  had  been  employed  continuously  in  a copper 
refinery  for  twenty-five  years,  working  in  the 
electrolytic  department  where  he  handled  sheets 
of  copper  wet  from  the  vats.  His  gloves  were 
quickly  worn  through,  and  his  underwear  and 
the  skin  of  his  body  would  be  stained  with  green 
copper  salts. 

Physical  examination  in  June,  1944,  revealed  a 
mild  pallor  of  the  skin  and  mucous  membranes. 
The  skin  was  soft  and  of  a feminine  type,  and 
there  was  no  pigmentation.  There  was  a paucity 
of  body  hair;  he  shaved  about  twice  a week. 
Pubic  hair  distribution  was  of  the  ferninine  type. 
The  testes  were  small  and  the  genitalia  were 
poorly  developed.  Blood  pressure  was  130  milli- 
meters of  mercury  systolic  and  90  millimeters 
diastolic.  There  was  no  demonstrable  enlarge- 
ment of  liver,  spleen  or  lymph  nodes. 

Laboratory  data:  Urinalysis  was  normal.  Hemo- 
globin was  13.4  grams  per  100  c.c.,  erythrocyte 
count  4,220,000,  leukocyte  count  5,800,  with  a 
differential  count  of  55  per  cent  polymorphonu- 


32 


Rocky  Mountain  Medical  Journal 


clear  neutrophiles,  4.4  per  cent  lymphocytes,  and 
1 per  cent  basophiles.  There  was  slight  anisocy- 
tosis  of  the  erythrocytes.  The  reticulocyte  per- 
centage, was  1.1.  Platelet  count  was  130,000. 
Gastric  analysis  was  performed  on  several  oc- 
casions and  free  hydrochloric  acid  was  never 
found  to  be  present  in  the  gastric  secretion,  even 
following  histamine.  Roentgen  examination  of 
the  stomach,  small  intestines,  and  colon  was  per- 
formed on  three  occasions  during  the  next  two 
and  one-half  years,  and  was  always  normal, 
except  for  the  presence  of  a few  small  diverticuli 
in  the  lower  ileum.  Roentgenographic  examina- 
tion of  the  skull  was  normal.  Electrocardiogram 
was  normal. 

Clinical  course:  Initial  diagnosis  was  deferred 
and  the  patient  was  treated  symptomatically 
with  45  drops  of  diluted  HCl  (USP),  and  1.0 
gram  of  ferrous  sulfate  a day.  He  received  only 
these  medications  during  the  next  fifteen  months, 
until  September,  1945,  at  which  time  his  hemo- 
globin was  12.9  grams,  erythrocyte  count  3,900,- 
000,  and  his  leukocyte  count  6,400,  with  a normal 
differential  (see  Table  I).  Since  this  represented 
an  essentially  unchanged  hemogram  from  that  of 
fifteen  months  previously,  it  was  decided  to  de- 
termine the  effect  of  large  doses  of  liver  extract. 
He  received  300  units  of  liver  extract  administered 
intramuscularly  in  a period  of  twelve  days.  One 
week  later  his  hemoglobin  was  11.7  grams, 
erythrocyte  count  3,540,000,  leukoycte  count  3,650, 
of  which  47  per  cent  were  polymorphonuclears, 
46  per  cent  lymphocytes,  4 per  cent  monocytes,  1 
per  cent  eosinophiles,  and  2 per  cent  basophiles. 
Platelet  count  was  178,000.  This  reticulocyte 
percentage  was  0.8.  The  clotting  time  was 
4 minutes  and  45  seconds.  The  bleeding  time 
was  16  minutes.  There  was  complete  lack  of 
clot  retraction  in  forty-eight  hours.  Coincident 
or  subsequent  to  the  oral  administration  of 
ascorbic  acid,  vitamin  K,  and  calcium,  his  bleed- 
ing time  and  clot  retraction  returned  to  normal, 
and  remained  essentially  normal  thereafter. 

The  patient  had  first  complained  of  some 
paresthesias  and  numbness  of  the  hands  in  Au- 
ugust,  1945,  prior  to  the  period  in  which  he  re- 
ceived intensive  liver  therapy.  Neurologic  ex- 
amination was  otherwise  normal,  and  the  par- 
esthesias did  not  improve  following  the  liver 
extract. 

In  August,  1946,  he  wa^.  admitted  to  the  hos- 
pital for  further  study,  as  the  diagnosis  of  pri- 


mary splenic  neutropenia  was  being  considered. 
Again,  the  patient’s  chief  complaint  was  weakness, 
and  his  physical  examination  was  essentially  un- 
changed from  that  of  twenty-seven  months  ear- 
lier. Urinalysis  was  again  normal.  During  the 
eleven  months  from  September,  1945,  to  August, 
1946,  the  patient’s  hemoglobin  had  decreased 
gradually  to  9.3  grams  per  100  c.c.,  but  his 
erythrocyte  count  remained  at  about  3.9  millions. 
His  leukocyte  count  decreased  to  1,800,  of  which 
only  36  per  cent  were  granulocytes.  Examination 
of  the  peripheral  blood  smears  revealed  hypo- 
cromia  of  the  erythrocytes,  polychromasia.  Jolly 
bodies,  and  occasional  stippling.  Bone  marrow 
biopsy  showed  that  erythopoiesis  was  perhaps 
somewhat  increased  and  that  granulopoiesis  was 
quite  active.  Neither  occult  blood  nor  ova  were 
present  in  the  feces.  Bromsulfalein  test  of  liver 
function  was  normal.  Only  a trace  of  urobilino- 
gen was  present  in  a 24-hour  collection  of  urine. 

Splenectomy  was  decided  upon  in  the  hope  that 
the  granulopenia  of  the  peripheral  blood  and  the 
anemia  might  be  due  to  abnormal  function  of 
that  organ.  The  patient  elected  to  have  this 
surgery  performed  at  the  Mayo  Clinic,  where 
all  of  the  above  mentioned  diagnostic  studies 
were  repeated  under  the  direction  of  Dr.  Byron 
E.  Hall  with  similar  results.  The  splenectomy 
was  performed  on  September  6,  1946.  The 
spleen  weighed  155  grams.  No  accessory  spleen 
was  found.  Careful  exploratory  examination  of 
the  other  abdominal  organs  revealed  no  abnor- 
mality. Microscopically,  a diffuse  hemosiderosis 
of  the  spleen  was  present  (Fig.  1). 

There  was  no  change  in  the  level  of  the 
patient’s  hemoglobin,  or  his  leukocyte  count  after 
operation,  and  the  granulopenia  persisted.  There 
was  an  excretion  of  44  milligrams  of  unrobilino- 
gen  per  day  in  the  feces  over  a four-day  period, 
indicating  that  hemolysis  was  not  a factor  in  the 
production  of  the  anemia. 

A review  of  the  patient’s  course  up  to  this 
time,  therefore,  led  to  the  following  conclusions: 
!.  although  occasional  macrocytes  had  been  ob- 
served in  smears  of  the  peripheral  blood,  the 
normal  urobilinogen  studies  and  the  low  normal 
reticulocyte  counts  would  exclude  an  hemolytic 
anemia;  2.  morphologic  studies  of  the  bone  mar- 
row and  failure  to  respond  to  large  doses  of 
liver  extract  administered  intramuscularly  had 
excluded  pernicious  anemia;  3.  the  persistence 
of  the  neutropenia  and  anemia  following  sple- 


TABLE  I 

Summary  of  Hematologic  Data  During  Last  32  Months  of  Patient’s  Life. 


Hemoglobin 

Erythrocyte 

Percentage 

Total 

Percentage 

Grams  per 

count  in 

reticulated 

leukocyte 

of 

Date 

100  c.c. 

millions 

erythrocytes 

count 

granulocytes 

June  1,  1944 

13.4 

4.2 

1.1 

5,800 

55 

September  19,  1945^ 

12.9 

3.9 

6,400 

72 

October  8 ,1945^ 

11.7 

3.5 

6.8 

3,650 

47 

August  30,  1946^ 

9.3 

3.9 

0.6 

1,800 

36 

October  7,  1946^ 

7.4 

3.4 

0.5 

3,400 

27 

November  21,  1946 

6.5 

3.3 

0.4 

3,300 

17 

Januarv  20,  1947 

3.5 

1.19 

2.3 

6,500 

12 

’^During  the  preceding  fifteen  months  the  patient  had  received  only  l.()  gram  of  ferrous  sulfate  daily; 
no  liver  extract  was  administered  in  this  fifteen  month  period. 

“This  was  on©  week  after  the  patient  had  received  300  units  of  liver  extract  intramuscularly  in  a 
period  of  twelve  days. 

“Immediately  preceding  splenectomy. 

‘‘Four  weeks  after  splenectomy. 


for  January,  1949 


33 


FIG.  1.  Section  of  spleen  removed  fifteen  months 
before  death.  A diffuse  hemosiderosis  is  present 
(X  100). 


nectomy  was  additional  evidence  tending  to  ex- 
clude the  case  as  being  one  of  the  primary 
splenic  neutropenia;  4.  the  hemosiderosis  found 
in  the  spleen  now  appeared  to  be  very  im- 
portant, and  the  diagnosis  of  hemochromatosis 
was  entertained  for  the  first  time. 

Oral  gluecose  tolerance  test  (the  patient 
weighed  143  pounds  and  100  grams  of  glucose 
were  used)  was  performed  on  November  4,  1946, 
with  the  following  results: 

Glycosuria 

Fasting  sugar  100  mgm.  per  100  c.c 0 

30  min.  after  glucose  208  mgm.  per  100  c.c 0 

00  min.  after  glucose  228  mgm.  per  100  c.c 0 

120  min.  after  glucose  216  mgm.  per  100  c.c 0 

180  min.  after  glucose  188  mgm.  per  100  c.c 0 

The  patient  was  again  given  large  doses  of 
liver  extract  intramuscularly,  and  iron  and  folic 
acid  orally.  Daily  urobilinogen  excretion  in  the 
feces  (for  a four-day  period)  was  125.4  milli- 
grams per  day.  There  was  but  a trace  of  urobi- 
linogen in  a 24-hour  collection  of  urine.  The 
percentage  of  reticulated  erythocytes  varied 
from  0.4  to  1.1.  Serum  calcium  was  9.6  milli- 
grams per  100  c.c.  The  patient  became  progres- 
sively weaker,  and  two  homologous  blood  trans- 
fusion of  500  c.c.  each  were  given.  These  were 
the  only  transfusions  which  he  received.  Epistaxis 
occurred  more  frequently.  In  spite  of  supportive 
treatment,  the  hemoglobin  dropped  to  3.5  grams, 
the  erythrocyte  count  to  1.2  millions,  and  the 
granulocytes  to  12  per  cent.  He  gradually  be- 
came weaker  and  died  on  Januay  31,  1947. 

Necropsy  examination:  Orily  the  positive  find- 
ings will  be  recorded.  The  liver  weighed  1,900 
grams.  The  consistency  was  very  slighly  in- 
creased and  its  cut  surface  was  brown  in  color. 
About  half  of  the  pancreas  appeared  to  be  re- 
placed by  adipose  tissue,  but  otherwise  it  ap- 
peared normal.  The  bone  marrow  of  the  lumbar 


vertebrae  was  light  red  in  color  and  appeared 
to  be  fairly  abundant.  The  rib  and  sternal  mar- 
row was  red  in  color,  but  appeared  sparse  in 
amount. 

Microscopic  examination:  Liver.  The  liver 
cells  all  contained  a small  amount  of  brown 
pigment  uniformly  distributed  throughout  the 
liver  substance  without  regard  to  the  lobules 
(Fig.  2).  The  pigment  granules  varied  some- 
what in  size  and  shape,  but  for  the  most  part 
they  were  small.  The  granules  stained  blue 
with  the  Prussian  Blue  reaction.  There  was 
slight  atrophy  of  the  liver  cords  in  the  mid- 
portion of  the  lobules.  Moderate  numbers  of 
lymphocytes  and  large  monuclear  cells  were 
found  in  the  fibrous  tissue  of  the  triads.  A small 
amount  of  pigment  was  found  in  macrophages 
in  the  triads. 


FIG.  2.  Section  of  liver  obtained  at  necropsy.  Iron- 
staining  pigment  was  uniformly  distributed 
throughout  the  liver  substance  (x  430). 


Pancreas:  The  secretory  elements  showed  no 
change.  The  islets  showed  no  evidence  of  de- 
generation or  of  fibrous  tissue  replacement.  No 
evidence  of  pigmentation  was  found  in  the 
pancreas. 

Skin:  The  basal  layers  of  the  epidermis  con- 
tained finely  divided  brown  pigment,  but  did 
not  exceed  that  normally  found.  The  pigment 
appeared  to  be  limited  to  the  basal  cells. 

Bone  marrow:  The  sternal  marrow  was  very 
cellular.  There  was  a marked  reduction  in  the 
erythrocytic  series,  and  progenitors  of  the  gran- 
ulocytic series  were  also  decreased  in  number. 
Many  plasma  cells  were  present.  Large  num- 
bers of  promyelocytes  and  large  mononuclear 
cells  were  seen.  The  megakaryocytes  appeared 
normal.  No  evidence  of  pigmentation  was  seen. 
No  difference  was  noted  in  the  marrow  of  the 
ribs  and  the  vertebrae. 

The  microscopic  appearance  of  the  spleen, 


34 


Rocky  Mountain  Medical  Journal 


which  was  removed  at  operation,  has  been  de- 
scribed above. 

Pigment  granules  which  stained  blue  with 
the  iron  stain  were  found  in  mucosal  cells  of  the 
gastrointestinal  iract,  in  the  stratum  granulo- 
sum  of  the  adrenals,  and  in  most  of  the  sections 
taken  from  the  brain. 

Pituitary:  No  abnormality  was  noted,  and  no 
pigmentation  was  seen. 

Testes:  There  was  moderately  active  sperma- 
togenesis of  the  left  testicle;  the  interstitial  cells 
were  somewhat  reduced  in  number.  There  was 
marked  atrophy  of  the  right  testicle  and  only 
a few  inters atial  cells  remained.  There  was  no 
evidence  of  pigmentation  of  any  of  the  cells. 

Discussion 

Hemochromatosis  is  usually  characterized 
by  the  triad  of  bronzing  pigmentation  of 
the  skin,  cirrhosis  of  the  liver,  and  diabetes 
mellitus.  Pigmentation  of  the  skin,  although 
not  always  present,  may  be  an  early  sign. 
The  cirrhosis  is  usually  associated  with  an 
enlarged,  firm  liver,  ascites  and/or  jaun- 
dice. The  diabetes  varies  in  severity  from 
mild  to  marked. 

It  would  appear  that  there  are  two  clini- 
cal types  of  hemochromatosis.  The  first  type 
is  represented  by  the  classical  form  of  the 
disease  in  which  the  visceral  symptoms  and 
signs  depend  upon  the  extent  of  fibrous 
tissue  reaction  in  the  various  organs. 
Anemia  is  not  marked,  as  the  patients  in 
this  group  are  capable  of  utilizing  iron  in 
the  formation  of  hemoglobin.  The  second 
type  is  represented  by  those  patients  who 
present  certain  or  all  of  the  above  char- 
acteristic features,  and  in  addition,  develop 
an  inability  to  utilize  iron  properly  in  the 
formation  of  hemoglobin.  In  this  latter 
group  of  patients,  the  iron  derived  from  the 
destruction  of  intrinsic  and  transfused  blood 
I is  not  used  again  to  form  hemoglobin,  but, 
as  the  result  of  a disturbance  of  metabolism 
as  yet  not  understood,  it  is  deposited  in  the 
various  organs  including  the  bone  marrow®. 
! In  them,  we  encounter  the  paradox  of  a 
j patient  having  a cellular  bone  marrow,  a 
large  excess  of  iron  in  the  body,  and  yet 
j progressively  falling  levels  of  hemoglobin 
I and  erythrocytes  in  the  peripheral  blood. 

In  our  patient,  symptoms  referable  to 
I anemia  were  his  presenting  complaint;  pig- 
j mentation  of  the  skin  never  developed,  and 
although  the  glucose  tolerance  curve  was 
elevated,  glycosuria  was  never  demon- 
. strated.  Chesner®  has  recorded  a similar 


case  (although  in  a 14-year-old  boy)  with- 
out pigmentation  or  diabetes  in  whom  the 
presence  of  anemia  preceded  the  onset  of 
all  other  symptoms  by  approximately  six 
years.  Sheldon^  and  others  have  observed 
no  evidence  of  increased  hemolysis  in  pa- 
tients with  hemochromatosis  and  our  find- 
ings of  normal  urobilinogen  excretion  in 
urine  and  feces  are  in  accord  with  this 
concept. 

As  Herbut  and  his  associates®  ® have 
pointed  out,  it  is  increasingly  evident  that 
there  are  many  combinations  and  various 
degrees  of  fibrosis  and  pigmentation  of  the 
liver  and  pancreas,  with  and  without  dia- 
betes, and  that  the  relationship  between 
cirrhosis,  diabetes  and  hemochromatosis  is 
more  than  casual.  It  is  the  opinion  of  these 
investigators  that  alloxan  or  an  allied  sub- 
stance causes  necrosis  of  the  periportal 
hepatic  tissue  and  islets  of  Langerhans,  re- 
sulting in  cirrhosis  of  the  liver  and  diabetes, 
and  that  abnormal  retention  of  iron  (wheth- 
er derived  endogenously  or  exogenously) 
results  in  hemosiderosis. 

The  possible  relationship  between  pro- 
longed exposure  to  copper  and  the  metabol- 
ism of  iron  is  interesting.  ' While  Mallory’s^® 
conclusions  as  to  the  importance  of  copper 
poisoning  in  the  production  of  hemochro- 
matosis are  not  universally  accepted,  our 
case  inclines  us  to  speculate  with  Mallory 
about  the  role  of  copper  in  certain  cases  at 
least.  Insofar  as  we  can  determine,  no 
comprehensive  study  has  been  made  of  the 
incidence  of  hemochromatosis  in  workers 
exposed  to  absorbable  copper.  It  would 
only  be  possible  to  conduct  such  a study 
on  a long  range  basis  over  many  years. 
The  co-workers  of  our  patient  in  the  de- 
partment where  exposure  was  extreme  had 
rarely  worked  more  than  a year  or  two 
there,  and  the  few  who  had  worked  five 
to  ten  years  or  more  were  not  traceable. 

Conclusions 

1.  An  additional  case  of  hemochromatosis 
associated  with  refractory  anemia  and  cellu- 
lar bone  marrow  is  reported,  furthering  the 
concept  that  there  are  two  clinical  types 
of  this  disease. 

2.  The  urobilinogen  excretion  in  the  urine 


for  January,  1949 


35 


and  feces  of  this  patient  revealed  no  evi- 
dence of  increased  hemolysis. 

3.  The  question  of  the  role  of  copper  poi- 
soning as  an  etiological  factor  in  hemochro- 
matosis appears  in  this  case. 


REFERENCES 

^Kark,  R.  M. : Two  Cases  of  Aplastic  Anemia.  Guy’s 
Hosp.  Reports,  87:343,  July,  1937. 

“Mackey,  R. : An  Unusual  Case  of  Aplastic  Anemia 
With  Organ  Changes  Re.sembling  Hemochromatosis. 
Med  J.  Australia,  1:172,  Feb.  7,  1942. 

“Bomford,  R.  R.,  and  Rhoads,  C.  P. : Refractory 
Anemia.  Quart.  J.  Med.,  10:175,  July,  1941. 

^Zeltmacher,  K.,  and  Bevans,  M. : Aplastic  Anemia 


and  Its  Association  With  Hemochromatosis.  Arch. 
Int.  Med.,  75:395,  June,  1945. 

“Rath,  C.  E.,  and  Pinch,  C.  A.:  Sternal  Marrow 
Hemosiderin.  A Method  for  the  Determination  of 
Available  Iron  Stores  in  Man.  J.  Lab.  and  Clin. 
Med.,  33:81,  Jan.,  1948. 

“Chesner,  C. : Hemochromatosis.  Review  of  Liter- 
ature and  Presentation  of  a Case  Without  Pigmenta- 
tion or  Diabetes.  J.  Lab.  and  Clin.  Med.,  31:1029, 
Sept.,  1946. 

’Sheldon,  J.  H. : Haemochroinatosis.  London.  Ox- 
ford Medical  Press,  1935. 

“Herbut,  P.  A.,  Watson,  J.  S.,  and  Parsons,  E. : 
Alloxan  in  Experimental  Hemochromatosis.  Am.  J. 
Clin.  Path.,  16:506,  Aug.,  1946. 

“Herbut,  P.  A.,  and  Tamaki,  H.  T.:  Cirrhosis  of 
the  Liver  and  Diabetes  as  Related  to  Hemochroma- 
tosis. Am.  J.  Clin.  Path.,  16:506,  Oct.,  1946. 

’“Mallory,  P.  B. : The  Relation  of  Chronic  Poison- 
ing With  Copper  to  Hemochromatosis.  Am.  J.  Path., 
1:117,  Jan.,  1925. 


INVERSION  OF  THE  UTERUS* 

WITH  REPORT  OF  CASE 
RAYMOND  MUNDT,  M.D. 

CROWNPOINT,  NEW  MEXICO 


Postpartum  inversion  of  the  uterus  may 
be  intra-uterine  or  incomplete,  when  the 
fundus  does  not  pass  the  cervix;  intra- 
vaginal,  incomplete  or  complete,  when  the 
uterus  remains  in  the  vaginal  canal;  extra- 
vaginal,  and  complete,  when  the  inverted 
organ  prolapses  outside  the  introitus. 

Frequency 

Stated  variously  by  different  authors:  Mc- 
Cullough, one  to  30,000  deliveries;  Dublin 
Rotunda  Hospital,  one  to  160,000;  while 
Stander  reports  one  to  4,000  at  New  York 
Lying-in  Hospital. 

Etiology 

Marked  laxity  of  the  uterine  walls  and 
probably  thinness,  especially  of  the  pla- 
cental site,  increased  intra-abdominal  pres- 
sure or  too  vigorous  Crede’s  maneuver, 
traction  upon  the  umbilical  cord,  are  all 
factors.  Vogel  believes  that  most  cases  are 
due  to  the  violence,  as  the  great  majority 
occur  outside  the  hospital.  Harer  and 
Sharkey  found  that  76  per  cent  were  due 
to  faulty  technic.  The  complication  may 
follow  abortion,  but  most  cases  follow  full 
term  delivery.  Stander  found  the  majority 
in  multiparae,  while  Vogel  recorded  more 
than  50  per  cent  in  primiparae. 

Symptoms 

Shock  and  threatened  collapse  are  usual, 
but  the  symptoms  may  be  slight  and  the 

’Opinions  expressed  in  this  article  are  those  of 
the  author  and  do  not  constitute  official  statements 
of  the  Office  of  Indian  Affairs,  U.  S.  Department  of 
the  Interior.  The  author  is  Senior  Physician  at 
the  Eastern  Navajo  Hospital. 


condition  discovered  only  at  subsequent 
examination. 

Diagnosis 

Abdominal  palpation  reveals  the  absence 
of  the  fundus,  vaginal  examination  reveals 
a mass  in  the  vagina  if  the  inversion  is 
more  than  intra-uterine.  Prolapsed  extra- 
vaginal  inversion  is,  of  course,  quite  ob- 
vious. 

Treatment 

DeLee  and  Stander  recommend  manual 
reposition  if  the  case  is  seen  soon  after  the 
onset.  If  the  placenta  is  still  attached, 
Stander  recommends  that  it  be  left  until  re- 
placement is  completed.  Spinelli  devised 
an  operation  in  which  the  anterior  cul-de- 
sac  is  opened,  the  uterus  split  virtually 
through  its  anterior  surface,  reverted  and 
satured.  DeLee  advised  vaginal  packing, 
also  the  colpeurynter,  in  resistant  cases. 
Huntingtin,  et  al.,  opened  the  abdomen 
and  pulled  the  fundus  up  with  Allis  clamps; 
Haultain,  after  opening  the  abdomen,  in- 
cised the  cervical  ring  posteriorly  and 
pushed  the  fundus  from  below.  Norton 
believes  that  vaginal  hysterectomy  is  the 
treatment  of  choice  in  cases  of  complete 
inversion  and  devised  an  ingenious  method 
for  the  control  of  hemorrhage.  He  used 
a tonsil  snare  with  rubber  covered  wire 
about  the  neck  of  the  uterus. 

■ f 

Prognosis 

If  the  case  is  seen  early,  modern  methods 
of  treatment  should  nullify  mortality. 


36 


Rocky  Mountain  Medical  Journal 


Zangemeister,  quoted  by  DeLee,  gave  the 
mortality  as  23  per  cent  in  1913.  Stander 
in  1940  reported  a mortality  of  zero  in 
eight  cases  at  New  York  Lying-in  Hospital. 
I.  S.  Clarkson,  Jr.,  in  1945  summarized  the 
mortality  statistics. 

CASE  REPORT 

Mrs.  A.  T.,  aged  20,  was  admitted  December  8, 
1947,  with  the  chief  complaint  of  being  unable  to 
void  since  delivery  of  her  first  child  in  the  hogan 
three  days  previously.  There  had  been  no  medi- 
cal or  nursing  care;  it  is  probable  that  she  was 
attended  by  a native  “Medicine  Man”  who  may 
have  made  pressure  on  the  abdomen  and  trac- 
tion on  the  umbilical  cord  to  deliver  the  pla- 
centa. As  she  understood  no  English,  it  was 
impossible  to  learn  whether  or  not  the  third 
stage  was  completed. 

Physical  examination  revealed  a well  de- 
veloped, well  nournshed  Navajo  primipara,  ap- 
pearing to  be  in  moderate  shock.  The  skin  and 
mucosae  were  pale,  the  supra-pubic  region  was 
distended  and  tender,  bloody  lochia  was  present. 
Attempts  at  voiding  caused  the  appearance  of 
a raw  red  mass  at  the  vaginal  orifice.  She  was 
catheterized  and  1,950  c.c.  of  cloudy  urine  ob- 
tained. This  was  normal  except  for  hyaline  and 
granular  casts.  After  perineal  preparation,  the 
mass  was  palpated  with  the  gloved  hand  and 
found  to  be  the  uterus,  completely  inverted. 

The  blood  pressure  was  110/60;  temperature, 
98.6F.;  pulse,  84;  respiration,  20.  The  blood  count 
was:  R.B.C.  2,040,000;  hemoglobin,  50  per  cent 
(Dare);  W.B.C.,  24,650;  segs.,  88;  juveniles,  1; 
stabs,  2;  s.  lymphs,  7;  Monocytes  1,  blood  type  0. 
The  vaginal  smear  was  positive  for  Gonoccoccus. 
The  Wasserman  report  as  negative  was  received 
later. 

Treatment  and  Course:  Penicillin  20,000  units 
i.m.  three  hourly  was  given  for  nine  days.  This 
was  increased  to  40,000  units  on  three  postopera- 
tive days.  Crude  liver  extract  2 c.c.  i.m.  was 
given  for  ten  days.  Ferrous  sulfate  18  grains 
daily  was  given  for  four  days  and  9 grains 
daily  for  ten  days.  Demerol  100  mg.  per  hypo 
was  given  on  admission  and  on  the  third  and 
fourth  hospital  days  for  pain.  Sulfamerazine  and 
sodium  bicarbonate  in  full  dosage  was  given  for 
three  days  preoperatively  and  nine  days  post- 
operatively.  Blood  plasma  500  c.c.  intravenously 
was  given  on  the  day  of  admission,  500  c.c.  whole 
blood  was  given  two  days  preoperatively,  300  c.c. 
one  day  preoperatively.  During  operation  500 
c.c.  10  per  cent  dextrose  in  water,  500  c.c.  normal 
saline,  300  c.c.  whole  blood  and  250  c.c.  plasma 
were  given.  Postoperatively  500  c.c.  plasma, 
1,000  c.c.  whole  blood  and  1,000  c.c.  5 per  cent 
dextrose  in  normal  saline  were  given.  A warm 
potassium  permanganate  vaginal  douche  was 
given  on  each  of  two  preoperative  days. 

Precperative  Course:  On  the  third  hospital 
day,  the  patient  voided  voluntarily;  catheteriza- 
tion was  required  up  to  that  time.  The  tempera- 
ture rose  to  99.8  F.  on  the  second  hospital  day, 
pulse  120,  respiration  24;  these  fell  to  normal 
on  the  third  hospital  day.  The  blood  pressure 
was  120/60  preoperatively  on  the  fourth  day; 
the  R.B.C.  was  3,650,000  with  hemoglobin  65 
per  cent  (Dare);  urinalysis  showed  a trace  of 
sugar  and  many  bacteria,  but  was  otherwise 
normal. 


Operation:  On  the  fourth  hospital  day,  a supra- 
cervical vaginal  hysterectomy  was  done  under 
spinal  anesthesia  with  novocaine  150  mg.  In 
order  to  prevent  any  mishap  with  the  intra- 
venous needle,  venesection  was  done  on  the  right 
arm  and  a cannula  inserted.  Fluid,  plasma  or 
blood  were  kept  running  during  the  operation. 

Findings:  The  uterus  of  large  puerperal  size, 
completely  inverted,  edematous  and  covered  with 
decidua  was  lying  in  the  vagina.  The  bladder 
Was  not  involved  in  the  inversion  as  tested  by 
soimding.  The  cervical  stump  was  friable  and 
hemorrhagic. 

Procedure:  The  uterus  was  delivered  with 

a tenaculum  and  a No.  12F  catheter  was  clamped 
about  the  neck.  The  uterus  was  incised  longi- 
tudinally, each  round  ligament  and  uterine  tube 
was  sature  ligated  with  chromic  gut,  cut  and 
allowed  to  retract.  The  area  of  each  uterine 
artery  was  suture  ligated  with  chromic  gut,  the 
ends  left  long  and  clamped.  The  uterus  was 
amputated  below  the  tourniquet,  the  edges  of 
the  stump  were  grasped  with  Allis  forceps  and 
the  tourniquet  removed,  the  edges  were  satured 
with  chromic  gut,  continuous,  bleeding  points 
inside  were  sature  ligated  with  the  same.  The 
stump  was  then  closed  with  chromic  gut  inter- 
rupted, and  frosted  with  sulfathiazole  crystals. 
Two  vaginal  packs  were  placed  in  the  posterior 
fornix  and  one  in  the  anterior,  extruding  ends 
were  caught  in  a sature  which  was  taped  to 
the  abdomen.  A pessar  catheter  was  placed  in 
the  bladder,  allowed  to  drain  and  clamped. 
Hemorrhage  during  operation,  moderate.  Shock, 
none. 

The  immediate  postoperative  condition  was 
good;  temperature,  99  F.;  pulse,  82;  blood  pres- 
sure, 110/70.  Intravenous  fluid,  plasma  and 
whole  blood  were  continued. 

Postoperative  Course:  The  first  postoperative 
day,  the  temperature  was  100.4  F.,  the  pulse  112, 
the  respiration  28,  the  blood  pressure  114/80. 
The  next  day  the  T.P.R.  dropped  to  normal 
and  subsequently  did  not  exceed  99.6  F.,  88  and 
24.  On  this  day  the  vaginal  packs  were  re- 
moved; there  was  a trickle  of  blood,  so  one 
fresh  pack  was  frosted  with  sulfathiazole  crystals 
and  inserted  into  the  fornices.  There  was  no 
evidence  of  infection.  Two  days  later,  this  pack 
v/as  removed  and  there  was  no  further  hemor- 
rhage. The  pessar  catheter  was  also  removed. 
On  the  fifth  and  sixth  days  the  patient  was 
assisted  to  the  bathroom  and  on  the  seventh  day, 
was  up  and  about  the  ward.  Vaginal  examina- 
tion the  ninth  day  showed  the  cervix  to  be  in 
place,  a mucoid  discharge  (negative  for  gonococ- 
cus) was  present.  The  patient  was  discharged 
in  good  condition  on  the  tenth  postoperative  day. 

Pathological  Report:  The  report  of  the  Na- 
tional Institute  of  Health  follows: 

Diagnosis:  Uterus  with  decidual  reaction. 

Gross:  The  specimen  received  is  a firm  piece 
of  yellow-white  homogenous  tissue  measuring 
3x3x2  cm.  One  surface  is  brownish  in  color. 

Microscopic:  The  sections  studied  consist  large- 
ly of  a pale  staining  edematous  myometrium, 
and  a surface  layer  of  blood  clot,  infarcted  tissue, 
and  blood  sinuses  with  intervening  decidual 
cells.  Among  the  latter  are  found  a number  of 
small  patches  of  syncitial  trophoblasts.  A few 
scattered  endometrial  glands  are  found.  The 
microscopic  appearance  does  not  differ  signifi- 
cantly from  that  ordinary  expected  postpartum. 


for  January,  1949 


37 


Comment 

This  case  was  in  a primipara  as  were 
more  than  50  per  cent  of  those  reported  by 
Vogel.  It  probably  followed  rough  handling 
as  reported  by  DeLee,  Stander,  et.  al.  The 
patient  was  in  partial  shock  as  noted  by 
these  authors.  Because  of  the  bladder  dis- 
tention, abdominal  palpation  did  not  im- 
mediately reveal  the  diagnosis,  but  vaginal 
examination  did. 

This  case  would  be  classed  as  a complete 
intravaginal  inversion.  Because  of  the  large 
uterine  size,  edematous  condition  and  in- 
fection, manual  reposition,  the  Spinelli  or 
Huntington  operations  were  deemed  inad- 
visable. 


Vaginal  hysterectomy  as  done  was  con- 
sidered less  shocking  to  the  patient  and 
offered  the  best  chance  of  avoiding  a fa- 
tality. Undoubtedly,  the  amount  of  blood, 
plasma  and  parenteral  fluids,  as  well  as 
the  penicillin  and  sulfonamides  aided  great- 
ly in  the  favorable  outcome.  Unquestionable 
early  recognition  of  this  condition  is  of 
great  importance;  as  DeLee  states,  the 
fundus  has  been  torn  off  under  the  notion 
that  it  was  the  placenta,  cut  off  as  a tumor, 
or  the  whole  uterus  pulled  out  as  a second 
twin.  All  obstetricians  should  keep  this 
condition  in  mind  as  a possible  complica- 
tion, especially  in  cases  that  they  have  not 
personally  delivered. 


CARCINOMA  OF  THE  SKIN* 

THOMAS  K.  MAHAN,  M.D. 

GRAND  JUNCTION,  COLORADO 


Carcinoma  of  the  skin  is  the  most  com- 
mon form  of  cancer  with  which  we  have  to 
deal.  In  a large  series  of  cases,  cancer  of 
the  skin  comprised  40  per  cent  of  the  total 
number  of  cases  of  cancer.'  Since  the  ra- 
diation therapy  department  of  St.  Mary’s 
Hospital  was  opened,  50  per  cent  of  the 
cancer  cases  seen  have  been  primary  in  the 
skin.  This  comparatively  high  incidence  is 
partly  due  to  the  fact  that  x-ray  and  radium 
therapy  were  not  locally  available  before 
the  opening  of  our  department.  We  un- 
doubtedly see  and  treat  some  patients  who, 
because  of  the  apparent  mildness  of  their 
symptoms,  would  not  have  traveled  200  or 
250  miles  to  receive  treatment  for  a skin 
cancer  but  who  will  come  into  a local  clinic 
for  treatment.  Nevertheless  as  time  goes 
on  we  shall  probably  continue  to  see  a high 
percentage  of  skin  cancers  in  our  patients 
because  so  many  of  them  pursue  an  out-of- 
doors  occupation.  Exposure  to  sun  is  such 
a commonly  accepted  etiologic  factor  that 
this  condition  has  been  called  “Farmers 
Skin”  and  “Sailors  Skin.” 

Frequent  exposure  to  certain  physical 
agents  like  light,  sun,  x-ray,  radium,  heat 
and  cold  all  predispose  to  skin  cancer.  An 

‘Presented  at  the  Annual  Western  Colorado  Spring 
Clinics,  Grand  Junction,  Colorado,  April  3,  1948. 


example  of  this  is  the  Kangri  cancer  which 
develops  on  the  abdomen  of  certain  orien- 
tals who  wear  an  earthenware  charcoal 
heater  on  the  abdomen.  During  the  war 
we  saw  a much  higher  incidence  of  skin 
cancer  in  men  who  were  in  training  for 
months  in  the  desert  than  we  see  now  in  a 
comparable  age  group  in  civilian  practice. 
An  example  of  exposure  to  certain  hydro- 
carbons is  the  famous  chimney  sweeps’  can- 
cer of  the  scrotum.  An  example  of  the  role 
played  by  certain  drugs  and  chemicals  is 
the  cancer  occurring  on  the  palms  of  the 
hands  and  soles  of  the  feet  of  people  who 
have  received  arsenical  treatments.  Car- 
cinoma not  infrequently  occurs  in  the  site 
of  old  chronic  inflammatory  change  such  as 
scars,  sinus  tracts,  and  areas  of  lupus  vul- 
garis. 

A brief  review  of  the  microscopic  anat- 
omy of  the  skin  will  recall  to  your  mind 
that  the  skin  consists  of  an  underlying 
layer  of  connective  tissue  called  the  dermis 
or  corium  and  an  overlying  epidermis  con- 
sisting of  five  layers.  The  surface  division 
of  the  epidermis,  called  the  stratum  cor- 
neum,  consists  of  epithelial  cells  which  have 
become  dry,  flat,  and  horny — the  cells  near 
the  surface  being  flattest.  The  deeper  cells 
being  more  typical  and  rounded.  The  stra- 


38 


Rocky  Mountain  Medical  Journal 


turn  corneum  is  thick  on  the  palms  of  the 
hands  and  plantar  aspects  of  the  feet.  It  is 
thinnest  over  the  face,  flexor  surface  of  the 
elbows,  the  abdomen  and  the  prepuce.  The 
next  layer  is  the  stratum  lucidum,  a thin 
colorless  band  of  irregular  cells  just  be- 
neath the  stratum  corneum.  These  cells  do 
not  have  recognizable  nuclei  in  the  ordinary 
stained  slide.  The  third  layer  is  the  stratum 
granulosum.  It  consists  of  two  or  three 
layers  of  flattened  irregular  cells  having 
demonstrable  nuclei.  Immediately  beneath 
it  is  the  broad  rete  mucosum  or  the  stratum 
spinosum  also  called  the  malpighian  layer. 
It  consists  of  muitiple  rows  of  polygonal 
cells  having  large  oval  nuclei  and  arranged 
in  a mosaic  pattern.  These  cells  are  more 
flattened  in  the  superficial  layers  and 
rounder  in  the  deeper  layers.  This  is  the 
stratum  most  concerned  with  normal  and 
pathologic  growth.  It  lies  just  superficial 
to  the  fifth  and  deepest  layer,  the  stratum 
germinativum  or  basal  cell  layer  which 
consists  of  a single  layer  of  columnar  cells 
situated  on  the  so-called  basement  mem- 
brane, an  imaginary  line  which  separates 
the  epidermis  from  the  corium.^ 

Many  of  us  were  taught  that  the  basal 
cell  was  the  parent  cell  of  the  epidermis.  As 
these  cells  multiplied  and  developed,  they 
were  pushed  toward  the  periphery  under- 
going the  changes  of  the  different  layers 
until  they  came  to  lie  in  the  stratum  cor- 
neum as  dead  flattened  cells  waiting  to  be 
desquamated  by  a newer  generation  of  de- 
veloping cells.  Andrews^  refers  to  some 
studies  which  suggest  that  actually  mitoses 
occur  throughout  both  the  basal  cell  and 
the  prickle  cell  layers  and  most  of  the  cells 
growing  over  a wound  arise  in  the  prickle 
cell  layer. 

Carcinoma  of  the  skin  covers  a wide  va- 
riety of  pathologic  conditions.  The  two 
main  types  are  basal  cell  carcinoma  and 
squamous  cell  or  prickle  cell  or  epidermoid 
carcinoma.  I intend  to  confine  my  remarks 
to  these  two  conditions.  Basal  cell  car- 
cinoma develops  from  the  basal  cells  of  the 
malpighian  layer.  It  is  characterized  by 
multiple  foci  whose  individual  cells  have  a 
palisade  arrangement.  These  tumors  are  of 


slow  evolution,  almost  never  metastasize 
but  tend  to  local  recurrence  after  removal. 
Squamous  cell  carcinoma  is  characterized 
by  overgrowth  of  adult  squamous  cells 
which  breaks  through  the  basement  line. 
Cornification  or  pearl  formation  is  fre- 
quently seen.  This  type  is  faster  growing 
and  metastasizes  to  the  regional  lymph 
nodes.  There  is  a third  cancer,  the  baso- 
squamous  cell  which,  as  it  name  implies, 
has  some  of  the  characteristics  of  both. 

The  clinical  appearance  of  both  types  is 
fairly  typical  and  the  diagnosis  is  usually 
apparent  from  the  clinical  examination.  The 
basal  cell  cancer  usually  begins  as  a pin- 
head size  waxy  or  pearly  nodule;  however, 
it  may  occasionally  develop  on  a pre-exist- 
ing keratosis.  Gradually  it  enlarges  by  the 
development  of  other  waxy  nodules  which 
coalesce  to  form  an  elevated  plaque  having 
a waxy  color.  Frequently  telangiectatic  ves- 
sels are  seen  to  course  over  it.  A crust 
forms  in  the  center,  sooner  or  later  the 
crust  is  knocked  off,  the  base  may  bleed, 
then  it  may  go  through  a stage  of  apparent 
healing,  then  another  crust  forms.  This 
cycle  is  repeated  many  times.  A history  of 
the  lesion  getting  “better  and  worse,”  “bet- 
ter and  worse,”  can  usually  be  obtained. 
Finally,  there  is  a large  ulcer  which  may 
or  may  not  be  crusted  over  with  rolled 
waxy  borders.  As  the  lesion  advances,  it 
destroys  any  and  all  underlying  tissues  so 
that  eventually  the  whole  nose  or  the  whole 
side  of  the  face  may  be  eaten  away.  The 
course  is  characterized  by  chronicity.  These 
changes  take  years  to  occur  with  little  per- 
ceptible change  from  month  to  month. 

Squamous  cell  carcinoma  arises,  more 
often  than  not,  on  a pre-existing  keratosis. 
If  the  crust  of  a hyperkeratosis  is  removed 
and  the  base  is  raw  and  bleeding,  from  a 
practical  standpoint,  one  may  assume  that 
malignant  degeneration  has  begun.  The 
cancer  begins  as  a dry  waxy  growth  with 
an  indurated  button  base.  There  is  a horny 
overgrowth  in  the  center  which  can  be 
separated  fairly  easily  but  leaves  a bleeding 
base.  On  the  lip,  the  lesion  is  constantly 
moistened  so  that  it  becomes  ulcerated  with- 
out the  waxy  keratinization.  It  grows  and 

3& 


for  January,  1949 


invades  the  underlying  tissues.  The  ulcer- 
ated surfaces  may  be  cauliflower  like,  with 
a foul  exudate.  Squamous  cell  carcinoma 
metastasizes  rather  rapidly  on  the  extremi- 
ties, slower  on  the  face. 

The  clinical  differentiation  between  squa- 
mous cell  and  basal  cell  lesions  is  frequently 
possible,  occasionally  difficult  and  some- 
times impossible.  If  the  history  extends 
over  three  or  four  years,  it  is  probably  ba- 
sal rather  than  epidermoid.  A lesion  1 cm. 
in  diameter  and  less  than  a year  old  is 
probably  squamous.  The  basal  lesion  has 
a rolled  waxy  border,  the  squamous  cell 
has  an  elevated,  hard,  ringlike  margin.  A 
great  deal  of  stress  has  been  laid  on  the 
location  of  the  lesion  as  a differential  point. 
One  must  remember  that  either  lesion  may 
occur  anywhere  on  the  skin  but  basal  cell 
is  most  common  on  the  face  above  the  lips 
in  a band  of  skin  extending  up  to  the  level 
of  the  eyebrows  and  the  tops  of  the  ears 
while  the  squamous  cell  lesion  is  more  com- 
mon on  the  ears,  at  the  muco-cutaneous 
junctions,  on  the  extremities,  the  penis  and 
the  vulva.  Squamous  cell  lesions  occur  in 
a younger  age  group  than  the  basal  cell. 

Carcinoma  of  the  skin  must  be  differen- 
tiated from  other  skin  conditions.  Syphilis, 
“the  great  imitator,”  frequently  simulates 
skin  cancer.  However,  carcinoma  frequently 
occurs  on  the  face  and  hands  while  chancre 
is  rare  in  those  locations.  Cancer  will 
usually  have  a history  measured  in  years, 
chancre  in  weeks  and  gumma  in  months. 
The  Wasserman  reaction  and  dark  field  ex- 
amination are  further  aids. 

Lupus  vulgaris  is  becoming  more  rare  all 
the  time  but  it  still  occurs.  It  is  a disease 
of  childhood  whereas  skin  cancer  is  a dis- 
ease of  old  age — Ackerman^  states  that  it  is 
rare  before  40  years  of  age.  However,  one 
of  our  patients  with  a squamous  cell  car- 
cinoma of  the  lip  is  a young  farmer  twenty- 
nine  years  old.  Another  differential  point 
is  that  the  lesion  of  lupus  is  composed  of 
small  brownish  nodules  and  it  frequently 
heals  on  one  edge  while  advancing  on  an- 
other. One  confusing  feature  is  that  cancer 
frequently  occurs  in  a lupus  scar.  Guinea 
pig  inoculation  is  sometimes  of  inestimable 


value.^  Hyperkeratosis,  as  was  mentioned 
earlier,  has  a scale  formation  which  sepa^ 
rates,  leaving  a dry  base.  If  the  base  oozes 
blood  or  serum,  it  is  probably  an  early 
epithelioma.  Fungus  infections  occasion- 
ally attack  the  skin  in  a manner  similar  to 
cancer  but  they  usually  occur  in  a younger 
age  group  and  the  lesions  are  multiple  and 
scattered.  Psoriasis  may  be  confused  with 
multiple  basal  cell  lesions  of  the  skin  <of 
the  chest.  Psoriatic  lesions  in  the  skin  of 
the  elbows  and  knees  may  make  the  differ- 
entiation. Biopsy  may  be  necessary  to  ex- 
clude nonpigmented  nevi  and  nonpigmented 
malignant  melanoma.  The  latter  is  very 
radio-resistant  so  that  differentiation  is  im- 
portant. 

After  a clinical  diagnosis  is  made,  the  first 
step  in  the  treatment  is  to  obtain  an  ade- 
quate biopsy.  This  is  often  omitted  because 
we  are  so  frequently  correct  in  our  clinical 
diagnosis,  we  tend  to  become  overconfident. 
In  a series  of  2,000  carcinomas  of  the  skin, 
90  per  cent  were  accurately  diagnosed  clin- 
ically while  in  a series  of  1,000  lesions 
which  were  clinically  considered  to  be  be- 
nign, 15  per  cent  were  found  to  be  carcin- 
oma when  studied  histologically.^  An  ade- 
quate biopsy  of  all  cases  in  which  there  is 
the  slightest  doubt  regarding  the  clinical 
diagnosis  will  occasionally  save  the  physi- 
cian considerable  embarrassment. 

To  be  satisfactory,  a biopsy  should  fulfill 
certain  criteria.  An  inadequate  biopsy  will 
only  serve  to  further  confuse  the  clinician. 
If  a negative  report  is  received  and  the  le- 
sion is  clinically  malignant,  the  biopsy 
should  be  repeated. 

How  can  one  be  sure  of  obtaining  a sat- 
isfactory specimen?  One  way  is  to  visualize 
the  malignant  lesion  as  an  open  face  goose- 
berry pie  with  a margin  of  normal  sur- 
rounding skin  represented  by  the  pie  crust. 
One  removes  a wedge  in  much  the  same 
manner  as  a pie  is  ordinarily  cut.  The 
wedge  need  not  be  wide;  it  may  be  quite 
narrow,  but  it  should  extend  from  the  cen- 
ter well  beyond  the  limits  of  the  lesion  to 
include  an  outer  crust  of  normal  tissue  and 
it  should  be  deep  enough  to  include  all 
layers  of  the  skin. 


40 


Rocky  Mountain  Medical  Journal 


The  treatment  of  skin  cancer  may  be  di- 
vided into  the  treatment  of  the  primary  le- 
sion, treatment  of  metastasis,  and  treatment 
of  the  advanced  case.  Wide  surgical  ex- 
cision is  unquestionably  a gratifying  treat- 
ment for  skin  lesions.  Unfortunately  this 
is  not  applicable  to  all  portions  of  the  body. 
For  example,  a large  area  of  skin  may  be 
sacrificed  from  the  back  or  the  thigh  but 
removal  of  significant  areas  of  skin  from 
the  nose  or  eyelid  necessitiates  rather  ex- 
tensive plastic  repair. 

If  surgical  excision  is  practiced,  wide  and 
deep  removal  is  imperative.  A general  rule 
to  follow  is  to  remove  from  .5  to  1 cm.  of 
surrounding  normal  tissue.  Anything  less 
is  a definite  invitation  to  recurrence.  Suc- 
cessful cancer  surgery  requires  a state  of 
mind  diametrically  opposite  from  the  sur- 
geon’s normal  philosophy.  Usually  he  must 
be  interested  in  conserving  as  much  tissue 
as  possible.  The  oncologist  must  be  willing 
to  sacrifice  as  much  tissue  as  can  possibly 
be  lost  and  still,  by  means  of  plastic  repair, 
preserve  a functioning  part.  Cautery  ex- 
cision offers  no  advantage  over  the  clean 
scalpel.  It  has  the  disadvantage  of  distort- 
ing the  pathologic  specimen.  The  latter  is 
an  important  consideration  because  the 
pathologist  should  be  required  to  express 
his  opinion  as  to  whether  or  not  the  removal 
was  complete. 

X-ray  and  radium  therapy  have  a wider 
field  of  usefulness  because,  in  most  in- 
stances, they  can  destroy  the  disease  with 
less  deformity  of  the  remaining  tissues  than 
is  possible  with  surgery.  The  resulting  scar 
and  deformity  must  be  considered  because 
most  of  these  lesions  are  on  the  exposed 
portions  of  the  body.  Ninety-eight  per  cent 
of  basal  cell  lesions  and  75  per  cent  of 
squamous  cell  lesions  are  on  the  head  and 
neck.*’’ 

An  epidermoid  carcinoma  of  the  lower 
lip  may  be  cured  by  either  surgery  or  ir- 
radiation. Surgical  removal  requires  a V 
section  well  beyond  the  limits  of  the  cancer 
with  a plastic  repair  of  the  entire  lower  lip. 
The  same  lip  treated  with  irradiation  will 
have  a soft,  flat,  or  slightly  depressed  pale 
scar  about  1 cm.  in  diameter  bigger  than  the 


original  lesion.  Many  of  these  are  not  vis- 
ible at  three  or  four  feet  distance.  Surface 
application  of  radium,  when  it  is  possible 
to  use  it,  gives  a better  cosmetic  result  than 
x-ray  and  x-ray  gives  a better  result  than 
interstitial  needles.  Of  course  other  con- 
siderations than  the  cosmetic  result  fre- 
quently govern  the  choice  of  treatment. 

The  choice  of  treatment,  then,  depends  on 
the  limitations  which  the  location  of  the 
cancer  imposses,  the  peculiarities  of  be- 
havior of  the  various  types  of  cancer,  and 
the  advantages  and  disadvantages  of  each 
method  of  treatment.  These  may  be  dis- 
cussed under  the  following  headings  modi- 
fied from  the  outline  by  Pack.® 

1.  Location:  Tissue  difficult  of  plastic  re- 
pair should  be  treated  with  irradiation.  Tis- 
sue overlying  bone  or  cartilage  should  be 
treated  with  surgery.  This  statement  does 
not  apply  to  the  nose  or  the  ear.  Consider- 
able care  must  be  used  in  these  two  sites 
but  other  considerations  make  careful  and 
judicious  irradiation  the  treatment  of  choice. 
The  eyelids  should  be  treated  with  low 
voltage  roentgen  ray,  protecting  the  eye  to 
prevent  cataract  or  iridocyclitis.  The  skin 
over  the  bony  prominences  of  the  hands  and 
feet  is  poorly  nourished  so  it  is  best  treated 
with  surgery.  Late  radionecrosis  or  recur- 
rence often  follows  treatment  to  the  scalp. 
Radium  is  preferable  to  x-ray  in  this  loca- 
tion. 

2.  Type  of  cancer:  Spindle  cell  epidermoid 
cancer  is  radio  resistant  and  should  be 
treated  surgically.  Paget’s  disease  should 
be  considered  as  a carcinoma  of  the  breast 
and  amputated.  Carcinoma  in  burns  and 
scars  should  be  treated  surgically  but  car- 
cinoma in  a draining  sinus  may  be  treated 
with  x-ray. 

3.  Recurrence:  The  recurrence  should  be 
treated  by  a different  means  than  the  pri- 
mary was  treated.  For  example,  if  the  pri- 
mary lesion  was  treated  with  x-ray,  the 
recurrence  should  be  treated  surgically  and 
vice  versa. 

The  treatment  of  metastasis  is  fortunately 
not  a frequent  problem.  It  has  been  va- 
riously estimated  that  6 to  18  per  cent  of 
patients  who  had  no  metastasis  when  the 


for  January,  1949 


41- 


primary  was  treated,  will  later  develop 
metastases.^  When  it  occurs  it  is  a grave 
sign.  Irradiation  therapy  cannot  cure  squa- 
mous or  spindle  cell  carcinoma  metastasis 
to  regional  nodes.  If  intensive  irradiation 
cannot  sterilize  a metastatic  node  there  is 
no  logic  in  the  prophylactic  irradiation  of 
the  regional  nodes  using  doses  of  one-fifth 
to  one-half  the  maximum  permissible  irra- 
diation. Therefore  the  treatment  must  be 
surgical  and  requires  a radical  neck  dissec- 
tion. One  instance  where  irradiation  might 
be  preferable  to  surgery  is  in  the  case  of 
involvement  of  a solitary  pre-auricular 
node.  The  possibility  of  facial  paralysis 
after  surgical  excision  is  real  and  this  par- 
ticular node  is  so  superficial  as  to  render  it 
more  susceptible  to  irradiation.  Duffy^  es- 
tablished indications  for  neck  dissection  for 
intra-oral  lesions.  The  same  indications 
may  be  used  in  consideration  of  all  cancer 
of  the  head  and  neck.  They  are:  1.  The 
primary  lesion  should  be  controlled.  2.  The 
primary  lesion  should  be  limited  to  one  side 
of  the  mouth.  Of  course  this  does  not  ap- 
ply as  regards  the  skin.  3.  The  carcinoma 
should  show  marked  histologic  differentia- 
tion. This  is  not  so  important  in  the  skin 
as  in  the  mouth.  4.  The  metastases  must  be 
limited  to  one  group  of  nodes  in  two  con- 
tiguous cervical  triangles.  5.  The  carcinoma 
must  not  have  perforated  the  capsule 
of  the  lymph  node.  6.  There  must  not  be 
an  adenopathy  on  the  other  side.  However, 
some  do  not  consider  bilateral  involvement 
a contra-indication.  7.  There  must  not  be  a 
distant  metastasis.  8.  The  patient  should  be 
in  good  condition. 

Prophylactic  neck  dissection  is  not  war- 
ranted because  of  the  risk  involved  and  the 
small  percentage  of  patients  who  will  later 
develop  metastasis  have  a fair  chance  for 
survival  with  adequate  radical  treatment 
after  metastases  have  developed.  So  we' 
feel  that  neck  dissection  should  be  reserved 
for  those  patients  who  meet  the  conditions 
laid  down  by  Duffy. 

Occasionally  one  sees  a patient  with  skin 
cancer  so  advanced  as  to  make  any  treat- 
ment futile.  Therapy  is  directed  toward 
making  the  patient  comfortable  and  keeping 


the  lesion  clean.  If  a large  foul  ulcerating 
lesion  can  be  kept  clean,  a great  deal  will 
have  been  done  to  make  the  patient  more 
comfortable.  Frequent  dressings  with  oc- 
casional spraying  with  sulfa  powder  or  local 
application  of  penicillin  will  suppress  secon- 
dary infection.  Zinc  ointment  or  aluminum 
paste  will  soothe  the  surrounding  macerated 
skin.  Five  to  10  per  cent  of  cancer  cases 
terminate  in  fatal  hemorrhage.®  I know  of 
no  way  of  combatting  hemorrhage  in  large 
skin  lesions  except  with  pressure  bandages 
and  adequate  sedation. 

Acetyl  salicylic  acid  will  go  a long  way 
toward  relieving  pain  if  it  is  used  in  ade- 
quate dosage.  The  patient  may  be  instructed 
to  take  one  or  two  aspirins  every  hour  if 
necessary  until  he  is  relieved.  I have  seen 
patients  carried  long  periods  of  time  on 
comparatively  large  doses  of  aspirin  with- 
out adverse  systemic  effect.  Later  barbit- 
urates may  be  added  to  the  aspirin  with 
good  effect,  still  later  codeine  may  be  neces- 
sary. If  the  patient  complains  of  epigastric 
distress  from  the  aspirin,  he  may  be  re- 
lieved with  concomitant  doses  of  sodium  bi- 
carbonate. Finally  all  of  these  things  fail 
and  we  must  resort  to  more  powerful  nar- 
cotics. The  use  of  alcohol  injections  both 
to  nerve  roots  and  intravenously  for  its 
systemic  effect  may  postpone  the  use  of  the 
narcotics.  I have  had  inadequate  experience 
with  cobra  venom  to  express  an  opinion  re- 
garding it. 

The  prognosis  in  adequately  treated  early 
carcinoma  of  the  skin  is  good.  It  has  the 
best  prognosis  of  all  malignant  neoplasms 
but  this  advantage  is  frequently  decreased 
or  lost  by  procrastination,  neglect,  or  inade- 
quate treatment.  Recurrent  basal  cell  or 
squamous  cell  lesion  has  a much  worse 
prognosis  than  the  original  lesion.  The 
presence  of  regional  metastases  markedly 
decreases  the  prognosis  in  squamous  cell 
lesions.  The  prognosis  in  unselected  basal 
cell  lesions  is  usually  given  as  about  90  to 
93  per  cent  five-year  cure  and  70  to  80  per 
cent  for  squamous  cell  lesions.  The  prog- 
nosis is  about  the  same  whether  the  method 
of  treatment  is  radiation  or  surgical.  For 
example.  Hale  and  Holmes,  in  an  unselected 


42 


Rocky  Mountain  Medical  Journai 


series  of  1,422  cases,  treated  1,035  with  ir- 
radiation with  12  per  cent  failures  and  387 
were  treated  surgically  with  12  per  cent 
failures.  The  moral  to  these  figures  ap- 
pears to  be  early  and  adequate  treatment. 


REFERENCES 

’Ackerman,  L.  V.,  and  Del  Regato,  J.  A.;  “Cancer 
Diagnosis,  Treatment,  and  Prognosis.”  St.  Louis, 
1947,  C.  V.  Mosby  Co. 

^Andrews,  G.  C. : “Diseases  of  the  Skin.”  Third  Edi- 
tion, Philadelphia,  1947,  W.  B.  Saunders. 


®McKee,  G.  M.,  and  Cipollaro,  A.  C. : “X-rays  and 
Radium  in  the  Treatment  of  Diseases  of  the  Skin.” 
Philadelphia,  1946,  Lea  & Fiblger. 

<Torrey,  F.  A.,  and  Levin:  Quoted  by  (1).  , 

'Pack,  Geo.  T.:  “Treatment  of  Cutaneous  Epithe- 
lioma.” Arch  of  Derm,  and  Syph.,  53:576-585,  June, 
1946. 

'Lenz,  Maurice:  "Radiotherapy  of  Epithelioma  of 
the  Skin.”  Arch  of  Derm,  and  Syph.,  53:588-596,  June, 
1946. 

’Duffy,  J.  J. : in  Pack,  G.  T.,  and  Livingston,  E.  M. : 
“Treatment  of  Cancer  and  Allied  Diseases.”  New 
York,  1940,  Paul  B.  Hoeber,  Inc. 

'Morgan,  Hugh:  “The  Care  of  the  Patient  With 
Terminal  Cancer.”  Rocky  Mt.  Med.  Jour.,  February, 
1948. 

'Hale,  C.  H.,  and  Holmes,  G.  W. : “Carcinoma  of  the 
Skin.”  Radiology,  48,  563-568,  June,  1947. 


MALIGNANCY  RECORDS 

CLAUDE  L.  SHIELDS,  M.D. 

SALT  LAKE  CITY 


The  original  purpose  of  this  paper  was  to 
analyze  data  on  cancer  as  treated  by  the 
general  surgeon  in  a small  city  and  compare 
with  statistics  from  large  medical  centers. 
It  was  first  read  before  the  Salt  Lake  Sur- 
gical Society.  Later  it  was  rearranged  for 
the  educational  program  of  the  Interna- 
tional College  of  Surgeons  to  emphasize  the 
need  of  careful  case  history  study  and  read 
before  a group  of  young  surgeons. 

The  etiology  of  cancer  continues  to  chal- 
lenge scientific  endeavor.  However,  when 
the  observations  made  and  the  results  of 
animal  experiments  of  the  last  few  years  are 
considered,  the  progress  which  is  being 
made  is  impressive.  It  is  not  the  purpose 
in  this  material  to  upholdr  any  particular 
theory  as  to  malignancy,  but  due  to  such 
interesting  and  encouraging  finding,  lending 
hope  to  the  solution  of  the  cancer  problem, 
I desire  to  urge  a more  extensive  and 
united  movement  on  the  part  of  the  medical 
profession  in  gathering  and  recording  data. 
It  is  desirable  that  forms  used  in  making 
records  be  of  a uniform  type  eventually, 
although  it  is  probably  hardly  feasible  just 
at  this  time.  The  uniform  type  of  record,  if 
it  is  developed  successfully,  should  make  the 
work  in  connection  with  cancer  simpler.  It 
would  make  the  attack  on  cancer  more  ef- 
ficient and  valuable  and  when  a study  is 
undertaken  it  would  be  less  difficult  to 
work  out  conclusions. 

In  order  that  we  may  more  nearly  paral- 
lel important  findings  in  animal  experimen- 
tation, it  is  proposed  more  space  be  given 


pertinent  questions  than  is  now  found  on 
most  existing  forms.  Space  for  a more  ade- 
quate family  history,  asking  for  the  names 
of  the  individuals  with  their  addresses,  or 
place  of  death,  and  cause  of  death  would 
seem  necessary.  A question  asking  about 
previous  infection,  irritation  or  injury  at  the 
site  of  the  lesion;  should  appear  on  such  a 
form.  It  would  also  seem  desirable  that 
consideration  be  given  the  character  of  the 
early  nourishment  of  the  individual. 

I realize  some  of  the  difficulties  in  the 
way  of  unification  of  record  forms.  I have 
changed  my  system  four  times.  In  the  sum- 
ming up  of  the  report  of  the  Committee  on 
Clinical  Records  of  the  American  Hospital 
Association  in  1937,  in  response  to  a ques- 
tionnaire sent  to  231  widely  distributed  hos- 
pitals, the  following  was  the  result:  “Twen- 
ty-seven per  cent  replied  that  they  had 
found  the  record  forms  suggested  by  the 
previous  committee  useful;  21  per  cent  had 
not  found  them  useful;  and  6 per  cent  re- 
plied that  they  had  not  seen  these  forms. 
Seventeen  per  cent  had  adopted  some  of  the 
form  proposed;  35  per  cent  had  not  adopted 
any  of  the  forms  and  46  per  cent  did  not 
make  any  reply  to  the  questionnaire.” 

That  report  is  somewhat  discouraging 
from  an  unification  point  of  view,  but  it 
does  show  a widespread  appreciation  of  the 
importance  of  records.  Thus  our  efforts  to- 
ward more  complete  records,  especially  in 
malignancy  cases,  should  be  stimulated  to 
further  effort  as  an  important  factor  in  the 
study  of  carcinoma.  The  proposal  has  been 


for  January,  1949 


43 


made  in  some  states  that  committees  of 
physicians  be  appointed  for  the  purpose  of 
studying  forms  for  obtaining  records  of  can- 
cer cases.  Such  state  committees,  it  has 
been  pointed  out,  could  work  with  a com- 
mittee on  cancer  control  and  the  committee 
on  clinical  records.  It  has  been  suggested 
that  when  a record  form  is  worked  out 
which  will  meet  requirements  copies  be  sent 
to  the  county  medical  societies  within  the 
state  and  that  the  cooperation  of  these  so- 
cieties in  the  project  be  invited.  It  was 
urged  that  these  societies  be  encouraged  to 
use  these  forms  in  making  records  of  all 
cancer  cases,  both  institutional  and  non- 
institutional,  such  records  to  be  properly 
filed  at  some  designated  place. 

Should  such  a unified  system  of  obtaining 
data  on  malignant  cases  be  adopted  gener- 
ally, much  valuable  information,  which  is 
not  now  obtained,  ought  to  be  forthcoming. 
But  whether  unification  of  record  forms 
eventuates  or  not,  it  is  plain  that  the  im- 
portance of  records  in  cancer  is  being  real- 
ized throughout  the  country.  In  any  group 
of  100  white  females,  statistics  indicate  that 
thirteen  will  die  of  cancer.  It  is  estimated 
that  450,000  persons  in  the  United  States  are 
afflicted  with  cancer.  Many  facts  come  out 
with  regard  to  cancer  which  require  ex- 
tremely carefully  prepared  and  most  ac- 
curate records.  There  appears  to  have  been 
in  recent  years  a definite  increase  in  cancer 
of  the  breast.  Cancer  of  the  breast  has  also 
been  shown  to  be  more  frequent  among 
women  who  have  not  nursed  children.  A 
decrease  in  cancer  of  the  cervix  has  been 
shown.  Cancer  of  the  cervix  is  more  fre- 
quent among  women  who  have  had  children 
and  have  torn  cervices  than  in  women  who 
have  never  been  pregnant.  There  are  fewer 
women  out  of  every  100  who  nurse  children 
and  fewer  who  suffer  injury  to  the  birth 
canal,  of  course. 

But  such  information  is  not  available  un- 
der our  pre\/^ailing  system  of  record  keeping. 
There  has  been  little  investigation  of  the 
hereditary  factors  in  cancer  in  humans. 
Here  and  there  a family  has  been  selected 
for  intensive  study,  but  the  data  obtained 
have  been  meager  for  definite  conclusions. 


Maud  Slye  studied  many  generations  of 
mice,  showing  that  she  could  breed  cancer 
in  mice  in  three  generations.  But  there  is  a 
difference  between  mice  and  men,  say  the 
skeptics,  as  to  the  hereditary  cause  of  can- 
cer. It  was  in  1932  that  McFarland  and 
Meade  published  a paper  on  the  genetic 
origin  of  tumors,  supported  by  their  simul- 
taneous and  symmetrical  occurrence  in 
homologous  twins.  Their  studies  seemed  to 
indicate  that  if  a tumor  developed  in  an 
identical  twin  in  a given  organ  at  a given 
time,  the  same  type  of  tumor  would  develop 
in  the  other  twin  in  the  corresponding  or- 
gan, at  or  near  the  same  time.  The  con- 
clusion was  that  it  may  be  logical  to  infer 
that  each  of  the  new  beings  will  be  sub- 
jected to  a considerable  degree  to  the  same 
inheritance  factors.  Cancer  of  the  breast 
has  developed  in  homologous  twins  within 
a few  months  of  each  other.  Such  was  re- 
ported by  Mumford.  These  tumors  devel- 
oped at  the  age  of  90.  In  1939,  Phillips  of 
the  Mayo  Foundation  reported  a case  of  bi- 
lateral mammary  carcinoma  in  identical 
twins.  It  appeared  in  the  first  twin  three 
years  before  it  appeared  in  the  second. 

Recently  Bittner  and  his  co-workers  of  the 
Jackson  Memorial  Laboratory  at  Bar  Har- 
bor, Maine,  performed  some  interesting 
feeding  experiments  on  mice  born  to  fe- 
males showing  a high  breast  tumor  inci- 
dence. These  young  mice  were  removed 
from  their  mothers  as  soon  as  recorded  and 
fostered  by  females  of  a type  showing  low 
breast  tumor  incidence.  Of  these  fostered 
females  and  their  progeny  23.1  per  cent  de- 
veloped breast  tumors  while  the  incidence 
of  the  breast  tumors  among  the  control 
mice  was  83.2  per  cent.  They  concluded 
that  their  experiments  indicated  that  some 
influence  is  transmitted  in  mothers’  milk 
which  is  of  prime  importance  in  determin- 
ing the  incidence  of  breast  tumors;  that  the 
incidence  of  tumors  may  be  decreased  by 
fostering  females  of  a high  breast  tumor 
stock  by  low  tumor  stock  mothers. 

C.  C.  Little  recently  stated,  “In  tissue  cul- 
ture the  cancer  cell  is  not  malignant.  It 
does  no  harm.  It  speedily  and  effectively 
outgrows  most  other  types  of  cells.  The 


44 


Rocky  Mountain  Medical  Journal 


only  thing  that  makes  it  sinister,  abnormal, 
and  an  outlaw  is  the  fact  that  it  ordinarily 
arises  in  an  environment  pledged  to  limita- 
tion, inhibitation,  regulation  and  selective 
opportunity  for  growth.  None  of  these 
things  are  recognized  by  the  cancer  cell, 
which  is  engaged  in  living  independently 
with  a high  degree  of  primitive  biologic  ef- 
fectiveness.” 

As  I have  stated,  I changed  my  own  sys- 
tem of  records  four  times  and  this  made  a 
study  I have  finished  very  difficult.  An 
outstanding  problem  was  that  of  following 
the  patient  who  might  have  been  treated  in 
one,  two  or  three  hospitals  and  tracing  the 
history  in  each  institution.  Some  cases 
came  directly  to  the  hospital  from  another 
physician  and  had  no  office  history.  Such 
a difficulty  is  not  found  in  large  clinics,  but 
it  will  be  found  in  private  practice  operat- 
ing in  more  than  one  hospital.  Incorporat- 
ing hospital  record  data  into  office  records 
overcomes  this.  When  findings  and  proce- 
dure in  an  operation  is  dictated  to  the  hos- 
pital historian,  it  is  well  to  instruct  her  to 
make  a carbon  copy  of  the  report  which 
may  be  attached  to  the  office  history  of  the 
patient,  along  with  all  laboratory  data  and 
any  other  hospital  records.  This  makes  it 
easier  to  carry  on  a statistical  study  of  any 
particular  disease,  because  all  of  the  records 
are  available,  and  it  is  not  necessary  to  trace 
them  in  various  hospitals. 

When  a patient  returns  after  a lapse  of 
years,  the  physician  may  have  forgotten 
many  essential  details  which  he  can  find  in 
his  office  records.  The  following  illustrates 
the  type  of  office  history  forms  I have 
adopted.  It  is  a modification  of  the  Mayo 
Clinic  record  system  which  I set  up  in  the 
office  of  Dr.  A.  J.  Hosmer  in  1914.  The  most 
lecent  changes  in  this  system  is  the  allow- 
ance of  more  space  for  urine  analyses,  blood 
work,  and  blood  pressure  records.  This  is 
essential  for  a private  office  as  the  patient 
is  usually  seen  over  a longer  period  of  time 
than  in  large  clinics  when  the  patient  is 
away  from  home  for  a check-up.  Following 
is  the  forms  used: 

Card  A — Alphabetical  classification  of  patients’ 
names. 

Card  B — Diagnosis  listing. 


Card  C — History  sheet. 

Card  D — Reporting  form  for  American  College 
of  Surgeons. 

This  report  consists  of  records  of  cancer 
cases  treated  from  the  year  1913  to  1943. 

1.  Number  of  records  studied,  567. 

2.  Number  found  unoperable,  369. 

3.  Records  discarded  because  contact  with  pa- 

tient lost,  33. 

4.  Discarded  because  early  pathologic  studies 

were  inadequate,  53. 

5.  Records  used  for  study  of  five-year  cures, 

113. 

6.  Number  of  five-year  cures,  23. 

7.  Per  cent  of  five-year  cures,  4.91. 

Breakdown  of  cures  into  cancer  types: 


Location  of  Tumor  No.  Kind  of  Treatment 


Cervix  4 Cures  by  radium  only 

Breast  6 1 cured  by  x-ray 

5 cured  by  operation 
Sarcoma  2 Both  cured  by  ampu- 

tation 

Miscellaneous 5 Cured  by  operation 


It  will  be  noted  from  above  that  there  are 
a large  number  of  discarded  charts  because 
of  loss  of  contact  with  the  patients.  Fifty- 
three  charts  were  discarded  because  of  in- 
adequate pathologic  study,  there  being  no 
full  time  pathologist  in  charge  of  the  hos- 
pital laboratory  during  that  period  of  time. 
This  shows  that  a vast  amount  of  work  is 
done  in  hospital  records  which  is  absolutely 
valueless  when  they  are  used  to  study  the 
progress  of  cure  in  cancer  cases.  During 
this  thirty-year  period  approximately  one 
patient  each  month,  a total  of  368,  was  ex- 
amined in  the  office  or  at  their  homes  and 
found  to  have  far  advanced  malignancies 
for  which  the  only  treatment  prescribed 
was  to  alleviate  pain,  and  make  the  patient 
as  comfortable  as  possible. 

These  figures  are  the  basis  for  the  pes- 
simism of  a majority  of  surgeons  with  re- 
gard to  cancer  therapy.  They  do  not  show 
one  case  of  cancer  of  the  stomach  cured, 
and  I cannot  remember  a single  case  in  my 
practice  of  a gastric  carcinoma  surviving 
more  than  five  years  after  operation. 

In  many  of  these  cases  the  Schiller  test 
was  used.  However,  it  was  not  very  help- 
ful in  making  an  early  diagnosis  of  cancer 
of  the  cervix.  The  vaginal  smear  as  ad- 
vised by  Meige,  et  al.,  may  be  of  some  help. 


for  January,  1949 


45 


However,  in  the  cases  where  we  have  found 
cancer  cells  in  the  vaginal  smear,  other 
methods  of  diagnosis  have  shown  the  car- 
cinoma to  be  in  an  advanced  stage. 

Text-books  and  some  -authorities  have 
stated  that  carcinoma  is  rare  after  the  age 
of  80  years.  These  figures  show  a relatively 
large  number  of  persons  in  the  years  be- 
tween seventy-five  and  eighty-five  dying 
from  carcinoma.  Ninety-one  deaths  were 
found  to  occur  in  this  age  period.  Nettleship 
has  stated,  “It  is  suggestive,  too,  that  the 
average  age  specific  mortality  rate  for  gas- 
tric cancer  is,  as  for  other  forms  of  gas- 
trointestinal cancer,  progressive  with  age. 
Among  white  persons,  the  mean  age  at  the 
time  of  death  is  65,  and  the  maximum  num- 
ber of  deaths  in  any  one  ten-year  age  pe- 
riod occurs  between  the  ages  of  65  and  74. 
Previously  the  peak  was  at  an  earlier  age 
period.” 

One  group  of  cases,  of  which  I have  rec- 
ords, was  made  up  of  eight  cases  of  perni- 
cious anemia  which  later  developed  car- 
cinoma. The  most  unusual  case  in  this 
group  was  the  wife  of  a chiropractor,  who 
had  been  treated  by  her  husband  until  cord 
symptoms  causing  paralysis  below  the 
twelfth  thoracic  segment  compelled  her  to 
seek  a medical  examination.  Dr.  Perce  then 
gave  her  sufficient  liver  extract  to  abolish 
all  symptoms,  including  paralysis,  for  one 
and  one-half  years.  We  saw  her  during  a 
relapse,  and  again  she  was  treated  for  eight 
months  by  liver  and  hydrochloric  acid  ther- 
apy. When  she  returned  a year  later  she 
was  found  to  have  a carcinoma  of  the  car- 
diac end  of  the  stomach  extending  into  the 
esophagus.  She  was  referred  to  Dr.  James 
Percy,  who  performed  a cautery  trans- 
thoracic resection  esophagogastrostomy 
which  gave  excellent  palliative  results 
for  two  and  one-half  years,  when  the  pa- 
tient died  from  a mediastinal  metastasis. 

Owens  has  estimated  that  there  are  450,- 
000  persons  with  cancer  in  the  United 
States  and  Mullen  holds  that  one-third  of 
this  great  number,  or  150,000,  should  ap- 
proximate the  number  of  cases  of  gastric 
cancer.  Reports  of  a large  number  of  sur- 
geons indicate  that  only  about  5 per  cent  of 


gastric  carcinoma  cases  are  amenable  to 
surgical  treatment.  The  outlook  for  cancer 
of  the  breast  is  more  optimistic,  because  the 
surgeon  is  consulted  before  the  serious 
symptoms  develop. 

The  symptoms  listed  by  Lahey  for  gastric 
carcinoma  are:  1.  indigestion,  2.  anorexia,  3. 
pain,  4.  loss  of  weight.  5.  vomiting,  6.  dys- 
phagia, 7.  weakness,  8.  hemorrhage,  9.  con- 
stipation, 10,  diarrhea,  11.  mass. 

It  is  obvious  that  if  many  of  these  symp- 
toms were  observed  in  breast  cancer,  the 
surgeon  would  be  reasonably  sure  of  distant 
metastasis.  Most  of  the  patients  having 
breast  lesions  now  seek  medical  diagnosis 
as  soon  as  a lump  is  evident  in  the  breast, 
and  then  the  surgeon  has  an  opportunity  of 
using  inspection,  palpation,  x-ray,  transil- 
lumination, and  biopsy.  This  is  not  possible 
in  early  gastric  carcinoma.  The  surgeon 
should  be  more  daring  in  diseases  of  the 
gastrointestinal  tract,  and  that  exploratory 
operations  should  be  performed  more  fre- 
quently in  the  attempt  to  cut  down  the  large 
group  of  inoperable  gastric  carcinomas  is 
indicated  by  these  figures. 

Hegner,  in  a recent  statement  on  carcin- 
oma of  the  breast,  said:  “The  present  day 
preaching  of  the  curability  of  cancer  is  not 
founded  on  fact.  It  cannot  so  be  predicated 
until  we  know  the  cause  and  cure.  It  is 
easier  and  more  certain  to  prevent  than  it 
is  to  cure.  Our  slogan  should  be  to  prevent 
rather  than  to  cure  cancer.  Far  better  to 
remove  a probable  cancer  with  a certainty 
of  cure,  than  attempt  eradication  of  a posi- 
tive cancer  with  a probability  of  cure.” 


AMERICAN  COLLEGE  OF  SURGEONS  AN- 
NOUNCES 1949  SECTIONAL  MEETING 
SCHEDULE 

The  American  College  of  Surgeons  announces 
that  six  two-day  Sectional  Meetings  will  be 
held  between  January  7 and  April  13,  1949,  for 
physicians  and  surgeons,  and  professional  per- 
sonnel of  hospitals.  A seventh  meeting  to  be 
held  in  the  West  the  latter  part  of  April  will 
be  announced  later.  The  latest  developments 
in  medical  science  and  in  hospital  service  will 
be  presented  at  each  meeting.  The  schedule 
follows : 

January  7-8:  Edgewater  Park,  Mississippi,  Edge- 
water  Gulf  Hotel. 

January  14-15:  Houston,  Texas,  Rice  Hotel. 
February  11-12:  Kansas  City,  Missouri,  Hotel  Presi- 
dent. 

March  15-16:  Washington,  D.  C.,  Statler  Hotel. 
March  21-22:  Buffalo,  New  York,  Statler  Hotel. 
April  12:13.  Edmonton,  Alberta,  MacDonald  Hotel. 


46 


Rocky  Mountain  Medical  Journal 


Bowel  Regulation 
in  Peptic  Ulcer... 

In  the  medical  management  of  un- 
complicated peptic  ulcer,  “regula- 
tion of  bowel  function  is  essential. 
...  A combination  of  antacid  pow- 
ders . . . having  mildly  laxative 
effects  or  the  use  of  a hydrogel  sub- 
stance, such  as  agar  agar  or  Meta- 
mucil,  will  produce  results.” 


By  furnishing  a water-retaining,  gelatinous  residue  in  the  large 
bowel,  Metamucil  acts  gently  without  irritation  to  promote 
smooth,  normal  evacuation. 


METAMUCIL 


is  the  highly  refined  mucilloid  of  Plantago 
ovata  (50%),  a seed  of  the  psyllium  group, 
combined  with  dextrose  (50%)  as  a dis- 
persing agent. 

S EARLE  RESEARCH  IN  THE  SERVICE  OF  MEDICINE 


*Gerendasy,  J.:  Modern  Treatment  of  Peptic  Ulcer,  J.  M.  Soc. 
New  Jersey  ^J;84  (March)  1946. 


for  January,  1949 


47 


Organization 

National  Affairs  - Proceedings  - Programs  - Society  Notices  - News  - Auxiliary 


Colorado  Demands 
Action  by  A.M.A.! 

The  following  letter  should  need  no  explana- 
tion or  introduction.  Mimeographed  copies  of 
the  original  were  sent  simultaneously  to  the 
secretarial  offices  of  all  state  medical  societies, 
to  all  ranking  officers  of  the  American  Medical 
Association,  and  to  members  of  the  A.M.A. 
House  of  Delegates. 

December  14,  1948. 
Dr.  George  F.  Lull,  Secretary, 

American  Medical  Association, 

535  North  Dearborn  St., 

Chicago  10,  Illinois. 

Dear  Doctor  Lull: 

Believing  that  immediate  constructive  action 
is  imperative  to  the  success  of  the  American 
Medical  Association’s  educational  program,  the 
Board  of  Trustees  of  the  Colorado  State  Medical 
Society  in  regular  session  December  11,  directed 
that  your  Board  be  respectfully  requested  to 
act  forthwith  on  these  two  proposals: 

1.  Immediate  creation  of  the  necessary  ma- 
chinery to  enable  an  AMA  spokesman,  the 
President  or  yourself  as  circumstances  warrant, 
to  answer  promptly  and  categorically  those  pub- 
lic comments  by  national  figures  who  oppose 
our  American  system  of  medical  practice,  such 
as  Mr.  Ewing  and  Mr.  Dingell.  The  people 
deserve  a reply. 

2.  The  calling  of  an  AMA  sponsored  con- 
ference of  top-level  state  society  executive  sec- 
retaries and  public  relations  directors  as  soon 
as  possible  but  not  later  than  January  15  to 
work  under  the  guidance  of  the  AMA  steering 
committee  in  actually  formulating  a national 
program  of  publicity,  factual  advertising  and 
subsidiary  educational  activities. 

It  is  our  earnest  belief  that  these  proposals 
merit  the  fullest  consideration  and  that  time  is 
of  the  essence.  The  zero  hour  is  near.  Action 
must  not  be  delayed! 

Since  the  House  of  Delegates  authorized  the 
$25  assessment,  we  have  received  from  every 
section  of  our  state,  comments  to  the  effect  that 
the  physicians  want  to  know  what  will  be  done 
with  this  money.  A typical  Colorado  county 
society  met  a few  evenings  ago  and  every 
member  said  he  would  be  glad  to  pay  the 
assessment  provided  he  knew  what  sort  of  a 
program  was  planned,  if  it  would  be  earnest 
and  vigorous,  and  when  it  would  start.  These 
men  cited  the  current  Colorado  program,  based 
on  increased  dues,  as  an  example  of  action 
and  results.  They  expect  the  same  sort  of 
action  and  leadership  from  the  AMA.  They 
must  not  be  disappointed  or  let  down.  We  feel 
it  must  be  forthcoming  (1)  because  we  are  in 
a fight  and  must  take  the  initiative  within  a 
matter  of  days  and  (2)  because  aggressive  action 
and  knowledge  of  a sound  national  program 
is  essential  to  an  informed  membership  and  to 
cooperation  in  raising  the  necessary  funds. 


We  feel  a spokesman  is  necessary  to  answer 
certain  statements  at  the  national  level.  None 
should  go  unchallenged.  We  feel  that  President 
Sensenich  should  immediately  clarify  the  matter 
of  the  assessment,  which  was  not  done  at  St. 
Louis,  and  we  attach  a suggested  statement 
which  will  inform  the  public  of  the  fact  that  the 
AMA  is  not  raising  a “slush  fund.”  We  think 
Rep.  Dingell  should  have  been  answered  when 
he  said  more  than  half  of  the  AMA  membership 
would  not  pay  the  assessment.  The  AMA  must 
arouse  its  members  to  prove  him  false.  There 
are  other  instances.  We  must  take  the  offensive! 
We  cannot  permit  the  proponents  of  political 
medicine  do  all  the  talking!  That  mistake  was 
made  by  a once-great  political  party  in  the 
recent  election. 

In  suggesting  a January  conference  to  map 
the  educational  and  publicity  program,  we  hereby 
offer  to  make  available  for  such  a gathering,  a 
representative  from  Colorado.  It  is  our  belief 
that  the  guidance  and  counsel  of  our  excellent 
state  society  executives  are  invaluable  and 
needed  at  this  time. 

We  further  believe  there  is  need  for  immediate 
implementing  of  a general  national  pattern  which 
each  state  society  can  follow.  Here  are  some 
other  considerations: 

What  are  the  half  dozen  most  important  things 
that  any  state  society  can  do  now?  Can  we 
develop  a punchy  campaign  slogan?  Will  the 
program  utilize  radio,  and  if  so,  how?  Do  we 
contemplate  paid  advertisements  in  weekly  news- 
papers to  cover  the  rural  areas?  How  effective 
is  advertising  directed  to  World  War  II  vet- 
erans? How  can  we  best  tell  the  story  of  the 
total  costs  of  medical  care?  What  are  some  of 
the  technics  which  all  state  societies  can 
use  in  working  with  various  groups  and  or- 
ganizations, with  the  press  and  radio,  with 
special  writers,  women’s  page  editors,  etc.?  What 
can  be  done  at  the  national  level  to  encourage 
radio  programs  and  commentators,  magazines 
and  other  outlets  to  bring  the  problem  out  in 
the  open  and  tell  the  whole  story?  What  can 
be  done  to  get  into  production  immediately: 
(1)  a small  pamphlet  which  adequately  informs 
the  physician  about  the  federal  medicine  prob- 
lem so  that  he  can  make  a brief  and  intelligent 
speech  which  the  socializers  must  squirm  to 
answer  and  (2)  a small,  attractive  and  brief 
series  of  pamphlets  to  educate  the  public,  to 
be  produced  by  the  AMA  and  distributed  by 
the  states,  to  be  used  in  mailings  and  as  give- 
away pieces  at  meetings? 

These  are  just  a few  of  the  problems,  as 
we  see  them.  These  must  be  decided  and 
decided  very  soon  so  that  every  physician  in 
the  nation  may  be  informed  and  may  be  en- 
listed in  the  campaign.  Time  is  running  out! 
We  urge  that  our  proposals  be  given  immediate 
attention. 

Sincerely, 

COLORADO  STATE  MEDICAL  SOCIETY. 

Casper  F.  Hegner,  M.D.,  President. 

Ervin  A.  Hinds,  M.D.,  Chairman,  .Board 
of  Trustees. 


48^ 


Rocky  Mountain  Medical  Journal 


GRAPH  OF  MEASLES  INCIDENCE 


The  above  graph  is  based  on  U.  S.  P.  H.  measles 
incidence  figures  for  a ten  year  period. 


— without  fear  of  side  reactions 


There’s  one  sure  way  of  silencing  crying  youngsters  and 
nervous  mamas  who  complain  about  reactions  — specify 
Cutter  Immune  Serum  Globulin— Human.  Successful  results 
with  this  product  are  not  happenstance.  They  come  from: 


1 . The  right  raw  material  — fresh  venous  blood  from  normal  donors. 

2.  The  water-clarity  of  a hemolysis-free  and  non-pyrogenic  product. 

3.  The  concentration  of  160  mgm.  per  cc.  of  gamma  globulin— main- 
tains consistent  globulin  potency  yet  permits  low  volume  adjustable 
dosage: 


For  prevention  — 

0.1  cc.  Immune  Serum  Globulin 
For  modification  — 

0.02  cc.  Immune  Serum  Globulin 


intramuscularly, 
per  pound 
body  weight 


Prepare  now  for  measles’  peak  season  just  ahead.  Notify 
your  pharmacist  the  amount  of  gamma  globulin  you  ex- 
pect to  use-^and  specify  Cutter. 

CUTTER  laboratories  * BERKELEY  10,  CALIFORNIA 


Prevent  or  modify  measles  with  — 

IMMUNE  SERUM 


for;;  JANXJARYj-  1949 1.;  fv  - •?! 


49 


REPORT  OF  DELEGATES  TO  A.M.A. 
REGARDING  INTERIM  SESSION 

On  November  30,  the  House  of  Delegates  of 
the  American  Medical  Association  met  in  St. 
Louis  at  the  1948  Interim  Session. 

As  may  well  be  imagined,  this  meeting  had 
undertones  of  urgency  that  have  seldom  been 
present.  The  threat  of  government  medicine 
after  our  last  national  election  was  bringing 
matters  to  a head  at  an  unprecedented  rate.  The 
American  Medical  Association’s  deliberations 
have  not  been  noted  for  their  rapidity  in  meeting 
the  exigencies  of  the  moment,  except  in  times  of 
great  stress  and  strain.  This  year  the  business  of 
the  House  was  transacted  rapidly  and  there  was 
very  little  bickering  over  small  matters.  There 
were,  of  course,  only  two  matters  of  paramount 
interest  to  come  up  at  this  time.  The  first  was 
embodied  in  a resolution  introduced  by  Dr.  Wil- 
liam Halley  and  which  carried  with  it  the  signa- 
tures of  the  delegations  from  the  following  states: 
Arizona,  California,  Colorado,  Connecticut,  In- 
diana, Kansas,  Michigan,  Minnesota,  Montana, 
Ohio,  Pennsylvania,  Texas,  Utah,  Washington, 
and  Wisconsin. 

The  resolution  read  as  follows: 

WHEREAS,  The  people  of  the  United  States  right- 
fully look  to  the  American  Medical  Association  for 
leadership  in  all  matters  affecting  the  health  of  this 
nation;  and 

WHEREAS,  Much  erroneous  information  has  been 
given  to  the  public  on  the  subject  of  standards,  costs 
and  distribution  of  medical  care  and  it  has  become 
imperative  that  this  widespread  false  propaganda  fa- 
voring governmental  management  of  medical  prac- 
tice be  immediately  contradicted  by  factual  informa- 
tion disseminated  to  all  citizens  of  this  country; 
therefore,  be  it 

RESOLVED,  By  the  House  of  Delegates:  That  the 
American  Medical  Association,  through  its  Board 
of  Trustees,  forthwith  undertake  the  preparation  of 
a dignified  and  wholly  factual  national  publicity 
and  advertising  campaign  to  accomplish  this  purpose, 
the  campaign  to  be  presented  simultaneously  and 
uniformly  in  both  the  national  periodical  press  and, 
by  distribution  to  the  constituent  state  associations 
and  component  county  societies,  in  the  newspapers 
of  the  entire  United  States. 

A number  of  other  resolutions  of  similar  pur- 
pose were  pooled  in  the  Reference  Committee. 
There  was  apparently  no  particular  opposition 
oecause  there  was  a common  realization  that  to 
adequately  present  the  side  of  organized  medi- 
cine to  the  public  would  cost  money. 

The  other  important  questions  were  the  reso- 
lutions concerning  the  approval  of  the  integra- 
tion of  the  Blue  Cross,  Blue  Shield,  and  Asso- 
ciated Medical  Care  Plans  plus  a requested  na- 
tional insurance  set-up.  There  was  a great  deal 
of  contradictory  feeling  in  regard  to  these  pro- 
posals and  considerable  lack  of  understanding  of 
their  scope  and  purpose.  A Reference  Committee 
was  appointed  to  thrash  out  this  question.  The 
Colorado  delegation  and,  I presume,  many  others, 
talked  over  the  proposals  involved  with  both 
proponents  and  opponents  of  this  plan  until  the 
small  hours  of  the  morning  on  two  preceding 
nights.  The  special  Reference  Committee  men- 
tioned sat  from  9 o’clock  in  the  morning  until 


3 o’clock  in  the  afternoon  without  pause  and  then 
brought  in  an  approval  of  the  plan,  with  the  ex- 
eption  of  the  substitution  of  a national  enroll- 
ment agency  in  the  place  of  a national  insurance 
company.  This  compromise  passed  the  House 
promptly  and  unanimously. 

The  mere  statement  that  the  House  of  Dele- 
gates of  the  American  Medical  Association  spon- 
sored these  two  matters  doesn’t  sound  particular- 
ly startling  unless  you  reflect  on  the  fact  that 
they  constitute  a complete  reversal  of  the  think- 
ing on  the  part  of  a great  many  of  the  medical 
profession. 

To  those  of  us  in  the  Rocky  Mountain  states 
and  Michigan,  Texas,  and  California,  who  have 
long  been  aware  of  the  dangers  confronting  us, 
it  was  merely  the  fulfillment  of  a plan  already 
overdue.  Whether  we  are  too  late  in  the  field 
with  too  little,  remains  to  be  seen. 

Your  alternate  enjoyed  the  opportunity  of 
serving  at  this  particular  meeting,  but  found  it 
physically  and  intellectually  impossible  to  fill 
the  shoes  of  Dr.  George  Unfug.  To  me,  the  in- 
teresting side-lights  were  the  decisive  attitude 
of  the  delegates,  the  willingness  to  cooperate,  and 
the  pleasure  of  being  in  on  the  ground  floor 
when  aggressive  and  constructive  legislation  was 
occurring. 

After  listening  to  General  Paul  Hawley  explain 
the  purposes  of  the  national  insurance  set-up  as 
a reinsuring  body  with  a bicameral  control  and 
with  the  power  evenly  divided  between  the  or- 
ganizational officers  and  the  medical  profession, 
many  of  us  lost  our  fear  of  the  scheme.  General 
Hawley  pointed  out  one  other  very  important 
fact.  This  was  that  to  the  best  of  his  knowledge, 
in  no  country  where  socialized  medicine  had 
taken  over  were  the  previously  established 
health  organizations  assimilated  by  the  govern- 
ment. One  of  the  objections  to  such  plans  which 
had  previously  alarmed  me,  was  that  if  such  an 
agency  should  fail  it  could  easily  be  taken  over 
by  the  government  and  the  whole  voluntary 
structure  be  so  engulfed.  However,  this  seems 
not  to  have  occurred.  The  prepayment  plans  of 
other  countries  have  been  wrecked  but  not 
assimilated  because  they  were  obviously  not  able 
to  compete  against  at  least  partially  tax  sup- 
ported government  measures,  either  in  their 
extent  of  care  or  the  cost  of  membership. 

I believe  this  issue  will  be  raised  again  at  the 
next  regular  meeting  of  the  American  Medical 
Association  and  that  every  member  of  the  State 
Society  should  inform  himself  on  this  proposition 
so  that  the  delegates  at  the  next  meeting  may 
know  the  will  of  the  members. 

HERMAN  C.  GRAVES,  M.D., 
(Alternate  for  Delegate 
George  A.  Unfug,  M.D.),  for 
himself  and  WILLIAM  H. 
HALLEY,  M.D. 


50 


Rocky  Mouiitain  Medical  Journal 


even 


after 


40 


a woman's  work  is  never  done... 


Dishes,  dustpans,  a thousand  details . . . the  three  "d's"  of 
household  drudgery. ..  ore  challenge  enough  at  any  ago, 
but  a stock  of  dinner  dishes  con  look  mountain  high  to  the 
woman  in  the  menopause.  This  is  a disquieting  aspect  of  tho 
doily  life  of  such  patients  that  physicians  con  bring  into  proper 
perspective  with  "Premor/n/^ 

'"'^Premorin''  therapy,  it  has  been  found,  has  in  it  a certain  "plus" 
that  produces  a sense  of  well-being  in  most  women.  "Premarin"  quickly 
relieves  the  symptoms  of  the  menopause.  It  is  orally  active,  and  is  rapidly 
absorbed  from  the  intestine. 


While  sodium  estrone  sulfate  is  the  principal  estrogen 

in  "Premarin,"  other  equine  estrogens estradiol, 

equilin,  equilenin,  hippulin  . . . are  probably  also  pres- 
ent in  varying  amounts  as  water  soluble  conjugates. 


ESTROGENIC  SUBSTANCES  (WATER  SOLUBLE) 
also  known  as  CONJUGATED  ESTROGENS  (equine) 


Ayerst,  McKenna  & Harrison  Limited  22  East  40tli  Street,  New  York  1 6,  New  York 


-1901 


for  January,  1949 


51 


NATIONAL  CONFERENCE  ON 
MEDICAL  SERVICE 

PRELIMINARY  PROGRAM 

Palmer  House,  Chicago,  Illinois,  February  6,  1949 

9:00  A.M.  Registration:  Foyer  of  Red  Lacquer 
Room,  Fourth  Floor,  Palmer  House. 

9:30  A.M.  Call  to  Order. 

Appointment  of  Committees. 

Address  of  the  President — E.  F.  Sladek, 
M.D.,  Traverse  City,  Michigan. 

9:45  A.M.  Legalized  Medical  Research. 

Medical  Problems — Chris  J.  D.  Zarafonetis, 
M.D.,  University  of  Michigan. 

Legal  Problems — George  Wakerlin,  M.D., 
University  of  Illinois. 

10:25  A.M.  Title  to  be  announced — James  R.  Mc- 
Vay,  M.D.,  Kansas  City,  Missouri;  Chairman, 
Council  on  Medical  Service,  A.M.A. 

10:50  A.M.  Progress  of  the  World  Health  Or- 
ganization— Frank  Calderone,  M.D.,  Director, 
American  Office,  World  Health  Organization. 

11:05  A.M.  Progress  of  the  World  Medical  Asso- 
ciation— Creighton  Barker,  M.D.,  Executive 
Secretary,  Connecticut  State  Medical  Asso- 
ciation. 

11:20  A.M.  Medical  Program  of  the  United  Mine 
Workers  of  America  V/elfare  and  Retirement 
Fund — Warren  F.  Draper,  M.D.,  Executive 
Medical  Director. 

11:40  A.M.  Discussion  Period. 

12:15  P.M.  Subscription  Luncheon. 

1:00  P.M.  The  A.M.A.  Puts  on  Its  Fighting  Togs 
— Speaker  to  be  announced. 

2:00  P.M.  What’s  Happening  in  Washington  This 
Week — James  D.  Boyle,  United  Public  Health 
League. 

2:30  P.M.  Discussion.  To  be  opened  by  Joseph 
S.  Lawrence,  M.D.,  Director  of  the  Washing- 
ton Office,  A.M.A. 

2:40  P.M.  Panel  Discussion  on  Postgraduate 
Education  of  the  Doctor. 

(a)  Responsibility  of  Medical  Schools  in 
Continued  Postgraduate  Education  of 
the  Doctor — George  N.  Aagaard,  Di- 


rector of  Postgraduate  Medical  Ed- 
ucation Program,  University  of  Min- 
nesota. 

(b)  Function  of  the  State  Medical  Society 
in  Postgraduate  Work— C.  W.  Smith, 
M.D.,  Harrisburg,  Pennsylvania. 

(c)  Survey  Findings  on  Specialization  in 
Colorado — Harold  I.  Goldman,  M.D., 
Denver,  Colorado. 

3:40  P.M.  Discussion  Period. 

4:00  P.M.  Can  Corporations  Such  as  Hospitals 
Legally  Engage  in  the  Practice  of  Medicine? 
— Wilbur  Bailey,  M.D.,  Los  Angeles,  Cali- 
fornia. 

4:30  P.M.  Report  of  Committees  and  Election 
of  Officers. 

5:00  P.M.  Adjournment. 

(Note:  All  papers  will  begin  exactly  as  sched- 
uled. No  speaker  will  be  allowed  to  speak  over- 
time.) 


AMERICAN  BOARD  OF  OBSTETRICS  AND 
GYNECOLOGY,  INC 

The  next  written  examination  and  review  of 
case  histories  (Part  I)  for  all  candidates  will  be 
held  in  various  cities  of  the  United  States  and 
Canada  on  Friday,  February  4,  1949. 

Arrangements  will  be  made  so  far  as  is  possible 
for  candidates  to  take  the  Part  I examination 
(written  paper  and  submission  of  case  records) 
at  places  convenient  for  them.  Candidates  who 
successfully  complete  the  Part  I examination 
proceed  automatically  to  the  Part  II  examina- 
tion to  be  held  May  8 to  14,  inclusive,  1949,  at 
the  Hotel  Shoreland,  Chicago,  Illinois.  Notice 
of  the  exact  time  and  place  of  the  Part  I and 
Part  H examinations  will  be  sent  all  candidates 
well  in  advance  of  the  examination  date.  Clos- 
ing date  for  reapplication  for  admission  to  the 
Part  H examinations  will  be  April  1,  1949. 

New  bulletins  are  now  available  for  distribu- 
tion upon  application  and  give  details  of  all 
changes  in  Board  requirements  and  regulations 
made  at  the  annual  meeting  of  the  Board  held 
in  Washington,  D.  C.,  May  16  to  May  22,  1948. 
These  relate  both  to  candidates  and  to  hospitals 
conducting  residency  service  for  training. 

Application  forms  and  bulletins  are  sent  upon 
request  made  to  American  Board  of  Obstetrics 
and  Gynecology,  Inc.,  1015  Highland  Building, 
Pittsburgh  6,  Pennsylvania. 


The  typical  congenital,  anteflexed  uterus  is  a 
small  uterus  with  a long,  conical  cervix. 


52 


Rocky  Mountain  Mepical  Journal 


No  milk  laboratorY 
in  the  world  more  modern! 


This  is  the  new  three  and  one-half 
million  dollar  Sturgis  (Michigan) 
Similac  Laboratory.  This  additional 
capacity  was  made  necessary  by  your 
confidence  in  Similac,  and  your  in- 
creasing use  of  the  product  in  your 
infant  feeding  practice. 

The  years  of  basic  and  clinical  research 
which  preceded  the  introduction  of 
Similac,  established  with  us  a habit  for 

m & R DIETETIC  LABORATORIES, 


research.  And  the  many  years  of  accept- 
ance which  Similac  has  enjoyed  since 
its  introduction,  make  us  fully  con- 
scious that  continuing  research  is  an 
obligation. 

In  our  present  resources  to  fulfill  this 
obligation  we  take  a pardonable  pride. 

But  our  greatest  pride  will  continue  to 
be  the  high  esteem  in  which  Similac  is 
held  by  Doctors  everywhere. 

INC.  • COLUMBUS  16,  OHIO 


> ■ _ ...  - ^mmmi  ; 


for  January,  1949 


53 


Dr.  Sudan  Hails 
His  Successor 

The  American  Medical  Association’s  first 
“family  doctor  of  the  year”  was  quick  to  con- 
gratulate his  successor  on  November  20  when 
the  AMA  House  of  Delegates  in  session  at  St. 
Louis  voted  the  second  annual  general  practi- 
tioner award  to  Dr.  W.  L.  Pressly  of  Due  West, 
South  Carolina.  A few  hours  after  the  AMA 
action,  Dr.  A.  C.  Sudan  sent  the  following  tele- 
gram to  Dr.  Pressly: 

“Regret  deeply  I am  unable  to  shake  your 
hand  while  extending  sincere  congratulations 
and  assuring  you  I concur  most  heartily  with 
the  American  Medical  Association  delegates  in 
their  designation  of  you  as  recipient  of  the 
General  Practitioner  award.  By  honoring  you 
the  American  Medical  Association  brings  honor 
to  itself  and  a great  profession.” 

Dr.  Sudan,  chosen  at  Cleveland,  Ohio,  a year 
ago  by  the  American  Medical  Association  to  re- 
ceive the  newly  created  award,  was  unable  to 
attend  the  interim  session  at  St.  Louis. 


Obituaries 

GEORGE  B.  GILMORE 

Dr.  George  Benjamin  Gilmore  of  Colorado 
Springs,  Colorado,  died  on  November  28,  1948, 
at  the  age  of  67. 

Born  in  Lawrence,  Kansas,  in  1881,  Dr.  Gil- 
more attended  Northwestern  University  Medical 
School,  graduating  in  1903.  He  was  licensed  in 
Colorado  the  following  year. 

A member  of  the  El  Paso  County  and  Colorado 
State  Medical  Societies,  Dr.  Gilmore  had  always 
shown  a keen  interest  in  medical  and  civic 
affairs.  Long  a practicing  physician,  his  passing 
will  be  mourned  by  the  many  who  had  come  to 
know  and  respect  him. 


BROOKS  D.  GOOD 

Dr.  Brooks  D.  Good,  Managing  Director  and 
President  of  the  Cragmoor  Sanatorium  Founda- 
tion of  Colorado  Springs,  died  on  November  4, 
1948,  at  the  age  of  52. 

Born  in  Abbey ville,  Mississippi,  on  April  1, 
1896,  Dr.  Good  received  his  medical  education  at 
the  University  of  Mississippi  and  Tulane.  He 
interned  at  Charity  Hospital  in  Vicksburg,  Mis- 
sissippi. 

Dr.  Good  had  been  associated  with  the  sana- 
torium since  1923,  becoming  its  head  in  October, 
1947. 


DALE  O.  GROVES 

Dr.  Dale  O.  Groves  of  Colorado  Springs  died 
on  October  12,  1948,  at  the  agex)f  67. 

Born  in  Corning,  Kansas,  on  August  22,  1881, 
Dr.  Groves  graduated  from  the  Central  Medical 
College  of  St.  Louis,  Missouri,  in  1903.  He  was 
licensed  to  practice  in  Colorado  in  1905  and  the 
next  year  opened  his  office  in  Calhan,  Colorado. 
He  continued  practice  in  Calhan  until  1927,  at 
which  time  he  moved  to  Colorado  Springs. 

Dr.  Groves  was  a member  of  the  El  Paso 
County  and  Colorado  State  Medical  Socities.  He 


was  elected  to  membership  in  1931  and  in  1941 
became  an  honorary  member. 

Dr.  Groves’  passing  will  be  mourned  by,  the 
many  who  had  come  to  know  him  during  his 
years  of  active  practice. 


DAVID  HENRY  LAWRENCE 

Dr.  David  Henry  Lawrence,  Jr.,  of  Denver, 
died  on  November  30,  1948,  at  the  age  of  41. 

Born  in  Galveston,  Texas,  on  January  12,  1907, 
Dr.  Lawrence  received  his  premedical  education 
at  the  University  of  Texas,  graduating  with  a 
Bachelor  of  Arts  degree  in  1928.  He  then  at- 
tended the  University  of  Colorado  School  of 
Medicine,  graduating  in  1932. 

Dr.  Lawrence  interned  at  St.  Luke’s  Hospital 
in  Denver,  following  which  he  had  a surgical 
residency  at  Colorado  General  and  Denver  Gen- 
eral Hospitals.  He  was  elected  to  membership 
in  the  Denver  County  and  Colorado  State  Medi- 
cal Societies  in  October,  1934.  Dr.  Lawrence 
was  a diplomate  of  the  American  Board  of 
Surgery. 


ROBERT  S.  LILLA 

Dr.  Robert  S.  Lilia  of  Nucla,  Colorado,  died 
on  November  1,  1948,  at  the  age  of  50. 

Born  in  Webster,  Massachusetts,  on  December 
25,  1898,  Dr.  Lilia  attended  Notre  Dame  for  his 
pre-medical  education  and  graduated  in  medicine 
from  Jefferson  Medical  College  in  Philadelphia. 

Dr.  Lilia  served  for  a number  of  years  in  the 
United  States  Army.  When  his  health  failed  he 
came  to  Cortez,  Colorado,  and  later  moved  to 
Nucla.  It  was  in  Nucla  he  had  practiced  the 
past  six  years. 

Dr.  Lilia  was  a member  of  the  San  Juan 
County  and  Colorado  State  Medical  Societies. 
Widely  known  throughout  Southwestern  Colo- 
rado, he  will  be  greatly  missed  by  his  many 
patients  and  friends. 


WILLIAM  F.  SINGER 

Dr.  William  Frederic  Singer  of  Pueblo,  Colo- 
rado, died  on  October  25,  1948,  at  the  age  bf  78. 

Born  in  New  York  in  1869,  Dr.  Singer  gradu- 
ated from  Syracuse  University  College  of  Medi- 
cine in  1896.  He  obtained  his  license  to  practice 
in  Colorado  the  same  year,  and  a short  time  later 
was  elected  to  membership  in  the  Pueblo  County 
Medical  Society. 

Having  practiced  in  southern  Colorado  for 
fifty-four  years.  Dr.  Singer  was  widely  known 
throughout  the  area.  His  death  will  be  mourned 
by  his  many  friends  in  and  out  of  the  profession. 


ROBERT  P.  E.  STARR 

Dr.  Ellis  Starr  died  in  Denver  on  November 
10,  1948,  at  the  age  of  67,  following  a two  months 
illness. 

Born  in  Glasgow,  Kentucky,  on  November  27, 
1881,  Dr.  Starr  graduated  from  the  University  of 
Louisville  Medical  College.  During  his  more  than 
thirty  years  of  active  practice  in  Kansas  he 
limited  his  work  to  eye,  ear,  nose  and  throat. 
Two  years  ago  Dr.  Starr  retired  and  moved  to 
Denver. 

He  was  a member  of  the  American  Medical 
Association  and  since  moving  to  Denver  became 
affiliated  with  the  Denver  County  and  Colorado 
State  Medical  Societies. 


54 


Rocky  Mountain  Medical  Journal 


Announcing... 

DIHYDROSTREPTOMYCIN 

A New,  Dramatic  Advance  In  Antibiotic  Therapy 


* Less  Frequent  Allergie  Manifestations 

* Unsurpassed  Purity 

* Undiminished  Antibacterial  Activity  against  Mycobac- 
terium tubercufos/s 

Dihydrostreptomycin  Merck  is  a new,  highly 
purified  antibiotic,  chemically  distinct  from 
streptomycin,  and  characterized  by  greatly  re- 
duced neiurotoxicity. 


Allergic  manifestations  due  to  dihydrostrep- 
tomycin therapy  are  rare,  and  no  local  skin  irri- 
tation or  other  allergic  phenomena  have  been 
reported  thus  far  among  personnel  who  fre- 
quently handle  this  drug. 

Dihydrostreptomycin  Merck  and  Strepto- 
mycin Calcium  Chloride  Complex  Merck  may 
be  used  interchangeably  in  the  treatment  of 
tuberculosis. 


S'- 

-■ 


DIHYDROSTREPTOMYCIN 

MERCK 


(supplied  as  the  sulfate  or  the  hydrochloride) 


MERCK  & CO.,  Inc.  RAHWAY,  N.  J. 


for  January,  1949 


Denver  Children  s Hospital 
Summer  Clinics 

The  professional  staff  of  The  Children’s  Hos- 
pital of  Denver  is  offering  three  days  of  clinics, 
demonstrations,  seminars  and  round  table  dis- 
cussions of  the  current  methods  of  diagnosis  and 
treatment  of  diseases  of  infants  and  children. 
The  clinics  will  be  held  at  Children’s  Hospital 
on  June  29,  30  and  July  1,  1949.  All  of  the 
specialty  groups  of  the  staff  will  participate  in 
the  program  which  is  designed  for  the  general 
practititioner  and  all  physicians  interested  in 
children’s  diseases.  Three  guest  speakers  whose 
work  is  recognized  throughout  the  world  will 
augment  the  staff  during  the  three-day  session. 
Dr.  Mitchell  I.  Rubin,  Medical  Director  of  the 
Children’s  Hospital  of  Buffalo  and  Professor  of 
Pediatrics  at  the  University  of  Buffalo,  will 
participate  in  medical  subjects.  Dr.  Wolf  Zuel- 
zer, Pathologist  and  Director  of  Pediatric  Re- 
search of  the  Children’s  Hospital  of  Michigan, 
v/ill  take  a leading  part  in  the  discussion  of 
hematological  and  pathological  material.  Dr. 
Willis  Potts,  Surgeon-in-Chief  of  the  Children’s 
Memorial  Hospital  in  Chicago,  is  the  visitor  who 
will  have  a major  role  in  the  discussion  of 
surgical  subjects. 

Each  of  the  guest  speakers  is  well  known  in 
a special  field — such  as  nephritis  and  nephrosis 
for  Dr.  Rubin,  blood  diseases  for  Dr.  Zuelzer  and 
cardiac  surgery  for  Dr.  Potts — but,  in  addition 
to  presentation  of  these  subjects,  all  are  emi- 
nently qualified  and  will  participate  in  the  broad 
fields  of  the  specialties  which  they  represent. 

Registration  will  be  limited  to  seventy-five. 
Applications  should  be  addressed  to  the  Chair- 
man of  the  Summer  Clinics  Committee,  Chil- 
dren’s Hospital,  Denver,  Colorado. 


The  Colorado  Society  of  Anesthesiologists  held 
a dinner  meeting  at  the  University  Club,  Denver, 
on  November  26.  Despite  bad  weather  condi- 
tions, members  from  Pueblo,  Colorado  Springs 
and  Greeley  attended.  Dr.  C.  Walter  Metz  gave 
a report  of  the  transactions  of  the  annual  meet- 
ing of  the  American  Society  of  Anesthesiologists 
which  was  held  in  St.  Louis  in  November.  Dr. 
Philip  Lief,  Associate  Professor  of  Anesthesiology 
at  the  University  of  Colorado  Medical  Center, 
spoke  on  “The  Administration  of  Procaine  Intra- 
venously.” Dr.  William  Draper,  Professor  of 
Pharmacology,  was  made  the  first  honorary 
member  of  the  Society. 


PRESIDENT-ELECT  AMERICAN  SOCIETY  OF 
CLINICAL  PATHOLOGY 

At  the  twenty-seventh  annual  meeting  of  the 
American  Society  of  Clinical  Pathologists,  held 
in  Chicago  on  October  14,  Dr.  James  B.  Mc- 
Naught,  Professor  of  Pathology  at  the  University 
of  Colorado,  was  elected  President-Elect  of  the 
Society.  His  term  of  office  will  begin  in  Oc- 
tober of  1949. 


Auxiliary 

MEDICAL  AUXILIARY  NOTES 

At  the  recent  Chicago  Conference  of  State 
Auxiliary  Presidents  and  Presidents-elect  many 
intensely  interesting  projects  were  described  and 
discussed.  Familiar  and  expected  were  the  ac- 
tivities promoting  Hygeia  and  wider  acquaint- 
ance and  friendliness  among  doctors’  wives;  in- 
spiring and  different  were  the  activities  promot- 
ing nurse  recruitment,  health  and  sex  education 
and  better  cooperation  between  medical  societies 
and  auxiliaries. 

The  activities  regarding  nurse  recruitment 
were  varied.  There  were  gifts  and  plans  to  fur- 
nish recreation  for  student  nurses,  scholarships, 
and  meetings  with  High  School  girls  where  a 
nurse  and  a doctor  spoke. 

Some  State  Auxiliaries,  particularly  Michigan 
and  Indiana,  had  sponsored  district  health  insti- 
tutes, drawing  together  private  and  public  health 
physicians  and  all  other  health-minded  groups  to 
consider  local  needs  and  resources.  These  meet- 
ings had  lasted  for  one  or  two  days  and  had  been 
considered  highly  effective  in  promoting  under- 
standing and  action. 

The  Oregon  group  had  worked  to  educate  the 
public  about  approved  prepayment  medical  serv- 
ice plans,  thus  offering  a constructive  “yes”  in- 
stead of  only  a belligerent  “no.”  This  was  time- 
ly because  their  State  Society  is  now  under  suit 
by  the  United  States  Government  for  restrictive 
practices. 

These  same  Oregon  Medical  Wives,  at  the  re- 
quest of  their  Medical  Society,  had  arranged  for 
each  P.T.A.  in  the  state  to  see  the  sex  education 
film,  “Human  Growth,”  which  doctors  had  helped 
to  develop  and  finance,  in  cooperation  with  edu- 
cators and  technical  experts.  This  film  has  had 
such  an  immediate  approval  that  the  same  group 
is  now  developing  a film  for  use  in  the  lower 
grades.  Of  course,  the  A.M.A.  for  many  years 
has  offered  fine  pamphlets,  articles  in  Hygeia, 
and  has  recommended  films  on  the  same  subject. 

Cooperation  between  State  Medical  Societies 
and  their  Auxiliaries  ranged  from  annual  grants 
up  to  $1,000,  printing  the  monthly  news  bulle- 
tin, offering  doctors  as  speakers  to  lay  groups, 
and  (hold  onto  your  chairs)  representatives 
from  the  Auxiliary  meeting  regularly  with  the 
Medical  Board  and  Public  Relations  Commit- 
tee! 

It  would  seem  that  increased  understanding 
and  teamwork  will  be  necessary  to  carry  out  the 
program  which  our  Public  Relations  Department 
is  advocating.  This  program  includes  such  rec- 
ommendations as: 

1.  Establishing  and  publicizing  public  health 
facilities. 

2.  Better  school  health  services. 

3.  Rural  health  education. 

4.  Community  health  councils. 

5.  Prepayment  medical  service  plans.  - 

The  Colorado  Medical  Auxiliary  recognizes 

the  challenge,  in  such  a program  and  invites  the 
thinking  and  financial  help  of  the  members  of 
the  Colorado  Medical  Society. 

Your  President, 

CAROLINE  G.  WEARNER. 

(Mrs.  A.  A.) 


SOUTHWEST  ALLERGY  FORUM 

For  your  information  the  Southwest  Allergy 
Forum  will  meet  in  El  Paso,  April  4 and  5.  1949. 


56 


Rocky  Mountain  Medical  Journai. 


CJB^P  SUPPORTS  /or  the  LOW  BACK 


Discussing  the  general  treat- 
ment of  low  back  pain  in  a 
recent  article,  an  orthopedic 
surgeon*  comments  on  sup- 
ports (among  other  items)  as 
follows:  “The  second  remedy 
tried  by  time  is  further  rest 
provided  by  support  after  the 
patient  gets  out  of  bed.  Various 
corsets,  braces,  and  casts  have 
been  used  and  the  one  criterion 
is  that  they  be  well  fitted  and 
do  the  work  intended.” 


The  Camp  lumbosacral, support  (illustrated)  fits  down  over  the  gluteal 
region  and  restricts  the  motion  of  the  pelvic  and  lumbar  joints.  The 
lower  adjustment  following  about  the  major  portion  of  the  pelvic  girdle 
is  a prime  factor  in  relieving  the  weight-bearing  joints  of  the  lower  spine. 

The  support  lends  itself  readily  to  reinforcement  with  the  Gamp  spinal 
brace  (illustrated).  The  brace  is  made  of  spring  steel  and  comes  in 
varying  lengths  — twelve,  fourteen,  sixteen,  and  eighteen  inch  lengths. 
Aluminum  uprights,  and  pads  are  also  provided  by  Gamp  for  reinforce- 
ment of  orthopedic  supports. 

Gamp  fitters  are  trained  and  supervised  by  nurses  and  instructors. 
*Hugh  T.  Jones,  M.D. 

Low  Back  Pain  from  the  Orthopedic  Standpoint 
California  Medicine 
■V  Vol.  68,  February,  1948 


S.  H.  GAMP  and  COMPANY  • JACKSON,  MICHIGAN 

World’s  Largest  Manufacturers  of  Scientific  Supports 
Offices  in  New  York  • Chicago  • Windsor,  Ontario  • London,  England 


for  January,  1949 


57 


COLORADO 

UTAH 

Medical  School  Notes 

State  Medical  Association 

Research  funds  have  doubled  in  the  past  year 
at  the  University  of  Colorado  Medical  Center. 
The  Center  received  more  than  $250,000  from 
November  1,  1947,  to  October  31,  1948,  and  131 
major  projects  are  now  under  way  at  the  Center. 

The  bulk  of  support  has  been  received  from 
government  agencies,  with  a total  of  $147,518.48 
received  during  the  nine-month  period,  October 
1,  1947,  to  June  30,  1948.  Grants-in-aid  from 
private  sources  during  that  period  totaled  $36,- 
953.15.  These  totals  do  not  include  funds  re- 
ceived from  the  Child  Research  Council. 

One  of  the  major  projects  set  up  last  year  is 
the  cardiovascular  pulmonary  laboratory,  spon- 
sored by  the  Henry  Strong  Denison  foundation, 
Ruth  Porter  Waring,  and  the  Rockefeller  Foun- 
dation. Purpose  of  the  laboratory,  organized 
last  November  as  a joint  effort  of  the  depart- 
ments of  medicine,  physiology,  pharmacology, 
and  surgery,  is  to  serve  as  a functional  unit  for 
diagnosis  and  research  in  the  cardiovascular  and 
pulmonary  fields. 

Eleven  major  government  projects  are  spon- 
sored by  the  U.  S.  Public  Health  Service  and 
the  Army  and  Navy. 


The  University  of  Colorado  announces  the 
establishment  of  a department  of  biophysics  at 
the  University  Medical  Center  in  Denver.  A 
graduate  program  leading  to  the  Ph.D.  degree 
in  biophysics  will  be  offered. 

Courses  of  instruction  include  training  in  the 
use  of  radioactive  isotopes  in  biology,  the  inter- 
actions of  ionizing  radiations  with  living  systems, 
study  of  the  behavior  of  biologically  important 
macromolecules,  and  bio-statistics.  The  depart- 
ment will  also  take  part  in  the  Atomic  Energy 
Commission’s  program  for  postdoctoral  training 
in  biophysics. 

A research  program  centering  about  cellular 
growth  processes,  and  study  of  the  radiation 
chemistry  of  artificially-induced  mutations  is 
now  being  set  up  . Dr.  Theodore  Puck,  formerly 
of  the  departments  of  medicine  and  biochemistry 
of  the  University  of  Chicago,  has  been  named 
professor  and  head  of  the  department. 


The  new  drug,  streptomycin,  has  proved  more 
effective  than  any  other  yet  discovered  in  con- 
trolling progressive  tuberculosis  in  the  lungs  and 
other  organs  of  the  body.  There  are  certain 
limitations  and  disadvantages  in  its  use,  and  it 
is  not  expected  that  streptomycin  will  replace 
conventional  methods  of  treatment,  such  as  bed 
rest  and  the  mechanical  measures,  like  pneu- 
mothorax, which  selectively  put  diseased  tissue 
at  rest.  It  has  appeared  so  promising,  how- 
ever, that  its  potentialities  must  be  thoroughly 
explored.  More  money  is  being  spent  on  strep- 
tomycin research  in  the  United  States  today 
than  on  any  other  phase  of  tuberculosis  re- 
search.— Edmond  R.  Long,  M.D.,  Chairman  Comm, 
on  Tuberc.  Research,  NTA. 


Obituaries 

LOUISE  E.  BOUTELLE 

Louise  E.  Boutelle,  M.D.,  passed  away  quite 
unexpectedly  of  a heart  attack  on  November  3 
at  the  age  of  64.  She  spent  her  early  life  in  her 
native  state,  Minnesota,  and  qualified  for  teach- 
ing school,  which  profession  she  followed  until 
she  took  up  the  study  of  medicine  at  the  Uni- 
versity of  Minnesota  Medical  School  where  she 
graduated  in  1916.  After  her  graduation  she 
spent  two  years  in  Providence,  R.  I.,  doing 
special  study  and  training  in  psychiatry  under 
Dr.  Arthur  Ruggles  and  spent  the  remaining 
twenty  years  of  her  life  in  the  field  of  psychiatry, 
wherein  her  services  were  much  in  demand  as 
is  evidenced  by  her  being  asked  to  take  over 
the  position  of  Assistant  Superintendent  of  the 
Cherokee  Hospital  at  Cherokee,  Iowa.  She  had 
the  spirit  of  service  so  deeply  ingrained  in  her 
makeup  that  nothing  appealed  to  her  unless  it 
gave  opportunity  to  serve  her  fellow  humans. 
She  was  never  married,  yet  she  took  on  the 
responsibilities  of  parenthood  by  adopting  and 
“raising”  four  children,  two  girls  and  two  boys. 
Her  unassuming  attitude  was  such  that  one  re- 
quired close  association  with  her  to  find  her 
valuable  qualities  and  the  perfection  she  attained 
in  her  special  field  of  psychiatry.  The  message 
she  has  left  with  us  by  the  ideals  she  established 
in  her  manner  of  living  is  a challenge  to  any 
aspiring  individual  and  we  have  great  reason 
here  in  Utah  to  mourn  her  loss. 


FRANK  M.  McHUGH 

Frank  M.  McHugh,  well-known  Salt  Lake 
City  physician,  died  Sunday,  September  10,  1948, 
of  coronary  thrombosis. 

Dr.  McHugh  was  born  in  Louisville,  Ky.,  in 
1886.  He  was  a graduate  of  the  Louisville 
Medical  School,  class  of  1908.  He  interned  at 
Louisville  City  Hospital  and  for  one  year  was 
assistant  to  Dr.  Joseph  Beck  in  North  Chicago 
Hospital.  For  five  years  prior  to  graduating 
from  medical  school  he  was  physical  education 
director  at  the  Young  Men’s  Hebrew  Association 
in  Louisville,  Kentucky.  During  World  War  I, 
Dr.  McHugh  served  as  a captain  in  the  Medical 
Corps  of  the  American  Expeditionary  Force.  He 
was  assigned  to  Base  Hospital  No.  96  at  Beaune, 
France,  and  later  at  Base  Hospital  No.  69  in 
Savenay,  France,  in  charge  of  the  eye,  ear,  nose 
and  throat  clinic.  From  1917  to  1928  he  was 
affiliated  with  the  Intermountain  Clinic  in  Salt 
Lake  City  as  head  specialist.  He  studied  diseases 
of  the  eye  during  1926  at  Vienna,  Austria. 

Dr.  McHugh  was  a member  of  the  Salt  Lake 
City  Board  of  Health  for  twenty  years.  He  was 
a member  of  Mt.  Moriah  Lodge  F.  and  A.  M., 
Utah  Consistory  No.  1,  A.  and  A.  S.  R.,  the 
Shrine,  Salt  Lake  Kiwanis  Club  and  a charter 
member  of  Speech  Readers’  Club.  He  was  a 
member  of  the  Salt  Lake  County  Medical  So- 
ciety, Utah  State  Medical  Association  and  the 
American  Medical  Association.  He  was  a Past 
President  of  the  Utah  State  Medical  Association, 


58 


Rocky  Mountain  Medical  Journal 


''SMOKE  LESS.. .OR 
CHANGE  TO  PHILIP  MORRIS" 

...  if  smokers  are  affected  by  the  irritant 
properties  of  cigarette  smoke 


Sometimes  physicians  may  advise  "Don't  smoke 
at  all."  But  even  where  that  is  indicated,  how  many  patients 
will  forego  the  pleasure  of  smoking? 


For  such  patients,  as  for  all  smokers,  the  choice  should  be 
the  least  irritating  of  cigarettes.  Many  throat  specialists  suggest 
Philip  Morris*  because  they  are  convinced  from  published  studies**,  as  well 
as  their  own  observations  that  Philip  Morris  alone,  of  all  the 
leading  cigarettes,  is  by  far  the  least  irritating  to  the 
sensitive  tissues  of  the  nose  and  throat. 


Perhaps  you  too  will  find  it  advisable  to  suggest  to  your  patients 
who  smoke  . . ."Change  to  Philip  Morris." 


MORRIS 


Philip  Morris  & Co.,  Ltd.,  Inc.,  119  Fifth  Avenue,  N.  Y. 


IF  YOU  SMQKE  A PIPE... We  suggest  an 
unusually  fine  new  blend —Country  Doctor 
Pipe  Mixture.  Made  by  the  same  process  as 
used  in  the  manufacture  of  Philip  Morris 
Cigarettes. 


*Completely  documented  evidence  on  tile. 

**Reprints  on  Request: 

Laryngoscope,  Feb.  1935,  Vol.  XLV,  No.  2,  149-154; 
Laryngoscope,  Jan.  1937,  Vol.  XLVIl,  No.  I,  58-60;  Proc. 
Soc.  Exp.  Biol,  and  Med.,  1934,  32-241;  N.  Y.  Stale  Journ. 
Med.,  Vol.  35,  6-1-25,  No.  II,  590-592. 


for  January,  1949 


59 


the  Salt  Lake  County  Medical  Society  and  the 
Utah  Oto-Ophthalmological  Society. 

Dr.  McHugh  is  survived  by  his  wife;  two 
daughters,  Dr.  Olivia  McHugh,  Salt  Lake  City, 
and  Louise  McHugh,  Cambridge,  Mass.,  and  one 
sister,  Mrs.  Ernest  Preston,  Louisville,  Ky. 


W.  R.  WHERRITT 

Dr.  W.  R.  Wherritt,  prominent  Heber  physician 
and  surgeon,  died  at  his  home  in  Heber  City, 
Utah,  Monday,  November  1,  1948,  at  8:00  a.m., 
of  a heart  ailment.  Dr.  Wherritt  had  been  a 
practicing  physician  in  Heber  for  more  than, 
forty-eight  years.  He  was  born  in  Pleasant  Hill, 
Mo.,  December  16,  1875,  and  graduated  from  a 
school  of  pharmacy  and  was  a druggist  for  sev- 
eral years  before  studying  to  become  a physician. 
He  was  graduated  from  Kansas  City  Medical 
College  in  1897  and  soon  afterwards  began  prac- 
ticing at  Cripple  Creek,  Colo.  He  came  to 
Heber  in  1900.  He  had  been  City  and  Wasatch 
County  physician  most  of  the  time  since  he  be- 
gan practicing  here.  He  v/as  a member  of  Story 
Lodge,  No.  4,  F.  and  A.  M.,  Provo;  was  a 32nd 
degree  Mason  and  was  a member  of  El  Kalah 
Temple,  A.A.N.O.M.C.,  Salt  Lake  City.  Surviv- 
ing are  a son.  Dr.  J.  Russell  Wherritt,  Salt  Lake 
City;  a daughter,  Mrs.  Lois  Todd,  Heber;  a 
brother.  Dr.  Charles  F.  Wherritt,  Kamas,  Sum- 
mit County,  and  six  grandchildren. 


UTAH 

Medical  School  Notes 


Dr.  C.  H.  Hardin  Branch,  formerly  Executive 
Director  of  the  Institute  of  Pennsylvania  Hos- 
pital, at  Philadelphia,  has  been  appointed  Pro- 
fessor and  Head  of  the  newly-formed  Depart- 
ment of  Psychiatry  at  the  University  of  Utah 
College  of  Medicine.  Dr.  Branch  assumed  his 
duties  October  1,  1948. 

Dr.  Edwin  A.  Lawrence  has  been  named  Pro- 
fessor of  Surgery  (Oncology),  and  Director  of 
the  Cancer  Teaching  Program  in  the  College  of 
Medicine.  Dr.  Lawrence  was  formerly  director 
of  the  Tumor  Clinic  at  Yale  University  and 
more  recently  has  been  in  private  practice  in 
thoracic  surgery  in  Salt  Lake  City. 


UROLOGY  AWARD 

The  American  Urological  Association  offers  an 
annual  award  of  $1,000.00  (first  prize  of  $500.00, 
second  prize  $300.00  and  third  prize  $200.00)  for 
essays  on  the  result  of  some  clinical  or  laboratory 
research  in  urology.  Competition  shall  be  lim- 
ited to  urologists  who  have  been  in  such  specific 
practice  for  not  more  than  five  years  and  to 
residents  in  urology  in  recognized  hosptials.  The 
first  prize  essay  will  appear  on  the  program 
of  the  forthcoming  meeting  of  the  American 
Urological  Association,  to  be  held  at  the  Bilt- 
more  Hotel  in  Los  Angeles,  May  16-19,  1949.  For 
full  particulars  write  the  Secretary,  Dr.  Thomas 
D.  Moore,  899  Madison  Avenue,  Memphis  3, 
Tennessee.  Essays  must  be  in  his  hands  before 
February  15,  1949. 


WYOMtNC 

State  Medical  Society 


The  1949  Meeting 

This  is  to  be  held  at  Casper.  The  Natrona 
County  Medical  Society  at  its  regular  Friday 
limcheon  on  December  4,  1948,  set  the  meeting 
dates  at  September  12-14,  1949,  approximately 
half  way  between  the  meetings  of  the  Utah  and 
Colorado  Societies.  The  meeting  place  has  not 
yet  been  definitely  determined,  but  tentative 
plans  have  been  made  to  use  the  Elks  Home, 
this  because  of  ample  room  for  those  in  attend- 
ance and  for  exhibit  displays. 

Dr.  H.  L.  Harvey  is  the  chairman  of  the  Ar- 
rangements Committee.  He  is  to  be  assisted 
by  Drs.  G.  R.  James  and  R.  H.  Reeve.  As 
meeting  arrangements  progress  and  plans  begin 
to  take  form,  additional  committees  are  to  be 
created  and  chairmen  appointed. 

We  in  Casper  are  looking  forward  to  a big 
meeting  in  the  month  of  September.  The 
Wyoming  State  Medical  Society  is  your  Society. 
Six  months  does  seem  a long  way  in  the  future, 
but  please  take  your  little  red  pencil  £md  mark 
a circle  around  the  dates  of  September  12-14, 
1949!  Come  to  Casper  as  our  guests.  We  shall 
do  everything  we  can  to  make  the  occasion  a 
never  to  be  forgotten  one. 


NATRONA  COUNTY  MEDICAL  SOCIETY 
ELECTIONS 

At  the  regular  Friday  luncheon  on  December 
4,  1948,  the  Natrona  County  Medical  Society 
elected  the  following: 

Dr.  M.  C.  Henrich,  President;  Dr.  J.  R.  Han- 
sard, Vice  President,  and  Dr.  George  Knapp, 
Secretary  and  Treasurer. 

The  Delegates  to  the  Wyoming  State  Medical 
Society  are:  Drs.  G.  W.  Henderson,  G.  O.  Beach 
and  Gordon  Whiston,  and  the  Alternates  Dr. 
R.  P.  Fitzgerald,  G.  R.  James  and  H.  B.  Anderson. 
Dr.  H.  E.  Stuckenhoff  is  the  new  members  of 
the  Board  of  Censors. 

All  the  newly  elected  officers  are  residents 
of  Casper  and  are  to  serve  through  1949. 


Malaria,  smallpox,  tuberculosis,  venereal  dis- 
ease, diphtheria,  many  others,  could  all  be  got 
rid  of — from  the  whole  world,  without  any 
further  knowledge  or  research,  if  we  had  mental 
health  and  social  health  in  the  people  of  the 
the  world,  if  enough  people  in  enough  places 
could  think  in  factual  terms  and  had  good  men- 
tal health.  Nothing  keeps  the  disease  alive 
except  ignorance  and  shortsighted  self-interest. 
Long-sightedness  would  get  rid  of  those  things 
quickly. — Brock  Chisholm,  M.D.,  Mental  Hygiene, 
July,  1948. 


60 


Rocky  Mountain  Medical  Journal 


1 


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Electronic  timing  o£  exposures  for 
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Electronic  Milli-Stabilizer  to  make 
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Automatic  Valve  Tube  Booster. 

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ing for  you,  protecting  your  equip- 
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It  will  pay  you  to  see  this  remarkable 
machine  before  you  get  any  X-Ray 
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And  behind  it  stands  the  finest  serv- 
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Call  us  the  next  time  you  need  help 
with  your  equipment  or  for  films  and 
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City State  


jor  January,  1949 


61 


COLORADO 

Hospital  Association 

The  Colorado  Hospital  Association  met  in  its 
Twenty-Fourth  Annual  Meeting  Wednesday,  No- 
vember 10,  1948,  at  the  Shirley-Savoy  Hotel  in 
Denver  with  a registration  of  128  members  and 
guests,  practically  every  section  of  the  State 
being  represented. 

On  Tuesday  evening  a meeting  of  the  officers 
and  trustees  was  held  to  transact  the  necessary 
business  preliminary  to  the  meeting. 

The  principal  issues  confronting  the  meeting 
were,  first,  the  proposed  new  licensing  regula- 
tions and  standards  for  hospitals,  sanatoria,  and 
convalescent  homes  as  promulgated  by  the  De- 
partment of  Public  Health  of  the  State  of  Colo- 
rado; and  second,  legislation  regarding  the  li- 
censing of  practical  nurses.  It  was  felt  that 
the  association  should  take  an  active  part  in 
both  of  these  measures.  Consequently  a com- 
mittee was  appointed  to  study  the  proposed 
regulations  and  make  recommendations  to  the 
trustees  of  the  association. 

A second  committee  was  appointed  which  will 
formulate  such  principles  as  it  is  felt  should  be 
incorporated  in  a Practical  Nurse  Bill  and  will 
consult  with  the  State  Medical  Society.  The 
Legislative  Committee  will  then  represent  the 
association  and  will  assist  the  Colorado  Nurse 
ALSSociation  in  every  way  possible  in  presenting 
a workable  bill. 

At  the  luncheon,  the  meeting  was  addressed 
by  Mr.  Edson  P.  Lichty,  Executive  Director  of 
the  Blue  Cross  Plan  for  Hospital  Care,  of  Chi- 
cago, Illinois. 

Mr.  Lichty  reviewed  the  organization  of  the 
Blue  Cross,  its  ideals  and  aims  and  explained 
what  such  a plan  could  and  should  do  for  its 
subscribers  and  for  the  hospitals. 

All  papers  were  well  received  and  evoked 
considerable  discussion. 

The  entire  program  was  as  follows: 

“The  Present  Status  of  the  Cancer  Registry,” 
James  R.  McDowell,  M.D.,  Colorado  State 
Board  of  Health,  Denver. 

“Medical  Staff  Organization,”  George  A.  W. 
Currie,  M.D.,  Administrator  of  Hospitals, 
University  of  Colorado  Medical  Center. 

Business  Session: 

Report  of  Delegate  to  American  Hospital  As- 
sociation; report  of  committees;  election  of 
officers;  new  business. 

Luncheon: 

“What  a Blue  Cross  Plan  Should  Offer  to  the 
Public  and  the  Hospitals,”  Mr.  Edson  P. 
Lichty,  Executive  Director,  Blue  Cross  Plan 
for  Hospital  Care,  Chicago,  Illinois. 


“The  Hospital  Administrator’s  Appraisal  of 
Current  Nursing  Problems,”  Mr.  Owen  B. 
Stubben,  Assistant  Director,  Denver  General 
Hospital. 

“Hospital  Needs  in  Colorado,”  Mr.  Herbert  D. 
Moe,  Director  of  Hospital  Facilities  Section, 
Colorado  State  Board  of  Health,  Denver. 

“Round  Table  Discussion.”  Moderator:  Mr. 
Roy  R.  Prangley,  Superintendent,  St.  Luke’s 
Hospital,  Denver. 

New  officers  and  trustees  were  elected  for  the 
year  1949,  and  will  be  found  listed  in  the  Hos- 
pital Association’s  regular  page  in  the  front 
part  of  this  issue. 


SCIENTIFIC  EXHIBITS 

Members  of  the  Colorado  State  Medical  So- 
ciety planning  scientific  exhibits  for  the  Annual 
Session  in  September  are  urged  to  get  in  touch 
with  the  Chairman  of  the  Committee  on  Scien- 
tific Exhibits.  Your  committee  feels  that  these 
exhibits  contribute  materially  to  the  success  of 
the  meeting  and  would  appreciate  hearing  from 
interested  exhibitors. 

FRANK  C.  CAMPBELL,  M.D., 
Chairman. 


In  the  treatment  of  pulmonary  tuberculosis, 
complete  bed  rest  is  the  foundation  upon  which 
the  physician  builds.  In  addition  to  this,  collapse 
therapy  of  various  kinds  is  used  to  provide 
local  rest  to  some  portions  of  the  lung  to  initiate 
healing  of  the  diseased  process,  to  correct  an 
unfavorable  mechanical  situation  such  as  the 
presence  of  a cavity  in  the  lung  parenchyma,  or 
to  speed  up  the  healing  process.  With  the  ad- 
dition of  collapse  therapy  one  may  shorten  the 
time  of  complete  bed  rest,  allowing  the  patient 
to  be  ambulatory  and  return  to  a productive  oc- 
cupation at  an  earlier  date. — Harold  Guyon 
Trimble,  M.D.,  Am.  Rev.  Tuberc.,  May,  1948. 


Mortality  from  tuberbulosis  in  the  United 
* States  continues  to  decline.  The  death  rate  in 
1946  in  metropolitan  New  York  was  33  in 
the  white  population  and  158  in  the  colored. 
The  combined  death  rate  for  the  recorded  mor- 
tality for  New  York  City  for  1946  was  41.7  as 
compared  with  45.4  the  year  previous,  a decline 
of  8 per  cent — one  of  the  largest  in  years.  The 
incidence  rate  during  the  1942-1946  period  varied 
all  the  way  from  47  per  hundred  thou- 
sand in  the  Gravesend  Health  Center  District 
of  Brooklyn  to  a rate  of  380,  almost  eight  times 
as  great,  in  central  Harlem. — Current  Comment, 
J.A.M.A.,  June  26,  1948. 


There  is  apparently  no  way  of  predicting  the 
subsequent  evolution  of  the  incipient  minimal 
lesion  in  tuberculosis  other  than  by  actual  ob- 
servation of  its  behavior  over  a considerable 
period  of  time.  Neither  the  age  of  the  patient 
nor  the  location  or  roentgenological  appearance 
of  the  lesion,  could  be  regarded  as  dependable 
guides  for  estimating  the  relative  risk  of  pro- 
gressive disease. — David  Reisner,  M.D.,  Am.  Rev. 
Tuberc.,  March,  1948. 


62 


Rocky  Mountain  Medical  Journal 


an  aid  in  treatment  of  specific  breast  conditions 


^4  corntmE  wmm 

are  custom-fitted  to  prescription... 


Straps  adjusted  for  maximum  com- 
fort with  gentle -yet -firm  support. 

I B ■■  M ■■  Back  width  designed  to 
encourage  good  posture. 

■ MB!  Correct  bust  cup  selected  for 
proper  uplift  and  separation. 


Torso  fitted  to  patient.’s 
personal  measurements. 


'Proper  physiological  support  for  the 
breast  is  a medical  problem,  and  patients  are 
grateful  to  the  physician  who  recognizes  this 
fact.  Lov-e’s  extensive  therapeutic  line  of  breast 
supports  provides  remedial  support  for  specific 
breast  conditions.  From  more  than  500  bust-cup- 
torso  size  variations,  the  patient’s  correct  size  is 
selected,  then  fitted  to  her  individual  measure- 
ments by  specially  trained  Lov-e’  technicians, 
according  to  your  exact  instmctions. 

Lov-e  Brassieres  are  available  in  a wide  variety 
of  all  fine  fabrics  including  cottons,  rayon  jac- 
quards and  nylons.  Also  available:  sleeping  bras- 
sieres, hospital  binders,  artificial  breastSj  muscle 
pads  and  maternity  garter  supports. 

The  May  Company 

lov-e  section, 

CORSET  DEPARTMENT, 

THIRD  FLOOR 

DENVER,  COLORADO 


M ATE  RN  ITY 

— for  pre-natal  and 
post-natal.  Helps 
prevent  leakage. 
Adjusted  without 
charge  during  preg- 
nancy. 


MASTECTOMY 

— fitted  with  Lov-e’ 
bust  pads  to  restore 
bust  contour.  Aids 
psychologically. 


HYPERTROPHIC 

— inner  pocket  for 
pendulous  bust. 
Built  up  back. 
Padded  shoulder 
■straps.  Redistributes 
bust  weight. 


for  January,  1949 


63 


AMERICAN  COLLEGE  OF  SURGEONS 

Following  is  a list  of  initiates  who  were  re- 
ceived into  fellowship  in  the  American  College 
of  Surgeons  at  the  Convocation  during  the  Clin- 
ical Congress  in  Los  Angeles:  -Colorado,  Drs. 
Jack  D.  Bartholomew,  Boulder;  Howard  F. 
Bramley,  Denver;  Samuel  B.  Childs,  Denver; 
Carl  J.  Gilman,  Boulder;  Bernard  E.  Grossman, 
Denver;  E.  Miner  Morrill,  Fort  Collins;  Robert 
C.  Shattuck,  Denver;  Henry  Swan,  Denver;  Ed- 
ward H.  Vincent,  Colorado  Springs;  Charles  B. 
Wills,  Denver.  Montana,  Drs.  Sidney  C.  Pratt, 
Miles  City;  David  H.  Unsell,  Billings;  John  C. 
Wolgamot,  Great  Falls.  New  Mexico,  Drs.  Jo- 
seph W.  Hillsman,  Carlsbad;  Wallace  E.  Nisson, 
Albuquerque;  Raymond  L.  Young,  Albuquerque. 
Utah,  Drs.  Rees  H.  Anderson,  Salt  Lake  City; 
William  R.  Brown,  Ogden;  David  A.  Dolowitz, 
Salt  Lake  City;  Philip  M.  Howard,  Salt  Lake 
City;  Rulon  F.  Howe,  Ogden;  William  H.  Moretz, 
Salt  Lake  City;  Vernon  L.  Stevenson,  Salt  Lake 
City.  Wyoming,  George  R.  James,  Casper. 


AMERICAN  ACADEMY  OF  GENERAL 
PRACTICE 

Colorado  members  of  the  American  Academy 
of  General  Practice  organized  a permanent  Colo- 
rado Chapter  and  elected  the  following  officers: 
President,  Cyrus  W.  Anderson,  Denver;  Vice 
President,  Willis  B.  Hardesty,  Berthoud;  Secre- 
tary, S.  P.  Esposito,  Aurora;  Treasurer,  Homer 
B.  Catron,  Englewood.  Directors:  Walter  L. 
Newburn,  Trinidad  (one  year);  Paul  R.  Hilde- 
brand, Brush  (two  years);  James  M.  Perkins, 
Denver  (three  years).  Delegates:  John  H.  Amesse, 
Denver;  Lawrence  L.  Hick,  Delta;  Alternates: 
Robert  M.  Maul,  Denver;  Carl  H.  Graf,  Boulder. 
Nominating  Committee:  Michael  P.  Ryan,  Den- 
ver; Morgan  A.  Durham,  Idaho  Springs. 


The  first  and  greatest  needs  is  education;  edu- 
cation of  the  people,  and  through  them  educa- 
tion of  the  state.  It  is  evident  that  if  every 
man  and  woman  in  the  United  States  were 
familiar  with  the  main  facts  relating  to  the 
manner  in  which  tuberculosis  is  communicated 
and  the  simple  measures  necessary  for  their  pro- 
tection, not  only  might  we  reasonably  expect 
as  a direct  result  of  this  great  knowledge  a 
great  diminution  in  the  death  rate  of  the  disease, 
but  the  people  would  soon  demand  and  easily 
obtain  effective  legislation  for  its  prevention  and 
control. — Edward  L.  Trudeau,  M.D.,  Nat.  Tuberc. 
A.  Tr.,  1905. 


Health  education  is  recognized  as  an  essential 
tool  in  tuberculosis  control.  The  general  public 
must  know  the  seriousness  of  the  disease  and  its 
cost  in  human  misery  and  money  before  it  will 
accept  its  responsibility  to  support  the  work 
financially. — Report,  Expert  Committee  on  Tu- 
berculosis, Office  International  de’Hygiene  Pub- 
lique,  Paris,  Pub.  Health  Rep.,  May  7,  1948. 


Routine  chest  roentgenograms  are  now  made 
on  all  patients  at  the  time  of  their  admission 
to  all  (Veterans  Administration)  hospitals  and 
on  all  veterans  who  visit  our  outpatient  depart- 
ments for  pension  or  compensation  examinations, 
unless  they  have  been  examined  within  the 
previous  six  months.  In  addition  to  this,  annual 
roentgenograms  are  to  be  obtained  for  all  hos- 
pital employees  and  all  patients  who  are  hos- 
pitalized for  more  than  one  year. — John  B. 
Barnwell,  M.D.,  Am.  Rev.  Tuberc.,  July,  1948. 


The  appearance  of  tubercle  bacilli  in  sputum, 
gastric  contents  or  other  body  fluids  is  an  ex- 
tremely significant  episode  in  the  course  of 
tuberculous  infection.  Hence  a thorough  and 
systematic  search  for  tubercle  bacilli  must  be 
instituted  in  all  cases  where  the  presence  of 
tuberculosis  is  suspected  or  where  tuberculosis 
must  be  considered  a possibility  in  differential 
diagnosis. — Francis  J.  Weber,  M.D.,  Pub.  Health 
Rep..  Sept.  3,  1948. 


The  postponement  of  the  first  infection  from 
childhood  to  adult  life,  which  we  are  witnessing 
at  present,  may  have  a corresponding  effect  on 
the  age  at  which  the  initial  manifestation  of 
chronic  pulmonary  tuberculosis  is  likely  to 
develop.  At  any  rate,  from  a practical  stand- 
point, it  seems  inadvisable  to  regard  the  risk 
of  developing  the  disease  as  limited  to  any 
particular  age  in  adult  life. — David  Reisner,  M.D., 
The  Am.  Rev.  Tuberc.,  March,  1948. 


Instead  of  crying:  “Can  we  afford  some  new 
service?”  we  are  now  tending  to  realize  that 
we  cannot  afford  ill-health  and  the  resulting 
loss  of  productive  work.  We  are  beginning  to 
realize  that  expenditure  on  preventive  services 
and  on  health  research  pays  an  enormous  divi- 
dend.— Sir  Andrew  Davidson,  Brit.  M.J.,  Feb. 
7,  1948. 


There  can  be  no  isolationism  in  the  field  of 
health.  The  fight  against  infectious  disease  is 
not  a national  or  racial  problem;  it  is  a task 
for  the  whole  of  humanity.  . . . The  all-inclusive 
objective  of  any  sound  tuberculosis  program 
is  the  prevention  and  eventual  eradication  of 
tuberculosis  from  the  peoples  of  the  world. — 
Bull.  World  Health  Organization,  1948. 


It  is  now  generally  accepted  that  what  the 
tuberculin  test  is  to  the  establishment  of  the 
presence  of  infection,  and  the  x-ray  to  early 
case  finding,  bacteriological  examination  for  tu- 
bercle bacilli  is  to  the  determination  of  clinical 
activity  .—Francis  J.  Weber,  M.D.,  Pub.  Health 
Rep.,  Sept.  3,  1948. 

The  chnical  and  x-ray  pictures  of  virus  pneu- 
monia may  at  times  be  duplicated  by  early  acute 
tuberculosis,  and  patients  diagnosed  as  having 
virus  infections  should  not  be  dismissed  until 
the  chest  films  are  entirely  clean. — David  T. 
Smith,  M.D.,  Am.  Rev.  Tuberc.,  April,  1948. 


There  would  be  little  question  that  the  mor- 
tality and  morbidity  from  tuberculosis  infection 
in  the  children  of  Europe  seriously  increased 
owing  to  war  conditions,  and  in  many  countries 
is  still  a matter  of  the  greatest  concern. — Richard 
W.  B.  Ellis,  M.D.,  Brit.  M.J.,  Feb.  7,  1948. 


64 


Rocky  Mountain  Medical  Journal 


GRADUATE  and  POSTGRADUATE  COURSE 

Courses  in  the  Sciences  Fundamental 

to 

Medical  and  Surgical  Specialties 

at 

University  of  Colorado  Medical  School 

Denver,  Colorado 

January  3 to  June  4,  1949 

These  courses  are  designed  to  orient  the  student  in  the  basic  sciences 
required  for  certification  by  the  various  American  Specialty  Boards,  except 
Otolaryngology  and  Ophthalmology.  Attendance  on  a full-time  or  part-time 
basis  may  be  arranged  according  to  individual  needs.  Unit  courses  are  given 
in  anatomy  of  the  surgical  specialties,  experimental  surgery,  gross  and 
microscopic  pathology,  neuropathology,  neuroanatomy  and  radio-physics. 
There  are  symposia  and  seminars  covering  the  various  clinical  phases  of 
physiology,  biochemistry,  pharmacology,  pathology  and  bacteriology  closely 
correlated  with  patient  problems  as  related  to  the  clinical  specialties. 

University  credit  is  granted.  Tuition  for  full  course  is  $250.00.  Part- 
time  attendance  can  be  arranged  at  $25.00  per  credit  hour.  Minimum 
number  of  credit  hours  allowed  is  three,  maximum  is  ten. 

Apply  to  Director  of  Graduate  and  Postgraduate  Medical  Education, 
University  of  Colorado  Medical  Center,  Denver  7,  Colorado. 


COUNCIL  ACCEPTED 


Brand  of  theobromine-calcium  salicylate. 
Trade  Mark  reg.  U,  S.  Pat.  Off. 


For  the  Failing  Heart  of  Middle  Life 

Prescribe  2 or  3 tablets  of  Theocalcin,  t.  i.  d.  After 
relief  is  obtained,  continue  with  smaller  doses  to  keep 
the  patient  comfortable.  Theocalcin  strengthens  heart 
action,  diminishes  dyspnea  and  reduces  edema. 


f : 


Qrp.  Orange,  N.  J. 


I 


for  January,  1949 


65 


Adverltsement 


From  where  I sit 
Ju  Joe  Marsh 


Juberculosis  Abstracts 

Issued  Monthly  by  the  National  Tuberculosis 
ssociation 

Vol.  XXII  JANUARY,  1W9  No.  1 

“Doctor,  should  I do  any  flying?”  Many  patients 
with  tuberculosis  of  the  lungs  want  an  answer  to  this 
sometimes  difficult  question.  Whether  or  not  it  is 
wise  for  them  to  fly  depends  on  a number,  of  things. 
Some  can  do  it  safely.  The  rest  are  facing  danger. 


"Husbands,  Wives, 
and  Marriage" 

Maybe  you  read  that  survey  pub- 
lished recently  in  one  of  the  national 
magazines^  entitled  ""Husbands^ 
Wives,  and  Marriage.’* 

It  showed  that  among  happily 
married  couples,  those  who  criticized 
themselves  outnumbered  those  who 
criticized  the  other  person.  Among 
unhappily  married  couples,  it  was  just 
the  opposite — each  one  tended  to  criti- 
cize the  other. 

That’s  the  way  it  is  in  our  town, 
as  I guess  it  is  in  yours.  Criticism, 
whether  it’s  of  a wife’s  taste  for  hats, 
or  a husband’s  taste  for  pipe  tobacco 
and  an  evening  glass  of  beer  or  ale,  is 
a sure  start  towards  unhappiness. 

As  for  what  made  happy  marriages, 
companionship  within  the  home  was 
listed  most  important  of  aU.  And  from 
where  I sit,  a husband  and  wife  who 
can  spend  an  evening  by  the  fire — with 
nothing  more  exciting  than  a glass  of 
beer,  and  a friendly  conversation — 
are  a truly  weU-matched  couple! 


Copyright,  19 U8,  United  States  Brewers  Foundation 


HAZARDS  OF  FLYING  FOR  TB  PATIENTS 

Air  on  the  ground  is  much  heavier  than  it  is  a mile 
or  two  up.  At  sea  level  it  exerts  a'  pressure  of  fifteen 
pounds  on  each  square  inch  of  the  body  surface,  which 
is  not  felt  because  it  presses  equally  on  all  sides. 
This  pressure  diminishes  rapidly  as  one  rises  from 
sea  level.  In  other  words,  the  higher  one  goes,  the 
lower  the  pressure. 

Inside  Air  Expands 

A toy  baloon  has  rubber  walls  that  stretch.  Take 
this  balloon  up  in  the  sky  and  it  will  get  bigger  be- 
cause the  air  inside  expands  as  the  pressure  of  the 
air  surrounding  the  balloon  decreases. 

Many  patients  with  pulmonary  tuberculosis  have 
abnormal  collections  of  air  in  their  bodies.  A cavity 
in  the  lung  represents  such  a collection — so  do  pneu- 
mothorax and  pneumoperitoneum.  They  are  major 
hazards  in  flying  since  they  behave  like  the  balloon. 

The  size  of  these  abnormal  collections  of  air  will 
vary  with  the  height  above  sea  level.  They  will  be- 
come seven  per  cent  larger  at  2,000  feet,  about 
50  per  cent  larger  at  10,000  feet  and  nearly  100  per 
cent  larger  at  16,000  feet. 

Commercial  planes  usually  fly  below  10,000  feet. 
They  may  have  to  fly  higher  when  crossing  moim- 
tains  or  encountering  storms.  At  any  height,  changes 
can  be  expected  in  all  collections  of  air. 

Breathing  Hazards 

A refill  for  pneumothorax  or  pneumoperitoneum  is 
calculated  to  produce  the  right  pressure  on  the  lung. 
A bigger  refill  might  do  harm.  Going  up  in  an 
airplane  is  just  like  getting  a bigger  refill. 

Flying  is  definitely  hazardous  for  those  who  have 
pneumothorax  complicated  by  adhesions  as  they  may 
break  or  they  may  pull  hard  enough  to  rip  the 
surface  of  the  lung.  Air  will  then  leak  into  the 
pneumothorax  air  pocket  and  dangerously  increase 
its  size.  Massive  increase  will  push  the  heart  toward 
the  opposide  side  of  the  chest  and  compress  the 
opposite  lung.  If  respiration  is  embarrassed,  the 
patient  may  beecome  alarmingly  short  of  breath,  have 
palpitation,  sudden  weakness,  even  shock. 

Some  patients  have  pneumothorax  compressing  both 
lungs.  Their  capacity  to  breathe  is  much  diminished. 
Flying  for  them  is  contraindicated  as  it  can  well 
bring  on  severe  shortness  of  breath  and  other  frighten- 
ing symptoms. 

Pressure  and  Hernia 

Beneath  the  breast  bone  one  lung  is  separated  from 
the  other  by  a group  of  structures  known  as  the 
mediastinum.  This  mediastinum  has  several  weak 
spots.  Through  these  a pneumothorax  may  bulge  into 
the  opposite  side  of  the  chest.  This  is  called  hernia 
of  the  mediastinum  and  is  not  without  danger  even 
on  the  ground.  In  flight,  such  a situation  can  be- 
come exceedingly  uncomfortable. 

Those  patients  who  notice  discomfort  after  pneu- 
mothorax or  pneumoperitoneum  refills  will  certainly 
have  greater  discomfort  when  flying.  Those  who  are 
short  of  breath  on  exertion  will  have  more  difficulty 


66 


Rocky  Mountain  Medical  Joixrnai 


SPECIALISTS  IN  THERAPY  FOR  CHRONIC  ALCOHOLISM 
BY  THE  CONDITIONED  REFLEX  AND  ADJUVANT  METHODS 

Recognized  by  the  American  Medical  Association  ■ Member  American  Hospital  Association 
7106  35th  Ave.  S.W.,  Seattle  6,  Wash.  WEst  7232  Cable  Address:  REFLEX 


the  conditioned  reflex  and  adjuvant  methods  of 
treatment  for  chronic  alcoholism.  Shadel  Sanitarium  lays  the 
groundwork  for  recovery  through  intensive,  individualized 
therapy.  Rehabilitation  must  follow,  with  the  family  doctor 
supervising  the  patient’s  physical  rejuvenation,  and  the  Sani- 
tarium’s Field  Rehabilitation  staff  assisting  with  his  alcoholic 
problems.  Our  object  is  . . . Cooperation  with  the  family  physi- 
cian in  mapping  out  a path  toward  recovery. 


for  January,  1949 


67 


Unless  she  has  a long  memory,  she  probably 
doesn’t  realize  it — but  I owe  a big  debt  to  the 
head  nurse  in  one  of  my  hospitals.  The  story 
goes  like  this : 

One  hot  afternoon  last  summer  I was  dem- 
onstrating the  Cutter  Saftiflask  set-up  to  her 
— how  easy  it  is  to  strip  off  the  metal  Safticap, 
remove  the  vacuum-sealed  inner  liner,  and  at- 
tach our  expendable  infusion  set.  Then,  over 
a coke,  we  fell  to  discussing  other  steps  in 
I.V.  technic — such  as  starting  the  infusion, 
checking  the  rate  of  flow,  and  making  sure 
the  needle  stays  in  the  vein. 

When  I was  leaving,  she  said:  “Have  you 
any  pictures  illustrating  all  these  other  steps 
we’ve  just  talked  about?  I’d  like  to  show  them 
to  our  student  nurses.  I’m  sure  I’ll  do  a better 
job  of  explaining  . . . and  save  a lot  of  words 
and  time  . . . if  I can  show  close-ups  of  these 
steps,  not  just  talk  about  them.” 

You  can  be  sure  I gave  her  all  the  photos  in 
my  briefcase — and  that  night  I wrote  my 
brass  hats  at  the  Lab  about  that  conversation. 
They  picked  up  the  ball,  and  it  wasn’t  long 
till  they’d  wrapped  up  the  idea  in  a brand-new 
I.V.  stripfilm. 

Man,  that  film’s  a honey.  The  photos  were 
all  taken  in  one  of  the  best,  most  modern  hos- 
pitals. Every  step  in  recommended  I.V.  pro- 
cedure is  shown — from  the  moment  the  Safti- 
flask solution  is  removed  from  central  supply 
to  fill  the  doctor’s  order  till  the  infusion  is 
completed. 

If  you’d  like  the  film  showm  in  your  hospital, 
or  before  any  of  your  medical  groups,  just 
drop  a line  to  our  office  in  Berkeley  and  all  the 
details  will  be  arranged.  I’m  sure  you’ll  like 
the  film  as  well  as  I do.  Already,  in  several 
hospitals  where  I’ve  shown  it,  it’s  been  made 
an  important  part  of  the  regular  training  pro- 
gram. 


CUTTER  LABORATORIES  • BERKELEY  10,  CALIFORNIA 


when  flying.  Patients  who  have  recently  bled  from 
the^  lungs  should  postpone  any  thought  of  flying  be- 
cause of  the  danger  of  reopening  the  blood  vessel. 

Cavities  produced  by  tuberculosis  frequently  con- 
tain air  which  expands  in  flight.  When  air  can  es- 
cape from  a cavity  the  danger  is  minimal.  If  an 
obstruction  is  present  the  trapped  air  in  expanding 
may  tear  the  walls  of  the  cavity  or  injure  a blood 
vessel  with  subsequent  bleeding  which  can  threaten 
life. 

To  prevent  serious  discomfort  or  damage,  some 
patients  may  have  to  breathe  oxygen  through  a mask 
when  flying.  Other  patients  will  fare  better  if  air 
is  removed  from  their  pneumothorax  or  pneumoperi- 
toneum before  they  fly.  Airplanes  that  fly  far  above 
the  earth,  20,000  or  30,000  feet,  are  pressurized. 
Pumping  systems  maintain  an  air  pressure  inside  the 
cabins  simulating  conditions  much  closer  to  the  ground. 
Otherwise,  no  one  could  remain  alive  at  those  heights. 
Nevertheless,  a few  patients  face  danger  in  a pressur- 
ized airplane  because  the  pressure  in  the  cabin  cannot 
be  kept  at  ground  level  values. 

The  tuberculosis  patient  is  wise  who  consults  his 
doctor  before  he  flies. 

Hazards  of  Flying  for  TB  Patients,  Ezra  VolM 
Bridge.  M.D^,  The  NTA  Bulletin,  May,  1948. 


PROSTHETIC  INDUSTRY  ESTABLISHES 
CERTIFICATION  BOARD 

To  improve  the  professional  standards  of  man- 
ufacturers of  artificial  limbs  and  braces,  and 
the  fitters  employed  by  such  firms,  an  American 
Board  for  Certification  has  been  established  in 
Washington,  D.  C. 

Three  orthopedic  surgeons  and  four  leaders  in 
the  orthopedic  appliance  industry  constitute  the 
national  board  which  will  grant  certification. 
The  orthpedic  surgeons  are  Drs.  Rufus  Alldredge 
of  New  Orleans,  Henry  H.  Kessler  of  Newark, 
and  Atha  Thomas  of  Denver. 

Lay  members  of  the  board  are  Chester  C. 
Haddan  of  Denver,  Lee  J.  Fawver  of  Kansas 
City,  J.  B.  Korrady  of  Chicago,  and  David  E. 
Stolpe,  New  York.  Mr.  Haddan  is  president  and 
Glenn  E.  Jackson  is  executive  director. 

“To  be  qualified  for  certification,”  said  Mr. 
Haddan,  “an  applicant  must  prove  that  he  has 
had  at  least  four  years  of  actual  experience 
under  proper  supervision  or  two  years  of  special 
training  and  one  year  of  experience.  In  addi- 
tion, the  applicant  must  present  the  signatures 
of  two  physicians  who  state  that  he  meets 
various  other  requirements.  More  than  100 
firms  and  200  fitters  have  already  applied  for  | 
certification.  i 

“The  medical  profession  has  been  of  invaluable 
assistance  during  the  two  years  of  intensive 
work  which  has  finally  resulted  in  the  incorpora- 
tion of  the  American  Board  for  Certification 
of  the  Prosthetic  and  Orthopedic  Appliance  In- 
dustry.” 


68 


Rocky  Mountain  Medical  Journal 


t. 


Factories  throb  to  the  pound  of  his  inventions — while  he  sits.  Hour 
after  silent  hour  he  sits  and  schemes  mechanical  schemes  or  times 
the  pace  of  tiny  models.  In  his  spare  time?  Moves  to  a rocking 
chair  and  reads.  Has  no  appetite?  Neither  do  hundreds  of  others 
whose  occupations  or  pastimes  require  little  physical  energy.  And 
you  could  cite  many  other  reasons  for  inadequate  diets — excessive 
smoking,  indifference,  ignorance,  strong  likes  and  dislikes  ...  In 
many  such  cases,  your  prescription  for  one  or  more  vitamins 
accompanies  your  advice  on  dietary  reform.  When  you  prescribe 
an  Abbott  product,  you  are  assured  that  your  patient  will  receive 
the  full  potencies  intended.  There  is  an  Abbott  vitamin  product  to 
fill  every  need — for  one  or  a combination  of  vitamins,  for  supple- 
mentary or  therapeutic  levels  of  dosage,  for  oral  or  parenteral 
administration.  Your  pharmacy  will  be  glad  to  fill  your  prescriptions. 
Abbott  L ab o r atorie s,  N orth  Chicago,  Illinois 


for  January,  1949 


69 


New  Books  Received 

Detailed  Atlas  of  the  Head  and  Neck:  By  Raymond 
C.  Truex,  M.S;,  Ph.D.,  Associate  Professor  of  Anat- 
omy, College  of  Physicians  and  Surgeons,  Columbia 
University:  and  Carl  E.  Kellner,  Artist,  Depart- 
ment of  Anatomy,  College  of  Physicians  and  Sur- 
geons, Columbia  University.  With  162  pages  and 
135  illustrations.  New  York  Oxford  University 
Press,  1948.  Price,  $15.00. 


A Mannal  of  Clinical  Thepapentics — A Guide  of  Stu- 
dents and  Practitioners:  By  Windsor  C.  Cutting, 
M.D.,  Professor  of  Therapeutics,  Stanford  Univer- 
sity School  of  Medicine,  San  Francisco,  California. 
Second  Edition.  712  pages.  Philadelphia  and  Lon- 
don: W.  B.  Saunders  Company. 


Preoperative  and  Postoperative  Care  of  Surgical  Pa- 
tients: By  Hugh  C.  Ilgenfritz,  A.B.,  M.D.,  F.A.C.S. ; 
Formerly  Assistant  Professor  of  Surgery,  Louisiana 
University  School  of  Medicine,  and  Visiting  Sur- 
geon, Charity  Hospital  of  Louisiana  at  New  Or- 
leans— with  Foreword  by  Urban  Maes,  M.D.,  D.Sc., 
F.A.C.S.,  Emeritus  Professor  of  Surgery,  Louisiana 
Sta'te  University  School  of  Medicine:  Consulting 
Surgeon,  Charity  Hospital  of  Louisiana  at  New  Or- 
leans: Consulting  Surgeon,  Touro  Infirmary:  Con- 
sulting Surgeon,  Veterans  Administration  Hos- 
pital, New  Orleans.  Illustrated.  St.  Louis,  The  C.  V. 
Mosby  Company,  1948.  898  pages. 


Microbiology  and  Pathology:  By  Charles  F.  Carter, 
B.S.,  M.D.,  Instructor  in  Pathology  and  Applied 
Microbiology,  Parkland  Hospital  School  of  Nurs- 
ing, Dallas,  Texas:  Consulting  Pathologist,  St. 
Louis  Southwestern  Railway  Hospital,  Texarkana, 
Arkansas:  Consulting  Pathologist,  Mother  Frances 
Hospital,  Tyler,  Texas:  Formerly  Director  of  Lab- 
oratories, Parkland  Hospital — with  216  text  illus- 
trations and  25  color  plates.  Fourth  edition.  St. 
Louis,  The  C.  V.  Mosby  Company,  1948. 


Occupational  Therapy  Source  Book:  Edited  by 
Sidney  Licht,  M.D.  With  introduction  by  C.  Charles 
Burlingame,  M.D.,  Psychiatrist-in-Chief,  The  In- 
stitute of  Living.  90  pages.  The  Williams  and 
Wilkins  Company,  Baltimore,  1948.  $1.00. 


British  Surgical  Practice:  Under  the  General  Editor- 
ship of  Sir  Ernest  Rock  Carling,  F.R.C.S.,  F.R.C.P., 
Consulting  Surgeon,  Westminster  Hospital;  and 
J.  Paterson  Ross,  M.S.,  F.R.C.S.,  Surgeon  and  Dl- 
~ector  of  Surgical  Clinical  Unit,  St.  Bartholomew’s 
Hospital;  Professor  of  Surgery,  University  of  Lon- 
don. In  eight  volumes  (with  Index  Volume),  Vol- 
ume 3.  524  pages  with  illustrations.  Butterworth 
& Company  (Publishers),  Ltd.,  London,  England. 
The  C.  V.  Mosby  Company,  St.  Louis,  Mo.,  U.  S.  A., 
1948. 


A Doctor  Talks  to  Teen-Agers.  A Psychiatrist’s  Ad- 
vice to  Youth:  By  William  S.  Sadler,  M.D.,  F.A.P.A., 
Chicago;  Consulting  Psychiatrist,  Columbus  Hos- 
pital; Fellow  of  the  American  Psychiatric  Asso- 
ciation, The  American  Medical  Association,  The 
American  Association  for  the  Advancement  of 
Science;  Member  of  the  American  Psychopatho- 
logical  Association.  379  pages.  The  C.  V.  Mosby 
Company,  St.  Louis,  Missouri,  1948.  $4.00. 


Physician’s  Handbook.  Fifth  Edition:  By  John  War- 
kcntin,  Ph.D.,  M.D.,  and  Jack  D.  Lange,  M.S.,  M.D. 
293  pages.  University  Medical  Publishers,  Post 
Office  Box  No.  761,  Palo  Alto,  California.  $2.00. 


Psychiatry  in  General  Practice:  By  Melvin  W. 
Thorner,  M.D.,  D.Sc.,  Assistant  Professor  of  Neu- 
rology, The  Graduate  School  of  Medicine,  Univer- 
sity of  Pennsylvania.  659  pages.  W.  B.  S'aunders 
Company,  Philadelphia-London,  1948. 


Symposia  on  Nutrition  of  The  Robert  Gould  Research 
Foundation.  Volume  I>  Nutritional  Anemia:  Edited 
by  Arthur  Lejwa.  194  pages.  The  Robert  Gould  Re- 
search Foundation,  Inc.,  Cincinnati,  Ohio.  October 
16-18,  1947. 


Human  Biochemistry:  By  Israel  S.  Kleiner,  Ph.D., 
Professor  of  Biochemistry  and  Director  of  the 
Department  of  Physiology  and  Biochemistry,  New 
York  Medical  College,  Flower  and  Fifth  Avenue 
Hospitals;  Formerly  Associate,  The  Rockefeller 
Institute  for  Medical  Research,  New  York.  With 
seventy-seven  text  illustrations  and  five  color 
plates.  Second  edition.  649  pages.  The  C.  V.  Mosby 
Company,  St.  Louis,  1948.  $7.00. 


Your  Baby,  The  Complete  Book  for  Mothers  and 

Fathers:  By  Gladys  Denny  Shultz,  Contributing 
Editor,  Ladies’  Home  Journal;  and  Lee  Forrest 
Hill,  M.D.,  Former  President,  American  Academy 
of  Pediatrics.  Photography  by  Joseph  Di  Pietro. 
Line  Drawings  by  Reisie  Lonette.  278  pages. 
Doubleday  and  Company,  Inc.,  Garden  City,  N.  Y., 
1948.  $3.50. 


Essentials  of  Pathology:  By  Lawrence  W.  Smith. 
M.D.,  P.C.A.P.,  Professor  of  Pathology,  Temple 
University  School  of  Medicine;  Associate  Professor 
of  Pathology,  Cornell  University  Medical  School, 
and  Assistant  Professor  of  Pathology,  Harvard 
Medical  College;  Corresponding  Member  of  the 
Royal  Flemish  Medical  Academy  of  Belgium.  And 
Edwin  S.  Gault,  M.D.,  F.C.A.P.,  Associate  Professor 
of  Pathology  and  Bacteriology,  Temple  University 
School  of  Medicine.  With  a Foreword  by  the  Late 
James  Ewing,  M.D.,  Memorial  Hospital,  New  York 
City.  Third  Edition,  764  pages,  illustrated.  The 
Blakiston  Company,  Philadelphia  and  Toronto. 


A-B-C’s  of  Sulfonamide  and  Antibiotic  Therapy:  By 

Perrin  H.  Long,  M.D.,  F.R.C.P.,  Professor  of  Pre- 
ventive Medicine,  The  Johns  Hopkins  University 
School  of  Medicine;  Physician,  The  Johns  Hopkins 
Hospital.  231  pages.  W.  B.  Saunders  Company, 
Philadelphia  and  London,  1948. 


Handbook  of  Orothopaedic  Surgery:  By  Alfred  Rives 
Shands,  Jr.,  B.A.,  M.D..  Medical  Director  of  the 
Alfred  I.  duPont  Institute  of  the  Nemours  Foun- 
dation, Wilmington,  Delaware;  Visiting  FTofessor 
of  Orthopaedic  Surgery,  University  of  Pennsyl- 
vania School  of  Medicine,  Philadelphia,  Pennsyl- 
vania. In  Collaboration  with  Richard  Beverly 
Raney.  B.A.,  M.D.,  Associate  in  Orthopaedic  Sur- 
gery, Duke  University  School  of  Medicine,  Dur- 
ham, North  Calorllna;  Lecturer  in  Orthopaedic 
Surgery,  University  of  North  Carolina  School  of 
Medicine,  Chapel  Hill,  North  Carolina.  Illustrated 
by  Jack  Bonacker  Wilson.  Third  Edition.  574  pages. 
The  C.  V.  Mosby  Company.  $6.00. 


Bailey’s  Text-Book  on  Histology:  Revised  by  Philip 
E.  Smith,  Ph.D.,  Professor  of  Anatomy.  College  of 
Physicians  and  Surgeons,  Columbia  University;  and 
Wilfred  M.  Copenhaver,  Ph.D.,  Associate  Professor 
of  Anatomy,  (College  of  Physicians  and  Surgeons, 
Columbia  University.  Twelfth  Edition.  781  pages. 
The  Williams  &. Wilkins  Company,  Baltimore,  1948. 
$7.00. 


Technique  of  Treatment  for  the  Cerebral  Palsy 
Child:  By  Paula  P.  Egel,  Cerebral  Palsy  Director, 
Children’s  Hospital,  Buffalo,  New  York.  Intro- 
duction by  Winthrop  M.  Phelps.  M.D.,  Medical  Di- 
rector, Children’s  Rehabilitation  Institute,  Balti- 
more, Maryland.  Appendix  by  Moir  P.  Tanner, 
P.A.C.H.A.,  Superintendent,  (Children’s  Hospital, 
Buffalo,  New  York.  Drawings  by  Dorothea  Mint- 
line. 203  pages.  Illustrated.  The  C.  V.  Mosby  Com- 
pany, St.  Louis,  1948.  $3.50. 


A.M.A.  Interns’  Mannal:  Published  by  the  W.  B. 
Saunders  Company,  Philadelphia-London,  1948. 
201  pages. 


The  Case  Against  Socialized  Medicine-— A Construc- 
tive Analysis  of  the  Attempt  to  CoUective  Ameri- 
can Medicine:  By  Lawrence  Sullivan.  Fifty-three 
pages.  The  Statesman  Press,  National  Press  Build- 
ing, Washington,  D.  C.,  1948.  $1.50. 


Personal  and  Community  Health:  By  C.  E.  Turner, 
A.M.,  Ed.M.,  D.Sc.,  Dr.P.H.,  Professor  of  Public 
Health  Emeritus,  Massachusetts  Institute  of  Tech- 
nology; Formerly  Associate  Professor  of  Hygiene 
in  the  Tufts  College  Medical  and  Dental  Schools; 
Sometime  Member  of  the  Administrative  Board  in 
the  School  of  Public  Health  of  Harvard  Univer- 
sity and  the  Massachusetts  Institute  of  Tech- 
nology; Formerly  Visiting  Professor  of  Health 
Education,  School  of  Public  Health,  University  of 
California.  Eighth  Edition.  565  pages.  The  C.  V. 
Mosby  Company,  St.  Louis,  Missouri,  1948.  $4.00. 


70 


Rocky  Mountain  Medical  Journal 


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71 


Cancer  Mannal — Standards  for  the  Dia^osfs  and 
Treatment  of  Cancer:  By  The  Cancer  Committee  of 
the  Iowa  State  Medical  Society.  160  pag-es,  $1.00. 


Synopsis  of  Psychosomatic  Diagnosis  and  Treatment: 

By  Flanders  Dunbar,  M.D.,  with  the  assistance  of 
Jacob  Arlow,  M.D.;  Raymond  Hussey,  M.D.;  Ber- 
tram Lewin,  M.D. ; Robert  C.  Lowe,  M.D.;  Sydnej"- 
Rubin,  M.D.;  E.  Schneider,  M.D.;  Lester  W.  Son- 
tag,  M.D.,  and  Members  of  the  Staff  of  the  De- 
partments of  Medicine  and  Psychiatry,  Columbia- 
Presbyterian  Medical  Center,  New  York  City.  501 
pages.  The  C.  V.  Mosby  Company,  St.  Louis,  Mis- 
souri, 1948.  $6.50. 

A Treastise  on  Contemporary  Religions  Jurispru- 
dence: By  I.  H.  Rubenstein  of  the  Illinois  Bar.  The 
Waldain  Press,  Chicago,  1948. 


The  Clinical  Management  of  A'aricose  Veins:  By  Da- 
vid Wooldfolk  Barrow,  M.D.,  Lexington,  Kentucky. 
With  a Foreword  by  Arthur  W.  Allen,  M.D.  Paul 
B.  Hoeber,  Inc.,  Medical  Book  Department  of  Har- 
per & Brothers,  New  York.  Price,  $5.00. 


The  Skin  Diseases,  A Manual  for  Practitioners  and 
Stndents:  By  James  Marshall,  M.D.,  B.S.,  M.R.C.S., 
L.R.C.P. ; Consulting  Dermatologist,  Central  Mid- 
dlesex County  Hospital:  Director  of  Venereal  Dis- 
eases Clinic,  Royal  Northern  Hospital.  London: 
lately  Adviser  in  Venereology  to  the  War  Office, 
etc.:  Membre  de  la  Societe  Francaise  de  Derma- 
tologic et  de  Syphiligraphie : Membre  Correspon- 
dant  de  la  Societe  Beige  de  Dermatologic  et  de 
Syphiligraphie.  London,  MacMillan  & Co.,  Ltd., 
1948.  Price,  $7.50. 


The  Shame  of  the  States:  By  Albert  Deutsch.  A Rey- 
nal  & Hitchcock  Book.  Harcourt,  Brace  and  Com- 
pany, New  York.  Price,  $3.00. 

Pathology:  Edited  by  W.  A.  D.  Anderson,  M.A.,  M.D., 
P.A.C.P.,  Professor  of  Pathology  and  Bacteriology, 
Marquette  University  School  of  Medicine,  Mil- 
waukee, Wisconsin.  With  1183  Illustrations  and  10 
Color  Plates.  The  C.  V.  Mosby  Company,  St.  Louis, 
1948. 


An  Introduction  to  Ga.stro-Enterology.  Fourth  Edi- 
tion, Revised  and  Enlarged:  By  Walter  C.  Alvarez, 
Professor  of  Medicine,  LTniversity  of  Minnesota, 
The  Mayo  Foundation,  and  a Senior  Consultant  in 
the  Division  of  Medicine,  the  Mayo  Clinic:  Author 
of  "Nervousness,  Indigestion  and  Pain.”  With  269 
Illustrations.  Paul  B.  Hoeber,  Inc.,  Medical  Book 
Department  of  Harper  & Brothers,  New  York. 
Price,  $2.50. 


Nursing  for  the  Future.  A Report  Prepared  for  the 
National  Nursing  Council:  By  Esther  Lucile  Brown, 
Ph.D.,  Director,  Department  of  Studies  in  the  Pro- 
fessions. Russell  Sage  Foundation,  1948.  Price, 
$2.00. 


Contemporary  Religions  Jurisprudence:  By  I.  H.  Ru- 
benstein of  the  Illinois  Bar.  The  Waldain  Press, 
Chicago,  1948.  Price,  $2.50. 


Book  Review 


General  Endocrinology:  By  Donnel  Turner,  Ph.D., 
Associate  Professor  of  Zoology  at  Northwestern 
University.  New,  1st  edition.  604  pages  with  164 
figures.  Philadelphia  and  London:  W.  B.  Saunders 
Company,  1948.  Price,  $6.75. 

This  book  was  written  as  a reference  in  gen- 
eral endocrinology  for  use  by  undergraduate 
students,  and  therefore  the  clinical  aspects  are 
not  primarily  stressed. 

For  clinicians  desiring  additional  detailed  un- 
derstanding of  endocrine  dysfunction,  it  is  an 
adequate  source  of  material  and  can  be  extreme- 
ly helpful  for  its  references  and  reviews. 

Turner  has  written  a book  which  can  be  used 
closely  with  available  allied  texts.  It  does  not 
overlap  greatly  and  should  have  a wide  recep- 
tion among-  those  especially  interested  in  the 
medical  sciences  associated  with  glandular  dis- 
eases. 

The  appearance  of  Turner’s  “General  Endo- 
crinology” answers  a dire  need  relative  to  en- 
docrinology on  a biologic  level.  The  full  dis- 


cussion of  the  anatomical,  physiological,  and  em- 
bryological  aspects  of  glandular  diseases  wiU 
justify  its  wide  acceptance. 

E.  PAUL  SHERIDAN. 


History  of  the  Children’s  Hospital  of  Denver,  Colo.: 

John  W.  Amesse,  M.D.  95  pages.  The  Children’s 

Hospital  Association,  Denver,  1947. 

This  is  a delightful  record  of  the  development 
of  an  institution  from  its  beginidng.  It  makes 
one  feel  the  institution  is  living  and  has  a soul 
for  the  author  talks  of  people  and  what  they  have 
done,  and  he  makes  the  people  talk  of  what  they 
are  doing.  The  author’s  own  personality  is  cast 
heavily  in  shadow  across  the  whole  picture.  It 
is  good  to  have  a written  record  of  such  a past, 
for  the  glory  of  the  present  hospital  may  not 
reveal  what  has  gone  into  its  accomplishment. 
The  author  has  succeeded  admirably  in  recording 
such  a useful  story. 


Practice  of  Allergy:  By  Warren  T.  Vaughan,  M.D., 
Richmond.  Virginia.  Revised  by  J.  Harvey  Black, 
M.D.,  Dallas,  Texas.  Second  Edition.  The  C.  V. 
Mosby  Company,  St.  Louis.  1948. 

Dr.  Vaughan’s  projected  revision  of  his  widely 
accepted  text  on  allergy  was  prevented  by  his 
death.  Dr.  Black,  in  a most  self-effacing  manner, 
has  succeeded  in  bringing  the  book  up-to-date, 
while  still  retaining  the  flavor  of  Vaughan’s  per- 
sonalized style.  The  1,132  pages  of  scholarly  ex- 
position is  remarkably  easy  to  read  and  yet  is  a 
most  informative  book  on  the  subject.  The  prac- 
ticing allergist  will  find  the  preparation  of  ex- 
tracts, mold  culture  and  identification,  and  the 
finer  details  of  allergic  diagnosis  and  manage- 
ment well  presented.  The  man  who  does  only 
occasional  work  in  the  field  will  appreciate  the 
question  and  answer  method  of  discussion  of 
pollen  treatment,  the  detailed  description  of  food 
allergy  diagnosis,  the  lists  of  the  frequently  un- 
suspected sources  of  food,  inhalant,  and  contact 
allergens,  and  the  notations  of  the  commercial 
sources  of  the  various  therapeutic  adjuvants. 

There  are  minor  deficiencies  in  the  book,  but 
mention  of  them  would  be  carping  criticism.  The 
book,  in  this  edition,  remains  as  it  was  the  first 
edition,  standard  equipment  for  the  allergist  and 
a grand  source  book  for  anyone  needing  help 
with  problems  in  allergy. 

ROBERT  F.  BERRIS. 


Bailey’s  Text-Book  on  Histology:  Revised  by  Philip 
E.  Smith.  Ph.D.,  Professor  of  Anatomy,  College  of 
Phy.sicians  and  Surgeons,  Columbia  University:  and 
Wilfred  M.  Copenhaver  Ph.D.,  Associate  Professor 
of  Anatomv,  College  of  Physicians  and  Surgeons, 
Columbia  University.  Twelfth  Edition.  781  pages. 
The  Williams  & Wilkins  Company,  Baltimore,  1948. 
$7.00. 

The  selection  of  a fraction  of  the  vast  descrip- 
tive and  postulatory  literature  of  histology  which 
is  appropriate  for  inclusion  in  a beginner’s  text- 
book on  thi  subject  is  not  a simple  matter.  That 
the  selection  and  elimination  be  guided  by  some 
intelligent  policy  is  essential,  and  we  find  as- 
surance in  the  preface  of  the  12th  edition  (as  in 
previous  editions)  in  this  statement;  “In  present- 
ing controversial  subjects,  we  have  emphasized 
points  of  agreement  rather  than  of  disagreement, 
and  have  excluded  a considerable  body  of  facts 
which  should  be  included  if  this  was  a source 
book  for  teachers  and  research  workers.”  It  may 
well  be  left  to  the  competent  teacher  to  enhance 
his  course  by  reference  to  the  newer  evidence 
even  while  it  is  in  the  controversial  state,  and 
to  instill  in  the  student’s  mind  healthy  doubt  as 
to  the  finality  of  some  of  the  conclusions,  but  it 
defeats  the  purpose  of  the  textbook  to  beset  the 
student’s  course  with  insecurities  and  biases. 


72 


Rocky  Mountain  Medical  Journal 


THE  ASSOCIATION  FOR  THE  STUDY  OF  INTERNAL 
SECRETIONS  ANNOUNCES  A POSTGRADUATE 
ASSEMBLY  IN  ENDOCRINOLOGY 

Oklahoma  Cify,  Oklahoma  Skirvin  Hotel  February  21-26,  1949 

The  faculty  will  consist  of  prominent  reseorchers  end  clinical  endocrinologists  in  the  various 
branches  of  the  medical  sciences,  gathered  from  the  United  States  and  Canada,  and  will  include  the 
following: 


Dr.  Willard  M.  Allen 

Professor  and  Head,  Department  of  Obstetrics 
and  Gynecology,  Washington  University 
School  of  Medicine 

Dr.  Edwin  B.  Astwood 

Research  Professor  of  Medicine 
Tufts  College 

Dr.  J.  S.  L.  Browne 

Professor  of  Medicine 
McGill  University 

Dr.  Edward  A.  Doisy 

Professor  and  Head,  Department  of  Biochemis- 
try, St.  Louis  University  School  of  Medicine 

Dr.  Laurance  W.  Kinsell 

Associate  Clinical  Professor  of  Medicine 
University  of  California  Medical  School 

Dr.  Roberto  Escamilla 

Associate  Clinical  Professor  of  Medicine 
University  of  California  Medical  School 

Dr.  E.  C.  Hamblen 

Associate  Professor  of  Obstetrics  and  Gyne- 
cology, Duke  University  School  of  Medicine 

Dr.  C.  N.  H.  Long 

Sterling  Professor  of  Physiological  Chemistry 
and  Dean,  Yale  University  School  of  Medicine 

Dr.  Cyril  M.  MacBryde 

Associate  Professor  of  Clinical  Medicine 
Washington  University  School  of  Medicine 

Dr.  E.  Perry  McCullagh 

Chief,  Dept,  of  Endocrinology  and  Metabolism 
Cleveland  Clinic 


Dr.  Horold  L.  Mason 

Professor,  Physiological  Chemistry,  Mayo 
Foundation,  University  of  Minnesota 

Dr.  Warren  0.  Nelson 

Professor  of  Anatomy 
Wayne  University 

Dr.  Edward  Rynearson 

Associate  Professor  of  Medicine 
Mayo  Foundation 

Dr.  Hans  Selye 

Professor  of  Experimental  Medicine 
University  of  Montreal 

Dr.  E.  Kost  Shelton 

Associate  Professor  of  Medicine 
University  of  Southern  California 

Dr.  Paul  M.  Starr 

Clinical  Professor  of  Medicine 
University  of  Southern  California 

Dr.  Willard  O.  Thompson 

Clinical  Professor  of  Medicine 
University  of  Illinois  College  of  Medicine 

Dr.  George  Thorn 

Hershey  Professor  of  Physic 
Harvard  Medical  School 

Dr.  Henry  H.  Turner 

Associate  Professor  of  Medicine 
University  of  Oklahoma  School  of  Medicine 

Dr.  Lawson  Wilkins 

Associate  Professor  of  Pediatrics 
Johns  Hopkins  Hospital 


This  course  will  be  a practical  one,  of  interest  and  value  to  the  specialists  and  those  in  general 
practice.  The  program  will  consist  of  lectures,  clinics  and  demonstrations.  Ample  time  will  be  given 
to  questions  and  answers  at  the  end  of  each  session,  and  registrants  are  encouraged  to  contact 
members  of  the  faculty  for  individual  discussion. 

A fee  of  $100  will  be  charged  for  the  entire  course  and. the  attendance  will  be  limited  to  100. 
REGISTRATION  WILL  BE  IN  THE  ORDER  OF  CHECKS  RECEIVED  AND  WILL  CLOSE  ON  FEBRU- 
ARY 1,  1949.  Should  there  be  an  insufficient  number  of  applicants  to  fill  the  course,  the  regis- 
tration fee  will  be  immediately  refunded  in  its  full  amount. 

Please  forward  application  on  your  letterhead,  together  with  check  payable  to  The  Association 
for  the  Study  of  Internal  Secretions,  to  Harry  H.  Turner,  M.D.,  Chairman  of  the  Postgraduate  Com- 
mittee, 1200  North  Walker  Street,  Oklahoma  City,  Oklahoma,  before  February  1,  1949. 


Applicants  should  make  reservations  directly  with  hotels  of  their  choice.  Some  of  the  better 
downtown  hotels  in  Oklahoma  City,  listed  according  to  their  proximity  to  the  Skirvin,  are:  Skirvin 
Tower,  Huckins,  Wells-Roberts,  Biltmore  and  Black. 


for  January,  1949 


73 


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It  is  not  difficult  to  believe  that  the  considered 
opinions  of  the  anatomists  responsible  for  the 
current  and  recent  editions  of  this  book  can  be 
trusted  in  both  fields  of  judgment  involved  in 
the  execution  of  their  policy — ^viz.,  in  the  limits 
of  acceptability  of  evidence  and  conclusions  in 
disputed  problems,  and  in  the  reduction  of  the 
ever-increasing  welter  of  material  to  a reasonable 
maximum  that  may  be  assimilated  by  beginning 
students  in  the  time  available  to  them.  It  is 
advantageous,  too,  that  Bailey’s  Textbook,  now 
being  the  product  of  several  collaborating  edi- 
tors, does  not  suffer  from  the  over-emphasis  or 
over-complication  of  certain  fields,  as  is  so  con- 
spicuously the  case  when  a single  editor  sdelds  to 
the  temptation  to  expand  in  disproportionate  de- 
tail the  subject  of  his  own  especial  interest. 

One  must  not  fail  to  give  credit  to  Karl  Kellner 
for  the  excellent  three-dimensional  drawings  that 
contribute  so  much  to  the  clarity  of  the  text. 
This  device  has  been  too  sparingly  used  in  Amer- 
ican textbooks — -this  in  spite  of  the  fact  that  al- 
most all  histology  teachers  agree  that  one  of  the 
most  difficult  parts  of  their  teaching  is  to  get 
students  to  appreciate  the  third  dimension,  in- 
stead of  trying  to  learn  only  the  two  dimensions 
of  the  microscopic  field.  May  there  be  more 
and  more  of  such  drawings!  It  is  regrettable  that 
some  very  unsatisfactory  line  drawings,  which 
can  be  revered  only  for  their  hoary  age,  are 
still  used.  It  is  to  be  hoped  that  they  are  slated 
for  replacement  in  future  editions. 

The  1940  revision  (10th  edition)  was  reprinted 
each  subsequent  year  until  the  1944  revision 
(11th  edition,  appeared.  The  eleventh  edition 
was  reprinted  each  year  imtil  the  present  re- 
vision (12th  edition).  This  popularity  is  deserved. 

THEODORE  S.  ELIOT. 


WANTADS 

YOUNG  MARRIED  PHYSICIAN  wishes  salary  asso- 
ciation with  reputable  general  practitioner  in  Colo- 
rado. Prefer  western  part  of  the  state.  Graduate 
of  Class  A medical  school,  will  complete  Navy  in- 
ternship in  July,  1949.  Please  contact  Dr.  D.  C. 
Beer,  9012  Barcelona,  Oakland,  California. 


Denver’s  Fireproof 

COLBURN  HOTEL 

D.  B.  Cerise  is  the  genial  Host  and  Manager 

• CONVENIQfT  — Located  only  a ten-minute  walk 
Irom  the  heart  of  the  city. 

• PLEASANT  — Away  from  — above  the  noise  and 
rush  of  downtown  Denver. 

• EXCELLENT  FOOD  — Dining  that  has  satisfied  the 
demanding  tastes  of  all  patrons. 

• Visit  Our  New  Cocktail  Lounge. 

TENTH  AVE.  at  GRANT  ST. 

Phone  MAin  6261  Denver,  Colo. 


COLVIN-Medical  Books 

Medical  Publications  of  All  Publishers 

Books  Sent  for  Examination  on  Request 
We  Maintain  This  Book  Store  for  Your  Convenience 
Books  Make  Fine  Christmas  Gifts 
Write  or  Come  to 
705-706  MAJESTIC  BUILDING 

Denver  2,  Colorado  Call  MAin  3866 


74 


Rocky  Mountain  Medical  Journal 


1 

t 


DIGILANID LANATOSIDES  A,  B and  C 

(Council-Accepted) 

RELIABLE  ORAL  DIGITALIS  THERAPY 

Digilanid  contains  the  complex  glycosides  of  digitalis  lanata  in  chemically 
pure  form,  assuring  maximum  efficiency  for  maintenance  and  whenever 
oral  digitalis  therapy  is  indicated.  Uniform  in  potency,  stable,  well  toler- 
ated and  adequately  absorbed. 

SUPPLIED— Tablets,  Ampuls,  Suopositories  and  Liquid 


SANOOZ 


Literature,  Samples  and  Bibliography  on  Request 

SANDOZ  CHEAAICAL  WORKS,  INC.,  NEW  YORK 

West  Coast  Office: 

450  Sutter  Street  San  Francisco  8,  Calif. 


LIVERMORE  SANITARIUM 


• The  Hydropathic  Department 
devoted  to  the  treatment  of  gen- 
eral diseases,  excluding  surgical 
and  acute  infectious  cases.  Special 
attention  given  funaional  and  or- 
ganic nervous  diseases.  A well 
equipped  clinical  laboratory  and 
modern  X-ray  Department  are  in 
use  for  diagnosis. 


• The  Cottage  Department  (for 
mental  patients)  has  its  own  fa- 
cilities for  hydropathic  and  other 
treatments.  It  consists  of  small 
cottages  with  homelike  surround- 
ings, permitting  the  segregation  of 
patients  in  accordance  with  the 
type  of  psychosis.  Also  bungalows 
for  individual  patients,  offering 
the  highest  class  of  accommoda- 
tions with  privacy  and  comfort. 


GENERAL  FEATURES 

1.  Climatic  advantages  not  excelled  in  United  States.  Beautiful  grounds  and  attractive  surrounding  country. 

2.  Indoor  and  outdoor  gymnastics  under  the  charge  of  an  athletic  director.  An  excellent  Occupational  Department. 

3.  A resident  medical  staff.  A large  and  well-trained  nursing  staff  so  that  each  patient  is  given  careful  individual  attention. 

Information  and  circulars  upon  request.  CITY  OFFICES: 

Address:  O.  B.  JENSEN,  M.D. 

Superintendent  and  Medical  Director  San  FRANCISCO  Oakland 

Livermore,  California  450  Sutter  Street  1624  Franklin  Street 

Telephone  313  GArfield  1-5040  GLencourt  1-5988 


for  January,  1949 


75 


YORK 

PHARMACY 

Denver’s  Finest  Prescription  Store 
Free  Delivery 
Phone  FR.  8837 

2300  East  Colfax  Avenue  at  York  Street 
Almay  Cosmetics 


^Iba  'Dairy 

Properly  Pasteurized  Milk 

Ice  Cream — Butter — ^Buttermilk 

a 

Phone  1101  Boulder,  Colo 


jSllll 


LABORim 


Inorganic  and  Organic  Chemicals 
Biological  Stains  • Solutions 
Chemical  Indicators  • Test  Papers 

DUtribut^d  by 
Phyiidan  and  Laboratory  Supply  House* 

The  COLEMAN  & BELL  COMPANY,  Inc. 

HANVFACnmiNC  CHEMISTS  NORWOOD,  OHIO,  U.S.A. 


COLEMAN  & BELL  ~?ZcUctHrt/,  Ohia 


(Attention . . . 
DENVER  PHYSICIANS 

(Patronize  Your 
Denver  Advertisers 


Let’s  exact  the  same  high  standard  of  purity  in  drinking  water  we 
do  in  foods,  medicines,  and  morals. 

“Good  health  deserves  it.  Bad  health  demands  the  hest  water.” 


DEEP  ROCK  WATER  CO. 

Distributors  of 

MOUNTAIN  VALLEY  MINERAL  WATER 
614  27th  Street  From  Hot  Sorinss.  Arkansas  TAbor  5121 


76 


Rocky  Mountain  Medical  Journal 


ARMSTRONG  CASTER  CO. 

Distributors  for 

THE  COLSON  LINE 

OF  CASTERS  — WHEEL  CHAIRS  — INHALATORS  — STRETCHERS 


828  14th  Street 


AND  FOOD  CONVEYORS 


Denver  2,  Colorado 


ALpine  1797 


The  Fairhaven  Maternity  Hospital 

Mrs.  H:  E.  Lowther,  Superintendent 

Seclusion  for  the  unwed  mother.  Write  for  descriptive  booklet. 

1349  JOSEPHINE  EAst  9944  DENVER 


• Preferred  and  Common  Stocks 

* Industrial  Bonds 

* Public  Utility  Bonds 

* Railroad  Bonds 

* Municipal  Bonds 

* Government  Bonds 

Peters^  Writer  & Christensen 

Inc. 

Investment  Bankers 

601-8  U.  S.  National  Bank  Bldg.,  Denver 

MAin  6281  ^ 

WESTERN  ELECTRIC 

HEARING  AIDS 


Engineered  by  Bell  Telephone  Laboratories 


SOME  o£  the  exclusive  features  of  this 
new  Vacuum  Tube  Hearing  Aid  are: 
Sealed  Crystal  Microphone — gives  same 
dependable  service  under  all  conditions  of 
temperature  and  humidity.  Stabilized  Feed- 
back — amplification  without  distortion. 
No  sudden  blast  from  loud  sounds  when 
volume  is  turned  up. 

For  other  iniormation  write  or  call 

M.  F.  Taylor  Laboratories 

721  Republic  Building 
MAin  1920  Denver,  Colo. 


SERVICE 


QUALITY 


PAUL  WEISS 

PRESCRIPTION 

OPTICIAN 


1620  ARAPAHOE  ST. 


DENVER 


MAin  1722 


American 

Ambulance 

Company 


THE  FINEST  OF 
CARE  AND  SERVICE 

Oxygen  Equipped 
Cadillacs 

Now  Radio  Telephone  Controlled 


2045  DOWNING  TAbor  2261 

DENVER 


Cook  Countv  Graduate 
School  of  Medicine 

ANNOUNCES  CONTINUOUS  COUBSES 

SURGERY — Intensive  Course  In  Surgical  Technique, 
two  weeks,  starting  January  24,  February  21.  Sur- 
gical Technique,  Surgical  Anatomy  and  Clinical  Sur- 
gery, four  weeks,  starting  February  7,  March  7. 
Surgical  Anatomy  and  Clinical  Surgery,  two  weeks, 
starting  February  21,  March  21.  Surgery  of  Colon 
and  Rectum,  one  week,  starting  March  7,  April  11. 
Surgical  Pathology  every  two  weeks. 

GYNECOLOGY — Intensive  Course,  two  weeks,  start- 
ing Febryary  21,  March  21.  Vaginal  Approach  to 
Pelvic  Surgery,  one  week,  starting  February  14. 

OBSTETRICS — Intensive  Course,  two  weeks,  start- 
ing March  7. 

MEDICINE — Intensive  Course,  two  weeks,  starting 
April  4.  Personal  Course  in  Gastroscopy,  two  weeks, 
starting  March  7. 

PEDIATRICS — Intensive  Course,  four  weeks,  start- 
ing April  4. 

DERMATOLOGY — Formal  Course,  two  weeks,  start- 
ing April  18.  Clinical  Course  every  two  weeks. 

CYSTOSCOFY — Ten  day  Practical  Course  every  two 
weeks. 

ROENTGENOLOGY — Lecture  and  Diagnostic  Course, 
two  weeks,  starting  the  first  Monday  of  every 
month.  Clinical  Course  starting  third  Monday  of 
every  month. 

GENERAL,  INTENSIVE  AND  SPECIAL  COURSES 
IN  ALL  BRANCHES  OF  MEDICINE,  SURGERY 
AND  THE  SPECIALTIES. 

TEACHING  FACULTY  — ATTENDING  STAFF  OF 
COOK  COUNTY  HOSPITAL 


Address:  Registrar,  427  South  Honore  Street, 
Chicago  12,  Illinois 


78 


Rocky  Mountain  Medical  Journal 


Colorado  State  Medical  Society  Library 

and 

Medical  Society  City  and  County  of  Denver  Library 

CONTAIN  JOINTLY 


Total  number  of  volumes 34,523 

Number  of  periodicals  received  in  1943: 

American,  187  Foreign,  47  Total,  234 


SERVICE  TO  ALL  MEMBERS  OF  THE  COLORADO  STATE  MEDICAL  SOCIETY 


WE  RECOMMEND 

PFAB  PHARMACY  KINCAID  PHARMACY 

Sheridan  Bldv.  at  West  Colfax  7024  West  Colfax  at  Saulsbury  St. 

AComa  2539-2530  Lakewood  436  — 1500 

PROFESSIONAL  SERVICE 

Prescriptions,  Biologicals  and  Fine  Cosmetics 
JESS  KINCAID,  Proprietor 
Free  Deliveries  on  Prescriptions 


Winning  Health 

in  the 

Pikes  Peak  Region 


COLORADO  SPRINGS 


Inquiries  Solicited 


GLOCKNER  PENROSE  HOSPITAL 

Sisters  of  Charity 

HOME  OF  MODERN  SANATORIA 


FAIRFAX  SANITARIUM 


Kirkland,  Wash. 

Situated  one  mile  north  of  Juanita 


TREATING  NERVOUS  AND 


MENTAL  DISEASES 


Beautiful  and  restful  surroundings  affording 
recreational  facilities.  Cottage  plan  for  segre- 
gation of  patients.  Insulin  and  Electro-shock 
Therapy  when  indicated. 

Attending  Physicians 
FREDERICK  LEMERE,  M.D. 

NATHAN  K.  RICKLES,  M.D. 

JAMES  H.  LASATER,  M.D. 

MORTON  E.  BASSAN,  M.D. 

JACK  J.  KLEIN,  M.D. 

Manager:  A.  G.  HUGHES 
Route  2,  Box  365,  Kirkland 
Phone:  Kirkland  2391 


for  January,  1949 


79 


Bonita  Pharmacy 

(Established  1921) 

Prescription  Pharmacists 

6th  Avenue  at  St.  Paul  Street 

“RICHT-A-WAY”  SERVICE 

GERALD  P.  MOORE.  Manager 
Phone  FRemont  2797 


We  Welcome  Members  of  the 
Medical  Profession 

PLza  Motet 

Under  Management  of 
Mrs.  Addie  A.  and  Edward  A.  Miller 
Proprietors 

ALL  OUTSIDE  ROOMS 
Comer  15th  and  Tremont 
A Stone’s  Throw  to  Medical  Buildings 

TAbor  5101  DENVER 


50  y.a.6  of  Clk  icai  pre6cription 

Service  to  the  ^boctori  of  C^ke^enne 


ROEDEL^S 

PRESCRIPTION  DRUG  STORE 

CHEYENNE,  WYOMING 


^t^octor — 


Rockmont  Collectelopes 
Will  Save  You  Money 

Write  or  Phone  for  Sample* 

Rockmont  Envelope  Co. 

DENVER 

750  Acoma  St.  MAin  4244 

SALT  LAKE  CITY 

1414  First  National  Bank  Bldg.  5-2276 


JL 

BROWN  SCHOOLS 


For  Exceptional  Children 

Four  distinct  units.  Tiny  Tots  through 
the  Teens.  Ranch  for  older  boys.  Spe- 
cial attention  given  to  educational  and 
emotional  difficulties.  Speech,  Music, 
Arts  and  Crafts.  Full  time  Psychologist. 
Under  the  daily  supervision  of  a Certi- 
fied Psychiatrist.  Registered  Nurses. 
Private  swimming  pool,  fireproof 
building.  View  Book.  Summer  Camp. 
Approved  by  State  Division  of  Special 
Education. 

BERT  P.  BROWN 

President 

Paul  L.  White,  M.D.,  F.A.P.A., 
Medical  Director 

Box  3028,  South  Austin  13,  Texas 


The  Craving  for  Candy  Often  Is 

A CALL  FOR  ENERGY 


Recommend  Brecht’s 

For  Your  Patients  . . . 


SUGAR  PUUMS  . . . tenderest  of  fruit-flav- 
ored Jelly  Candies:  made  with  sugar,  corn 
syrup,  dextrose,  citrus  fruit  pectin,  U.  S. 
Certified  Colors.  Cellophane-topped  Party 
Packages. 

PANTRY  SHBLiF  . . . delicious  hard  candies 
in  many  flavors.  Refreshing  fruit  drops, 
crunchy  filled  wafers  . . . flavor  sealed — 
in  glass  jars. 

DAINTY  STICKS  ...  SO  delicious  and  pure. 
Made  from  sugar,  dextrose,  corn  syrup,  fin- 
est flavorings,  U.  S.  Certified  Colors.  As- 
sorted flavors. 


80 


Rocky  Mountain  Medical  Journal 


OFFICIAL 

☆ 

REGISTRY 

Read  the 

Established  to  Meet  the  Communit3r’s 

Every  Need  for  Nursing  Care 

-k  -k  -K 

Advertisements 

GRADUATE  REGISTERED  NURSES 

Hourly  Nursing  Service  Positions 

They 

Filled — Information  on  All 

Nursing  Service 

This  registry  is  endorsed  by  the 
Colorado  State  Graduate  Nurses’ 
Association  and  American  Nurses’ 

Support  Your 

Journal 

Association 

•k  ^ 

Undergraduates  and  Practical  Nurses 

Furnished  Upon  Request 

☆ 

KEystone  0168 

ARGONAUT  HOTEL 

No  Test  Tubes  • No  Measuring  • No  Boiling 

Diabetics  welcome  “Spot  Tests”  (ready  to  use  dry 
reagents) , because  of  the  ease  and  simplicity  in  using. 

No  test  tubes,  no  boiling,  no  measuring;  just  a little 
powder,  a little  urine — color  reaction  occurs  at  once 
if  sugar  or  acetone  is  present. 

. . . fjdce^me'  (denco) 

FOR  E>ETECTEON  OF  FOR  DETECTION  OF 

SUGAR  IN  THE  URINE  ACETONE  IN  THE  URINE 


SAME  SIMPLE 
TECHNIQUE  FOR  BOTH 

1.  A LITTLE  POWDER 

2.  A LITTLE  URINE 
COLOR  REACTION  IMMEDIATEU 


A carrying  case  containing  cne 
vial  of  Acetone  Test  (Denco) 
and  one  vial  of  Galatest  is  now 
available.  This  is  very  conven- 
ient for  the  medical  bag  or  for 
the  diabetic  patient.  The  case 
also  contains  a medicine  dropper 
and  a Galatest  color  chart.  This 
handy  kit  or  refills  of  Acetone 
Test  (Denco)  and  Galatest  are 
obtainable  at  all  prescription 
pharmacies  and  surgical  supply 
houses. 


Accepted  fot  advertising  in  the  Journal  of  the  A,M,A, 
WRITE  FOR  DESCRIPTIVE  LITERATURE 


(DENCO) . . ♦ 

The  Denver  Chemical  Manufacturing  Co.,  inc. 

143  Varick  Street,  New  York  13,  N.  Y. 


accIdeT^^^TSpita^^^ickness 

INSURANCE 

For 

Physicians,  Surgeons,  Dentists  Exclusively 

AIL 

^ PREMIUMS 

COME  FROM 


$5,000.00  accidental  death  $8.00 

$25.00  weekly  lodannlty,  accident  and  slekneei  Quarterly 

$10,000.00  accidental  death  $16.00 

$50.00  weekly  indeeuilty,  accident  and  elcknesi  Quarterly 

$15,000.00  accidental  death  $24.00 

$75.00  weekly  Indeoalty,  aeddent  and  deknen  Quarterly 

$20,000.00  accidental  death  $32.00 

$100.00  we^ly  Indemnity,  aeddent  and  slcknesa  Quarterly 


AI,«0  HOSPITAI,  BXPBNSB  FOR  MBMBBUUI, 
WIVES  AND  CHDUDREJN 


8Sc  out  of  each  $1.00  gross  income  used  for 
member^  benefit 


$3,000,000.00  $15,000,000.00 

INVESTED  ASSETS  PAID  FOR  CLAIMS 

$200,000.00  deposited  with  State  of  Nebraska  for  protection  of  oor  members. 

Disability  need  not  be  incurred  in  line  of  duty — 
benefits  from  the  beginning  day  of  disability 

PHYSICIANS  CASUALTY  ASSOCIATION 
PHYSICIANS  HEALTH  ASSOCIATION 

46  years  under  the  lome  mcmogement 
dno  Flr«t  Nnetonnl  Raok  Riiilding.  Oninha  2,  Nebranka 


jor  January,  1949 


81 


RELIABLE  DRUGGISTS 


PATRONIZE  DENVER’S  INDEPENDENT  DRUGGISTS 


WE  RECOMMEND 

COUNTRY  CLUB 
PHARIRACY 

PRESCRIPTION  SPECIALISTS 

1700  E.  6th  Ave.  EAst  7743 

Denver,  Colorado 

We  Recommend 

PFAB  PHARMACY 

JESS  L.  KINCAID,  Prop. 

Prescriptiorts,  Biologicals 
and  Fine  Cosmetics 

5190  W.  Colfax  at  Sheridan 

Phone  TAbor  9931-0951 

DENVER,  COLORADO 

HATCH  PHARMACY 

PRESCRIPTIONS  OUR  SPECIALTY 

Drugs  — Sundries 

Free  immediate  Deliveries  on  Prescriptions 
794  Colorado  Blvd.  Denver,  Colo. 

Phone  EAst  7718 

“When  in  Need  Think  of  Us  Indeed” 

We  Recommend 

EARIYEST  DRUG  COMPANY 

T.  H.  BRAYDEIN.  Prop. 

PRESCRIPTION  SPECIALISTS 
Prompt  Delivery  Service 

1699  Broadway  Phone  KEystone  7237 

Denver,  Colorado 

“Conveniently  Located  for  the  Doctor” 

HYDE’S  PHARMACY 

ACCURATE  PRESCRIPTIONS 

Chas  W.  Hyde,  Prop. 

Rocky  Mountain  Distributor  for  Sherman 
Biologicals  and  Pharmaceuticals 

Free  Deliveries 

62S  16th  St.  (Mack  Bldg.)  KE.  4811 

Doyle's  Pharmacy 

*^ke  Particular  ^J^ru^^ht** 

East  17th  Ave.  at  Grant  ' KE.  5987 

21  Years  in  the  Heart  of  North  Denver 

GUIDO  SHUMAKE  DRUGS 

(Formerly  Otto  Drug  Co.) 

PRESCRIPTIONS  ACCURATELY 
COMPOUNDED 

Free  Delivery  Service 

West  38th  Ave.  and  Clay  Denver,  Colo. 

Phone  GRand  9934 

We  Recommend 

BONNIE  BRAE 

DRUG  COMPANY 

Alfred  C.  Andersen,  Owner  and  Manager 
Prescriptions  Accurately  Compounded 

Drugs Sundries 

FREE  IMMEDIATE  DELIVERIES 

ON  EMERGENCY  PRESCRIPTIONS 

763  South  University  Boulevard 

Phone  RAce  2874  — Denver,  Colorado 

WE  RECOMMEND 

Whittaker’s  Pharmacy 

“The  Friendly  Store” 

^^tienilon  . . . 

PHYSICIANS 

PRESCRIPTION  SPECIALISTS 

West  32nd  and  Perry,  Denver,  Colo. 
Phone  GLendale  2401 

jf^utponize  ...^ctueptiderd 

82  Rocky  Mountain  Medical  Journal 


RELIABLE  DRUGGISTS 

PATRONIZE  DENVER’S  INDEPENDENT  DRUGGISTS 


Downing  Street  Pharmacy 

GEORGE  M.  HILL,  Prop. 
PROFESSIONAL  PHARMACIST 
901  Downing  St.  Denver,  Colo. 

Phone  CHerry  2767 

Complete  Merchandise  Line 
Free  Delivery  on  Prescriptions 


East  Denver’s  Prescription  Drug  Store 

Bert  C.  Corgan,  Prop. 

3401  FRANKLIN  STREET 
KEystone  7241 


OVERSTAKE’S  PHARMACY 

Gail  E.  Overstake 
Prescription  Specialists 

DRUGS  — SUNDRIES  — 
COSMETICS  — CANDIES 

We  Deliver 

1000  So.  Gaylord  — RAce  4401 


D.  MALCOLM  CAREY,  Pharmacist 

Phone  AComa  3711 

224  Sixteenth  Street  Denver,  Colorado 


PROFESSIONAL  MEN  RECOMMEND 


WALTERS  DRUG  STORE 
801  COLORADO  BLVD. 
Denver,  Colorado 

☆ 

Telephone  FRemont  5391 


.3Va  lAJide  to  i3u^  at  'MJeidd 

WEISS  DRUG 

PRESCRIPTION  SPECIALISTS 

☆ 

Colfax  and  Elm  Denver,  Colorado 

Phone  EAst  1814 


We  Xtecommend 

VAN'S  PHARMACY 

THOS.  A.  VANDERBUR 

Prescriptions,  Drugs,  Cosmetics,  Magazines 
Sundries  Excellent  Fountain  Service 

2850  Umatilla  St.,  Cor.  29tli  Ave,  at  Umatilla 
GRand  7044  Denver,  Colo. 


Dansberry’s  Pharmacy 

“New  Ultra  Modern  Prescription  Service’’ 

JAMES  F.  DANSBERRY 
Owner  and  Manager 

Champa  at  14th  Street  Denver,  Colorado 
Phone  KEystone  4269 


Harl  Cleveland,  Owner 

CLEVELAND  PHARMACY 

VV.  29th  Ave.  at  Speer  Ph.  GL.  9272 

Modem  Prescription  Department 
Registered  Pharmacist 
Drugs  — Sundries  — Soda  Fountain 

HOURS:  Week  Days,  8 a.m.  to  10  p.m. 

Sundays,  10  am.  to  1 p.m.,  5 p.m.  to  9 p.m. 

Prescriptions  Delivered  Promptly 


WE  RECOMMEND 

f.AKEWOOD  PHARMACY 

R.  W.  Hoitgren,  Prop. 
PRESCRIPTION  SPECIALISTS 


West  Colfax  at  Wadsworth 
Lakewood  Colorado 

Phone  Lakewood  65 


for  January,  1949 


83 


Qolorado  Springs  ^Psychopathic  Hospital 


A Private  Hospital  for  Nervous  and  Mental  Diseases 

Situated  in  a beautiful  valley  two  miles  south  of  Colorado  Springs,  which  is  nationally  known  as  a health 
center.  New  building  for  mild  cases  of  Functional  Neurosis,  affording  complete  classification  of  patients. 
Home-like  surroundings,  scientific  medical  treatment  and  nursing  care.  Booklet  and  rates  on  application. 

C.  F.  Rice,  Superintendent,  Colorado  Springs,  Colorado 


(Established  1895) 

BOUIiDER,  COLORADO 

• Pictured  Above — Restful,  congenial,  home- 
like sun  oundings,  combined  with  the  most  mod- 
ern equipment.  Colorado’s  finest  institution. 
Excellent  dietary  and  Nursing  Service. 


dSouider- doiorado  Sanitarium 


COLORADO’S  TWIN  HEALTH  INSTITUTIONS 


Porter  Sanitarium  and  Sdodpitai 

(Established  1930) 

DENVER,  COLORADO 

• Pictured  Below — Complete  Medical,  Surgical 
and  Obstetrical  services.  A GOOD  OUIET  place 
for  test  and  convalescence.  Fully  equipped  Lab- 
oratory and  X-Ray  departments.  Also  modern 
Hydrotherapy  and  Electrotherapy  departments. 


RATES  ARB  MODERATE  • • INRDIRIES  INVITED 


84 


Rocky  Mountain  Medical  Journal 


RECOGNIZE  THESE  CONTAINERS? 


i F you  know  the  history  of  ready-to-use  intra- 
venous solutions,  you’ll  recognize  the  first  two  contain- 
ers as  real  "old-timers”  in  the  field.  The  one  at  left 
was  used  by  Baxter  in  1928  for  the  first  commercially 
prepared  parenteral  solutions  sold  in  the  United  States. 
A year  or  so  later  the  middle  bottle  was  also  used. 
These  bottles  were  satisfactory  in  the  early  days  of 
solution  pioneering,  but  in  1931  farsighted  Baxter 
leadership  replaced  them  with  the  Vacoliter  container, 
offering  greater  protection  to  solutions  and  more  con- 
venience to  hospitals.  The  Vacoliter  container  shown 
at  right  is  the  result  of  continuous  improvement 
throughout  the  years.  In  Vacoliter  containers,  solution 
sterility  has  been  protected  successfully  since  1931. 


California 


Don 


4 

THE  SEASONED  SKILL 
OF  THE  SPECIALIST... 

A . . 

Xjl.  specialist  acquires  rank  through  study 
and  experience.  He  thus  develops  a seasoned  skill 
which  is  seldom  equaled  hy  others  whose  efforts  are 
dispersed  in  a wider  range  of  activities.  This 
seasoned  skill  of  the  specialist  is  inherent  in  the 
production  of  Vacoliter  solutions  and  all  Baxter 
equipment.  The  wealth  of  experience  and  speciali2ed 
techniques  back  of  these  Baxter  products  underlies 
the  confidence  with  which  they  are  accepted  in  the 
greater  part  of  the  world.  Baxter  has  produced 
parenteral  solutions  for  mass-dosage  longer  than 
any  other  manufacturer,  and  has  continuously 
specialized  in  solution  research  and  production. 


lAJooc/ci*o^t  J^oSpitai—JPueLio,  C^otoi^ado 

A private  hospital  for  the  scientific  treatment  of  neuro-psychiatric  disorders,  including 
alcoholism  and  drug  addiction.  Beautiful  landscaping  and  home-like  surroundings  afford 
a restful  atmosphere.  Accommodations  vary  from  single  rooms  with  or  without  bath  to 
rooms  en  suite,  allowing  for  segregation  of  guests. 


Detailed  information  furnished  on  request. 


Karl  J.  Waggener,  M.D. 


Wendell  T.  Wingett,  M.D. 


THE  CHILDREN’S  HOSPITAL  ASSOGATION 

of  DENVER 

NON-SECTARIAN NON-PROFIT 

Providing  medicinal  and  surgical  aid  to  sick  and  crippled  children  of  the  Rocky 
Mountain  Region  from  Birth  to  Maturity 

Every  modern  scientific  aid  available  to  the  physicians  and  surgeons 
of  Colorado  and  Wyoming 

Approved  by  the  American  Medical  Association  and  Full  Three-Year 

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for  January,  1949 


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86 


Rocky  Mountain  Medical  Journal 


Index  to  Advertisers 


Page 


Page 


Page 


Abbott  Laboratories 69 

Alba  Dairy 76 

American  Ambulance  Co 76 

American  Medical  and  Dental 
Association 8 

Armstrong  Caster  Co 77 

Association  for  the  Study  of 
Internal  Secretions,  The 73 


Ayerst,  McKenna  & Harrison.  51 


Baxter Insert  between  84  & 85 

Blair  Surgical  Supply 61 

Bonita  Pharmacy 80 

Bonnie  Brae  Drug 82 

Boulder-Colorado 

Sanitarium  84 

Brecht  Candy  Co 80 

Brown  Schools 80 

Cambridge  Dairy 4 

Camel  Cigarette 3 

Camp  & Co.,  S.  H 57 

Capital  Chevrolet 4 

Cascade  Laundry 74 

Children’s  Hospital 

Assocation  85 

Ciba  Pharmaceutical 9 

City  Park  Dairy 10 

Cleveland  Pharmacy 83 

Coca-Cola  86 

Colburn  Hotel 74 

Colorado  Springs 

Psychopathic  Hospital 84 

Colvin  Medical  Books 74 

Cook  County  Graduate 

School  of  Medicine^ : 78 

Country  Club  Pharmacy 82 

Cutter  Laboratories 49  & 68 

Dansberry’s  Pharmacy 83 

Deep  Rock  Water 76 

Denver  Chemical  Co 81 


Denver  Oxygen  Co 12 

Dorr  Optical  Co 14 

Downing  Street  Pharmacy 83 

Doyle’s  Pharmacy 82 

Dryer  and.Astler 86 

Earnest  Drug  Co 82 

Ehret  Engraving  Co.^ 12 

Fairfax  Sanitarium 79 

Pairhaven  Maternity 

Hospital 77 

Franklin  Drug  Co 83 

Gabriel  Restaurant 74 

Garden  Grove 88 

Glockner  Penrose 

Hospital  79 

Hewitt,  Edward  M - 74 

Hyde's  Pharmacy 82 

Jackson’s  Cut  Rate  Drug 78 

Karg  Paint  Co 74 

Kendrlck-Bellamy  Co 2 

Kincaid  Drug  Co 79 

Lakewood  Pharmacy 83 

Lilly,  Eli  & Co. 

Insert  between 16  «&  17 

Livermore  Sanitarium 75 

Lov-6  Brassiere  Co 63 

M.  & R.  Dietetic 

Laboratories,  Inc 53 

Mead,  Johnson 

& Co Cover  IV 

Merck  & Co 55 

Newton  Optical  Co 78 

Nurses  Official  Registry 81 

Overstake’s  Pharmacy 83 

Park  Floral  Co 12 

Parke,  Davis  & Co Cover  II  & 1 

Peters,  Writer  & 

Christensen,  Inc 77 

Pfab  Pharmacy 82 

Philip  Morris  59 


Physicians  and  Surgeons 

Telephone  Service  Exch 78 

Physicians  Casualty  Co 81 

Physicians  and  Hospitals 

Supply  Co.,  Inc 71 

Plaza  Hotel 80 

Porter  Sanitarium 

and  Hospital  84 

Professional  Pharmacy 83 

Roche  Ambulance  Service 86 

Rockmont  Envelope  Co 80 

Roedel’s  Prescription  Drug 80 

Sandoa  Chemical  Works 75 

Sobering  Corporation 13 

Searle  & Co.,  G.  D 47 

Shadel  Sanitarium 67 

Shaford-Fletcher  Optical  Co 10 

Shumake  Drugs,  Guido 82 

Stodghill’s  Imperial 

Pharmacy  lo 

Taylor,  M.  F.,  Laboratories 77 

Telephoning  Answering 

Service ' 4 

Thornton,  George  R 2 

United  States  Brewing 

Industry  66 

University  Inn 78 

Van’s  Pharmacy 83 

Walters  Drug  Store 83 

Wantads  74 

Weiss  Drug 83 

Weiss,  Paul 77 

Western  Electric 

Hearing  Aids 77 

Western  Newspaper  Union 86 

Wheatridge  Farm  Dairy 78 

Whittaker’s  Pharmacy 82 

Winthrop-Stearns,  Inc 5 

Woodcroft  Hospital 85 

Wyeth,  Inc 7 

York  Pharmacy 76 


for  January,  1949 


87 


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Headquarters,  Both  Events,  Shirley-Savoy  Hotel 


Happen 

Here 


Lest  we  forget — we  who  are  of  the  vita- 
J min  D era — severe  rickets  is  not  yet  eradi- 
cated, and  moderate  and  mild  rickets  are 


still  prevalent.  Here  is  a white  child,  sup-  Example  oj  severe  rickets  in  a sunny  cliTne 

posedly  well  fed,  if  judged  by  weight  alone, 
a farm  child  apparently  living  out  of  doors 

a good  deal.  This  boy  was  reared  in  a state  having  a latitude  be- 
tween 37°  and  42°,  where  the  average  amount  of  fall  and  winter 
sunshine  is  equal  to  that  in  the  major  portion  of  the  United  States.  And 
yet  such  stigmata  of  rickets  as  genu  varum  and  the  quadratic  head 
are  plain  evidence  that  rickets  does  occur  under  these  conditions. 

How  much  more  likely,  then,  that  rickets  will  develop  among 
city-bred  children  who  live  under  a smokepall  for  a large  part  of 
each  vear.  True,  vitamin  D is  more  or  less  routinely  prescribed 
nowadays  for  infants.  But  is  the  antiricketic  routinely  admin- 
istered in  the  home?  Does  the  child  refuse  it?  Is  it  given  in  some  un- 
standardized form,  purchased  from  a false  sense  of  economy  because 
the  physician  did  not  specify  the  kind? 


A uniformly  potent  source  of  vitamin  D such  as  Oleum  Perco- 
morphum,  administered  regularly  in  proper  dosage,  can  do  more 
than  protect  against  the  gross  visible  deformities  of  rickets.  It  may 
prevent  hidden  but  nonetheless  serious  malformations  of  the  chest 
and  the  pelvis  and  will  aid  in  promoting  good  dentition.  Because 
the  dosage  is  measured  in  drops.  Oleum  Percomorphum  is  well 
taken  and  well  tolerated  by  infants  and  growing  children. 


OLEUM  PERCOMORPHUM 
WITH  OTHER  FISH-LIVER 
OILS  AND  VIOSTEROL 

Potency,  60,000  vitamin  A units 
and  8,500  vitamin  D units  per 
gram.  Supplied  in  10  cc.  and 
50  cc.  bottles;  and  as  capsules 
in  bottles  containing  50  and  250. 


MEAD  JOHNSON  & COMPANY,  EVANSVILLE,  INDIANA,  U. S. A. 


Please  enclose  professional  card  when  requesting  samples  of  Mead  Johnson  products  to  co-operate  in  preventing  their  reaching  unauthorized  persons 


u 


Cancer  in  Infancy  and  Childhood — Philip  Rosen- 
blum,  Chicago. 

The  Medical  Care  of  Tuberculosis  by  the  State 
OF  Colorado — Edward  N.  Chapman,  Denver. 

Carcinoma  of  the  Colon — Kenneth  B.  Castleton, 
Salt  Lake  City. 

The  Brucellosis  Problem — George  W.  Stiles, 
Denver. 

The  Allergic  Nasal  Syndrome — Leo  P.  Coakley, 
Missoula,  Montana. 

A Clinical  Study  of  Auricular  Flutter — G. 
Paul  Smith,  Grand  Junction,  and  Joseph  E. 
Weldon,  St.  Louis. 

(For  complete  Table  of  Contents, 
turn  the  first  page) 

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THEELIN’  S dose-for-dose  uniformity  is  assured  by 
chemical  determination  of  identity  and  purity,  and  standardization  by 
weight.  The  variety  of  clinically  convenient  dosage  forms  permits 

individualized  treatment  schedules. 


THEELIN  Aqueous  Suspensioni-cc.  ampoules  of  i mg. 
(10,000  I.U.),  2 mg.  (20,000  I.U.),  and  5 mg.  (50,000  I.U.). 

THEELIN  In  OIL1-cc.  ampoules  of  0.1  mg.  (1000  I.U.),  0.2  mg. 

(2000  I.U.),  0.5  mg.  (5000  I.U.)  and  1 mg.  (10,000  I.U.). 

THEELIN  Steri-Vials®  In  Oil,  vials  of  lo  cc.,  i mg. 

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D-size,  $5;  E-size,  $3.50;  F-size,  $2  postpaid, 
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Table  of  Contents 

VOLUME  46  NUMBER  2 

FEBRUARY,  1949 


Page 


Editorials 

The  Twenty-five  Dollar  Assessment 105 

Better  Than  We  Could  Do  It 105 

Cancer  Consciousness  106 

We  Suffer  a Major  Loss 106 

Silhouettes  From  the  A.M.A.  House  of  Del- 
egates   106 

Correspondence  107 


Original  Articles 

Cancer  in  Infancy  and  Childhood,  Philip 
Rosenblum 109 

The  Medical  Care  of  Tuberculosis  by  the 
State  of  Colorado,  Edward  N.  Chapman..  115 

Carcinoma  of  the  Colon,  Kenneth  B.  Cas- 


tleton  119 

The  Brucellosis  Problem,  George  W.  Stiles  124 

The  Allergic  Nasal  Syndrome,  Leo  P. 
Coakley  125 

A Clinical  Study  of  Auricular  Flutter,-  G. 
Paul  Smith  and  Joseph  E.  Weldon 130 


Organization 

Colorado 

Fourteenth  Annual  Midwinter  Postgrad- 
uate Clinics  of  the  Colorado  State 
Medical  Society,  Preliminary  Program  138 


Obituaries  142 

New  Mexico  142 

Montana 

Interim  Session,  Montana  State  Medical 
Association  142 

Utah 

Medical  Service  Bureau  of  the  Utah 
State  Medical  Association 146 


90 


Rocky  Mountain  Medical  Journal 


NEED  NOT 
MEAN 


Clinical  studies  2, 3 demonstrate  that  the 
results  of  inadequate  dietaries  are  insidi- 
ously cumulative  and  may  not  become 
evident  for  many  years.  Many  of  the 
afflictions  of  old  age  are  now  attributed 
to  lifelong  faulty  dietaries  and  no  longer 
need  be  the  inevitable  accompaniment  of 
advanced  years. 

In  advanced  age  the  wisdom  of  die- 
taries high  in  vitamins,  minerals,  and  pro- 
tein, low  in  fat,  and  moderate  in  carbo- 
hydrate, is  pointedly  emphasized  in 
reported  clinical  studies.  Liberal  amounts 
of  vitamin  B complex  and  of  calcium,  in 
particular,  are  important  for  increasing 


the  appetite  and  for  supporting  the  cal- 
cium integrity  of  the  skeletal  structure. 

Ovaltine  in  milk,  a delicious  multiple 
dietary  supplement,  is  highly  useful  in 
the  management  of  aged  patients.  Its 
multiple  vitamins,  its  important  miner- 
als, and  its  biologically  complete  protein 
are  the  very  nutrients  required  for  effect- 
ing full  adequacy  of  even  seriously  faulty 
diets.  The  refreshing  tastefulness  and 
easy  digestibility  are  welcomed  by  the 
aged. 

The  rich  dietary  contribution  made  by 
three  daily  glassfuls  of  Ovaltine  in  milk, 
is  outlined  in  detail  in  the  table. 


•Boss,  E.P.:  The  Physiologic  and  Clinical  Phenomena  of  Aging,  New  Orleans  M.  & S.  J. 

97:64  (Aug.)  1944. 

^ Spies,  T.D.,  and  Collins,  H.S.:  Observation  on  Aging  in  Nutritionally  Deficient  Persons, 

J.  Gerontol.  1:33  (Jan.)  1946. 

sStieglitz,  E.J.:  Therapy  of  the  Aged,  M.  Ann.  District  of  Columbia  17:197  (Apt.)  1948. 

THE  WANDER  COMPANY,  360  N.  MICHIGAN  AVE.,  CHICAGO  1,  ILL. 


Three  servings  daily  of  Ovaltine,  each  made  of 
V2  oz.  of  Ovaltine  and  8 oz.  of  whole  milk,*  provide; 


CALORIES 

. . 676 

VITAMIN  A 

3000  I.U. 

PROTEIN 

. . 32  Gm. 

VITAMIN  Bi 

1.16  mg. 

FAT 

. . 32  Gm. 

RIBOFLAVIN 

2.0  mg. 

CARBOHYDRATE  . . 

. . 65  Gm. 

NIACIN  

6.8  mg. 

CALCIUM  

. . 1.12  Gm. 

VITAMIN  C 

30.0  mg. 

PHOSPHORUS  . . . 

. . 0.94  Gm. 

VITAMIN  0 

417  I.U. 

IRON 

. . 12  mg. 

COPPER  

0.5  mg. 

*Based  on  average  reported  values  for  milk 


for  February,  1949 


91 


ROCKY  MOUNTAIN  MEDICAL  JOURNAL 

Title  Registered,  U.S.  Patent  Office 
Publication  Office: 

835  Republic  Building  (1612  Tremont  Place),  Denver  2,  Colorado 
Telephone  C Kerry  5521. 

EDITORIAL  BOARD 

Colorado:  Douglas  W.  Macomber,  M.D.,  Scientific  Editor,  1820  Gilpin  St.,  Denver;  Lyman  W.  Mason, 
M.D.,  Associate  Editor,  1214  Republic  Bldg.,  Denver,  (Chairman  of  Editorial  Board). 

Montana:  Raymond  F.  Peterson,  M.D.,  Scientific  Editor,  Butte,  Mont.;  Herbert  T.  Caraway,  M.D., 
Associate  Editor,  Billings,  Mont. 

New  Mexico:  Carl  H.  Gellenthein,  M.D.,  Scientific  Editor,  Valmora,  New  Mexico;  Harold  L.  Janu- 
ary, M.D.,  Associate  Editor,  First  National  Bank  Bldg.,  Albuquerque,  New  Mexico. 

Utah:  Richard  P.  Middleton,  M.D.,  Scientific  Editor,  Boston  Bldg.,  Salt  Lake  City;  W.  H.  Tibbals, 
Associate  Editor,  316  Atlas  Bldg.,  Salt  Lake  City. 

Wyoming:  Earl  Whedon,  M.D.,  Scientific  Editor,  Sheridan;  Arthur  R.  Abbey,  Associate  Editor,  P.O. 
Box  897,  Cheyenne. 


Managing  Editor:  Harvey  T.  Sethman,  835  Republic  Bldg.,  Denver. 
Business  Manager:  Helen  Kearney,  835  Repubhc  Bldg.,  Denver. 


Ownership  and  Sponsorship:  The  Rocky  Mountain 
Medical  Journal  Is  owned  by  th®  Colorado  State 
Medical  Society  and  is  published  monthly  as  a non- 
profit enterprise  for  the  mutual  benefit  of  the  or- 
ganizations which  Jointly  sponsor  it.  It  is  published 
under  the  direction  of  the  Board  of  Trustees  of  the 
Colorado  State  Medical  Society,  assisted  by  an  Edi- 
torial Board  representing  the  sponsoring  organiza- 
lion.s.  It  is  the  Official  Journal  of  the  Colorado  State 
Medical  Society,  the  Montana  State  Medical  Associa- 
tion. the  New  Mexico  Medical  Society,  the  Utah 
State  Medical  Association,  the  Wyoming  State  Medi- 
cal Society,  the  Rocky  Mountain  Medical  Conference, 
and  the  Colorado  Hospital  Association. 

Manuscripts:  Scientific  Articles,  Case  Reports,  etc., 
from  any  state  for  which  this  is  the  Official  Journal 
should  be  submitted  to  the  Scientific  Editor  for  that 
state  as  named  in  the  Editorial  Board,  above.  Other 
material  from  any  participating  state  should  be  sub- 
mitted to  the  Associate  Editor  for  that  state  as 
named  above.  Manuscripts  from  outside  the  Rocky 
Mountain  area  should  be  sent  direct  to  the  Journal 
office.  Manuscripts  must  be  typewritten,  double  or 
triple  spaced,  using  only  one  side  of  each  sheet.  It 
is  the  policy  of  this  Journal  to  omit  bibliographies. 


Advertising:  National  representatives:  The  Coop- 
erative Medical  Advertising  Bureau,  635  North  Dear- 
born Street,  Chicago  10,  111.  Local  advertising  from 
firms  in  the  Rocky  Mountain  area  should  be  submit- 
ted to  the  Associate  Editor  of  the  appropriate  state 
or  to  the  Journal  office.  Advertising  forms  close  on 
the  20th  of  the  month  preceding  publication;  allow 
ten  days  additional  to  insure  submitting  proofs  for 
approval. 

Subscription;  J2.50  per  year  in  advance,  postpaid  in 
the  United  States  and  its  possessions;  single  copy, 
25  cents  plus  postage.  Subscription  is  included  in 
medical  society  dues  of  sponsoring  state  medical 
organizations. 

Copyright:  This  Journal  is  copyright,  1949,  by  the 
Colorado  State  Medical  Society.  Requests  for  permis- 
sion to  reproduce  anything  from  the  columns  of  this 
Journal  should  be  addressed  to  the  Journal  office. 

Second  Class  Matter:  Entered  as  second  class  mat- 
ter Jan.  22,  190G,  at  the  Postoffice  at  Denver,  Colo., 
under  the  Act  of  Congress  of  March  3,  1879.  Accepted 
for  mailing  at  special  rates  of  postage  provided  for 
in  Section  1103,  Act  of  Oct.  3,  1917;  authorized  July 
17,  1918. 


Essential  Automobiles  Given  Priority — We  Recommend 

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Phone:  TAbor  5191  13th  Ave.  at  Broadway  to  Lincoln  Denver,  Colo. 


Don't  miss  important  telephone  calls 

Let  us  act  as  your  secretary  while  you  are  away,  day  or  night: 
our  kindly  voice  conscientiously  tends  your  telephone  business, 
accurately  reports  to  you  when  you  return. 

Telephone  ANSWERING  Service  call  ALpine  i4i4 


Cambridge  Dairy  Grade  ‘‘A”  Milk  Is  Produced  and  Processed  at  690  S.  Colo.  Blvd. 

We  do  not  handle  Shipped-in  Milk  produced  Where?  How  and  by  Whom?  Doctors  know  the  difference 
Now  Homogenized  Vitamin  D Milk  is  available  for  baby  feeding  and  family  use. 


We  Invite  Your  Inspection  and  Appreciate  Your  Recommendation. 


promotes 

aeration  . . . free  cirainage 
!“  in  colds  ■ 

. . . sinusitis 


Nasal  engorgement  and  hypersecretion 
accompanying  the  common  cold  and  sinusitis  are 
quickly  relieved  by  the  vasoconstrictive  action  of 


Nasal  membrane  showing  increased 
leukocytes  with  denudation  of  cilia. 


Normal  appearing  nasal  epithelium, 


NEO-SVNEPH  RI NE® 

HYDROCHLORIDE 
Brand  of  Phenylephrine  Hydrochloride 

The  decongestive  action  of  several  drops  in  each 
nostril  usually  extends  over  two  to  four  hours.  The 
ehect  is  undiminished  after  repeated  use. 

Relatively  nonirritating  . . . Virtually  no  central 
stimulation. 

Supplied  in  14%  solution  (plain  and  aromatic), 

1 oz.  bottles.  Also  1%  solution  (when  greater  con- 
centration is  required),  1 oz.  bottles,  and  14% 
water  soluble  jelly,  % oz.  tubes. 


Heo-Synephrine,  trademark  reg.  U.  S.  & Canada 


THE  COLORADO  STATE  MEDICAL  SOCIETY 

Next  Annual  Session:  Shirley-Savoy  Hotel,  Denver;  Sept.  20,  21,  22,  23,  1949 


OFFICERS 

Terms  of  Officers  and  Committees  expire  at  the  Annual  Session 
in  the  year  indicated.  Where  no  year  is  indicated,  the  term 
is  for  one  year  only  and  expires  at  the  1949  Annual  Session. 

President:  Casper  F.  Hegner,  Denyer. 

President-elect:  Fred  A.  Humphrey,  Fort  Collins. 

Vice  President:  Lester  L.  Ward,  Pueblo. 

Constitntlonal  Secretary  (three  years);  George  R.  Buck,  Denver,  1951. 
Treasurer  (three  years):  George  C.  Shivers,  Colorado  Springs,  1950. 

Additional  Trustees  (three  years):  Ervin  A.  Binds,  Denver,  1949;  E.  H. 
Munro,  Grand  Jurction,  1949;  S.  P,  Newman,  Denver,  1950;  Claude  D. 
Bonham,  Boulder,  1951. 

(The  above  nine  officers  compose  the  Board  of  Trustees  of  which  Dr. 
Ervin  A.  Hinds  is  the  1948-1949  Chairman.) 

Board  of  Councilors  (three  years):  District  No.  1:  Clemens  F.  Eaklns, 
Brush,  1951;  No.  2:  Ella  A.  Mead,  Greeley,  1951;  No.  3:  L.  G.  Crosby. 
Denver,  i95i;  No.  4:  banning  E.  Likes,  Lamar,  1950;  No.  5:  Guy  H. 
Hopkins,  Pueblo,  1950:  No.  6;  Lester  E.  Thompson,  Salida,  1950;  No.  7: 
A.  L.  Burnett.  Durango.  1949;  No.  8:  Lawrence  L.  Hick,  Delta,  1949; 
No.  9:  W.  W.  Sloan,  Hayden,  1949  (Chairman  of  Board  for  1948-49). 

Board  of  Supervisors  (two  years);  A.  B.  Gjellum,  Del  Norte,  1949;  L.  W. 
Lloyd,  Durango,  1949;  R.  G.  Howlett,  Golden,  1949;  Scott  A.  Gale, 
Pueblo.  1949;  L.  D.  Dickey,  Fort  Collins,  1949;  N.  A.  Madler,  Greeley, 
1949  (Chairman  of  Board  for  1948-49);  L.  D.  Buchanan,  Wray,  1950; 
W.  F.  Deal,  Craig,  1950;  G.  C.  Cary,  Grand  Junction,  1950;  W.  A. 
Campbell,  Colorado  Springs,  1950;  Ralph  S.  Johnston,  Sr.,  La  Junta, 
1950;  William  A.  Liggett.  Denver,  1950. 

Delegates  to  American  Medical  Association  (two  years) : George  A.  Unfug, 
Pueblo,  1949  (Alternate:  Herman  C.  Graves,  Grand  Junction,  1949): 
William  H.  Halley,  Denver,  1960  (Alternate:  Kenneth  C.  Sawyer,  Denver. 
1950). 

Foundation  Advocate;  Walter  W.  King,  Denw. 

Executive  Office  Staff:  Mr.  Harvey  T.  Sethman,  Executive  Secretary: 
Miss  Helen  Kearney,  Assistant  Executive  Secretary;  Mr.  Evan  A.  Edwards, 
Field  Secretary;  Miss  Mary  E.  McDonald,  Committee  Secretary;  835  Re- 
public Building,  Denver  2,  Colo.,  Telephone  CHerry  5521. 

Generai  Counsel:  Mr.  J.  Peter  Nordlund,  Attorney-at-Law,  Denver. 

STANDING  COMMITTEES 

Credentials:  George  R.  Buck,  Denver,  Chairman,  ex-officio;  others  to 
be  appointed. 

Public  Policy:  Kenneth  C.  Sawyer,  Denver,  Chairman;  McKinnle  L. 
Phelps,  Denver,  Vice  Chairman;  John  S.  Bouslog,  Denver;  F.  R.  Calhoun, 
Denver;  Frank  B.  McGlone,  Denver;  T.  M.  Rogers,  Sterling;  Sidney  An- 
derson, Alamosa;  Richard  L.  Davis,  La  Junta;  Herman  C.  Graves.  Grand 
Junction:  John  L.  McDonald.  Colorado  Springs;  George  E.  Rice,  Pueblo; 
John  D.  Gillaspie,  Boulder.  Ex-Officio  members;  Casper  F.  Hegner,  Presi- 
dent; Fred  A.  Humphrey,  President-elect;  George  R.  Buck,  Constitutional 
Secretary. 

Sub-Committee  on  Legislation:  H.  I.  Barnard,  Denver,  Chairman;  others 
to  be  appointed. 

Health  Education  (two  years):  A.  C.  Sudan,  Denver,  Chairman,  1949; 

J.  D.  Bartholomew,  Boulder,  1949;  R.  J.  Savage,  Denver,  1949;  R.  T. 
Porter,  Greeley,  1949;  Robert  B.  Bradshaw,  Alamosa,  1949;  L.  W.  Bortree, 
Colorado  Springs,  1950;  F.  0.  Robertson,  Denver.  1950.;  J.  L.  Sadler,  Fort 
Collins,  1950;  Harold  T.  Low,  Pueblo,  1950;  John  H.  Amesse,  Denver, 
1950;  E.  H.  Munro,  Grand  Junction,  1950. 

Scientific  Work:  W.  B.  Condon,  Denver,  Chairman:  Robert  S.  Liggett, 
Karl  F.  Arndt,  Frank  T.  Joyce,  Marshall  G.  Nims,  Vincent  G.  Cedar- 
blade,  all  of  Denver. 

Sub-Committee  on  Scientific  Exhibits;  Frank  C.  CampbeU,  Chairman; 
NoUe  Mumey,  Edgar  W.  Barber,  R.  W.  Vines,  all  of  Denver. 

Arrangements:  To  be  appointed. 

Medicolegal  (two  years):  R.  W.  Arndt,  1960,  Chairman;  George  B. 
Packard.  Jr.,  1950:  K.  D.  A.  Allen,  1950.;  C.  S.  Bluemel,  1949;  Lyman 
W.  Mason,  1949;  Harry  C.  Hughes,  1949;  all  of  Denver. 

Medical  Education  and  Hospitals:  George  F.  WoUgast,  Denver,  Chairman; 
W.  W.  Sloan,  Hayden;  F.  R.  Plngrey,  Durango;  E.  B.  Mugrage,  Denver; 
D.  W.  McCarty,  Longmont;  A.  E.  Lubchenco,  Denver. 

Library  and  Medical  Literature;  A.  J.  Markley,  Denver,  Chairman;  T.  E. 
Beyer,  Denver;  J.  J.  Connor,  Delta;  H.  Dumont  Clark,  Denver. 

Medical  Service  Plans;  F.  H.  Good,  Denver,  Chairman;  C.  E.  Honsteln, 
Fort  Collins;  James  R.  Blair,  Denver;  Vernon  L.  Bolton,  Colorado  Springs; 
Scott  A.  Gale,  Pueblo;  John  A.  Weaver.  Jr..  Greeley;  John  E.  Hyland, 
Monte  Vista;  Thomas  K.  Mahan,  Grand  Junction. 

Necrology:  W.  H.  Wilson,  Denver,  Chairman. 

PUBLIC  HEALTH  COMMITTEES 

General  Committee  on  Public  Health:  Consists  of  the  chairmen  of  the 
following  eleven  public  health  subcommittees,  presided  over  by  Robert  W. 
Dickson,  Denver,  as  General  Chairman. 

Cancer  Control;  J.  C.  MendenhaU,  Denver,  Chairman;  John  B.  Grow, 
Denver;  S.  W.  HoUey,  Greeley;  T.  Leon  Howard,  Denver:  James  B.  Mc- 
Naught,  Denver;  Roger  G.  Howlett,  Golden:  James  W.  McMullen,  Colorado 
Springs:  James  E.  Donnelly,  Trinidad;  Banning  E.  Likes,  Lamar;  Thomas 

K.  Mahan.  Grand  Juncfion. 


Crippled  Children:  I.  E.  Hendryson,  Denver,  Chairman;  Mary  L.  Moore, 
Grand  Junction;  Richard  H.  MeUen,  Colorado'  Springs;  Sidney  E,  Bland- 
ford.  Jr..  Denver:  Paul  R.  Hildebrand,  Brush;  Samuel  P.  Nevnnan,  Denver. 

Industrial  Health:  B.  F.  Bell,  Louviers,  Chairman;  A.  R.  Woodbume, 
Denver:  Vincent  E.  Kelly,  Leadville;  D.  W.  Boyer,  Pueblo;  H.  G.  Harvey,  Jr., 
Denver;  Robert  Woodruff,  Denver;  Frank  J.  McDonough,  Grand  Junction. 

Local  Health  Units;  Monroe  R.  Tyler,  Denver,  Chairman;  Harold  EL 
Haymond,  Greeley;  R.  B.  Richards.  Fort  Morgan;  Nicholas  S.  SaUba,  Wal- 
senburg;  Marvel  L.  Crawford,  Steamboat  Springs;  R.  Sherwln  Johnston,  Jr., 
La  Junta. 

Maternal  and  Child  Health;  John  R.  Evans,  Denver,  Chairman;  Joseph 
H.  Lyday,  Denver:  John  M.  Nelson,  Denver;  Tracy  D.  Peppers,  Greeley; 
J.  H.  Woodbrldge,  Pueblo;  M.  E.  Snyder,  Colorado  Springs. 

Mental  Hygiene;  Bradford  Murphey,  Denver,  Chairman;  E.  James  Brady, 
Colorado  Springs;  Frank  H.  Zimmerman,  Pueblo;  Paul  A.  Draper,  Colorado 
Springs;  J.  P.  Hilton,  C.  S.  Bluemel,  John  M.  Lyon,  Q.  H.  Ashley,  Lewis 
C.  Overholt,  Clarke  H.  Barnacle,  Harold  R.  Carter,  all  of  Denver. 

Milk  Control:  George  W.  Stiles,  Denver,  Chairman;  Max  M.  Glnsburg, 
Denver;  N.  J.  Miller,  D.V.M.,  Eaton;  Millard  F.  Schafer,  Colorado  Springs; 
Robert  W.  Vines,  Denver;  Mr.  Wendell  Vincent,  Denver. 

New  Hospital  Construction;  D.  R.  ColHer,  Wheatridge.  Chairman; 
Henry  M.  Powell,  Colorado  Springs;  Mr.  John  R.  Peterson,  Fort  Collins; 
Florence  R.  Sabin,  Denver:  Herbert  A.  Black,  Pueblo. 

Public  Water  Supplies:  E.  I.  Dobos,  Denver,  Chairman;  Robert  Barnard, 
Eagle;  WilUam  C.  Shontz,  San  Luis;  Carl  W.  Maynard,  Pu^lo;  W.  B. 
Crouch,  Colorado  Springs;  H.  D.  Palmer,  Denver;  B.  Robert  Orr,  Frulta. 

Tuberculosis  Control:  John  I.  Zarit,  Denver,  Chairman;  W.  J.  Hlnzel- 
man,  Greeley;  H.  M.  Van  Dcr  Schouw,  Wheatridge:  John  P.  McGraw,  Pueblo; 
Arthur  Rest,  Denver;  H.  Calvin  Fisher,  Denver;  T.  D.  Cunningham,  Denver. 

Venereal  Disease  Control;  Sam  W.  Downing,  Denver,  Chairman;  Paul  B. 
Stidham,  Grand  Junction;  H.  E.  Coakley,  Pueblo;  D.  E.  Newland,  Denver; 
Joseph  H.  Patterson,  Denver,  James  R.  McDowell,  Denver. 

SPECIAL  COMMITTTES 

Rocky  Mountain  Medical  Conference  (five  years);  L.  Clark  Hepp,  Denver, 
1953;  G.  P.  Llngenfelter,  Denver,  1952,  Chairman;  Ward  Darley,  Denver, 
1951;  L.  W.  Bortree,  Colorado  Springs,  1950;  George  H.  Gillen,  Denver, 
1949. 

Advisory  to  Auxiliary;  Fred  A.  Humphrey,  Fort  Collins,  Chairman;  Ervin 
A.  Hinds,  George  R.  Buck,  Denver. 

Midwinter  Clinics:  Samuel  B.  Childs,  Jr.,  Chairman;  Raymond  C.  Chat- 
field,  E.  L.  Binkley,  Jr.,  A.  J.  Kauvar,  Terry  J.  Gromer,  aU  of  Denver. 

Rehabilitation:  W.  W.  Haggart,  Denver,  Chairman;  Atha  Thomas,  Den- 
ver; Lawrence  T.  Brown,  Denver;  J.  E.  A.  Connell,  Pueblo:  Thad  P.  Sears, 
Ft.  Logan:  Kenneth  C.  Sawyer.  McKlnnie  L.  Phelps,  George  R.  Buck. 
Bradford  Murphey,  all  of  Denver. 

Advisory  to  the  Goodwill  Industries’  Rehabilitation  Program:  Lewis  C. 
Overholt,  Chairman;  WilUam  H.  Halley,  Maurice  Katzman,  Terry  J. 
Gromer.  Lorenz  W.  Frank,  WilUam  R.  Lipscomb,  Irvin  E.  Hendr^on, 
all  of  Denver. 

Rural  Health  Commission:  Leonard  N.  Myers,  Cheyenne  Wells,  Chairman; 
V.  V.  Anderson,  Del  Norte;  James  S.  Orr,  Frulta;  Keith  F.  Krausnlek, 
Lamar;  Robert  M.  Lee,  Fort  ColUns.  Ex-officio  member:  Fred  A.  Hum- 

phrey, Fort  Collins. 

Medical  Disaster  Commission:  Foster  Matcbett,  Denver,  Chairman;  Karl 
Arndt,  Denver,  Secretary;  Mark  S.  Donovan,  Harry  C.  Hughes,  Adolph  J. 
Kafka,  Roderick  J.  McDonald,  WilUam  F.  Stanok,  Henry  Swan,  Karl  P. 

Sunderland,  K D.  A.  Allen,  all  of  Denver;  Lawrence  W.  Holden,  Boulder; 
Richard  H.  Mellen.  Colorado  Springs;  Richard  H.  Altmix,  Englewood;  Jacob 

O.  Mall,  Estes  Park;  Thad  P.  Sears,  Fort  Logan;  Donald  E.  Cowen,  Fort 

Morgan;  Kenneth  E.  Prescott,  Grand  Junction;  Walter  A.  Schoen,  Greeley; 
David  W.  McCarty,  Longmont;  David  W.  Boyer,  Pueblo;  J.  G.  Espey,  Craig; 
Leo  W.  Loyd,  Durango;  Keith  F.  Krausnlek,  Lamar;  Robert  M.  Lee,  Ft.  Col- 
lins; George  H.  Lord,  Aurora;  J.  Gordon  Hedrick,  Wray;  James  P.  Rlgg, 

Grand  Junction. 

Lay  Organization  Standards:  George  R.  Buck,  Fredrick  H.  Good,  Ken- 

neth C.  Sawyer,  Frank  B.  McGlone,  T.  D.  Cunningham,  Bradford  Murphey, 
Casper  F.  Hegner,  John  S.  Bouslog,  all  of  Denver. 

Study  of  Child  Welfare  Clinics:  Ralph  E.  Verploeg,  Denver,  Chairman; 
J.  W.  White,  Pueblo-  Jackson  L.  Sadler,  Fort  ColUns;  L.  E.  Maurer, 
Boulder;  Haney  M.  Tupper,  Grand  Junction;  Harvey  S.  Rusk,  Pueblo. 

Advisory  to  U.M.W.  Welfare  Fund  (E.xecutive  Committee,  three-year 
terms;  others,  one-year)  : Executive:  W.  W.  Haggart,  1951,  Cliairman; 

P.  H.  Good,  1951;  J.  S,  Bouslog,  1951,  all  of  Denver;  W.  H.  Halley, 
1950:  C.  F,  Hegner,  1950,  both  of  Denver;  R.  F.  Bell,  1950,  Louviers; 
McKinnie  Phelps  1949,  Denver;  F.  A.  Humphrey,  1949,  Fort  ColUns; 
J.  M.  Lamnie,  1949,  Walsenburg.  Other  members:  K.  C.  Sawyer,  A.  C. 
Sudan,  Bradford  Murphey,  all  of  Denver;  C.  D.  Bonham,  Boulder;  J.  W. 
Craighead,  Pueblo;  J.  E.  Donnelly,  Trinidad;  Ligon  Price,  Mt.  Harris;  M.  J. 
McCallum,  Erie. 

Liaison  to  Colorado  State  Nurses  Association:  John  R.  Evans,  Samuel  P. 
Newman,  Denver. 

Liaison  to  Colorado  Bar  Association:  W.  S.  Dennis,  Chairman;  A.  C. 
Sudan,  R.  W.  Arndt,  all  of  Denver. 

Medical-Dental  Liaison:  Guy  W.  Smith,  Denver,  Chairman;  George  R. 
Warner,  Denver;  Calvin  N.  CaldweU,  Pueblo. 

Representative  to  Rocky  Mountain  Radio  Council:  WilUam  E.  Hay, 
Denver;  (Alternate:  Chauncey  A.  Hager,  Denver). 

Representative  to  Belle  Bonfils  Memorial  Blood  Bank:  0.  S.  Pbilpott, 
Denver. 

Representatives  to  Liaison  Council  on  Graduate  Education  (two  years) : 

L.  R.  Safaiik,  Denver,  1949;  Harold  1.  Goldman,  Denver,  1950. 

Delegate  to  Colorado  interprofessional  Council  (five  years) : K.  D.  A. 
.Allen,  Denver,  1949;  (Alternate:  Carl  A.  McLauthUn,  Denver,  1949). 


94 


Rocky  Mountain  Medical  Journal 


bleeding  even 
in  brain  surgery 
with  Gelfoam* 


Not  only  in  neurosurgery— where  hemostatic  certainty 

and  minimal  scarring  are  so  critical — but  in  many  other 
less  dramatic  but  very  common  surgical  applications,  Gelfoam, 

an  absorbable  gelatin  sponge,  provides  remarkable  control  of 
bleeding.  Its  prompt  clotting  action  effectively  arrests  trickling 
from  small  veins,  surface  oozing,  capillary  bleeding 
and  hemorrhage  following  resection.  Cut  or  molded  to  the 
desired  shape  and  applied  with  or  without  thrombin, 
Gelfoam  is  safely  left  in  situ  to  be  absorbed  with 
little  or  no  fear  of  tissue  reaction. 

*Trademark,  Reg.  U.S.  Pat.  Off. 


Fine  pharmaceuticals  since  1886 


Upjohn 

KALAMAZOO  99,  MICHIGAN 


for  February,  1949 


95 


MONTANA  STATE  MEDICAL  ASSOCIATION 


OFFICERS 

Terms  of  Officers  and  Committees  expire  at  the  Annual  Session 
In  the  year  Indicated.  Where  no  year  Is  indicated,  the  term  is 
for  one  year  only  and  expires  at  1949  Annual  Session. 

President:  Thomas  L.  Hawkins,  Helena. 

President-elect:  Thomas  F.  Walker,  Great  Falls. 

Vice-President:  E.  G.  Johnson,  Harlowton. 

Secretary-Treasurer:  Herbert  T.  Caraway,  Billings. 

Delegate  to  American  Medical  Association:  Baymond  F.  Peterson,  Butte, 
1950;  Alternate,  Thomas  B,  Moore,  Kallspell,  1950. 


STANDING  COMMITTEES 

Execntive  Committee:  T.  L.  Hawkins,  Helena,  Chairman;  T.  F.  Walker, 
Great  Falls;  H.  T.  Caraway,  BiUlngs;  L.  W.  Allard,  BlUings;  M.  A. 
ShlUlngton,  Glendlre. 

Economics  Committee:  J.  C.  Shields,  Butte,  Chairman;  C.  P.  Brooke,  St 
Ignatius;  K.  B.  Durnin,  Great  Falls;  Leland  G.  Russell,  Billings;  S.  D. 
Whetstone,  Cut  Bank. 

Legislative  Committee:  J.  M.  Flinn,  Helena,  Chairman;  F.  D.  Hurd, 
Gnat  Falls;  P.  E.  Kane,  Butte;  J.  C.  MacGregor,  Great  Falls;  Claude 
M,  Mears,  Helena. 

Necrology  and  History  of  Medicine  Committee:  L.  W.  Brewer,  Missoula, 
Chairman;  I.  J.  Bridenstlne.  Missoula;  J.  H.  Irwin,  Great  Falls;  Claude 
M.  Mears,  Helena-  J.  P.  Ritchey,  Missoula. 

Public  Relations  Committee;  H.  W.  Gregg,  Butte,  Chairman;  W.  L.  DuBols, 
Cut  Bank;  R.  V.  Morledge,  BiUlngs;  W.  H.  Stephan,  Dillon;  Dora  Walker, 
Great  Falls. 

Legal  Affairs  and  Malpractice  Committees  J.  C.  MacGregor,  Great  Falls, 
Chairman;  Raymond  Eck,  Lewlstown;  W.  E.  Harris,  Livingston;  John  E. 
Hynes,  Billings;  B.  D.  Knapp,  Wolf  Point. 

Program  Committee:  C.  H.  Fredrickson,  Missoula,  Chairman;  H.  T. 
Caraway,  BiUlngs-  H.  W.  Gregg,  Butte;  J.  J.  McCabe,  Helena;  E.  S. 
Murphy.  Missoula. 

Interprofessional  Relationship  Committee;  L.  W.  AUard,  BilUngs,  Chair- 
man; C.  R.  Canty,  Butte;  S.  A.  Cooney,  Helena;  S.  N.  Preston,  Missoula; 
F.  I.  Sabo,  Bozeman. 


Nominating  Committee;  H.  H.  James,  Butte,  Chairman;  E.  L.  Anderson, 
Fort  Benton;  R.  D.  Harper,  Sidney;  J.  J.  Malee,  Anaconda;  W.  R.  Mc- 
Elwee,  Townsend. 

Auditing  Committee:  E.  H.  Lindstrom,  Helena,  Chairman;  F.  H.  Crago, 
Great  Falls;  E.  D.  Harper,  Sidney;  G.  W.  Setzer,  Malta;  E.  G.  Johnson, 
Harlowton. 

Cancer  Committee:  Mary  E.  Martin,  BilUngs,  Chairman;  W.  F.  Cash- 
more,  Helena;  C.  H.  Fredrickson,  Missoula;  E.  F.  Peterson,  Butte;  W.  C. 
Robinson,  Shelby. 

Maternal  and  Child  Welfare  Committee:  F.  L.  McPbail,  Great  Falla, 
Chairman;  L.  W..  Brewer.  Missoula;  P.  L.  Eneboe,  Bozeman;  Maude  M. 
Gerdes,  Billings;  D.  L.  Gillespie,  Butte;  A.  L.  Gleason,  Great  Falls;  E.  L. 
Hall,  Great  Falls;  D.  S.  MaeKenzie,  Jr.,  Havre;  R.  E.  Mattison,  BiUlngs: 
0.  M.  Moore,  Helena;  F.  W.  Paul,  KaUspell;  C.  W.  Pemberton,  Butte; 
S.  N.  Preston,  Rlissoula;  A.  E.  Ritt,  Great  Falls. 

Tuberculosis  Committee:  F.  I.  Terrill,  Galen,  Chairman;  C.  B.  Craft, 
Bozeman;  E.  A.  Dolan,  Anaconda;  A.  R.  Kintner,  Missoula;  J.  A.  Layne, 
Great  Falls. 

Fracture  and  Orthopedic  Committee:  J.  K.  Colman,  Butte,  Chairman;  L.  C. 
Allard,  BilUngs;  W.  H.  Hagen,  BilUngs;  S.  L.  Odgers,  Butte;  J.  C.  Wol- 
gamot.  Great  Falls. 

Rural  Health  Committee:  B.  C.  Farrand,  Jordan,  Chairman;  B.  A. 
Benke,  KaUspell;  W.  A.  Lacey,  Havre;  W.  G.  TangUn,  Poison;  J.  H. 
Williams,  Culbertson. 

Industrial  Vlfelfare  Committee;  R.  B.  Richardson,  Great  Falls,  Chairman: 
M.  A.  Gold,  Butte:  P.  E.  Logan,  Great  FaUs;  D.  S.  MaeKenzie,  Jr.,  Havre; 
R.  E.  Walker,  Livingston. 

Rheumatic  Fever  and  Heart  Committee:  F.  R.  Sebemm,  Great  FaUs. 
Chairman;  D.  T.  Berg.  Helena;  H.  W.  Gregg,  Butte;  A.  R.  Kintner,  Mis- 
soula; P.  E.  Logan,  Great  FaUs;  F.  H.  Lowe,  Missoula;  J.  J.  Malee, 
Anaconda;  0.  M.  Moore,  Helena;  H.  W.  Power,  Conrad;  R.  E.  SmaUey, 
Billings. 

SPECIAL,  COMMITTEES 

Emergency  Medical  Service  Committee:  R.  F.  Peterson,  Butte,  Chairman; 
Paul  J.  Cans,  Lewistown;  J.  J.  McCabe,  Helena;  S.  A_  Olson,  Glendive; 
L.  G.  RusseU,  BilUngs. 

lAB  Fee  Schedule  Committee;  H.  H.  James,  Butte,  Chairman;  E.  B. 
Lindstrom,  Helena;  J.  J.  Malee,  Anaconda;  D.  S.  McKenzie,  Jr.,  Havre; 
F.  K.  Waniata,  Great  Falls. 


Collection 

of 

Accounts 

All  reports  show  a trend  toward  slower  and  harder  collections  in  the 
months  ahead. 

At  the  first  sign  of  neglect  you  will  save  money  if  they  are  turned  over 
to  us  for  collection. 

Comparison  of  collection  results,  backed  by  35  years  of  experience,  proves 
you  obtain  greater  results  at  less  cost,  when  you  list  your  accounts 

with 

The  American  Medical  and  Dc 

Suite  524,  810  14th  St.  TAbor  2331 

intal  Association 

Denver,  Colorado 

96 


Rocky  Mountain  Medical  Journal 


Effective  in  combating 
simple  depression 

When  the  cause  of  the  underlying 
emotional  disturbance  is  apparent — 
and  when  it  has  been  properly  ventilated— 
'Benzedrine’  Sulfate  has  proved  its 
effectiveness  in  the  treatment  of  mild  but 
persistent  psychogenic  depressions, 
such  as  may  be  found: 

Attending  old  age 

With  prolonged  postoperative  recovery 
Accompanying  prolonged  pain 

When  psychopathic  problems  develop  after  childbirth 
Precipitated  by  the  menopause 

With  debilitating  or  crippling  chronic  organic  disease 


Benzedrine*  Sulfate 


tablets 


(racemic  amphetamine  sulfate,  S.K.F.) 

one  of  the  fundamental  drugs  in  medicine 
Smith,  Kline  & French  Laboratories,  Philadelphia 


T.  M.  Reg.  U.  S.  Pat.  Off, 


for  February,  1949 


97 


NEW  MEXICO  MEDICAL  SOCIETY 

Next  Annual  Session:  Roswell,  May  5,  6,  7,  1949 


OFFICERS  — 1948-1949 

President:  P.  L.  Travers,  Santa  Fe. 

President-Elect:  J.  W.  Hannett,  Albuquerque. 

Vie*  President:  I.  J.  Marshall,  BosweU. 

Secretary-Treasurer:  H.  L.  January,  Albuquerque. 

Councilors  (3  years) : W.  D.  Dabbs,  Clovis;  A.  C.  Shuler,  Carlsbad. 
Ceonellors  (2  years);  R.  0.  Brosra,  Santa  Fe;  C.  H.  Oellentblen,  Valmora. 
Councilors  (1  year);  Carl  Mulky,  Albuquerque;  L.  S.  Evans,  Las  Cruces. 

COMMITTEES  — 1948-1949 

Basic  Science:  W.  E.  Mssen,  Albuquerque,  Chairman;  Le  Grand  Ward, 
Santa  Fe;  Vincent  Accardi,  Gallup. 

Rural  Medical  Serica  Service;  Stuart  W.  Adler,  Albuquerque,  Chairman; 
W.  B.  Cantrell,  Hot  Springs;  Samuel  B.  Zeigler,  Espanola;  A.  T.  Gordon, 
Tucumcarl;  L.  G.  Foster,  Reserve. 

Cancer:  Murray  M.  Friedman,  Santa  Fe,  Chairman;  Van  A.  Odle,  Bosnell; 
J.  B.  Van  Atta,  Albuquerque;  J.  W.  Grossman,  Albuquerque;  B.  W.  Maher, 
Albuquerque. 


Venereal  Disease  Control;  Sam  Jelso,  Albuquerque,  Chairman;  V.  K. 
Berchtold,  Santa  Fe;  L.  M.  Miles,  Albuquerque;  L.  3.  Evans,  Las  Cruces; 
H.  L.  January,  Albuquerque. 

Legislative:  Albert  Lathrop,  Santa  Fe,  Chairman;  W.  0.  Connor,  Albu- 
querque; W.  B.  Lovelace,  II,  Albuquerque;  Walter  A.  Start,  Laa  Vegas; 
George  S.  Morrison,  Roswell;  B.  0.  Brown,  Santa  Fe. 

Public  Relations:  D.  A.  McKinnon,  Jr.,  Albuquerque,  Chairman;  James 
L.  McCrory,  Santa  Fe;  H.  M.  Mortimer,  Las  Vegas;  Frank  W.  Parker,  Jr., 
Gallup. 

Tuberculosis:  R.  0.  Brown,  Santa  Fe,  Chairman;  C.  H.  GeUentblen, 
Valmora;  D.  0.  Shields,  Albuquerque;  H.  S.  A.  Alexander,  Santa  Fe. 

Advisory  Committee  on  Ins.  Compensation:  Eugene  W.  Flske,  Sants  Fe, 
Chairman;  John  F.  Conway,  Clovis;  A.  C.  Shuler,  Carlsbad;  B.  E.  Forbls, 
Albuquerque. 

Committee  on  National  Emergency  Medical  Service:  A.  E.  Reymont,  Santa 
Fe,  Chairman;  C.  M.  Thompson,  Albuquerque;  L.  G.  Bice,  Albuquerque; 
Walter  A.  Stark,  Las  Vegas. 


Stodghill's  Imperial  Pharmacy 

Prescriptions  Exclusively 

For  your  prescriptions  we  stock  a complete  line  of  ALMAY — non-allergic — cosmetics. 

Five  Pharmacists 

319  16th  St.  TAbor  4231  Denver,  Colo. 


Ocuiiit  prescription  Service  ^xciusiueii^ 

SHADFORD-FLETCHER  OPTICAL 

CO. 

Dispensing  Opticians 

228  16th  Street,  Denver,  Colo. 

AComa  2611 

58 


Rocky  Mountain  Medical  Journal 


HttittUtti 

■ 

or  one  hundred  patients 


It  is  possible  to  limit  your  choice  of  estrogenic  substances  to 
one  preparation— AMNIOTIN^and  still  meet  the  greatly  vary- 
ing needs  of  all  your  menopausal  patients. 


AMNIOTIN  is  the  ONLY  complex  of  naturally  occurring 
mixed  estrogens  for  use  by  three  routes:  intramuscular,  oral, 
and  intravaginal.  Its  great  range  of  potency  and  flexibility  of 
administration  enables  you  to  individualize  the  therapy  for 
each  and  every  patient  with  a single  preparation. 

Squibb  AMNIOTIN*  Ampuls  and  Vials 

SQUIBB  complex  of  naturally  occurring  estrogens  Capsules  (oral) 

Pessaries  (capsule  type) 


for  February,  1949 


99 


THE  UTAH  STATE  MEDICAL  ASSOCIATION 


OFFICERS  1»4S-1949 
President:  0.  A.  Ogilvie,  Salt  Lake  City. 

President-elect:  C.  H.  Jenson,  Ogden.  ‘ ' 

Past  President:  J.  C.  Hubbard,  Price. 

Honorary  President:  0.  W.  French,  Coalville. 

First  Vice  President:  J.  G.  McQuanie,  Richfield. 

Second  Vice  President:  Ezra  Cragun,  Lewiston. 

Third  Vice  President:  R.  W.  Farnsworth,  Cedar  City. 

Secretary:  Ray  T.  Woolsey,  Salt  Lake  City. 

Executive  Secretary:  Mr.  W.  H.  Tlbbals,  Salt  Lake  City. 

Treasurer:  L.  B.  White,  Salt  Lake  City. 

Councilor  First  District:  J.  G.  Oison,  Ogden. 

Councilor  Second  District:  V.  L.  Rees,  Salt  Lake  City. 

Councilor  Third  District:  L.  W.  Oaks,  Provo. 

Delegate  to  A.M.A.,  1948:  James  P.  Kerby,  Salt  Lake  City. 

Alternate  Delegate  to  A.M.A..  1948:  J.  J.  Weight.  Provo. 

Editor  of  the  Utah  Section  of  the  Rocky  Mounnain  Medical  Journal: 
B.  P.  Middleton,  Salt  Lake  City. 

STANDING  COMMITTEES 
Rocky  Mountain  Medical  Conference  Continuing  Committee:  R.  P.  Mid- 
dleton, Chairman,  Salt  Lake  City,  1949;  K.  B.  Castieton,  Salt  Lake  City, 
1950;  Clark  Rich,  Ogden,  1951;  Noall  Z.  Tanner,  Layton,  1952;  T.  R. 
Seager,  Vernal,  1953. 

Scientific  Program  Committee:  Ray  T.  Woolsey,  Chairman,  Salt  Lake 
City;  Drew  M.  Peterson,  Ogden;  Stanley  N.  Clark,  Provo;  P.  M.  Howard, 
Salt  Lake  City:  V.  P.  HTiite,  Salt  Lake  City;  L.  V.  Broadbent,  Cedar 
City;  Paul  A.  Pemberton,  Salt  Lake  City. 

Public  Policy  and  Legislation  Committee:  F.  R.  King,  Chairman,  Price, 
1951:  Jesse  J,  Weight,  Prqvo,  1949;  M.  L.  Crandall,  Salt  Lake  City, 
1949;  V.  L.  Stevenson,  Salt  Lake  City,  1949;  N.  F.  Hicken,  Salt  Lake 
City,  1950;  Omar  Budge,  Logan,  1950;  John  Coletti,  Salt  Lake  City,  1950; 
W.  B.  West,  Ogden.  1951;  R.  V.  Larson.  Roosevelt,  1951. 

Medical  Defense  Committee:  W.  J.  Thomson.  Chairman,  Ogden,  1949: 
R.  W.  Owens,  Salt  Lake  City,  1949;  J.  L.  Hansen,  Vernal,  1949;  Homer 
Smith,  Salt  Lake  City,  1950;  L.  N.  Ossman,  Salt  Lake  City,  1950;  Erwin 

D.  Zeman,  Ogden.  1950;  Charles  W.  Woodruff,  Salt  Lake  City,  1951; 

James  Westwood,  Provo,  1951;  L.  H.  Merrill,  Hiawatha,  1951. 

Medical  Education  and  Hospitals  Committee:  I.  Bruce  McQuanie,  Chair- 
man, Ogden,  1949:  L.  J.  Paul,  Salt  Lake  City,  1949;  0.  A.  Ogflvie, 
Salt  Lake  City,  1949;  G.  G.  Richards,  Salt  Lake  City,  1950.;  Bay  T. 
Woolsey,  Salt  Lake  City,  1950;  T.  E.  Rohinson,  Salt  Lake  City,  1950; 

Seth  E.  Smoot,  Provo,  1951;  George  H.  Curtis,  Salt  Lake  City,  1951; 

B.  0.  Porter,  Logan,  1951;  R.  H.  Young,  Ex-Officio,  Salt  Lake  City. 

Medical  Economics  Committee:  Russell  Smith,  Chairman,  Provo,  1949; 
A.  R.  Denman,  Helper,  1949;  W.  T.  Ward,  Salt  Lake  City,  1950;  W.  R. 
Merrill,  Brigham  City,  1951;  Ralph  Pendleton.  Salt  Lake  City,  1951. 


Public  Health  Committee;  John  R.  Bourne,  Chairman,  Roosevelt,  1949; 
F.  D.  Spencer,  Salt  Lake  City,  1950;  Ralph  Ellis,  Ogden,  1951. 

Military  Affairs  and  National  Emergency  Committee:  Chrles  Woodruff, 
Chairman,  Salt  Lake  City;  L.  J.  Paul,  Salt  Lake  City;  Mazel  Skolfield, 
Salt  Lake  City;  W.  M.  Gorishek,  Standardville  L.  R.  Cullimore,  Orem; 

Ray  H.  Barton,  Magna;  D.  T.  Madson,  Price;  Riley  G.  Clark,  Provo; 

Willis  Hayward,  Logan;  Dean  Tanner,  Ogden. 

Tuberculosis  and  Cardiovascular  Diseases  Committee;  Elmer  M.  Kil- 
patrick, Chairman,  Salt  Lake  City;  Ray  Rumel,  Salt  Lake  City;  D.  0.  N. 
Lindberg,  Ogden;  W.  C.  Walker,  Salt  Lake  City;  Donald  M.  Moore,  Ogden; 
Don  C.  Merrill,  Provo. 

Cancer  Committee:  0.  A.  Ogilvie,  Chairman,  Salt  Lake  City:  S.  W. 

Fennemore,  Price;  E.  D.  Zeman,  Ogden;  W.  G.  Noble,  Richmond:  Harold 

Austin,  Provo;  Stanley  G.  Rees,  Gunnison;  Paul  K.  Edmunds,  Cedar  City; 
F.  G.  Eskelson,  Vernal;  K.  B.  Castieton,  Salt  Lake  City. 

Fracture  Committee:  A.  M.  Okelberry,  Chairman,  Salt  Lake  City;  Clark 
Rich,  Ogden;  Roy  H.  Robinson,  Kenilworth;  S.  M.  Budge,  Logan;  Norman 
R.  Beck,  Salt  Lake  City;  Louis  Perry,  Ogden;  J.  G.  McQuarrle,  Richfield; 
D.  C.  Evans,  Fillmore. 

Necrology  Committee:  W.  T.  Hasler,  Chairman,  Provo;  L.  A.  Stevenson, 
Salt  Lake  City;  Jos.  A.  Phipps,  Salt  Lake  City. 

Industrial  Health  Committee;  Paul  S.  Richards,  Chairman,  Bingham 
Canyon;  L.  J.  Taufer,  Salt  Lake  City;  Frank  Gorishek,  Helper;  Byron  Daynes, 
Salt  Lake  City;  E.  B.  Kuhe,  Salt  Lake  City;  D.  C.  Barker,  Ogden. 

Advisory  Committee  to  the  Woman’s  Auxiliary:  Vernal  Johnson,  Chair- 
man, Ogden;  0.  P.  Heninger,  Provo;  L.  G.  Moench,  Salt  Lake  City;  James 

K.  Palmer,  Salt  Lake  City. 

. Public  Relations  Committee:  R.  P.  Middleton,  Chairman,  Salt  Lake  City; 
Louis  P.  Matthei,  Ogden;  R.  W.  Farnsworth,  Cedar  City;  Quinn  A.  Whit- 
ing, Price;  Clyde  J.  Daines,  Logan;  Ray  E.  Spendlove,  Vernal;  H.  I. 
Goodwin,  Salt  Lake  City;  Gilbert  Wright,  Salt  Lake  City;  Roy  B.  Hammond, 
Provo. 

Inter-Professional  Committee:  J.  Leroy  Kimball,  Chairman,  Salt  Lake 

City;  C.  C.  Hetzel,  Jr.,  Ogden;  T.  E.  Bauman,  Park  City;  Paul  Clayton, 
Salt  Lake  City;  Ralph  G.  Rigby,  Salt  Lake  City. 

Mintal  Hygiene  Committee:  Roy  A.  Darke,  Chairman,  Salt  Lake  City; 

L.  G.  Moench,  Salt  Lake  City;  Wm.  D.  Pace,  Salt  Lake  City;  George  Cochran, 
Salt  Lake  City;  E.  L.  Weimers,  Provo. 

Fee  Schedule  Committee:  K.  B.  Castieton,  Chairman,  Salt  Lake  City; 

Howard  K,  Belnap,  Ogden;  J.  E.  Trowbridge,  Bountiful;  U.  B.  Bryner. 

Salt  Lake  City;  W.  Leroy  Smith,  Salt  Lake  City;  J.  B.  Wherritt,  Heber 
City;  0.  W.  Budge.  Logan. 

Special  Committee  to  Study  Dues:  H.  R.  Reicbman,  Chairman,  Salt 

Lake  City;  Eliot  Snow,  Salt  Lake  City;  Ezra  Cragun,  Lewiston. 

Rural  Health  Committee:  J.  J.  Weight,  Chairman,  Provo;  J.  G.  McQuarrle, 
Richfield;  J.  P.  Burgess,  Hyrum;  Noall  Z.  Tanner,  Layton. 


i3eller  ^iou/eri  at  f^eaionaLit  f^rlcai 

^l^enuer  Ox^^en  C^o.j  ^nc. 

“Orders  Delivered  to  Any  City  by 
Guaranteed  Service” 

Corner  10th  and  Lawrence  Sts. 
TAbor  5138 

Special  attention  given  to  floral  tributes 
Also  Hospital  Flowers 

Medical  Gas  Division 

MEDICAL  OXYGEN 

Call  KEystone  5106 

CARBON  DIOXIDE-OXYGEN 
MIXTURES 

Vark  3loral  Co.  Store 

AVIATORS’  BREATHING  OXYGEN 
WATER  COMPRESSED  NITROGEN 
WATER  COMPRESSED  AIR 

1643  Broadway  Denver,  Colo. 

Twenty-Four  Hour  Service 

COLOR.  PROCESS.  |\  ITr^ 
LINE  & HALFTONE  / A -\ 

BEN  DAY iLn  U 

ILLUSTRATORS-DESIONERS 


.COLORADO  fa^fUl 


PHOTO 


100 


Rocky  Mountain  Medical  Journal 


by  far  the  most  potent 

ORAL  ESTROGEN 

available  clinically 


In  exceedingly  minute  doses— as  little  as  0.02  mg. 
(1/3200  gr.)  daily— Estinyl*  maintains 
the  average  menopausal  patient  free  of 
symptoms.  Even  when  initiating  therapy 
and  in  the  more  severe  cases,  unusually 
small  dosage— measured  in  hundredths 
of  a milligram— has  been  found  effective. 


(ETHINYL  ESTRADIOL) 


Estinyl,  a derivative  of  the  ovarian  follicular 
hormone,  estradiol,  evokes  the  sense  of  well-being 
characteristic  of  natural  hormone  therapy.  It 
acts  rapidly,  often  completely  controlling  climacteric 
symptoms  within  a few  days.  In  therapeutic 
dosage  side  effects  are  notably  infrequent.  Unique 
response  to  minimal  dosage  permits  effective 
estrogen  therapy  at  low  cost  to  patients. 


DOSAGE;  One  Estinyl  Tablet  (0.02  mg.)  or  one  teaspoon- 
ful of  Estinyl  Liquid  (0.03  mg.)  daily,  may  be  prescribed, 
reducing  dosage  as  symptoms  subside. 

ESTINYL  Tablets,  0.02  (buff)  or  0.05  mg.  (pink),  in  bottles 
of  100,  250  and  1000. 

ESTINYL  Liquid,  0.03  mg.  per  4 cc.  (teaspoonful),  in  bottles 
of  4 and  16  oz. 


CORPORATION  • BLOOMFIELD,  NEW  JERSEY 

IN  CANADA.  SCHERING  CORPORATION  LIMITED.  MONTREAL 


THE  WYOMING  STATE  MEDICAL  SOCIETY 


OFFICERS 

President:  George  E.  Baker,  Casper. 

President-Elect:  DeWitt  Dominick,  Cody. 

Vice  President:  K.  E.  Krueger,  Rock  Springs. 

Treasurer:  P.  M.  Schunk,  Sheridan. 

Corresponding  Secretary:  George  H.  Phelps,  Cheyenne. 

Delegate  A.M.A.:  R.  H.  Reeve,  Casper. 

Alternate  Delegate  A.M.A.:  W.  A.  Bunten,  Cheyenne. 

Executive  Secretary:  Mr.  Arthur  Abbey,  Cheyenne. 

COM31iTTEES 

Rocky  Mountain  Medical  Conference:  Earl  \Miedon.  Chairman,  Sheridan; 
George  N.  Phelps,  Cheyenne;  H.  L.  Harvey.  Casper;  C.  W.  Jeffrey,  Rawlins; 
L.  W.  Storey,  Laramie. 

Syphilis  Committee:  N.  E.  Morad,  Chairman,  Casper;  G.  M.  Groshart, 

Worland;  L.  H.  Wilmoth,  Lander;  L.  G.  Booth,  Sheridan;  F.  H.  Haigler, 

Midwest. 

Cancer  Committee:  Earl  Whedon,  Chairman,  Sheridan;  John  Gramlieh, 

Cheyenne;  DeWitt  Dominick,  Cody;  J.  R.  Newman,  Kemmerer;  E.  W.  New- 
man, Cheyenne. 

Medical  Economics  Committee:  C.  L.  Rogers,  Chairman,  Sheridan;  Nels 

A.  Vicklund,  Thermopolis;  R.  A.  Corbett,  Saratoga;  G.  R.  James,  Casper; 
S.  S.  Hellewell,  Evanston. 

Fracture  Committee:  Philip  Teal.  Chairman.  Cheyenne:  Silva  J.  Giovale, 
Cheyenne;  Robert  V.  Batteiton,  Rawlins;  Lowell  D.  Kattenhorn,  Powell; 
Joseph  E.  Hoadley,  Gillette. 

Medical  Defense  Committee:  Geoi^e  Baker,  Chairman,  Casper;  Andrew 
Bunten,  Cheyenne;  E.  W.  DeKay,  Laramie. 

Councillors:  Earl  Whedon,  Chairman,  Sheridan;  R.  J.  Boesel,  Cheyenne; 
E.  W.  DeKay,  Laramie;  George  Baker,  President,  Casper;  George  Phelps, 
Secretary,  Cheyenne. 

Advisory  to  Woman’s  Auxiliary:  John  R.  Bunch.  Chairman,  Laramie; 
Virgil  L.  Thorpe,  Newcastle;  H.  J.  Aldrich.  Sheridan;  G.  B.  Savory,  Chey- 
enne. 

Advisory  to  Workmen’s  Compensation  Department:  J.  D.  Shingle,  Chair- 
man, Cheyenne;  G.  H.  Phelps,  Cheyenne;  W.  A.  Bunten,  Cheyenne;  R.  H. 
Reeve,  Casper;  Albert  T.  Sudman,  Green  River;  P.  M.  Schunk.  Sheridan. 


Industrial  Health  Committee:  K.  E.  Krueger,  Chairman,  Rock  Springs; 
Willard  Pennoyer,  Cheyenne;  Thomas  B.  Croft,  Lovell;  Eugene  Pelton, 
Laramie. 

Veterans’  Affairs  and  Military  Service  Committee:  A.  J.  AUegretti,  Chair- 
man. Cheyenne;  Jack  Rowlett,  Laramie;  Everett  Ellis,  Cheyenne;  Bernard 
Sullivan.  Laramie;  G.  W.  Koford,  Cheyenne;  Bernard  Stack,  Thermopolis; 
J.  W.  Sampson,  Sheridan;  DeWitt  Dominick,  Cody;  Paul  R.  Holtz,  Lander; 
George  E.  Baker,  President,  Casper;  George  Phelps,  Secretary,  Cheyenne. 

Blue  Cross  Hospital  Committee:  R.  1.  Williams.  Chairman,  Cheyenne,  1950; 
W.  A.  Bunten.  Cheyenne,  1949;  E.  W.  DeKay,  Laramie,  1951;  Cedric 
Jones,  Cody,  1952. 

Public  Policy  and  Legislation:  George  Phelps,  Chairman,  Cheyenne; 
Andrew  Bunten,  Cheyenne;  George  Baker,  President,  Casper;  G.  W.  Koford, 
Cheyenne;  E.  W.  DeKay,  Laramie;  G.  W.  Henderson,  Casper. 

National  Physicians  Committee:  George  Phelps,  Chairman,  Cheyenne; 
Andrew  Bunten,  Treasurer,  Cheyenne;  E.  W.  DeKay,  Laramie;  George  Baker, 
Casper. 

Poliomyelitis  Committee:  H.  L.  Harvey,  Chairman,  Casper;  N.  A.  Vicklund, 
Thermopolis;  Leo  Keenan,  Torrington;  DeWitt  Dominick,  Cody;  Philip  Teal, 
Cheyenne;  Franklin  Yoder,  Cheyenne;  F.  A.  Mills,  Rawlins. 

State  Institutions  Advisory  Committee:  J.  F.  Whalen,  Chairman,  Evans- 
ton; George  Phelps,  Cheyenne:  C.  W.  Jeffrey,  Rawlins;  Earl  Whedon.  Sheri- 
dan; G.  M.  Groshart,  Worland;  R.  H.  Kanable,  Basin. 

Necrology  Committee:  Earl  Whedon,  Chairman,  Sheridan;  John  B. 
Krahl,  Torrington;  Franklin  Yoder,  Cheyenne. 

Rural  Health  Committee:  Paul  Holtz,  Chairman,  Lander;  Andrew  Bun- 
ten. Cheyenne;  Samuel  Worthen,  Afton;  Wm.  K.  Rosene,  Wheatland;  Claude 
RaffI,  Basin. 

Public  Health  Department  Liaison  Committee:  E.  C.  Ridgeway,  Chair- 
man. Cody;  R.  P.  Fitzgerald,  Casper;  R.  V.  Batterton,  Rawlins;  J.  W. 
Sampson,  Sheridan;  R.  C.  Stratton,  Green  River;  Willard  Pennoyer, 
Cheyenne. 

Child  Health  Committee:  Paul  W.  Emerson,  Chairman,  Cheyenne:  John 
Gramlieh,  Cheyenne;  Thomas  Croft,  Lovell;  Bernard  Sullivan,  Laramie; 
Paul  R.  Holtz,  Lander;  Geo.  E.  Baker,  Casper;  A.  R.  Abbey,  Cheyenne. 

Council  on  National  Emergency  Medidal  Service:  George  H.  Phel|;», 
Chairman,  Cheyenne;  R.  H.  Reeve,  Casper;  DeWitt  Dominick,  Cody;  E.  W. 
DeKay,  Laramie;  K.  S.  Krueger,  Rock  Springs;  P.  M.  Schunk,  Sheridan. 


COLORADO  HOSPITAL  ASSOCIATION 


OFFICERS 

President:  Frank  G.  Palladlno,  Community  Hospital.  Boulder. 
President-Elect:  Walter  G.  Christie,  Presbyterian  Hospital,  Denver. 

Vice  President:  Hubert  W.  Hughes,  St.  Anthony  Hospital,  Denver. 
Treasurer:  Sister  Mary  Thomas,  Mercy  Hospital,  Denver. 

Trustees:  Koy  R.  Prangley,  St.  Luke's  Hospital,  Denver  (1949);  James 
P.  Dixon,  M.D.,  Denver  General  Hospital,  Denver  (1949);  Louis  Liswood, 
National  Jewish  HospiUl,  Denver  (1950);  DeMoss  Taliaferro,  Children's 
Hospital,  Denver  (1950);  Roy  R.  Anderson,  Presbyterian  Hospital,  Denver 
(1951);  Rev.  Allen  H.  Erb,  Mennonite  Hospital,  La  Junta,  Colo.  (1951). 

Delegate  to  the  American  Hospital  Association:  Herbert  A.  Black,  M.D.. 
Parkview  Hospital,  Pueblo. 

Alternate:  Msgr.  John  R.  Mulroy,  Catholic  Hospitals,  Denver. 

STANDING  COMMITTEES 
Auditing:  Ben  M.  Blumberg,  Chairman,  (1948),  General  Rose  Me- 
morial Hospital,  Denver;  M.  A.  Moritz  (1949),  Denver  General  Hospital, 
Denver;  R.  W.  Pontow  (1950),  Colorado  General  Hospital,  Denver. 

Constitution  and  Rules:  Samuel  S.  Golden,  M.D.,  Chairman,  Beth  Israel 
Hospital,  Denver;  Henry  H.  Hill,  Weld  County  Hospital,  Greeley;  Sister 
M.  Johanna,  Sacred  Heart  Hosplt^,  Lamar. 

Legislative:  Msgr.  John  R.  Mulroy,  Chairman,  CathoUe  Hospitals,  Denver; 
DeMoss  Taliaferro.  Children’s  Hospital,  Denver;  Carl  Ph.  Schwalb,  Denver; 
Robert  C.  Knlffen,  Colorado  General  Hospital,  Denver;  Herbert  A.  Black, 
H.D.,  Parkview  Hospital,  Pueblo. 

Membership:  Leo  W.  Belfel,  Chairman,  St.  Vraln  Hospital,  Longmont; 
B.  B.  Jaffa,  M.D.,  Denver. 

Nominating:  Herbert  A.  Black,  M.D.,  Chairman,  (1948),  Parkview 
Hospital,  Pueblo;  John  C.  ShuU,  (1949),  Porter  Sanitarium  and  Hospital. 
Denver;  Hubert  W.  Hughes,  (1950),  St.  Anthony  Hospital,  Denver. 


Program:  Boy  R.  Prangley,  Chairman,  SL  Luke’s  Hospital,  Denver;  B.  B 
Jaffa,  M.D.,  Denver. 

Nursing  and  Public  Education:  DeMoss  Tallafeiro,  Children’s  Hospital, 
Denver;  Sister  M.  Louis,  St.  Anthony  Hospital,  Denver;  Miss  Merle  Love, 
R.N.,  Presbyterian  Hospital,  Denver;  Sister  M^a  GraUa,  R.N.,  Glockner 
Sanatorium,  Colorado  Springs;  Frank  G.  Palladlno,  Community  Hospital, 
Boulder. 

Resolutions:  S.  Russ  Denzler,  Chairman,  Colorado  Hospital,  Canon  City: 
Carl  Ph.  Schwalb,  Denver;  Walter  G.  Christie,  Presbyterian  Hospital.  Denver. 

SPECIAL,  COMMITTEES 

Public  Relations:  John  C.  Shull,  Chairman,  Porter  Sanitarium  and  Hos- 
pital, Denver;  James  P.  Dixon,  M.D.,  Denver  General  Hospital,  Denver: 
Sister  Maty  Lultgard,  St.  Thomas  More  Hospital,  Canon  City. 

Rates  and  Charges;  Hubert  W.  Hughes,  Chairman,  St.  Anthony  Uoe- 
pital,  Denver;  Walter  0.  Christie,  Presbyterian  Hospital,  Denver;  Beu  11. 
Blumberg,  General  Rose  Memorial  Hospital,  Denver;  Msgr.  John  B.  Mulroy, 
Catholic  Hospitals,  Denver;  Leo  W.  Reifel,  St.  Vraln  Hospital,  Longmont; 
Roy  R.  Prangley,  St.  Luke’s  Hospital,  Denver;  DeMoss  Taliaferro,  Children’s 
Hospital,  Denver. 

Hospital  Survey  and  Planning:  James  H.  Walker,  Chairman,  Good  Sa- 
maritan Hospital,  Sterling;  Arthur  A.  Fisher,  Arehltect,  Denver;  B.  B. 
Jaffa,  M.D..  Denver. 

State  Board  of  Health  Advisory:  Msgr.  John  R.  Mulroy,  Chairman,  Catho- 
Ue  Hospitals,  Denver;  DeMoss  Taliaferro,  ChUdren’s  Hospital,  Denver;  B.  B. 
Jaffa,  M.D.,  Denver. 

Delegate  to  Colorado  Inter-Professlonal  Counsll:  Hubert  W.  Hughes,  SL 
Anthony  Hospital,  Denver. 

Representatives  to  Liaison  Connell  on  Graduate  Education:  Boy  B. 
Prangley,  St.  Luke’s  Hospital,  Denver;  Frank  0.  PaUadIno,  Community 
Hospital,  Boulder. 


A 


S. 


eruice 


ccuracu  and  ^peed  in  f^reicription 

DORR  OPTICAL  COMPANY 


421  16th  Street 


Denver,  Colorado 


KEystone  5511 


102 


Rocky  Mountain  Medical  Journal 


fnoDiFiED  miiK 


’^*£  8AKIR  LASORATORIfS 


•AKSR  i,a»OI!>£®*** 


TWO  ADDED  SUGARS 

V-  . d 6 oer  centcajis 
milk  containBjbout,,.^...^^ 

rrHaYDlGESTiD  PROTilJ^ 

KtORl  EASIL  ® more 


I and  less  — ^ ^ 

1 ingjojljebsill-— 

AH  ADJUStED  a.l) 

, nk  is  usuaiiy  r 

and  f ' iiiin"i 

aJ  fORTiFlEB  AT  7 STRikTe/»i« 

tij  Smarting  with  tubern  . POINTS 

fom...r.  cows’  


To  ^Upptv 


fortified  vitamin  content 

SIMILAR  TO  HUMAN  MILK 


ie  for  human  milk  gains  acceptance  by  the 
* only  to  the  extent  that  it  is  well  tolerated 


A COMPLETE  MILK  DIET 




Rifled 


mounts 
Calcin 


in  the 


content 


salts 


Developed  to  Meet  the  Needs  of 
the  Physician  in  Infant  Feeding 


are 


« POWDER 


o 


LIQUID 


Start  with  either  and  change 
from  one  to  the  other,  to 
meet  individual  requirements. 


A copy  of  this  informative  folder  which  com- 
pletely describes  Baker’s  Modified  Milk,  with 
feeding  directions,  will  be  mailed  on  request. 


tl  (OUNlllON  \! 


THE  BAKER  UBORATORIES  INC,  Cleveland,  Ohio 


for  February,  1949 


103 


CHECK  LIST 

for  choice  of 
a laxative 

Phospho-  type  of 
ACTION 

(HEITI* 

^ prompt  action 
Thorough  action 
1/  Gentle  action 

SIDE 

EFFECTS 

1/  Free  from 

Mucosal  Irritation 

Absence  of  Con- 
stipation Rebound 

^ No  Development 
of  Tolerance 

Safe  from  Excessive 
Dehydration 

^ No  Disturbance  of 
Absorption  of 
Nutritive  Elements 

^ Causes  no 

Pelvic  Congestion 

^ No  Patient 
Discomfort 

I/'  Nonhabituating 

Free  from 
Cumulative  Effects 

• 

ADMINIS- 

TRATION 

^ Flexible  Dosage 
^ Uniform  Potency 
I/'  Pleasant  Taste 


Judicious  Laxation 


rough  controlled  action 


Phospho-SocJa  (Fleet)*,  over  the  years, 
has  won  discriminating  preference 
by  thousands  of  physicians  . . 
because  of  its  controHecf  action  — 
its  freedom  from  undesj.rable  siide 
effect  — and  its  ease  of  administration, 
Your  prescription  of  Phospho-Sodg 
(Fleet)*  assures  elective  (and  safe) 
results,  ilberoil  samples  on  request. 

C.  B.  FLEET  CO.  INC. 

LYNCHBURG,  VIRGINIA 

PHOSPHO-SODA'  ond  'fUET 

ore  registered  trode  morlcs  of  C.  6,  fled  Co.,  Inc. 


PHOSPHO- SO  IIA 

(FLEiET)^ 

I Phospho-Sodo  (Fleet  ’ is  a solution 

containing  in  each  TOO  cc=  sodium 
brphosphate  48  Gm.  and  sodium  phosphate  18  Gm. 


ACCEPTED  FOR  A 0 V E RT  t S I MG  BY  THE  JOURNAL  OF  THE  AMERICAN  mEDICAI  ASSOCIATiOm 


104 


Rocky  Mountain  Medical  Journal 


, Units  pfr 


fROIAMIM*’ 

ZINC  a 

ILETIN  , 
'•HSUIIN,  lllHf' 
Canine  zinc  iH*® 


^ROTAMINBi 
ZINC  A 
ILETIN 

“NSuim,  IILL'O 
'^AMine  zinc  INS'" 

80  Units  pc' 
*aif  CartfuU)/ 


.isasissjsi 


tsJtSI'E 

^ ^nits  per ' 


.."•V  AND  COMll"; 
U^APOIIS. 


iJ*-Ly  andcon^^ 
■"•anakilis,  o**-!, 


Good  News  for  Your  Diabetic  Patients 


The  adequately  treated  diabetic  patient  has  actual  proof  from 
laboratory  reports  to  show  that  his  condition  has  responded  to  treatment. 
If  the  patient  is  in  coma,  then  proper  treatment  will  save  his  life.  If  he 
is  a chronic  invalid  because  his  diabetes  has  been  neglected,  then 
correct  management  will  not  only  prevent  death  from  coma  but  may 
restore  the  patient  to  good  health.  Few  therapeutic  procedures  can  be 
used  by  the  physician  with  such  precision  and  with  such  assurance  of 
benefit  as  the  modern  treatment  of  diabetes. 

For  prompt  effect — 

Iletin  (Insulin,  Lilly),  40  and  80  units 
per  cc. 

For  sustained  effect — 

Protamine,  Zinc  & Iletin  (Insulin,  Lilly), 

40  and  80  units  per  cc. 

Intermediate  effects  may  be  obtained  by  suitable  admixtures  of 
Insulin  and  Protamine  Zinc  Insulin. 


ELI  LILLY  AND  COMPANY,  INDIANAPOLIS  6,  INDIANA,  U.S.A. 


First,  of  course,  are  those  of  the  attending  physician.  It  is  he 
who  must  make  the  diagnosis  and  prescribe  diet,  exercise,  and 
Insulin.  The  physician’s  success,  however,  is  inextricably  bound 
up  in  the  ability  and  integrity  of  the  manufacturer  who  makes 
and  tests  the  Insulin  he  prescribes. 

Pharmaceutical  manufacturing,  like  the  practice  of  medicine, 
draws  upon  many  sciences  and  skills.  During  the  twenty-six 
years  of  the  Banting  Era,  for  example,  Eli  Lilly  and  Company 
has  painstakingly  built  up  a competent  staff  of  experienced 
technicians  in  the  specialized  field  of  Insulin  manufacture  and 
control. 

Every  lot  of  Iletin  (Insulin,  Lilly),  from  the  grinding  of  the 
frozen  pancreas  glands  to  the  final  physiological  assay,  is  under 
a specialist’s  supervision.  These  men  welcome  the  responsibility 
of  serving  you  and  your  patient  with  potent,  stable,  and 
uniform  preparations  of  Iletin  (Insulin,  Lilly). 


LILLY  SPECIALISTS  SERVE  THE  MEDICAL  PROFESSION 


FEBRUARY 

1949 


IR-Ocky  yAountain 

yUedical  Journal 

E-ditorial * 


Colorado 
Montana 
New  Mexico 
Utah 
Wyoming 


The  Twenty- five  Dollar  Assessment 

JpROGRESS  in  American  medicine  is  an 
achievement  which  we,  as  doctors,  are 
proud  to  relate  to  the  general  public.-  Yet, 
for  some  time  now,  many  stories  reaching 
lay  readers  have  dealt  with  isolated  cases 
of  distress,  indicting  the  medical  profession, 
along  with  articles  based  on  glib  promises 
of  social  planners. 

During  the  ensuing  year,  the  medical  pro- 
fession must  concentrate  its  efforts  on  one 
problem:  to  tell  the  American  people  about 
the  many  contributions  which  the  medical 
profession  has  made  to  alleviate  disease, 
preserve  life  and  postpone  death.  Our  story 
must  stress  the  importance  of  our  present 
system  of  voluntary  care  and  present  the 
true  facts  about  medical  care  and  health 
protection. 

The  House  of  Delegates  of  the  American 
Medical  Association,  at  the  Interim  Session 
in  St.  Louis,  fully  recognized  these  prob- 
lems by  creating  a means  for  carrying  on  a 
nationwide  health  education  program.  To 
finance  this  program  an  assessment  of  $25 
was  made  on  each  member  of  the  American 
Medical  Association.  Members  of  the  Amer- 
ican Medical  Association  do  not  pay  dues. 
If  they  desire  to  become  Fellows  of  the 
Scientific  Assembly  they  make  application 
and  pay  $12  a year  dues,  which  include  a 
subscription  to  The  Journal.  This  hardly 
pays  for  the  paper  and  printing — notwith- 
standing the  fact  that  the  doctor  receives 
the  best  medical  periodical  published  any- 
where in  the  world. 

In  1947,  the  expenses  of  the  Association 
exceeded  income.  For  that  reason  dues  of 
Fellows  were  raised  from  $8  to  $12.  How- 
ever, even  higher  costs  have  kept  apace 
with  this  raise  and  the  Association  may 
show  a net  loss  for  1948. 


The  medical  profession  as  a whole  is  of 
the  firm  opinion  that  government  control 
of  medicine  would  lower  the  standards  of 
medical  care  in  the  United  States,  and  is 
so  sincere  in  this  belief  that  it  feels  every- 
thing possible  should  be  done  to  prevent 
such  control  from  being  thrust  upon  us. 

A coordinating  committee  has  been 
formed  to  help  solve  many  of  the  problems 
which  we  face,  and  it  is  enlisting  the  sup- 
port of  every  physician.  This  committee 
is  composed  of  Dr.  E.  L.  Henderson,  chair- 
man; Dr.  Edward  S.  Hamilton,  Dr.  Gunnar 
Gundersen,  Dr.  Walter  B.  Martin,  Dr.  Louis 
H.  Bauer,  Dr.  John  W.  Cline,  Dr.  William 
Bates,  Dr.  R.  B.  Robins,  Dr.  R.  L.  Sensenich, 
and  Dr.  George  F.  Lull. 

<4 

Better  Than  We 
Could  Do  It 

'^HERE  recently  came  to  hand  the  follow- 
ing  editorial  published  December  7, 1948, 
by  the  Phoenix  Gazette,  leading  newspaper 
of  Phoenix,  Arizona.  We  salute  the  Editor 
of  the  Gazette.  He  has  told  our  story  for  us 
better  than  we  could  have  told  it  ourselves. 
Here  it  is,  republished  with  permission  of 
the  Gazette: 

A Job  for  the  Doctors 

Senator  Murray  of  Montana  resorts  to  dema- 
gogy when  he  accuses  the  American  Medical  As- 
sociation of  raising  a $3,500,000  political  fund  to 
fight  his  compulsory  health  insurance  plan.  He 
probably  knows  as  well  as  the  doctors  do  that 
this  is  a deviation  from  the  strict  truth.  The 
doctors  have  assessed  themselves  $25  each  to 
raise  an  educational  fund.  Strictly  speaking, 
there  is  quite  a difference  between  public  edu- 
cation to  defeat  a bill  and  lobbying. 

The  A.M.A.  is  composed  of  most  of  the  repu- 
table physicians  and  surgeons  in  the  United 
States.  The  family  doctors  of  ninety-nine  out  of 
100  of  us  are  members.  They  are  honorable, 
decent  men  and  women  on  whom  most  of  us 


for  February,  1949 


105 


have  complete  reliance.  There  is  nothing  sinister 
about  them.  They  are  trying,  each  in  his  own 
way,  to  do  the  best  job  possible  for  the  people 
who  depend  on  them. 

The  money  they  are  raising  is  to  be  used  in 
telling  the  people,  through  advertisements,  liter- 
ature, lectures,  and  possibly  motion  pictures,  just 
what  socialized  medicine  would  mean.  The  doc- 
tors as  a whole,  like  most  other  people,  believe 
that  voluntary  plans  of  health  insurance  are 
likely  to  be  much  more  satisfactory  than  a gov- 
ernment system,  where  patients  are  run  through 
a mill  with  government  doctors  and  government 
nurses  looking  at  their  tongues  and  handing  them 
pills  as  they  pass  through. 

Perhaps  the  doctors  could  do  a better  grass- 
roots educational  job  than  any  advertising  agen- 
cy if  each  would  take  a few  minutes  a day  to 
tell  his  patients  the  truth  about  socialized  medi- 
cine. 

^ <4 

Cancer  Consciousness 

TlyfEDICAL  literature  and  the  work  of  our 
societies  are  more  and  more  concerned 
with  cancer.  The  editors  of  this  journal 
a few  weeks  ago  thought  that  our  large 
November  issue,  concerned  entirely  with 
the  subject  of  cancer,  would  relieve  the 
files  of  unpublished  articles  for  several 
issues  as  far  as  cancer  is  concerned.  How- 
ever, a number  of  articles  antedating  last 
summer’s  Cancer  Conference  are  still  on 
hand  and  are  now  being  prepared  for  pub- 
lication. 

Perpetuation  of  cancer-consciousness  on 
the  part  of  every  doctor  deserves  priority 
among  the  profession’s  major  projects.  Con- 
quest of  malignancy  and  education  of  the 
public  is  our  responsibility  and  obligation. 

Cancer-consciousness  on  the  part  of  every 
doctor  should  be  as  much  a part  of  him  as 
the  aseptic-consciousness  is  a fundamental 
technical  attribute  of  the  surgeon.  There 
is  undeniable  evidence  that  cancer  cells  can 
be  transplanted  by  hands,  gloves,  and  in- 
struments nearly  as  easily  as  germs  may 
be  conveyed  from  one  place  to  another. 
Changing  of  gloves  and  resterilization  of 
instruments  should  be  as  mandatory  in 
dealing  with  cancer  as  in  limiting  sepsis 
when  bacterially  clean  and  unclean  fields 
are  contacted  in  the  same  operation.  May 
each  of  us  guard  his  technic  automatically 
and  without  exception  as  one  contribution 
in  the  conquest  of  cancer. 


We  Suffer 
A Major  Loss 

IJERTRAM  BARR  JAFFA,  M.D.,  member 
of  the  Editorial  Board  of  the  Rocky 
Mountain  Medical  Journal  as  Editor  for  the 
Colorado  Hospital  Association  for  the  last 
thirteen  years,  died  January  23,  1949,  fol- 
lowing an  attack  of  coronary  thrombosis. 

We  bow  our  heads  in  tribute  to  the  mem- 
ory of  a man  who,  though  of  an  unusually 
quiet  and  retiring  nature,  nonetheless  left 
his  mark  deeply  upon  his  profession  of  med- 
icine and  upon  several  worthy  avocations. 
To  Bert  Jaffa  his  service  to  mothers  came 
first,  in  his  chosen  field  of  obstetrics  and 
gynecology.  But  close  behind  were  his  man- 
ifold interests  in  hospital  management  and 
advancement  where  he  served  many  years 
m high  offices  of  the  Colorado  Hospital  As- 
sociation, his  deep  concern  for  public  health 
which  he  retained  to  the  end  though  many 
years  had  passed  since  he  served  as  Den- 
ver’s Manager  of  Health  and  Charity,  and 
his  religious  devotion  to  the  work  of  the 
many  Masonic  bodies  in  which  he  was  an 
outstanding  leader. 

We  have  suffered  a major  loss,  but  we 
are  better  to  have  known  him  and  to  have 
called  him  friend  as  well  as  co-worker. 


StLHOUETTES 

from  the  A.M.A.  House  of  Delegates 


“You  don’t  know  about  me  without  you  have 
read  a book  by  the  name  of  The  Adventures  of 
Tom  Sawyer,”  said  Huckleberry  Finn.  And  the 
appended  comments  will  be  pointless  (pointless, 
in  any  case,  perhaps)  unless  you  have  read  the 
editorial  “The  Assessment  and  Public  Opinion” 
in  the  Journal  A.M.A.  of  December  25,  1948. 

This  rather  lengthy  exposition  of  the  status 
quo,  excepting  the  quotation  from  the  St.  Louis 
Globe-Democrat,  is  about  two-thirds  verbosity 
and  one-third  soporific.  Cannot  an  editorial  be 
written  without  injecting  Murray,  Dingel,  Froth- 
ingham,  Ewing? 

The  assessment  was  approved  by  the  House  of 
Delegates  on  December  1,  1948.  The  purposes  for 
which  the  levy  was  made  were  stated,  clearly,  in 
resolutions  presented  and  in  the  report  of  the 
reference  committee.  The  objectives  were  known 
to  every  member  of  the  House  of  Delegates. 
These  objectives  could  have  been  made  available, 
immediately,  to  the  press  and  radio  and,  by  spe- 


106 


Rocky  Mountain  Medical  Journal 


cial  release,  to  the  members  of  the  American 
Medical  Association. 

It  is  some  sort  of  comment  on  something  to 
have  loyal  and  interested  physicians,  one  month 
after  the  assessment  was  authorized,  inquire  as 
to  the  purposes  for  which  the  assessment  will  be 
utilized.  It  demonstrates  once  more  the  wis- 
dom of  “getting  thar  fustest  with  the  mostest.” 
As  for  such  childish  and  typical  outbursts  as 
“war  chest,”  “slush  fund,”  “frantic  taxation,” 
“lobbying,”  let  the  howlers  be  assured  that  we 
are  spending  our  own  money,  not  the  money  of 
the  taxpayers  or  of  contributors  to  the  Red  Cross 
and  ^the  American  Cancer  Society.  Being  our 
own  money  it  will  be  spent  wisely  and  judici- 
ously. 

The  editorial  has  disturbing  overtones,  or  un- 
dertones, of  complacency.  Complacency  is  the 
enemy  of  success.  We  have  had  experience.  For 
instance:  “Leaders  of  the  medical  profession  in 
individual  states  need  not  be  overcome  by  ap- 
prehension or  fear.  They  need  only  to  recognize 
the  necessity  for  such  leadership  as  the  Coordi- 
nating Committee  must  provide.  They  should 
recognize  the  desirability  of  a well  coordinated 
program  under  such  leadership  rather  than  a 
state  of  confusion  with  innumerable  leaders  wide- 
ly scattered  throughout  the  country  and  out  of 
intimate  contact  with  the  central  organization.” 

Has  the  esteemed  editorialist  ever  heard  of 
telephone,  telegraph  and  air  mail? 

Is  all  wisdom  and  initiative  concentrated  in  a 
committee?  Is  the  American  Medical  Association 
a committee  or  is  it  140,000  interested  physicians 
inspired  by  a common  objective?  The  editorial 
goes  on:  “It  would  be  inconsistent  ....  to  ap- 
proach this  problem  in  a confused  or  disorderly 
manner.”  The  Coordinating  Committee  for  the 
Protection  of  the  People’s  Health  (memorize  the 
title,  please)  is  composed  of  outstanding,  ener- 
getic, experienced  and  courageous  physicians. 
There  is  no  probability,  indeed  no  possibility, 
that  the  problem  will  be  approached  in  a con- 
fused or  disorderly  manner.  Neither  is  there 
any  probability  that  this  committee  will  not  ap- 
preciate the  wisdom  of  enlisting  the  active  co- 
operation of  every  member  of  the  American  Med- 
ical Association.  The  committee  will  realize, 
more  than  most  of  us,  that  “proceeding  in  an 
orderly,  scientific  manner  to  do  the  task  as- 
signed” may  not  be  sufficiently  effective  in  deal- 
ing with  the  pouter  pigeons  on  the  Potomac. 

It  was  thoughtless  and  misleading  to  associate 
in  the  same  paragraph  the  state  society  which 
“circularized  the  official  bodies  ....  with  its 
concept,  etc.,”  with  commercial  organizations 
which,  rightfully,  seek  remunerative  business. 
The  constituent  association — whichever  one  it 
was — had  no  pecuniary  interest.  It  might  have 
had  a sincere  professional  interest. 

However,  the  light  is  breaking  through.  As 


a source  of  current  information  and  timely  com- 
ment, the  editorial  pages  of  the  Journal  are  be- 
ing replaced  rapidly  by  the  Secretary’s  Letter. 


Correspondence 


APROPOS  OF  THE  EWING  REPORT 

To  the  Editor: 

Senator  William  Borah,  in  discussing  the  ac- 
tivities of  a group  desiring  the  establishment  of 
a federal  bureau  made  this  comment — “They 
start  with  a bureau,  but  before  long,  at  the  ex- 
pense of  the  taxpayer,  demand  a whole  set  of 
furniture.” 

The  question  under  discussion,  namely.  Social- 
ized Medicine”  or  “State  Medicine,”  if  adopted 
will  be  under  the  supervision  of  a new  bureau 
or  one  already  established  but  expanded  to  care 
for  the  additional  load.  The  proper  name  for  the 
suggested  enterprise  should  then  be  “Bureau- 
cratic Medicine.” 

The  thing  to  decide  then — Is  this  adventure 
created  for  those  and  their  following  who  might 
be  interested  economically,  or  is  it  for  the  inter- 
est of  the  public,  which  in  this  case  is  the  pa- 
tient? 

What  Will  It  Cost?  In  an  editorial  in  the 
American  Journal  of  Surgery  at  the  time  of  the 
introduction  of  the  ^Murray- Wagner  Bill,  it  was 
estimated  that  it  would  require  4 per  cent  of  the 
payroll  on  the  part  of  the  employee  and  4 per 
cent  of  the  payroll  on  the  part  of  the  employer. 
Federal  employees  were  to  have  a preferential 
rate  of  3 per  cent  without  being  matched  by  the 
federal  government.  Employers,  farmers,  etc.,  to 
be  taxed  an  equivalent  amount  out  of  income. 
Twenty  per  cent  of  the  fund  was  to  be  held  by 
the  bureau  for  administrative  purposes. 

Mr.  Ewing  estimated  that  -it  would  cost  21/4 
per  cent  of  the  payroll  on  the  part  of  the  em- 
ployee and  2y4  per  cent  on  the  part  of  the  em- 
ployer, but  in  ten  years  there  would  be  an  in- 
crease in  cost  of  331/3  per  cent,  making  it  3 per 
cent  for  each,  or  6 per  cent  on  the  payroll  of  the 
country.  (Many  people  are  laboring  under  the 
delusion  that  they  are  going  to  get  something  for 
nothing). 

Mr.  Ewing  makes  also  the  following  state- 
ments: 

1.  Ill  health  costs  25  times  as  much  as  labor 
strife. 

2.  325,000  die  each  year  who  could  be  saved. 

3.  Four-fifths  of  our  people  cannot  afford  doc- 
tor bills. 

The  above  statements  have  no  factual  basis, 
but  are  in  line  with  propaganda  put  out  by  those 
seeking  new  bureaus,  and  are  definitely  wild 
guesses. 

The  Committee  on  the  Cost  of  Medical  Care 
(hospitals,  physicians’  supplies)  which  was 
started  during  the  Hoover  administration  re- 


fer February,  1949 


107 


ported  that  the  cost  per  family  was  approxi- 
mately $60  per  year. 

Under  the  Ewing  plan  it  would  in  ten  years 
take  $45  per  1,000  payroll;  $90  per  $2,000;  $135 
for  3,000.  (I  here  allowed  IVz  per  cent  off  6 per 
cent  above  for  other  benefits). 

For  nearly  three  years  it  was  my  privilege  to 
serve  on  the  Economics  Committee  of  the  Colo- 
rado State  Medical  Society.  This  committee 
worked  diligently  to  obtain  facts  pertaining  to 
the  medical  care  of  our  people. 

Our  studies  of  the  medical  profession  itself, 
showed  that  there  were  a few  whose  talents  were 
tainted  with  commercialism  and  whose  charges 
were  at  times  in  excess  of  the  patient’s  ability  to 
pay.  But  by  and  large  we  were  pleased  to  have 
found  that  the  medical  profession  had  not 
changed — that  it  was  still  serving  our  people  at 
all  hours  in  all  kinds  of  weather — and  that  the 
relationship  between  patient  and  physicians  was 
‘.onscientiously  close.  Many  of  the  staffs  of  coun- 
ty, state  and  municipal  hospitals  were  serving 
gratuitously. 

Selecting  one  county  in  the  state  of  Colorado  at 
random,  we  found  in  the  study  of  the  estates  of 
deceased  physicians  that  nearly  60  per  cent  left 
amounts  inadequate  for  the  future  care  of  their 
families. 

In  the  study  of  the  relationship  between  em- 
ployer and  employee,  we  found  the  medical  set- 
up of  a number  of  industries  to  be  excellent.  The 
employees  selected  their  medical  staffs — who 
were  ethical  members  of  the  profession.  The 
relationship  between  all  concerned  was  close, 
intimate  and  human,  such  as  is  never  to  be 
found  in  medical  practice  by  remote  control 
through  multitudinous,  time  consuming  instruc- 
tions and  reports.  It  is  decidedly  to  the  ad- 
vantage of  labor  to  control  its  own  welfare 
funds  without  paying  managerial  tribute  to  any 
other  group.  This  has  been  demonstrated,  I 
think,  by  Mr.  John  L.  Lewis,  President  of  the 
Mine  Workers  of  America. 

I wish  here  to  quote  the  following  from  Vet- 
erans Administration  Instructions  in  the  Care  of 
Non-hospitalized  Veterans  as  an  example  of  Bu- 
reaucratic medicine: 

Report  of  Treatments  Rendered  (Form  2e90-a)— 

On  or  before  the  last  day  of  each  month,  a “Report 
of  Treatments  Rendered”  (Form  2690-a,  a sample 
copy  attached)  must  be  promptly  mailed  to  this  of- 
fice. These  reports  must  be  received  at  this  office 
not  later  than  the  2nd  of  the  succeeding-  month  so 
that  our  report  can  be  made  to  the  central  office, 
Washington,  D.  C.  A complete  separate  report  will 
be  submitted  for  each  beneficiary  who  has  received 
authorized  treatment  during  the  month.  A certified 
bill  for  services  rendered  must  accompany  the 'com- 
pleted Form  2690-a.  The  following  fee  schedule  is 
authorized: 

(1)  Office  visits  $2.00. 

(2)  Home  visits  $3.00. 

In  the  past  many  of  these  report  forms  have  not 
been  completely  filled  in.  This  results  in  delay, 
since  it  will  be  necessary  in  the  future  to  return 
them  for  completion.  The  “Complaints,”  “Clinical 
Findings,”  and  “Treatment”  columns  must  be  filled 
in  each  time  that  the  patient  is  seen  by  the  phy- 
sician. Also  note  that  on  the  bottom  of  this  form 
the  patient  must  sign  this  report  each  time  he  is  seen 
by  the  physician,  showing  dates  treatments  were 
rendered. 

(Prescription  for  treatment  of  authorized  cases 


should  be  forwarded  to  this  office  to  be  filled  by  the 
Regional  Office  Pharmacist  and  mailed  direct  to  the 
veteran  together  with  the  physician’s  instructions. 
If  emergency  medication  is  necessary,  and  authority 
for  emergency  treatment  (Form  2690)  has  been  pre- 
pared to  be  forwarded  immediately  to  this  office  or 
Form  2690  has  already  been  submitted,  then  the 
prescription  may  be  filled  by  a local  drug  firm,  and 
the  druggists’  bills,  together  with  a copy  of  the 
original  prescription,  bearing  the  signature  of  the 
veteran  on  the  reverse  side  and  stating  the  disability 
for  which  the  medicine  is  necessary,  should  be  for- 
warded to  this  office  for  consideration  of  payment). 

In  many  instances  we  have  served  veterans 
gratuitously,  feeling  that  the  compensation  did 
not  justify  the  paperwork. 

In  Conclusion: 

I would  like  to  make  the  following  suggestions 
in  lieu  of  those  made  by  Mr.  Ewing: 

1.  That  preventive  medicine  be  made  the  para- 
mount function  of  the  federal  government’s 
health  program.  The  Florence  Sabin  law  in  Colo- 
rado is  an  excellent  example. 

2.  The  federal  allotments  to  hospitals  should 
be  expanded  for  the  following  reasons:  a.  Home 
nursing  is  becoming  expensive  and  inadequate 
because  of  increase  in  hourly  cost  and  because 
old-age  pension  plans  have  removed  many  from 
that  field,  b.  Home  nursing,  except  for  minor 
ailments,  is  as  obsolete  as  having  a mechanic 
overhaul  your  car  in  your  own  garage,  c.  Hos- 
pital maintenance  costs  have  also  increased  be- 
cause of  obvious  reasons. 

3.  Blue  Cross  hospital  plans  should  be  made  ac- 
cessible to  all  people.  Labor  and  other  groups 
v/ould  find  it  advantageous  to  affiliate  and  be 
represented  on  its  board  of  directors. 

4.  Private  patients  should  select  their  own  phy- 
sicians and  prearrange,  if  they  desire,  the  cost 
and  terms  for  service. 

5.  ^ Indigent  patients  should  be  cared  for 
through  welfare  boards  in  accordance  with  fee 
schedules  recommended  by  the  board. 

6.  Hospitals  should  continue  to  remain  open  to 
emergency  cases  and  no  one  need  suffer  for  lack 
of  attention  under  those  circumstances. 

I do  not  agree  with  the  statement  that  the 
program  of  compulsory  health  insurance  be  des- 
ignated “Political  Medicine.”  It  is  definitely 
“Bureaucratic  Medicine.”  Statesmanship  with 
mature  judgment  above  party  consideration  is 
required  before  a payroll  tax  of  6 per  cent  is  fas- 
tened upon  generations  yet  unborn. 

The  Colorado  State  Medical  Society  has  elected 
a Board  of  Supervisors  to  act  as  a court  of  ap- 
peal before  which  any  individual  can  appear  in 
person  or  through  correspondence  because  of 
overcharge  or  violation  of  professional  ethics. 

Would  the  individual  have  the  same  oppor- 
tunity before  a federal  bureau  whose  iron  cur- 
tain often  prevents  our  duly  elected  representa- 
tives from  obtaining  information? 

I am  sure  that  the  medical  profession  will 
gladly  obey  the  dictates  of  our  Congress,  and  I 
feel  that  they  will  in  turn  consider  the  present 
patient-physician  relations  to  be  essential  for  the 
welfare  of  the  patient. 

BYRON  B.  BLOTZ,  M.D. 


108 


Rocky  Mountain  Medical  Journal 


Original  Articles 

CANCER  IN  INFANCY  AND  CHILDHOOD* 

PHILIP  ROSENBLUM,  M.D. 

CHICAGO 


Cancer  in  infancy  and  childhood  has  al- 
ways been  considered  a rare  disease.  Of  all 
deaths  in  the  United  States  due  to  cancer, 
less  than  1 per  cent  occur  in  children  under 
15  years  of  age.  But  this  does  not  tell  the 
true  story  because  the  high  cancer  death 
rate  places  it  well  among  the  causes  of 
childhood  mortality.  In  1945  in  Chicago, 
there  were  fifty-one  deaths  from  cancer 
recorded,  excluding  neuroblastoma,  in  the 
age  group  0 to  9 years;  and  nineteen  deaths 
in  children  10  to  14  years,  inclusive.  The 
actual  figures  are  probably  higher,  espe- 
cially since  Hodgkin’s  disease  and  leukemia 
were  not  included. 

It  is  strange  that  only  recently  have  the 
medical  profession  and  the  laity  realized 
the  frequency  with  which  neoplasms  do 
occur  in  children  and  their  importance  as 
a child  health  problem.  In  certain  age 
groups  cancer,  leukemia,  and  other  tumors 
have  exceeded  almost  all  the  common  dis- 
eases among  the  causes  of  death  during 
childhood.  This  is  probably  because  the 
treatment  of  some  of  the  previously  more 
common  causes  of  death,  such  as  pneumonia, 
meningitis,  whooping  cough,  appendicitis, 
etc.,  has  recently  been  more  successful. 
Then  again,  the  laity  and  the  profession 
have  become  cancer  conscious,  owing  to  the 
widespread  publicity  given  this  disease. 
Also  earlier  and  more  accurate  diagnoses 
are  made.  In  childhood,  not  only  is  the 
histologic  diagnosis  of  the  tumors  impor- 
tant, but  also  the  recognition  of  the  pos- 
sible future  effects  of  the  anatomical  and 
physiological  changes  of  the  growing  child 
upon  that  tumor.  These  changes  can  often 
be  observed  in  the  child.  Such  neoplasms 
as  melanoma  and  neurofibroma  may  appear 

♦Read  in  Santa  Pe,  New  Mexico,  Cancer  Society 
Refresher  Course,  April  15,  1948.  The  author  is 
■Senior  Attending  Physician,  Department  of  Pedi- 
atrics, Michael  Reese  Hospital,  Chicago,  Illinois. 


to  begin  as  benign  but,  as  the  child  grows 
older,  some  will  become  malignant. 

The  signs  and  symptoms  of  disease  in 
infants  and  children  vary  considerably  from 
those  in  adults,  and  in  cancer  this  is  no  ex- 
ception. The  course  of  cancer  in  infancy 
and  childhood  is  generally  rapid,  with  early 
metastases.  In  general,  sarcoma  appears 
to  be  more  frequent  than  carcinoma.  Em- 
bryonic and  neurogenic  tumors  are  more 
frequent  than  others.  The  latter  group  are 
represented  by  Wilm’s  tumor,  neuroblas- 
toma, and  retinal  glioma,  and  are  usually 
encountered  before  three  years  of  age. 

Tumors  of  the  central  nervous  system, 
leukemia,  lymphoma,  Hodgkin’s  disease, 
nasopharyngeal  fibroma,  and  endothelial 
myeloma  of  the  bone  (Ewing’s  tumor) — are 
most  commonly  found  in  the  age  group  4 
to  12  years.  The  most  common  sites  of 
primary  cancer  in  children  are  the  eye,  the 
central  nervous  system,  the  kidney,  the 
adrenals,  the  bones,  and  the  hematopoietic 
tissues.  However,  one  must  keep  in  mind 
that  primary  cancer  may,  and  does,  occur  in 
any  part  of  the  body. 

Several  factors  enter  into  delay  in  the 
diagnosis  of  cancer  in  the  child  from  1 to  6. 
Babies  receive  excellent  care,  as  a rule,  dur- 
ing their  first  year.  However,  between  the 
ages  of  1 and  6,  children  do  not  receive  the 
necessary  periodic  examination,  except  in 
large  communities  where  nursery  schools 
are  in  operation,  and  there  are  very  few  of 
these  where  thorough  examinations  are  re- 
quired. In  this  age  group,  cancers  such  as 
Wilm’s  tumor,  retinoblastoma,  and  some 
somatic  sarcomas,  occur  more  frequently 
than  at  other  ages.  Again,  there  are  many 
benign  tumors,  such  as  hemangiomas,  neuro- 
fibromas and  lymphangiomas,  which  are 
potentially  fatal  and  are  observed  at  this 
same  period.  So  in  this  age  group  many 


for  February,  1949 


109 


cancers  which  could  be  successfully  treated 
are  not  diagnosed  because  of  the  lack  of 
regular  examinations,  and  the  fact  that 
people  are  unaware  that  cancer  does  occur 
in  infancy  and  childhood.  Naturally  the 
symptoms  of  a disease  which  may  affect  so 
many  different  parts  of  the  body  will  vary 
with  its  nature  and  location.  However, 
there  are  certain  things  that  should  suggest 
that  the  normal  physiological  processes 
have  been  altered.  We  should  be  on  our 
guard  for  the  child  who  shows  significant 
differences  physically  and  mentally,  from 
his  associates,  or  the  child  in  whom  the 
parent  or  teacher  has  noticed  a radical 
change  in  personality  or  school  work.  Every 
abnormal  swelling  should  be  considered  as 
a possible  cancer. 

Children  may  fall,  develop  some  sort  of 
lameness  and  complain  of  pain  in  the  af- 
fected part.  These  are  often  simple  injuries, 
but  one  must  always  be  on  the  alert  for  the 
possibility  of  a more  serious  finding,  such 
as  a beginning  cancer.  It  happens  occasion- 
ally that  an  unsuspected  cancer  may  be 
present  for  some  time,  an  injury  first  at- 
tracting attention  to  a swelling  or  other 
manifestation.  It  is  the  tendency  to  mini- 
mize such  complaints  in  infancy  and  child- 
hood and  now,  with  the  increase  in  psy- 
chiatric and  somatic  medicine,  many  are 
attributed  to  behavior  disorders,  when  in 
reality  they  may  be  the  warning  signs  of 
serious  disease. 

In  children  we  do  not  have  the  problem 
of  the  common  adult  cancers  that  occur  in 
the  mouth,  stomach,  breast,  and  prostate 
gland.  Most  of  the  cancers  in  childhood, 
with  the  exception  of  those  in  the  central 
nervous  system  and  some  lymphomas,  are 
readily  accessible  to  examination  and  a 
diagnosis  can  often  be  made  just  on  phy- 
sical examination  alone.  These,  therefore, 
are  more  accessible  to  therapy. 

In  the  diagnosis  of  childhood  cancer  one 
should  keep  in  mind; 

1.  The  changes  that  occur  in  the  growth 
of  a.  the  entire  body,  or  b.  individual  mem- 
bers. 

2.  Changes  in  temperament,  behavior,  in- 
telligence, and  disposition. 


3.  Swelling  of  nontraumatic  origin. 

4.  An  undiagnosed  disorder  of  short  or 
long  duration. 

Parents  often  neglect  obtaining  proper 
treatment  for  their  child  following  a diag- 
nosis of  cancer,  because  they  feel  that  this 
disease  is  always  fatal  in  a child.  While 
the  prognosis  may  often  be  unfavorable,  a 
hopeless  attitude  in  the  presence  of  cancer 
is  not  always  justified.  There  are  many 
curable  cancers  that  occur  in  the  age  group 
from  birth  to  five  years,  where  optimum 
treatment  is  instituted  in  time. 

Tumors  of  the  Bones 

Of  all  the  tumors,  those  involving  the 
bones  form  the  largest  group.  The  benign 
varieties  of  osseous  tumors  include  bone 
cyst,  osteochondroma,  giant  cell  tumor,  and 
the  osteoid  osteoma.  Some  benign  types  of 
osseous  tumors,  such  as  osteochondroma  and 
giant  cell  tumors,  may  become  cancerous. 
Most  of  these  are  osteogenic  sarcoma  and 
endothelioma  or  Ewing’s  tumor.  Osteogenic 
sarcoma  occurs  chiefly  in  the  humerus,  fe- 
mur, and  tibia  and  less  so  in  other  long  and 
flat  bones.  Endothelioma  more  frequently 
affects  long  bones  than  flat  bones.  The 
bones  may  also  be  involved  by  direct  ex- 
tension of  an  adjacent  tumor  of  the  soft 
part.  The  bones  are  affected  in  leukemia  as 
well  as  in  metastatic  cancer,  such  as  neu- 
roblastoma, retinoblastoma,  and  embryonal 
carcino-sarcoma  of  the  kidney  (Wilm’s  tu- 
mor) . Osseous  involvement  may  also  occur 
as  part  of  the  constitutional  anatomic  al- 
teration of  neurofibromata. 

In  the  diagnosis  of  tumors  of  the  bone, 
pain  may  be,  and  often  is,  the  principal 
symptom.  Impaired  function,  fever,  and 
later  swelling  of  the  affected  part  are  pres- 
ent in  osteogenic  sarcoma.  The  roentgeno- 
gram is  often  difficult  to  interpret.  As  is 
well  known,  the  disease  is  insidious  and 
often  occurs  in  a growing  child.  The  active 
growth  of  a child  may  interfere  with  the 
early  subjective  and  objective  indications 
of  the  disease. 

Ewing’s  Tumor 

A fairly  frequent  bone  cancer  is  a Ewing’s 
tumor.  These  tumors  may  arise  from  the 


110 


Rocky  Mountain  Medical  Journal 


tubular  or  from  the  flat  bones.  The  tumor 
metastasizes  fairly  early,  mainly  in  the 
lungs,  and  is  very  malignant.  It  responds 
well  to  radiation  at  first  and  then  seems 
to  become  resistant.  In  the  long  bones  the 
tumor  is  first  seen  radiologically  as  a thick- 
ening of  the  cortex  and  a widening  of  the 
medullary  cavity,  followed  by  a splitting  or 
lamination  of  the  periosteum  to  give  an 
onion-like  appearance.  At  this  stage  the 
radiologic  picture  is  often  mistaken  for 
osteomyelitis  and  it  is  then  that  biopsy  is 
of  greatest  value  in  establishing  a true  diag- 
nosis. As  the  tumor  progresses,  there  is  an 
extensive  destruction  of  the  spongiosa  and 
the  cortex.  Sun-ray  radiation  of  spicules 
into  the  soft  tissue  mass  may  appear,  simi- 
lar to  the  osteoblastic  type  of  osteogenic 
sarcoma.  There  may  be  involvement  of  the 
epiphysis,  although  the  usual  site  is  at  the 
end  of  the  long  bone.  The  tumor  may  arise 
anywhere  along  the  shaft  and  eventually 
involves  over  one-third  of  the  bone.  When 
Ewing’s  endothelioma  arises  in  a flat  bone 
the  radiological  picture  changes  markedly. 
It  has  the  appearance  of  increased  density 
and  there  is  sclerosis  of  the  bone  with  de- 
struction of  the  cortex.  Clinically  these  tu- 
mors are  quite  painful  and  radiological 
evidence  may  be  lacking  for  months.  Pain 
that  persists  in  spite  of  immobilization  and 
in  the  absence  of  any  evidence  of  tubercu- 
losis or  blood  dyscrasias,  should  make  one 
suspicious  of  the  tumor  formation.  Tumors 
of  the  bone  must  be  differentiated  from  (a) 
rheumatic  infections,  (b)  pyogenic  osteo- 
myelitis, (c)  tuberculosis,  and  (d)  syphilis. 
We  must  also  differentiate  it  from  the  non- 
infectious  group,  which  includes  scurvy, 
sickle-cell  anemia,  xanthomatosis,  or  Schil- 
ler-Christian  Disease. 

Tumors  of  the  Genito-Urinary  Tract 

Wilm’s  Tumor:  This  tumor  is  another  of 
the  frequent  childhood  tumors.  It  is  an 
embryonal  adenomyosarcoma  or  mixed  tu- 
mor and  is  the  typical  renal  tumor  in  child- 
hood. Compared  to  it,  other  forms  of  renal 
tumor  in  juveniles  are  distinctly  rare.  In 
the'' past  the  true  nature  of  the  tumor  has 
not  always  been  recognized  at  operation  or 
at  the  time  of  the  histological  examination. 


Wilms  believed  that  the  glandular  elements 
found  in  these  tumors  take  their  origin  from 
the  Wolffian  body.  Recently  Nicholson  has 
stated  that  these  tumors  are  not  congenital 
new  growths  but  rather  developmental  mal- 
formations. The  greatest  majority  occur  in 
the  first  three  years  of  life,  are  rarely  en- 
countered after  the  tenth  year,  and  occur 
chiefly  in  males.  Wilm’s  tumor  is,  as  a 
rule,  of  large  size  when  seen  clinically.  The 
involved  kidney  usually  occupies  the  entire 
side  of  the  abdomen  and  displaces  viscera 
in  direct  proportion  to  the  size  of  the  tumor. 
It  is  encapsulated  as  a rule.  The  kidney 
takes  no  part  in  the  tumor  formation,  so 
that  a layer  of  fibrous  tissue  freed  from 
renal  tissue  separates  the  tumor  from  what 
is  left  of  the  kidney,  which  is  often  more  or 
less  atrophied  by  pressure. 

The  embryonal  structure  of  these  tumors 
is  their  most  distinguishing  feature.  The 
types  of  cells  and  their  proportionate 
amount  vary  in  different  tumors.  Regional 
involvement  by  extension  is  the  usual 
method  of  growth.  However,  extension 
metastases  may  occur,  engulfing  the  viscera 
so  completely  that  such  organs  as  the  pan- 
creas and  suprarenals  are  enclosed.  Oc- 
casionally there  are  pulmonary  metastases. 

Symptoms:  It  seems  that  in  the  early 
stages  there  are  few  symptoms.  Ihe  en- 
largement of  the  abdomen  is  often  what 
brings  the  patient  to  the  doctor.  A mass  is 
usually  felt  by  the  mother  during  the  child’s 
batji;  there  may  be  some  fever,  abdominal 
pain,  some  loss  of  weight,  constipation,  vom- 
iting, and  frequency  of  urination,  but  these 
are  rare.  There  is  usually  a secondary 
anemia,  and  the  white  blood  count  is  often 
increased.  Hematuria  is  rare.  When  it 
does  occur,  it  is  usually  intermittent  and 
only  present  when  the  tumor  develops  from 
the  central  part  of  the  kidney.  The  diag- 
nosis is  usually  made  in  a young  child  by 
the  presence  of  an  abdominal  tumor  with  a 
history  of  rapid  enlargement.  This  has  to 
be  differentiated  from  other  neoplastic  and 
inflammatory  tumors.  A complete  neu- 
rological examination  should  be  done. 
Barium  enema,  cystoscopy,  and  intravenous 
pyelograms  are  helpful  in  differentiating 


fdlr-  'FlfeRUARY,  'T949'-  ■ 


111 


other  masses.  The  prognosis  is  grave  as  the 
patient  is  usually  seen  late.  The  tumor  is 
quite  large  when  it  is  first  recognized.  A 
biopsy  is  contraindicated  because  of  its  ma- 
lignant nature.  Nephrectomy  is  the  choice 
of  treatment.  These  tumors  are  radio-sen- 
sitive and,  when  very  large,  x-ray  treat- 
ment is  usually  recommended  before  oper- 
ation as  well  as  postoperatively. 

Other  infrequent  tumors  of  the  genito- 
urinary tract  involve  the  testes  and  may  be 
teratoid  in  nature.  Tumors  of  the  vesical 
neck  and  prostate  region  also  occur,  and.  in 
girls  ovarian  tumors  are  not  too  rare. 

Tumors  of  the  Eye  and  Orbit 

Retinoblastoma;  This  is  one  of  the  two 
highly  malignant  and  terrible  tumors  ob- 
served with  comparative  frequency  during 
infancy.  Retinoblastoma  seldom  occurs 
after  five  years  of  age.  It  arises  from  the 
glandular  layer  of  the  retina,  grows  slowly 
in  most  instances  and  produces  few  symp- 
toms. It  is  discovered  usually  by  the  par- 
ent who  notices  the  peculiar  cat’s-eye,  pu- 
pillary reflex,  in  the  affected  eye.  There  is 
dilatation  of  one  pupil  and  a green  grey  or 
white  reflex.  Other  symptoms  observed 
are  orbital  bulge,  conjunctival  discharge 
and  congestion;  a squint,  crying  when  the 
unaffected  eye  is  covered,  and  turning  of 
the  head  to  permit  use  of  the  unaffected 
eye.  Diagnosis  of  this  tumor  is  made  on 
ophthalmoscopic  findings  of  the  grey  white 
mass.  If  uncontrolled,  metastases  to  the 
bone,  lymphoids,  subcutaneous  areas,  and 
viscera  may  occur.  Surgery  and  x-ray  are 
used  and  may  be  curative  if  an  early  diag- 
nosis is  made. 

Neuroblastoma:  This  tumor  may  ocur  at 
any  age  in  childhood  but  its  greatest  fre- 
quency is  during  the  first  five  years  of  life. 
It  arises  from  the  sympathetic  neuroblast 
and  the  primary  lesion  may  occur  in  various 
localities.  The  adrenal  medulla  is  probably 
the  most  common  primary  site.  It  may  also 
occur  in  the  celiac  plexus,  the  cervical- 
thoracic  sympathetic  and  intracranial,  as 
well  as  in  the  peripheral  nerves.  The  course 
is  moderate  to  extensive  local  spread  with 
metastases  to  the  liver,  lymph  nodes  and 


bone,  particularly  the  skull.  It  is  an  em- 
bryonal type  of  tumor  and  may  mature  into 
a benign,  ganglio-neuroma  in  rare  instances. 
The  diagnosis  is  made  on  biopsy.  However, 
its  presence  must  be  suspected  in  the  diag- 
nosis of  abdominal  and  intrathoracic  masses 
as  well  as  by  lymphadnopathy.  In  treat- 
ment, these  tumors  respond  very  well  to 
x-ray  therapy  and  when  accessible  should 
be  removed. 

There  are  two  types  of  neuroblastoma; 
one  the  so-called  Pepper  type  which  metas- 
tasizes to  the  liver;  the  other  Hutchinson’s 
which  metastasizes  to  bone.  The  neuro- 
blastomas metastasizing  to  bones  from  the 
adrenals  seem  to  have  a predilection  for  the 
proximal  ends  of  the  long  bone,  while 
leukemia  usually  is  found  at  the  distal  ends. 
The  neuroblastomas  have  a peculiar  quill- 
like radiation  due  to  periosteal  reaction. 
Leukemia  seldom  shows  periosteal  reaction 
and  lesions  are  not  widespread  as  a rule. 

Neurofibromatosis;  Under  this  condition, 
not  rare  in  childhood,  we  have  the  frequent 
picture  of  the  skin  with  characteristic  cafe- 
au-lait  spots.  There  may  be  subcutaneous, 
submucous,  or  visceral  fibromas,  sometimes 
of  great  size.  There  may  be  osseous  changes 
and  cerebral  defects.  There  is  a marked 
familiar  incidence  in  this  disorder,  and  some 
men  feel  that  some  12  to  15  per  cent  be- 
come malignant.  The  symptoms  which  are 
produced  by  these  tumors  vary  with  their 
location.  Occasionally  pressure  symptoms 
may  be  quite  pronounced.  Personality  de- 
fects and  mental  retardation  may  be  pres- 
ent, and  swelling  of  an  extremity  also  may 
accompany  the  condition. 

Intracranial  Tumors 

Brain  tumors  occur  in  children  about  one 
admission  out  of  700  in  active  pediatric 
service  in  a general  hospital.  Unlike  adults, 
children  suffer  frequently  from  tumors  be- 
low the  tentorium.  Over  two-thirds  of  all 
brain  tumors  are  found  in  this  location.  Ap- 
proximately one-third  of  all  intracranial 
tumors  in  childhood  are  curable  if  treat- 
ment is  instituted  before  irreparable  injury 
to  the  brain  has  occurred.  Naturally  the 
symptoms  depend  on  the  site  affected  and 


112 


Rocky  Mountain  Medical  Journm, 


the  degree  of  intracranial  hypertension  pro- 
duced. In  the  infant  and  young  child  the 
easily  expansive  head  may  permit  a tumor 
to  develop  for  a prolonged  period  before 
any  signs  or  symptoms  are  evident. 

The  clinical  picture  of  brain  tumors  is 
characterized  primarily  by  symptoms  of  in- 
creasing intracranial  pressure  including 
bouts  of  morning  vomiting  and  morning 
headaches,  impairment  of  vision  which  may 
come  late  in  children,  apathy  and  drowsi- 
ness. In  some  instanes  slight  focal  neuro- 
logical changes  including  incoordination  of 
hand  movements  and  staggering  gait  may 
point  to  a cerebellar  lesion.  In  the  supra- 
sellar group  endocrine  changes  may  be  ap- 
parent and  x-rays  frequently  disclose  intra- 
cranial calcification.  Enlargement  of  the 
head  may  occur  and  a positive  MacEwens’ 
sign  or  cracked  pot  resonance  on  percussion 
is  an  early  and  very  helpful  clinical  find- 
ing. Changes  in  the  optic  disks  occur  but 
sometimes  too  late  to  be  of  importance  in 
early  diagnosis.  When  the  diagnosis  is  sus- 
pected, careful  neurological  studies  and 
ventriculograms  may  be  needed  to  establish 
an  exact  diagnosis  and  localization  of  the 
tumor.  This,  however,  is  not  always  with- 
out danger,  nor  always  advisable  according 
to  some  neuro-surgeons. 

Malignant  tumors  of  the  cerebellum  are 
fairly  common  in  children.  Astrocytoma  is 
the  most  frequent  one  in  this  group.  It 
occurs  predominantly  in  boys  usually  about 
5 years  of  age,  and  because  the  posterior 
part  of  the  midline  of  the  cerebellum  where 
it  develops  is  part  of  the  vestibular  mech- 
anism and  is  concerned  with  the  mainte- 
nance of  balance,  this  tumor  is  characterized 
by  unsteadiness  of  posture  and  gait.  The 
signs  of  intracranial  pressure  develop  some- 
what more  slowly  than  in  medulloblas- 
tomas. These  are  among  the  most  favorable 
of  all  the  tumors  of  the  brain.  They  can 
usually  be  removed  completely.  Cerebellar 
symptoms  may  precede  or  follow  signs  of 
intracranial  hypertension.  Such  symptoms 
are  ataxia,  in  which  a child  may  walk  on  a 
wide  base,  vertigo,  and  nystagmus.  Hypo- 
tonia is  frequent  after  the  disease  has  pro- 


gressed. The  knee  jerks  are  diminished  or 
absent.  There  is  usually  a nystagmus  of 
the  eyes  which  is  coarser  when  looking  to- 
ward the  side  of  the  tumor  and  more  rapid 
and  fine  on  looking  to  the  other  side. 

Of  the  supratentorial  tumors,  cranio- 
pharyngioma is  the  more  common.  Because 
of  its  location  in  the  suprasellar  region,  it 
produces  a variety  of  symptoms.  In  addi- 
tion to  the  symptoms  of  intracranial  hyper- 
tension which  are  almost  always  present, 
visual  difficulties  and  optic  atrophy,  hem- 
ianopsia and  somatic  changes,  such  as 
obesity,  pubertas  precox  and  infantilism  are 
a frequent  occurrence.  Psychic  changes  are 
not  uncommon.  The  diagnosis  can  usually 
be  confirmed  by  roentgenographic  evi- 
dences. Separation  of  the  sutures,  increased 
definition  of  the  digital  markings,  crystal- 
line shadows  in  the  suprasellar  areas  and 
frequent  destruction  of  the  clinoid  processes 
are  demonstrable.  Because  of  the  many 
types  of  cerebral  structures  affected  by 
neoplastic  diseases,  many  erroneous  diag- 
noses are  made.  Chief  among  these  are 
gastro-intestinal  disorders,  behavior  prob- 
lems and  chorea. 

Lymphoblastomas 

These  form  another  large  group  occurring 
in  children.  Leukemia  and  Hodgkin’s  dis- 
ease occur  most  frequently.  These  cannot 
be  differentiated  radiologically  when  they 
involve  the  mediastinal  lymph  nodes.  The 
sternal  marrow,  peripheral  blood  studies 
and  biopsy  of  the  superficial  lymph  nodes 
may  establish  the  diagnosis;  the  radiological 
examination  merely  confirms  the  evidence. 
Both  of  the  conditions  may  involve  the 
mediastinal  nodes  and  present  similar  pic- 
tures, and  both  respond  well  to  radiation 
therapy  temporarily. 

Nasopharyngeal  Fibroma 

This  is  also  a rather  frequent  tumor  of 
childhood.  In  the  symptomatology,  obstruc- 
tion to  breathing,  especially  after  the  second 
year,  not  caused  by  a foreign  body  or  al- 
lergy, should  arouse  one’s  suspicions.  A 
frequent  sign  may  be  persistent  cervical 
adenopathy. 


for  February,  1949 


113 


Puberty  Mastitis  (Mastitis  Adolescentium) 

This  condition  is  frequently  encountered 
in  pediatric  practice  and  was  called  to  my 
attention  originally  when  a mother  brought 
her  11-year-old  girl  to  see  me.  She  had 
one  breast  removed  six  months  previously, 
and  now  noticed  there  was  a similar  swell- 
ing in  the  other  breast.  Also,  one  of  my 
friends,  an  internist,  had  noticed  in  one  of 
his  own  children’s  breast,  a boy  of  15,  a 
swelling  behind  the  nipple,  and  was  greatly 
alarmed  until  he  was  reassured  that  this 
was  not  an  uncommon  condition.  Puberty 
mastitis  has  definite  characteristics.  It  oc- 
curs in  girls  between  the  ages  of  8 and  12 
and  in  boys  between  12  and  15  years.  It  is 
an  induration  which  always  occurs  behind 
the  nipple.  It  is  probably  caused  by  some 
endocrine  dysfunction,  and  local  trauma 
may  play  a role.  Pathologically,  it  is  a 
pericanalicular  and  periacinous  infiltration 
with  connective  tissue  and  lymphocytes,  to- 
gether with  epithelial  hyperplasia.  The  con- 
dition is  benign  and  disappears  within  a few 
months. 

Another  condition  I would  like  to  men- 
tion is  the  premenstrual  enlargement  of  the 
breast  which  sometimes  occurs  in  adoles- 
cent girls,  and  has  been  mistaken  for  a real 
tumor  and  the  breast  unnecessarily  re- 
moved. 

Conclusions 

Every  physician  must  be  alerted  to  the 
cancer  problem  and  to  the  fact  that  it  may 
and  does  occur  in  infancy  and  childhood. 
It  is  not  always  easy  to  make  a diagnosis 
even  if  one  is  regularly  conscious  of  its 
possibility.  One  should  continue  to  observe 
the  child  with  an  unusual  growth  or  re- 
tardation of  growth  of  the  body  as  a whole, 
or  of  its  members.  The  unusual  child,  the 
child  with  changed  behavior;  one  who  just 
is  not  doing  well  but  with  no  specific  com- 
plaint, or  the  onset  of  unexplainable  ner- 
vous changes,  should  make  one  very  cau- 
tious, always  keeping  in  mind  the  possibility 
of  a cancer. 

It  takes  repeated  examinations,  as  well 
as  x-rays  and  often*-  a biopsy,  to  establish 
a definite  diagnosis.  Even  with  everything 


at  our  disposal,  when  the  diagnosis  of  a can- 
cer is  made  it  may  be  so  far  advanced  that 
recovery  under  ideal  treatment  is  impos- 
sible. It  is  hoped  some  method  of  early 
recognition  will  be  found;  perhaps  chemical 
studies  such  as  high  alkaline  phosphatase, 
or  some  special  enzyme  in  the  blood;  or  that 
sojne  nuclear  diagnostic  procedure  may  pre- 
sent itself. 

The  cancer  problem  is  not  an  easy  one, 
but  if  it  is  constantly  held  as  the  hypothe- 
sis in  the  diagnosis  of  a child  presenting 
itself  for  examination,  better  results  may 
be  accomplished  than  in  the  past. 


Book  Review 

The  Clinieai  Managreiiient  of  Varicose  Veins:  By  Da- 
vid Woolf  oik  Barrow,  M.D.,  Lexington,  Kentucky. 

With  a Foreword  by  Arthur  W.  Allen,  M.D.  Paul 

B.  Hoeber,  Inc.,  Medical  Book  Department  of  Har- 
per & Brothers,  New  York. 

This  is  a well  written  and  well  illustrated  text. 
The  normal  and  abnormal  anatomy  of  the  veins 
of  the  leg  is  concisely  but  clearly  given  in  text 
and  drawings.  A theory  of  etiology  of  varicose 
veins  is  well  presented.  The  various  methods  of 
treatment  and  their  combinations  in  certain 
types  of  cases  is  given  clearly.  The  study  of  this 
text  will  reward  the  reader  with  a good  work- 
ing knowledge  of  varicose  veins  and  their  com- 
plications. 

I hesitate  to  recommend  more  highly  a text 
that  leans  so  heavily  on  major  surgery  in  the 
treatment  of  this  condition,  especially  the  old 
treatment  of  stripping  the  veins.  True,  the  tech- 
nic used  to  accomplish  this  is  an  improvement 
over  that  in  use  twenty  to  thirty-five  years  ago, 
in  that  it  is  a little  less  mutilating,  and  some  of 
the  old  dangers  are  escaped  by  the  newer  method 
of  getting  surgery  patients  out  of  bed  earlier. 
Nevertheless,  it  is  still  major  surgery  that  in  my 
opinion  is  rarely  required  if  the  operator  has  the 
patience  to  use  the  injection  technic,  either  with 
or  without  ligation,  to  its  fullest  advantage, 
rather  than  trying  to  accomplish  the  whole  cure 
in  a short  time. 

Retrograde  injection  at  the  time  of  ligation  is 
described  and  illustrated.  I am  happy  to  find  the 
use  of  this  other  hurry-up  treatment  placed  in 
the  secondary  role  which  it  has  earned  through 
its  dangers.  I believe  after  a few  more  years 
the  author  will  place  the  stripping  operation  in 
the  same  category. 

Also,  it  is  good  to  see  the  lesser  saphenous  vein 
discussed  separately  from  the  great  saphenous. 
Perhaps  this  will  help  to  stop  the  senseless  liga- 
tion of  the  great  saphenous  for  varicose  veins 
limited  to  the  lesser  saphenous. 

There  is  not  enough  dermatology  to  help  the 
reader  avoid  disappointment  in  the  treatment  of 
leg  ulcers  complicated  by  fungus  infestation.  The 
recommended  sympathectomy  seems  a radical  ap- 
proach to  this  problem,  though  it  should  help  by 
drying  the  skin,  making  a less  favorable  me- 
dium for  fungus  growth. 

An  excellent  bibliography  is  appended. 

EARL  J.  PERKINS. 


114 


Rocky  Mountain  Medical  Journal 


THE  MEDICAL  CARE  OF  TUBERCULOSIS  BY  THE  STATE  OF 

COLORADO* 

EDWARD  N.  CHAPMAN,  M.D. 

DENVER 


This  paper  is  an  attempt  to  answer  the  re- 
quest of  physicians  in  Colorado  for  exact 
information  as  to  how  the  state  care  of  the 
needy  tuberculous  is  handled.  The  system 
of  state  care  of  the  tuberculous  in  Colorado 
is  unique.  Colorado  has  no  state  sanatorium. 
Why  should  this  be? 

Colorado  is  unusual  among  states  in  that 
there  are  a number  of  good  private  sana- 
toria for  the  care  of  the  tuberculous  within 
its  boundaries.  Many  of  them  are  out- 
standing institutions.  Some  are  supported 
by  national  organizations  like  the  Lutheran 
Sanatorium  at  Wheatridge,  the  Swedish 
Sanatorium  at  Englewood,  the  Mennonite 
Sanatorium  at  La  Junta,  the  Catholic  in- 
stitutions— St.  Francis  in  Denver,  St.  Fran- 
cis in  Colorado  Springs  and  Glockner  in 
Colorado  Springs — and  the  two  large  Jewish 
sanatoria  in  and  near  Denver.  Cragmor 
has  an  endowment  fund  established  by  a 
New  York  relative  of  a grateful  Colorado 
patient.  Since  very  few  states  have  private 
institutions  for  the  treatment  of  tubercu- 
losis, they  have  had  to  build  their  own 
sanatoria.  Colorado  has  thus  far  preferred 
to  place  state  patients  in  private  Colorado 
sanatoria  which  have  first  been  approved 
for  care  by  the  Colorado  State  Board  of 
Public  Welfare.  The  minimum  ward  rate 
is  paid  to  these  institutions. 

Our  present  system  of  care  began  in  1937 
as  the  result,  not  of  the  vote  of  the  legisla- 
ture, but  through  an  initiated  law  passed 
by  a majority  of  the  voters  at  the  election 
of  1936 — passed  at  the  same  time  and  in  the 
same  way  as  our  Old  Age  Pension  law 
which  was  also  an  initiated  measure.  The 
Tuberculosis  Assistance  law  was  drawn  up 
as  a result  of  the  efforts  of  the  Colorado 
State  Tuberculosis  Association  and  it  is  a 
credit  to  the  foresightedness  of  such  inde- 
fatiguable  workers  in  the  field  of  tubercu- 

*Presented  at  the  78th  annual  meeting  of  the 
Colorado  State  Medical  Society  at  Glenwood  Springs, 
September  22-25,  1948.  The  author  is  Director.  Di- 
vision of  Tuberculosis  Hospitalization,  Colorado 
State  Department  of  Public  Welfare. 


iosis  as  Miss  Helen  Burke,  Dr.  C.  O.  Giese, 
Dr.  John  Crouch,  Dr.  Lorenz  Frank,  and 
many  others  that  it  has  functioned  so  well. 
This  law  placed  the  care  of  tuberculosis  in 
a newly  created  division  of  the  State  De- 
partment of  Public  Welfare.  Only  active 
cases  of  the  disease  are  eligible  for  care  and 
they  must  have  been  residents  of  the  state 
for  a minimum  of  three  years. 

Over  the  years  there  have  been  increases 
in  the  appropriation  in  order  to  provide  for 
more  patients  as  waiting  lists  have  risen 
and  to  assist  the  hospitals  with  increased 
costs.  The  total  appropriation  for  tuber- 
culosis care  made  by  the  last  legislature  was 
$350,000  as  the  state’s  share  for  the  bien- 
nium which,  when  matched  by  a similar 
amount  by  the  counties,  makes  a total  of 
$700,000  for  this  two-year  period.  The  ex- 
pense of  the  program  is  shared  on  a 50  per 
cent  reimbursement  basis  with  the  counties 
from  whence  patients  originate. 


, Since  no  state  hospitals  or  state-employed 
physicians  (other  than  the  director)  are 
used,  this  system  is  as  far  removed  from 
state  medicine  as  it  is  possible  to  put  it. 
Patients  at  each  institution  are  placed  under 
the  care  of  one  physician  at  that  institution. 
He  must  be  experienced  in  the  practice  of 
Tuberculosis  and  selected  by  the  Director 
from  among  two  or  three  such  qualified 
physicians  nominated  by  the  Board  of  the 
Hospital.  Thus,  he  is  a man  that  is  satis- 
factory to  all  concerned.  The  final  result 
of  all  this  is  one  of  the  best  examples  of 
cooperative  medical  care  known  to  me. 
Since  the  inception  of  the  program  eleven 
years  ago,  approximately  1,500  cases  have 
been  given  care.  At  present  eleven  insti- 
tutions are  used.  They  are; 


Mesa  Vista  Sanatorium 


) In  Boulder 


Colorado  General  Hospital 
Lutheran  Sanatorium 
St.  Francis  Sanatorium 
Swedish  National  Sanatorium 


) 

) In  and  near 
) Denver 
) 


Colorado  Springs  Psychopathic  ) 
(temporary  problem  cases  only)  ) 


for  February,  1949 


115 


Cragmor  Sanatorium 
Glockner  Sanatorium 
St.  Francis  Sanatorium 
Sunnyrest  Sanatorium 
(ambulant  care  only) 


) In  or  near 
) Colorado 
) Springs 
) 

) 


Mennonite  Hospital 
and  Sanatorium 


) 

) In  La  Junta 


At  this  writing  the  case  load  is  approxi- 
mately 225  patients — more  than  the  maxi- 
mum that  can  be  cared  for  under  the  present 
appropriation.  About  60  per  cent  of  these 
are  hospitalized  in  the  Colorado  Springs 
area.  Occasionally  patients  on  pneumo- 
thorax are  discharged  from  the  sanatoria 
when  ready  and  carried  as  out-patients. 
These  out-patients  continue  to  receive  pneu- 
mothorax at  state-county  expense  at  the 
hands  of  qualified  physicians  as  long  as 
this  method  of  treatment  is  necessary.  Since 
these  patients  live  outside  the  institutions 
their  cost  for  care  is  less  than  it  would  be 
if  they  remained  hospitalized. 

The  last  legislature  made  one  important 
addition  to  the  efficiency  of  the  state  care 
program  and  that  was  in  appropriating  suf- 
ficient funds  to  open  a 26-bed  ward  at  Colo- 
rado General  Hospital  in  Denver,  to  which 
the  Director  can  send  cases  needing  chest 
surgery.  Difficult  diagnostic  problems 
among  our  tuberculous  patients  may  be  sent 
there  for  evaluation.  Kenal  and  orthopedic 
tuberculosis  can  be  handled  there  also. 
Since  the  size  of  the  ward  is  quite  limited, 
patients  are  only  kept  as  long  as  study  or 
surgery  requires  and  then  sent  back  to  one 
of  the  sanatoria  for  convalescence.  Opened 
in  February,  1948,  this  new  facility  is  al- 
ready proving  a very  valuable  adjunct  to 
our  program. 

At  the  time  of  the  last  analysis,  approx- 
imately one-third  of  all  patients  under  care 
had  come  to  Colorado  for  their  health  and 
then  exhausted  their  resources.  Numbered 
among  this  group  of  health  seekers  are 
school  teachers,  nurses,  engineers,  and  a 
number  of  others  with  a rather  high  degree 
of  educational  achievement.  National  stud- 
ies have  shown  that  94  per  cent  of  tubercu- 
losis patients  exhaust  their  resources  before 
they  can  return  to  a self-supporting  basis. 
About  one-third  of  the  total  cases  were 
Spanish-Americans.  Again  I want  to  em- 
phasize that  each  case  before  acceptance 


must  pass  a means  test  and  have  lived  in 
Colorado  for  three  years.  They  do  not  gain 
residence  if  hospitalized  in  the  state  by 
some  outside  agency  such  as  the  Federal 
Government  or  by  some  other  state. 

The  duties  of  the  Director  are  many  and 
varied.  He  must  coordinate  the  whole  pro- 
gram (not  an  easy  task  with  patients  scat- 
tered in  eleven  institutions  over  am  area  of 
200  miles) , determine  the  medical  eligibility 
of  each  application,  make  the  necessary  ar- 
rangements for  hospitalization  of  approved 
cases  or  their  transfer  from  one  sanatorium 
to  another,  visit  each  institution  as  often  as 
necessary  in  order  to  determine  the  type  of 
care  received  and  to  consult  with  the  phy- 
sicians regarding  the  progress  of  each  case 
and  possible  necessary  change  in  treatment. 
He  must  also  approve  all  bills  and  under  the 
law  determine  the  time  that  each  patient 
shall  be  discharged.  All  changes  in  the  ap- 
proved list  of  charges  must  be  worked  out 
by  him  with  the  consent  of  the  State  Board 
of  Public  Welfare  and  he  reports  to  the 
Board  at  each  monthly  meeting  regarding 
the  progress  of  the  program.  The  Director 
must  also  assist  the  sanatoria  on  disciplinary 
cases,  and  time  must  be  spent  with  lay 
health  and  rehabilitation  organizations  in- 
terested in  tuberculosis. 

The  present  method  of  procedure  for  ap- 
plication for  state  care  is  for  the  applicant, 
following  diagnosis  of  tuberculosis  by  his 
physician,  to  apply  to  his  local  County  Wel- 
fare Department.  The  County  Department 
will  determine  (1)  from  proof  which  the 
applicant  must  submit,  that  he  has  been  a 
resident  of  Colorado  for  at  least  three  years, 
and  (2)  that  he  is  financially  unable  to  pro- 
vide for  his  own  care.  This  investigation 
may  take  from  three  to  four  weeks,  espe- 
cially if  proof  of  residence  is  difficult  to 
obtain.  The  County  Department,  having  es- 
tablished proof  of  residence  and  need,  for- 
wards the  application  to  the  Division  of 
Tuberculosis  Hospitalization  of  the  State 
Welfare  Department,  together  with  a re- 
cent x-ray  and  report  of  sputum  examina- 
tion. There  the  application  is  acted  upon 
within  a week,  and  hospitalization  arranged 
immediately. 


116 


Rocky  Mountain  Medical  Journal 


You  will  note  that  there  is  bound  to  be 
a delay  of  from  three  to  five  weeks  follow- 
ing diagnosis  before  the  patient  is  actually 
in  an  institution.  This  is  longer  than  is  de- 
sirable, but  is  legally  necessary.  In  cases 
of  hemorrhage  or  extreme  illness  the  Coun- 
ty Welfare  Department,  if  it  deems  neces- 
sary, can ' hospitalize  a case  immediately  in 
an  institution  (the  Division  of  Tuberculosis 
Hospitalization  is  glad  to  aid  counties  in 
securing  beds  for  emergencies)  and  then  the 
application  for  state  aid  can  be  sent  in  later. 
Of  course,  in  cases  like  these  the  county  has 
to  pay  the  full  cost  of  care  until  such  time 
as  the  application  is  completed  and  ap- 
proved. 

What  are  the  advantages  and  disadvan- 
tages of  our  unique  system  of  care?  First 
the  advantages,  as  I see  them,  are  as  fol- 
lows: 

1.  Most  of  the  patients  are  housed  nearer 
their  homes  than  would  be  the  case  if  we 
had  one  central  institution.  This  is  espe- 
cially important  in  persuading  the  Spanish- 
Americans  to  accept  hospitalization.* 

2.  The  standard  of  living  can  be  raised  for 
the  patient  in  almost  every  case.  If  it  is 
found  that  it  has  not  been  raised,  the  patient 
is  usually  moved  to  another  institution. 

3.  Since  our  patients  are  under  the  private 
care  of  ten  leading  physicians  especially 
trained  in  tuberculosis,  and  with  years  of 
experience  in  its  treatment,  the  medical 
care  received  is  more  skilled  for  a large  pro- 
portion of  the  cases  than  it  would  be  in  a 
central  state  institution  which  would  prob- 
ably have  one  or  two  well  trained  men  on 
the  staff.  The  rest  of  the  staff  might  be 
interns  in  training  and  thus  inexperienced. 

4.  Smaller  institutions  are  apt  to  have  a 
more  home-like  atmosphere  and  the  food 
is  likely  to  be  better  than  in  a large  state 
hospital. 

5.  The  morale  of  patients  is  helped  when 
they  see  that  they  are  receiving  approxi- 
mately the  same  care  as  private  pay-pa- 
tients in  the  same  institution.  There  is  only 

*Patients  frequently  do  better,  other  things  being 
equal,  at  a short  distance  from  home  rather  than 
when  hospitalized  in  their  own  city.  They  relax  better 
since  all  the  problems  of  the  household  are  not 
brought  to  them.  Every  time  Johnny  falls  down 
stairs  the  mother  is  not  informed  of  this  disturbing 
fact.  An  institution  beyond  telephone  local  rates 
and  not  too  close  for  daily  visits  is  often  best. 


one  sanatorium  used  from  which  complaints 
have  been  received  that  state  cases  are  dis- 
criminated against;  and  I think  this  situa- 
tion has  been,  in  part  at  least,  corrected. 

6.  The  cost  to  the  taxpayers  in  Colorado 
is  over  30  per  cent  less  for  care  of  the  tu- 
berculous on  a per  day  basis  than  in  such 
states  as  Massachusetts,  New  York,  Con- 
necticut, and  California — states  recently 
visited  by  me  to  observe  methods  used  in 
the  state  care  of  tuberculosis. 

7.  Every  one  of  these  institutions,  with 
one  possible  exception,  is  more  adequately 
supported  and  staffed  at  the  present  time 
than  is  usually  found  in  public  institutions. 

8.  The  religious  influence  in  the  sana- 
toria is  helpful  in  maintaining  morale.  In 
general,  patients  are  placed  in  institutions 
of  their  own  faith. 

One  of  the  best  guides  as  to  how  well 
satisfied  patients  are  with  their  care  is  the 
percentage  of  discharges  against  advice.  It 
was  only  17  per  cent  in  1947  as  against  a 
national  figure  of  double  that  size,  indicat- 
ing that  our  patients  in  general  like  the 
care  they  receive. 

If  our  system  of  state  care  of  active  tu- 
berculosis was  seriously  inadequate  one 
would  hardly  expect  the  very  rapid  decline 
in  the  resident  death  rate  from  pulmonary 
tuberculosis  (shown  in  Chart  1)*  which  is 
taking  place  in  Colorado — much  more  rapid 
than  for  the  United  States  as  a whole.  Al- 
ready our  death  rate  is,  considerably  below 
the  national  average. 

The  disadvantages,  as  I see  them,  of  using 
a number  of  private  sanatoria  instead  of  one 
large  state  institution,  are  these: 

1.  It  is  difficult  to  have  a large,  well- 
coordinated,  and  complete  program  where 
the  patients  are  scattered  over  so  much 
territory  and  in  so  many  institutions.  A 
considerable  amount  of  time  is  consumed  by 
the  Director  in  travel,  and  if  the  Director 
fails  in  his  responsibility  to  visit  institutions 

*You  will  note  that  the  death  rate  used  in  this 
chart  is  for  deaths  of  Colorado  residents  from  pul- 
monary tuberculosis  (whether  death  occurred  in 
Colorado  or  elsewhere).  These  figures  were  ob- 
tained from  Dr.  Beesley,  Director  of  the  Division 
of  Vital  Statistics  of  the  Colorado  State  Health  De- 
partment, and  should  represent  most  accurately  the 
situation  in  Colorado.  The  total  tuberculosis  death 
rate  (“residence  not  allocated”)  is  not  truly  repre- 
sentative since  this  rate  includes  the  deaths  of 
health  seekers  from  other  states  who  have  come  to 
Colorado  and  died  in  our  institutions. 


for  February,  1949 


117 


1S40  1»41  1942  1943  1944  194S  1946  1947 

CHART  I* 

Comparison  of  Death  Rate  From  Pulmonary  Tu- 
berculosis, United  States  and  Residents  of  Colo- 
rado, 1940  Through  1947 

frequently,  considerable  variation  in  the 
care  received  by  the  patients  might  result. 

2.  There  is  a marked  variation  between 
the  physical  plants  of  the  institutions.  Some 
have  marble  halls  while  a few  are  old  and 
could  stand  rehabilitation.  This  difference 
is  offset  to  a considerable  extent,  as  is  so 
often  the  case,  by  a tendency  of  the  institu- 
tions with  the  less  desirable  physical  plants, 
to  make  up  this  deficiency  through  an  un- 
usually skilled  medical  staff.  This  is  for- 
tunately the  case  in  Colorado.  Hence,  a new 
sanatorium  advocated  by  some  would  im- 
prove the  physical  surroundings  for  less 
than  half  of  our  cases  but  would  not  neces- 
sarily improve  the  care  received. 

3.  Clinical  material  for  medical  school 
teaching  is  not  being  utilized  to  fullest  ex- 
tent, except  for  the  cases  hospitalized  at  the 
Colorado  General  Hospital. 

More  than  half  of  our  state  cases  in  the 
past  year  and  a quarter  have  received  a 
short  course  of  streptomycin,  an  achieve- 
ment few  states  have  been  able  to  attain. 
As  a matter  of  fact,  in  most  states,  judging 
from  reports  that  have  come  to  my  atten- 
tion thus  far,  little  if  any  streptomycin  has 
been  made  available  to  indigent  state  cases. 
Among  our  patients  no  case,  where  there  is 
a reasonable  expectation  of  good  results,  is 
now  deprived  of  a short  course  of  this  val- 
uable drug,  though,  where  friends  or  rela- 
tives of  the  patient  can  reimburse  the  Wel- 
fare Department  for  the  streptomycin  used, 
they  are  encouraged  to  do  so. 

•Preliminary. 


Following  the  symposium  on  streptomy- 
cin at  San  Francisco  in  June,  1947,  at  the 
National  Tuberculosis  Association  meeting, 
it  was  decided  to  make  this  drug  available 
to  certain  state  cases  who  had  the  type  of 
disease  which  most  readily  responded  to 
this  treatment,  but  to  limit  the  amount  to 
one  gram  a day  and  for  a period  of  treat- 
ment of  only  six  weeks.  This  was  a much 
smaller  dosage  and  a very  much  shorter 
period  of  treatment  than  in  general  use 
elsewhere,  and  some  of  our  medical  advisors 
felt  that  it  represented  such  an  under-dos- 
age as  to  be  a waste  of  money.  However, 
our  results  have  thus  far  proved  just  the 
contrary.  Our  cases  seemed  to  have  de- 
rived just  as  much  benefit  without  develop- 
ing any  of  the  complications  like  permanent 
dizziness  or  deafness  or,  insofar  as  we  have 
been  able  to  determine,  resistance  to 
streptomycin.  If  they  develop  a spread  of 
their  disease,  another  short  course  of  strep- 
tomycin can,  therefore,  be  given.  Very  few 
relapses  have  occurred.  It  will  interest  you 
to  know  that  the  Veterans  Administration 
in  April,  1948,  adopted  this  dosage  of  one 
gram  a day  for  six  weeks  as  the  optimum 
procedure  in  their  hospitals. 

As  time  goes  on  I am  becoming  more, 
rather  than  less,  enthusiastic  about  the  re- 
sults that  can  be  expected  from  streptomy- 
cin in  properly  selected  cases.  The  text 
books  on  the  treatment  of  tuberculosis  are 
going  to  have  to  be  completely  revised  and 
for  the  first  time  in  history  we  have  a drug 
that  does  arrest  the  growth  of  the  tubercle 
bacillus  without  at  the  same  time  killing  the 
patient.  Also,  it  is  quite  within  the  realm 
of  possibility  that  there  will  be  no  longer 
any  need  for  increasing  sanatorium  facili- 
ties. We  shall  always  have  the  chronic, 
fibroid,  cavity  case  with  us,  unsuitable  for 
streptomycin  or  surgery  and  care  must  be 
given  these  cases  as  long  as  they  need  it  or 
as  long  as  they  remain  sputum  positive.  In- 
deed, the  time  may  come  when  early  new 
cases  of  tuberculosis  will  be  treated  with 
streptomycin  or  some  similar  antibiotic  in 
the  local  hospital  of  their  home  city  under 
isolation  technic  just  as  a case  of  pneu- 


118 


Rocky  Mountain  Medical  Journal 


monia  might  be  treated  with  penicillin.* 
The  one  thing  of  which  we  cannot  still  be 
sure  is  that  a case  with  arrested  disease 
through  the  use  of  streptomycin  will  stay 
arrested.  Only  time  will  answer  this  very 
momentous  Question. 

The  greatest  need  at  the  present,  in  addi- 
tion to  a slightly  larger  appropriation,  is  a , 
better  program  of  rehabilitation  and  med- 
ical social  service,  now  being  worked  out, 
which  will  help  to  build  patient  morale  and 
return  them  to  society  as  self-supporting 
individuals.  All  in  all,  I am  fairly  well 
c-onvinced  that  our  system  of  state  care  of 
the  needy  tuberculous  in  Colorado  can  give 
our  state  patients  considerably  above  aver- 

*The dosage,  however,  must  be  limited  to  one 
which  will  not  produce  resistance  to  the  drug.  The 
worst  thing  possible  is  to  throw  a patient  unneces- 
sarily into  streptomycin  resistance.  It  is  quite 
likely  that  even  smaller  doses  than  42  grams  will 
produce  just  as  good  results.  Probably  no  disease 
has  been  so  grossly  over-treated  as  has  tuberculosis 
with  streptomycin.. 


age  care  when  compared  with  that  fur- 
nished by  other  states.  It  is  far  from  perfect 
and  there  is  still  room  for  much  further  im- 
provement. A big  factor  in  the  successful 
functioning  of  the  program  has  been  the 
helpful  cooperation  of  the  Colorado  State 
Board  of  Public  Welfare  under  the  able 
chairmanship  of  Roy  A.  Davis,  who  has  been 
appointed  alike  by  two  Democratic  and  two 
Republican  Governors,  and  Earl  M.  Kouns, 
Director  of  the  State  Department  of  Public 
Welfare,  and  his  staff.  A close  working  re- 
lationship, very  helpful  to  this  department, 
has  been  established  during  the  last  few 
years  with  the  Colorado  State  Tuberculosis 
Association,  the  State  Department  of  Health 
and  the  State  Department  of  Vocational 
Training.  Finally,  I have  been  very  agree- 
ably surprised  by  the  marked  appreciation 
shown  by  the  patients  for  the  care  which 
they  have  received  at  the  hands  of  the  state. 


CARCINOMA  OF  THE  COLON 

KENNETH  B.  CASTLETON,  M.D. 

SALT  LAKH  CITY 


Carcinoma  of  the  large  bowl  is  the  second 
most  common  carcinoma  of  the  gastro-in- 
testinal  tract,  its  frequency  being  exceeded 
only  by  carcinoma  of  the  stomach.  Of  all 
tumors  of  the  intestine,  carcinoma  is  by 
all  odds  the  most  common.  It  is  apparently 
increasing  in  frequency.  Some  of  this  ap- 
parent increase  is  probably  due  to  better 
and  more  accurate  diagnosis,  some  to  better 
vital  statistics,  but  there  is  apparently  a 
real  increase  aside  from  these  factors.  No 
doubt  the  greater  number  of  population 
living  to  adult  life  accounts  for  part  of  this. 


TABLE 

1 

MOST  COMMON  SITES 

OF  MALIGNANCY* 

Number 

Per  Cent 

Lip 

..  764 

.56 

Tongue  

..  1,097 

.81 

Mouth  - 

..  620 

.46 

Jaw  

..  950 

.70 

Pharjuix 

..  912 

.68 

Esophagus  

..  2,386 

1.77 

Stomach,  duodenum 

..27,241 

20.31 

Intestine 

..15,634 

11.45 

Rectum,  anus  

..  7;325 

5.47 

Liver 

..10,425 

7.77 

Pancreas  

..  4,440 

3.31 

•Reprinted  from  The  Fight  on  Cancer,  published 
by  the  American  Society  for  the  Control  of  Cancer. 


In  the  practice  of  the  general  practitioner, 
it  is  not  a common  finding.  In  the  prac- 
tice of  the  surgeon  of  considerable  experi- 
ence, however,  it  is  a rather  common  con- 
dition and  in  the  experience  of  surgeons 
in  large  clinics  doing  a great  deal  of 
surgery,  it  is  one  of  the  most  common  ab- 
dominal surgical  lesions  encountered. 

The  cause  of  carcinoma  of  the  colon  is, 
of  course,  unknown  and  will  remain  obscure 
until  the  mystery  of  carcinoma  and  pos- 
sibly growth  itself  is  understood.  The 
importance  of  polyps  as  precursors  of  car- 
cimona,  however,  deserves  great  emphasis. 
It  is  well  known  that  polyps  of  the  colon 
are  definite  precursors  of  cancer  and  some 
authorities  believe  that  as  high  as  50  per 
cent  of  cancer  of  the  colon  arises  from 
previously  benign  polyps.  These  are  true 
tumors  and  not  the  result  of  inflammation. 
Here  then  is  a fertile  field  for  cancer  pro- 
phylaxis— the  recognition  and  removal  of 
polyps,  particularly  in  the  rectum  where 
they  are  easily  accessible. 

The  disease  may  be  found  at  any  age, 
but  it  is  most  common  in  the  fifth  and  sixth 


for  February,  1949 


119 


decades  of  life.  It  is  not  uncommon  in  pa- 
tients in  their  twenties,  and  cases  have  been 
reported  in  children  of  twelve,  five,  and 
even  three  years  of  age.  It  is  more  common 
in  males  than  in  females. 

Pathology 

There  are  two  principal  types  of  lesions: 
1.  soft  medullary  adenocarcinoma,  and  2. 
scirrhous  or  fibrocarcinoma.  In  both  forms 
mucoid  degeneration  is  not  uncommon,  oc- 
curring in  about  5 to  10  per  cent  of  cases. 
The  difference  in  these  two  types  of  lesions 
in  the  two  halves  of  the  colon  is  important. 
Those  of  the  right  half  of  the  colon  tend 
to  be  large  bulky  growths  which  ulcerate 
early.  They  are  often  cauliflower-like  and 
microscopically  are  adenocarcinoma.  Those 
of  the  left  side  tend  to  be  infiltrating  and 
are  annular,  encircling,  and  scirrhous  in 
type.  They  tend  to  cause  narrowing  of  the 
lumen  and  ulcerate  late. 

Growths  of  the  right  colon  rarely  cause 
obstruction  in  spite  of  their  large  size. 
There  is  a considerable  tendency  to  per- 
foration and  abscess  formation,  however, 
and  occasionally  intussusception  is  seen. 
Those  of  the  left  colon  cause  obstruction 
and  this  is  the  outstanding  feature  of  the 
left-sided  growths.  Polypoid  growths  may 
occur  on  either  side,  but  are  more  common 
on  the  right  side. 

The  exact  histogenesis  of  the  mucoid 
type  is  not  known.  Although  slow-grow- 
ing, it  tends  to  be  more  malignant  from 
the  standpoint  of  ultimate  cure  than  the 
other  types  because  of  its  greater  tendency 
to  recur.  Grossly,  there  are  large  quantities 
of  a gelatin-like  substance,  which  may  ap- 
pear as  nodules  on  the  surface. 

Microscopically  most  carcinomas  of  the 
colon  are  of  fairly  low  malignancy.  Ac- 
cording to  Broders  classification,  16  per 
cent  are  Grade  I,  54  per  cent  Grade  II,  21 
per  cent  Grade  III,  and  10  per  cent  Grade 
IV  in  right-sided  lesions  as  reported  by 
Rankin,  while  in  left-sided  lesions  the  fig- 
ures are  13,  67,  16  and  4 per  cent,  re- 
spectively. 

The  relative  frequency  of  malignant 
lesions  in  various  parts  of  the  colon  is 
shown  by  the  following  chart.  Excluding 
the  rectum,  the  most  common  sites  are  the 


sigmoid  and  the  cecum,  the  other  sites 
showing  comparatively  little  difference  in 
relative  frequency  of  involvment. 


SITE  OF  CARCINOMA  OF  LARGE  BOWEL 

Lahey  Clinic 

Mayo  Clinic 

Series 

Series 

1,457  Cases, 

3,542  Cases, 

Per  Cent 

Per  Cent 

Cecum  

6.52 

5.95 

Ascending  Colon  

3.30 



Hepatic  Flexure 

2.94 

Transverse  Colon 

4.51 

16.99 

Splenic  Flexure 

2.40 

17.1 

Descending  Colon  ... 

3.97 

Sigmoid  

12.42 

13.55 

Rectosigmoid  & Rectum....62.79 

62.84 

Signs  and  Symptoms 

As  Rankin  pointed  out,  the  right  and  left 
halves  of  the  colon  differ  in  so  many  re- 
spects embryologically,  anatomically,  and 
physiologically  that  the  colon  might  almost 
be  regarded  as  a dual  organ.  Embroyologi- 
cally  the  foregut  gives  rise  to  most  of  the 
upper  intestinal  tract  down  to  the  first  or 
second  portion  of  the  duodenum.  The  mid- 
gut gives  rise  to  the  rest  of  the  small  bowel 
and  the  right  half  of  the  colon  to  about 
the  middle  of  the  transverse  colon.  The 
hindgut  gives  rise  to  the  left  half  of  the 
colon  and  rectum.  That  portion  of  the 
bowel  derived  from  the  midgut  is  supplied 
by  the  superior  mesenteric  vessels  and  that 
portion  originating  from  the  hindgut  by 
the  inferior  mesenteric  vessels.  Anatomical- 
ly the  two  sides  differ  in  that  the  diameter 
of  the  lumen  of  the  right  side  tends  to  be 
considerably  larger  than  that  of  the  left, 
and  the  thickness  of  the  wall  is  distinctly 
less. 

Physiologically  the  right  colon  is  virtually 
the  same  as  the  rest  of  the  bowel  that  is 
derived  from  the  midgut — that  is,  its  func- 
tion is  largely  absorption.  Much  of  the 
water  is  absorbed  from  the  right  colon, 
especially  from  the  cecum  and  ascending 
colon.  On  the  left  side  of  the  colon,  there 
is  comparatively  little  absorption,  the  func- 
tion here  being  principally  one  of  storage 
of  the  stool  until  evacuation.  As  has  been 
pointed  out  already,  the  types  of  malig- 
nancies differ  markedly  in  the  two  halves 
of  the  colon.  As  might  be  expected,  the 


120 


Rocky  Mountain  Medical  Journal 


symptoms  likewise  tend  to  differ  rather 
strikingly. 


SIGNS  AND 
Right  Colon 

SYMPTOMS 

Left  Colon 

Pain,  indigestion  or 

Obstructive  symptoms 

distress 

Change  in  bowel 

Change  in  bowel  habits 

habits 

Anemia  and  weakness 

Blood  in  stools 

Palpable  tumor 

Weight  loss 

Weight  loss 

In  general,  symptoms  of  right-sided  lesions 
are  more  vague  than  those  of  the  left  side. 
The  onset  is  insidious  and  usually  consists 
of  a mild  distress,  pain,  or  “indigestion” 
which  may  be  mistaken  for  chronic  appen- 
dicitis, and  lead  to  appendectomy,  at  which 
time  the  true  diagnosis  may  or  may  not  be 
made.  It  may  also  be  mistaken  for  gall  blad- 
der disease,  peptic  ulcer,  nervous  indiges- 
tion, arthritis  of  spine,  colitis,  etc.  Anemia 
and  weakness  may  be  prominent  findings  in 
right-sided  carcinoma.  Occasionally  the 
anemia  may  be  so  profound  as  to  dominate 
the  picture  and  lead  one  to  suspect  primary 
pernicious  anemia  or  carcinoma  of  the 
stomach.  This  occurs  without  visible  loss 
of  blood  and  one  must  wonder  whether 
there  is  a toxic  factor  here  due  to  a per- 
verted absorption  of  toxins  from  the  large 
ulcerated  surface  of  the  carcinoma.  Un- 
doubtedly, there  is  some  blood  loss,  how- 
ever. 

Change  in  bowel  habit  is  one  of  the  most 
important  of  the  early  symptoms  of  carcin- 
oma, not  only  of  the  right  side  but  of  any 
part  of  the  colon,  and  a history  of  this 
should  immediately  arouse  suspicion  in  an 
adult.  This  may  consist  of  a slight  tendency 
to  constipation  (16  per  cent)  or  tendency 
to  looseness  in  a patient  (30  per  cent)  whose 
bowels  have  been  previously  normal.  Or 
the  constipated  person  may  become  more 
constipated  or  more  normal,  according  to 
their  story.  Alternating  periods  of  diarrhea 
and  constipation  are  of  great  significance 
and  demand  a thorough  investigation. 

Weight  loss  is  a common  finding  and  is 
present  in  a high  percentage  of  cases.  This 
may  be  the  only  or  main  symptom  on  pres- 
entation of  the  patient  for  examination. 

Occasionally  the  first  or  only  indication 
that  something  is  wrong  is  the  presence 


of  a lump.  According  to  Rankin,  this  is 
true  in  10  per  cent  of  cases.  This  may 
be  found  by  the  patient  or  it  may  be  dis- 
covered by  the  physician  on  a routine 
physical  examination,  a pre-employment  ex- 
amination, or  during  a life  insurance  ex- 
amination, etc.  Usually  such  a mass  is 
slightly  tender  and  is  more  often  felt  in 
the  lower  quadrant  than  elsewhere. 

In  the  left-sided  lesions,  one  symptom 
stands  out  above  all  others,  namely,  cramps 
or  abdominal  pain  suggestive  of  obstruc- 
tion. Why  is  obstruction  so  common  on 
the  left  side  as  compared  with  the  right? 
There  are  several  reasons — first,  because  of 
the  nature  of  the  growth  as  pointed  out 
above.  Left-sided  lesions  tend  to  be  en- 
circling growths  which  obstruct.  Another 
reason  is  the  decreased  diameter  of  the 
lumen  of  the  bowel,  and  a third  is  the  fact 
that  on  the  left  side  the  fecal  current  is 
solid  whereas  on  the  right  side  it  is  liquid. 

Another  symptom  of  great  importance  is 
a change  in  the  bowel  habits  (80  per  cent). 
This  may  be  constipation  or  a tendency  to 
diarrhea  (30  per  cent)  or  an  alternating 
diarrhea  and  constipation.  Blood  in  the 
stools  is  important,  if  present.  Although 
occult  blood  is  nearly  always  present,  gross 
blood  occurs  in  a minority  of  cases  except 
in  carcinoma  of  the  rectum  where  it  is 
very  frequent.  Obstruction  is  usually 
chronic  and  progressive,  but  occasionally  it 
occurs  with  explosive  suddenness,  especially 
in  lesions  of  the  splenic  flexure  where  acute 
obstruction  is  not  uncommon. 

It  must  be  emphasized  that  great  loss 
of  weight  and  dehydration  are  really  symp- 
toms of  metastasis  and  early  death. 

Differential  Diagnosis 

The  most  important  procedures  in  the 
establishment  of  an  accurate  diagnosis  are: 
1.  an  accurate  sequential  history,  2.  a care- 
ful physical  examination  including  a rectal 
examination,  3.  sigmoidoscopic  examina- 
tion with  biopsy,  if  possible,  and  4.  roent- 
genographic  examination.  In  the  well-ad- 
vanced case  a diagnosis  can  be  made  or 
strongly  suspected  from  the  history  alone, 
but  in  the  early  case,  the  vague  and  often 
bizarre  nature  of  the  symptoms  will,  at 
times,  scarcely  suggest  the  true  diagnosis. 


for  February,  1949 


121 


The  same  may  be  said  regarding  the  physi- 
cal examination  for,  although  one  may  pal- 
pate the  lesion  through  the  abdominal  wall, 
this  is  the  exception  rather  than  the  rule. 
Sigmoidoscopic  examination  is  of  great 
value.  It  may  be  possible  to  see  the  lesion, 
determine  its  site  accurately  and  remove 
a piece  for  microscopic  examination.  The 
greatest  advance  in  the  early  diagnosis  of 
carcinoma  of  the  colon  has  been  made  at 
the  hands  of  the  roentgenologist  and  today 
the  accuracy  of  diagnosis  of  these  lesions 
above  the  rectum  and  lower  sigmoid  com- 
pares favorably  with  that  of  lesions  in  the 
upper  gastro-intestinal  tract.  The  barium 
enema  is  the  procedure  of  choice,  often 
combined  with  air  injection.  The  barium 
meal  is  usually  not  desirable,  partly  because 
of  its  inaccuracy  and  partly  because  of  the 
danger  of  producing  an  acute  intestinal 
obstruction  superimposed  on  a chronic 
process. 

Although  70  per  cent  of  surgical  pro- 
cedures on  the  colon  are  for  malignancy, 
there  are  numerous  other  pathologic  proc- 
esses which  must  be  considered  in  the  dif- 
ferential diagnosis.  In  lesions  of  the  right 
colon,  one  must  consider  especially  tuber- 
culosis, regional  enteritis,  polyps  and  ac- 
tinomycosis. In  the  left-sided  pathology 
diverticulosis,  diverticulities,  chronic  ulcer- 
ative colitis,  spastic  colitis  and  polyps  must 
be  differentiated. 

One  of  the  most  difficult  differential 
diagnoses  to  make  is  that  between  carcinoma 
of  the  colon  and  diverticulitis  in  certain 
cases,  especially  if  the  presence  of  diver- 
ticuli  is  known  and  one  suspects  a super- 
imposed malignancy.  Such  a differentia- 
tion may  occasionally  be  impossible  and  lap- 
arotomy may  be  necessary  to  establish  the 
diagnosis,  although  this  is  xare. 

Treatment 

The  treatment  of  carcinoma  of  the  colon 
is  surgical.  Radiation  plays  little  or  no 
role  except  perhaps  in  selected  cases  of 
carcinoma  of  the  rectum  where  radium  may 
be  used  chiefly  in  a palliative  role.  The 
main  question  for  the  surgeon  then,  after 
the  diagnosis  is  established  is,  “Is  the  lesion 
resectable?”  In  the  light  of  our  present 
limited  knowledge  of  the  disease,  for  all 


practical  purposes,  curability  depends  on 
J.  early  diagnosis,  2.  adequate  surgical  re- 
moval. 

Operability  may  be  difficult  to  determine. 
In  some  cases,  the  patient  clinically  is  hope- 
less as  evidenced  by  signs  of  metastasis. 
Nodules  may  be  palpable  through  the  ab- 
dominal wall  in  the  liver,  or  on  the  rectal 
shelf  on  digital  examination.  Even  with 
the  abdomen  open,  the  question  of  resecta- 
bility may  be  a most  difficult  one.  Liver 
metastases  indicate  incurability.  Marked 
fixation  mitigates  against  cure,  yet  one  may 
be  surprised  in  some  of  these  cases  how 
an  apparently  inoperable  lesion  due  to  fix- 
ation may  decrease  in  size  after  a proximal 
colostomy,  showing  that  much  of  the  fixa- 
tion is  due,  not  to  malignant  involvement 
of  adjacent  structures,  but  to  inflammatory 
reaction. 

In  recent  years  there  has  been  a steady 
increase  in  resectability,  a decrease  in  mor- 
tality and  an  improvement  in  the  five-year 
cure  rate.  In  most  clinics  the  resection 
rate  is  now  up  to  70  to  85  per  cent,  and 
the  five-year  curability  is  around  50  per 
cent.  This  is  infinitely  better  than  in  car- 
cinoma of  the  stomach,  pancreas,  liver,  pros- 
tate, ovary  and  many  other  internal  organs. 
It  is  doubtful  if  any  internal  malignancy 
gives  such  a high  rate  of  curability  as  car- 
cinoma of  the  colon. 

The  preoperative  preparation  of  the  pa- 
tient is  of  tremendous  imporance.  With- 
out going  into  great  detail,  suffice  it  to  say 
that  these  efforts  are  directed  along  two 
main  channels — 1.  to  build  up  the  patient 
in  a general  way  with  blood,  fluids,  vita- 
mins, etc.  2.  measures  to  decompress  the 
bowel.  This  involves  the  use  of  enemas 
alone  if  there  is  marked  obstruction,  or 
mild  laxatives  and  enemas  if  the  obstruction 
is  mild  or  absent.  Sulfasuxadine  of  sulfa- 
thaladine  should  be  used  for  several  days, 
the  former  if  there  is  some  constipation, 
the  latter  if  there  is  diarrhea. 

One  of  the  greatest  advances  that  oc- 
curred in  the  early  development  of  colon 
surgery  was  the  introduction  of  stage  pro- 
cedures. These  still  play  a vital  role  in 
colon  surgery,  especially  in  some  types  of 
cases  such  as  acute  obstruction.  With  im- 
provement in  technic,  better  preoperative 


122 


Rocky  Mountain  Medical  Journal 


preparation  and  postoperative  care,  how- 
ever, fewer  stage  procedures  are  being 
used  in  recent  years. 

The  choice  of  anesthesia  is  largely  a per- 
sonal matter.  My  own  choice  is  either 
spinal  or  intratracheal  cyclopropane  with 
curare.  In  exploring  the  abdomen,  the  liver, 
regional  nodes,  and  rectal  shelf  should  be 
examined  for  metastasis  and  the  growth 
itself  palpated  last  to  diminish  the  danger 
of  spreading  infection.  One  should  remem- 
ber that  fixation  of  the  growth  and  en- 
largement of  lymph  nodes  may  both  be 
due  to  infection  rather  than  malignancy, 
and  metastases  to  the  liver  do  not  always 
contraindicate  resection,  for  it  is  our  duty 
to  palliate  as  well  as  cure  and  if  one  can 
remove  the  growth  even  without  curing  the 
patient,  their  remaining  days  will  be  far 
more  comfortable.  Palliative  colostomy  is 
also  worthwhile  at  times,  although  it  gives 
much  less  relief  than  palliative  resection. 

In  lesions  of  the  right  colon,  resection  of 
the  terminal  six  inches  of  ileum  and  entire 
right  colon  to  the  middle  of  the  transverse 
colon  with  anastomosis  of  the  ileum  to  the 
transverse  colon  is  the  procedure  of  choice. 
This  can  usually  be  done  in  one  stage  but 
in  poor  risk  patients,  especially  with  per- 
forations, etc.,  a two-stage  procedure  will 
be  much  safer.  I use  an  end  to  side  anas- 
tomosis although  an  end  to  end  or  side  to 
side  may  be  used.  The  use  of  an  ileostomy 
as  a decompressive  measure  has  become 
almost  obsolete  since  the  advent  of  the 
Miller-Abbott  tube. 

In  lesions  beyond  the  hepatic  flexure 
around  to  the  lower  sigmoid  one  may  use 
either  of  two  general  types  of  procedures — 
1.  a Mikulicz  procedure  or  one  of  its  modi- 
fications such  as  the  Rankin  obstructive 
resection,  or  2.  a primary  resection  with 
end  to  end  anastomosis  with  or  without  a 
proximal  colostomy.  There  can  be  little 
doubt  that  in  the  hands  of  the  average  sur- 
geon a Mikulicz  type  of  procedure  such  as 
the  Rankin  resection  is  safer  than  a re- 
section with  primary  anastomosis.  The  lat- 
ter is  entirely  unsafe  even  in  the  most 
skilled  hands  in  cases  with  obstruction  be- 
cause dilated  or  thickened  bowel  is  unsuited 
for  anastomosis.  If  the  obstruction  is  very 
mild  it  can  be  done  with  reasonable  safety, 


provided  a colostomy  is  done  at  some  proxi- 
mal site  such  as  the  cecum,  and  some  sur- 
geons even  carry  out  primary  anastomosis 
without  colostomy  if  there  is  no  obstruc- 
tion. This  requires  very  careful  preopera- 
tive preparation  and  meticulous  technic. 

When  one  gets  into  the  lower  sigmoid, 
one  gets  into  a controversial  problem  re- 
garding the  best  procedure.  The  combined 
abdomino-perineal  resection  is  still  favored 
by  most  surgeons  and  it  is  my  practice  to 
use  it  if  it  is  too  low  to  bring  up  as  a 
Rankin  obstructive  resection.  Some  men, 
however,  are  doing  the  so-called  anterior 
resections  even  to  the  upper  rectum  with 
primary  anastomosis,  usually  with  a colos- 
tomy in  the  transverse  colon.  This  is  dif- 
ficult and  probably  not  the  procedure  of 
choice  unless  one  has  had  much  experience 
with  it. 

Without  going  into  a discussion  of  the 
surgical  procedures  in  carcinoma  of  the 
rectum,  suffice  it  to  say  that  combined 
abdomino-perineal  resection  of  Miles  is  the 
standard  procedure.  Attempts  to  spare  the 
sphincter  should  be  looked  on  with  sus- 
picion, at  least  until  its  advocates  can  show 
curability  figures  that  will  compare  with 
those  obtained  by  the  abdomino-perineal 
procedure. 

In  general,  I want  to  emphasize  that  colon 
surgery  is  big  surgery.  It  carries  a mortality 
that  is  higher  than  most  types  of  abdom- 
inal surgery.  I am  sure  that  for  most 
general  surgeons  stage  procedures  will 
prove  safest  in  the  long  run  for  many  cases 
and  that  the  controversial  procedures  such 
as  sphincter  saving  operations,  anterior  re- 
sections, etc.,  should  be  avoided.  In  spite  of 
the  formidability  of  many  surgical  proce- 
dures, the  curability  of  carcinoma  of  the 
colon  is  probably  the  highest  of  any  internal 
malignancy.  My  plea  is  to  “stir  up”  among 
us  a “colon  consciousness”  so  to  speak  and  to 
urge  rectal  examinations  on  all  routine  ex- 
aminations, and  sigmoidoscopies,  in  all  cases 
of  hemorrhoids,  with  enemas  and  x-ray  ex- 
aminations of  the  colon  on  patients  with 
symptoms  suggesting  this  disease.  Surgery 
probably  has  gone  about  as  far  as  it  can  in 
the  treatment  of  this  condition.  It  remains 
now  for  us  to  diagnose  the  disease  in  its 
early  stages. 


for 'February,  1949 


123 


THE  BRUCELLOSIS  PROBLEM 

SAFEGUARDING  OUR  CITIZENS  FROM  DISEASE 
GEO.  W.  STILES,  M.D.,  Ph.D.* 

DENVER 


The  Colorado  State  Medical  Society,  the 
Colorado  Veterinary  Medical  Association, 
and  the  State  Department  of  Public  Health 
are  vitally  interested  in  reducing  the  inci- 
dence of  all  human  diseases  in  the  state.  To 
this  end,  the  assistance  and  united  effort  of 
every  doctor  and  citizen  in  the  state  is  high- 
ly essential.  This  request  applies  to  all 
persons,  whether  living  in  rural  or  urban 
areas,  but  especially  to  people  living  in  vil- 
lages, on  farms  or  ranches,  who  usually  have 
less  public  health  protection. 

Few  people  realize  that  the  lower  animals 
may  harbor  many  types  of  disease-produc- 
ing organisms  in  their  bodies  or  excretions. 
In  Hull’s  book  on  “Diseases  Transmitted 
From  Animals  to  Man”  some  ninety-one 
maladies  are  listed,  some  caused  by  bac- 
teria or  parasites;  others  are  ascribed  to 
fungi  or  viruses. 

Among  the  most  devitalizing  and  linger- 
ing of  these  infections  is  Brucellosis,  com- 
monly known  in  man  as  “Undulant  Fever.” 
This  disease  has  its  origin  in  infected,  dis- 
eased cows,  swine  or  goats;  and  livestock 
owners  who  harbor  such  animals  furnish 
a continuous  source  of  germ  infection  for 
the  human  race.  This  may  be  by  contact 
with  meat  or  discharges  from  diseased  ani- 
mals, or  by  the  use  of  raw,  unpasteurized 
dairy  products,  such  as  milk,  cream,  ice 
cream,  cheese  or  butter. 

Livestock  raisers,  especially  owners  of 
beef  and  dairy  types  of  cattle,  should  real- 
ize that  their  own  families  may  be  in  jeop- 
ardy and  need  protection  against -brucello- 
sis, the  same  as  city  dwellers,  who  have  no 
physical  contact  with  diseased  animals, 
and  who  probably  consume  adequately  pas- 
teurized dairy  products. 

Laboratory  Examinations  and  Case 
Reporting 

During  the  past  seven  months,  February 
to  August  inclusive,  the  State  Laboratory 

‘Director  of  the  Laboratory  Section,  Colorado  State 
Department  of  Public  Health.  In  collaboration  with 
the  Milk  Controi  Committee  of  the  Colorado  State 
Medical  f^ociety. 


has  tested  3,497  human  blood  samples  for 
brucellosis  submitted  by  physicians  from 
ailing  patients.  Of  this  number,  389  or  11.2 
per  cent  gave  agglutination  reactions  in 
titers  of  1/100  or  above  (called  positive),  and 
498  or  14.2  per  cent  in  titers  below  1/100 
(called  suspicious) . During  this  same  period, 
doctors  reported  168  cases  of  brucellosis  to 
the  State  Epidemiological  Section,  many  of 
which  had  shown  high  blood  agglutination 
titers. 

Recently  the  State  Laboratory  has  recov- 
ered on  culture  and  typed  two  strains  of 
Brucella  organisms,  Br.  abortus  and  Br. 
melitensis,  from  humans  showing  acute 
symptoms  of  the  disease.  One  patient  had 
treated  an  aborting  cow,  and  the  other  lived 
in  the  southern  part  of  the  state  where 
goats  abound.  The  latter’s  history  indicated 
drinking  water  from  open  streams,  but  he 
denied  drinking  goat’s  milk  or  intimate  con- 
tact with  them. 

The  morbidity  report  on  brucellosis  for 
the  year  1947  shows  268  cases  were  re- 
ported from  twenty-eight  of  the  sixty-three 
counties  in  the  state,  while  from  the  remain- 
ing thirty-five  counties  not  a single  case  of 
brucellosis  was  reported  for  the  entire  year. 
One  county  alone,  outside  of  Denver,  re- 
ported forty-one  cases.  (See  accompanying 
chart) . 


We  realize  the  diagnosis  of  brucellosis  is 
often  attended  with  difficulty;  however,  by 


124 


Rocky  Mountain  Medical  Journal 


the  use  of  laboratory  tests,  including  blood 
cultures,  skin  tests,  a carefully  prepared 
history,  and  a critical  study  of  the  clinical 
picture,  more  cases  of  brucellosis  should  be 
reported.  At  the  Congress  on  Brucellosis, 
held  in  Mexico  City,  1946,  four  authors  of 
papers  show  “the  increment  of  human 
cases  was  due  not  only  to  better  diagnosis 
but  to  a real  increase  in  the  occurrence  of 
the  infection.”  From  personal  experience 
and  the  expressed  opinions  of  others,  the 
author  believes  many  cases  of  brucellosis, 
especially  of  the  chronic  type,  remain  un- 
discovered, not  only  in  Colorado,  but 
throughout  the  nation. 

Recommendations 

1.  Physicians  drawing  blood  samples  for 
agglutination  should  secure  the  specimen 
before  giving  the  cutaneous  or  skin  test, 
since  such  a procedure  might  cause  a false 


agglutination  in  some  persons.  Likewise  the 
recent  administration  of  brucella  vaccine 
usually  causes  the  production  of  antibodies 
in  the  patient;  therefore  resulting  in  false 
blood  reactions. 

2.  Adequate  laws  should  be  enacted  to  de- 
tect brucella-diseased  animals,  especially 
dairy  cattle,  and  the  proper  identification 
by  brand  or  tag  of  reacting  animals  to  pro- 
tect prospective  purchasers  from  buying 
dangerous  cows. 

The  State  Laboratory  is  ready  and  willing 
to  render  any  assistance  possible  to  medi- 
cal practitioners,  and  to  make  blood  tests 
and  cultures  on  request  from  brucella-sus- 
pected cases.  By  united  effort  this  malady 
can  be  controlled,  provided  livestock  own- 
ers recognize  their  responsibility,  and  the 
public  at  large  will  cooperate  in  stamping 
out  this  unnecessary,  preventable  disease  in 
both  animals  and  humans. 


THE  ALLERGIC  NASAL  SYNDROME* 

LEO  P.  COAKLEY,  M.D. 

MISSOULA,  MONTANA 


During  the  past  ten  years,  otolaryngolo- 
gists have  become  more  aware  of  a rapidly 
increasing  nasal  syndrome.  This  has  been 
described  by  Williams^  as  “the  intrinsic  al- 
lergy syndrome”  and  by  Roberts^  as  “a  new 
sinus  syndrome.”  However,  I am  of  the 
opinion  that  the  symptoms  described  are 
fequently  a local  manifestation  of  a general- 
ized dietary  deficiency.  There  are  many 
factors  involved  in  the  production  of  the 
allergic  nasal  syndrome,  some  of  them  ob- 
vious, while  others  may  take  a great  deal 
of  painstaking  investigation  to  arrive  at  a 
definite  diagnosis.  Therefore,  this  type  of 
condition  should  not  be  viewed  to  narrow 
confines  of  nasal  speculum  but  rather  we 
should  as  physicians  see  the  patient  in  his 
entirety,  as  we  are  dealing  with  patients 
who  represent  many  problems  referable  to 
the  nose  and  throat  which  are  local  mani- 
festations of  generalized  conditions. 

It  seems  logical  that  we  should  be  inter- 
ested in  the  nutrition  and  biochemistry  of 
the  patient  as  many  of  these  conditions  can 
be  corrected  by  proper  diet  and  vitamin 

’■Westsm  Montana  Clinic  Missoula,  Montana. 


therapy  rather  than  surgical  intervention. 
Suppuration  or  infection  are  not  charac- 
teristic of  this  condition  and  in  the  past  a 
vast  number  of  these  patients  with  hyper- 
plastic rhinitis  have  been  subjected  to  op- 
erative procedures  with  such  an  obvious 
lack  of  success  that  the  idea  grew  up  among 
surgeons  and  laity  that  sinusitis  could  not 
be  cured  by  surgical  procedures. 

The  pathology  is  rather  vague.  Robert 
states  that  in  his  opinion  there  is  a dis- 
turbed balance  of  colloidal  chemistry.  Ac- 
cording to  Williams  and  many  others,  the 
syndrome  complex  is  produced  by  a cellular 
injury  with  the  release  of  histamine.  Hista- 
mine released  in  the  tissue  spaces  acts  on 
the  arterioles  and  capillaries  and  produces 
an  arterial  constriction  and  capillary  dila- 
tation. In  addition,  permeability  of  the 
capillary  walls  increases  and  localized  ede- 
ma occurs  subsequently. 

There  are  many  allergic  conditions  which 
produce  the  symptoms  as  described  in  the 
syndrome,  but  those  of  an  allergic  nasal 
syndrorne  are  milder  than  those  common  in 
true  allergy.  Skin  tests,  either  by  the 


for  February,  1949 


125 


scratch  or  interdermal  procedure,  have  been 
disappointing  in  that  most  of  them  are  nega- 
tive. Occasionally,  although  all  the  food 
tests  are  negative,  there  may  be  a positive 
reaction  to  one  of  the  pollens.  The  condi- 
tion is  not  seasonal  but  is  present  the  year 
around  and  the  best  one  word  description 
of  it  is  that  of  Lillie®  who  called  it  a “wet” 
nose. 

The  syndrome  is  characterized  by 

1.  A feeling  of  fullness  and  congestion  in 
the  nose. 

2.  Transient  nasal  obstruction  which  shifts 
from  side  to  side  giving  an  hour  glass  type 
of  obstruction. 

3.  Post-nasal  discharge  of  a mucoid  char- 
acter. 

4.  Production  of  large  quantities  of  watery 
mucoid  material  in  the  nose. 

5.  Generalized  body  fatigue. 

6.  Neuritis  or  myalgia  in  various  parts  of 
the  body,  especially  superscapular. 

7.  Allergic  manifestations  such  as  sneez- 
ing and  photophobia. 

The  nasal  mucosa  is  normally  a pale  ver- 
milion. The  architecture  of  the  superficial 
vessels  and  especially  the  turbinates  re- 
semble the  parallel  pipes  of  a heating  or 
cooling  system.  Numerous  communica- 
tions exist  at  short  intervals  between  the 
artery  and  the  vein.  The  erectile  tissue  of 
the  nasal  mucosa  consists  of  spaces  obtain- 
ing their  blood  supplies  from  small  surface 
capillaries  originating  from  the  post-nasal 
artery  and  emptying  into  the  mucosal  veins. 
The  walls  of  these  vessels  are  plentifully 
supplied  with  elastic  tissue  and  muscle  fi- 
bers reaching  into  the  lumina  as  trabecular 
prominences.  Stimulation  by  the  inspired 
air  plays  some  part  in  the  regulation  of 
patency  through  the  autonomic  system.  The 
blood  vessels  reaching  the  nasal  cavity  from 
the  pterygoid  fossa  are  innervated  almost 
entirely  by  branches  of  the  sphenopalatine 
ganglion. 

The  control  of  nasal  congestion  and  glan- 
dular activity  are  not  under  the  power  of 
the  will  since  unstriped  or  pale  muscle  and 
glands  are  involved.  It  is  well  known  that 
the  central  processes  of  the  cell  bodies  of 
the  sympathetic  afferent  neurons  synapse 


with  either  somatic  or  sympathetic  efferent 
or  motor  neurons  within  the  central  ner- 
vous system  in  the  completion  of  reflex 
arcs.  Experimental  evidence  tends  to  show 
that  afferent  somatic  neurons  participate  in 
the  formation  of  the  reflex  arcs  in  which 
the  efferents  are  of  the  sympathetic  type. 
It  is  therefore  possible  that  an  impulse  from 
the  nasal  cavity  meant  primarily  to  bring 
about  reflexly  a pure  motor  response  of 
striated  muscles  results  in  a vasomotor 
phenomenon  as  well,  e.g.  turgescence  of  the 
erectile  tissues  of  the  nose.  Although  the 
turgescence  and  depletion  of  the  nasal  mu- 
cosa is  commonly  a simple  reflex  phe- 
nomenon, the  erectile  tissue  of  the  nose  is 
readily  influenced  by  psychic  states  indi- 
cating a connection  with  the  vasomotor  cen- 
ters and  cerebral  cortex. 

A large  portion  of  nasal  ailments  of  ner- 
vous origin  have  for  their  basis  a derange- 
ment of  the  autonomic  nervous  system.  This 
system  functions  below  the  level  of  con- 
sciousness, is  not  subject  to  control  of  the 
will  and  serves  to  carry  out  a purely  vege- 
tative process  such  as  vascular  tone,  the 
action  of  smooth  muscular  fibers  and  the 
regulation  of  glandular  secretion.  It  there- 
fore enters  largely  into  the  emotional  states 
which  accompany  these  bodily  functions. 

With  such  a profuse  neuro-vascular  sys- 
tem one  can  readily  appreciate  the  effi- 
ciency of  the  nose  as  a heating  and  humidi- 
fying system  and  at  the  same  time  be  im- 
pressed with  the  potentialities  of  trouble 
when  such  a system  through  a derange- 
ment of  its  nervous  supply  either  overflows 
or  collapses.  Many  of  the  reactions  seen 
in  the  nose  are  no  doubt  due  to  a lowered 
resistance  or  atonic  condition  of  the  nervous 
and  vascular  systems.  Diet,  particularly  a 
high  fat  diet,  has  a definite  effect  on  the 
tissues  of  the  nose  in  relation  to  its  ability 
to  withstand  external  stimuli. 

The  food  habits  of  human  populations  liv- 
ing in  different  climates  exhibit  marked  dif- 
ferences. Whether  these  various  differ- 
ences are  due  to  a physiological  adaptation 
or  to  relative  availability  is  unknown.  The 
predilection  of  the  Eskimo  for  diets  high  in 
protein  and  fat  may  mean  that  this  t3rpe  of 


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Rocky  Mountain  Medical  Journal 


diet  is  best  adapted  to  withstand  intense 
cold  or  that  high  carbohydrate  foods  are 
not  available.  Mitchell®  and  associates  have 
shown  that  man’s  ability  to  withstand  in- 
tense cold  is  increased  by  high  fat  foods 
eaten  at  small  meals  at  frequent  intervals. 
The  least  favorable  type  of  diet  regime  dur- 
ing eight  hours  of  exposure  to  cold  is  a 
single  high  protein  meal  containing  20  per 
cent  of  the  daily  caloric  intake.  The  high 
fat  meals  are  probably  superior  because  of 
heat  emission  rather  than  heat  production. 

In  normal  times  the  average  American 
consumes  about  100  pounds  of  fat  annually, 
deriving  about  one-third  of  his  total  calories 
from  it.  The  average  daily  intake  is  about 
125  gm.  per  day.  Of  this  approximately 
half  is  prepared  or  “visible”  fat  and  half 
“hidden”  fat  contained  in  other  foods.  The 
chief  prepared  fats  are  lard,  butter  fat,  cot- 
tonseed oil,  soy  bean  oil  and  corn  oil.  The 
chief  sources  of  hidden  fats  are  meats  and 
dairy  products. 

The  availability  of  fats  varies  at  times; 
during  the  last  war  due  to  the  great  de- 
mands made  upon  our  supply  there  was  a 
shortage.  However,  the  Committee  on  Fats 
of  the  National  Research  Council  recom- 
mended that  in  the  rationing  of  foodstuffs 
the  supply  not  be  reduced  below  68  pounds 
per  person  per  year.  This  could  be  met 
through  a supply  of  40  pounds  of  “hidden” 
fat  and  28  pounds  of  “visible”  fats. 

The  question  of  essentiality  of  the  fats  in 
human  nutrition  is  discussed  at  some  length 
by  Hanson  and  Burr.^  Early  investigators 
in  the  field  of  nutrition  were  of  the  opinion 
that  the  dietary  fat  was  merely  a source  of 
calories.  Later  investigators  discovered  the 
essential  nature  of  certain  fatty  acids,  par- 
ticularly linoleic  and  arachidonic  acids.  Ex- 
periments have  been  carried  on  with  rats. 
The  exclusion  of  the  essential  fatty  acids 
from  the  diets  of  rats  lead  to — 

1.  Development  of  scaly  skin  and  caudle- 
necrosis. 

2.  Retardation  of  growth. 

3.  Increased  water  consumption. 

4.  Early  death. 

Other  more  or  less  specific  effects  of  the 
deficiency  are  histological  changes  in  the 


ovaries,  uterus  and  other  tissues.  Complete 
cure  of  the  deficiency  symptoms  is  effected 
by  the  addition  of  linoleic  or  arachidonic 
acid.  The  daily  requirement  in  the  rats  is 
1 per  cent  of  the  daily  dietary  intake.  Since 
there  is  no  evidence  experimentally  in  the 
human  being,  it  is  assumed  that  human 
beings  and  rats  have  the  same  metabolic 
process  and  therefore  the  requirements  for 
humans  should  be  about  1 per  cent  of  the 
dietary  intake. 

Observations  of  infants  on  a low  fat  diet 
have  been  made.  It  is  interesting  to  note, 
that  other  than  the  eczematous  eruptions 
that  occur,  the  observations  were  concluded 
when  the  infants  became  anemic  and  suf- 
fered from  repeated  infections.  These  in- 
fections cleared  when  fat  was  restored  to 
the  diet.  Fresh  lard,  corn  oil,  and  raw  lin- 
seed oil  are  rich  in  finoleic  and  arachidonic 
acid  and  are  recommended  for  relief  of  fatty 
acid  deficiency.  Results  obtained  from  the 
addition  of  fresh  lard  and  corn  oil  have  been 
much  better  than  those  obtained  with  raw 
linseed  oil.  Fats  and  fat  meat,  particularly 
the  animal  fat  contained  in  steaks  and  pork, 
are  essential  in  any  well  balanced  diet,  par- 
ticularly so  in  an  individual  who  has  a nasal 
syndrome.  Children  with  this  ssmdrome 
will  usually  state  that  they  do  not  eat 
fats  of  any  type  and  the  parents  will  often 
encourage  the  child  by  cutting  out  all  the 
fatty  acid  containing  fat  from  the  meat. 
Their  diets  will  consist  of  large  quantities 
of  pastry  and  milk. 

Lillie  has  always  insisted  upon  his  pa- 
tients with  an  allergic  nasal  syndrome  to 
increase  the  amount  of  animal  fat  taken 
with  each  meal.  In  the  general  work  now 
being  done,  many  authors  are  stressing  the 
amino  and  fatty  acids  as  being  as  impor- 
tant as  the  vitamins. 

One  of  the  greatest  difficulties  in  ascer- 
taining the  essential  nature  of  the  unsat- 
urated fatty  acids  in  human  beings  is  the 
inability  to  measure  accurately  the  amount 
of  linoleic  and  arachidonic  acids  in  the  blood 
and  tissues.  The  adoption  of  spectoscopic 
methods  to  the  quantitative  measurement  of 
the  fatty  acids  in  the  blood  and  tissues  gives 
promise  of  more  accurate  studies  of  the  es- 


for  February,  1949 


127 


sential  fatty  requirements  of  human  beings. 

The  dietary  habits  of  the  modern  Ameri- 
can people  have  undergone  a drastic  change 
in  the  past  ten  years.  There  has  been  a 
trend  to  enormous  consumption  of  sugar 
and  highly  refined  flour.  Milk  has  been  ad- 
vertised and  publicized  until  the  average 
mother  feels  that  milk  is  the  only  require- 
ment for  the  normal  growth  and  develop- 
ment of  the  average  child.  Dietary  defi- 
ciencies such  as  scurvy  and  pellagra  in  the 
past  were  diseases  of  the  poor.  However,  at 
the  present  time  the  poor  have  a better 
dietary  regime  than  the  wealthy  and  mid- 
dle class  people  as  their  diets  are  selected 
for  them. 

There  are  those  who  argue  that  the  aver- 
age American  diet  is  ample.  It  is  true  that 
ample  food  is  available,  but  ample  food  is 
not  available  in  the  drug  store,  candy  store 
and  bakery.  The  no  breakfast  habit,  the 
drug  store  luncheon  and  a hurried  trip  to 
the  bake  shop  on  the  way  home  are  not 
ample.  Diet  fads,  particularly  reduction 
diets,  have  eliminated  all  of  the  vitamin- 
containing  foods,  particularly  fats  and  fat 
meat,  until  the  patient  is  eating  a waste 
product  which  does  nothing  for  him  other 
than  to  lend  bulk.  It  is  no  wonder  that  we 
are  a nation  of  nasal  cripples. 

Most  patients  feel  that  they  are  eating 
an  adequate  diet,  otherwise  they  would 
change.  However,  their  daily  requirement 
is  any  amount  of  food  that  will  satisfy  their 
appetite  and  usually  consists  of  carbohy- 
drates. Usually  these  patients  are  psycho- 
neurotic and  are  seen  because  of  their  nasal 
condition. 

Personal  habits,  particularly  loss  of  sleep, 
have  a great  bearing  on  this  nasal  condition. 
A great  many  people,  especially  during  war 
time,  did  not  get  sufficient  rest  and  a great 
percentage  of  these  patients  will  complain 
of  fatigue  and  at  times  exhaustion. 

It  is  surprising  how  many  patients  use 
cathartics.  In  Robert’s  series  of  cases  31 
per  cent  was  found  to  be  using  some  form 
of  cathartics,  either  self-prescribed  or  pre- 
scribed by  a druggist.  All  cathartics  inter- 
fere with  absorption  and  assimilation  of 
food  and  the  lubricating  types,  such  as  min- 


eral oil,  interfere  with  the  absorption  of  vi- 
tamin A. 

The  physiology  of  the  nervous  tissue  is 
greatly  disturbed  by  the  following: 

1.  Excessive  use  of  alcohol. 

2.  Excessive  intake  of  carbohydrates. 

3.  Cathartics. 

4.  Excessive  smoking. 

The  excessive  use  of  alcohol  produces 
nerve  irritation  and  pain  and  eventually 
neural  degeneration.  This  has  been  known 
for  years,  but  the  others,  such  as  a large 
intake  of  carbohydrates,  excessive  cathar- 
tics and  excessive  smoking,  have  not  been 
such  common  knowledge.  The  absorption 
of  vitamin  B complex  is  essential  to  the 
physiology  of  nervous  tissue. 

The  estimated  average  per  capita  con- 
sumption of  refined  sugar  is  115  pounds  a 
year.  Not  all  this  is  put  in  our  food  but  is 
consumed  in  sweetened  carbohydrate  drinks 
and  confections.  That  sugar  has  a definite 
inhibitory  action  on  vitamin  B complex  is 
so  well  recognized  that  vitamin  B complex 
is  put  into  the  solution  before  intravenous 
glucose  is  started. 

A complete  dietary  history  is  absolutely 
essential.  In  our  office  we  use  a dietary  his- 
tory chart  as  prepared  by  Roberts.  This 
chart  is  given  to  the  patients  and  they  are 
instructed  to  answer  the  questions  at  home 
and  return  the  completed  blank  by  mail.  An 
analysis  of  the  diet  history  of  100  cases 
picked  at  random  discloses  many  interesting 
features.  Patients  with  this  nasal  syndrome 
drink  a large  quantity  of  milk,  the  average 
being  from  twenty-one  to  eighty  glasses  a 
week.  Children  are  more  inclined  to  drink 
large  quantities  of  milk  due  to  the  fact  that 
during  the  last  few  years  we  have  been 
made  conscious  of  the  growth  and  develop- 
mental qualities  on  the  radio,  through  the 
newspapers  and  schools.  Most  adults  drink 
about  one  glass  of  milk  with  each  meal. 
Both  adults  and  children  eat  large  amounts 
of  carbohydrates,  particularly  candy  bars 
and  pastries.  Vegetables  are  eaten  sparingly 
by  both  classes;  children  are  inclined  to  eat 
cereals,  most  adults  are  not.  The  most  out- 
standing feature  of  the  diet  history,  common 
to  both  adults  and  children,  is  the  fact  that 


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Rocky  Mountain  Medical  Journal 


this  class  of  patients  does  not  eat  fats  or  fat  faults  in  the  patient’s  diet  must  be  corrected 
meat.  It  has  been  shown  earlier  in  this  and  the  following  suggestions  made; 


paper  that  the  nose  with  its  delicate  neu- 
romuscular and  vascular  systems  requires 
fat  in  order  to  keep  up  its  tone  and  to  with- 
stand external  stimulations.  These  patients 
do  not  eat  fat  and  I am  of  the  opinion  that 
the  condition  we  describe  as  a nasal  syn- 
drome is  a local  weakening  of  the  structures 
with  an  increased  permeability  of  the  cells 
due  to  a dietary  deficiency,  particularly  fat. 

Treatment 

The  autonomic  nervous  system  should  be 
appraised  as  to  whether  the  patient  is  dom- 
inant sympathetic  or  dominant  parasympa- 
thetic. The  dominant  sympathetic  has  a 
tendency  to  be  obese,  they  are  nervous  and 
high  strung,  and  t^eir  skin  is  wet  from  per- 
spiration; the  dominant  parasympathetic  is 
the  opposite.  The  dominant  sympathetic 
needs  small  doses  of  iodine  and  mild  acidu- 
lation  while  the  dominant  parasympathetic 
frequently  needs  thyroid  and  much  more 
acidulation.  These  patients  have  been  found 
to  have  a slight  achlorhydria  and  small 
doses  of  dilute  hydrochloric  acid  are  given 
at  the  onset  of  treatment.  Five  to  ten  drops 
of  dilute  hydrochloric  acid  in  cold  water 
with  the  meals  seem  to  have  a beneficial 
effect  on  the  digestion  and  assimilation  of 
the  food. 

Faulty  eating  habits  as  revealed  in  the 
diet  history  should  be  corrected.  Children 
are  not  allowed  to  drink  milk  for  a period 
of  a month.  This  is  due  to  the  fact  that 
many  children  under  my  observation  have 
the  habit  of  drinking  two  or  three  glasses 
of  milk  as  soon  as  they  reach  the  table.  Is 
it  any  wonder  that  they  do  not  care  to  eat 
anything  else?  White  bread  is  also  denied. 
Many  children  will  make  a meal  of  bread 
and  milk  and  nothing  else.  Many  authors 
feel  that  milk,  sweets,  and  white  breads  are 
the  mucus-producing  foods.  However, 
Proetz®  denies  this  statement.  Whether  they 
produce  mucus  or  not,  in  this  case,  it  is  be- 
side the  point.  I deny  these  foods  due  to 
mechanical  reasons. 

Each  case  is  an  individual  problem.  The 


1.  At  least  one  substantial  serving  of  meat 
per  day.  The  patient  is  advised  to  eat  fat 
with  the  lean.  Most  patients  will  object  to 
this  and  at  the  start  they  are  advised  to  eat 
a piece  of  fatty  food  equivalent  to  a piece 
an  inch  square. 

2.  Potatoes  and  gravy  are  urged  at  least 
once  a day.  Many  patients  who  will  not  eat 
fat  meat  will  eat  the  gravy  which  is  nothing 
more  than  the  fat  from  the  meat. 

3.  Cereals  are  advised  once  a day  and  at 
this  time  they  are  permitted  milk  on  the 
cereal. 

4.  Salads  of  raw  vegetables,  particularly 
leafy  varieties,  are  advised  at  least  twice 
daily. 

5.  Fruit  juices  are  urged  at  each  meal; 
however,  the  amount  should  not  exceed 
four  ounces. 

6.  Sugar  and  all  sweet  desserts  are  de- 
nied. 

7.  Coffee  and  tea  are  allowed,  but  the 
patient  is  advised  to  use  very  little  sugar 
or  better  still  to  use  saccharine  as  a sweet- 
ening agent. 

After  the  dietary  deficiences  have  been 
studied  and  corrected,  it  is  well  to  give  some 
form  of  vitamin  therapy.  These  patients 
are  definitely  deficient  in  all  natural  vi- 
tamins. 

After  their  dietary  problem  is  corrected, 
they  are  given  intravenous  vitamin  therapy 
of  vitamin  B complex.  This  is  done  to  build 
up  the  vitamin  content  of  the  body  rapidly 
and  also  to  help  the  assimilation  of  vitamins 
taken  by  mouth.  Roberts  uses  a 2 c.c.  am- 
pule of  vitamin  B complex  which  contains 


Thiamin  Chloride  10  mg. 

Riboflavine  4 mg. 

Nicotinamide  150  mg. 

Pantothenic  Acid  5 mg. 

Pyridoxine  Hydrochloride  10  mg. 


With  the  intravenous  vitamin  therapy,  the 
patient  is  given  one  gel-seal  of  Multicebrin 
every  morning  a half  hour  before  break- 
fast. These  contain 


■for  February,  1949 


129 


Thiamin  Chloride 3 mg. 

Riboflavin  3 mg. 

Pyridoxine  1.5  mg. 

Pantothenic  Acid  5 mg. 

Nicotinamide  25  mg. 

Ascorbic  Acid  75  mg. 

Vitamin  A 10,000  units 

Vitamin  D 100  units 

Conclusions 

1.  The  nose  is  a delicate  network  of 
nerves,  muscle  and  blood  vessels  and  it  is 
subject  to  external  stimulation  the  same  as 
any  part  of  the  body. 

2.  Fat  and  a fat  diet  have  a definite  ef- 
fect on  the  body  and  nose  to  withstand  cold 
and  external  stimulation. 

3.  The  diets  of  American  people  have 
changed  until,,  although  food  is  ample,  the 
people  have  taken  the  various  fads  in  re- 
gard to  their  eating  habits. 


4.  Diet  histories  have  proved  the  lack  of 
fats  in  the  diet  and  have  shown  the  amaz- 
ing increase  of  milk  consumption,  par- 
ticularly among  children. 

5.  High  fat  diet  is  recommended  for  the 
treatment,  along  with  a well  balanced  gen- 
eral diet. 

6.  Vitamin  therapy  is  used  as  an  aid  to 
the  digestion  and  assimilation  of  food. 

REiPERENCEiS 

'Williams,  H.  L. : Intrinsic  Allergy  as  It  Affects 
the  Ear,  Nose  and  Throat.  The  Intrinsic  Allergy 
Syndrome.  Trans,  of  American  Academy  of  Opthol- 
mology  and  Otolaryngology,  p.  379-412,  1943  and  1944. 

'Roberts,  Sam  E.:  A New  Sinus  Syndrome.  Trans, 
of  American  Academy  of  Ophthalmology  and  Oto- 
laryngology, p.  177-193,  1944-1945. 

'Lillie,  H.  L. : Personal  communication. 

'Hansen,  A.  E.,  and  Burr,  George  O. : J.A.M.A.,  Vol. 
132,  No.  14,  p.  855-859. 

“Proetz,  Arthur  A.:  Applied  Physiology  of  the  Nose. 
P.  303,  Anals  Publishing  Co.,  1941. 

“Mitchell,  H.  H.,  and  Associates:  American  Journal 
of  Physiology,  Vol.  146,  No.  1,  p.  84-96,  1946. 


A CLINICAL  STUDY  OF  AURICULAR  FLUTTER* 

G.  PAUL  SMITH,  M.D.,  Grand  Junction,  Colo.,  and  JOSEPH  E.  WELDEN,  M.D.,  St.  Louis,  Mo. 


Auricular  flutter  is  uncommon,  occurring 
once  for  every  fourteen  cases  of  auricular 
fibrillation.  It  may  be  difficult  both  to 
diagnose  and  treat.  This  paper  was  written 
to  illustrate  some  of  these  difficulties.  The 
work  was  greatly  facilitated  by  the  use  of 
a “direct  writing”  electrocardiograph.! 
Electrocardiographically  auricular  flutter  is 
an  arrhythmia  characterized  by  regular 
auricular  activity  at  a rate  of  200-400  per 
minute,  a definite  proportion  of  which  re- 
sults in  ventricular  action.  Auricular  flutter 
was  first  so  named  by  Jolly  and  Ritchie  in 
1911.  The  following  year  Sir  Thomas  Lewis 
described  the  typical  electrocardiogram  of 
auricular  flutter,  the  effect  of  carotid  pres- 
sure on  it,  the  ratio  between  the  auricular 
and  ventricular  rates  and  the  close  relation- 
ship between  auricular  flutter  and  other 
auricular  arrhythmias. 

Digitalis  has  been  used  in  the  treatment 
of  auricular  flutter  with  varying  success 

♦We  wish  to  express  our  appreciation  and  gratitude 
especially  to  Julius  Jensen,  M.D.,  and  John  J.  Ham- 
mond, M.D.,  for  their  most  helpful  advice  and  criti- 
cism; and  to  Miss  Bell,  R.N.,  and  Miss  Harriet 
Schwentker,  R.N.,  and  also  to  the  housestaff  of  the 
St.  Louis  City  Hospital  for  their  assistance  in  making 
this  paper  possible.  Presented  before  the  Mesa  Coun- 
ty Medical  Society  October  5,  1948. 

tThe  Sanborn  Viso-cardiette  was  used  in  this  study. 


since  the  condition  was  first  described,  later 
quinidine  has  also  been  used.  In  1927  Park- 
inson and  Bedford  made  the  observation 
that  quinidine  helps  only  when  it  restores 
normal  sinus  rhythm;  when  it  fails  to  do  so, 
it  may  aggravate  failure  by  a direct  de- 
pressing effect  on  the  myocardium. 

In  the  study  of  auricular  flutter  it  is  often 
important  promptly  to  ascertain  changes  in 
mechanism  and  the  effect  of  therapeutic 
measures  such  as  the  oral  or  parenteral  use 
of  quinidine,  lanatoside  “C”  and  atropine 
or  of  vagal  stimulation,  for,  if  these  changes 
can  be  immediately  recognized  the  doses 
can  be  more  accurately  gauged  and  over- 
dosage avoided.  Therefore,  in  this  work  the 
“direct  recording”  feature  of  the  electrocar- 
diograph was  of  material  assistance. 

Procedure 

Material:  The  present  study  is  based  upon 
eleven  cases.  Nine  were  culled  from  a group 
of  seventy-five  patients  who  were  collected 
for  another  purpose  in  the  St.  Louis  City 
Hospital  from  August  1,  1947,  to  May  31, 
1948,  because  they  had  heart  rates  above 
140.  Two  others  were  found  in  the  course 


130 


Rocky  Mountain  Medical  Journal 


of  routine  examination  of  cardiac  patients 
without  regard  to  rate.  The  patients  had 
various  forms  of  heart  disease,  (Table  1). 
The  average  age  was  64.  Males  outnum- 
bered the  females  nine  to  two.  Two  had 
pulmonary  disease,  one  of  them  also  pleu- 
ral effusion,  which  was  due  to  either  car- 
diac failure  or  pulmonary  disease.  One 
other  patient  had  pleural  effusion  without 
demonstrable  lung  pathology. 


TABLE  1 

Chronic  rheumatic  heart  disease  with  mitral 


stenosis  1 

Syphilitic  aortitis 1 

Arteriosclerotic  heart  disease  6 

Myocardial  infarction  1 

Arteriosclerotic  and  hypertensive  heart  disease  2 

Myocardial  Infarction  1 

Hypertensive  heart  disease  1 

Marked  scoliosis  1 


Two  patients  gave  a history  of  moderate 
alcoholism;  two  had  diabetes  mellitus. 
Cerebrovascular  accidents  were  seen  in  two 
cases,  once  before  flutter  had  developed  and 
once  four  days  after  it  had  stopped  follow- 
ing the  administration  of  quinidine.  All 
eleven  patients  showed  some  signs  of  car- 
diac decompensation.  It  was  advanced  in 
three,  moderate  in  four  and  slight  in  four. 
One  patient  had  had  auricular  flutter  for 
one  and  one-half  years,  one  had  had  it  for 
less  than  two  weeks.  Two  had  previously 
had  chronic  auricular  fibrillation.  Three 
had  had  normal  sinus  rhythm.  In  four 
cases  the  rhythm  preceding  the  period  of 
observation  was  unknown. 

As  might  be  expected,  the  main  attention 
was  given  to  the  treatment  of  the  cardiac 
failure  and  to  certain  other  coexisting  con- 
ditions. The  therapy  of  cardiac  decompen- 
sation was  the  usually  accepted  treatment. 
Five  cases  had  received  digitalis  before 
auricular  flutter  was  noted.  All  the  patients 
were  digitalized  with  the  various  forms  of 
digitalis  which  happened  to  be  on  trial  in 
the  hospital  at  the  time.*  The  effect  of 
digitalis  on  flutter  was  the  same  with  all 
the  preparations  which  were  used  and 
therefore  this  inconsistency  was  presum- 
ably of  little  consequence.  (It  may  be 
noted,  however,  that  Tandowsky  is  of  the 
opinion  that  lanatoside  “C”  has  a specific 


effect  on  the  arrhythmia,  which  is  not 
shared  by  the  other  digitalis  preparations.) 

Quinidine  was  given  to  seven  patients.  A 
test  dose  of  0.2  gm.  of  quinidine  preceded 
the  treatment.  The  next  day  but  occasion- 
ally in  three  or  four  hours  0.4  gm.  was 
given  every  two  hours  until  the  total  daily 
dose  was  administered.  This  was  deter- 
mined by  the  therapeutic  effects  or  by  toxic 
symptoms.  Occasionally  this  dose  was  ex- 
ceeded or  the  interval  between  doses  short- 
ened. 

COMMENTS  ON  CHART  1 

Case  1.  A white  female,  aged  63,  with  mitral 
stenosis  had  had  chronic  auricular  fibrillation 
for  many  years.  By  the  third  hospital  day  1.2 
gm.  of  digitalis  had  been  given  and  on  that  day 
the  patient  suffered  a cerebrovascular  accident. 
On  the  same  day  the  ventricular  rate  (by  auscul- 
tation) increased  from  120  to  180.  Digoxin,  0.4 
mg.,  was  then  given  intravenously.  On  the  fourth 


day  paroxysmal  supraventricular  tachycardia  de- 
veloped. On  that  day  0.2  gm.  of  digitalis  and  1.4 
gm.  of  quinidine  in  divided  doses  were  given. 
On  the  fifth  day  auricular  flutter  was  discov- 

•Variations  in  the  following-  list  of  drugs  were 
used  in  these  cases:  Oral  digitalis  leaf,  oral  digoxin, 
oral  digilanid,  intramuscular  digalen,  intravenous 
digoxin,  intravenous  lanatoside  “C,”  intravenous 
strophanthin  K. 

UK/iftr  OP  tHE 

OP  PrYSlClA?® 

r , , r 


for  February,  1949 


131 


ered.  It  was  transient  and  recur]:;ed  for  a few 
hours  on  the  tenth  day.  Quinidine  was  main- 
tained at  0.8  gm.  per  day  from  the  fifth  to  the 
ninth  day.  On  the  tenth  day  the  patient  be- 
came comatose.  The  coma  persisted  and  the  pa- 
tient expired  on  the  thirteenth  hospital  day. 


Electrocardiograms  from'  Chart  E 
Column  A Column  B Column  C 


Case  2.  A white  male,  aged  65,  with  arterio- 
sclerosis and  hypertension  was  admitted  with 
evidence  of  auricular  flutter  and  an  anterior 
myocardial  infarct.  Symptoms  of  cardiac  de- 
compensation had  been  present  for  three  days. 
Oral  digitalis  was  given.  Symptomatic  improve- 
ment was  noted.  During  the  second  week  quini- 
dine was  given  in  small  doses  up  to  0.6  gm.  per 
day  for  three  days.  At  this  time  flutter  changed 
to  fibrillation.  There  was  slight  decompensation 
on  bed  rest.  At  the  end  of  the  second  week 
quinidine  was  given  for  two  days  in  divided 
doses  totaling  1 gm.  per  day.  During  the  fourth 
week  2 gms.  per  day  for  two  days  were  ad- 
ministered. No  change  in  the  auricular  fibrilla- 
tion was  noted.  The  patient  was  discharged 
slightly  improved.  The  ventricular  rate  was  slow 
during  the  entire  stay. 

Case  3.  A white  male,  aged  82,  with  aortic 
regurgitation  and  a positive  serology  entered 
the  hospital  with  cardiac  decompensation.  Au- 
ricular flutter  was  diagnosed.  The  patient  had 
been  receiving  digitalis  irregularly.  Digitalis  was 
given  0.3  gm.  daily  for  three  days  and  0.1  gm. 
daily  thereafter.  On  the  sixth  day  a 0.2  gm.  test 
dose  of  quinidine  was  given.  Quinidine  was  then 
administered  in  divided  doses  as  follows:  2 gm. 
on  the  seventh  day,  2.4  gm.  on  the  eighth,  3.2 
gm.  on  the  tenth  and  2.0  gm.  on  the  twelfth. 
Flutter  persisted  for  eleven  days  and  on  the 
twelfth  day  apparently  reverted  directly  to  nor- 
m.al  sinus  rhythm.  Improvement  was  noted  after 


the  onset  of  normal  sinus  rhythm.  On  the  fourth 
day  after  reversion  a cerebrovascular  accident 
occurred  and  the  patient  expired  the  next  day. 
Auricular  rates  are  charted  on  three  occasions: 
275  on  the  second  day,  200  on  the  eighth  and  220 
on  the  tenth.  Ventricular  rates  remained  below 
100  during  the  entire  course. 

Case  4.  A white  male,  aged  72,  with  arterio- 
sclerotic heart  disease  entered  with  signs  and 
symptoms  of  an  acute  abdominal  condition  and 
auricular  flutt,er  with  a ventricular  rate  of  186 
and  auricular  rate  of  372.  Treatment  was  in- 
stituted with  penicillin  and  streptomycin.  On 
the  sixth  day  surgical  drainage  was  performed. 
Intravenous  digoxin  was  given  in  divided  doses 
every  four  to  six  hours.  Daily  doses  were  as 
follows:  0.75  mg.,  1.0  mg.,  0.0  mg.,  0.1  mg.,  0.35 
mg.,  0.1  mg.,  and  0.2  mg.  On  the  fourth  day  the 
flutter  changed  to  normal  sinus  rhythm.  On  the 
fifth  day  flutter  recurred.  On  the  seventh  day 
normal  sinus  rhythm  reappeared.  The  patient 
had  no  further  instances  of  rapid  pulse  on  main- 
tenance doses  of  digitalis  but  succumbed  to  mul- 
tiple liver  abscesses  several  days  later. 

Case  5.  A white  male,  aged  61,  with  arterio- 
sclerotic heart  disease  and  a history  of  excessive 
beer  consumption.  Symptoms  of  cardiac  failure 
were  slight  and  of  only  ten  days  duration.  Au- 
ricular flutter  with  a ventricular  rate  of  150  was 
diagnosed.  Treatment  consisted  of  oral  digitalis 
in  divided  doses.  Daily  doses  were  as  follows: 
0.6,  0.4,  0.6,  0.3,  0.2  gms.  for  seven  days  then  0.1 
gm.  daily.  On  the  fourth  day  auricular  fibrilla- 
tion with  a ventricular  rate  of  100  developed.  On 
the  ninth  day  normal  sinus  rhythm  was  noted 
and  persisted  throughout  the  hospital  stay.  On 
the  tenth  and  twelfth  days  quinidine  was  inad- 
vertently given. 

Case  6.  A white  male,  aged  63,  with  arterio- 
sclerotic heart  disease,  pneumonia,  and  right 
pleural  effusion.  Symptoms  and  signs  of  cardiac 
decompensation  were  slight.  On  admission  the 
pulse  was  regular  at  128.  On  the  second  hospital 
day  auricular  flutter  was  diagnosed  with  a ven- 
tricular rate  of  160  and  auricular  rate  of  320.  A 
single  intravenous  dose  of  0.75  mg.  of  digoxin 
was  given.  The  following  day  normal  sinus 
rhythm  was  present.  Penicillin  and  supportive 
tiierapy  failed  to  control  the  pneumonia  and  the 
patient  expired  on  the  ninth  day.  There  had 
been  no  recurrences  of  tachycardia. 

Case  7.  A white  female,  aged  55,  with  diabetes 
and  symptoms  of  cardiac  insufficiency  for  two 
years.  On  admission  she  was  also  found  to  have 
an  anterior  myocardial  infarct.  After  three  days 
auricular  flutter  developed  which  lasted  until 
the  fifteenth  day.  Then  paroxysmal  supraventric- 
ular tachycardia  developed  which  lasted  until 
the  seventeenth  day,  when  a recurrence  of  the 
flutter  was  noted.  Between  the  fourth  and  twen- 
ty-second days  the  ventricular  rate  varied  be- 
tween 115  and  140.  Daily  doses  of  cardiac  drugs 
were  given  as  follows:  digalen  intramuscularly, 
4 c.c.  on  the  eleventh  day,  2 c.c.  on  the  twelfth 
and  6 c.c.  on  the  thirteenth.  Quinidine  was  given 
in  0.8  gm.  doses  daily  on  the  eleventh,  twelfth 
and  thirteenth  days;  2.4  gm.  were  given  on  the 
sixteenth  and  1.8  gm.  on  the  seventeenth  days. 
On  the  seventeenth  day  transient  shock  was 
noted.  The  next  day  increased  cardiac  insuffi- 
ciency was  present.  On  the  eighteenth  and  nine- 
teenth days  0.5  c.c.  of  strophanthin  K was  given. 
During  the  next  five  days  4 c.c.  of  digalen  were 
given  daily  intramuscularly.  Quinidine,  1.6  gm. 
was  again  given  on  the  twenty-third  and  1.4  gm. 
on  the  twenty-fourth  days.  On  the  twenty-third 
day  a normal  sinus  rhythm  was  noted  which 


132 


Rocky  Mountain  Medical  Journal 


changed  to  auricular  fibrillation  on  the  twenty- 
fifth  day.  During  the  next  five  months  the  pa- 
tient was  maintained  on  digitalis  0.1  gm.  daily 
and  chronic  auricular  fibrillation  persisted.  Au- 
ricular flutter  was  then  again  noted  and  it  re- 
mained unchanged  for  at  least  two  months. 

Case  8.  A white  male,  aged  53,  with  hyper- 
tensive and  arteriosclerotic  heart  disease  en- 
tered in  advanced  congestive  failure  with  an 
apical  heart  rate  of  150.  Auricular  fibrillation 
was  present.  The  next  day  the  apical  pulse  was 
176  and  regular.  Auricular  flutter  was  diagnosed; 
1.6  nig.  of  lanatoside  “C”  was  given  before  the 
flutter  occurred.  The  flutter  was  transient,  as 
on  the  third  day  auricular  fibrillation  was  again 
present.  On  the  fifth  day  digitalis,  0.3  gm.  daily 
for  three  days,  was  given  and  then  0.1  gm.  daily. 
Auricular  fibrillation  persisted.  The  ventricular 
rate  decreased  gradually  to  100  on  the  tenth  day. 

Case  9.  A white  male,  aged  72,  with  arterio- 
sclerotic heart  disease  and  advanced  congestive 
failure  was  noted  to  have  auricular  flutter  on  ad- 
mission. The  flutter  persisted  and  over  a six-day 
period  the  ventricular  rate  gradually  decreased 
from  140  to  100.  Cardiac  medication  was  given 
as  follows:  1.5  mg.  digoxin  orally  on  the  first 
day,  0.5  mg.  orally  and  0.5  mg.  intravenously  on 
the  second  day,  1 gm.  quinidine  on  the  third  day, 
oral  digoxin,  0.5  mg.  on  the  fourth  day,  0.4  gm. 
quinidine  and  0.75  mg.  oral  digoxin  on  the  fifth 
day,  1.2  gm.  quinidine  and  0.5  mg.  oral  digoxin 
on  the  sixth  day.  The  patient  was  moribund  on 
the  seventh  day  and  expired  on  the  eighth  day 
in  uremia. 

• 

Case  10.  A white  male,  aged  60,  with  hyper- 
tensive cardiovascular  disease  and  marked 
scoliosis  due  to  poliomyelitis  complained  of 
shortness  of  breath,  ankle  edema,  and  orthopnea. 
On  admission  the  pulse  was  160.  Auricular  flut- 
ter was  confirmed  by  electrocardiography.  The 
ventricular  rate  decreased  to  80  only  three  hours 
after  1.6  mg.  of  lanatoside  “C”  was  given  intra- 
venously. Four  hours  after  the  drug  was  given 
auricular  fibrillation  occurred  with  an  apical 
rate  of  80.  Fourteen  hours  after  the  administra- 
tion of  the  drug  normal  sinus  rhythm  was  es- 
tablished with  a pulse  rate  of  108.  The  pulse 
rate  remained  regular  between  95  and  110  with- 
out specific  cardiac  therapy  during  the  rest  of 
the  hospital  stay. 


Chart 


Case  11.  A white  male,  aged  60,  with  minimal 
evidence  of  arteriosclerotic  heart  disease  en- 
tered because  of  recurrent  episodes  of  slight 
dyspnea,  palpitation  and  a “heavy”  sensation  in 
the  precordial  region.  The  patient  frequently 


drank  beer  to  excess.  A year  and  a half  ago  he 
was  treated  in  another  hospital  for  eight  weeks 
without  effect  on  chronic  auricular  flutter.  The 
chart  shows  auricular  and  ventricular  rate 
changes  as  determined  by  electrocardiograms. 
On  admission  the  apical  rate  was  140  per  min- 
ute. The  first  tracing  showed  an  auricular  rate 
of  272  and  a ventricular  rate  of  110.  Vigorous 
therapy  with  lanatoside  “C”  intravenously  and 
oral  digilanid  was  given  in  divided  doses  as  fol- 
lows: 


EleetrgcaraiQgrams  ffsa  Chart  11 
CoiUma  .A  Column  B Column  C 


The  ventricular  rate  slowed  promptly  to  70  on 
the  second  day.  A slight  increase  in  auricular 
rate  was  noted.  Carotid  pressure  had  little  effect 
on  the  auricular  rate  but  caused  marked  very 
transient  slowing  of  the  ventricle.  /Mecholyl,  25 
mg.,  was  followed  by  little  change  in  the  auricu- 
lar rate  and  an  increase  in  the  ventricular  rate 
from  70  to  92.  Atropine  used  after  auricular 
slowing  from  quinidine  resulted  in  further  imme- 
diate auricular  slowing  and  a slight  increase  in 
the  ventricular  rate.  Quinidine  was  usually  fol- 
lowed by  a slight  ventricular  acceleration.  The 
maximum  auricular  slowing  followed  the  ad- 
ministration of  3.2  gms.  of  quinidine.  The  auric- 
ular rate  was  165  at  that  time.  [Magnesium  sul- 
fate, 10  c.c.  of  25  per  cent  solution,  intravenously 
resulted  in  practically  no  change.  In  spite  of  re- 
newed vigorous  administration  of  lanatoside  “C” 
and  digilanid,  flutter  persisted.  When  seen  two 
weeks  later  the  patient  still  had  auricular  flutter. 
The  ventricular  rate  was  106.  Digitalis  is  being 
continued  in  maintenance  doses. 

Results 

In  most  respects  our  findings  resemble 
those  already  established  in  the  literature 
on  auricular  flutter.  Auricular  flutter  was 
found  in  the  middle  and  older  age  groups 
(Table  2).  The  control  cases  were  ninety- 
seven  in  number  taken  at  random  from  the 
m.edicine  service  wards.  Although  both  age 


Oays  

...1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

L.  “C”  mg 

1.6 

0.8 

0.8 

0.8 

0 

0 

0 

0 

0 

0 

0.8 

0.8 

0.8 

Digilanid  mg. 

.0 

0 

0 

0.33 

0 

0.33 

0.33 

0.33 

0.33 

0.33 

0.33 

0.33 

0.33 

Oral  quinidine  was  given  after  a 0.2  gm.  test  dose  as  follows: 

Days 4 6 7 8 

Quinidine  (total  dose  completed  in  8 hr.  periods) 2.0  2.0  2.8  3.2  gms. 


133 


for  February,  1949 


groups  average  the  same,  the  control  cases 
have  representation  in  all  decades  while  the 
flutter  group  is  confined  to  the  sixth  to  ninth 
decades.  Males  predominated  over  females 
nine  to  two.  Organic  heart  disease  and 
varying  degrees  of  failure  were  present  in 
all  our  cases  though  they  were  very  slight 
in  one  (Case  11). 

Pulmonary  disease,  which  was  present  in 
two  cases,  may  possibly  have  been  instru- 
mental in  causing  the  flutter  in  these.  In 
six  cases  severe  congestive  failure  and  au- 
ricular flutter  coexisted  and  in  these  (Cases 
4,  6,  8 and  10)  relief  of  symptoms  was  noted 
when  the  mechanism  changed  either  to 
auricular  fibrillation  or  normal  sinus 
rhythm,  in  others  (Cases  7 and  9)  the  con- 
gestive failure  was  prolonged  when  diffi- 
culty was  encountered  in  abolishing  the  ar- 
rhythmia. 

In  six  cases  the  ratio  of  auricular  to  ven- 
tricular complexes  was  2:1  when  untreated. 
When  4:1  ratio  was  encountered,  it  usually 
remained  constant  throughout  the  tracing; 
3 to  1 ratio  and  greater  than  4 to  1 ratios 
were  often  inconstant  and  resulted  in  an 
irregular  ventricular  rhythm  resembling 
auricular  fibrillation  on  auscultation.  The 
basic  ratio  of  any  tracing  would,  however, 
reveal  itself  on  close  observation  of  the  ven- 
tricular rhythm  and  regular  action  would 
recur  at  frequent  intervals. 

Mecholyl  was  given  to  patient  No.  11 
while  he  was  receiving  digitalis.  The  ven- 
tricular rate  increased  from  72  to  92,  but 
there  was  no  change  in  the  auricular  rate. 
Atropine  caused  a decrease  in  the  auricular 
rate  from  240  to  228  and  an  increase  in  the 
ventricular  rate  from  80  to  114.  No  change 
in  rate  followed  magnesium  sulfate. 

Digitalis  in  Cases  5,  10  and  11  caused  an 
increase  in  the  auricular  flutter  rate  and  a 
decrease  in  the  ventricular  rate.  In  Case  4 
the  auricular  as  well  as  the  ventricular  rate 
was  slowed.  At  times  digitalis  was  followed 


by  a change  to  auricular  fibrillation  (Cases 
5,  8 and  10)  which  then  in  turn  often  re- 
verted to  normal  sinus  rhythm  (Cases  5 and 
10).  In  Cases  4 and  6 auricular  flutter  ap- 
parently changed  directly  to  normal  sinus 
rhythm  while  the  patient  was  receiving 
digitalis.  In  three  cases  (1,  7 and  8)  the 
patients,  auricular  fibrillators,  had  been  on 
digitalis  when  flutter  occurred.  Case  1 also 
had  had  quinidine.  Case  8 had  transient 
flutter  occurring  after  1.6  mg.  of  lanatoside 
“C”  was  given  intravenously.  Recurrent 
flutter  occurred  when  Case  7 was  on  main- 
tenance digitalis. 

Quinidine.  In  Cases  3 and  7 quinidine  was 
followed  by  a change  from  flutter  to  normal 
sinus  rhythm,  while  in  Cases  9 and  11  there 
was  no  such  change. . It  was  given  in  two 
cases  (1  and  2)  both  before  and  after  flutter 
changed  to  fibrillation.  No  further  change 
was  noted  in  these  cases.  Quinidine  was  fol- 
lowed by  a slowing  of  the  auricular  flutter 
rate  from  272  to  165  per  minute  in  case  11. 
Patients  9 and  11  received  both  digitalis  and 
quinidine  without  change  in  mechanism; 
No.  9 was  very  sick,  the  course  was  pro- 
gressively downhill  and  the  patient  died  on 
the  eighth  hospital  day.  In  Case  11  auric- 
ular flutter  was  well  established,  having 
been  present  for  one  and  one-half  years; 
there  was  little  evidence  of  failure.  How- 
ever, patient  No.  11  became  severely  nau- 
seated on  the  day  large  doses  of  both  digi- 
talis preparations  and  quinidine  were  given 
together. 

Auricular  flutter  is  closely  related  to 
other  auricular  rhythms,  which  are  fre- 
quently observed  to  precede  or  follow  it. 
On  admission  auricular  flutter  was  present 
in  seven  cases,  of  which  two  persisted 
throughout,  two  passed  directly  into  normal 
sinus  rhythm,  two  changed  to  fibrillation 
then  in  turn  to  normal  sinus  rhythm,  and 
one  changed  to  persistent  auricular  fibrilla- 
tion. On  admission  auricular  fibrillation 
was  present  in  two  of  our  cases,  of  which 


TABLE  2 

Decades  

2nd 

3rd 

4th 

5th 

6th 

7th 

8th 

9th 

Total 

Control  cases  

6 

5 

10 

15 

20 

30 

9 

2 

97 

Auricular  flutter  .. 

0 

0 

0 

0 

2 

6 

2 

1 

11 

134 


Rocky  Mountain  Medical  Journal 


one  changed  to  flutter  and  then  back  into 
fibrillation,  the  other  changed  to  paroxysmal 
auricular  tachycardia  to  flutter  then  back 
to  auricular  fibrillation.  Two  patients  were 
first  seen  with  a normal  sinus  rhythm  in 
whom  one  developed  auricular  flutter  and 
then  returned  to  normal  sinus  rhythm,  the 
other  had  a series  of  arrhythmias  in  the  fol- 
lowing order:  auricular  flutter,  auricular 
tachycardia,  auricular  flutter,  normal  sinus 
rhythm,  auricular  fibrillation  and  auricular 
flutter.  The  close  relationship  of  auricular 
flutter  to  other  auricular  mechanisms  was 
illustrated  by  the  promptness  with  which 
it  alternated  with  them  (Table  3). 


TABLE  3 

Case  1. 

Fibrillation  to  auricular  tachycardia 
to  flutter  to  filbrillation  to  flutter  to 
fibrillation. 

" 2. 

Flutter  to  fibrillation. 

" 3. 

Flutter  to  normal  sinus  rhythm. 

4. 

Flutter  to  normal  sinus  rhythm. 

" 5. 

Flutter  to  fibrillation  to  normal  sinus 
rhythm. 

" 6. 

Normal  sinus  rhythm  to  flutter  to  nor- 
mal sinus  rhythm. 

7. 

Normal  sinus  rhythm  to  flutter  to 
auricular  tachycardia  to  flutter  to 
normal  sinus  rhythm  to  fibrillation 
to  flutter. 

" 8. 

Fibrillation  to  flutter  to  fibrillation. 

9. 

Flutter  persistent. 

" 10. 

Flutter  to  fibrillation  to  normal  sinus 
rhythm. 

" 11. 

Flutter  persistent. 

Discussion 

The  advantage  of  direct  electrocardio- 
graphic observation  in  clinical  evaluation  of 
this  kind  was  repeatedly  impressed  upon 
us.  Changes  are  immediately  registered  and 
treatment  can  be  adjusted  as  soon  as  in- 
dicated. Also  the  advantage  in  both  under- 
graduate and  postgraduate  instruction  is 
obvious. 

Occasionally  when  flutter  waves  are 
small  and  inconspicuous,  special  or  addi- 
tional leads  may  facilitate  the  diagnosis.  If 
auricular  waves  are  not  detected  in  one  or 
more  leads  from  a multiple  lead  tracing, 
esophageal  or  a precordial  lead  taken  from 
the  third  interspace  just  to  the  right  of  the 
sternum  usually  amplify  the  auricular  com- 
plex. 

for  February,  1949 


The  physical  diagnosis  of  auricular  flut- 
ter depends  upon  the  following  signs:  regu- 
lar rapid  jugular  pulsations,  regular  ven- 
tricular rhythm  or  irregular  ventricular  ac- 
tion with  recurring  regularly  spaced  rhythm 
pattern,  exercise  test  resulting  in  irregular- 
ity or  doubling  of  the  heart  rate,  transient 
decrease  in  pulse  (a  fractional  portion  of 
the  original  rate)  during  vagal  stimulation, 
and  varying  intensity  of  the  first  heart 
sound.  The  diagnosis  is  usually  tentative 
because  these  signs  are  difficult  to  establish 
with  certainty.  Jugular  pulsations  are  dif- 
ficult to  detect,  often  there  is  no  change 
after  exercise,  carotid  pressure  may  be  in- 
effective, and  the  first  sound  varies  only 
when  the  rhythm  is  irregular,  as  it  does 
also  in  other  arrhythmias. 

The  diagnosis  of  auricular  flutter  is  made 
from  the  electrocardiogram.  The  character- 
istic rapid,  regular  auricular  flutter  waves 
with  their  constantly  changing  baseline  con- 
firms it.  Only  in  a few  instances  are  spe- 
cial leads  necessary.  Sometimes  the  record- 
ing of  vagal  stimulation  aids  in  the  diag- 
nosis (Case  7). 

The  differential  diagnosis  is  from  sinus 
tachycardia,  auricular  fibrillation,  paroxys- 
mal supraventricular  tachycardia  and  ven- 
tricular tachycardia.  It  is  most  accurately 
made  from  the  electrocardiogram.  Digitalis 
is  indicated  in  all  of  them  except  ventricu- 
lar tachycardia  in  which  it  is  contraindi- 
cated because  of  the  danger  of  precipitating 
ventricular  fibrillation. 

Prompt  discovery  of  the  usual  signs  of 
drug  effect  and  danger  signs  is  made  pos- 
sible by  direct  bedside  tracings  (Table  4). 

Auricular  flutter  may  be  expected  in  thy- 
rotoxic, rheumatic,  arteriosclerotic,  hyper- 
tensive and  syphilitic  heart  disease.  Occa- 
sionally it  occurs  in  the  absence  of  organic 
heart  disease.  Acute  infections  are  some- 
times accompanied  by  auricular  flutter.  Our 
patients  were  relatively  old  and  underlying 
conditions  incident  to  age  prevailed  (Table 
1).  In  patients  predisposed  to  auricular 
flutter,  the  arrhythmia  may  be  provoked  by 
extraneous  factors:  Two  patients  (5  and  11) 
gave  a history  of  recent  alcoholic  excess. 
According  to  White  acute  alcoholism  may 
precipitate  cardiac  irregularities.  Patient  9, 

135 

op  the 

Pffysf/'i, ... 


cnr , 

^^^LECE  Qr? 


TABLE  4 


Signs  of  Drug  Effect 

Digitalis 

Shortening  of  the  Q-T  interval 
S-T  and  T wave  changes 
Lengthening  of  P-R  interval 
Bradycardia 
Quinidine 

Lengthening  of  Q-T  interval 
S-T  and  T wave  changes 

Less  commonly  P-R  lengthening  & Tachycardia 

Danger  Signs 

Digitalis 

Extrasystoles,  coupling,  partial  and  complete 
heart  block,  ventricular  tachycardia  and  ven- 
tricular fibrillation. 

Quinidine 

Widening  of  QRS  over  25  per  cent,  periods  of 
sinus  arrest  or  asystole,  rapid  irregular  heart 
action,  tachycardia  over  130-140,  ventricular 
tachycardia  and  ventricular  fibrillation. 


in  whom  treatment  was  ineffective,  died  in 
uremia.  This  condition  also  has  been  con- 


sidered a cause  of  cardiac  irritation.  In  two 
cases  we  noted  the  presence  of  pulmonary 
disease.  In  four  out  of  eleven  cases  of  ar- 
rhythmia following  pneumonectomy  Massie 
found  flutter.  Digitalis  may  have  caused 
flutter  in  our  Cases  1,  7 and  8;  quinidine  may 
have  been  a factor  in  Case  1 since  the  pa- 
tient was  receiving  this  drug  when  she  de- 
veloped the  arrhythmia. 

Auricular  flutter  is  sometimes  compli- 
cated by  spontaneous  alternations  with  au- 
ricular fibrillation  and  paroxysmal  auricular 
tachycardia.  Probably  all  of  these  arrhyth- 
mias are  closely  related.  Emboli  are  re- 
ported in  about  7 per  cent  of  cases  of  au- 
ricular flutter.  Hemiplegia  developed  in  two 
of  our  cases;  however,  in  one  auricular 
fibrillation  was  present  at  the  time  the  em- 
bolus occurred  and  embolism  is  more  com- 


DESCRIPTIONS  OF  ELECTROCARDIOGRAMS  FROM  CHART  1 

Column  A 

Case  No.  1 

First  day 

1.  Lead  II 

Auricular  fibrillation 

Column  B 

Fifth  day 

Precordial  lead  Vj 

Auricular  flutter 

Independent  junctional  rhythm 

Column  C 

Tenth  day 

Precordial  lead 

Auricular  flutter 

High  grade  block 

Case  No.  2 

Second  day 

2.  Precordial  lead  Vo 

Auricular  flutter 

6:1  A.  V.  ratio 

Fifth  day 

Special  Precordial  lead,  third 
right  interspace 

4:1  and  5:1  A.  V.  ratio 

Thirty-third  day 

Same  lead  as 

Column  B,  row  2 

Auricular  fibrillation 

Case  No.  3 

Eleventh  day 

3.  Lead  III 

Auricular  flutter 

3:1  and  4:1  A.  V.  ratio 

Case  No.  3 

Twelfth  day 

Lead  II 

Sinus  rhythm 

P-R  interval  0.28  sec. 

Case  No.  4 

Third  day 

Lead  I 

Auricular  flutter 

3:1  A.  V.  ratio 

Case  No.  4 

Second  day 

4.  Lead  II 

Auricular  flutter  Carotid  pressure  and  release 

2:1  A.V.  ratio  shown  by  arrows 

Case  No.  4 

Fourth  day 

Lead  II 

Sinus  rhythm 

P-R  0.21  sec. 

Case  No.  5 

First  day 

5.  Augmented  vector  foot 

lead 

Auricular  flutter 

2:1  A.  V.  ratio 

Fifth  day 

Lead  III 

Auricular  fibrillation 

Ninth  day 

Lead  II 

Sinus  rhythm 

P-R  0.20  sec. 

Case  No.  7 

Sixtieth  day 

6.  Lead  I 

Aur.  fibrillation 

After  six  months 

Precordial  lead  Vi 

Auricular  flutter 

2:1  A.  V.  ratio 

Same  date  as  B 6 

Special  precordial  lead  thira  rt. 
intersp. 

Increased  A.  V.  block  from, 
carotid  pressure 

Case  No.  8 

Second  day 

7.  Lead  I 

Aur.  flutter 

2:1  A.  V.  ratio 

Lead  II 

Note  widening  of  QRS 
due  to  flutter  wave. 

Lead  III 

Case  No.  10 

First  day 

8.  Lead  II 

Auricular  flutter 

2:1  A.  V.  ratio 

Four  hours  after 
lanatoside  “C” 

Lead  II 

Auricular  fibrillation 

Fourteen  hours  after 
lanatoside  “C” 

Lead  II 

Sinus  rhythm 

136 


Rocky  Mountain  Medical  Journal 


DESCRIPTIONS  OF  ELECTROCARDIOGRAMS  FROM  CHART  H 


Column  A 

Before  treatment 

1. 

Lead  I 

Column  B 

Auricular  rate  272 

Ventricular  rate  110 

Lead  II 

Column  C 

Lead  III 

Sixteen  hours  after  1.6  mg. 

2.  Lanatoside  “C” 

Auricular  rate  284 
Ventricular  rate  71 

Lead  II 

15  minutes  after  25 
mg.  Mecholyl 

Aur.  rate  280 

Vent,  rate  92 

Lead  II 

1 hour  after  24  grains  quinidine 
Aur.  rate  240 

Vent,  rate  80 

Lead  II 

The  third  day  on  lanatoside  “C”  during 

3.  carotid  pressure 

Auricular  rate  280 

Lead  II 

Shortly  after  tracing 

Col.  C,  row  2 

5 minutes  after  1 mg. 

atropine  intravenously 

Aur.  rate  228 

Vent,  rate  114 

Lead  II 

After  36  grains  quinidine 

4.  Aur.  rate  200 

Vent,  rate  67 

Lead  II 

After  42  grains  quinidine 

Aur.  rate  176 

Vent,  rate  87 

Lead  II 

After  48  grains  quinidine 

Aur.  rate  164 

Vent,  rate  82 

Lead  II 

mon  in  association  with  fibrillation.  Con- 
gestive failure  may  be  due  to  the  rapid 
heart  rate  in  cases  of  auricular  flutter  and 
is  aggravated  by  the  poor  effect  of  auricular 
contraction  upon  ventricular  filling. 

Digitalis  is  the  most  effective  drug  in  the 
treatment  of  flutter.  Recent  publications 
have  presented  better  results  in  therapy 
than  heretofore,  attributing  their  successes 
to  more  rapid  acting  digitalis  preparations 
given  in  larger  doses  and,  when  quinidine 
is  used,  larger  doses  given  at  shorter  in- 
tervals. However,  if  digitalis  and  quinidine 
are  given  together,  both  in  large  doses, 
toxic  rhythms  may  result  from  their  syn- 
ergistic action. 


Book  Reviews 

The  Skin  Diseases,  A Manual  for  Practitioners  and 
Students:  By  James  Marshall,  M.D.,  B.S.,  M.R.C.S., 
I.R.C.P. : Consulting-  Dermatologist,  Central  Mid- 
dlesex County  Hospital;  Director  of  Venereal  Dis- 
eases Clinic,  Royal  Northern  Hospital,  London; 
lately  Adviser  in  Venereology  to  the  War  Office, 
etc.;  Membre  de  la  Societe  Francaise  de  Derma- 
tologic et  de  Syphiligraphie;  Membre  Correspon- 
dant  de  la  Societe  Beige  de  Dermatologie  et  de 
Syphiligraphie.  London,  MacMillan  & Co.,  Ltd., 
1948.  Price,  $7.50. 

Dr.  Marshall,  formerly  of  London  and  now  a 
practitioner  of  South  Africa,  has  written  a book 
designed  for  general  practitioners  and  students. 
It  comprises  adequate  discussion  of  all  the  com- 
mon skin  diseases,  mention  and  brief  description 
of  some  of  the  rarer  cutaneous  skin  disorders 
and  a brief  review  of  syphillis.  The  descriptions 
are  clear  and  well  illustrated  by  photographs,  a 
few  of  which  are  in  color.  One  impressive  state- 
ment in  the  book  is  that  “no  specific  treatment 
should  be  instituted  for  a nonspecific  condition 
or  a condition  in  which  the  diagnosis  is  in 
doubt.”  Another  statement  also  worthy  of  em- 
phasis is  “penicillin  is  being  used  enormously  for 
the  treatment  of  skin  diseases  and  a great  deal 
of  which  is  entirely  wasted.”  The  same  is  true 
of  the  suKonamides,  “these  two  remedies,  used 


Summary 

Eleven  cases  of  auricular  flutter  were 
studied  in  regard  to  etiology,  diagnosis, 
electrocardiographic  findings,  effects  of 
vagal  stimulation,  immediate  and  delayed 
effects  of  drug  administration  and  associ- 
ated conditions. 

The  advantage  of  controlling  such  cases 
as  well  as  other  arrhythmias  by  tracings 
visible  at  the  bedside  is  emphasized.  A bet- 
ter understanding  of  the  mechanism,  diag- 
nosis, and  treatment  may  result  if  the  “di- 
rect recording”  electrocardiograph  is  used 
routinely  on  such  studies  in  the  future. 


with  discretion  in  conditions  where  there  are 
definite  indications,  are  of  great  value,  but  their 
misuse  will  only  bring  them  into  unmerited  dis- 
repute.” The  book  is  362  pages  and  adds  another 
creditable  text  for  general  practitioners  in  a 
field  which  is  in  danger  of  being  overcrowded 
with  small  texts  on  dermatologic  conditions. 

O.  S.  PHILPOTT. 


Pathology:  Edited  by  W.  A.  D.  Anderson,  M.A.,  M.D., 
P.A.C.P.,  Professor  of  Pathology  and  Bacteriology, 
Marquette  University  School  of  Medicine,  Mil- 
■waukee,  Wisconsin.  With  1183  Illustrations  and  10 
Color  Plates.  The  C.  V.  Mosby  Company,  St.  Louis, 
1948. 

This  is  the  first  edition  of  a book  which  is  cer- 
tain to  become  an  important  portion  of  the  arm- 
amentarium of  every  teacher  and  student  of 
pathology. 

The  collaborators  are  well  chosen  and  present 
authoritative  viewpoints  in  their  respective 
fields. 

General  and  special  pathology  is  well  and  con- 
cisely presented.  Figures  and  plates  are  well 
chosen,  clear  cut,  pertinent  and,  in  most  in- 
stances, original. 

The  bibliography  at  the  end  of  each  chapter  is 
complete  and  should  be  of  great  help  to  the  user 
of  the  book. 

S.  K.  KURLAND. 


for  February,  1949 


137 


Organization 

National  Affairs  - Proceedings  - Programs  - Society  Notices  - News  - Auxiliary 


COLORADO 

State  Medical  Society 


FOURTEENTH  ANNUAL  MIDWINTER 
POSTGRADUATE  CLINICS  OF  THE 
COLORADO  STATE  MEDICAL 
SOCIETY 

March  1,  2,  3,  4,  1949 

PRELIMINARY  PROGRAM 

(A  detailed  pamphlet  program  will  be  mailed  to  each 
member  of  the  Society  early  in  February). 

All  Buffet  Limcheons,  Round  Table  Discussions, 
Afternoon  Meetings^  Symposium  and  Dinner  Dance 
will  be  held  at  the  Shirley-Savoy  Hotel.  The  Morning 
Clinics  will  be  held  on  Wednesday,  March  2,  at  Chil- 
dren’s Hospital:  Thursday,  March  3,  at  Colorado  Gen- 
eral Hospital,  and  Friday,  March  4,  at  Fitzsimons  Gen- 
eral Hospital. 

Tuesday,  March  1,  1949 

AFTERNOON 

2:00 — Registration  Opens  in  the  Empire  Room,  Shir- 
ley-Savoy Hotel. 

EVENING 

6:30 — Dinner  Meeting  of  the  Medical  Society  of  the 
City  and  County  of  Denver.  (All  physicians 
attending  the  Clinics  are  cordially  invited). 
Silver  Glade,  Cosmopolitan  Hotel. 

9:30 — Annual  Smoker. — Colorado  Room,  Shirley-Sa- 
voy Hotel. 

Wednesday,  March  2,  1949 
MORNING 
Children’s  Hospital 
Herman  I.  Laff,  M.D.,  Presiding 
President  Children's  Hospital  Staff 

8:30 — Registration  Opens  (at  both  Hospital  and  Ho- 
tel) . 

9:00 — Pediatric  Clinics. — Cases  presented  by  staff  of 
Children’s  Hospital  with  discussion  by  James 
L.  Wilson,  M.D.,  Ann  Arbor,  Michigan 
(Guest) . 

10:00 — Surgical  Clinics. — Cases  presented  by  staff  of 
Children’s  Hospital  with  discussion  by  Francis 
D.  Moore,  Boston  (Guest). 

10:45 — E.N.T.  Clinics. — Cases  presented  by  staff  of 
Children’s  Hospital  with  discussion  by  Law- 
rence R.  Boies,  M.D.,  Minneapolis. 

11:30 — Allergy  Clinics. — Cases  presented  by  staff  of 
Children’s  Hospital  with  discussion  by  Her- 
bert J.  Rinkel,  M.D.,  Kansas  City  (Guest). 
12:15 — Adjourn. 

NOON 

12:30 — All  Exhibits  Open. 

12:30 — Buffet  Luncheon  and  Round  Table  Discussion 
in  Colorado  Room,  Shirley-Savoy  Hotel. 


Question  and  Answer  Period  conducted  by 
James  L.  Wilson,  M.D.,  Francis  D.  Moore, 
M.D.,  Herbert  J.  Rinkel,  M.D.,  Lawrence  R. 
Boies,  M.D.  (Guests). 

AFTERNOON 

Lincoln  Room  of  the  Shirley-Savoy  Hotel 
F.  A.  Humphrey,  M.D.,  Presiding 
President-elect,  Colorado  State  Medical  Society 

2:00 — Antibiotic  Therapy.  — Paul  B.  Beeson,  M.D., 
Atlanta,  Georgia  (Guest). 

2:45 — Management  of  Portal  Hypertension. — Arthur 
H.  Blakemore,  M.D.,  New  York  (Guest). 

3:30 — Intermission  to  study  exhibits. 

3:45 — Uterine  Surgery. — IWilliam  C.  Danforth,  M.D., 
Evanston,  Illinois  (Guest). 

4:30 — Problem  of  Inhalant  Allergy. — Herbert  J.  Rink- 
el, M.D.,  Kansas  City  (Guest). 

5:00 — Food  Allergy. — Herbert  J.  Rinkel,  M.D.,  Kan- 
sas City  (Guest). 

5:30 — Adjourn. 

5:30 — Exhibits  close  for  the  day. 

EVENING 
(Open  Date) 

Thursday,  March  3,  1949 

MORNING 

Colorado  General  Hospital 
Robert  S.  LiggetTi,  M.D.,  Presiding 

Professor  of  Medicine,  University  of  Colorado  School 
of  Medicine 

8:30 — Registration  Opens  at  both  Hospital  and  Hotel. 

9:00 — Medical  Clinics. — Cases  presented  by  staff  of 
Colorado  General  Hospital  with  discussion  by 
A.  C.  Corcoran,  M.D.,  Cleveland  (Guest). 

10:00 — Surgical  Clinics. — Cases  presented  by  staff  of 
Colorado  General  Hospital  with  discussion  by 
Arthur  H.  Blakemore,  M.D.,  New  York 
(Guest) . 

1 1 : 00 — Obstetrics  and  Gynecology  Clinics.  — Cases 
presented  by  staff  of  Colorado  General  Hos- 
pital with  discussion  by  William  C.  Danforth, 
M.D.,  Evanston,  Illinois  (Guest). 

1 2 : 00 — Adj  oum . 

NOON  . 

12:30 — All  Exhibits  Open. 

12:30 — iBuffet  Limcheon  and  Round  Table  Discussion, 
Colorado  Room,  Shirley-Savoy  Hotel. 

Question  and  Answer  period  conducted  by  A. 
C.  Corcoran,  M.D.,  Arthur  H.  Blakemore, 
M.D.,  and  William  C.  Danforth,  M.D.  (Guests). 

AFTERNOON 

Lincoln  Room  of  the  Shirley-Savoy  Hotel 
O.  W.  Davidson,  M.D.,  Presiding 
President  of  the  Kansas  Medical  Society 

2:00 — Surgical  Therapy  in  Cardiovascular  Disease. — 
Arthur  H.  Blakemore,  M.D.,  New  York 
(Guest) . 

2:45 — Current  Problems  in  Otology. — Lawrence  R. 
Boies,  M.D.,  Minneapolis  (Guest). 

3:30 — Intermission  to  study  Exhibits. 


138 


Rocky  Mountain  Medical  Journal 


Bowel  Management 
of  the  Irritable  Colon  . . . 


"As  an  aid  in  reestablishing  a normal  rhythm,  the  tem- 
porary use  of  a biand  bulk-producer  . . . may  be  bene- 
ficial  Patients  having  irritable  colon  who  believe  they 

are  suffering  from  constipation  commonly  use  high-residue 
diets, . . . They  may  not  realize  that  this  practice  is  similar 
to  using  irritating  cathartics  or  large  enemas  and  often 
increases  the  tendency  to  constipation  by  increasing 
spasm  of  the  colon."^ 


Metamucil  is  "a  bland  bulk-producer”  which  gently 
initiates  reflex  peristalsis  and  movement  of  the 
intestinal  contents.  The  "smoothage”  therapy  of 
Metamucil  encourages  a return  of  the  normal  func- 
tion of  the  colon  without  irritating  the  mucosa. 


METAMUCIL 


is  the  highly  refined  mucilloid  of  Plantago  ovata 
(50%),  a seed  of  the  psyllium  group,  combined 
with  dextrose  (50%)  as  a dispersing  agent. 


SEARLE 


RESEARCH 


IN  THE  SERVICE  OF  MEDICINE 


*CoNins,  E.  N,t  The  Diagnosis  and  Treatment  of  Irritable  Colon:  Physiologic,  Local, 
Irritative  and  Psychosomatic  Factors,  M.  Clin.  North  America  32:398  (March)  1 948. 


for  February,  1949 


139 


3:45 — Present  Status  of  the  Treatment  of  Essential 
Hypertension. — A.  C.  Corcoran,  M.D.,  Cleve- 
land (Guest). 

4:30 — Present  Day  Management  of  Duodenal  Ulcer. 
— Francis  D.  Moore,  M.D.,  Boston  (Guest). 

5: 15 — Adjourn. 

EVENING 

7:00 — All  Exhibits  Open. 

8:00 — Symposium  on  Abdominal  Pain. — Casper  F. 
Hegner,  M.D.,  Presiding.  James  L.  Wilson, 
M.D.,  Arthur  H.  Blakemore,  M.D.,  Lawrence 
R.  Boies,  M.D.,  William  C.  Danforth,  M.D., 
Herbert  J.  Rinkel,  M.D.,  Francis  D.  Moore, 
M.D.,  A.  C.  Corcoran,  M.D.,  Paul  B.  Beeson, 
M.D.  (Guests).  Lincoln  Room,  Shirley-Savoy 
Hotel. 

8:00 — Woman's  Auxiliary. — Health  Education  Mov- 
ies. (Members  of  the  Auxiliary  and  their 
friends  are  cordially  invited). 

Friday,  March  4,  1949 

MORNING 

Pitzsimons  General  Hospital,  Aurora,  Colorado 
Colonel  Edwin  Roberts,  M.D.,  Presiding 
Commanding  Officer  Fitzsimons  General  Hospital 

8:30 — Registration  Opens  (at  both  Hospital  and  Ho- 
tel) . 

9:00 — Medical  Clinics. — Cases  presented  by  staff  of 
Fitzsimons  General  Hospital  with  discussion 
by  Paul  B.  Beeson,  M.D.,  Atlanta  (Guest). 

10:00 — Surgical  Clinics. — Cases  presented  by  staff  of 
Fitzsimons  General  Hospital  with  discussion 
by  Francis  D.  Moore,  M.D.,  Boston  (Guest). 

11:00 — E.N.T.  Clinics. — Cases  presented  by  staff  of 
Fitzsimons  General  Hospital  with  discussion  by 
Lawrence  R.  Boies,  M.D.,  Minneapolis  (Guest). 

12:00— Adjourn. 

NOON 

12:30 — All  Exhibits  Open, 

12:30 — Buffett  Luncheon  and  Round  Table  Discussion, 
Colorado  Room,  Shirley-Savoy  Hotel. 

Question  and  Answer  period  conducted  by  Paul 
B.  Beeson,  M.D.,  Francis  D.  Moore,  M.D.,  and 
Lawrence  R.  Boies,  M.D.  (Guests). 

AFTERNOON 

Lincoln  Room  of  the  Shirley-Savoy  Hotel ' 
George  E.  Baker,  M.D.,  Presiding 
President,  Wyoming  State  Medical  Society 

2:00 — Analysis  of  Symptoms  of  Respiratory  Pathology 
in  Infancy.^ — ‘James  L.  Wilson,  M.D.,  Ann  Ar- 
bor (Guest). 

2:45 — Fever  of  Obscure  Origin. — Paul  B.  Beeson, 
M.D.,  Atlanta  (Guest). 

3:30 — Intermission  to  study  exhibits. 

3:45 — The  Kidney  in  Disease. — A.  C.  Corcoran, 
M.D.,  Cleveland  (Guest). 

4:30 — Current  Concepts  of  the  Metabolic  Alterations 
Produced  by  Trauma,  Surgery  and  Repair. — 
Francis  D.  Moore,  M.D.,  Boston  (Guest). 

5: 15 — Adjourn. 

EVENING 

7:30 — Annual  Subscription  Dinner  Dance. — Lincoln 
Room,  Shirley-Savoy  Hotel.  Dress  optional. 


TECHNICAL  EXHIBITS 

Aloe  Company.  A.  S.,  Booth  Number  31. 
Ames  Company,  Inc.,  Booth  Number  25. 
Baker  Laboratories,  Inc.,  Booth  Number  7. 


Berbert,  George  H.  6 Sons,  Booths  Numbers  36,  40 
cuid  41. 

Blair  Surgical  Supply,  Booths  Numbers  37  and  38. 

Ciba  Pharmaceutical  Products,  Inc.,  Booth  Number  15. 

Colvin  Brothers,  Booth  Number  12. 

Dictaphone  Corporation,  Booth  Number  27. 

Durbin  Surgical  Supply  Co.,  Booth  Number  19. 

General  Electric  X-Ray  Corp.,  Booth  Number  35. 

Gerber  Products  Co.,  Booth  Number  33. 

Narrower  Laboratories,  Booth  Number  2. 

HARROV/ER  LABORATORY,  INC.,  of  Glendale,  Califor- 
nia, invites  you  to  visit  the  Mucotin  exhibit  which  has 
three  main  points  of  interest.  1.  Gastroscopic  studies  of  a 
gastric  ulcer  and  its  response  to  treatment.  2.  Antacid 
effectiveness  studies.  3.  Gastroscopic  studies  of  the  coat- 
ing action  of  Mucotin.  Mucotin  is  accepted  by  the  Coun- 
cil on  Pharmacy  and  Chemistry  of  the  American  Medical 
Association. 

Lanteen  Medical  Laboratories,  Inc.,  Booth  Number  9. 

Lederle  Laboratories,  Booth  Number  8. 

Eli  Lilly  and  Co.,  Booth  Number  26. 

M 6 R Dietetic  Laboratories,  Inc.,  Booth  Number  39. 

M & R Dietetic  Laboratories,  Inc.,  Booth  Number  39,  will 
display  Similac,  a food  for  infants.  Our  representatives 
will  appreciate  the  opportunity  to  discuss  the  merit  and 
suggested  application  for  both  the  normal  and  special 
feeding  cases. 

Mead  Johnson  and  Company,  Booth  Number  4. 

William  S.  Merrell  Co.,  Booth  Number  20. 

Mosby  Company  of  California,  C.  V.,  Booth  Num- 
ber 1. 

Muckle  X-Ray  Co.,  Booth  Number  24. 

Parke,  Davis  6 Co.,  Booth  Number  11. 

Members  of  the  PARKE,  DAVIS  & COMPANY  Medical 
Service  Staff  will  be  on  hand  at  our  Commercial  Exhibit 
for  consultation  and  general  discussion  of  the  Products 
classified  in  our  Pharmaceutic,  Antibiotic,  and  Biologic 
Lines.  Important  Specialties,  such  as  Penicillin  S-R,  Bena- 
dryl, Vitamin  Products,  Hypnotics,  Antibiotics,  Etamon, 
Oxycel,  Thrombin  Topical,  Influenza  Virus  Vaccine,  and 
other  Biologies  will  be  featured.  You  are  cordially  invited 
to  visit  our  Booth  with  the  assurance  that  your  interest 
will  indeed  be  very  much  appreciated. 

Philip  Morris  6 Co.,  Ltd.,  Inc.,  Booth  Number  5. 

Philip  Morris  & Company  will  demonstrate  the  method 
by  which  it  was  found  that  Philip  Morris  Cigarettes,  in 
which  diethylene  glycol  is  used  as  the  hygroscopic  agent, 
are  less  irritating  than  other  cigarettes.  Their  represen- 
tative will  be  happy  to  discuss  researches  on  this  subject, 
and  problems  on  the  physiological  effects  of  smoking. 

Republic  Drug  Company,  Booth  Number  28. 

Sandoz  Chemical  Works,  Inc.,  Booth  Number  22. 

Schering  Corporation,  Booth  Number  34. 

Searle  6 Co.,  G.  D.,  Booth  Number  17. 

Sharp  6 Dohme,  Inc.,  Booth  Number  10. 

Smith,  Kline  and  French,  Booth  Number  32. 

Squibb  & Sons,  E.  R.,  Booth  Number  6. 

Westinghouse  X-Ray  Co.,  Booth  Number  30. 


Auxiliary 

WOMAN’S  AUXILIARY  PROGRAM 
Thursday,  March  3 

3:00  p.m.-5:00  p.m. — Tea  for  Board  Members. 
Home  of  Mrs.  A.  A.  Wearner,  President,  330 
Albion  Street,  Denver. 

8:00  p.m. — Health  Education  Films.  Shirley- 
Savoy  Hotel. 

Friday,  March  4 

10:00  a.m. — Midwinter  Board  Meeting  and  Lunch- 
eon*. Cosmopolital  Hotel. 


*LunciiPon  tickets  $1.50.  Send  reservations  to  Mrs. 
Wearner. 


140 


Rocky  Mountain  Medical  Journal 


WILL  OCCUR  IN  THE  NEXT  3 MONTHS 


GRAPH  OF  MEASLES  INCIDENCE 


OF 

CASES  WILL  OCCUR 
IN  THE  NEXT 
3 MONTHS 

JU □□□DL 

A S O N D 


The  obove  graph  is  based  on  U.  S.  P.  M.  measles 
incidence  figures  for  a 'ten  year  period. 


*No  cases  of  reaction  resulting  from  use  of  Cutter 
Immune  Serum  Globulin  have  been  reported. 


You  con  prevent  or  modify  measles 
without  fear  of  side  reactions 


There’s  one  sure  way  of  silencing  crying  youngsters  and 
nervous  mamas  who  complain  about  reactions  — specify 
Cutter  Immune  Serum  Globulin— Human.  Successful  results 
with  this  product  are  not  happenstance.  They  come  from; 

!•  Excellent  raw  material  — fresh  venous  blood  from  normal  donors. 
2«  The  water-clarity  of  a hemolysis-free  and  non-pyrogenic  product. 

3.  The  concentration  of  160  mgm.  per  cc.  of  gamma  globulin— main- 
tains consistent  globulin  potency  yet  permits  low  volume  adjustable 
dosage: 


Tor  prevention  — 

0.1  cc.  Immune  Serum  Globulin 
For  modification  — 

0.02  cc.  Immune  Serum  Globulin 


intromuscufarfy/ 
per  pound 
body  weight 


Prepare  now  for  measles’  peak  season  just  ahead.  Notify 
your  pharmacist  the  amount  of  gamma  globulin  you  ex- 
pect to  use— and  specify  Cutter. 

CUTTER  LABORATORIES  • BERKELEY  10.  CALIFORNIA 


be  prepared  with  — 


IMMUNE  SERUM  GLOBULIN- 


for  February,  1949 


141 


Obituaries 

BERTRAM  B.  JAFFA 

Dr.  Bertram  B.  Jaffa,  well-known  Denver  ob- 
stetrician, died  on  January  22,  1949,  at  the  age 
of  53. 

Bom  in  Starkville,  Colorado,  on  January  3, 
1896,  he  moved  to  Roswell,  New  Mexico,  when 
a child,  where  he  completed  his  elementary 
and  high  school  education.  Ke  graduated  from 
the  University  of  Colorado  in  1917  with  a 
bachelor  of  arts  degree. 

Dr.  Jaffa  served  with  the  Army  Air  Force 
during  World  War  I.  Upon  his  return  to  civilian 
life  he  entered  the  University  of  Colorado  School 
of  Medicine,  graduating  in  1922.  He  interned 
at  Denver  General  Hospital  and  in  1923  became 
a resident  physician.  In  1928  he  became  man- 
ager of  health  and  charities  for  the  City  of 
Denver.  He  was  a member  of  the  Denver  County 
and  Colorado  State  Medical  Societies,  the  Centr^ 
Obstetrical  and  Gynecological  Society  and  the 
American  College  of  Surgeons. 

Dr.  Jaffa’s  passing  will  be  keenly  felt  by  his 
many  patients  and  friends.  He  had  a large 
following  and  was  highly  respected  by  all  who 
knew  him. 


JOHN  B.  DAVIS 

Dr.  John  Bramwell  Davis,  widely  known  Den- 
ver urologist,  died  on  December  23,  1948,  at  the 
age  of  74. 

Born  in  Indianapolis,  Indiana,  on  November  4, 
1874,  he  came  to  Denver  with  his  parents  when 
he  was  six.  He  attended  Denver  University  and 
Gross  Medical  College,  receiving  his  medical  de- 
gree from  the  latter  in  1902. 

A fellow  of  the  American  College  of  Surgeons 
and  a diplomat  of  the  American  Board  of  Urolo- 
gy, Dr.  Davis  served  as  president  of  the  South 
Central  Section  of  the  American  Urological  As- 
sociation in  1941-42.  He  was  chief  of  the  Urolo- 
gical service  at  Colorado  General  Hospital  from 
1930  to  1933. 

A member  of  the  Medical  Advisory  Board  of 
Selective  Service,  Dr.  Davis  also  served  for  sev- 
eral years  as  secretary  to  the  Colorado  State 
Board  of  Medical  Examiners. 

Nationally  prominent  in  his  field,  his  passing 
will  be  keenly  felt  and  mourned  throughout  the 
urological  world. 


COLORADO  SOCIETY  OF  ANESTHESIOL- 
OGISTS 

The  Colorado  Society  of  Anesthesiologists  held 
a dinner  meeting  at  the  University  Club,  Denver, 
January  14,  1949.  Invited  guests  were  the  phy- 
sicians who  had  enrolled  in  the  Postgraduate 
Course  in  Anesthesiology  for  General  Practition- 
ers given  at  the  University  of  Colorado  Medical 
Center.  This  work  had  been  under  the  super- 
vision of  Dr.  Philip  Lief,  Professor  of  Anes- 
thesiology. After  cocktails  and  dinner.  Dr. 
C.  Walter  Metz,  Chairman  of  the  Section  on 
Anesthesiology  of  the  American  Medical  Asso- 
ciation, spoke  on  ‘“Anesthesiology  in  Relation  to 
General  Practice,”  and  Dr.  Lawrence  Camp- 
bell, President  of  the  Society,  spoke  on  “The 
Need  for  an  Anesthesiological  Study  Commis- 
sion.” This  was  followed  by  a general  discussion 
period  which  was  very  interesting  since  the 
guests  came  from  the  various  communities  of  the 
Rocky  Mountain  Area,  and  were  doctors  who 
were  administering  the  anesthetics  in  their  lo- 
calities. 


NEW  MEXICO 

Medical  Society 


ANNUAL  MEETING 

The  next  annual  session  of  the  New  Mexico 
Medical  Society  will  be  held  in  Roswell,  May 
5,  6,  and  7,  1949.  The  Chavez  County  Medical 
Society  is  planning  an  excellent  meeting  and 
hope  that  all  members  of  the  State  Society 
will  plan  to  attend. 

MONTANA 

State  Medical  Association 


INTERIM  SESSION,  MONTANA  STATE 
MEDICAL  ASSOCIATION 

The  mid-winter  session  of  the  Montana  State 
Medical  Association  was  held  in  Helena,  Mon- 
tana, Friday  and  Saturday,  January  28  and  29, 
1949.  This  interim  session  was  divided  into  two 
sections:  The  House  of  Delegates  meeting  on 
Friday  and  the  first  part  of  Saturday  morning, 
and  the  Scientific  Session  the  later  half  of 
Saturday  morning  and  Saturday  afternoon. 

During  the  Friday  afternoon  session  of  the 
House  of  Delegates  an  adjournment  was  declared 
in  order  that  the  House  reconvene  as  the  Ad- 
niinistrative  members  of  the  Montana  Physi- 
cians’ Service.  The  principal  matter  of  business 
at  the  Montana  Physicians’  Service  meeting  was 
a report  of  a special  fee  schedule  committee  and 
its  subsequent  adoption  by  the  Administrative 
members  after  several  minor  changes  had  been 
made.  These  recommendations  were  then  re- 
ferred to  the  Board  of  Trustees  of  the  Montana 
Physicians’  Service  and  later  reported  out  of 
that  body  as  being  accepted. 

Among  the  important  problems  taken  up  by 
the  House  of  Delegates  was  the  endorsement  by 
the  Medical  Association  of  the  formation  of  a 
local  unit  of  the  American  Heart  Association  in 
Montana  and  the  establishment  of  a pilot  pro- 
gram in  Cascade  Coimty  for  the  care  and  treat- 
ment of  rheumatic  fever  patients.  The  associa- 
tion also  took  official  action,  endorsing  in  prin- 
ciple the  proposal  of  the  United  Mine  Workers 
and  their  Welfare  and  Retirement  Fund  as  being 
worked  out  in  this  area  under  the  able  leader- 
ship of  the  Colorado  State  Medical  Society. 

The  House  also  appealed  by  resolution  to  the 
Legislature,  presently  in  session,  to  pass  a bill 
v.’hich  would  appropriate  monies  to  assist  in 
the  erection  of  additional  facilities  in  the  state 
for  the  care  of  tuberculous  Indians.  The  House 
gave  earnest  consideration  again  to  the  proposed 
legislation  regarding  changes  of  the  personnel 


142 


Rocky  Mountain  Medical  Journal 


During  the  past  several  years,  Lederle  has  made 
a very  substantial  investment  in  time  and  money 
for  the  investigation  of  nutritional  deficiency 
states.  The  vast  majority  of  such  investigations 
lead  down  dead-end  streets,  but  occasionally — 
and  most  fortunately  for  mankind — a brilliant 
result  is  achieved.  One  of  the  fields  in  which  these 
efforts  have  proven,  and  are  proving,  successful 
is  the  field  of  nutritional  macrocytic  anemias. 
The  first  step  in  the  conquest  of  this  field  was  the 


perfection  of  a practicable  intramuscular  liver 
extract  by  Lederle  several  decades  ago.  More 
recently,  the  Lederle-Cyanamid  research  team 
isolated  and  synthesized  folic  acid,  which  has 
been  proven  specific  for  the  macrocytic  anemias 
of  sprue,  infancy  and  childhood,  pregnancy,  gas- 
trointestinal dysfunction,  and  pellagra.  We  are 
close  to  a solution  of  many  other  similar  nutri- 
tional problems.  FOLVITE*  Folic  Acid  Lederle, 
in  various  forms,  is  available  for  prescription  use. 


LEDERLE  LABORATORIES  DIVISION 


AMER/CA/V 


(j^uunid 


COMPA/vr 


30  ROCKEFELLER  PLAZA  • NEW  YORK  20.  N.  Y. 


for  February,  1949 


143 


of  the  State  Board  of  Health.  The  work  of  the 
Medical  Association  committee  together  with  the 
Montana  State  Dental  Association  committee 
which  resulted  in  the  legislation  being  intro- 
duced, received  the  approval  of  the  delegates, 
s 

The  House  went  on  r^prd  as  enthusiastically 
approving  the  $25  special  assessment  made  by 
the  House  of  Delegates  of  the  American  Medical 
Association  in  December  and  urged  every  mem- 
ber of  the  State  Association  to  forward  his 
assessment  at  an  early  date.  An  excellent  re- 
port of  the  Public  Relations  Commitee,  Dr.  H.  W. 
Gregg,  Chairman,  was  presented  to  the  dele- 
gates and  the  excellence  of  the  report  was  rec- 
ognized by  official  action  of  the  House.  This 
report  was  as  follows: 

Report  of  Committee  on  Public  Relations,  Montana 
State  Medical  Association 

Your  committee  met  in  Great  Falls,  Montana,  on 
January  23,  1949. 

Present  were  Dr.  Dora  Walker,  Great  Falls;  Dr. 
W.  L.  DuBois,  Conrad;  Dr.  R.  V.  Morledge,  Billing’s, 
and  Dr.  H.  W.  Gregg,  Butte.  Dr.  W.  H.  Stephan, 
the  fifth  member  of  the  committee,  was  absent. 

Much  valuable  assistance  was  given  the  com- 
mittee by  Dr.  Thomas,  Walker,  President-elect  of 
the  State  Medical  Society,  and  Dr.  Frank  McPhail, 
Chairman  of  the  Montana  Health  Planning  Com- 
mittee. Dr.  Hawkins,  whom  we  hoped  to  have 
present,  was  unable  to  attend. 

Your  committee  started  with  the  premise  which 
is  peihaps  as  old  as  the  medical  profession,  but 
which  we  feel  is  sometimes  forgotten  in  our  de- 
fense against  forces  which  tend  to  degrade  the 
medical  profession.  This  premise  is  that  all  of 
our  public  relations  should  place  emphasis  first 
on  public  welfare,  and  not  on  the  welfare  of  our 
profession.  Wo  know,  of  course,  that  what  hap- 
pens to  the  doctor  has  a definite  relation  to  public 
welfare  and  that  if  the  doctor  is  forced  into  a 
type  of  practice  which  makes  it  impossible  for 
him  to  do  his  best  work,  the  public  will  be  the 
first  to  suffer.  However,  in  our  relations  with  the 
public  we  have  not  perhaps  always  been  careful 
to  make  this  plain. 

It  is  the  feeling  of  your  committee,  that  if  there 
ever  was  a time  for  vituperation  and  name  calling, 
in  our  dealings  with  those  who  oppose  us,  that 
time  has  long  since  passed. 

It  is  your  committee’s  feeling  that  there  is  still 
much  confusing  in  the  minds  of  our  own  profession 
as  to  just  what  is  happening;  That  we  are  not 
yet  aware  that  the  revolution  of  the  1930s,  if  one 
is  to  call  it  that,  has  had  a profound  effect  on 
every  part  of  living  in  every  country  in  the  world. 
We  must  realize  that  today,  all  over  the  world, 
many  more  things  are  expected  of  governments 
than  were  expected  fifty  years  ago.  We  must 
realize  that  no  government  can  stand  which  does 
not  in  some  way  arrange  for  some  of  the  things 
which  people  are  demanding  from  their  govern- 
ments. 

We  feel  that  perhaps  on  the  county  society  level, 
one  meeting  a month,  or  at  least  one  meeting  every 
two  months,  might  well  be  devoted  to  papers  by 
some  of  our  profession  who  might  educate  our 
own  profession  as  to  the  basic  principles  and  the 


details  of  the  changes  that  are  going  on,  and  that 
are  proposed  in  medical  practice. 

It  is  yourf  committee’s  feeling  that  it  is  entirely 
futile  to  fight  socialized  medicine  as  long  as  we 
close  our  eyes  to  the  problems  which  make  so  large 
a percentage  of  our  people  vote  for  men  who  are 
committed  to  the  bringing  about  of  socialized 
medicine. 

As  a committee  and  as  individual  members  we 
are  unalterably  opposed  to,  and  feel  that  the  medi- 
cal profession  of  Montana  is  unalterably  opposed 
to,  any  system  that  does  not  involve  free  choice 
of  phjtsihlans  and  payment  on  a fee  for  service 
basis.  We  dp  not  feel  that  it  would  add  anything 
to  medical  care  to  put  the  whole  population  on  any 
system  comparable  to  even  the  best  contract  practice 
in  the  country. 

Your  committee  feels  that  just  now  ’’the  house 
is  on  fire”  and  that  every  concentrated  effort  must 
be  made  by  the  profession  to  keep  present  proposed 
pernicious  legislation  from  being  enacted  at  the 
present  session  of  Congress.  , 

It  is  our  impressiolP  that  probably  our  best  mode 
of  attack  to  carry  out  this  purpose  is  prompt  pay- 
ment of  the  assessment  to  the  American  Medical 
Association.  The  American  Medical  Association  has 
employed  a public  relations  firm  which  success- 
fully fought  the  fight  against  state  socialized  medi- 
cine in  California  and  we  believe  that  we  have  our 
best  chance  in  working  through  this  medium. 

If  this  legislation  can  be  defeated  during-  the 
present  sfession  of  Congress  we  shall  have  another 
year  td  organize  our  forces  and  to  improve  our 
public  ,r,^lations,  and  further  to  bring  forward  con- 
structi-vfe  plans  for  something  to  take  the  place  of 
compuftory  insurance  and  to  meet  the  demands  of 
the  people  who  are  so  radically  bent  on  imme- 
diately socializing  the  whole  set-up  of  medicine. 

Wye  believe  that  some  of  the  suggestions  which 
might  be  made  to  head  off  the  set-up  that  is  being 
pushed  at  us  must  be  suggestions  and  help  in 
fully  utilizing  the  Blue  Shield  and  Blue  Cross. 

We  believe  that  if  the  present  proposed  radical 
legislation  is  beaten  for  this  year.  Congress  might 
be  willing  to  listen  to  suggestions  for  full  support 
of  our  voluntary  insurance  set-ups,  both  by  the 
people  and  perhaps  by  the  Government  itself. 

It  was  further  suggested,  and  is  only  thrown 
out  as  a suggestion,  that  perhaps  it  might  be 
possible  for  our  leaders  to  go  directly  to  Senator 
Murray,  for  instance,  and  to  other  men  who  are 
trying  to  force  legislation  which  we  do  not  want, 
and  that  if  we  have  something  concrete  to  offer 
in  the  place  of  the  compulsory  insurance  bill,  we 
might  get  somewhere.  This  is,  of  course,  prob- 
lematic at  the  present  tjme,  especially  since  the 
proponents  of  socialized  medicine  apparently  re- 
ceived a further  mandate  from  the  voters  at  the 
last  general  election.  Most  of  the  committee  mem- 
bers have  rather  definite  ideas  about  possibilities 
along  this  line. 

Further  little  suggestions  for  improving  our 
public  relations  in  Montana  are  inserted. 

First,  that  which  has  been  mentioned  before — 
educate  ourselves. 

Secondly,  in  our  dealings  with  our  own  people, 
let  us  try  to  help  in  a reasonable  way  to  educate 
them.  For  instance,  if  patients  come  to  us  with 
stories  of  tremendous  bills  or  bills  which  they  think 
are  tremendous  from  one  of  our  colleagues,  it  is 
perfectly  silly  for  dny  of  us  to  say  to  that  patient 
“Did  he  actually  charge  you  that  much?”  We 
should  try  our  best  to  explain  why  the  bill  is  large. 


144 


Rocky  Mountain  Medical  Journal 


ESTRUGENONE 


TRADEMARK 


(Estrogenic  Substances,  Water  Insoluble) 

50,000  1.  U.  (5  mg.)  per  cc. 

With  Benzyl  Alcohol  2% 

ESTRUGENONE  * — a new  form  of  purified  estrogens  from  natural  sources, 
affording  the  advantages  of  parenteral  therapy  at  no  greater  cost  than  oral 
medication. 


Single  injection  provides  dissolved  estrogens  (about  one-tenth  the  injected 
dose)  for  rapid  action,  and  a central  implant  of  the  remainder,  consisting  of 
thin  microplatelets  which  exert  an  effect  lasting  approximately  a month. 
CONTROL  OF  THERAPY  remains  in  the  hands  of  the  physician,  without 
requiring  numerous  office  visits.  When  shorter  intervals  between  treatments 
are  desired,  ESTRUGENONE  20,000  I.  U.  (2  mg.)  per  cc.  may  be  given. 
FEATURES:  Slow  drop  in  estrogen  level  permits  physiologic  adjustment  to 
low  postmenopausal  blood  hormone  levels  . . . Minimal  likelihood  of  with- 
drawal bleeding . . . Microplatelets  pass  readily  through  a 22-gauge  needle . . . 
Syringes  are  easily  cleaned  after  use. 

SUPPLIED:  ESTRUGENONE  50,000  I.  U.  (5 mg.) per  cc.;  5-cc.  multiple-dose  vials. 
ESTRUGENONE  20,000 1.  U.  (2  mg.)  per  cc.:  5-cc.  vials;  1-cc.  ampuls,  boxes  of  25. 


* Exclusive  trademark  of  Kremers-Urban  Co. 


Established  1894 

Box  2038 MILWAUKEE  1,  WISCONSIN 


for  February,  1949 


145 


For  instance,  it  may  be  explained  that  if  a man 
has  a gall  bladder  operation,  and  the  cost  is  quite 
large  for  both  hospital  and  doctor,  it  is  quite 
possible  that  the  patient  has  never  spent  more 
than  a few  dollars  for  medical  care  in  his  whole 
life  before  and  that  this  charge  properly  should 
be  spread  over  a lifetime. 

Of  course,  the  committee  realizes,  as  all  of  us 
realize,  that  even  in  Montanaj  the  medical  pro- 
fession does  have  some  very  few  gougers  and  we 
feel  that  the  medical  profession  must  police  it  own 
ranks  along  this  line. 

We  feel  that  we  should  ask  the  hospitals  to  in- 
form the  public  in  some  way  as  to  why  hospital 
bills  are  up.  It  should  be  self-evident,  but  we 
feel  that  it  would  improve  our  public  relations  were 
the  hospitals  to  try  to  make  this  more  plain. 

With  all,  it  is  your  committee’s  impression  that 
the  medical  profession  should  in  every  way  stand 
behind  decent,  sensible  public  health  reforms,  both 
on  county,  state  and  national  levels.  More  will 
be  said  about  this  in  other  committee  reports. 

Your  committee  further  recommends  that  every 
effort  be  made  to  interest  the  young  men  of  the 
state  in  the  problems  of  public  relations.  We  feel 
that  many  of  our  committees  in  the  State  Medical 
Society  should  be  chairmaned  and  mostly  staffed 
by  young  men.  Those  of  us,  more  or  less  past 
fifty,  have  perhaps  tried  to  do  too  much  of  the 
thinking  for  our  profession.  We  have  now  a 
younger  generation  who  have  grown  up,  gotten 
their  education,  and  have  begun  practice  since  the 
so-called  revolution  of  the  30s.  Much  of  the  trouble 
in  which  we  find  ourselves  now  is  the  younger 
men's  baby  and  they  should  have  a chance  to 
rightly  or  wrongly  care  for  their  own. 

The  House  of  Delegates  also  approved  the 
present  program  of  Nurse  Recruitment  in  Mon- 
tana and  expressed  a desire  to  assist  in  this 
effort.  It  was  suggested  that  individual  doctors 
be  urged  to  contribute  to  this  effort  and  also  that 
the  assistance  of  the  Public  Health  League  of 
Montana  be  enlisted. 

By  vote  of  the  House  of  Delegates,  it  was 
decided  to  hold  the  next  session  on  the  two 
days  immediately  preceding  the  meeting  of  the 
Rocky  Mountain  Medical  Conference  in  Buttte, 
Montana. 

Following  adjournment  of  the  House,  the 
Scientific  Session  began  and  the  following  ex- 
cellent papers  were  read:  “The  Use  of  Peni- 
cillin in  Pyogenic  Bone  Infections,”  by  Dr.  S.  L. 
Odgers,  Butte;  “Common  Tumors  of  the  Skin,” 
by  Dr.  F.  S.  Marks,  Billings;  “Hypertension,”  by 
Dr.  M D.  Winter,  Miles  City;  “The  Jaundiced 
Patient,”  by  Dr.  J.  A.  Layne,  Great  Falls;  and 
“Lessons  Learned  Through  a Six-Year  Maternal 
Mortality  Study  in  Montana — 1 940  Through 
1945,”  by  Dr.  G.  A.  Carmichael,  Missoula. 

An  excellent  banquet  was  provided  by  the 
Lewis  and  Clark  County  Medical  Society  on 
Friday  evening  in  the  Rathskeller  Room  of  the 
Montana  Club.  Dr.  Thomas  L.  Kawkins  pre- 
sided as  toastmaster  and  the  guest  speaker  was 
Mr.  Ed.  G.  Toomey,  prominent  Helena  attorney. 


UTAH 

State  Medical  Association 


MEDICAL  SERVICE  BUREAU  OF  THE 
UTAH  STATE  MEDICAL 
ASSOCIATION 

Summary  of  the  Minutes  of  the  Annual 
Stockholders  Meeting 

September  2,  1948 

Hotel  Ei  Escalante 
Cedar  City 
Utah 

The  annual  stockholders’  meeting  was  held  at 
the  El  Escalante  Hotel  in  Cedar  City,  Utah,  on 
September  2,  1948,  at  7:00  p.m.  The  meeting 
was  a dinner  meeting  to  which  all  of  the  stock- 
holders were  invited  guests.  Following  dinner 
the  meeting  was  addressed  by  Dr.  Gordon  B. 
Leitch  of  Portland,  Oregon,  on  the  subject  of 
“Doctor  Cooperation  With  Prepaid  Medical  Care 
Plans”  and  by  Mr.  Thomas  Hendricks,  Secretary 
of  the  Council  on  Medical  Service  of  the  A.M.A., 
who  spoke  on  the  subject  “Ten  Commandments 
of  Prepayment  Medical  are  (for  the  Partici- 
pating Physician).” 

The  meeting  was  then  called  to  order  by  Dr. 
Sol  G.  Kahn,  President,  as  a business  session  with 
116  members  in  attendance.  The  minutes  of  the 
annual' meeting  of  1947  were  approved  as  printed 
in  the  Rocky  Mountain  Medical  Journal.  Dr. 
Kahn  then  made  his  report  as  President.  His 
report  is  as  follows: 

President’s  Report 

“We  have  had,  this  evening,  the  privilege  of 
hearing  from  our  two  very  excellent  guest 
speakers  as  to  the  importance  of  the  prepaid 
medical  care  movement,  to  both  the  people  of 
this  country  and  to  the  members  of  the  medical 
profession.  The  significance  of  what  has  been 
said  by  these  gentlemen  must  not  go  unmarked 
by  the  profession  of  this  state. 

“Here  in  Utah  we  have  been  working  as- 
siduously to  establish  and  develop  a successful 
prepaid  surgical  and  maternity  care  plan.  How 
well  we  have  progressed  you  have  noted  in  the 
statistics  contained  in  the  report  of  the  Secretary, 
which  has  been  distributed  to  you. 

“The  problems  confronted  by  your  Board  of 
Directors  in  carrying  forward  such  a program 
have  been  many  and  varied.  The  administrative 
details  have  been  handled  largely  by  our  execu- 
tive staff,  but  the  problems  of  policy  and  of 
physician  relations  have  occupied  the  attention 
of  the  Board,  and  it  is  in  this  latter  field,  that  of 
physician  relations,  where  ultimately  the  success 
or  failure  of  the  program  will  be  determined. 


146 


Rocky  Mountain  Medical  Journal 


it 


Clinicians  generally  favor  the  use  of  an  occlusive 
device  supplemented  by  a sperm-immobilizing  agent 
for  optimum  protection.  However,  authoritative 
studies  have  established  that  a high  degree  of  pro- 
tection is  afforded  by  use  of  a jelly  alone— provided 
that  the  jelly  has  rapid  spermatocidal  action  together 
with  adhesive  and  cohesive  properties  sufficient  to 
provide  a dependable  barrier. 

When  dependence  must  be  placed  on  the  “jelly 
alone”  method,  there  is  no  better  product  available 
than  “RAMSES”*  Vaginal  Jellyt  because: 

1.  It  provides  rapid  spermatocidal  action. 

2.  It  possesses  dependable  adhesive  and  cohesive 
properties— will  not  melt  or  run  at  body  temperatures. 

3.  Direct-color  photographs  show  that  it  will  occlude 
the  cervix  for  ten  hours. 

“RAMSES”  Vaginal  Jelly  is  available  in  regular  |wBWl 
and  large-size  tubes  through  all  pharmacies. 

t Active  ingredients : Dodecaethyleneglycol 
Monolaurate  5%;  Boric  Acid  1%;  Alcohol  5%. 


gynecological  division 

423  West  55th  Street,  New  York  1 9,  N.  Y. 
qualify  first  since  1883 


for  February,  1949 


147 


The  reason  for  this  seems  too  apparent  to  neces- 
sitate elucidation,  but  strangely  enough  there  are 
many  doctors  in  this  state  who  do  not  appreciate 
or  understand  the  significant  position  which  they 
occupy  in  this  movement.  Upon  the  shoulders 
of  the  doctors  who  are  practicing  medicine  in 
this  state  rests  the  responsibility  of  satisfying  the 
people  of  this  locale  with  the  quality  and  cost 
of  medical,  care. 

“Individually  this  is  not  a new  burden  to  the 
doctor;  it  is,  however,  a new  burden  collectively. 
Each  doctor  has  always  had  the  burden  of  satisfy- 
ing his  own  patients  in  order  to  build  a successful 
practice.  Today  this  burden  cannot  be  borne 
alone  by  each  individual  doctor.  Our  society  has 
grown  more  complex  as  has  the  practice  of  med- 
icine. The  doctor  has  lost  the  position  of  esteem 
in  which  he  was  formerly  held  by  all;  instead  of 
being  the  best-loved  man  in  the  town  he  is  now 
frequently  one  of  the  most  financially  affluent, 
but  this  change  has  not  won  friends  for  the  med- 
ical profession.  The  people  are  tired  of  having 
to  place  their  earnings  at  the  disposal  of  a doctor 
because  of  the  misfortune  of  illness.  They  are 
willing  to  pay  a reasonable  fee,  yes,  but  in  this 
era  of  specialization  where  the  patient  is  re- 
ferred from  doctor  to  doctor  the  cost  of  what  is 
currently  considered  adequate  medical  care  has 
become  prohibitive  to  the  average  citizen.  With 
stress  which  the  profession  has  placed  on  spe- 
cialization and  on  fees  for  their  services  the 
personal  touch  so  invaluable  to  the  old-time  pro- 
fessional man,  such  as  occupied  the  field  when 
I started  practice,  has  been  lost.  This  is  a trag- 
edy, and  may  well  mark  the  end  of  the  medical 
profession  as  a profession  unless  each  and  every 
doctor  cooperates  to  save  it.  One  of  the  means 
by  winch  this  problem  may  be  met,  if  not  the 
only  means,  is  through  your  Medical  Service  Bu- 
reau and  the  plan  which  it  offers  to  the  people 
to  prepay  the  cost  of  their  surgical  and  maternity 
care. 

“To  make  this  plan  work  calls  for  the  whole- 
hearted support  of  every  physician.  We  cannot 
permit  our  ranks  to  be  divided.  Unfortunately, 
the  Board  of  Directors  has  been  compelled,  due 
to  the  refusal  of  two  of  the  participating  phy- 
sicians in  the  Medical  Service  Bureau  to  cooper- 
ate during  the  past  year,  to  demand  the  resigna- 
tion of  the  men  involved  from  the  Bureau.  They 
are  thus  no  longer  eligible  to  render  service  un- 
der the  Surgical  Service  and  Maternity  Care 
Plan.  Why  has  such  action  been  necessary?  Be- 
cause these  men  placed  the  importance  of  the 
fee  which  they  received  for  their  specialty  above 
the  considerations  of  the  good  of  society  at  large 
or  the  medical  profession.  Because  of  their  dis- 
satisfaction with  the  fee  allowed  them  for  service 
under  the  plan  these  men  talked  against  their 
own  plan,  spoke  against  their  own  agency  to 
their  patients  and  attempted  to  persuade  these 
patients  that  the  Surgical  Service  and  Maternity 


Care  Program  was  a fraud.  The  damage  done  by 
such  members  of  the  profession  is  inestimable. 
In  each  case  the  patient  will  be  an  enemy  of  that 
particular  doctor  from  now  on.  Whether  we  have 
been  successful  in  regaining  for  the  profession 
the  patient’s  good  will  I frankly  admit  is  doubt- 
ful. 

“The  people  understand  and  have  received  this 
Surgical  Service  and  Maternity  Care  Contract  as 
sponsored,  supported  and  underwritten  by  the 
medical  profession.  Confidence  in  the  plan  rests 
on  that  basis.  When  members  of  our  own  pro- 
fession who  are  participating  physicians  speak 
against  the  plan  they  hurt  not  just  themselves 
but  do  a disservice  to  every  physician  and  sur- 
geon in  the  State  of  Utah  and  in  the  United 
States. 

“I  recognize  very  clearly  the  tremendous  im- 
portance of  the  economic  factor  involved  for 
every  doctor  in  supporting  the  Surgical  Service 
and  Maternity  Care  Plan.  But  I also  recognize 
vdth  even  greater  clarity  that  the  doctor  will  not 
be  paid  by  the  state,  in  the  event  of  State  Medi- 
cine, even  a small  proportion  of  the  income 
which  many  of  our  members  now  enjoy.  Is  it 
not  better  to  concede  a few  dollars  on  each  in- 
dividual case,  recognize  that  it  will  mean,  per- 
haps, a small  reduction  in  income  for  each  doctor 
if  the  prepaid  medical  care  movement  is  suc- 
cessful, and  still  preserve  our  professional  in- 
tegrity? 

“You  will  hear  these  dissenters  say  that  if  they 
are  to  be  regimented  in  medical  practice  they 
would  as  soon  be  regimented  by  the  state  as  by 
some  bureau,  whether  they  own  the  bureau  or 
not.  Regimented?  In  what  way  are  they  regi- 
mented? Only  in  the  fee  which  they  may  charge. 
Under  the  present  condition  no  one  dictates  the 
type  of  care,  the  manner  of  practice,  the  number 
of  patients,  or  the  manner  of  treatment  to  be 
afforded.  Under  any  program  of  State  Medicine 
regimentation  would  not  stop  at  the  compensation 
to  be  paid  the  doctor  for  his  services;  it  would 
include  all  phases  of  medical  practice. 

“If  all  we  physicians  will  remember  the  im- 
portance of  properly  serving  the  people,  it  has 
been  my  experience  that  the  remuneration  will 
work  itself  out.  Let  us  cooperate  to  make  our 
program  work.  I venture  the  opinion  that  all  of 
our  problems  can  be  solved  if  we  work  together. 
Be  loyal  to  yourself,  be  loyal  to  your  profession 
and  to  the  program  which  it  is  sponsoring  for 
the  benefit  of  the  people  of  this  state,  with  the 
hope  that  it  may  preserve  the  medical  profes- 
sion.” 

Other  Reports 

Dr.  J.  G.  Olson,  Vice  President,  made  a report 
of  the  year’s  developments  as  he  saw  them  and 
stressed  the  need  for  broadening  the  program 
and  suggested  the  desirability  of  a lay  member 
of  the  Board  or  a lay  liaison  committee  to  co- 


148 


Rocky  Mountain  Medical  Journal 


Consistent  Research  Makes  Scientific  Design  Basic  In 


CAMP  SCIENTIFIC  SUPPORTS 


For  many  decades  it  has  been  our  privilege  to  work  closely  with 
physicians  and  surgeons  in  the  design,  improvement  and  manu* 
facture  of  anatomical  supports  to  meet  the  needs  of  their  patients. 
The  unique  Camp  adjustment  feature  insures  proper  firmness 
about  the  pelvis  and  controlled  support  of  the  abdomen,  spinal 
column  and  gluteal  region  without  compression.  Write  for  your 
copy  of  the  Camp  "Reference  Book  for  Physicians  and  Surgeons.” 


THIS  EMBLEM  is  displayed  only  by  reliable  merchants 
in  your  community.  Camp  Scientific  Supports  are  never 
sold  by  door-to-door  canvassers.  Prices  are  based  on 
intrinsic  value.  Regular  technical  and  ethical  training 
of  CAMP  fitters  insures  precise  and  conscientious  atten- 
tion to  your  recommendations. 


S.  H.  CAMP  and  COMPANY,  Jackson,  Michigan 
World’s  Largest  Manufacturers  of  Scientific  Supports 
Offices  in  NewY ork  • Chicago  • W indsor,  Ontario  • London,  England 


for  February,  1949 


149 


Advertisement 


From  where  I sit 
Joe  Marsh 


To  Dunk  or 
Not  To  Dunk? 

Dunking  doughnuts  is  Sober  Hop- 
kins’ favorite  morning  pastime  . . . 
and  for  a long  time  now  Ma  Hopkins 
has  been  trying  hard  to  break  him  of 
the  habit.  She  feels  it  sets  a bad  exam- 
ple for  the  children. 

So  one  morning  she  puts  a real 
heavy  frosting  of  chocolate  on  the 
doughnuts  . . . figuring  that  will  sm-ely 
stop  him.  Sober  thinks  it  over  for  a 
little  while  and  then:  Dunk!  Taste? 
Smile!!  And  Sober  compliments  the 
missus  on  the  lovely  mocha  flavor! 

I guess  there’ll  always  be  two 
schools  of  thought:  to  dunk  or  not  to 
dunk.  But  from  where  I sit,  it’s  a mat- 
ter of  personal  choice  and  taste — like 
some  folks  prefer  beer  to  cider,  ale  to 
beer.  And  the  less  we  criticize  those 
differences  of  taste,  the  better. 

In  fact,  Ma  Hopkins  got  so  curious 
about  the  flavor  of  chocolate-covered 
doughnuts  dunked  in  coffee,  that  she 
tried  it  herself.  Now — you’ve  guessed 
it — she’s  a daily  dunker,  too! 


Copyright,  19 U8,  United  States  Brewers  Foundation 


operate  with  the  Board.  Dr.  Olson  pointed  out 
the  necessity  for  the  doctors  to  cooperate  to  a 
greater  extent  in  emphasizing  and  selling  this 
program  to  the  public. 

A written  report  submitted  by  the  Treasurer, 
William  LeRoy  Smith,  M.D.,  and  Allen  H.  Tib- 
bals,  Secretary,  was  approved  as  submitted. 

Under  the  heading  of  new  business.  Dr.  J.  G. 
McQuarrie  made  an  inquiry  as  to  the  activities 
of  the  Medical  Service  Bureau  in  Southern  Utah 
and  the  position  of  the  doctor  in  relation  to  sales 
effort.  This  inquiry  was  answered  by  Dr.  Wool- 
sey; 


Election 

The  meeting  then  proceeded  to  the  election  of 
directors.  Dr.  Claude  L.  Shields  and  Dr.  Ray  T. 
Woolsey  were  duly  elected  to  succeed  them- 
selves. Dr.  L.  A.  Stevenson  stated  that  as  he 
planned  to  be  away  most  of  the'  winter  he  be- 
lieved it  would  be  advisable  not  to  place  his 
name  in  nomination.  Dr.  Sims  Duggins  of  Pan- 
guitch  was  elected  to  succeed  Dr.  Stevenson. 

Dr.  J.  P.  Kerby  was  recognized  to  discuss  the 
question  of  the  hospitals’  encroachment-  on  the 
practice  of  medicine  and  moved  that  the  stock- 
holders of  the  Medical  Service  Bureau  go  on 
record  as  opposing  the  efforts  and  attempts  of 
hospitals  to  engage  in  the  practice  of  medicine 
and  that  the  Blue  Cross  be  urged  to  remove 
from  their  contract  the  offering  of  any  type  of 
medical  service.  The  motion  was  seconded  by 
J.  G.  Olson,  M.D.  Dr.  Woolsey  spoke  to  the  mo- 
tion and  read  an  excerpt  from  California  Medi- 
cine setting  out  the  opinion  of  the  California 
Attorney  General  on  the  subject.  Dr.  Kerby’s 
motion  was  carried  unanimously. 

An  inquiry  was  made  as  to  the  situation  ex- 
isting in  New  Mexico  between  Blue  Cross  and 
the  doctors  in  that  state.  This  was  answered 
briefly.  Opposition  to  continued  relations  be- 
tween Blue  Cross  and  Blue  Shield  as  existing 
m Utah  was  expressed  by  L.  B.  White,  M.D.,  and 
others.  No  formal  action  was  taken  in  regard 
thereto.  The  meeting  was  adjourned  at  10:40  p.m. 


Surgical  Supports  Expertly  Fitted. 

Miss  Mabel  P.  Cliff,  Authorized  Fitter 


2>. 


JSupJa  Co 


enver  ..jur^ical  .^uppl^  t^ompan^ 

“For  better  service  to  the  profession.” 

1438-40  Tremont  Place  CHerry  4458 

Denver  2,  Colorado 


150 


Rocky  Mountain  Medical  Journal 


FUfiACIN 


tfcUW  **  '*  SOtuetE  ©ASS. 

^ ^si^Hsto  OHiY  »r  o» 

****  ’►ROeUCT  AMD  US€S  AVAitAHS  t® 

^l*AftATlO«  I^OS  TO^tCAi  * 


(brand  of  NITROFURAZOH^ 


»li€  f>OVN»,A 


For  surface  infections . . . 


-^Aduei^  ^an  ^ne^/eum 

infection  may  be  minimized  by  the  prompt,  topical  application  of  an  efficient  antibacterial  agent.  For  this 
purpose,  fine-mesh  gauze  strips  impregnated  with  Furacin  Soluble  Dressing  may  be  used.  The  effectiveness 
of  Furacin  in  combatting  mixed  infections  of  burns  without  delay  of  healing  has  been  well  demonstrated.* 
Furacin  N.N.R.,  brand  of  nitrofurazone,  is  available  as  Furacin  Soluble  Dressing  and  as  Furacin  Solution,  both 
containing  0.2  per  cent  Furacin.®  These  preparations  are  indicated  for  topical  application  in  the  prophylaxis 
and  treatment  of  infections  of  wounds,  second  and  third  degree  hums,  cutaneous  ulcers,  pyodermas  and  skin 
grafts.  Literature  on  request.  £AJ0N  LABORATORIES.  INC..  NORWICH.  N.Y. 

•Snyder,  M.  L.,  Kiehn,  C.  L.  and  Christophersoni  J.  W. : Mil.  Surgeon,  97:  380,  1945.  • Shipley,  E.  R.  and  Dodd,  M.  C.: 
Surg.,  Gynec.  & Obst.,  S'i : 366,  1947  • Mays,  J.  L. : J.  Med.  Assoc.  Georgia,  Se : 263,  1947.  • Curtis,  L. : Surg.  Clin.  N. 
America,  1466  (Dec.)  1947. 


jot  February,  1949 


151 


SHIRLEY-SAVOY 

HOTEL 

At  Your  Service 

New  Lincoln  Auditorium 
and 

Private  Dining  Room 

☆ 

J.  Edgar  Smith,  President 

Ed  C.  Bennett,  Manager 

Ike  Walton,  Managing  Director 

* 

☆ 

BROADWAY  and  EAST  17th  AVE. 
Denver,  Colo.  TAbor  2151 


POSTGRADUATE  COURSE 
FOR  PHYSICIANS 

A COURSE  ON  PROBLEMS  OF 
NEWBORN  INFANTS 
Premature  and  Full  Term 

Sponsored  by  the 

UNIVERSITY  OF  COLORADO 
SCHOOL  OF  MEDICINE 

and  the 

COLORADO  STATE  DEPARTMENT 
OF  HEALTH 

April  7,  8,  and  9,  1949 

at 

UNIVERSITY  OF  COLORADO 
MEDICAL  CENTER 

4200  East  Ninth  Avenue 
Denver  7,  Colorado 

The  program  for  this>  course  will  be  essentially 
the  same  as  that  for  the  course  which  was  given 
in  October,  1948.  The  detailed  program  will 
be  announced  in  the  near  future.  Physicians 
are  requested  to  register  through  the  director 
of  graduate  and  postgraduate  education  at 
the  University  of  Colorado  Medical  Center. 


A SPECIFIC 

h 

Boggio^s  fine  food,  excellent  service 
and  friendly  atmosphere  are  always  an 
easy-to-take  prescription  — relaxing, 
soothing  and 

Oh,  shucks,  you  know  what  we  mean. 
THERE  IS  STILL  ONLY  ONE  BOG- 
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BOGGIO’S 

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AL.SO  HOSPITAJ.  BXPBIVSB  FOR  MBMBBRa, 
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members’  benefit 


$3,000,000.00  $15,000,000.00 

INVESTED  ASSETS  PAID  FOR  CLAIMS 

$200,000.00  dtpMltad  with  Statt  at  Nahraika  for  orotootloa  of  tor  doahon. 

Disability  need  not  be  incurred  in  line  of  duty — 
benefits  from  the  beginning  day  of  disability 

PHYSICIANS  CASUALTY  ASSOCIATION 
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46  ywan  under  Ihw  ■am*  managwmwat 
400  FIrat  NationnI  Bank  Bnllding,  Omaha  2,  Nebraakn 


152 


Rocky  Mountain  Medical  Journal 


You  Used  PICKER  X-RAY 
in  the  Army 

Can  You  Afford  to  Use  Less  in 
Your  Own  Practice? 


THE  NEW  PICKER  V-7 
OFFERS  YOU 

Time  limit  switches  providing  posi- 
tive protection  to  all  X-Ray  tubes. 

Kilovolt  limiting  switches  to  protect 
tubes  and  cables  against  overload. 

Electronic  timing  of  exposures  for 
absolute  accuracy. 

Electronic  Milli-Stabilizer  to  make 
the  milliamperage  remain  correct  re- 
gardless of  line  changes  without  any 
Hlament  control  necessary. 

Automatic  Valve  Tube  Booster. 

Direct  Reading  Kilovolt  Meter. 

In  plain  words  a completely  auto- 
matic control  that  does  all  the  think- 
ing for  you,  protecting  your  equip- 
ment against  damage  by  human  error. 

It  will  pay  you  to  see  this  remarkable 
machine  before  you  get  any  X-Ray 
Unit. 

And  behind  it  stands  the  finest  serv- 
ice organization  in  the  Rocky  Moun- 
tain Area. 

Call  us  the  next  time  you  need  help 
with  your  equipment  or  for  films  and 
chemicals. 

YOU  CAN  DEPEND  ON 
PICKER  X-RAY  EQUIPMENT 


Blair  Surgical  Supply,  Inc. 

X-RAY  ENGINEERING 
ALBUQUERQUE  — DENVER 
PHOENIX  — TUCSON 


'AMMMtlHIIIIIHMIMIMMmtHIMMUtlHMIHIHaitlllKMMimilllHMIlllliaillHIIIMIIIKIMMMHIIIIIIMKdMMIIIIIIIIMIIIHMMIIIIIIII 

Date 

Blair  Surgical  Supply,  Inc. 

20  E.  9th  Ave. 

Denver,  Colorado 

Gentlemen: 

Please  have  your  representative 
call  on  me. 

Dr 

Street  

City State 


for  February,  1949 


153 


PHYSICAL 

REHABILITATION 


SOCIAL 

REHABILITATION  ii'i 


V^f  rjO 

Aevoted 

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Since  it^  t\ae 

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By  the  Conditioned  Reflex  and  Adjuvant  Methods 

7106  35th  AVE.  S.W.,  SEATTLE  6,  WASH.,WEst  7232 
Cable  Address:  REFLEX 


154 


Rocky  Mountain  Medical  Journal 


M aid  in  treatment  of  specific  breast  conditions 


CORRECTIVE  RRfflERES 

are  custom- fitted  to  prescription... 


Straps  adjusted  for  maximum  com- 
fort with  gentle -yet -firm  support. 

I M ■■  M M Back  width  designed  to 
encourage  good  posture. 

■ H H Correct  bust  cup  selected  for 
proper  uplift  and  separation. 


Torso  fitted  to  patient’s 
personal  measurements. 


'Proper  physiological  support  for  the 
breast  is  a medical  problem,  and  patients  are 
grateful  to  the  physician  who  recognizes  this 
fact.  Lov-e’s  extensive  therapeutic  line  of  breast 
supports  provides  remedial  support  for  specific 
breast  conditions.  From  more  than  500  bust-cup- 
torso  size  variations,  the  patient’s  correct  size  is 
selected,  then  fitted  to  her  individual  measure- 
ments by  specially  trained  Lov-e’  technicians, 
according  to  your  exact  instmctions. 

Lov-e  Brassieres  are  available  in  a wide  variety 
of  all  fine  fabrics  including  cottons,  rayon  jac- 
quards and  nylons.  Also  available:  sleeping  bras- 
sieres, hospital  binders,  artificial  breasts i muscle 
pads  and  maternity  garter  supports. 

The  May  Company 

lov-e  section, 

CORSET  DEPARTMENT, 

THIRD  FLOOR 

DENVER,  COLORADO 


MATERN  iTY 

— for  pre-natal  and 
post-natal.  Helps 
prevent  leakage. 
Adfusted  without 
charge  during  preg- 
nancy. 


HYPERTROPHIC 

— inner  pocket  for 
pendulous  bust. 
Built  up  back. 
Padded  shoulder 
straps.  Redistributes 
bust  weight. 


MASTECTOMY 

— fitted  with  Lov.e’ 
bust  pads  to  restore 
bust  contour.  Aids 
psychologically. 


jor  February,  1949 


155 


AQUEOUS  SUSPENSION  OF 
ESTROGENIC  SUBSTANCES- 
DORSE  Y ...Highly  purified 
Estrogenic  Substances  derived 
from  natural  sources  evenly 
suspended  for  uniform  dosage. 
Available  in  20.000  I.  U.  per 
CC.-10  cc.  rubber  capped  vials 
and  1 cc.  sealed  ampoules. 


AMINOPHYLLINE  SUPPOSI- 
TORIES-DORSEY  . . , Amino- 
phylline  in  a v^ater  soluble  base, 
made  for  ready  solubility  in  the 
rectum  at  body  temperature. 
No  need  for  refrigeration. 
Available  in  0.5  gm.  supposi- 
tories-boxes  of  T2 


THE  SMITH-DORSEY  COMPANY 

Lincoln.  Nebraska 
BRANCHES  AT  DALLAS  AND  LOS  ANGELES 


aqueous  suspension  of  tSTROOENIC  SUBSTANCES  • DORSEY 
AMINOPHYLLINE  SUPPOSITORIES  • DORSEY 


156 


Rocky  Mountain  Medical  Journal 


even  after  40 


does  creative  work... 


The  urge  to  do  creative  or  constructive  work  is  often 
rekindled  in  the  woman  relieved  of  menopausal  symp- 
toms. Restraints  placed  on  her  talents  by  the  nervous- 
ness, hot  flushes  and  other  manifestations  of  the  climacteric 
may  vanish  entirely  following  the  use  of  "Premar/n/^ 

In  addition,  there  is  a "plus"  in  '"^Premarin"  therapy. . .the 
gratifying  "sense  of  well-being"  so  frequently  reported  by  the 
patient.  Oral  activity,  comparative  freedom  from  side-effects  and 
flexibility  of  dosage  are  other  advantages  associated  with  this  natu- 
rally-occurring, conjugated  estrogen.  ^'‘Premarin"  is  supplied  in  tablets 
of  four  different  potencies  and  in  liquid  form. 


ft 


While  sodium  estrone  sulfate  is  the  principal  estrogen 
in  "Premarin/'  other  equine  estrogens ...  estradiol, 
equilin,  equilenin,  hippulin  . . . are  probably  also  pres- 
ent in  varying  amounts  as  water-soluble  conjugates. 


ESTROGENIC  SUBSTANCES  (WATER-SOLUBLE) 
also  known  os  CONJUGATED  ESTROGENS  (equine) 


Ayerst,  McKenna  & Harrison  Limited  22  East  40th  Street,  New  York  1 6,  New  York 

4904 


^or  February,  1949 


157 


A FAMILY  AFFAIR 

Luzier's  Bath  and  Body  Service  may  well  be  called  "A  Family  Affair"  because  aM 
members  of  the  family  delight  in  using  some  of  its  many  preparations. 

The  service  includes  a complete  line  of  Deodorants,  Bath  Oils,  Bath  Salts,  Body  Powders, 
Body  Massage  Cream,  and  it  goes  witiiout  saying  that  no  bath  and  body  service  would  be 
complete  without  a Sachet  Powder  and  a selection  of  delicately  fragrant  Colognes. 

The  items  of  this  service  may  be  purchased  individually  or  in  a set  package  which, 
incidentally,  makes  an  excellent  gift. 

This  service  is  just  one  of  the  many  cosmetic  services  made  available  to  the  public  by 
the  Cosmetic  Consultants  who  distribute  Luzier's  Fine  Cosmetics  and  Perfumes. 

LUZIER’S  FINE  COSMETICS  AND  PERFUMES 
Are  Distributed  in  Colorado  and  Wyoming  by: 

BURBRIDGE  & BURBRIDGE,  Divisional  Distributors 
519-20  Continental  Bank  Building 
Lincoln,  Nebraska 

District  Distributors 

Elizabeth  Haskin  Baker  & Baker  Cecile  Armstrong 

447  Milwaukee  Delta,  Colo.  1566  Pearl  St. 

Denver,  Colo.  Denver,  Colo. 

Catherine  Phelps  Love  & Love 

608  E.  22nd  1222  So.  Columbine 

Cheyenne,  Wyo.  Denver,  Colo. 

Local  Distributors 

Irene  K.  Reece  joyce  Kilgore  Rita  Parker 

1337  Madison  109  Minnequa  1603  Cheyenne  Blvd. 

Denver,  Colo.  Pueblo,  Colo.  Colorado  Springs,  Colo. 

Mildred  Funderburk  Selma  Sollee 

324  So.  7th  St.  1426  Grand  Ave. 

Grand  Junction,  Colo.  Pueblo,  Colo. 


158 


Rocky  Mountain  Medical  Journal 


THE 

LIEBEI-FIARSHEIM 

SW-227 

HAS  IT! 


Ceo.  Berbert  & Sons,  Inc. 

1524-1530  Court  Place 
Denver  2,  Colorado 


No  limit  to  the  usefulness  of  this  mod- 
ern diathermy  unit!  All  accepted  types 
of  treatment  applicators  may  be  used 
interchangeably.  Shown  here:  L-F 

Hinged  Treatment  Drum  and  L-F  Air- 
Spaced  Plates.  WRITE  FOR  DESCRIP- 
TIVE BULLETIN. 

Ask  for  Demonstration 
Booths  40  and  41 
Midwinter  Postgraduate  Clinics 
Morch  2,  3,  4,  1949 


for  February,  1949 


159 


(gaoMX 


160 


Rocky  Mountain  Medical  Journal 


In  a recent  coast  to  coast  test  of  hundreds  of  people  who  smoked  only 
Camels  for  30  days,  throat  specialists,  after  weekly  examinations,  reported; 


“Not  one  single  case  of 
throat  irritation  due  to 
smoking  CAMELS!” 


Doctors  smoke  for  pleasure,  too!  And  when  three 
leading  independent  research  organizations  asked 
113,597  doctors  what  cigarette  they  smoked,  the 
brand  named  most  was  Camel. 


Hundreds  of  men  and 
women  were  included  in  this 
coast  to  coast  test.  These 
men  and  women  smoked 
Camels  — and  only  Camels 
— for  30  consecutive  days. 
They  smoked  on  the  average 
of  one  to  two  packages  a day. 
Each  week  noted  throat  spe- 
cialists examined  the  throats 
of  these  Camel  smokers  — a 
total  of  2470  careful  examin- 
ations. In  every  report,  the 
findings  of  these  throat  spe- 
cialists were  the  same — “not 
one  single  case  of  throat  ir- 
ritation due  to  smoking 
Camels.” 


for  February,  1949 


161 


We  Recommend 

KARC’S  PAINT  CO. 

Lowe  Bros.  Paints  Kem-Tone 

Wall  Paper  Painters’  Supplies 

Art  Supplies 

FREE  DELIVERY  

Phone  CHerry  3779 

620  Santa  Fe  Drive  Denver 


Denver’s  Fireproof 

COLBURN  HOTEL 

D.  B.  Cerise  is  the  genial  Host  and  Manager 

• CONVENIENT  — Located  only  a ten-minute  walk 
from  the  heart  of  the  city. 

• PLEASANT  — Away  from  — above  the  noise  and 
rush  of  downtown  Denver. 

• EXCELLENT  FOOD  — Dining  that  has  satisfied  the 
demanding  tastes  of  all  patrons. 

• Visit  Our  New  Cocktail  Lounge. 

TENTH  AVE.  at  GRANT  ST. 

Phone  MAin  6261  Denver,  Colo. 


RESTAURANT  240 

MISS  M.  E.  GABRIEL,  Prop. 

SERVING  TRADITIONALLY  GOOD 
FOOD  AT  MODERATE  PRICES 

HOURS:  11:00  A.M.— 2:00  F.M.  4:30—7:30  P.M. 
SUNDAYS:  12  Noon  to  7:00  P.M. 

Closed  Wednesdays 

240  Broadway  Denver,  Colo. 

SPruce  2182 


For  Better  Prescription  Blanks 

STARCO 

PRODUCTS  CO. 

Phone  TAbor  6166 

1519  Lawrence  Street  Denver,  Colo. 


* 


production 


eruice 


ELECTROTYPES 

MATRICES 

STEREOTYPES 

PRINTING 

TYPOGRAPHY 


^lAJedtern 


Denver  - 
New  York  - 
Chicago  - - 


n 


ew&paper  l/inion 


% 


- - - - 1830  Curtis  St. 

- - - 310  East  45th  St. 

- - 210  So.  Desplaines  St. 


And  33  Other  Cities 

Silver  State  Laundry 

Highest  Quality  Laundry  Service 

Everything  washed  with  Ivory  Soap  and 
artesian  water  at  no  additional  cost  to  you 

Zoric  Garment  Cleaning  System 
Broadway  at  25th  Phone  TAbor  5181 

Denver 


We  Cater  to  the  Medical  Profession 

CASCADE  LAUNDRY 

10  Per  Cent  Discount  If  You  Bring  Your 
Laundry  in 

HAND  DRY  CLEANING 
“Deserving  of  Your  Patronage” 

1621  Tremont  Denver  TAbor  6379 
Charge  Accounts  Invited 


COLVm-Medical  Books 

Medical  Publications  of  All  Publishers 
Books  Sent  for  Examination  on  Request 
We  Maintain  This  Book  Store  for  Your  Convenience 
Books  Make  Fine  Christmas  Gifts 
Write  or  Come  to 
705-706  MAJESTIC  BUILDING 

Denver  2,  Colorado  Call  MAin  3866 


162 


Rocky  Mountain  Medical  Journal 


• • • ergotamine  tartrate 

For  the  Effective  Treatment  of 


MIGRAINE 

Accepted  by  American  Medical  Association 
Council  on  Pharmacy  and  Chemistry 

DOSAGE:  0.5  cc.  intramuscularly  as  early  as  pos- 
sible. In  resistant  cases  the  dosage  may  be  in- 
creased to  1 ce.  In  mild  attaeks  2 to  6 tablets 
preferably  sublingually — often  prove  effective. 

LITERATURE  ON  REQUEST 


SANDOZ  PHARMACEUTICALS 

West  Coast  Office — 450  Sutter  Street  San  Francisco  8,  California 


LIVERMORE  SANITARIUM 


• The  Hydropathic  Department 
devoted  to  the  treatment  of  gen- 
eral diseases,  excluding  surgical 
and  acute  infectious  cases.  Special 
attention  given  funaional  and  or- 
ganic nervous  diseases.  A well 
equipped  clinical  laboratory  and 
modern  X-ray  Department  are  in 
use  for  diagnosis. 


• The  Cottage  Department  (for 
mental  patients)  has  its  own  fa- 
cilities for  hydropathic  and  other 
treatments.  It  consists  of  small 
cottages  with  homelike  surround- 
ings, permitting  the  segregation  of 
patients  in  accordance  with  the 
type  of  psychosis.  Also  bungalows 
for  individual  patients,  offering 
the  highest  class  of  accommoda- 
tions with  privacy  and  comfort. 


1.  Climatic  advantages  not  excelled  in  United  States.  Beautiful  grounds  and  attractive  surrounding  country. 

2.  Indoor  and  outdoor  gymnastics  under  the  charge  of  an  athletic  director.  An  excellent  Occupational  Department. 

3.  A resident  medical  staff.  A large  and  well-trained  nursing  staff  so  that  each  patient  is  given  careful  individual  attention. 

Information  and  circulars  upon  request.  CITY  OFFICES : 

Address:  O.  B.  JENSEN,  M.D. 

Superintendent  and  Medical  Direaor  San  FRANCISCO  Oakland 

Livermore,  California  450  Sutter  Street  1624  Franklin  Street 

Telephone  313  GArfield  1-5040  GLencourt  1-5988 


for  February,  1949 


163 


The  Fairhaven  Maternity  Hospital 

Mrs.  H.  E.  Lowther,  SuperiatendeBt 

Seclusion  for  the  unwed  mother.  Write  for  descriptive  booklet. 

1349  JOSEPHINE  EAst  9944  DENVER 


y\/lercy  J-iospital 

Conducted  by  the  Sisters  of  Mercy 

School  of  Nursing  in  Connection 

A General  Hospital  Scientifically  Equipped 

1619  Milwaukee  St.,  Denver  FRemont  2771 


Presbyteriam  Hospital 

Nineteenth  Avenue  and  Gilpin  Street,  Denver,  Colorado 

A General  Hospital  for  Surgical,  Medical  or  Maternity  Cases 

One  hundred  sixty  beds  and  twenty-five  bassinets.  Fireproof.  Telephone  service  to  every 
bed.  Hot  and  cold  running  water  and  toilet  service  in  every  room.  Complete  laboratory 
and  x-ray  facilities,  including  x-ray  therapy.  Inquiries  welcomed. 


WESTERN  ELECTRIC 

HEARING  AIDS 

Engineered  by  Bell  Telephone  Laboratories 


SOME  of  the  exclusive  features  of  this 
new  Vacuum  Tube  Hearing  Aid  are: 
Sealed  Crystal  Microphone — gives  same 
dependable  service  under  all  conditions  of 
temperature  and  humidity.  Stabilized  Feed- 
back — amplification  without  distortion. 
No  sudden  blast  from  loud  sounds  when 
volume  is  turned  up. 

For  other  inionnatien  write  or  coll 

M.  F.  Taylor  Laboratories 

721  Republic  Building 
MAin  1920  Denver,  Colo. 


SERVICE  QUALITY 

PAUL  WEISS 

PRESCRIPTION 

OPTICIAN 

1620  ARAPAHOE  ST.  DENVER  MAin  1722 


164 


Rocky  Mountain  Medical  Journal 


NEWTON  OPTICAL  COMPANY 

GUILD  OPTICIANS 

V.  C.  NORWOOD,  Manager 

309-16th  Street  Denver 

Phone  KEystone  0806 

Catering  to  Medical  Proiession  Patronage 


COLUMBIAN 
BIFOCAL 
COMPANY 
Optical  Goods 

INTRICATE  PRESCRIPTIONS 
ACCURATELY  COMPOUNDED 


★ 


Exclitsively  Wholesale 


★ 


1412  Glenarm  PI.  Denver,  Colo. 

Phone;  KEystone  5109 


Cook  County  Graduate 
School  of  Medicine 

ANNOUNCES  CONTINUOUS  COURSES 

SURGERY — Intensive  course  in  Surgical  Technique,  two 
weeks,  starting  February  21,  March  21.  Surgical 
Technique,  Surgical  Anatomy  and  Clinical  Surgery, 
four  weeks,  starting  February  7,  March  7.  Surgical 
Anotomy  and  Clinical  Surgery,  two  weeks,  starting 
February  21,  March  21,  April  18.  Surgery  of  Colon 
and  Rectum,  one  week,  starting  March  7,  April  11. 
Surgical  Pathology,  every  two  weeks. 

GYNECOLOGY — Intensive  course,  two  weeks,  starting 
February  21,  March  21.  Vaginal  Approach  to  Pelvic 
Surgery,  one  week,  starting  February  14,  April  4. 

OBSTETRICS — Intensive  course,  two  weeks,  starting 
March  7,  April  4. 

MEDICINE — Intensive  course,  two  weeks,  starting  April 
4.  Personal  Course  in  Gastroscopy,  two  weeks, 
starting  March  7.  Electrocardiography,  four  weeks, 
starting  March  16. 

PEDIATRICS — Intensive  course,  two  weeks,  starting 
April  4. 

DERMATOLOGY — Formal  course,  two  weeks,  starting 
May  2.  Clinical  course  every  two  weeks. 

CYSTOSCOPY — Ten-day  practical  course  every  two 
weeks. 

ROENTGENOLOGY — Lectures  and  diagnostic  course,  two 
weeks,  starting  the  first  Monday  of  every  month. 
Clinical  course  starting  third  Monday  of  every 
month. 

GENERAL,  INTENSIVE  AND  SPECIAL  COURSES  IN  ALL 
BRANCHES  OF  MEDICINE,  SURGERY  AND 
THE  SPECIALTIES 

TEACHING  FACULTY — ATTENDING  STAFF  OF  COOK 
COUNTY  HOSPITAL 


Addrss:  Registrar,  427  South  Honore  Street, 
Chicago  12,  Illinois 


for  February,  1949 


165 


YORK 

PHARMACY 

Denver’s  Finest  Prescription  Store 
Free  Delivery 
Phone  FR.  8837 

2300  East  Colfax  Avenue  at  York  Street 
Almay  Cosmetics 


yllba  T)aLry 

Properly  Pasteurized  Milk 

Ice  Cream — Butter — Buttermilk 

a 

Phone  1101  Boulder,  Colo 


W.O.i^ocL 

Ambulance 

Service 


Prompt,  Careful  and  Courteous 
Serving  Denver  25  Years 

I 

A.i>proved  hy  Physicians  Generally 

18th  Ave.  at  Gilpin  St.,  Phone  EA.  7733 
=======================^^ 


Inorganic  and  Organic  Chemicals 
Biological  Stains  • Solutions 
Chemical  Indicators  • Test  Papers 

Dutributed  hy 

PhyiicUui  and  Laboratory  Supply  House* 

The  COLEMAN  & BELL  COMPANY,  Inc. 

MANUFACTURING  CHEMISTS  NORWOOD,  OHIO,  I).  S.  A. 


COLEMAN  & BELL  "TZeUetm/,  Oftio' 

hiiMHiMMuaiiiniiriiiii(ii(t!iiiitt»>»u»»titniiiijiiiiiiiiiithiiiiiiiiiiniiviiinittiitH»MttiiiiiiriiiriiHir!iiiii|iiiiiiuuiiiiiiiiiiiiiiiiiii!''' 


Let’s  exact  the  same  high  standard  of  purity  in  drinking  water  we 
do  in  foods,  medicines,  and  morals. 

“Good  health  deserves  it.  Bad  health  demands  the  best  water.” 

DEEP  ROCK  WATER  CO. 

Distributors  of 

MOUNTAIN  VALLEY  MINERAL  WATER 

614  27th  Street  From  Hot  Sorings,  Arkansas  TAbor  5121 


166 


Rocky  Mountain  Medical  Journal 


St.  Anthony  Hospital 

Write  or  Phone  Registrar  for  Information 

West  16th  Ave.  and  Perry  AComa  1761 

Denver,  Colorado 


FAIRFAX  SANITARIUM 

Kirkland,  Wash. 

Situated  one  mile  north  of  Juanita 

TREATING  NERVOUS  AND 
MENTAL  DISEASES 

Beautiful  and  restful  surroundings  affording 
recreational  facilities.  Cottage  plan  for  segre- 
gation of  patients.  Insulin  and  Electro-shock 
Therapy  when  indicated. 

Attending  Physicians 
FREDERICK  LEMERE,  M.O. 

NATHAN  K.  RICKLES,  M.D. 

JAMES  H.  LASATER,  M.D. 

MORTON  E.  BASSAN,  M.D. 

JACK  J.  KLEIN,  M.D. 

Manager;  A.  G.  HUGHES 
Route  2,  Box  365,  Kirkland 
Phone:  Kirkland  2391 


HOSPITALIZATION  AT  HOME 

FOR  the  comfort  of  your  patient  at  home  we  RENT  Hospital  Beds,  Wheel- 
chairs, Commodes,  Bedside  Tables,  Oxygen  Equipment,  Fracture  Beds 
and  Splints,  Electric  Breast  Pumps,  Physiotherapy  Equipment. 

All  New  Equipment — Low  Rental  Rates — 
Free  Delivery  Service 

1739  Welton  MAin  5183 

Denver,  Colorado 
24  Hour  Service 


GLOCKNER  PENROSE  HOSPITAL 

Sisters  of  Charity 

HOME  OF  MODERN  SANATORIA 


Winning  Health 

in  the 

Pikes  Peak  Region 


COLORADO  SPRINGS 


Inquiries  Solicited 


for  February,  1949 


167 


Bonita  Pharmacy 

(Established  1921) 

Prescription  Pharmacists 

6th  Avenue  at  St.  Paul  Street 
“RICHT-A-WAY”  SERVICE 

GERALD  P.  MOORE,  Manager 
Phone  FRemont  2797 


We  Welcome  Members  of  the 
Medical  Profession 

PLza  J4olJ 

Under  Management  of 
Mrs.  Addie  A.  and  Edward  A.  Miller 
Proprietors 

ALL  OUTSIDE  ROOMS 
Corner  15th  and  Tremont 
A Stone’s  Throw  to  Medical  Buildings 

TAbor  5101  DENVER 


ion 


50  y.^r>  of  €lk  icai  j-^reicripti 
•Service  to  llie  ^^octori  of  C^tie^ 


ROEDEL^S 

PRESCRIPTION  DRUG  STORE 

CHEYENNE,  WYOMING 


^^ocior — 

Rockmonl  Collectelopes 
Will  Save  You  Money 

Write  or  Phone  for  Samples 

Rockmont  Envelope  Co, 

DENVER 

750  Acoma  St.  MAin  4244 

SALT  LAKE  CITY 

1414  First  National  Bank  Bldg.  5-2276 


JL 

BROWN  SCHOOLS 


For  Exceptional  Children 


Four  distinct  units.  Tiny  Tots  through 
the  Teens.  Ranch  for  older  boys.  Spe- 
cial attention  given  to  educational  and 
emotional  difficulties.  Speech,  Mu^ic, 
Arts  and  Crafts.  Full  time  Psychologist. 
Under  the  daily  supervision  of  a Certi- 
fied Psychiatrist.  Registered  Nurses. 
Private  swimming  pool,  fireproof 
building.  View  Book.  Summer  Camp. 
Approved  by  State  Dirision  of  Special 
Education. 

BERT  P.  BROWN 

President 

Paul  L.  White,  M.D.,  F.A.P.A., 
Medical  Director 

Box  3028,  South  Austin  13,  Texas 


NURSES 

OFFICIAL 

REGISTRY 

Established  to  Meet  the  Community’s 
Every  Need  for  Nursing  Care 

-k 

GRADUATE  REGISTERED  NURSES 

Hourly  Nursing  Service  Positions 
Filled — Information  on  All 
Nursing  Service 

This  registry  is  endorsed  by  the 
Colorado  State  Graduate  Nurses’ 
Association  and  American  Nurses’ 
Association 

-k  -k 

Undergraduates  and  Practical  Nurses 
Furnished  Upon  Request 

KEystone  0168 

ARGONAUT  HOTEL 


168 


Rocky  Mountain  Medical  Journal 


VITAMINS 


NATURE 


• Especially  developed  for  infant  feeding, 
Milk  is  fortified  (from  natural  sources)  with 


vitamin  D and  2000  U.S.P.  units  vitamin  A 
quart. 


Special  Morning 
400  U.S.P.  units 
per  reconstituted 


MORIMIIMG  MILK 


RELIABLE  DRUGGISTS 


PATRONIZE  DENVER’S  INDEPENDENT  DRUGGISTS 


WE  RECOMMEND 

COUNTRY  CLUB 
PHAR]»IACY 

PRESCRIPTION  SPECIALISTS 

'A 

1700  E.  6th  Ave.  EA»t  7743 

Denver,  Colorado 

We  Recommend 

PFAB  PHARMACY 

JESS  L.  KINCAID,  Prop. 

Prescriptions,  Biologicals 
and  Fine  Cosmetics 

. 5190  W.  Colfax  at  Sheridan 

Phone  TAbor  9931-0951 

DENVER,  COLORADO 

HATCH  PHARMACY 

PRESCRIPTIONS  OUR  SPECIALTY 

Drugs  — Sundries 

Free  Immediate  Deliveries  on  Prescriptions 
794  Colorado  Blvd.  Denver,  Colo. 

Phone  EAst  7718 

“When  in  Need  Think  of  Us  Indeed” 

We  Recommend 

EARNEST  DRUG  COMPANY 

T.  H.  BRAYUEIN,  Prop. 

PRESCRIPTION  SPECIALISTS 
Prompt  Delivery  Service 

1699  Broadway  Phone  KEystone  7237 

Denver,  Colorado 

“Conveniently  Located  for  the  Doctor” 

HYDE’S  PHARMACY 

ACCURATE  PRESCRIPTIONS 

Chas  W.  Hyde,  Prop. 

Rocky  Mountain  Distributor  for  Sherman 
Biologicals  and  Pharmaceuticals 

Free  Deliveries 

629  16th  St.  (Mack  Bldg.)  KE.  4811 

Doyle's  Pharmacy 

J^articuiar 

East  17th  Ave.  at  Grant  KE.  5987 

21  Years  in  the  Heart  of  North  Denver 

GUIDO  SHUMAKE  DRUGS 

(Formerly  Otto  Drug  Co.) 

PRESCRIPTIONS  ACCURATELY 
COMPOUNDED 

Free  Delivery  Service 

West  38th  Ave.  and  Clay  Denver,  Colo. 

Phone  GRand  9934 

We  Recommend 

BONNIE  BRAE 

DRUG  COMPANY 

Alfred  C.  Andersen,  Owner  and  Manager 
Prescriptions  Accurately  Compounded 

Drugs Sundries 

FREE  IMMEDIATE  DELIVERIES 

ON  EMERGENCY  PRESCRIPTIONS 

763  South  University  Boulevard 

Phone  RAce  2874  — Denver,  Colorado 

WE  RECOMMEND 

Whittiaker’s  Pharmacy 

“The  Friendly  Store” 

..Attention  . . . 

PHYSICIANS 

PRESCRIPTION  SPECIALISTS 

West  32nd  and  Perry,  Denver,  Colo. 
Phone  GLendale  2401 

Jf^atponize 

170 


Rocky  Mountain  Medical  Journal 


RELIABLE  DRUGGISTS 

PATRONIZE  DENVER’S  INDEPENDENT  DRUGGISTS 


WE  RECOMMEND 

WALTERS  DRUG  STORE 

801  COLORADO  BLVD. 

LAKEWOOD  PHARMACY 

Denver,  Colorado 

R.  W.  Holtgren,  Prop. 

PRESCRIPTION  SPECIALISTS 

☆ 

West  Colfax  at  Wadsworth 

Telephone  FRemont  5391 

Lakewood  Colorado 

Phone  Lakewood  65 

i 

lAJiS0  to  at  lAJ0ids 

Downing  Street  Pharmacy 

WEISS  DRUG 

GEORGE  M.  HILL,  Prop. 

PROFESSIONAL  PHARMACIST 

PRESCRIPTION  SPECIALISTS 

901  Downing  St.  Denver,  Colo. 

M 

Phone  CHerry  2767 

Colfax  and  Elm  Denver,  Colorado 

Complete  Merchandise  Line 

Phone  EAst  1814 

Free  Delivery  on  Prescriptions 

We  Itecommend 

East  Denver’s  Prescription  Drug  Store 

VAN'S  PHARMACY 



THOS.  A.  VANDERBUR 

Prencrlptlons,  Dragra,  Cosmetics,  Magaslnes 

Sundries  Excellent  Ponmtain  Service 

Bert  C.  Corgan,  Prop. 

S859  Umatilla  St.,  Cor.  20tli  Ave.  at  Umatilla 

3401  FRANKLIN  STREET 

CRand  ^044  Denver,  Colo. 

KEystone  7241 

Daiislierry*s  Pharmacy 

OVERSTAKE’S  PHARMACY 

"New  Ultra  Modern  Prescription  Service” 

Gail  E.  Overstake 

JAMES  F.  DANSBERRY 

Prescription  Specialists 

Owner  and  Manager 

DRUGS  ~ SUNDRIES  — 

* 

COSMETICS  — CANDIES 

Champa  at  14th  Street  Denver,  Colorado 

We  Deliver 

Phone  KEystone  4269 

1000  So.  Gaylord  — RAce  4401 

Harl  Cleveland,  Owner 

CLEVELAND  PHARMACY 

PROFESSIONAL  MEN  RECOMMEND 

W.  29th  Ave.  at  Speer  Ph.  GL.  9272 

Modem  Prescription  Department 

Registered  Pharmacist 

Drugs  — Sundries  — Soda  Fountain 

HOUHS;  Week  Days,  S a.m.  to  10  p.m. 

D.  MALCOLM  CAREY,  Pharmacist 

Sundays.  10  am.  to  1 p.m..  S p.m.  to  9 p.m. 

Phone  AComa  3711 

Prescriptions  Delivered  Promptly 

224  Sixteenth  Street  Denver,  Colorado 

for  February,  1949 


171 


Vfe 

Qolorado  Springs  {Psychopathic  Hospital 

A Private  Hospital  for  Nervous  and  Mental  Diseases 

Situated  in  a beautiful  valley  two  miles  south  of  Colorado  Springs,  which  is  nationally  known  as  a health 
center.  New  building  for  mild  cases  of  Functional  Neurosis,  affording  complete  classification  of  patients. 
Home-like  surroundings,  scientific  medical  treatment  and  nursing  care.  Booklet  and  rates  on  application. 

C.  F.  Rice,  Superintendent,  Colorado  Spring's,  Colorado 


i^ouider- Coiorado  Sanitarium 


(Established  1895) 

B01JL.DER,  COLORADO 

• Pictured  Above — Restful,  congenial,  home- 
like surroundings,  combined  with  the  most  mod- 
ern equipment.  Colorado’s  finest  institution. 
Excellent  dietary  and  Nursing  Service. 


RATES  ARE  MODERATE  • • INQ,DIRIES  INVITED 


COLORADO’S  TWIN  HEALTH  INSTITUTIONS 


Porter  SaniL 


d Sdoipitai 


arium  an 
(Established  1930) 

DENVER,  COLORADO 

• Pictured  Below — Complete  Medical,  Surgical 
and  Obstetrical  services.  A GOOD  Q.UIET  place 
for  rest  and  convalescence.  Fully  equipped  Lab- 
oratory and  X-Ray  departments.  Also  modern 
Hydrotherapy  and  Electrotherapy  departments. 


172 


Rocky  Mountain  Medical  Journal 


(mthaJulk  me(!mlkn . . . 


White’s  Cod  Liver  Oil  Concentrate  Liquid  provides  potent, 
antirachitic,  natural  vitamins  A and  D.  Each  two  drops  is 
equivalent,  in  vitamin  content,  to  one  teaspoonful  of  cod 
hver  oil,*  containing  312  units  of  vitamin  D whoUy  derived 
from  cod  liver  oil,  and  3,120  units  of  vitamin  A,  supplied  by 
cod  liver  oil  concentrate  adjusted  and  standardized  with 
fish  liver  oils. 

ECONOMICAL  Cost-to-patient — about  a penny  a day  for 
antirachitic  protection  of  average  infant.  In  convenient, 
palatable  Liquid  form — dropper  administration. 

Also  available  in  pleasant-tasting  Tablets  and  higher  po- 
1^^  tency  Capsules.  White  Laboratories,  Inc.,  Pharmaceutical 

Manufacturers,  Newark  7,  N.  J. 


Cod  Liver  Oil  Concentrate 


One  of  White's  Integrated  Pediatric  Vitamin  Formulas 

*U.  S.  P.  Minimum  Requirements 


Dienestrol 
in  the 
menopausal 
syndrome 


CLINICAL  STUDIES  SHOW 


Less  withdrawal  bleeding 


"Occurrence  of  withdrawal  bleeding  is  relatively  infre- 
quent following  the  use  of  dienestrol.” 

Finkler,  R.  S.  and  Becker,  S.:  Dienestrol:  A New  Synthetic  Estrogen, 
J.A.  M.A.,  i:152  (Aug.)  1946. 


Well  tolerated 


'Dienestrol  was  very  well  tolerated  by  all  menopausal 
patients.” 

Rakoff,  A.  E.,  Paschkis,  K.  E.  and  Cantarow,  A.:  A Clinical  Evaluation 
of  Dienestrol,  A Synthetic  Estrogen,  J.  Clin.  Endocrinol.,  7:688  (Oct.) 
1947. 


Low  toxicity 


"This  low  incidence  of  nausea  [1.3  per  cent]  is  ...  in 
contrast  with  that  encountered  during  treatment  with 
other  synthetic  estrogens.” 

Finkler,  R.  S.  and  Becker,  S.;  "A  Preliminary  Evaluation  of  Dienestrol 
in  the  Menopause,  Am.  J.  Obst.  & Gynec.,  53:513  (Mar.)  1947. 


"Clinical  trials... indicate  that  doses  of  0.2  to  0.5  mg. 
Low  recommended  dosage  daily  are  adequate,  dependable  and  tolerated . . .” 

Sikkema,  S.  H.  and  Sevringhaus,  E.  L.:  Dienestrol:  Another  Synthetic 
Estrogen  of  Clinical  Value,  Am.  J.  Med.,  2:251  (Mar.)  1947. 


Now  in  2 forms: 


Dienestrol  Tablets  — 0.1  mg.  and  0.5  mg.  — bottles  of  100. 
Aqueous  Suspension  of  Dienestrol  — 5 mg.  per  cc.,  10  cc.  vials. 


WHITE  LABORATORIES,  Inc.,  Pharmaceutical  Manufacturers,  Newark  7,  N.  J. 


A private  hospital  for  the  scientific  treatment  of  neuro-psychiatric  disorders,  including 
alcoholism  and  drug  addiction.  Beautiful  landscaping  and  home-like  surroundings  afford 
a restful  atmosphere.  Accommodations  vary  from  single  rooms  with  or  without  bath  to 
rooms  en  suite,  allowing  for  segregation  of  guests. 


Detailed  information  furnished  on  request. 

Karl  J.  Waggener,  M.D.  Wendell  T.  Wingett,  M.D. 


THE  CHILDREN’S  HOSPITAL  ASSOCIATION 

of  DENVER 

NON-SECTARIAN NON-PROFIT 

Providing  medicinal  and  surgical  aid  to  sick  and  crippled  children  of  the  Rocky 
Mountain  Region  from  Birth  to  Maturity 

Every  modern  scientific  aid  available  to  the  physicians  and  surgeons 
of  Colorado  and  Wyoming 

Approved  by  the  American  Medical  Association  and  Full  Three-Year 

the  American  College  of  Surgeons  Nurses’  Training  Course 


for  February,  1949 


173 


Index  to  Advertisers 


Pag-e 


Abbey  Rents 167 

Abbott  Laboratories Cover  III 

Alba  Dairy 166 

American  Medical  and  Dental 

Association  96 

Ayerst,  McKenna  & Harrison_157 

Baker  Laboratories 103 

Berber!  & Sons,  Inc 159 

Blair  Surg'ical  Supply 153 

Boggio’s  152 

Bonita  Pharmacy 168 

Bonnie-Brae  Drug 170 

Boulder-Color  ado 

Sanitarium  112 

Brown  Schools 168 

Cambridge  Dairy 92 


Camel  Cigarette  160'rl61 

Camp  & Co.,  S.  H 149 

Capital  Chevrolet 92 


Cascade  Laundry 162 

Children’s  Hospital 

Association  173 

City  Park  Dairy 98 

Cleveland  Pharmacy 171 

Colburn  Hotel 162 

Coleman  & Bell 166 

Colorado  Springs 

Psychopathic  Hospital 172 

Columbia  Bifocal  Company 165 


Colvin  Medical  Books 162 

Cook  County  Graduate 

School  of  Medicine . 165 

Country  Club  Pharmacy 170 

Cutter  Laboratories 141 

Dansberry’s  Pharmacy 171 

Deep  Rock  Water 166 

Denver  Oxygen  Co 100 

Denver  Towel  Supply  Co 165 

Dorr  Optical  Co 102 

Downing  Street  Pharmacy 171 

Doyle’s  Pharmacy 170 

Durbin  Surgical  Supply  Co 175 


Page 


Earnest  Drug  Co 170 

Eaton  Laboratories 151 

Ehret  Engraving  Co 100 

Fairfax  Sanitarium 167 

Fairhaven  Maternity 

Hospital  164 

Fleet  Co.,  C.  B 104 

Franklin  Drug  Co 171 

Gabriel  Restaurant 162 

Giockner  Penrose 

Hospital 167 

Hatch  Pharmacy 170 

Hyde’s  Pharmacy 170 

Jackson’s  Cut  Rate  Drug 165 

Karg  Paint  Co 162 

Kendrick-Bellamy  Co 90 

Kremers  Urban  Company 145 

Lakewood  Pharmacy 171 

Lederle  143 

Lilly,  Eli  & Co. 

Insert  between 104-105 

Livermore  Sanitarium 163 

Lov-d  Brassiere  Co 155 

Luzier’s - 158 

Mead,  Johnson 

& Co Cover  IV 

Mercy  Hospital 164 

Morning  Milk 169 

Newton  Optical  Co.-- 165 

Nurses  Official  Registry 168 

Overstake’s  Pharmacy 171 

Park  Floral  Co 100 

Parke,  Davis  & Co Cover  II  & 89 

Pfab  Pharmacy ^ 170 

Physicians  and  Surgeons 

Telephone  Service  Exch 165 

Physicians  Casualty  Co 152 

Plaza  Hotel 168 

Porter  Sanitarium 

and  Hospital 172 

Postgraduate  Course 

for  Physicians 152 

Presbyterian  Hospital 164 


Page 


Professional  Pharmacy 171 

Roche  Ambulance  Service 166 

Rockmont  Envelope  Co 168 

Roedel’s  Prescription  Drug 168 

St.  Anthony  Hospital 167 

Sandoz  Chemical  Works 163 

Schering  Corporation 101 

Schmid,  Julius,  Inc 147 

Searle  & Co.,  G.  D 1 139 

Shadel  Sanitarium 154 

Shaford-Fletcher  Optical  Co 98 

Shirley  Savoy  Hotel 152 

Shumake  Drug,  Guido 170 

Silver  State  Laundry 162 

Smith-Dorsey  Company 156 

Smith-Kline  & French 97 

Squibb,  E-.  R 99 

iStarco  Products  Co 162 

Stodghill’s  Imperial 

Pharmacy 98 

Taylor,  M.  F.,  Laboratories 164 

Technical  Equipment 

Corporation  _• 176 

Telephoning  Answering 

Service  92 

Thornton,  George  R 90 

United  States  Brewing 

Industry  150 

Upjohn 95 

Van’s  Pharmacy 171 

Walters  Drug  Store 171 

Wander  Co 91 

Weiss  Drug 171 

Weiss,  Paul 164 

Western  Electric 

Hearing  Aids 164 

Western  Newspaper  Union 162 

Wheatridge  Farm  Dairy 165 

White Insert  between  172  & 173 

Whittaker’s  Pharmacy 171 

Winthrop-Stearns,  Inc 93 

Woodcroft  Hospital  173 

York  Pharmacy 166 


174 


Rocky  Mountain  Medical  Journal 


IT’S  NEW 


ALLISON  TABLE 

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During  the  Mid-Winter  Clinic” 

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THE  J.  DURBIN  SURGICAL 
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for  February,  1949 


175 


THIS  IS  YOUR  SERVICE- 
WHY  NOT  USE  IT? 


Men  of  science  and  medicine  agree  that  the  functional  efficiency  of  any 
piece  of  technical  apparatus  depends  in  large  measure  upon  the  service 
facilities  maintained  by  the  organization  selling  it. 

When  you  place  your  orders  for  scientific  instruments  with  us,  you  have 
the  assurance  that  experienced  technicians  will  always  be  available  to  pro- 
vide capable  service,  promptly  and  efficiently. 


We  list  below  just  a few 
Electrocardiographs 
Photoelectric  Colorimeters 
Warburg  Apparatus 
pH  Meters 
Microscopes 
Laboratory  Ovens 
Laboratory  Furniture 
Metobolators 
Operating  Room  Lights 
Woter  Stills 


of  the  products  we  sell  and  service: 
Electroencepholographs 
Spectrophotometers 

Dubnoff  Metobolic  Shaking  Incubators 
Analytical  Balances 
Photomicrographic  Equipment 
Laboratory  Incubators 
Hospital  Furniture 
Resuscitators 

Autoclaves  and  Sterilizers 
Anesthesia  Apporatus 


Biological  and  Blood  Bank  Refrigerators 
X-Ray  Equipment — Diagnostic  and  Therapy 
X-Ray  Diffraction  Spectrometers 

Films — Dark  Room  Accessories — Protective  Equipment 
Fenwall  System  for  the  Preparation  of  Parenteral  Medications 

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FEATURING 


NSTRUMENTATION 


N MODERN  ANALYSIS 


176 


Rocky  Mountain  Medical  Journal 


WHEN  HE’S 


TEMPTED  BY 


FORBIDDEN 


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What’s  a man  to  do?  He’s 
tired  of  dieting. 

The  vision  of  new 
health  and  a better 
figure  faded  with 
the  first  10  pounds  . . . 

and  now  all  he  can  see 
wherever  he  goes  is  food, 
food,  tempting  food  . . . 

• One  2.5  mg.  tablet  of  Desoxyn 

Hydrochloride,  an  hour  before  breakfast  and  lunch,  can  provide  meal-to-meal 
aid  in  curbing  the  appetite.  It  also  imparts  a desire  for  greater  activity  and  decreases 

the  feeling  of  fatigue.  A third  tablet  may  be  taken  in  midafternoon  if  necessary, 
and  if  it  does  not  cause  insomnia.  • Weight  for  weight,  Desoxyn  is  more 
potent  than  other  sympathomimetic  amines,  so  that  smaller  doses  may 
be  used.  Many  investigators  who  have  used  Desoxyn  extensively  claim  that 
its  action  is  faster  and  more  prolonged  with  relatively  few  side-efects. 

With  the  correct  dosage,  little  or  no  pressor  effect  has  been  observed. 

• As  an  adjunct  to  the  treatment  of  obesity,  as  relief  for  the 
depression  of  convalescence,  as  a safe,  effective  stimulant  for 
the  central  nervous  system,  remember  Desoxyn  Hydrochloride. 

For  the  complete  story  on  indications  and  dosages,  write  to 
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COPYMOUT  1947 
mead  iOHI<^N  I.  CO. 
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P 


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■V 
. > 
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The  Hospital  Administrator’s  Appraisal  of  Cur- 
rent Nursing  Problems — O'^joen  B.  Stubhen. 
Denver. 

Surgical  Treatment  of  X-Ray  Burns — Thomas 
W.  Stevenson,  M.D.,  New  York  City. 

A General  Review  of  Nitrous  Oxide  Anesthesia 
— Leland  O.  Learned,  M.D.,  Salt  Lake  City. 

Chronic  Empyema,  Present  Concepts  of  Treat- 
ment— William  B.  Condon,  M.D.,  and  Marvin 
E.  Johnson,  M.D.,  Denver. 

Unusual  Metastatic  Manifestations  of  Silent 
Gastric  Carcinoma — Lloyd  Smith,  M.D., 
Robert  J.  Freedman,  M.D.,  and  Oza  J. 
LaBarge,  M.D.,  Alexandria,  La. 

Certain  Aspects  of  the  Uterine  Cervix  Cancer 
Problem — C.  B.  Ingraham,  M.D.,  E.  Stewart 
Taylor,  M.D.,  and  Eleanor  Sinton,  M.D.,  Den- 
ver. 

Pneumatic  Rupture  of  the  Bowel— John  A. 
Weaver,  Jr.,  M.D.,  Greeley,  Colorado. 


Clinical  Investigation  of  Oenethyl  Mucate — 
Harold  1.  Goldman,  M.D.,  Denver. 

(For  complete  Table  of  Contents, 
turn  the  first  page) 


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OXYCEL  STRIPS  (Gauze  Type)  Sterile  18"  X 2"  four-ply  strips, 
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OXYCEL  FOLEY  CONES  Sterile  four-ply  gauze-type  discs  of  5"  Or  7" 
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Table  of  Contents 


VOLUME  46 


NUMBER  3 


MARCH,  1949 


Editorials 

Publication  Policies,  A Reminder 

Medical  Radio  Programs 

The  Challenge  We  Must  Meet 

Tribute 

The  Henry  Sewall  Memorial  Lecture... 
Silhouettes  From  the  A.M.A.  House  of 

Delegates  

Thoughts  of  a Maverick 

4- 


Page 


193 

194 
194 

194 

195 

196 
196 


Original  Articles 

The  Hospital  Administrator’s  Appraisal  of 
Current  Nursing  Problems,  Owen  B. 

Stubben  197 

Surgical  Treatment  of  X-Ray  Burns, 

Thomas.  W.  Stevenson,  M.D 198 

A General  Review  of  Nitrous  Oxide  An- 
esthesia, Leland  O.  Learned,  M.D 201 

Chronic  Empyema,  Present  Concepts  of 
Treatment,  William  B.  Condon,  M.D., 

and  Marvin  E.  Johnson,  M.D. 206 

Unusual  Metastatic  Manifestations  of  Silent 
Gastric  Carcinoma,  Lloyd  Smith,  M.D., 
Robert  J.  Freedman,  M.D.,  and  Oza  J. 

LaBarge,  M.D 210 

Certain  Asects  of  the  Uterine  Cervix  Can- 
cer Problem  in  Colorado,  C.  B.  Ingra- 
ham, M.D.,  E.  Stewart  Taylor,  M.D., 

and  Eleanor  Sinton,  M.D 214 

Pneumatic  Rupture  of  the  Bowel,  John  A. 

Weaver,  Jr.,  M.D 218 

Clinical  Investigation  of  Oenethyl  Mucate, 
Harold  1.  Goldman,  M.D 220 

Case  Reports 

Congenital  Tracheo-Esophageal  Fistula, 

Henry  Swan,  M.D.. 221 

Massive  Resection  of  the  Small  Intestine 
Due  to  Volvulus  With  Multiple  Divertic- 
ula of  the  Jejunum,  Kenneth  C.  Sawyer, 
M.D.,  Louis  W.  Soland,  M.D.,  and  Ray 
G.  Witham,  M.D 223 


■f 


Organization 


Colorado 

Western  Colorado  Spring  Clinics 226 

Denver  Children’s  Hospital  Summer 

Clinics 226 

Obituary  228 

Auxiliary  228 

Montana 

Obituary  230 

New  Mexico 

1949  Annual  Meeting 230 

Obituary  230 

Utah 

Utah  Senate  Memorializes  Congress  Op- 
posing State  Medicine 232 

Tuberculosis  Abstract 236 

Book  Corner 238 


178 


Rocky  Mountain  Medical  Journal 


c; 


» 


One  measure  of  powder  + 2 ounces 


water  = 2 ounces 


of 


A.?fOO» 

*»«  THE  ax  IMPORI^ 


normal  formula  — 20  calories  per  ounce 


measure  included  in  each  can 


SIMILAC  DIVISION 
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NAME 


ADDRESS, 


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for  March,  1949 


179 


ROCKY  MOUNTAIN  MEDICAL  JOURNAL 

Title  Registered,  U.S.  Patent  Office 


Publication  Office: 

835  Republic  Building  (1612  Tremont  Place),  Denver  2,  Colorado 
Telephone  CHerry  5521. 


EDITORIAL  BOARD 

Colorado:  Douglas  W.  Macomber,  M.D.,  Scientific  Editor,  1820  Gilpin  St.,  Denver;  Lyman  W.  Mason, 
M.D.,  Associate  Editor,  1214  Republic  Bldg.,  Denver,  (Chairman  of  Editorial  Board). 

Montana:  Raymond  F.  Peterson,  M.D.,  Scientific  Editor,  Butte,  Mont.;  Herbert  T.  Caraway,  M.D., 
Associate  Editor,  Billings,  Mont. 

New  Mexico:  Carl  H.  Gellenthein,  M.D.,  Scientific  Editor,  Valmora,  New  Mexico;  Harold  L.  Janu- 
ary, M.D.,  Associate  Editor,  First  National  Bank  Bldg.,  Albuquerque,  New  Mexico. 

Utah:  Richard  P.  Middleton,  M.D.,  Scientific  Editor,  Boston  Bldg.,  Salt  Lake  City;  W.  H.  Tibbals, 
Associate  Editor,  316  Atlas  Bldg.,  Salt  Lake  City. 

Wyoming:  Earl  Whedon,  M.D.,  Scientific  Editor,  Sheridan;  Arthur  R.  Abbey,  Associate  Editor,  P.O. 
Box  897,  Cheyenne. 

— 

Managing  Editor:  Harvey  T.  Sethman,  835  Republic  Bldg.,  Denver. 

Business  Manager:  Helen  Kearney,  835  Republic  Bldg.,  Denver. 


Ownership  and  Sponsorships  The  Hocky  Mountain 
Medical  Journal  is  owned  by  tho  Colorado  State 
Medical  Society  and  Is  published  monthly  as  a non- 
profit enterprise  for  the  mutual  benefit  of  the  or- 
granlzations  which  jointly  sponsor  It.  It  is  published 
under  the  direction  of  the  Board  of  Trustees  of  the 
Colorado  State  Medical  Society,  assisted  by  an  Edi- 
torial Board  representing-  the  sponsoring  organiza- 
tions. It  is  the  Official  Journal  of  the  Colorado  State 
Medical  Society,  the  Montana  State  Medical  Associa- 
tion, the  New  Mexico  Medical  Society,  the  Utah 
State  Medical  Association,  the  Wyoming  State  Medi- 
cal Society,  the  Rocky  Mountain  Medical  Conference, 
and  the  Colorado  Hospital  Association. 

Manuscripts:  Scientific  Articles,  Case  Reports,  etc., 
from  any  state  for  which  this  is  the  Official  Journal 
should  be  submitted  to  the  Scientific  Editor  for  that 
state  as  named  in  the  Editorial  Board,  abo-ve.  Other 
material  from  any  participating  state  should  be  sub- 
mitted to  the  Associate  Editor  for  that  state  as 
named  above.  Manuscripts  from  outside  the  Rocky 
Mountain  area  should  be  sent  direct  to  the  Journal 
office.  Manuscripts  must  be  typewritten,  double  or 
triple  spaced,  using  only  one  side  of  each  sheet.  It 
is  the  policy  of  this  Journal  to  omit  bibliographies. 


Advertising:  National  representatives:  The  Coop- 
erative Medical  Advertising  Bureau,  635  North  Dear- 
born Street,  Chicago  10,  111.  Local  advertising  from 
firms  in  the  Rocky  Mountain  area  should  be  submit- 
ted to  the  Associate  Editor  of  the  appropriate  state 
or  to  the  Journal  office.  Advertising  forms  close  on 
the  20th  of  the  month  preceding  publication;  allow 
ten  days  additional  to  insure  submitting  proofs  for 
approval. 

Subscription:  $2.50  per  year  in  advance,  postpaid  in 
the  United  States  and  its  possessions;  single  copy, 
25  cents  plus  postage.  Subscription  is  included  in 
medical  society  dues  of  sponsoring  state  medical 
organizations. 

Copyright:  This  Journal  is  copyright,  1949,  by  the 
Colorado  State  Medical  Society.  Requests  for  permis- 
sion to  reproduce  anything  from  the  columns  of  this 
Journal  should  be  addressed  to  the  Journal  office. 

Second  Class  Matter:  Entered  as  second  class  mat- 
ter Jan.  22,  1906,  at  the  Postoffice  at  Denver,  Colo., 
under  the  Act  of  Congress  of  March  3,  1879.  Accepted 
for  mailing  at  special  rates  of  postage  pro-vided  for 
in  Section  1103,  Act  of  Oct.  3,  1917;  authorized  July 
17.  1918. 


Essential  Automobiles  Given  Priority — We  Recommend 

CAPITAL  CHEVROLET  COMPANY 

Featuring  COMPLETE  REPAIR  SERVICE — Including  Body,  Fender  and  Paint  Work 

CAPITAL  CHEVROLET  COMPANY 

Phone:  TAbor  5191  13th  Ave.  at  Broadway  to  Lincoln  Denver,  Colo. 


Don't  miss  important  telephone  calls  . 


Let  us  act  as  your  secretary  while  you  are  away,  day  or  night: 
our  kindly  voice  conscientiously  tends  your  telephone  business, 
accurately  reports  to  you  when  you  return. 


Telephone  ANSWERING  Service  call  ALpine  mm 


Cambridge  Dairy  Grade  “A”  Milk  Is  Produced  and  Processed  at  690  S.  Colo.  Blvd. 

We  do  not  handle  Shipped-in  Milk  produced  Where?  How  and  by  Whom?  Doctors  know  the  difference 
Now  Homogenized  Vitamin  D Milk  is  available  for  baby  feeding  and  family  use. 

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Water  retention  (excessive  gain  in  weight- 
pitting  edema)  is  quite  common  in  pregnancy. 
Sodium,  particularly  if  used  excessively, 
accelerates  this  process.  Vice  versa,  sodium 
restriction  can  prevent  water  retention. 

Neocurtasal,  completely  sodium  free  salt,  palat- 
ably seasons  low  sodium  diets.  Neocurtasal 
looks,  tastes,  and  is  used  like  ordinary  table 
salt.  Available  in  convenient  2 oz.  shakers  and 
8 oz.  bottles. 


lEoeiimsiL' 


THE  COLORADO  STATE  MEDICAL  SOCIETY 


Next  Annual  Session:  Shirley-Savoy  Hotel,  Denver;  Sept.  20,  21,  22,  23,  1949 


OFFICERS 

Terms  of  Officers  and  Committees  expire  at  the  Annual  Session 
in  the  year  indicated.  Where  no  year  Is  indicated,  the  term 
is  for  one  year  only  and  expires  at  the  1949  Annual  Session. 

President:  Casper  P.  Hegner,  Denyer. 

President-elect:  Fred  A.  Humphrey,  Fort  Collins. 

Vice  President:  Lester  L.  Ward,  Pueblo. 

Constitutional  Secretary  (three  years):  George  B.  Buck,  Denver,  1951. 
Treasurer  (three  years):  George  C.  Shivers,  Colorado  Springs,  1950. 

Additional  Trustees  (three  years):  Ervin  A.  Hinds,  Denver,  1949;  E.  E. 
Munro,  Grand  Jurction,  1949;  S.  P.  Newman,  Denver,  1950;  (Baude  D. 
Bonham,  Boulder,  1951. 

(The  above  nine  officers  compose  the  Board  of  Trustees  of  which  Dr. 
Ervin  A.  Hinds  is  the  1948-1949  Chairman.) 

Board  of  Councilors  (three  years):  District  No.  1:  Clemens  F.  Eaklns, 
Brush,  1951;  No.  2:  Ella  A.  Mead,  Greeley,  1951;  No.  3:  L.  G.  Crosby. 
Denver,  1951;  No.  4:  Banning  E.  Likes,  Lamar,  1950;  No.  5:  Guy  H. 
Hopkins,  Pueblo,  1950;  No.  6:  Lester  E.  Thompson,  Salida,  1950;  No.  7; 
A.  L.  Burnett,  Durango,  1949;  No.  8:  Lawrence  L.  Hick,  Delta,  1949; 
No.  9:  W.  W.  Sloan,  Hayden,  1949  (Chairman  of  Board  for  1948-49). 

Board  of  Supervisors  (two  years);  A.  B.  GjeUum,  Del  Norte,  1949;  L.  W. 
Lloyd,  Durango,  1949;  B.  G.  Howlett,  (lolden,  1949;  Scott  A.  Gale, 
Pueblo,  1949;  L.  D.  Dickey,  Fort  ColUns,  1949;  N.  A.  Madler,  Greeley, 
1949  (Chairman  of  Board  for  1948-49);  L.  D.  Buchanan,  Wray,  1950; 
W.  F.  Deal,  (halg,  1950;  0.  C.  Cary,  Grand  Junction,  1950;  W.  A. 
Campbell,  Colorado  Springs,  1950;  Balpb  S.  Johnston,  Sr.,  La  Junta, 
1950;  WilUam  A.  Liggett,  Denver,  1950. 

Delegates  to  American  Medical  Association  (two  years) ; George  A.  linfug, 
Pueblo,  1949  (Alternate:  Herman  C.  Graves,  Grand  Junction,  1949); 
William  H.  Halley,  Denver,  1950  (Alternate;  Kenneth  C.  Sawyer,  Denver, 
1950). 

Foundation  Advocate:  Walter  W.  Klnf,  Demor. 

Executive  Office  Staff:  Mr.  Harvey  T.  Setbman,  Executive  Secretary; 
Miss  Helen  Kearney,  Assistant  Executive  Secretary;  Mr.  Evan  A.  Edwards, 
Field  Secretary;  Miss  Mary  E.  McDonald,  Committee  Secretary;  835  Be- 
publlc  Building.  Denver  2,  Colo.,  Telephone  CHerry  5521. 

General  Counsel:  Mr.  J.  Peter  Nordlund,  Attomey-at-Law,  Denver. 

STANDING  COMMITTEES 
Credentials:  George  B.  Buck,  Denver,  Chairman,  ex-offlclo;  others  to 
be  appointed. 

Public  Policy:  Kenneth  C.  Sawyer,  Denver,  Chairman;  McKlnnie  L. 
Phelps,  Denver,  Vice  Chairman;  John  S.  Bouslog,  Denver;  P.  B.  Calhoun, 
Denver;  Frank  B.  McGlone,  Denver;  T.  M.  Bogers,  Sterling;  Sidney  An- 
derson, Alamosa;  Bicbard  L.  Davis,  La  Junta;  Herman  C.  Graves,  Grand 
Junction;  John  L.  McDonald,  Colorado  Springs;  George  E.  Bice,  Pueblo; 
John  D.  Gillaspie,  Boulder.  Ex-Officio  members:  Casper  F.  Hegner,  Presi- 
dent; Fred  A.  Humphrey,  President-elect;  George  R.  Buck,  Constitutional 
Secretary. 

Sub-Committee  on  Legislation:  H.  I.  Barnard,  Denver,  Chairman;  others 
to  be  appointed. 

Health  Education  (two  years);  A.  C.  Sudan,  Denver,  Chairman,  1949; 

J.  D.  Bartholomew.  Boulder,  1949;  R.  J.  Savage,  Denver,  1949;  R.  T. 
Porter,  Greeley,  1949;  Robert  B.  Bradshaw,  Alamosa,  1949;  L.  W.  Bortree, 
(krlorado  Springs,  1950;  F.  0.  Robertson,  Denver,  1950.;  J.  L.  Sadler,  Fort 
Collins,  1950;  Harold  T.  Low,  Pueblo,  1950;  John  H.  Amesse,  Denver, 
1950;  E.  H.  Munro,  Grand  Junction,  1950. 

Scientific  Work:  W.  B.  Condon,  Denver,  Chairman;  Robert  S.  Liggett, 
Karl  F.  Arndt,  Prank  T.  Joyce,  Marshall  G.  Nims,  Vincent  G.  Cedar- 
blade,  aU  of  Denver. 

Sub-Committee  on  Scientific  Exhibits:  Frank  C.  Campbell,  Chairman; 
Nolle  Mumey,  Edgar  W.  Barber,  B.  W.  Vines,  aU  of  Denver. 

Arrangements:  To  be  appointed. 

Medieolegai  (two  years):  R.  W.  Arndt,  1950,  (Rialrman;  George  B. 
Packard,  Jr.,  1950;  K.  D.  A.  Allen,  1950.;  C.  S.  Bluemel,  1949;  Lyman 
W.  Mason,  1949;  Harry  C.  Hughes,  1949;  all  of  Denver. 

Medical  Education  and  Hospitals;  George  F.  WoUgast,  Denver,  Chairman; 
W.  W.  Sloan,  Hayden;  F.  R.  Pingrey,  Durango;  E.  R.  Mugrage,  Denver; 
D.  W.  McCarty,  Longmont;  A.  E.  Lubcbenco,  Denver. 

Library  and  Medical  Literature:  A.  J.  Markley,  Denver,  Chairman;  T.  E. 
Beyer,  Denver:  J.  J.  Connor,  Delta;  H.  Dumont  Clark,  Denver. 

Medical  Service  Plans:  F.  H.  Good,  Denver,  Chairman;  C.  E.  Honstein, 
Fort  Collins;  James  R.  Blair,  Denver;  Vernon  L.  Bolton,  Colorado  Springs; 
Scott  A.  Gale,  Pueblo;  John  A.  Weaver,  Jr.,  Greeley;  John  E.  Hyland, 
Monte  Vista;  Thomas  K Mahan,  Grand  Junction. 

Necrology:  W.  H.  Wilson,  Denver,  Chairman. 


PUBLIC  HEALTH  COMMITTEES 

General  Committee  on  Public  Health:  Consists  of  the  chairmen  of  the 
following  eleven  public  health  subcommittees,  presided  over  by  Robert  W. 
Dickson,  Denver,  as  General  Chairman. 

Cancer  Control:  J.  C.  Mendenhall,  Denver,  Chairman;  John  B.  Grow, 
Denver;  S.  W.  HoBey,  Greeley;  T.  Leon  Howard,  Denver;  James  B.  Mc- 
Naught,  Denver;  Roger  G.  Howlett,  Golden;  James  W.  McMullen,  Colorado 
Springs;  James  E.  Donnelly,  Trinidad;  Banning  E.  Likes,  Lamar;  Thomas 

K.  Mahan.  Grand  Junction. 


Crippled  Children:  I.  E.  Hendryson,  Denver,  Chairman;  Mary  L.  Moon, 
Grand  Junction;  Richard  H.  MeUen,  Colorado  Springs;  Sidney  B.  Blud- 
ford,  Jr.,  Denver;  Paul  B.  Hildebrand,  Brush;  Samuel  P.  Newman,  Domr. 

Industrial  Health:  B.  F.  BeU,  Louvlers,  Chairman;  A.  B.  Woodbnme, 
Denver:  Vincent  E.  Kelly,  LeadvUle;  D.  W.  Boyer,  Pueblo;  H.  G.  Harvey,  Jr., 
Denver;  Robert  Woodruff,  Denver;  Frank  J.  McDonough,  Grand  Junction. 

Local  Health  Units;  Monroe  R.  Tyler,  Denver,  Chairman;  Harold  E. 
Haymond,  Greeley;  R.  B.  Richards,  Fort  Morgan;  Nicholas  S.  Sallba,  Wal- 
senburg;  Marvel  L.  Crawford,  Steamboat  Springs;  B.  Sherwin  Johnston,  Jr., 
La  Junta. 

Maternal  and  Child  Health;  John  B.  Evans,  Denver,  Chairman;  Joseph 
H.  Lyday,  Denver;  John  M.  Nelson,  Denver;  Tracy  D.  Peppers,  Greeley: 
J.  H.  Woodbrldge,  Pueblo;  M.  B.  Snyder,  Colorado  Springs. 

Mental  Hygiene:  Bradford  Murphey,  Denver,  Chairman;  E.  James  Brady, 
Colorado  Springs;  Frank  E.  Zimmerman,  Pueblo;  Paul  A.  Draper,  (ktlorade 
Springs;  J.  P.  Hilton,  C.  S.  Bluemel,  John  M.  Lyon,  G.  H.  AsUey,  Lewie 
C.  Overbolt,  Clarke  H.  Barnacle,  Harold  B.  Carter,  aU  of  Denver. 

Milk  Control:  George  W.  Stiles,  Denver,  Chairman;  Max  M.  Glnsbun, 
Denver;  N.  J.  MlUer,  D.V.M.,  Eaton;  Millard  F.  Schafer,  Colorado  Springs; 
Robert  W.  Vines,  Denver;  Mr.  Wendell  Vincent,  Denver. 

New  Hospital  Construction:  D.  R.  Collier,  Wbeatrldge,  Chairman; 
Henry  M.  Powell,  Colorado  Springs;  Mr.  John  R.  Peterson,  Fort  Collins; 
Florence  R.  Sabin,  Denver;  Herbert  A.  Black,  Pueblo. 

Public  Water  Supplies:  E.  I.  Dobos,  Denver,  Chairman;  Robert  Barnard, 
Eagle;  William  C.  Shontz,  San  Luis;  Carl  W.  Maynard,  Pueblo;  W.  B. 
Crouch,  Colorado  Springs;  H.  D.  Palmer,  Denver;  E.  Robert  Orr,  Fruits. 

Tuberculosis  Control;  John  I.  Zarit,  Denver,  Chairman;  W.  J.  Hlnael- 
man,  Greeley;  H.  M.  Van  Der  Schouw,  Wbeatrldge;  John  P.  McGraw,  Pueblo; 
Arthur  Best,  Denver;  H.  Calvin  Fisher,  Denver;  T.  D.  Cunningham,  Denver. 

Venereal  Disease  Control:  Sam  W.  Downing,  Denver,  Chairman;  Paul  B. 
Stidham,  Grand  Junction;  H.  E.  Coakley,  Pueblo;  D.  E.  Newland,  Denver; 
Joseph  H.  Patterson,  Denver;  James  R.  McDoweU,  Denver. 

SPECIAL  COMMITTTES 

Rocky  Mountain  Medical  Conference  (five  years):  L.  Clark  Hepp,  Denver, 
1953;  G.  P.  Llngenfelter,  Denver,  1952,  Chairman;  Ward  Darley,  Denver, 
1951;  L.  W.  Bortree,  Colorado  Springs,  1950;  George  H.  Gillen,  Denver, 
1949. 

Advisory  to  Auxiliary:  Fred  A.  Humphrey,  Fort  Collins,  Chairman;  Ervin 
A.  Hln(&,  George  R.  Buck,  Denver. 

Midwinter  Clinics:  Samuel  B.  Childs,  Jr.,  Chairman;  Raymond  C.  Chat- 
field,  E.  L.  Binkley,  Jr.,  A.  J.  Kauvar,  Terry  J.  Gromer,  aU  of  Denver. 

Rehabilitation:  W.  W.  Haggart,  Denver,  Chairman;  Atha  Thomas,  Den- 
ver; Lawrence  T.  Brown,  Denver:  J.  E.  A.  Connell,  Pueblo;  Thad  P.  Sean, 
Ft  Logan;  Kenneth  C.  Sawyer,  McKlnnie  L.  Phelps,  George  B.  Buck, 
Bradford  Murphey,  all  of  Denver. 

Advisory  to  the  Goodwill  Industries’  Rehabilitiation  Program:  Lewis  C. 

Dverholt,  Chairman;  William  H.  Halley,  Maurice  Katxman,  Terry  1. 
Gromer.  Lorenz  W.  Frank,  WlUlam  R.  Lipscomb,  Irvin  B.  Hendryaon, 
all  of  Denver. 

Rural  Hdalth  Commission:  Leonard  N.  Myers,  Cheyenne  Wells,  Chairman; 
V.  V.  Anderson,  Del  Norte;  James  S.  Orr,  Fruita;  Kdth  F,  Krausalek, 
Lamar;  Robert  M.  Lee,  Fort  Collins.  Ex-offlclo  member:  Fred  A.  Hum- 
phrey, Fort  Collins. 

Medical  Disaster  Commission:  Foster  Matchett,  Denver,  Chairman;  Karl 
Arndt,  Denver,  Secretary;  Mark  S.  Donovan,  Harry  C.  Hughes,  Adolph  J. 
Kafka,  Roderick  J.  McDonald,  William  F.  Stanok,  Henry  Swan,  Karl  F. 
Sunderland,  K.  D.  A.  Allen,  all  of  Denver;  Lawrence  W.  Holden,  Boulder; 
Richard  H.  Mellen.  Colorado  Springs;  Richard  H.  Altmix,  Englewood:  Jacob 
0.  Mall,  Estes  Park;  Thad  P.  Sears,  Fort  Logan;  Donald  E.  Cowen,  Fort 
Morgan;  Kenneth  E.  Prescott,  Grand  Junction;  Walter  A.  Schoen,  Greeley; 
David  W.  McCarty,  Longmont;  David  W.  Boyer,  Pueblo;  J.  G.  Espey,  Craig; 
Leo  W.  Loyd,  Durango;  Keith  F.  Krausnick,  Lamar;  Robert  M.  Lee,  Ft  Col- 
lins; George  H.  Lord,  Aurora;  J.  Gordon  Hediick,  Wray;  James  P.  Bigg, 
Grand  Junction. 

Lay  Organization  Standards;  George  B.  Buck,  Fredrick  H.  Good,  Ken- 
neth C.  Sawyer,  Frank  B.  McGlone,  T.  D.  Cunningham,  Bradford  Murphey, 
Casper  F.  Hegner,  John  S.  Bouslog,  aU  of  Denver. 

Study  of  Child  Welfare  Clinics:  Ralph  H.  Verploeg,  Denver,  Chairman; 
J.  W.  White,  Pueblo:  Jadrson  L.  Sadler,  Fort  Collins;  L.  E.  Maurer, 
Boulder;  Harvey  M.  Tupper,  Grand  Junction;  Harvey  S.  Rusk,  Pueblo. 

Advisory  to  U.M.W.  Welfare  Fund  (Executive  Committee,  three-year 
terms;  others,  one-year):  Executive:  W.  W.  Haggart,  1951,  Chairman; 
F.  H.  Good,  1951;  J.  S.  Bouslog,  1951,  all  of  Denver;  W.  H.  Halley, 
1950;  C.  F.  Hegner,  1950,  both  of  Denver;  R.  F.  Bell,  1950,  Louvlers; 
McKinnie  Phelp.s.  1949,  Denver;  P.  A.  Humphrey,  1949,  Fort  Collins: 
J.  M.  Lamme,  1949,  Walsenburg.  Other  members;  K.  C.  Sawyer,  A.  C. 
Sudan,  Bradford  Murphey,  aU  of  Denver;  C.  D.  Bonham,  Boulder;  J.  W. 
Craighead,  Pueblo;  J.  E.  Donnelly,  Trinidad;  Ligon  Price,  Mt.  Harris;  M.  J. 
McCaUum,  Erie. 

Liaison  to  Colorado  State  Nurses  Association:  John  B.  Evans,  Samuel  P. 
Newman,  Denver. 

Liaison  to  Colorado  Bar  Association:  W.  S.  Dennis,  Chairman;  A.  C. 
Sudan,  R.  W.  Arndt,  aU  of  Denver. 

Medical-Dental  Liaison:  Guy  W.  Smith,  Denver,  Chairman;  George  B. 
Warner,  Denver;  Calvin  N.  CaldweU,  Pueblo. 

Representative  to  Rocky  Mountain  Radio  Council:  WHUam  E.  Hay, 
Denver;  (Alternate:  Chauncey  A.  Hager,  Denver). 

Representative  to  Belle  Bonfils  Memorial  Blood  Bank;  0.  S.  Philpott, 
Denver. 

Representatives  to  Liaison  Council  on  Graduate  Education  (two  years): 

L.  R.  Safarik,  Denver,  1949;  Harold  I.  Goldman,  Denver,  1950. 

Delegate  to  Colorado  Interprofessional  Council  (five  years) : K.  D.  A. 
Allen,  Denver,  1949;  (Alternate,  Carl  A,  McLauthUn,  Denver,  1949). 


182 


Rocky  Mountain  Medical  Journal 


mp  miM  can  a 


I 

_C.n  a recent  coast-to-coast 
test,  hundreds  of  men  and 
women  smoked  Camels— and 
only  Camels— for  30  consecu- 
tive days.  These  people 
smoked  on  the  average  of  one 
to  two  packages  of  Camels  a 
day  during  the  entire  test  pe- 
riod. Each  week,  throat  spe- 
cialists examined  these  Camel 
smokers.  A total  of  2,470  care- 
ful examinations  were  made 
by  these  doctors.  After  study- 
ing the  results  of  the  weekly 
examinations,  these  throat 
specialists  reported: 


“Not  one  single  case  of  throat 

IRRITATION  DUE  TO  SMOKING  CAMELS!” 


Test  Camel  mildness  for  yourself  in  your  own 
”T-Zone.”  T for  taste,  T for  throat.  If,  at 
any  time,  you  are  not  convinced  that  Camels 
are  the  mildest  cigarette  you’ve  ever  smoked, 
return  the  package  with  the  unused  Camels 
and  we  will  refund  its  full  purchase  price, 
plus  postage.  { Signed)  R.  J.  Reynolds  Tobacco 
Company,  Winston-Salem,  North  Carolina. 

Accore/ing^  to  a Action  wide  suri/^-. 

More  Doctors 
SMOKE  Camels 

tAan  any  other  cigarette 


Doctors  smoke  for  pleasure,  too!  And  when 
three  leading  independent  research  organiza- 
tions asked  113.597  doctors  what  cigarette 
they  smoked,  the  brand  named  most  was  Camel ! 


for  March,  1949 


183 


MONTANA  STATE  MEDICAL  ASSOCIATION 


OFFICERS 

Tenm  of  Officers  and  Committees  expire  at  the  Annual  Session 
in  the  year  indicated.  Where  no  year  is  indicated,  the  term  is 
for  one  year  only  and  expires  at  1949  Annual  Session. 

President:  Thomas  L.  Havklns,  Helena. 

President-elect:  Thomas  F.  Walker,  Great  Falls. 

Vice-President:  B.  G.  Johnson,  Harlowton. 

Secretary-Treasorer:  Herbert  T.  Caraway,  Billings. 

Delegate  to  American  Medical  Association:  Raymond  F.  Peterson,  Butte, 
1950;  Alternate,  Thomas  B.  Moore,  KalispeU,  1950. 


STANDING  COMMITTEES 

Exeentlyo  Committee:  T.  L.  Hawkins,  Helena,  Chairman;  T.  F.  Walker, 
Great  Falls;  H.  T.  Caraway,  Billings;  L.  W.  Allard,  Bluings;  H.  A. 
SblUlngton,  Glendlve. 

Economies  Committee:  J.  C.  Shields,  Butte,  Chairman;  C.  P.  Brooke,  St. 
Ignatius;  B.  B.  Dumln,  Great  Falls;  Leland  G.  Russell,  Billings;  S.  D. 
Whetstone,  Cut  Bank. 

Legislative  Committee;  J.  M.  FUnn,  Helena,  Chairman;  F.  D.  Hurd, 
Great  Falls;  P.  E.  Kane,  Butte;  J.  C.  MacGregor,  Great  Falls;  Claude 
H.  Mears,  Helena. 

Necrology  and  History  of  Medicine  Committee:  L.  W.  Brewer,  Missoula, 
Chairman:  I.  J.  Bridenstine.  Missoula;  J.  H.  Irwin,  Great  Falls;  Claude 
M.  Mears,  Helena'  J.  P.  Bitcbey,  Missoula. 

Pobllc  Relations  Committee;  H.  W.  Gregg,  Butte,  Chairman;  W.  L.  DuBols, 
Cut  Bank;  B.  V.  Morledge,  BlUlngs;  W.  H.  Stephan,  DlUon;  Dora  Walker, 
Great  Falls. 

Legal  Affairs  and  Malpractice  Commltteoi  J.  C.  MacGregor,  Great  FaUs, 
Chairman;  Raymond  Eck,  Lewlstown;  W.  E.  Harris,  Uvlngston;  John  E. 
Hynes,  Billings;  R.  D.  Knapp,  Wolf  Point. 

Program  Committee:  C.  H.  Fredrickson,  Missoula,  Chairman;  H.  T. 
Caraway,  BlUings-  H.  W.  Gregg,  Butte;  J.  J.  McCabe,  Helena;  E.  S. 
Murphy,  Missoula. 

Interprofessional  Relationship  Committee:  L.  W.  AUard,  BiUlngs,  Chair- 
man; C.  B.  Canty,  Butte;  S.  A.  Cooney,  Helena;  S.  N.  Preston,  Missoula; 
F.  I.  Sabo,  Bozeman. 


Nominating  Committee:  H.  H.  James,  Butte,  Chairman;  E.  I,.  AndenoB, 
Fort  Benton;  R.  D.  Harper,  Sidney;  J.  J.  Malee,  Anaconda;  W.  B,  Mo- 
Elwee,  Townsend. 

Auditing  Committee:  E.  H.  Llndstrom,  Helena,  Chairman;  F.  H.  Crago, 
Great  Falls;  R.  D.  Harper,  Sidney;  G.  W.  Setzer,  Malta;  B.  G.  Johnson, 
Harlowton. 

Cancer  Committee;  Mary  E.  Martin,  BlUings,  Oiairman:  W.  F.  Ciah- 
more,  Helena;  C.  B.  Fredrickson,  Missoula;  B.  F.  Peterson,  Butte;  W.  C. 
Robinson,  Shelby. 

Maternal  and  Child  Welfare  Committee:  F.  L.  McPhail,-  Great  Falla, 
Chairman;  L.  W.  Brewer,  Missoula;  P.  L.  Eneboe,  Bozeman;  Maude  M. 
Gerdes,  BlUings;  D.  L.  Gillespie,  Butte;  A.  L.  Gleason,  Great  Falla;  IL  I<. 
Hall,  Great  FaUs;  D.  S.  MacKenzie,  Jr.,  Harre;  B.  E.  MatUson,  BiUlnp: 
0.  M.  Moore,  Helena;  F.  W.  Paul,  KalispeU;  C.  W.  Pemberton,  Butte; 
S.  N.  Preston,  Missoula;  A.  E.  Bitt,  Great  Falls. 

Tuberculosis  Committee:  F.  I.  TerrUl,  Galen,  Chairman;  C.  B.  Cnft, 
Bozeman;  E.  A.  Dolan,  Anaconda;  A.  R.  Klntner,  Missoula;  J.  A.  Layne, 
Great  FaUs. 

Ffaeture  and  Orthopedic  Committee:  J.  K.  Colman,  Butte,  Chairman;  L.  C. 
Allard,  BilUngs;  W.  B.  Hagen,  BiUlngs;  S.  L.  O^ers,  Butte;  J.  C.  Wol- 
gamot.  Great  FaUs. 

Rural  Health  Committee:  B.  C.  Farrand,  Jordan,  Chairman;  B.  A. 
Benke,  KaUspell;  W.  A.  Lacey,  Havre;  W.  G.  TangUn,  Poison;  J.  H. 
WilUams,  Culbertson. 

industrial  Welfare  Committee:  B.  B.  Richardson,  Great  FaUs,  Chairman; 
M.  A.  Gold,  Butte;  P.  E.  Logan,  Great  FaUs;  D.  8.  MacKenzie,  Jr.,  Bam; 
R.  E.  Walker,  Livingston. 

Rheumatie  Fever  and  Heart  Committee:  F.  B.  Schemm,  Great  Falls, 
Chairman;  D.  T.  Berg,  Helena;  H.  W.  Gregg,  Butte;  A.  R.  Kintner,  Mis- 
soula; P.  E.  Logan,  Great  FaUs;  F.  H.  Lowe,  Misoula;  J.  J.  Malee, 
Anaconda;  0.  M.  Moore,  Helena;  H.  W.  Power,  Conrad;  B.  E.  Smalley, 
BilUngs, 

SPECIAL  COMMITTEES 

Emergency  Medical  Service  Committee:  B.  F,  Peterson,  Butte,  Cbaiiman; 
Paul  J.  Gans,  Lewlstown;  J.  J.  McCabe,  Helena;  S.  aL  Olson,  Glendlve; 
L.  G.  BusseU,  BilUngs. 

IA8  Fee  Schedule  Committee:  H.  H.  James,  Butte,  Chairman;  B.  H. 
Llndstrom,  Helena;  J.  J.  Malee,  Anaconda;  D.  S.  McKenzie,  Jr.,  Ham; 
F.  K.  Waniata,  Great  Falls. 


Collection 


of 


Accounts 


All  reports  show  a trend  toward  slower  and  harder  collections  in  the 
months  ahead. 

At  the  first  sign  of  neglect  you  will  save  money  if  they  are  turned  over 
to  us  for  collection. 

Comparison  of  collection  results,  backed  by  35  years  of  experieniie,  proves 
you  obtain  greater  results  at  less  cost,  when  you  list  your  accounts 

with 

The  American  Medical  and  Dental  Association 

Suite  524,  810  14th  St.  TAbor  2331  Denver,  Colorado 


184 


Rocky  Mountain  Medical  Journal 


MEAT... 

Jn  the  Uat'mal  Weight  Keduetion  Program 


One  dictum  is  universally  recognized  in  the  planning  of 
reducing  diets:  the  basic  requirements  of  good  nutrition 
remain  unaltered,  and  adequate  amounts  of  high-quality 
protein  are  the  cardinal  factor  in  the  successful  dietary 
management  of  overweight. 

Protein  allowance  in  such  a program  is  stated  to  be 
not  less  than  1.5  to  1.7  Gm.  per  Kg.  of  ideal  body  weight.* 
A further  advantage  of  the  diet  high  in  protein  and  low  in 
fat  and  carbohydrate  is  its  greater  simplicity;  the  tedious 
calculation  of  calories  may  be  omitted  without  impairing 
the  efl&cacy  of  the  program.^ 

It  is  therefore  recommended  that  lean  meat  be  given 
a dominant  role  in  reducing  diets.* 

The  protein  content  of  meat  is  notably  high.  Regardless 
of  cut  or  kind,  meat  provides  biologically  complete  protein 
able  to  satisfy  the  multiple  amino  acid  needs  of  the  body. 

Lean  meat,  particularly,  is  of  excellent  digestibility. 
Its  outstanding  satiety  value  assures  patient  cooperation,  a 
vital  factor  in  the  success  of  any  weight  reducing  program. 

1 McLester,  J.  S.:  Nutrition  and  Diet  in  Health  and  Disease,  ed. 

4,  Philadelphia  and  London,  W.  B.  Saunders  Company,  1943. 

2 Kunde,  M.  M.:  The  Role  of  Hormones  in  the  Treatment  of 
Obesity,  Ann.  Int.  Med.  28:971  (May)  1948. 


The  Seal  of  Acceptance  denotes  that  the  nutri- 
tional statements  made  in  this  advertisement 
are  acceptable  to  the  Council  on  Foods  and 
Nutrition  of  the  American  Medical  Association. 


American  Meat  Institute 

Main  Office,  Chicago... Members  Throughout  the  United  States 


for  March,  1949 


185 


NEW  MEXICO  MEDICAL  SOCIETY 

Next  Annual  Session:  Roswell,  May  5,  6.  7,  1949 


OFFICERS  — 1948-1949 

President:  P.  L.  Travers,  Santa  Fe. 

Prssldent-Eleet:  J.  W.  Hanoett,  AlbuquerQue. 

Vies  President:  I.  J.  Marshall,  Boswell. 

Seeretary^Treasurer:  H.  L.  January.  Albuquerque. 

CMnellon  <3  years):  W.  D.  Dabbs,  aovls;  A.  C.  Shuler,  Carlsbad. 
Ceoncliors  (2  years):  R.  0.  Brown,  Santa  Fe;  C.  H.  Qellenthlen,  Valmora. 
Coonellors  (1  year):  Carl  Mulky,  Albuquerque;  L.  S.  EraiB,  Las  OTices. 

COMMITTEES  — 1948-1949 

Basle  Sclenee:  W.  E.  Nlssen,  Albuquerque,  Chairman;  Le  Grand  Ward, 
Santa  Fe;  Vincent  Aceardl,  Gallup. 

Rural  Medical  Serica  Service:  Stuart  W.  Adler,  Albuquerque,  Cbalrman; 
W.  B.  Cantrell,  Hot  Springs;  Samuel  R.  Zeigler,  Espanola;  A.  T.  Gordon, 
Tucumcari;  L.  G.  Foster,  Reserve. 

Cancer:  Murray  M.  Friedman,  Santa  Fe,  Chairman;  Van  A.  Odle,  Boswell; 
J.  B.  Van  Atta,  Albuquerque;  j.  W.  Groesman,  Albuquerque;  B.  W.  Maher, 
Albuquerque. 


Venereal  Disease  Control:  Sam  Jelso,  Albuquerque,  Chairman;  V.  B. 
Berchtold,  Santa  Fe;  L.  M.  Miles,  Albuquerque;  L.  S.  Evans,  Las  Crueea; 
H.  L.  January,  Albuquerque. 

Legislative:  Albert  Lathrop,  Santa  Fe,  Chairman;  W.  0.  Connor,  Albu- 
querque; W.  B.  Lovelace,  II,  Albuquerque;  Walter  A.  Stark,  Las  Vegas; 
George  S.  Morrison,  Boswell;  B.  0.  Brown,  Santa  Fe. 

Public  Relations:  D.  A.  McKinnon,  Jr.,  Albuquerque,  Chairman;  James 
L.  McCrory,  Santa  Fe;  H.  M.  Mortimer,  Las  Vegas;  Frank  W.  Parker,  Jr., 
Gallup. 

Tuberculosis:  B.  0.  Brown,  Santa  Fe,  Cbalrman;  C.  H.  Gellenthlen, 
Valmora;  D.  0.  Shields,  Albuquerque;  H.  S.  A.  Alexander,  Sants  Fe. 

Advisory  Committee  on  Ins.  Compensation:  Eugene  W.  Fiske,  Santa  Fe, 
Chairman;  John  F.  Conway,  Clovis;  A.  C.  Shuler,  Carlsbad;  B.  E.  ForMa, 
Mbuquerque. 

Committee  on  National  Emergency  Medical  Service:  A.  E.  Beymont,  Santa 
Fe,  Chairman;  C.  M.  Thompson,  Albuquerque;  L.  G.  Bice,  Albuquerque; 
Walter  A.  Stark,  Las  Vegas. 


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“A”  designation  which  it  enjoys.  Choose  City  Park’s  regular  Grade  “A”  Pasteurized 
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186 


Rocky  Mountain  Medical  Journal 


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THE  UTAH  STATE  MEDICAL  ASSOCIATION 


OFFICERS  l»48-i»4» 

PrNlient:  0.  A.  Ogllrie,  Salt  Lake  City. 

PTMldent-eleet:  C.  H.  Jenson,  Ogden. 

Past  President:  J.  C.  Hubbard,  Price. 

Honorary  President:  0.  W.  French,  CoalTiUe. 

First  Vice  President:  J.  0.  HcQuarrie,  Bichfield. 

Second  Vice  President:  Ezra  Cragun,  Lewiston. 

Third  Vice  President:  B.  W.  Farnsworth,  Cedar  City. 

Secretary:  Bay  T.  Woolsey,  Salt  Lake  City. 

Execctlye  Secretary:  Mr.  W.  H.  Tlbbals,  Salt  Lake  City. 

Treasurer:  L.  B.  White,  Salt  Lake  City. 

Coincllor  First  District:  J.  0.  Olson,  Ogden. 

Coanellor  Second  District:  V.  L.  Bees,  Salt  Lake  City. 

Cocncllor  Third  District;  L.  W.  Oaks,  Proro. 

Delegate  to  A.M.A.,  1948:  James  P,  Kerby,  Salt  Lake  City. 

Alternate  Delegate  to  A,M.A.,  1948:  J.  J.  Weight,  Provo. 

Editor  of  the  Utah  Section  of  the  Rocky  Moonnain  Medical  Journal: 
R.  P.  Middleton.  Salt  Lake  City. 

STANDING  COMMITTB3ES 
Rocky  Mountain  Medical  Conference  Continuing  Committee:  B.  P.  Mid- 
dleton, Chairman,  Salt  Lake  City,  1949;  K.  B.  Castieton,  Salt  Lake  City, 
1950;  Clark  Bleb,  Ogden,  1951;  Noall  Z.  Tanner,  Layton,  1952;  T.  B. 
Seager,  Vernal,  1953. 

Scientific  Program  Committee:  Bay  T.  Woolsey,  Chairman,  Salt  Lake 
City;  Drew  M.  Peterson,  Ogden;  Stanley  N.  Clark,  Provo;  P.  M.  Howard, 
Salt  Lake  City;  V.  P.  White,  Salt  Lake  City;  L.  V.  Broadbent,  Cedar 
City;  Paul  A.  Pemberton.  Salt  Lake  City. 

Public  Policy  and  Legislation  Committee:  F.  B.  King,  Chairman,  Price, 
1951;  Jesse  J.  Weight,  Provo,  1949;  M.  L.  Crandall,  Salt  Lake  City, 
1949;  V.  L.  Stevenson,  Salt  Lake  City,  1949;  N.  F.  Hlcken,  Salt  Lake 
City,  1950;  Omar  Budge,  Logan,  1950;  John  Coletti,  Salt  Lake  City,  1950; 
W.  B.  West,  Ogden,  1951;  B.  V.  Larson.  Boosevelt,  1951. 

Medical  Defense  Committee:  W.  J.  Thomson,  Chairman,  Ogden,  1949; 
B.  W.  Owens,  Salt  Lake  City,  1949;  J.  L.  Hansen,  Vernal,  1949;  Homer 
Smith,  Salt  Lake  City,  1950;  L.  N.  (^sman.  Salt  Lake  City,  1950;  Erwin 

D.  Zeman,  Ogden.  1950;  Charles  W.  Woodruff,  Salt  Lake  City,  1951; 

James  Westwood.  Provo,  1951;  L.  H.  MerriU,  Hiawatha.  1951. 

Medical  Education  and  Hospitals  Committee:  I.  Bruce  McQuarrle,  Chair- 
man, Ogden,  1949;  L.  J.  Paul,  Salt  Lake  City,  1949;  0.  A.  OgHvie, 
Salt  Lake  City,  1949;  Q.  G.  Bichards,  Salt  Lake  City.  1950;  Bay  T. 
Woolsey,  Salt  Lake  City,  1950;  T.  E.  Bobinson,  Salt  Lake  City,  1950; 

Seth  E.  Smoot,  Provo,  1951;  George  H.  Curtis,  Salt  Lake  City,  1951; 

B.  0.  Porter,  Logan,  1951;  B.  H.  Young,  Ex-Officio,  Salt  Lake  City. 

Medical  Economics  Committee;  Bussell  Smith,  Chairman,  Provo,  1949; 
A.  B.  Denman,  Helper.  1949;  W.  T.  Ward,  Salt  Lake  City,  1950;  W.  B. 
Merrill,  Brigham  City,  1951;  Balph  Pendleton,  Salt  Lake  City,  1951. 


Public  Health  Committee;  John  B.  Bourne,  Chairman,  Boosevelt,  1949; 
F.  D.  Spencer.  Salt  Lake  City.  1950;  Balph  EUis,  Ogden,  1951. 

Military  Affairs  and  National  Emergency  CommIttH:  Chrles  Woodruff. 
Chairman,  Salt  Lake  City;  L.  J.  Paul,  Salt  Lake  City;  Hazel  Skolfleld, 
Salt  Lake  City;  W.  M.  Gorisbek,  StandardviUe  L.  B.  CuUimore,  Orem; 

Bay  B.  Barton,  Magna;  D.  T.  Madson,  Price;  Biley  G.  Clark,  Provo; 

Willis  Hayward,  Logan;  Dean  Tanner,  Ogdra. 

Tuberculosis  and  Cardiovascular  Diseases  Committee:  Elmer  M.  Kil- 
patrick, Chairman,  Salt  Lake  City;  Bay  Bumel,  Salt  Lake  City;  D.  0.  N. 
Lindberg,  Ogden;  W.  C.  Walker,  Salt  Lake  City;  Donald  M.  Moore,  Ogden; 
Don  C.  Merrill,  Provo. 

Cancer  Committee:  0.  A.  Ogilvle,  Chairman,  Salt  Lake  City;  S.  W. 

Fennemore,  Price;  E.  D.  Zeman,  Ogden;  W.  G.  Noble,  Blchmond;  Harold 

Austin,  Provo;  Stanley  G.  Bees,  Gunnison;  Paul  K.  Edmunds,  Cedar  City; 
F.  G.  Eskelson,  Vernal;  K.  B.  Castieton,  Salt  Lake  City. 

Fracture  Committee:  A.  M.  Okelbeny,  Chairman,  Salt  Lake  City;  Clark 
Rich,  Ogden;  Boy  H.  Robinson,  Kenilworth;  S.  M.  Budge,  Logan;  Norman 
R.  Beck,  Salt  Lake  City;  Louis  Perry,  Ogden;  J.  G.  McQuarrle,  Bichfield; 
D.  C.  Evans,  Fillmore. 

Necrology  Committee:  W.  T.  Hasler,  Chairman,  Provo;  L.  A.  Stevenson, 
Salt  Lake  City;  Jos.  A.  Phipps,  Salt  Lake  City. 

Industrial  Health  Committee:  Paul  S.  Bichards,  Chairman,  Bingham 
Canyois;  L.  J.  Taufer,  Salt  Lake  City;  Frank  Gorisbek,  Helper;  Byron  Daynee, 
Salt  Lake  City;  E.  B.  Kuhe,  Salt  Lake  City;  D.  C.  Barker,  Ogden. 

Advisory  Committee  to  the  Woman’s  Auxllfary:  Vernal  Johnson,  Chair- 
man, Ogden;  0.  P.  Heninger,  Provo;  L.  G.  Moench,  Salt  Lake  City;  James 

K.  Palmer,  Salt  Lake  City. 

Public  Relations  Committee:  R.  P.  Middleton,  Chairman,  Salt  Lake  City; 
Louis  P.  Matthei,  Ogden;  R.  W.  Farnsworth,  Cedar  City;  Quinn  A.  Whit- 
ing, Price;  Clyde  J.  Daines,  Logan;  Ray  E.  Spendlove,  Vernal;  H.  I. 
Goodwin,  Salt  Lake  City;  Gilbert  Wright,  Salt  Lake  City;  W B.  Hammond, 
Provo. 

Inter-Professional  Committee:  J.  Leroy  Kimball,  Chairman,  Salt  Lake 
City;  C.  C.  Hetzel,  Jr.,  Ogden;  T.  E.  Bauman,  Park  City;  Paul  Clayton, 
Salt  Lake  City;  Ralph  G.  Rigby,  Salt  Lake  City. 

Mental  Hygiene  Committee:  Roy  A.  Darke,  Chairman,  Salt  Lake  City: 

L.  G.  Moench,  Salt  Lake  City;  Wm.  D.  Pace,  Sait  Lake  City;  George  Cochran, 
Salt  Lake  City;  E.  L.  Weimers,  Provo. 

Fee  Schedule  Committee:  K.  B.  Castieton,  Chairman,  Salt  Lake  City; 
Howard  K.  Belnap,  Ogden;  J.  E.  Trowbridge,  Bountiful;  U.  B.  Bryner, 
Salt  Lake  City;  W.  Leroy  Smith,  Salt  Lake  City;  J.  R.  Wherrltt,  Heber 
City;  0.  W.  Budge,  Logan. 

Special  Committee  to  Study  Dues:  H.  B.  Relcbman,  Chairman,  Salt 
Lake  City:  Eliot  Snow,  Salt  Lake  City;  Ezra  Cragun,  Lewiston. 

Rural  Health  Committee;  J.  J.  Weight,  Chairman,  Provo;  J.  G.  McQuarrle, 
Richfield;  J.  P.  Burgess,  Hyrum;  Noall  Z.  Tanner.  Layton. 


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"Orders  Delivered  to  Any  City  by 
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Corner  10th  and  Lawrence  Sts. 

TAbor  5138 

Special  attention  given  to  floral  tributes 
Also  Hospital  Flowers 

Medical  Gas  Division 

MEDICAL  OXYGEN 

Call  KEy stone  5106 

CARBON  DIOXIDE-OXYGEN 
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AVIATORS’  BREATHING  OXYGEN 
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188 


Rocky  Mountain  Medical  Journal 


R.U.Q. 

Signs  and  symptoms  referable  to  the  right 
upper  quadrant  can  be  clarified  by  a cardi- 
nal diagnostic  step— oral  cholecystography 
with  Priodax.*  With  this  simple  proce- 
dure, the  diagnosis  of  chronic  gallbladder 
disease  can  usually  be  definitively  made  or 
ruled  out.  Such  precision  stems  from  the 
rapid  and  almost  complete  absorption  of 
Priodax. 

With  Priodax,  the  normal  gallbladder  is 
clearly  and  distinctly  visualized;  whereas 
nonvisualization  or  faint  visualization  al- 
most always  indicates  cholecystic  disease. 
Due  to  its  optimal  radiopacity,  gallstones 
show  up  well,  either  as  negative  shadows 
(if  radiolucent)  or  as  shadows  denser  than 
the  surrounding  Priodax  (if  radiopaque). 

PRIODAX 

(BRAND  OF  lODOALPHIONIC  ACID-SCHERING) 

Patient  tolerance  to  Priodax  is  excellent, 
untoward  reactions  such  as  severe  nausea 
and  vomiting  are  seldom  encountered.  Loss 
of  the  medium  is  thus  avoided  and  diagnos- 
tic accuracy  consequently  enhanced. 

PACKAGING:  Priodax,  beta- (4-hydroxy-3,  5- 
diiodophenyl)  -alpha-phenyl-propionic  acid.  Tablets 
are  available  in  envelopes  containing  six  0.5  Gm. 
tablets  (1  dose)  ; boxes  of  1,  5,  25  and  100  envel- 
opes. Hospital  Dispensing  Package  containing  4 
rolls  of  250  tablets  each. 


CORPORATION  • BLOOMFIELD,  N.  J. 

IN  CANADA.  SCHERING  CORPORATION  LTD..  MONTREAL 


THE  WYOMING  STATE  MEDICAL  SOCIETY 


OFFICERS 

President:  George  E.  Baker,  Casper. 

President-Elect:  DeWitt  Dominick,  Cody. 

Vice  President:  K.  E.  Krueger,  Rock  Springs. 
Treasurer:  F.  M.  Schunk,  Sheridan.  i 

Correspondhio  Secretary:  George  H.  Phelps,  Cheyenne. 
Delegate  A M.A.:  R.  H.  Reeve,  Casper. 

Alternate  Delegate  A.M.A. : VV.  A.  Bunten.  Cheyenne. 
Executive  Secretary:  Mr.  Arthur  Abbey,  Cheyenne. 


COMMITTEES 

Rocky  Mountain  Medical  Conference:  Earl  Whedon,  Chairman,  Sheridan; 
George  N.  Phelps,  Cheyenne:  H.  L.  Harvey,  Casper;  C.  W.  Jeffrey,  Rawlins; 
L.  W.  Storey.  Laramie. 

Syphilis  Committee:  N.  E.  Morad,  Chairman,  Casper;  G,  M.  Groshart, 
Worland;  L.  H.  Wilmoth,  Lander;  L.  G.  Booth,  Sheridan;  F.  H.  Haigler, 
Midwest. 

Cancer  Committee:  Earl  Whedon,  Chairman,  Sheridan;  John  Gramlich, 
Cheyenne;  DeWitt  Dominick,  Cody;  J.  R.  Newman,  Kemmerer;  E.  W.  New- 
man, Cheyenne. 

Medical  Economics  Committee;  C.  L.  Rogers,  Chairman,  Sheridan;  Nels 

A.  Vicklund,  Thermopolis;  R.  A.  Corbett,  Saratoga;  G.  R.  James,  Casper; 
S.  S.  Hellewell,  Evanston. 

Fracture  Committee;  Philip  Teal,  Chairman.  Cheyenne;  Silva  J.  Giovale, 
Cheyenne;  Robert  V.  Batterton,  Rawlins;  Lowell  D.  Kattenhorn,  Powell; 
Joseph  E.  Hoadley,  Gillette. 

Medical  Defense  Committee;  Geoi^e  Baker,  Chairman,  Casper;  Andrew 
Bunten,  Cheyenne;  E.  W.  DeKay,  Laramie. 

Councillors;  Earl  Whedon,  Chairman,  Sheridan;  R.  J.  Boesel,  Cheyenne; 

B.  W.  DeKay.  Laramie;  George  Baker,  President,  Casper;  George  Phelps, 
Secretary,  Cheyenne. 

Advisory  to  Woman’s  Auxiliary:  John  R.  Bunch,  Chairman,  Laramie; 
Virgil  L.  Thorpe,  Newcastle;  H.  J.  Aldrich,  Sheridan;  G.  B.  Savory,  Chey- 
enne. 

Advisory  to  Workmen’s  Compensation  Department:  J.  D.  Shingle,  Chair- 
man, Cheyenne;  G.  H.  Phelps,  Cheyenne;  W.  A.  Bunten,  Cheyenne;  R.  H. 
Reeve.  Casper;  Albert  T.  Sudraan,  Green  River;  P.  M.  Schunk,  Sheridan. 


Industrial  Health  Committee;  K.  E.  Krueger,  Chairman,  Rock  Springs; 
Willard  Pennoyer,  Cheyenne;  Thomas  B.  Croft,  Lovell;  Eugene  Pelton, 
Laramie. 

Veterans*  Affairs  and  Military  Service  Committee:  A.  J.  Allegrettl,  Chair- 
man, Cheyenne;  Jack  Rowlett,  Laramie;  Everett  Ellis,  Cheyenne;  Bernard 
Sullivan,  Laramie;  G.  W.  Koford,  Cheyenne;  Bernard  Stack,  Tbermopolla; 
J.  W.  Sampson,  Sheridan;  DeWitt  Dominick,  Cody;  Paul  R.  Holtz.  Lander; 
Geoi^e  E.  Baker,  President,  Casper;  George  Phelps,  Secretary,  Cheyenne. 

Blue  Cross  Hospital  Committee:  R.  I.  Williams,  Chairman,  Cheyenne,  1950; 
W.  A.  Bunten.  Cheyenne,  1949;  B.  W.  DeKay,  Laramie,  1951;  Cedric 
Jones,  Cody,  1952. 

Public  Policy  and  Legislation:  George  Phelps,  Chainnan,  Cheyenne; 

Andrew  Bunten,  Cheyenne;  George  Baker,  President,  Casper;  Q.  W.  Koford, 
Cheyenne;  E.  W.  DeKay,  Laramie;  G.  W.  Henderson,  Casper. 

National  Physicians  Committee:  George  Phelps,  Chairman,  Cheyenne; 

Andrew  Bunten,  Treasurer,  Cheyenne;  E.  W.  DeKay,  Laramie;  George  Baker, 
Casper. 

Poliomyelitis  Committee;  H.  L.  Harvey,  Chairman,  Casper;  N.  A.  Vicklund, 
Thermopolis;  Leo  Keenan,  Torrington;  DeWitt  Dominick,  Co^;  Philip  Teal, 
Cheyenne;  Franklin  Yoder,  Cheyenne;  F.  A.  Mills,  Rawlins. 

State  Institutions  Advisory  Committee;  J.  F.  Whalen,  Chairman,  Evans- 
ton; George  Phelps,  Cheyenne:  C.  W.  Jeffrey,  Rawlins;  Earl  Whedon,  Sheri- 
dan; G.  M.  Groshart,  Worland;  R.  H.  Kanable,  Basin. 

Necrology  Committee:  Earl  Whedon,  Chairman,  Sheridan;  John  B. 
Krahl,  Torrington;  Franklin  Yoder,  Cheyenne. 

Rural  Health  Committee:  Paul  Holtz,  Chairman,  Lander;  Andrew  Bun- 
ten.  Cheyenne;  Samuel  Worthen,  Afton;  Wm.  K.  Rosene,  Wheatland;  Claude 
Raffl,  Basin. 

Public  Health  Department  Liaison  Committee;  E.  C.  Ridgeway,  Chair- 
man, Cody;  R.  P.  Fitzgerald,  Casper;  R.  V.  Batterton,  RawUns;  J.  W. 
Sampson,  Sheridan;  R.  C.  Stratton,  Green  River;  Willard  Pennoyer, 

Cheyenne. 

Child  Health  Committee:  Paul  W.  Emerson,  Chairman,  Cheyenne;  John 
Gramlich,  Cheyenne;  Thomas  Croft,  Lovell;  Bernard  Sullivan,  Laramie; 

Paul  R.  Holtz,  Lander;  Geo.  E,  Baker,  Casper;  A.  R.  Abbey,  Cheyenne. 

Council  on  National  Emergency  Medical  Service:  George  H.  Phel^, 
Chairman,  Cheyenne;  R.  H.  Reeve,  Casper;  DeWitt  Dominick,  Cody;  E.  W. 
DeKay,  Laramie;  K.  S.  Krueger,  Rock  Springs;  P.  M.  Schunk,  Sheridan. 


COLORADO  HOSPITAL  ASSOCIATION 


OFFICERS 

President:  Frank  G.  Palladlno,  Community  Hospital,  Boulder. 

President-Elect:  Walter  G.  Christie,  Presbyterian  Hospital,  Denver. 

Vice  President:  Hubert  W.  Hughes,  St.  Anthony  Hospital,  Denver. 

Treasurer:  Sister  Mary  Thomas,  Alercy  Hospital,  Denver. 

Trustees:  Roy  R.  Pranglcy,  St.  Luke's  Hospital,  Denver  (1949);  James 
P,  Dl.von,  M.D.,  Denver  General  Hospital,  Denver  (1949):  Louis  Liswood, 
National  Jewish  Hospital,  Denver  (1950);  DeMoss  Taliaferro,  Children's 
Hospital,  Denver  (1950);  Roy  R.  Anderson,  Presbyterian  Hospital,  Denver 
(1951);  Rev.  Allen  H.  Erb,  Mennonite  Hospital,  La  Junta,  Colo.  (1951). 

Delegate  to  the  American  Hospital  Association:  Herbert  A.  Black,  M.D., 
Parkview  Hospital,  Pueblo. 

Alternate:  Msgr.  John  E.  Mulroy,  Catholic  Hospitals,  Denver. 

STAIVUIIVG  C03IM1TTEES 

Auditing:  Ben  M.  Blumberg,  Chairman.  (1948),  General  Rose  Me- 
morial Hospital,  Denver;  M.  A.  Moritz  (1949),  Denver  General  Hospital, 
Denver:  U.  W.  Pontow  (1950),  Colorado  General  Hospital,  Denver. 

Constitution  and  Rules:  Samuel  S.  Golden,  M.D.,  Chairman,  Beth  Israel 
Hospital,  Denver;  Henry  H.  Hill,  Weld  County  Hospital,  Greeley;  Sister 
M.  Johanna.  Sacred  Heart  Hospital,  Lamar. 

Legislative:  Jlsgr.  John  R.  Mulroy,  Chairman,  Catholic  Hospitals,  Denver; 
DeMoss  Taliaferro,  Children’s  Hospital,  Denver;  Carl  Ph.  Sebwalb,  Denver; 
Robert  C.  Kiiiffen,  Colorado  General  Hospital,  Denver;  Herbert  A.  Black, 
M.D.,  Parkview  Hospital,  Pueblo. 

Membership:  Leo  W.  Reifel,  Chairman,  St.  VraJn  Hospital,  Longmont; 
B.  B.  Jaffa.  M.D. , Denver. 

Nominating:  Herbert  A.  Black,  JI.D.,  Chairman,  (1948),  Parkvlevr 
Hospital,  Pueblo;  John  C.  Shull,  (1949),  Porter  Sanitarium  and  Hospital, 
Denver:  Hubert  W.  Hughes,  (1950),  St.  Anthony  Hospital,  Denver. 


Program:  Roy  R.  Prangley,  Chairman,  St.  Luke’s  Hospital,  Denver;  B.  B, 
Jaffa.  M.D. , Denver. 

Nursing  and  Public  Education:  DeMoss  Taliaferro,  Children’s  Hu.spllnl, 
Denver;  Sister  M.  Louis,  St.  Anthony  Hospital,  Denver:  Miss  Merle  Love, 
R.N.,  Presbyterian  Hospital,  Denver;  Sister  Marla  Gratia,  R.N.,  Glockuer 
Sanatorium.  Colorado  Springs;  Frank  G.  Palladiuo,  Community  llospitai, 
Buulder. 

Resolutions:  S.  Russ  Denzier,  Chairman,  Colorado  Hospital,  Canon  City; 
Carl  Ph.  Schwalb,  Denver;  Walter  G.  Christie,  Presbyterian  Hospital,  Denver. 

SPECIAL,  COMMITTEES 

Public  Relations:  John  C.  Shull,  Chairman,  Porter  Sanitarium  and  Hos- 
pital. Denver;  James  P.  Dixon,  M.D.,  Denver  General  Hospital,  Denver; 
Sister  Mary  Lultgard,  St.  Thomas  More  Hospital,  Canon  City. 

Rates  and  Charges:  Hubert  W.  Hughes,  Chairman,  St.  Anthony  Hos- 
pital, Denver;  Waiter  G.  Christie,  Presbyterian  Hospital,  Denver;  Beu  M. 
Blumberg,  Genera)  Rose  Memorial  Hospital,  Denver;  Msgr.  John  R.  Mulroy, 
Catliolic  Hospitals,  Denver;  Leo  W.  Reifel,  St.  Vraln  Hospital,  Longmont; 
Roy  R.  Prangley,  St.  Luke’s  Hospital,  Denver;  DeMoss  Taliaferro,  Children’s 
Hospital.  Denver. 

Hospital  Survey  and  Planning:  James  H.  Walker,  Chairman,  Good  Sa- 
maritan Hospital,  Sterling;  Arthur  A.  Fisher,  Architect,  Denver;  B.  B. 
Jaffa.  M.D..  Denver. 

State  Board  of  Health  Advisory:  Msgr.  John  R.  Mulroy,  Chairman,  Catho- 
lic Hospitals,  Denver;  DeMoss  Taliaferro,  Children’s  Hospital.  Denver;  B.  B. 
Jaffa,  M.D.,  Denver. 

Delegate  to  Colorado  Inter-Professional  Council:  Hubert  W.  Hughes,  St 
Anthony  Hospital,  Denver. 

Representatives  to  Liaison  Conncil  on  Graduate  Education:  Ray  B. 
Prangley,  St.  Luke’s  Hospital,  Denver;  Frank  G.  PaUadlno,  Community 
Hospital,  Boulder. 


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DORR  OPTICAL  COMPANY 


421  16th  Street 


Denver,  Colorado 


KEystone  5511 


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Rocky  Mountain  Medical  Journal 


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Bo  r Jen’s  prescription  specialties  are  flexibly  aJaptahle  to  cope  effectively 
with  the  sharply  increased  number  of  your  infant  feeding  problems. 


BIOLAC— a complete  infant  formula  (only 
vitamin  C supplementation  needed)  for  infants 
deprived,  of  mother’s  milk. 

DRYCO— a powdered,  high-protein,  low-fat, 
moderate  carbohydrate  milk  food  ideally  suited 
for  all  formulas. 

BETA-LACTOSE  —an  exceptionally  palatable, 
highly  soluble  milk  sugar  for  formula  modi- 
fication. 


MULL-SOY— a hypo -allergenic  emulsified  soy 
food  for  infants  and  adults  allergic  to  milk 
proteins.  The  1:1  standard  dilution  approxi- 
mates cow’s  milk  in  fat,  protein,  carbohydrate 
and  mineral  content. 

KLIM-a  spray-dried  whole  milk  with  soft  curd 
properties  essential  in  infant  feeding  and 
special  diets.  Particularly  valuable  when  avail- 
ability or  safety  of  fresh  milk  is  uncertain. 


Borden  prescription  products  are  available  at  all  drug,  stores. 
Complete  professional  information  mag  he  obtained  on  request. 


■■  '#■ 


**•-  ("I 

BORDEN’S  PRESCRIPTION  PRODHTTS  DIVISION  • 350  MADISON  AVENUE,  NEW  YORK  17.  N.  Y. 


JStiJ. 


192 


Rocky  Mountain  Medical  Journal 


Pulvules 

SECONAL  sodium 



Allvt  It.irb.«if»  * ■ Q—J  ) 

1 I/X  grs.  , 

WAKNINC  M.V  b.- iom  I, 


cauti<^- 

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No.  24J 


Pulvules 

SECONAL  SODIUM 

5/4  gr.  <»-®S 

M.,  b,  brf... 

CAUTION  -To  b. 


@ 


One  Pulvule  A. a. — Tomorrow,  Refreshed 


When  physicians  order  a bedtime  dose  of  ‘Seconal  Sodium’ 

(Sodium  Propyl-methyl-carbinyl  Allyl  Barbiturate,  Lilly),  \yi  grains, 
for  restlessness,  they  know  that  during  morning  rounds  they  are  likely  to 
find  a grateful  and  perhaps  more  cheerful  patient.  Bedtime  sedation 
with  ‘Seconal  Sodium’  encourages  wholesome,  natural  rest.  Its  rapid 
onset  of  action  carries  the  patient  gently  over  the  threshold  of  sleep.  The 
effect  is  brief — gone  within  six  to  eight  hours.  The  patient  awakens 
in  the  morning  strengthened  and  refreshed  from  a sound  night’s  rest. 

‘Seconal  Sodium’  is  supplied  in  ampoules,  powder,  pulvules, 
and  suppositories.  Elixir  ‘Seconal’  (Propyl-methyl-carbinyl  Allyl  Barbi- 
turic Acid,  Lilly)  is  also  available. 


ELI  LILLY  AND  COMPANY,  INDIANAPOLIS  6,  INDIANA,  U.S.A. 


A vaccine  is  injected  into  a child’s  arm.  The  physician,  the 
patient,  and  the  family  are  confident  that  a satisfactory  im- 
munity will  result.  If  a devastating  epidemic  of  the  disease 
in  question  should  occur,  the  chances  are  that  the  patient 
will  not  be  infected  or  will  experience  only  a relatively 
mild  attack.  This  faith,  of  course,  is  evidence  of  the  trust 
placed  in  the  biologists,  bacteriologists,  and  technicians 
who  comprise  the  group  of  competent  specialists 
responsible  for  the  manufacture  of  Lilly  biological  products. 

An  awareness  of  this  faith,  together  with  an  inherent  desire 
to  improve  and  perfect  the  product,  characterizes  the 
attitude  of  the  team  of  experts  in  this  field  at  the  Lilly  Research 
Laboratories.  Although  anonymous  to  the  patient,  these 
experienced  specialists  have  an  interest  equal  to  that  of  the 
physician  in  the  ultimate  result — better  health  for  all 
through  new  and  improved  medicinal  preparations. 


V 


LILLY  SPECIALISTS  SERVE  THE  MEDICAL  PROFESSION 


Sliocky 

Colorado 
Montana 
New  Mexico 
Utah 
Wyoming 


MARCH 

1949 


y^ountain 

y/Ledlcal  Journal 


Editorial 


Publication  Policies, 

A Reminder 

rrVERY  year  or  two  we  should  remind  our 
^ readers  of  the  publication  policies  of  the 
Rocky  Mountain  Medical  Journal  with  re- 
gard to  its  scientific  content,  since  ours  is 
a distinctive  Journal.  The  size,  scope,  and 
number  of  states  served  by  this  Journal 
have  increased  progressively  over  the  last 
two  decades  until  we  serve  the  five  Rocky 
Moimtain  states  which,  while  young  and 
comparatively  small  in  population,  cover  a 
huge  geographical  section  of  our  country. 
While  our  Journal  is  owned  by  the  Colorado 
State  Medical  Society,  it  is  operated  as  a 
cooperative  non-profit  venture  for  all  five. 

Due  to  our  limited  medical  population  and 
potential  medical  journal  circulation,  the 
budget  for  publication  purposes  is  neces- 
sarily limited.  In  recent  years  even  our 
printers  have  had  their  problems  multiplied 
by  shortages  of  paper  and  other  materials, 
although  this  problem  is  less  acute  now  than 
a year  ago.  It  has  been  necessary  for  sev- 
eral years  to  decline  many  an  article  which 
would  have  been  an  asset  to  our  Journal, 
and  this  will  continue  to  be  the  case  for  the 
foreseeable  future.  For  example,  guest 
speakers  at  annual  meetings  of  the  respec- 
tive state  societies  usually  present  and  later 
submit  to  the  Journal  two  papers,  of  which 
we  have  been  able  to  accept  and  publish 
only  one.  A number  of  splendid  articles 
have  come  from  the  University  of  Utah 
School  of  Medicine  and  from  the  University 
of  Colorado  Medical  Center.  As  these  in- 
stitutions have  grown  and  their  staffs  have 
been  increased  research  work  has  kept  pace. 
It  has  not  been  possible  to  accept  all  of 
their  material. 

The  Editorial  Board  and  the  staff  have 


endeavored  to  solve  these  problems  with 
impartiality  and  good  editorial  judgment, 
and  with  as  few  hurt  feeljngs  as  possible. 
With  few  exceptions  no  author  of  scientific 
papers  has  appeared  in  our  pages  more  than 
once  a year.  Voluminous  articles  contain- 
ing detail  of  interest  to  but  a few  specialists 
have  necessarily  been  rejected.  An  addi- 
tional small  saving  of  space  has  been  possible 
through  omission  of  references.  Few  read- 
ers pay  attention  to  bibliographies  and  they 
seldom  add  to  the  author’s  message.  Anyone 
directly  interested  in  a specific  reference 
may  always  communicate  directly  with  the 
author  and  an  author  particularly  proud  of 
his  list  of  references  may  make  special  ar- 
rangements with  our  business  office  to  in- 
clude them  in  his  reprints. 

This  Journal  is  designed  and  published 
primarily  for  the  use  of  members  of  the 
organizations  comprising  the  Rocky  Moun- 
tain Medical  Conference.  Thus  it  will  be 
a rare  occasion  when  articles  will  be  ac- 
ceptable from  others  than  members  of  these 
organizations  and  official  guest  speakers 
at  their  meetings.  Scientific  papers  and 
case  reports  from  within  any  of  the  partici- 
pating states  should  always  be  sent  to  the 
Scientific  Editor  for  that  state.  Organization 
news  and  other  non-scientific  material 
should  always  be  sent  to  the  Associate  Edi- 
tor for  the  appropriate  state.  These  editors 
are  listed  in  every  issue  on  the  second  page 
following  our  cover.  Material  which  cannot 
be  included  in  our  publication  program  will 
be  returned  to  the  author,  decisions  on  ac- 
ceptance being  made  as  early  as  possible. 

It  is  our  hope  that  these  publication  poli- 
cies can  be  carried  out  even  more  smoothly 
in  the  future  than  they  have  in  the  past 
and  we  will  admit  a bit  of  pride,  we  hope 
pardonable,  in  our  past.  And  we  also  hope 


for  March,  1949 


193 


that  the  future  will  lessen  the  handicaps 
that  have  occasionally  plagued  our  Board 
and  our  authors  so  that  our  Journal  may 
continue  to  keep  pace  with  the  growing  im- 
portance of  the  Rocky  Mountain  region  in 
medicine  and  medical  journalism. 

^ V <4 

Medical  Radio  Programs 

|~^ISCUSSING  potentialities  of  radio  for 
the  education  of  laymen  in  medical  mat- 
ters, several  interesting  comments  were 
made  at  the  meeting  of  State  Secretaries 
and  Editors  last  fall.  It  was  agreed  that 
simple  “talks”  are  of  questionable  value; 
questions  and  answers  in  conversational 
script  are  good;  introduction  of  “shorts” 
into  established  programs  may  have  a sig- 
nificant mass  appeal.  Some  seventy-seven 
million  receiving  sets  reach  nearly  our  en- 
tire mass  of  population.  The  majority  of 
people  want  medical  subjects  and  show  in- 
tense interest  in  medical  celebrities.  Most 
radio  commentators  are  interested  and  wel- 
come more  medical  script,  but  agree  that 
poor  dramatization  and  substandard  musical 
accompaniment  merely  lose  time  and  pro- 
grams to  opponents  of  our  profession. 

One  of  the  speakers  expressed  himself 
well:  “We  have  our  jackasses,  but  we  don’t 
have  to  let  them  bray.”  Our  programs  are 
doing  well  thus  far;  we  must  maintain  their 
high  standards  and  appeal. 

4 4 4 

The  Challenge  We  Must  Meet 

ji^EDICINE  has  advanced  more  during  the 
last  twenty-five  years  than  during  the 
preceding  century,  mostly  through  methods 
of  precision,  specific  preventive  and  cura- 
tive agents,  and  in  improvements  in  our 
hospitals.  All  of  these  things  take  trained 
minds  and  hands,  and  they  cost  money. 

People  will  spend  to  the  limit  for  non- 
essentials  but  will  not  provide  in  advance 
for  illness,  the  only  large  expense  which  is 
unpredictable  for  individuals  or  families. 
When  the  inevitable  hardship  arrives,  wage- 
earners  will  not  condemn  their  own  im- 
providence— but  many  will  hate  the  medical 
profession  and  accuse  it  of  creating  unman- 


ageable expenses.  We  cannot  change  hu- 
man personality  and  so  must  admit  that 
some  form  of  medical  care  insurance  is,  na- 
tionally, a necessity  in  terms  of  modern 
living. 

Experience  the  world  over  has  demon- 
strated that  any  full-service  plan  fails  ex- 
cept on  an  indeminity  basis.  Otherwise  peo- 
ple call  for  innumerable  house  visits,  go  to 
the  doctors’  offices  too  many  times,  demand 
eyeglasses,  teeth  and  other  protheses  be- 
yond limits  of  sensible  propriety.  America 
will  find  this  out  for  herself  the  hard  way 
unless  our  constructive  counter  measures 
prove  to  be  more  effective  than  dire  warn- 
ings. Let  us  not  make  the  mistake  that 
England  did- — negativism  and  poor  press  re- 
lationships. Their  people  got  the  impres- 
sion that  the  medical  profession  opposed 
State  Medicine  for  selfish  financial  reasons. 
Consequences  are  now  well  demonstrated. 
Our  full  cooperation  and  demonstration  of 
willingness  to  effect  superior  service  at  the 
level  of  large  national  accounts  may  save 
our  country  a similar  catastrophe. 

4 4 4 

Tribute 

y^FTER  the  American  Medical  Associa- 
tion announced  the  General  Practi- 
tioner Award  last  year,  the  Providence 
Medical  Journal  printed  this  tribute  to  the 
family  doctor: 

Dear  Medical  Ass’n., 

I been  hoping  you’d  do  something  like  this  for 
over  thirty-five  years,  and  I’d  like  it  to  be  our 
family  doctor,  who  has  been  doctoring  us  ever 
since  we  thought  the  first  baby  was  a tumor. 

You  probably  never  heard  of  him.  He’s  no 
one  of  your  big  men — never  invented  anything 
in  a medical  way  except  a little  spool  and  darn- 
ing needle  gadget  for  removing  ingrowing  hairs, 
and  the  only  time  he  got  into  your  journal,  he 
says,  was  the  time  he  had  a queer  fever  of  his 
own.  But  I feel  better  the  minute  he  comes  into 
the  house,  for  he  doesn’t  come  to  see  a lot  of 
organs,  he  comes  to  see  ME.  He  knows  me — 
knows  us  all — inside  and  out,  warts,  scars,  dis- 
position— everything.  He  knows  I can’t  eat  tuna- 
fish,  that  I get  flighty  with  two  degrees  of  fever, 
and  overdo  everything  from  mowing  the  lawn 
to  drinking  beer.  And  somehow  he  manages  to 
add  all  those  things  up  to  make  me  feel  like 
somebody.  I don’t  believe  I’d  ever  be  an  “inter- 
esting case”  to  him  no  matter  what  I got.  I’d 
just  be  me.  That’s  really  something  these  days. 


194 


Rocky  Mountain  Medical  Journal 


I don’t  have  to  call  on  him  often,  but  I’d  be  lost 
without  him. 

He’s  a grand  all-round  man,"  good  story  teller, 
good  listener,  good  friend,  a sort  of  father  con- 
fessor with  the  aid  of  a stethoscope.  It’s  unbe- 
lievable the  good  he’s  done  in  our  neighborhood. 
A lot  of  people  owe  him  money.  I’d  certainly  like 
to  see  him  get  the  medal. 

Yours  sincerely, 

ALMOST  ANYBODY. 

^ 

The  Henry  Sewall 
Memorial  Lecture 

'^HE  Denver  County  Medical  Society  re- 
cently enjoyed  an  address  by  Dr.  Regin- 
ald Fitz,  Assistant  Dean  of  Harvard  Medi- 
cal School,  and  President-elect  of  the  Amer- 
ican College  of  Physicians,  at  the  Medical 
Center’s  Denison  Memorial  Library.  Dr. 
Fitz  had  responded  to  an  invitation  request- 
ing that  he  deliver  the  annual  lecture  in 
memory  of  Dr.  Henry  Sewall.  Dr.  and  Mrs. 
Sewall  years  ago  had  provided  a trust  to 
make  possible  an  annual  lecture  by  a col- 
league eminent  in  scientific  medicine. 

The  speaker  was  introduced  by  Dr.  Rob- 
ert Stearns,  President  of  the  University  of 
Colorado.  Dr.  Stearns  reviewed  the  her- 
itage and  early  history  of  Dr.  Sewall, 
whose  presence  in  Colorado  was  “based 
upon  survival  of  the  unfit.”  Many  of  Colo- 
rado’s pioneer  physicians  had  arrived  for 
reasons  of  health  during  the  last  decade  of 
the  1800’s.  Fortunately,  the  majority  lived  to 
practice  creditably  for  many  years,  and 
many  begot  sons  who  have  carried  on.  Dr. 
James  Waring  also  gave  a short  introduc- 
tory talk  telling  of  the  father  of  Dr.  Fitz, 
who  was  well  known  for  his  work  upon  ap- 
pendicitis and  pancreatitis  and  of  Dr.  Sew- 
all’s  grandfather,  a Harvard  graduate  of 
1812  and  a well-known  physician.  These  re- 
marks were  singularly  appropriate,  for  the 
speaker  built  his  theme  about  the  fact  that 
many  of  our  contemporaries  are  sons  and 
grandsons  of  doctors. 

About  half  of  the  doctors  in  Who’s  Who 
are  grandsons,  sons,  and  fathers  of  doctors. 
The  same  proportion  has  long  existed  in  the 
House  of  Delegates  of  the  A.M.A.;  the  same 
facts  obtain  among  teachers  and  specialists 
within  the  profession.  Thus  there  is  a great 
tendency  for  doctors  to  beget  doctors.  Is  it 


not  therefore  our  profound  obligation  to 
arrange  the  profession  during  our  time  so 
that  our  sons  and  grandsons  will  find  it  as 
pleasant  as  possible?  There  have  been  ap- 
proximately 4,500  medical  graduates  yearly, 
but  only  2,800  deaths;  furthermore,  more 
and  more  doctors  are  still  active  after  the 
age  of  60.  The  longevity  is,  of  course, 
shared  with  the  populace — a tribute  to  the 
advances  in  medical  knowledge.  Among 
100,000  doctors  in  1907,  there  were  564  deaths 
per  year;  in  1942  there  were  195.  The  need 
and  demand  for  physicians  have  still  not 
been  fulfilled,  and  many  parts  of  America 
are  not  adequately  and  safely  covered  as 
far  as  medical  requirements  are  concerned. 

It  is  interesting  to  note  that  the  number 
of  doctors  declared  available  for  military 
service  in  World  War  II  was  in  proportion 
to  the  poor  economic  status  of  the  regions 
in  which  they  practiced.  In  other  words, 
many  doctors  welcomed  the  opportunity  to 
get  out  of  those  areas;  others  “made  the 
break”  to  greener  fields  after  the  clamor 
for  military  service  subsided.  Thus  we 
might  ask  whether  America  needs  more 
doctors  or  should  we  simply  make  better 
use  of  the  doctors  that  we  have.  These  ques- 
tions are  in  the  minds  of  our  educators  and 
have  to  do  with  emphasis  upon  general 
practice  and  the  important  work  of  turning 
out  good  doctors  from  our  medical  schools 
and  postgraduate  training  programs.  There 
should  be  more  family  doctors,  and  general 
practice  should  still  be  the  crowning  glory 
of  our  profession  and  the  essential  founda- 
tion for  specialization. 

Unfortunately,  most  young  doctors  want 
to  be  specialists,  denying  themselves  thereby 
the  obligation  and  satisfaction  of  family 
practice  which  is  so  full  of  human  interest. 
This  trend  may  be  one  of  the  things  which 
has  driven  families  to  cultists.  Blame  for 
survival  and  prosperity  of  the  irregulars 
may  be  largely  laid  at  our  feet,  for  we 
have  failed  to  provide  something  that  the 
people  need  and  want  and  which  many  have 
failed  to  find  within  our  ranks. 

Since  scientific  medicine  has  become  so 
deep  and  complex,  a large  part  of  its  teach- 
ing and  training  must  be  done  by  special- 
ists. It  is  understandable,  therefore,  that 


for  March,  1949 


195 


too  few  doctors  are  inspired  by  their  teach- 
ers to  become  general  practitioners.  Stu- 
dents find  thdmselves  idealizing  the  spe- 
cialists and  find  themselves  attracted  by 
alleged  monetary  attributes  of  the  special- 
ties. 

The  above  observations  provide  pabulum 
for  much  contemplation.  If  we  abide  by  the 
teachings  of  eminent  predecessors,  maintain 
our  humanity  and  provide  guidance  that 
our  people  need,  the  profession  indeed 
should  be  a pleasant  place  for  those  who  fol- 
low us.  Our  literature  recently  has  come 
to  be  full  of  the  term  “psychosomatic”  and 
all  that  it  implies.  But  it  is  not  new;  in 
fact,  it  is  ages  old.  It  enters  every  field  of 
medicine  and  is  an  important  part  thereof. 
Whether  we  are  general  practitioners  or 
specialists,  we  must  remember  its  far-reach- 
ing implication  and  importance.  Let  us  re- 
tain our  humanity,  deal  with  our  patients  as 
family  doctors,  and  teach  our  patients  how 
not  to  need  medical  care!  Preventive  medi- 
cine and  education  of  the  people  about  fun- 
damental truths  of  medical  science  should 
be  our  goal. 


SILHOUETTES 

from  the  A.M.A.  House  of  Delegates 


The  Board  of  Trustees  of  the  A.M.A.  and  the 
Coordinating  Committee  for  the  Protection  of  the 
People’s  Health  are  initiating  and  developing  the 
educational  program  with  commendable  rapidity. 
It  is  the  beginning  of  a new  policy  and  program 
by  the  A.M.A.  Hitherto,  for  some  decades,  there 
has  been  open  season  for  all  sorts  and  conditions 
of  men  to  criticize  organized  medicine  freely, 
loftily  and  frequently.  These  critics  were  not 
deterred  by  lack  of  knowledge  of  the  problems 
involved.  Physicians  have  invariably  turned  the 
other  cheek.  Now,  it  is  hoped  fervently,  the 
A.M.A.  has  turned  to  the  Old  Testament  ad- 
monition of  “an  eye  for  an  eye.”  Having  endured 
long  and  tiresome  sniping,  we  are  about  to  un- 
limber our  own  artillery.  And  this  through  an 
educational  program  to  all  of  the  people.  That 
this  program  will  be  successful  seems  assured, 
judging  by  the  squeals,  groans  and  epithets 
which  emanate  from  political  pack  rats  and  vote- 
buying small-timers. 

There  is  a minority  within  the  profession  which 
still  asks  to  be  informed  as  to  the  objectives  of 
this  educational  program,  in  what  manner  it  is 
to  be  carried  through  and  for  what  definite  pur- 


poses the  $25.00  assessment  is  to  be  expended. 
Such  demands  are  entirely  just  and  reasonable 
and  in  keeping  with  the  individualistic  and  sin- 
cere beliefs  of  all  physicians.  If  the  fund  were 
to  be  spent  for  legislative  skullduggery  and 
palm-crossing  lobbying,  they  would  want  no  part 
of  it.  But  “We  would  gladly  contribute  if  the 
funds  were  to  be  used  to  develop  a carefully 
worked  out,  comprehensive  plan  to  improve  med- 
ical care  and  education.”  That  makes  it  unani- 
mous. 

Their  questioning  attitude,  however,  confirms 
a long  held  suspicion — a suspicion  that  many 
physicians  do  not  read  the  proceedings  of  the 
House  of  Delegates.  The  answers  to  these  rea- 
sonable questions  may  be  found  in; 

(1)  “Statement  of  Policy  of  the  American  Med- 

ical Association,”  introduced  by  Cali- 
fornia and  published  in  the  Journal 
A.M.A.  of  December  18,  1948,  page  1171. 

(2)  “Resolution  of  National  Publicity,”  intro- 

duced by  Colorado  and  published  in  the 
Journal  A.M.A.  of  December  18,  1948, 
page  1173. 

(3)  “Report  of  the  Reference  Committee  on 

Legislation  and  Public  Relations,”  pub- 
lished in  the  Journal  A.M.A.  of  December 
25,  1,948,  page  1241. 

The  questioners  could  have  read  the  answer 
before  they  asked  the  questions. 

Having  this  basic  information,  any  member  of 
the  A.M.A.  may  obtain  and  understand  details 
as  stated  by  the  Coordinating  Committee  for  the 
Protection  of  the  People’s  Health.  Simple,  isn’t 
it?  Much  like  diagnosing  diabetes  mellitus  when 
a few  fimdamentals  are  known. 

The  time  has  arrived  when  speculative  weep- 
ing and  philosophical  dissertations  concerning  the 
poverty  of  past  performances  should  be  relegated 
to  the  arterio  sclerotic.  We  are  about  to  wit- 
ness a resurgence  of  the  Spirit  of  ’76' — no  other 
entity  than  the  usual,  ever  present  formula — 
American  guts. 

THOUGHTS  OF  A MAVERICK 

Transcending  all  other  considerations  in  the 
analysis  of  the  proposed  government  controlled 
plan  for  medical  care  is  the  implication  of  the 
inevitable  corruption  of  physicians. 

Arriving  late  at  a recent  luncheon  meeting  of 
the  National  Conference  on  Medical  Service,  a 
certain  editor  demanded  a seat  at  the  head  table. 
A high  ranking  officer  of  the  Conference,  al- 
ready seated,  relinquished  his  chair.  The  editor 
passed  the  luncheon  tab  along  to  another  officer 
of  the  Conference.  The  laurel  wreath  of  the 
late  “One-eyed  Connelly,”  the  greatest  gate- 
crasher of  all  time,  now  adorns  the  brow  of  an 
editor. 

To  the  Coordinating  Committee  for  the  Pro- 
tection of  the  People’s  Health:  “If  you  can  bear 
to  hear  the  words  I’ve  spoken  twisted  by  knaves 
to  make  a trap  for  fools  . . .” 

W.  H.  HALLEY. 


196 


Rocky  Mountain  Medical  Journal 


Original  Articles 


THE  HOSPITAL  ADMINISTRATOR’S  APPRAISAL  OF  CURRENT 

NURSING  PROBLEMS* 

OWEN  B.  STUBBENt 

DENVER 


Before  giving  my  appraisal  of  current 
nursing  problems,  it  may  be  interesting  to 
note  briefly  what  the  nurses  and  other  ad- 
ministrators feel  the  nursing  problems  of 
Colorado  are,  according  to  the  published 
results  of  the  Governor’s  Conference  on  the 
Nursing  Problems  in  Colorado,  as  of  Febru- 
ary, 1948.  The  Conference 

(A)  Emphasized  the  need  for  recruitment 
of  and  teaching  facilities  for  home  nursing 
personnel. 

(B)  Emphasized  the  need  for  standardized 
curriculum  in  nursing  schools. 

(C)  Recommended  that  plans  be  imple- 
mented for  the  training  of  practical  nurses 
and  for  their  licensure. 

(D)  Stressed  the  need  for  continuing  re- 
cruitment efforts  coupled  with  counseling 
and  vocational  guidance  programs  in  sec- 
ondary schools. 

(E)  Placed  particular  emphasis  on  the 
fact  that  economic  conditions  must  be  cor- 
rected  if  youth  is  to  be  attracted  to  the 
nursing  profession  and  graduates  are  to  be 
retained  in  it. 

(F)  Finally  felt  there  was  a need  for  in- 
creased education  of  the  public  to  make 
economical  and  appropriate  use  of  nursing 
personnel  as  related  to  group  nursing  in  hos- 
pitals, acceptance  of  practical  nurse  services, 
development  of  the  home  nursing  service, 
and  further  utilization  of  the  public  health 
nurse. 

It  is  evident  that  the  various  nursing 
groups  feel  there  is  a need  for  coordinated 
planning  and  action  on  their  part  in  trying 
to  accomplish  a solution  to  the  nursing 
problems  which  I have  mentioned.  Ob- 
viously many  of  these  problems,  if  not  all 

*Read  at  the  24th  Annual  Meeting  of  the  Colorado 
Hospital  Association  Wednesday,  November  10,  1948. 

tAssistant  Director,  Denver  General  Hospital. 


of  them,  are  hospital  problems  even  though 
we  as  hospital  administrators  may  feel  that 
minimal  participation  is  required  of  us  in 
the  solution  of  some  of  them.  Several  of 
the  problems  which  have  been  pointed  out 
are  most  certainly  problems  in  which  the 
hospitals  are  vitally  concerned — this  one 
for  example:  “Economic  conditions  must  be 
corrected  if  youth  is  to  be  attracted  to  the 
nursing  profession  and  graduates  are  to  be 
retained  in  it.” 

I presume  it  is  safe  to  say  that  most  of 
our  attention  is  directed  toward  the  latter 
part  of  this  problem,  the  retaining  of  grad- 
uates once  we  get  them.  This  immediately 
brings  to  mind  the  common  problems  of 
employment  policies,  basic  pay  rates,  an- 
nual leave,  reduction  of  overtime,  merit  in- 
creases, and  the  establishment  of  the  extent 
of  what  may  be  termed  “fringe”  benefits 
such  as  sick  leave,  room,  board  and  laundry 
allowances  and  pensions.  It  also  brings  to 
mind  other  problems  such  as  maintaining 
appropriate  assignment  of  personnel  in  light 
of  the  ever  present  shortage  of  qualified 
nurses,  rotation  problems  and  handling  of 
grievances. 

Despite  our  proclivity  for  feeling  that  our 
individual  problems  are  different  from 
those  of  our  colleagues,  it  seems  evident  to 
me  that  we  have  here  a remarkable  instance 
where  we  are  actually  all  faced  with  the 
same  problems.  I deem  it  absolutely  neces- 
sary that  we  as  hospital  administrators  must 
unite  our  efforts  and  develop  as  fast  a pace 
as  we  can  in  promoting  and  extending  our 
inter-hospital  relationships.  Only  by  free 
and  open  discussion  of  our  common  prob- 
lems can  we  hope  to  approach  anything  re- 
sembling a satisfactory  solution.  We  must 
develop  channels  of  communication  between 
ourselves  as  well  as  with  the  public  so  that 


for  March,  1949 


197 


we  may  all  be  better  informed.  I do  not 
wish  at  this  time  to  dwell  upon  the  field  of 
public  relations  and  the  role  it  may  play  in 
developing  public  understanding  of  our 
problems  and  in  promoting  the  continuation 
of  the  voluntary  hospital  system.  But  I 
would  like  to  emphasize  that  I sincerely 
feel  it  is  difficult  for  any  hospital  adminis- 
trator to  be  adequately  informed  on  the 
status  of  his  hospital  unless  inter-hospital 
relations  are  further  developed.  There  is 
nothing  more  disturbing  to  the  public  than 
to  hear  varied  interpretations  and  explana- 
tions of  what  is  essentially  a common  prob- 
lem. We  must  study  collectively  our  prob- 
lems; we  should  all  share  in  determining 
our  administrative  pattern  of  action,  and  it 
should  follow  that  the  course  of  action  de- 
cided on  shall  be  one  that  will  yield  maxi- 
mum benefits  to  all  participants. 

Even  if  we  were  of  the  opinion  that  the 
gravity  of  our  nursing  problems  is  unduly 


magnified,  we  do  not  have  to  look  far  to 
find  other  compelling  reasons  to  extend  the 
scope  of  inter-hospital  relations:  For  exam- 
ple, what  will  be  our  position  regarding 
compulsory  health  insurance?  Is  our  com- 
munity informed  and  supporting  us?  Have 
we  the  facts  at  hand  to  demonstrate  the 
value  of  the  services  we  are  rendering?  If 
the  solution  of  most  of  our  nursing  prob- 
lems is  in  economic  adjustment,  as  many 
think,  are  we  prepared  to  tell  our  public 
how  they  must  bear  the  cost  and  why? 

To  summarize  my  position,  we  must  de- 
velop and  expand  increasingly  inter-hospi- 
tal relationships  so  that  we  may  coordinate 
and  consolidate  our  efforts  more  effectively 
for  whatever  purpose  deemed  advisable. 
The  voluntary  hospital  system  is  in  a most 
vulnerable  position  today  and  the  burden 
is  on  us  to  demonstrate  to  our  public  that 
we  merit  and  deserve  their  unstinted  sup- 
port. 


SURGICAL  TREATMENT  OF  X-RAY  BURNS* 

THOMAS  W.  STEVENSON,  M.D. 

NEW  YORK  CITY 


Since  the  discovery  of  the  x-ray  by 
Roentgen  in  1895  it  has  been  more  and  more 
extensively  used.  Apparatus  has  become 
both  plentiful  and  efficient  and  this  thera- 
peutic agent  has  been  put  to  aU  sorts  of 
uses  with  a certain  amount  of  over-en- 
thusiasm. In  this  case  it  took  some  time  to 
learn  the  contra-indications  and  limitations, 
because  the  ill  effects  were  often  delayed 
fifteen  to  twenty-five  years  and  were  not 
readily  connected  with  the  original  ex- 
posure. Particularly  was  this  true  with  the 
blood  dyscrasias  and  sterility.  The  surface 
manifestations  are  more  readily  discernible, 
but  even  these  may  be  quite  insidious. 

It  is  this  group  of  surface  disturbances 
which  concern  the  plastic  surgeon.  They 
are  also  of  great  concern  to  the  patient 
because  of  the  abnormal  appearance  and  es- 
pecially because  of  the  intense  discomfort 
accompanying  the  burn.  In  the  acute  stages 

*From  the  Department  of  Surgery,  Plastic  Sur- 
gery Division,  Presbyterian  Hospital,  and  Columbia 
University,  College  of  Physicians  and  Surgeons,  New 
York,  New  York. 


there  is  usually  erythema.  This  appears 
several  days  after  exposure.  It  is  slightly 
more  dusky  in  color,  and  it  appears  to  sub- 
side more  slowly  than  sunburn,  which  it 
resembles.  In  light  doses  the  erythema  sub- 
sides without  leaving  visible  effects.  If  the 
dosage  is  heavier  some  desquamation  may 
follow  the  redness.  When  late  skin  changes 
occur  they  are  characterized  by  atrophy, 
pigmentary  changes,  telangiectasis  and  re- 
duction or  loss  of  hair  and  reduced  number 
of  sweat  glands  and  sebaceous  gland  ac- 
tivity. These  changes  may  not  appear  for 
many  years.  Oftentimes  keratoses  appear  in 
the  exposed  area.  Accompanying  the  kera- 
tosis may  be  excessive  thinning  of  the  skin. 
There  is  apt  to  be  reduction  in  the  amount 
of  subcutaneous  fat;  sometimes  there  is  an 
increase  of  fibrous  tissue.  Fibrous  thicken- 
ing is  characteristically  present  in  the  in- 
timal  layers  of  the  small  arteries  and  ar- 
terioles of  the  area.  This  results  in  reduced 
blood  supply  and  may  predispose  to  ulcera- 
tion. 


198 


Rocky  Mountain  Medical  Journal 


One  of  the  most  characteristic  surface 
changes  is  telangiectasis.  It  is  not  clear 
whether  this  surface  dilatation  of  venules 
is  due  to  an  injury  to  the  wall  of  the  vessel 
or  to  interference  with  venous  return.  The 
final  stage  of  the  cutaneous  burn  is  epi- 
thelioma formation.  This  neoplasm  usually 
begins  as  a minute  papule  which  eventually 
ulcerates.  The  majority  of  such  lesions  are 
squamous  cell  in  type,  but  many  basal  cell 
epitheliomata  are  found  also.  As  a rule 
these  neoplasms  remain  localized  but  late 
metastases  do  occur,  usually  to  the  regional 
lymph  nodes. 

In  my  experience  the  cases  in  which 
metastasis  has  occurred  have  been  of  long 
standing  or  cases  in  which  removal  has  been 
incomplete.  It  is  surprising  to  see  how  many 
of  these  lesions  are  still  being  treated  by 
radiotherapy.  More  than  a normal  number 
of  subcutaneous  neoplasms  are  found  in  ir- 
radiated areas.  The  number  of  cases  is 
insufficient  for  adequate  statistical  studies, 
but  in  a small  series  of  x-ray  burns  I have 
excised  three  rhabdomyosarcomas  and  four 
or  five  fibrosarcomas. 

There  are  two  types  of  deep  ulceration 
following  irradiation.  In  the  acute  type  the 
initial  erythema  progresses  rapidly,  vesicles 
appear,  and  later  the  skin  becomes  necrotic 
and  sloughing  takes  place.  Sequestration  of 
necrotic  tissue  is  greatly  retarded,  and  may 
not  occur  for  several  months.  When  it  does 
occur  a greyish,  shaggy,  painful,  foul-smell- 
ing wound  usually  results.  Granulation  tis- 
sue fails  to  appear,  and  no  sign  of  marginal 
epithelialization  is  seen.  This,  and  the  de- 
layed sequestration,  distinguish  these  le- 
sions from  any  other  form  of  traumatic 
wound.  Pain  is  usually  the  striking  feature. 
The  slightest  drying  of  the  surface  or  pres- 
sure of  a dressing  causes  excruciating  pain, 
seriously  interfering  with  the  patient’s  rest. 

Delayed  ulceration  may  take  jjlace  in  an 
irradiated  area  which  had  remained  healed 
for  several  years.  This  usually  results 
from  progressive  fibrosis  and  consequent 
reduction  in  local  blood  supply,  which 
eventually  leads  to  ischemic  necrosis  in  the 
central  portion.  As  this  condition  advances 


it  resembles  in  most  respects  acute  ulcera- 
tion. The  intense  pain  associated  with  deep 
ulceration  is  so  great  that  most  patients 
appear  undernourished  and  haggard.  They 
have  usually  exhausted  all  possible  means 
of  relief  of  pain  without  results. 

Surgical  treatment  of  this  problem  offers 
the  only  chance  of  complete  relief.  Local 
applications  of  all  sorts,  including  aloa 
vera  and  radon,  have  been  unable  to  heal 
advanced  ulceration.  Heavy  ointment  dress- 
ings usually  prove  more  soothing  to  the  pa- 
tient than  wet  dressings  or  dry  applications, 
but  ointment  is  a poor  preparation  for  sur- 
gical excision  because  of  its  macerating  ef- 
fect upon  the  surrounding  skin.  It  is  neces- 
sary to  obtain  as  clean  a surface  as  possible 
prior  to  excision,  and  this  is  best  accom- 
plished by  frequently  changed  moist,  nor- 
mal saline  dressings,  care  being  taken  to 
apply  a fine-meshed  material  next  to  the 
wound  so  that  coarse  fibres  of  gauze  will 
not  pull  upon  the  painful  parts  when  the 
dressing  is  removed.  Local  application  of 
penicillin  or  sulfa  drugs  has  not  been  as 
helpful  as  systemic  treatment.  Systemic 
therapy  is  more  effective  in  reducing  cellu- 
litis surrounding  the  ulcer,  and  is  a valuable 
guard  against  spreading  infection  following 
surgery.  Rest  and  elevation  of  the  part  also 
assist  in  reduction  of  the  edema. 

There  is  not  much  choice  about  the  form 
of  treatment  best  suited  to  the  relief  of  this 
condition.  The  simplest  procedure  is  com- 
plete excision  of  the  area  with  primary 
closure  of  the  wound.  This  is  only  possible 
in  small  lesions  on  certain  parts  of  the  body. 
There  may  be  failure  of  healing  because  of 
tension  in  a heavily  contaminated  field  in 
in  an  area  in  which  the  healing  power  has 
been  greatly  reduced  by  irradiation. 

Excision  and  covering  by  a free  graft  has 
similar  hazards  connected  with  it,  but  this 
is  the  procedure  of  choice  in  instances 
where  excision  can  be  carried  out  widely 
and  deeply  enough  to  permit  placing  a graft 
upon  a relatively  normal  tissue  bed.  The 
most  useful  and  generally  workable  plan 
has  been  to  bring  in  to  the  affected  area 
a pedunculated  flap  from  a distance.  If  such 
a procedure  is  planned  so  that  tension  is 


for  March,  1949 


199 


avoided,  and  the  flap  is  well  nourished, 
good  healing  can  usually  be  obtained.  The 
advantage  of  a pedicle  graft  is  that  it  brings 
its  own  nutrition  and  the  cells  of  which  it 
is  composed  have  normal  ability  to  repro- 
duce. Furthermore,  well  nourished  tissue 
sutured  in  place  without  tension  has  con- 
siderable resistance  against  infection.  A 
further  advantage  of  such  a graft  is  that  it 
can  be  placed  over  exposed  bone,  joint  or 
tendon  with  a fair  prospect  of  healing,  and 
a good  outlook  as  far  as  eventual  wear  and 
tear  is  concerned.  This  has  particular  ref- 
erence to  the  sole  of  the  foot  which  must 
comfortably  bear  weight.  The  disadvantages 
of  a pedicle  graft  are  obvious,  chiefly  the 
production  of  a large  scar  in  a remote  area, 
and  the  length  of  time  required  to  obtain 
the  graft  and  move  it  into  position. 

There  is  one  point  that  needs  to  be  em- 
phasized in  reference  to  the  application  of 
any  form  of  graft  to  these  wounds  and  that 
is  that  immediate  graft  application  is  much 
more  apt  to  succeed  than  any  delayed  form 
of  graft.  Freshly  cut  surfaces  are  cleaner 
and  better  able  to  accept  the  graft  than  a 
wound  that  has  been  excised  and  allowed 
to  wait  any  period  of  time  before  being 
grafted.  During  the  period  of  delay  the 
damaged  marginal  cells  are  unable  to  pro- 
liferate and  bacterial  growth  increases  as 
time  is  allowed  to  elapse.  Changes  in  the 
skin  surface  due  to  irradiation  require  ex- 
cision if  there  is  epitheliomatous  change  or 
threat  of  such  change. 

Some  elective  excisions  are  done  for  cos- 
metic reasons.  In  cases  of  superficial  change 
it  has  been  found  possible  to  carry  out  ade- 
quate excision  with  coverage  of  the  surface 
by  means  of  a free  graft.  Where  extensive 
damage  is  present  the  main  requirement  is 
adequate  removal,  and  in  such  cases  a ped- 
icle graft  may  be  desirable.  Regional  lymph 
node  dissection  is  certainly  indicated  if 
palpable  nodes  are  present,  and  may  have 
very  definite  prophylactic  value,  even  in  the 
absence  of  enlarged  nodes.  It  is  impossible 
to  distinguish  between  chronic  lymphad- 
enitis and  metastasis  without  a biopsy. 

It  is  interesting  to  note  the  source  of 
x-ray  burns:  The  largest  group  of  super- 


ficial burns  arise  from  the  treatment  of 
hypertrichosis,  which  was  an  exceedingly 
popular  treatment  twenty-five  years  ago. 
New  cases  of  this  type  are  fortunately  be- 
coming less  frequent.  There  are  a number 
of  unfortunate  burns  following  fracture  re- 
duction. Excessive  exposures  have  been  re- 
ceived during  diagnostic  procedures  and  in 
search  of  foreign  bodies.  The  patient  is 
burned  over  the  part  being  examined,  and 
there  has  also  been  a series  of  burns  upon 
the  fingers  of  the  examining  physician.  A 
number  of  new  cases  are  appearing  among 
veterinarians.  They  have  not  yet  learned 
through  bitter  experience  the  necessity  for 
greater  precaution  in  handling  irradiation. 
Quite  a number  of  patients  with  surface 
damage  have  received  radiotherapy  because 
of  acne  or  some  other  dermatitis.  The  main 
difficulty  seems  to  arise  when  the  treatment 
is  repeated  by  a second  and  a third  phy- 
sician without  knowledge  of  prior  treat- 
ment. This  has  been  especially  true  of 
treatment  to  plantar  warts.  The  most  in- 
tense burns  have  usually  resulted  from  the 
treatment  of  deeply  located  tumors.  Here 
again  the  number  of  burns  is  being  sub- 
stantially reduced  by  fractional  doses  of 
higher  intensity,  delivered  through  several 
portals.  There  has  been  a tendency  to  ig- 
nore individual  sensitivity.  Dosage  has  been 
computed  mathematically  without  sufficient 
reference  to  individual  sensitivity.  Unfor- 
tunately individual  sensitivity  cannot  read- 
ily be  measured. 

It  appears  beyond  doubt  that  some  pa- 
tients develop  damage  from  dosage  which 
is  hardly  noticed  by  the  average  individual. 
It  might  be  possible  to  test  a small  area  of 
the  patient’s  skin  prior  to  the  main  therapy. 
If  damage  developed  this  small  area  would 
be  excised  and  the  major  treatment  modi- 
fied or  abandoned. 

One  cannot  discuss  this  subject  without 
consideration  of  the  increasing  use  of  irra- 
diation in  industry  and  warfare.  Despite  all 
protective  measures  a certain  number  of 
injurious  exposures  will  occur.  A more 
widespread  understanding  of  the  patho- 
logical changes  and  the  treatment  of  x-ray 
burns  is  indicated. 


200 


Rocky  Mountain  Medical  Journal 


A GENERAL  REVIEW  OF  NITROUS  OXIDE  ANESTHESIA* 

LELAND  O.  LEARNED,  M.D. 

SADT  LAKE  CITY,  UTAH 


Nitrous  oxide  was  discovered  by  Joseph 
Priestley  between  1772  and  1776  during  his 
experiments  on  air.  He  marveled  at  its 
property  of  supporting  the  flame  of  a candle 
coupled  with  its  ability  in  pure  form  to 
kill  animal  life. 

In  1798  the  Pneumatic  Institute  was 
founded  by  Dr.  Thomas  Beddoes  near  Bris- 
tol for  the  treatment  of  consumption  and 
other  lung  conditions  by  the  inhalation  of 
gases.  A laboratory  assistant  there  became 
celebrated  by  publishing  his  observations 
on  nitrous  oxide  in  1800  which  to  this  day 
are  considered  a classic.  This  was  Hum- 
phrey Davy  who  wrote,  “On  April  11,  1799, 
I made  the  first  inspiration  of  pure  nitrous 
oxide.  It  passed  into  the  bronchia  without 
stimulating  the  glottis,  and  produced  no 
uneasy  feeling  in  the  lungs  ...  In  cutting 
...  (a  wisdom  tooth)  I experienced  . . . 
great  pain.  I breathed  nitrous  oxide.  The 
pain  always  diminished  after  the  first  four 
or  five  inspirations;  the  thrilling  came  on 
as  usual,  and  uneasiness  was  for  a few  min- 
utes swallowed  up  in  pleasure.  . . . Modi- 
fication of  the  powers  of  nitrous  oxide  by 
mixture  of  the  gas  with  oxygen  or  common 
air  will  probably  enable  the  most  delicate 
to  respire  it  without  danger  ...  As  nitrous 
oxide  in  its  extensive  operation  appears 
capable  of  destroying  physical  pain,  it  may 
probably  be  used  with  advantage  during 
surgical  operations  in  which  no  great  ef- 
fusion of  blood  takes  place.”  Davy’s  re- 
markable work  notwithstanding,  half  a 
century  of  pain  was  still  to  be  endured  until 
the  eventual  introduction  of  nitrous  oxide 
in  1844. 

An  itinerant  chemist  named  Gardner 
Quincy  Colton  was  delivering  a series  of 
lectures  on  chemistry.  As  a means  of 
brightening  up  the  duller  portions  he  would 
administer  nitrous  oxide  to  members  of  the 
audience.  Colton’s  demonstration  at  Hart- 
ford, Connecticut,  on  December  10,  1844, 

*From  the  Department  of  Anesthesiology,  Univer- 
sity of  Utah  School  of  Medicine.  Presented  before 
a meeting  of  the  Utah  State  Society  of  Anesthesiolo- 
gists, January  23,  1948. 


was  a notable  one,  for  it  was  there  that 
Horace  Wells,  the  dentist,  witnessed  a vol- 
unteer under  the  effects  of  the  gas  injure 
his  leg  sufficiently  to  draw  blood  al- 
though he  had  no  recollection  of  sustaining 
the  injury  nor  the  incident  pain. 

The  following  morning  Wells  invited  Col- 
ton to  his  office  to  administer  the  gas  to 
him  while  he  had  one  of  his  teeth  extracted 
without  pain.  Writing  for  the  Nitrous  Oxide 
Centennial,  Ralph  M.  Waters  states,  “Wells 
made  the  mistake  that  remains  a common 
one  to  this  day.  He  over-emphasized  the 
importance  of  the  drug  rather  than  of  a 
thorough  knowledge  of  its  effects  and  of 
skill  in  its  administration.  Colton,  who  had 
had  experience  and  therefore  possessed  con- 
siderable knowledge  of  nitrous  oxide  and 
skill  in  giving  it,  went  on  with  his  lecture 
tour  never  suggesting  by  word  or  deed  that 
he  ought  to  share  in  the  credit  for  the  first 
administration  of  surgical  anesthesia.  He 
was  emphatic  in  later  years  that  the  idea 
belonged  entirely  to  Wells.  The  more  fa- 
miliar one  becomes  with  the  men  who 
claimed ’a  share  in  the  honor  of  being  the 
discoverer  of  anesthesia,  the  more  certain 
one  is  that  Gardner  Q.  Colton  was  as  de- 
serving as  any.” 

In  1863  Colton  organized  the  famous  Col- 
ton Dental  Association,  and  by  1868,  40,000 
nitrous  oxide  anesthesias  had  been  given 
by  this  group.  In  1868  Clover  was  the  chief 
protagonist  for  nitrous  oxide  in  England.  He 
devised  new  inhalers  and  first  described  the 
use  of  nitrous  oxide  as  an  induction  agent 
before  the  administration  of  ether.  In  the 
same  year  E.  Andrews  of  Chicago  proposed 
the  use  of  oxygen  with  nitrous  oxide  for 
non-asphyxial  anesthesia.  Ten  years  later 
Paul  Bert  read  before  the  Academy  of 
Sciences  in  Paris  his  famous  paper  on  the 
use  of  nitrous  oxide-oxygen  under  increased 
pressure.  He  declared  that  to  obtain  sur- 
gical anesthesia  nitrous  oxide  must  have  a 
partial  pressure  equivalent  to  one  atmos- 
phere (760  mm.  Hg),  and  to  avoid  anoxe- 
mia oxygen  must  be  at  the  same  tension 


for  March,  1949'i 


201 


under  which  it  exists  in  air  (156  mm.).  To 
fulfill  both  of  these  requirements  he  pro- 
posed that  an  85  per  cent  nitrous  oxide — 
15  per  cent  mixture  be  administered  at  a 
pressure  of  one  and  one-quarter  atmos- 
pheres in  accordance  with  Dalton’s  Law  of 
Solubility  of  Mixed  Gases.  He  used  a pres- 
sure chamber  to  accomplish  this.  Having 
used  this  method  of  anesthesia  on  animals 
and  humans,  he  wrote  enthusiastic  accounts. 
Bert’s  criteria  for  surgical  anesthesia  must 
have  been  quite  different  from  the  current 
ones,  for  his  results  have  not  been  sub- 
stantiated by  present  day  workers  using 
even  greater  pressures  (Brown,  Lucas  and 
Henderson) . 

Further  progress  in  nitrous  oxide  an- 
esthesia since  Andrews’  introduction  of  oxy- 
gen has  been  in  the  development  of  gas 
apparatus.  In  1910  a new  stimulus  was 
given  to  nitrous  oxide  anesthesia  by  Crile’s 
“Anoci-Association”  principle  in  which  local 
infiltration  and  nitrous  oxide  inhalation 
anesthesia  were  combined  to  aid  in  the  real- 
ization of  the  so-called  “shockless”  opera- 
tion. 

Chemical  and  Physical  Properties 

Nitrous  oxide  is  prepared  commercially  by 
the  thermal  decomposition  of  ammonium 
nitrate.  The  gas  is  scrubbed  to  remove 
acids  and  alkalies,  compressed  by  stages  to 
prevent  decomposition  from  excessive  heat 
and  to  remove  non-liquefiable  gases  such 
as  nitrogen  and  oxygen,  and  treated  with 
iron  filings  to  remove  the  toxic  higher 
oxides  of  nitrogen.  It  is  marketed  in  steel 
cylinders  as  a liquid  under  pressure. 

It  is  a sweetish  colorless  gas,  stable  under 
ordinary  conditions,  and  highly  soluble  in 
water,  alcohol,  and  fats.  Although  non- 
inflammable,  nitrous  oxide  readily  yields  its 
oxygen  to  support  combustion;  in  this  re- 
spect it  is  equally  dangerous  as  oxygen  it- 
self in  the  presence  of  combustible  chem- 
icals. In  this  connection  serious  explosions 
have  occurred  during  the  administration  of 
nitrous  oxide-ether  mixtures.  It  is  stable 
in  the  presence  of  soda  lime.  Nitrous  oxide 
is  the  only  inorganic  gas  used  as  an  an- 
esthetic agent. 


Pharmacology 

Nitrous  oxide  is  highly  soluble  in  blood 
but  does  not  combine  with  hemoglobin. 
Chemically  inert  in  the  body,  it  is  excreted 
unchanged  very  rapidly  by  way  of  the  lungs, 
a small  amount  also  passing  through  the 
skin.  Although  nitrous  oxide  supports  ac- 
tive combustion,  the  oxygen  in  its  molecule 
is  unavailable  for  tissue  consumption.  With 
the  exception  of  the  nervous  system  the  tis- 
sues of  the  body  are  not  affected  by  the 
gas.  Any  alterations  in  the  tissues,  the 
metabolism,  or  the  vital  functions  are  due 
to  accompanying  anoxia  and  not  to  nitrous 
oxide  per  se.  Dogs  anesthetized  contin- 
uously for  three  days  recovered  as  readily 
as  if  anesthetized  only  a few  minutes  and 
without  ill  effects. 

The  exact  mode  of  action  of  nitrous  oxide 
is  unknown.  That  it  does  possess  anesthetic 
properties  which  are  independent  of  anox- 
emia is  incontrovertible.  Asphyxiant  gases 
such  as  helium  and  nitrogen  when  given  in 
such  concentrations  as  90  per  cent  with  10 
per  cent  oxygen  fail  to  produce  anesthesia, 
whereas  nitrous  oxide  in  concentrations  of 
80  per  cent  or  lower  frequently  does.  Much 
lower  concentrations  of  nitrous  oxide  pro- 
duce unquestionable  analgesia.  Various 
animal  experiments  further  substantiate  the 
depressant  effect  of  the  gas  upon  the  ner- 
vous system.  If  given  with  adequate  oxy- 
gen, nitrous  oxide  has  the  widest  margin 
of  safety  of  any  known  anesthetic  agent. 

Guedel  classifies  nitrous  oxide  as  a “15 
per  cent  potent  anesthetic  agent,”  meaning 
that  in  the  presence  of  adequate  oxygen 
and  under  ideal  conditions  of  basal  reflex 
irritability  it  is  capable  of  producing  first 
plane  surgical  anesthesia  and  no  more. 
However,  satisfactory  surgical  anesthesia  is 
seldom  achieved  under  these  circumstances. 
It  is  the  consensus  that  true  surgical  an- 
esthesia with  nitrous  oxide  does  not  exist 
without  some  measure  of  anoxemia.  Hence, 
in  order  to  obtain  satisfactory  anesthesia, 
nitrous  oxide  must  be  supplemented  by 
more  potent  agents  or  by  anoxia.  Based  on 
this  fact  are  essentially  two  ways  of  ad- 
ministering nitrous  oxide  for  surgical  an- 
esthesia. 


202 


Rocky  Mountain  Medical  Journal 


Methods  of  Administration 

Th?  McK?sson-Clement  viewpoint  em- 
ploys varying  degrees  of  anoxia  to  com- 
pensate for  the  lack  of  potency  of  nitrous 
oxide.  These  authors  declare  that  it  is  the 
only  inhalation  agent  that  may  be  used  with 
safe  degrees  of  oxygen  deficiency  because 
it  does  not  depress  the  protective  mechanism 
of  the  body  whereas  other  inhalation  agents 
have  toxic  and  depressing  action  on  the 
medullary  and  other  centers  including  the 
carotid  sinus.  They  state  further  that  hence 
cyanosis  and  hypoxia  are  dangerous  when 
associated  with  ether,  cyclopropane,  or 
chloroform  because  the  normal  protective 
mechanism  of  the  body  functions  either  in- 
efficiently or  not  at  all.  According  to  this 
method  of  giving  nitrous  oxide  the  surgical 
stage  of  anesthesia  is  subdivided  into  a light 
plane,  a normal  or  surgical  plane,  and  a pro- 
found plane,  the  signs  of  which  are  those 
produced  by  variations  in  the  oxygen  con- 
centration. 

It  is  apparent  that  the  light  plane  of  Mc- 
Kesson-Clement is  really  not  surgical  an- 
esthesia at  all  according  to  Guedel’s  scheme, 
that  the  profound  plane  consists  of  the  man- 
ifestations of  acute  asphyxia,  and  that  the 
normal  plane  corresponds  to  Guedel’s  plane 
one  or  two  with  superimposed  anoxia. 

Clement  stresses  the  importance  of  the 
time  factor.  Satisfactory  anesthesia  is  de- 
pendent on  tissue  saturation  with  the  an- 
esthetic substance.  Only  a few  inspirations 
of  pure  nitrous  oxide  are  sufficient  to  re- 
place the  oxygen  in  the  blood.  A much 
longer  time  is  required  to  displace  the 
nitrogen  and  oxygen  in  the  tissues.  To 
shorten  this  to  the  minimum,  secondary 
saturation  is  utilized. 

The  induction  of  anesthesia  with  100  per 
cent  nitrous  oxide  comprises  a primary 
saturation.  The  first  sign  of  oxygen  lack  is 
an  increased  respiratory  rate.  Oxygen  is 
added  in  that  percentage  which  allows  ef- 
ficient respiration  and  avoids  deep  narcosis. 
A gradual  saturation  of  the  tissues  is  thus 
effected  and  any  desired  plane  of  anesthesia 
accomplished.  Secondary  saturation  was 
accidentally  discovered  by  McKesson  who 
observed  that  a patient  in  profound  an- 


esthesia could  be  rapidly  resuscitated  with 
pure  oxygen,  following  which  occurred  a 
period  of  apnea  attended  by  complete  mus- 
cular relaxation.  The  mechanism  of  this 
phenomenon  lacks  explanation.  Clement 
states,  “A  secondary  saturation  requires  an 
intimate  knowledge  of  the  signs  of  anesthe- 
sia, a disregard  of  cyanosis,  and  an  appa- 
ratus capable  of  delivering  oxygen  under 
pressure  for  resuscitation  if  necessary.”  The 
technic  consists  of  a sudden  return  of  the 
mixture  at  any  time  during  the  anesthetic 
to  100  per  cent  nitrous  oxide  followed  by 
the  administration  of  oxygen  to  counteract 
the  excess  and  to  produce  relaxation.  The 
saturation  may  be  partial  or  complete. 
To  produce  partial  secondary  saturation 
the  nitrous  oxide  per  cent  is  suddenly  in- 
creased anywhere  up  to  96  or  100  per  cent. 
When  evidence  of  deep  anesthesia  appears, 
one  or  two  breaths  of  a mixture  containing 
from  25  to  50  per  cent  oxygen  is  given.  This 
procedure  is  repeated  until  the  desired  level 
is  obtained. 

Complete  secondary  saturation  is  achieved 
by  the  administration  of  pure  nitrous  oxide 
until  the  patient  is  on  the  verge  of  respira- 
tory arrest,  followed  by  one  or  two  breaths 
of  pure  oxygen.  The  nitrous  oxide  is  then 
maintained  at  90  per  cent.  Partial  differs 
from  complete  saturation  only  in  the  depth 
of  anesthesia  produced  before  the  adminis- 
tration of  oxygen.  They  both  accomplish 
the  same  result  except  that  complete  satu- 
ration is  more  drastic  and  acts  more  quickly. 

In  accordance  with  newer  concepts  in 
physiology  the  modern  school  of  nitrous 
oxide  anesthesia  places  foremost  the  need 
for  adequate  oxygen  intake  at  all  times,  this 
never  being  reduced  below  20  per  cent.  The 
weakness  of  nitrous  oxide  is  compensated 
for  by  the  use  of  heavy  premedication,  by 
combination  with  regional  anesthesia,  or  by 
fortification  with  more  potent  agents. 

It  is  well  known  that  certain  types  of  in- 
dividuals are  resistant  to  nitrous  oxide- 
oxygen  anesthesia.  They  are  alcoholics, 
drug  addicts,  hysterics,  children,  robust  or 
obese  persons,  or  anyone  with  an  elevated 
metabolic  rate  from  any  cause.  However, 
the  advantages  of  nitrous  oxide-oxygen 


for  March,  1949 


203 


anesthesia  can  be  given  these  patients  with 
the  aid  of  the  aforementioned  means.  Al- 
though no  detailed  account  of  all  of  the 
various  ways  of  combining  nitrous  oxide 
with  other  agents  will  be  attempted,  a few 
of  the  currently  used  technics  are  worthy 
of  mention. 

Sodium  pentothal  and  nitrous  oxide-oxy- 
gen anesthesia  is  an  ideal  example  of  com- 
bined anesthesia.  Barbiturates  are  potent 
hypnotics,  but  possess  virtually  no  anal- 
gesic properties.  Nitrous  oxide  is  a good 
analgesic  agent.  The  total  dosage  of  pen- 
tothal during  an  operation  is  considerably 
reduced  by  nitrous  oxide,  thus  there  is  less 
likelihood  of  prolonged  post-anesthetic  de- 
pression. 

Nitrous  oxide-ether-oxygen  mixtures 
have  long  been  a favorite  anesthetic  com- 
bination. The  nitrous  oxide  makes  for  a 
pleasant  induction;  the  ether  adds  the  nec- 
essary potency  to  provide  good  surgical 
anesthesia.  Heavy  pre-anesthetic  sedation 
with  opiates  and  barbiturates  is  sometimes 
all  that  is  needed  to  render  nitrous  oxide- 
oxygen  anesthesia  satisfactory  without  fur- 
ther supplementation. 

Cyclopropane  is  a currently  popular  sup- 
plementary agent,  used  either  continuously 
or  intermittently  with  nitrous  oxide-oxygen 
mixtures.  Rectal  tribromethanol  is  another 
method  of  enhancing  nitrous  oxide,  but  is 
now  being  rapidly  supplanted  by  the  more 
conveniently  administered  sodium  pento- 
thal. Both  of  these  supplements  are  to  be 
preferred  to  the  inflammable  ones  in  the 
presence  of  ignition  sources. 

Crile  for  many  years  combined  nitrous 
oxide-oxygen  with  local  infiltration  with 
gratifying  results.  It  can  also  be  used  to 
supplement  spinal  and  other  regional  nerve 
blocking  procedures.  Curare  has  opened 
new  vistas  for  the  proponents  of  nitrous 
oxide,  for  any  degree  of  muscle  relaxation 
can  be  provided  during  nitrous  oxide  an- 
esthesia. 

It  is  unfortunate  that  such  a use- 
ful agent  as  nitrous  oxide  has  been  unjustly 
criticized  because  of  its  misuse.  However, 
it  is  coming  once  again  into  its  own,  thanks 
to  more  rational  technics  of  administration. 


Untoward  Effects  of  Nitrous  Oxide 
Anesthesia 

The  overwhelming  preponderance  of  an- 
esthesiologists censure  as  totally  unphy- 
siological  and  hazardous  the  use  of  anoxia 
as  a supplement  for  nitrous  oxide.  The  con- 
tingent dangers  of  anoxemia  during  nitrous 
oxide  anesthesia  have  been  cited  by  Cour- 
ville,  Caine,  Eastman,  and  others.  The 
classical  monograph  of  Courville  merits  em- 
phasis. 

Patients  manifesting  cerebral  lesions  fol- 
lowing nitrous  oxide  anesthesia  have  been 
classified  by  this  author  into  five  clinical 
groups:  1.  Sudden  death  on  the  operating 
table.  2.  Delayed  exitus.  3.  Prolonged  sur- 
vival periods.  4.  Recovery  with  residual 
cortical  and  lenticular  damage.  5.  Transitory 
mental  and  emotional  changes.  The  patho- 
logic findings  in  the  brain  depend  upon  the 
severity  of  the  anoxic  insult  and  the  time 
interval  between  this  and  death.  They  vary 
from  simple  engorgement  with  petechial 
hemorrhages  through  patchy  necrosis  on  up 
to  extensive  degeneration  of  the  cerebral 
cortex  and  lenticular  nuclei. 

In  cases  surviving  a number  of  hours  or 
days  death  is  preceded  by  deepening  coma 
and  hyperthermia.  Symptoms  following 
cerebral  anoxemia  may  consist  of  mental 
and  emotional  aberrations,  convulsions  and 
other  motor  abnormalities,  and  visual  dis- 
turbances, usually  blindness  of  varying  de- 
grees. Any  or  all  of  these  may  be  tran- 
sitory or  permanent.  It  is  to  be  clearly 
understood  that  damage  to  the  brain  is  not 
due  to  any  toxic  property  of  nitrous  oxide, 
but  is  entirely  the  result  of  anoxemia. 

Next  to  the  brain,  the  heart  is  the  organ 
most  sensitive  to  anoxia.  Under  nitrous 
oxide  anesthesia  patients  with  coronary 
artery  or  myocardial  disease  may  develop 
acute  coronary  insufficiency  from  anoxemia 
without  the  warning  of  angina.  Impaired 
cardio-respiratory  function  due  to  anoxia 
may  lead  to  atelectasis,  pulmonary  edema 
or  cardiac  failure.  Thus  Haldane  eptio- 
mizes,  “Anoxia  not  only  stops  the  machine, 
but  wrecks  the  machinery.” 

To  preclude  the  use  of  anoxia  by  an- 
esthetists it  has  been  advocated  by  Roven- 


204 


Rocky  Mountain  Medical  Journal 


Stine  and  Barach  that  only  cylinders  of  80 
per  cent  nitrous  oxide — 20  per  cent  oxygen 
be  made  available,  comparable  to  medicinal 
helium-oxygen  mixtures. 

Advantages  of  Nitrous  Oxide-Oxygen 
Anesthesia 

1.  Rapid  induction  and  emergence.  Ni- 
trous oxide  is  virtually  eliminated  from  the 
blood  in  two  minutes;  no  trace  can  be  de- 
tected after  five.  Patients  react  quickly 
even  after  long  procedures. 

2.  It  is  non-irritating  and  has  a pleasant 
odor,  this  quality  alone  making  it  valuable 
for  inducing  ether  anesthesia. 

3.  Nitrous  oxide  is  non-toxic  and  provides 
the  widest  margin  of  safety  of  any  of  the 
systemic  anesthetic  agents. 

4.  Minimal  undesirable  after  effects  such 
as  nausea  and  vomiting. 

5.  Non-inflammability.  This  is  a major 
safety  factor  which  allows  its  use  in  the 
presence  of  cautery  and  other  sources  of 
ignition. 

6.  Used  in  combination  with  other  agents, 
nitrous  oxide  materially  reduces  their  total 
dosage,  obviating  excessive  postanesthetic 
depression. 

7.  A state  of  analgesia  is  most  readily  ob- 
tained with  nitrous  oxide.  This  is  of  value 
in  dental  work,  for  pains  during  the  first 
stage  of  labor,  and  for  special  procedures 
such  as  thoracoplasties  during  which  the  pa- 
tient retains  his  cough  reflex  to  bring  up 
secretions.  This  property  also  is  useful  for 
supplementing  inadequate  and  waning  re- 
gional nerve  blocks. 

Disadvantages 

All  of  its  disadvantages  are  due  to  the 
very  property  that  renders  it  safe,  namely, 
its  lack  of  potency.  On  this  account  it  is 
unsatisfactory  for  deep  anesthesia  where 
extreme  muscular  relaxation  is  required 
unless  it  is  properly  supplemented. 

Large  concentrations  of  oxygen  cannot  be 
successfully  used  with  it,  hence  it  is  inter- 


dicted in  any  condition  in  which  anoxemia 
from  any  cause  already  exists  or  in  which 
anoxemia  may  develop  as  from  severe  shock 
or  hemorrhage.  This  fact  was  recognized 
by  Humphrey  Davy  a century  and  a half 
ago. 

Summary 

A general  review  of  nitrous  oxide  has 
been  attempted  with  special  reference  to 
its  history,  physical  and  chemical  proper- 
ties, pharmacology,  methods  of  administra- 
tion, advantages  and  disadvantages,  with  a 
brief  description  of  the  untoward  effects 
resulting  from  anoxia  during  nitrous  oxide 
anesthesia. 

Conclusions 

Administered  with  sufficient  oxygen, 
nitrous  oxide  is  the  safest  general  anes- 
thetic available.  If  its  limitations  are  ac- 
knowledged and  the  substance  used  accord- 
ingly, nitrous  oxide  is  a most  valuable  en- 
tity in  the  realm  of  anesthesia. 


Book  Review 

Synopsis  of  Psycliosomatic  Diagnosis  and  Treatment; 

Uy  G landers  Dunbar,  M.D.,  with  the  assistance  of 
Jacob  Allow,  M.D.;  Raymond  Hussey,  M.D.;  Ber- 
tram Dewin,  M.D. ; Robert  C.  Lowe,  M.D.;  Sydney 
Rubin,  H.D. : E.  Schneider,  M.D.;  Lester  W.  Son- 
tag',  M.D.,  and  Members  of  the  Staff  of  the  De- 
partments of  Medicine  and  Psychiatry,  Columbia- 
Presbytet  ian  Medical  Center,  New  York  City.  501 
pages,  The  C.  V.  Mosby  Company,  St.  Louis,  Mis- 
souri, 1948.  ?6.50. 

The  purpose  of  this  book  was  to  add  a section 
of  psychosomatic  diagnosis  treatment  to  each 
chapter  of  Christian’s  revision  of  Osier’s  text- 
book. The  book,  in  general,  is  well  organized 
and  the  material  presented  in  a clear,  interesting 
manner.  The  introduction  briefly  reviews  the 
development  of  psychosomatic  medicine  and 
points  out  the  magnitude  of  the  problem  in- 
volved. The  psychosomatic  approach,  that  is, 
the  study  of  psycho-physiolo^cal  interrelation- 
ship, has  reveled  some  very  interesting  facts  in 
many  diseases  and  new  facts  -will  undoubtedly 
be  uncovered. 

An  excellent  discussion  of  determinants  of  pre- 
disposition to  psychosomatic  dysfunction  and  dis- 
ease indicates  the  complexity  of  the  processi  of 
somatization  of  anxiety  which  underlies  psycho- 
somatic illnesses.  The  contributing  etiological 
factors  are  believed  to  include  fetal  environ- 
ment, nutrition,  the  inheritance  of  physiological 
patterns,  etc.,  and  account  for  the  tremendous  dif- 
ference in  predisposition  to  psychosomatic  dis- 
orders. Although  rapid  advancements  have  been 
made  in  this  relatively  new  field  of  medicine, 
this  synopsis  clearly  reveals  some  of  the  de- 
ficiencies in  our  understanding  and  handling  of 
patients  with  psychosomatic  disorders.  The  ob- 
vious deficiency  does  not  distract  from  the  value 
of  this  book  and  it  is  believed  that  every  physi- 
cian will  find  many  chapters,  if  not  the  entire 
book,  interesting  and  instructive  reading. 

EWALD  W.  BUSSE. 


for  March,  1949 


205 


CHRONIC  EMPYEMA,  PRESENT  CONCEPTS  OF  TREATMENT* 

WILLIAM  B.  CONDON,  M.D.,  and  MARVIN  E.  JOHNSON,  M.D. 

DENVER 


As  a disease  entity,  chronic  empyema  has 
been  recognized  for  centuries.  Medical  his- 
tory of  the  disease  is  essentially  a story  of 
its  changing  forms  of  therapy,  and  from  the 
days  of  Hippocrates  until  the  present  there 
has  been  a constant  search  for  improved 
methods  of  treatment.  However,  the  pri- 
mary object  of  all  treatment  remains  the 
same  now  as  in  the  earliest  time,  namely 
to  bring  into  permanent  apposition  the  vis- 
ceral and  parietal  layers  of  the  pleurae.  To 
obtain  this  pleural  closure  with  the  least 
surgery,  the  shortest  period  of  disabihty  and 
the  preservation  of  the  greatest  vital  ca- 
pacity has  been  and  will  continue  to  be  the 
primary  aim. 

An  empyema  of  many  weeks,  months,  or 
years  duration  is  only  the  result  of  the  fail- 
ure of  the  two  pleural  surfaces  to  become 
fused.  This  failure  of  fusion  is  usually 
caused  by  the  presence  of  pus  from  the 
original  infection  remaining  in  the  pleural 
space.  Less  frequent  causes  of  chronicity 
in  an  empyema  are  the  presence  of  a bron- 
chopleural fistula  or  some  primary  under- 
lying process  that  the  body  cannot  over- 
whelm, such  as  a neoplastic  disease,  a for- 
eign body  or  some  granulamotous  process 
like  actinomycosis.  There  are  authorita- 
tive estimates  that  70  per  cent  of  all  cases 
of  chronic  non-tuberculous  empyema  are 
directly  caused  by  inadequate  drainage.^ 

To  obtain  an  effective  absolute  pleural 
closure,  innumerable  methods  have  been 
devised.  By  and  large,  however,  each 
method  is  either  a modification  or  a combi- 
nation of  the  three  basic  procedures — drain- 
age, thoracoplasty  or  decortication.  By 
drainage  we  mean  the  intercostal  or  trans- 
costal  tube  drainage  or  open  thoracotomy 
with  rib  resection.  The  open  type  of  drain- 
age is  used  much  more  often  than  the 
closed.^  Only  too  often  when  tubes  are  in- 
serted into  the  thoracic  cavity,  they  become 
clogged  with  debris  or  erode  through  the 
expanding  lung,  causing  a bronchopleural 

*Presented  before  the  77th  Annual  Meeting  of  the 
Colorado  Medical  Society,  Denver,  Colorado,  Septem- 
ber 18,  1947. 


fistula.  Then  upon  their  withdrawal  the 
chest  wall  closes  too  rapidly  so  that  a -small 
pleural  pocket  remains.  In  view  of  these 
disadvantages  plus  the  fact  that  the  period 
of  disability  is  not  decreased,  open  thoracot- 
omy with  wide  resection  of  one  or  more 
ribs  and  the  intervening  intercostal  muscles 
is  preferable  to  closed  tube  drainage. 

Thoracoplasty,  the  second  basic  proce- 
dure, is  sometimes  indicated  for  cases  which 
have  not  responded  to  more  conservative 
management.  In  1879  Estlander®  advo- 
cated this  method  which  allowed  the  parie- 
tal pleura  to  fall  in  and  meet  the  visceral 
pleura  when  the  chest  wall  was  collapsed. 
Schede*  modified  this  operation  by  remov- 
ing the  ribs,  the  intercostal  bundles  and 
parietal  pleura  over  the  empyema  and  thus 
exposed  or  “unroofed”  the  entire  cavity. 
These  procedures  still  find  wide  use  in  se- 
lected cases. 

The  third  basic  method  involves  the  re- 
moval of  the  thick  rigid  layer  of  chronic 
inflammatory  tissue  which  overlies  the  vis- 
ceral pleura  and  which  to  a large  extent 
prevents  the  lung  from  expanding.  Intro- 
duced by  Fowler®  in  1893  and  by  DeLorme® 
in  1894,  this  procedure  has  come  to  be 
known  as  “decortication.”  Because,  as  a 
word,  decortication  may  not  be  readily  un- 
derstood and  because  as  a surgical  proce- 
dure it  is  becoming  more  useful,  it  seems 
worthwhile  to  discuss  this  method  in  great- 
er detail. 

Originally  decortication  was  quite  lim- 
ited in  its  scope  and  seldom  used.  Only  the 
empyema  cavity  itself  was  entered  and  an 
attempt  made  to  remove  the  thickened  vis- 
ceral wall.  Then  open  drainage  was  es- 
tablished and  the  lung  allowed  to  expand 
slowly  against  atmospheric  pressure.’^  How- 
ever, we  can  attribute  the  revival  of  decor- 
tication during  the  last  war  to  the  stimula- 
tion provided  by  refined  methods  of 
administering  the  anesthetic  through  an 
intratracheal  tube  under  positive  pressure 
and  a better  understanding  of  intrathoracic 
physiology.  Its  first  use  was  in  the  Medi- 


206 


Rocky  Mountain  Medical  Journal 


terranean  Theater  in  the  treatment  of  or- 
ganized hemothoraces,  some  of  which  were 
highly  contaminated.®  ® Military  surgeons 
immediately  recognized  its  value  and  em- 
ployed the  procedure  extensively  in  the 
treatment  of  complications  following  pene- 
trating chest  wounds.  It  is  only  natural 
that  this  experience  is  now  being  applied 
to  the  so-called  ordinary  chronic  empyemas 
encountered  in  civilian  practice. 

In  the  modern  performance  of  this  opera- 
tion, a new  concept  in  thoracic  surgery  has 
actually  been  introduced.^®  This  principle 
is  the  conversion  of  a partial  empyema  into 
a total  one  in  order  to  gain  complete  pul- 
monary expansion.  Formerly  surgeons  re- 
moved only  the  thickened  fibrous  mem- 
brane which  covered  the  visceral  wall  of 
the  cavity  and  scrupulously  avoided  the 
uninvolved  pleural  space.  Currently  after 
removing  this  layer,  we  do  not  hesitate  to 
enter  all  reaches  of  the  thoracic  cavity  to 
free  the  lung  completely  of  adhesions  which 
bind  it  to  the  mediastinum  and  chest  wall 
and  to  separate  the  fibrous  bands  which 
have  formed  between  pulmonary  surfaces 
by  the  lung  buckling  upon  itself  when  in  a 
collapsed  state.®  This  more  extensive  oper- 
ation is  necessary  for  complete  and  imme- 
diate expansion.  Positive  intratracheal 
pressure  is  the  usual  means  of  obtaining 
complete  expansion  on  the  operating  table.. 
The  chest  incision  is  tightly  closed  and  the 
expansion  maintained  for  two  to  three  days 
by  intercostal  closed  catheter  suction.  This 
period  of  time  usually  suffices  to  drain  the 
slight  sero-sanguineous  effusion  following 
the  operation  and  to  allow  synechia  to  form 
between  the  visceral  and  parietal  pleurae. 
Although  the  preoperative  and  postopera- 
tive use  of  penicillin  is  most  desirable  and 
should  never  be  omitted,  that  it  is  not  an 
absolute  essential  is  shown  by  the  success- 
ful results  from  decortication  early  in  the 
war  when  penicillin  was  not  available.^’^ 

Thus,  if  we  are  to  follow  the  precepts 
previously  mentioned — to  effect  a cure  as 
rapidly  as  possible,  with  as  little  surgery 
and  as  little  diminution  in  the  vital  ca- 
pacity as  possible — then  in  the  early  acute 
phase  of  the  disease  frequent  aspirations 


will  be  done.  These  aspirations  may  oc- 
casionally be  definitive  treatment,  but  at 
least  they  will  limit  the  size  of  the  em- 
pyema cavity.  The  intrapleural  use  of  pen- 
icillin in  amounts  over  50,000  units  or  the 
intrapleural  use  of  streptomycin  when 
streptomycin-sensitive  organisms  are  pres- 
ent is  encouraged.  If  streptomycin  is  used, 
]t  must  remain  within  the  pleural  cavity  for 
at  least  six  to  eight  hours.  Amounts  of  one- 
half  to  two  grams  are  recommended.  Irri- 
gation with  weak  streptomycin  solutions  is 
of  no  value. 

It  is  common  experience  that  after  the 
intrapleural  use  of  penicillin  the  purulent 
aspirated  fluid  may  become  sterile  within 
a short  time.  It  should  be  stressed,  how- 
ever, that  a sterile  empyema  is  not  a cured 
emypema.^^  The  patient  still  remains  sick, 
and  with  the  passage  of  time  the  thickness 
and  rigidity  of  the  walls  increase.  Then 
either  drainage,  preferably  by  open  thorac- 
otomy with  rib  resection,  or  decortication 
becomes  imperative.  In  selecting  one  or  the 
other  of  these  procedures,  the  surgeon  must 
weigh  their  primary  advantages  and  dis- 
advantages. Open  thoracotomy  entails  a 
more  limited  surgical  procedure  but  also 
means  an  open  wound  with  its  accompany- 
ing partial  disability  for  a period  of  many 
weeks.  On  the  other  hand,  decortication 
involves  a more  extensive  surgical  proce- 
dure, but  it  usually  followed  by  a remark- 
ably short  period  of  disability,  and  with 
proper  performance  a totally  expanded  lung 
will  result  with  no  appreciable  diminution 
in  vital  capacity. 

CASE  REPORTS 

Case  1:  A man  72  years  old  was  first  seen  with 
what  appeared  to  be  an  acute  pneumonic  pro- 
cess. Shortly  thereafter  he  developed  the  phy- 
sical signs  of  pleural  effusion,  and  the  first  chest 
x-ray  showed  almost  complete  opacity  of  the 
left  thorax  (Fig.  1).  Multiple  aspirations  were 
carried  out  during  December,  1946,  and  Januap^, 
1947.  These  aspirations  were  productive  of  thick 
purulent  material  which  yielded  a pneumococcus 
on  culture.  By  February,  1947,  the  lung  had 
partially  expanded  and  the  empyema  came  to 
occupy  the  lower  third  of  the  thorax  (Fig.  2). 
Because  the  patient  had  been  quite  ill,  and  his 
course  complicated  by  auricular  fibrillation  with 
decompensation,  simple  thoracotomy  with  re- 
moval of  a segment  of  the  ninth  rib  was  done 
in  preference  to  decortication.  The  lung  slowly 
expanded  and  the  chest  wound  closed  and  be- 
came healed  by  May,  1947  (Fig.  3). 


for  March,  1949 


207 


Fig.  1,  Case  1.  Complete  opacity  of  left  thorax  with 
slight  shift  of  trachea  to  right  and  elevation  of 
left  leaf  of  diaphragm. 


Fig.  2,  Case  1.  Opacity  decreased  to  lower  third  of 
left  thorax. 


Comment:  Open  thoracotomy  was  undoubtedly 
the  safest  and  least  radical  procedure  which 
could  be  offered  this  patient.  However,  ten 
weeks’  partial  disability  resulted  before  the 
pleural  closure  was  complete.  This  case  may 
well  be  compared  with  the  following  similar  one 
that  was  treated  by  decortication. 


Fig.  3,  Case  1.  Complete  re-expansion  of  left  lung, 
following  open  drainage  through  resected  ninth 
rib. 


Case  2:  A man  60  years  old  was  admitted  to 
the  hospital  with  complaints  of  fever,  cough  and 
loss  of  weight.  His  illness  had  its  onset  with 
“influenza”  some  six  weeks  previously.  Roent- 
genograms showed  an  opacity  occupying  the 
lower  fourth  of  the  left  chest  (Fig.  4).  Diag- 
nostic thoracentesis  yielded  a thick  purulent 


Fig.  4,  Case  2.  Opacity  of  lower  fourth  of  left  chest 
proved  to  be  pus  by  thoracentesis. 


208 


Rocky  Mountain  Medical  Journal 


pig.  5,  Case  2.  Complete  re-expansion  of  left  lung 
four  days  following  decortication. 


material  from  which  streptococci  were  isolated. 
Complete  visceral  and  parietal  decortication  of 
the  thick  fibrous  walls  of  the  empyema  cavity 
was  performed  on  February  10,  1947,  and  the 
chest  was  closed  tightly  without  drainage.  The 
wound  healed  per  primum  and  the  patient  was 
discharged  on  the  tenth  hospital  day.  Chest 
x-rays  taken  on  February  14,  1947,  four  days 


Fig.  6,  Casei  3.  Opacity  lower  half  right  thorax  with 
fluid  level  and  slight  shift  of  mediastinum  to  left. 


after  decortication,  showed  the  lung  to  be  com- 
pletely expanded  (Fig.  5). 

Case  3:  A man  63  years  old  developed  shooting 
pains  in  the  right  chest  and  a cough  productive 
of  only  clear  sputum  in  January,  1946.  These 
symptoms  of  cough  and  chest  pain  increased  to 
such  an  extent  that  he  had  to  stop  work  in 
March,  1946.  In  Jime,  1946,  he  consulted  a pri- 


Fig.  7,  Case  3.  Decrease  in  size  of  empyema  cavity 
following  repeated  aspirations. 


Fig.  8,  Case  3.  Complete  re-expansion  following  total 
excision  of  empyema  cavity. 


for  March,  1949 


209 


vate  physician  because  of  the  chest  pain  and  in- 
creasing dyspnea.  Diagnostic  aspiration  of  the 
right  chest  was  performed  and  the  patient  sent 
immediately  to  the  Denver  General  Hospital 
where  frequent  chest  aspirations  were  continued 
(Fig.  6).  On  one  occasion  as  much  as  1300  c.c.  of 
greenish  purulent  material  was  obtained.  By 
late  August  all  attempts  at  aspiration  were  un- 
successful, although  a definite  cavity  containing 
a fluid  level  was  visualized  in  the  x-rays  (Fig.  7 ) . 
In  September,  1946,  exploratory  thoracotomy  was 
carried  out,  and  a thickened  fibrous  sac  lying 
between  the  medial  border  of  the  lower  lobe 
and  the  pericardium  and  resting  upon  the  dia- 
phragm was  found.  This  entire  empyema  pocket 
was  excised,  the  lung  expanded  and  the  chest 
closed  without  drainage  (Fig.  8).  The  patient 
made  an  uneventful  recovery.  He  was  dis- 
charged from  the  hospital  on  the  fourteenth 
postoperative  day  and  returned  to  work  four 
weeks  later. 

Comment:  Here  decortication  or  complete  ex- 
cision was  used  to  advantage  on  an  empyema 
which  occupied  a space  within  the  thorax  which 
would  have  been  extremely  difficult  to  drain. 

Discussion 

During  the  past  year  six  cases  of  chronic 
empyema  have  been  treated  with  decortica- 
tion. In  five  the  postoperative  course  has 
been  most  encouraging  with  complete  pleu- 
ral closure  within  the  first  few  days  follow- 
ing operation.  One  case,  inadvertently  de- 
corticated, proved  to  be  tuberculous  on 
pleural  biopsy,  although  previous  studies 


including  guinea  pig  inoculation  had  been 
negative.  Fairly  adequate  pulmonary  ex- 
pansion was  obtained  in  this  latter  case,  but 
the  pleural  surfaces  failed  to  adhere  and 
fluid  has  again  formed.  On  the  basis  of 
these  experiences,  we  now  are  of  the  opin- 
ion that  decortication  has  a valuable  and 
definite  place  in  our  treatment  of  chronic 
nontuberculous  empyema,  that  it  is  a 
treatment  without  undue  risk  and  that  it 
will  come  into  increasingly  frequent  usage. 

REPEREXCE'S 

’Clagett,  O.  T.,  Shepard,  V.  D. : Chronic  Empyema. 
J.  Thor.  Surg.  12:464-483,  1943. 

^Berman,  J.  K. : Non-tuberculous  Empyema  Thoracis 
in  Children.  Surg.  Gyne.  Obs.  76:183,  1943. 

®Estlander,  J.  A.:  Resection  des  cotes  dans  I’em- 
pygme  chronique.  Rev.  mens,  de  med.  et  de  chir.. 
Par.,  1879,  III,  157-170. 

■‘Schede,  M. : Innere  Medicin.  9 and  10  Congress, 
1890-91.  p.  41. 

^Fowler,  G.  R. : A Case  of  Thoracoplasty.  M.  Rec. 
44:838,  1893. 

“Delorme,  E.:  Nouveau  Traitemente  des  Empyemas 
Chroniques.  Gaz.  d.  hop.  67:94,  1894. 

’Mayo,  C.  H.,  Beckman,  E.  H. : Visceral  Pleurectomy 
for  Chronic  Empyema.  Ann.  Surg.  59:884-890.  1914. 

“Tuttle,  Wm.  M.,  Langston,  H.  T.,  Crowley,  R.  T. : 
Treatment  of  Organizing  Hemothorax  by  Pulmonary 
Decortication.  Jour.  Thor.  Surg.  16:117,  April,  1947. 

“Samson,  P.  C.,  Burford,  T.  H.:  Total  Pulmonary 
Decortication.  J.  Thor.  Surg.  16:127,  April,  1947. 

’“Churchill,  E.  W.:  Discussion.  J.  Thor.  Surg.  16:146. 
April,  1947 

’’Tuttle,  Wm.  M.:  Discussion.  J.  Thor.  Surg.  16:146. 
April,  1947. 

’’Blades,  Brian,  Hamilton,  J.  E.,  Dugan,  D.  J.:  Ob- 
servations on  the  Treatment  of  Empyema  Thoracis 
With  Penicillin.  Surg.  17:572-579,  1945. 


UNUSUAL  METASTATIC  MANIFESTATIONS  OF  SILENT  GASTRIC 

CARCINOMA* 

LLOYD  SMITH,  M.D.,  ROBERT  J.  FREEDMAN,  M.D.,  and  OZA  J.  LaBARGE,  M.D. 

ALEXANDRIA,  LOUISIANA 


Wikler,  Wiesel,  and  MaxwelP,  recently 
reported  a case  of  sympathetic  paralysis  due 
to  metastases  as  the  initial  sign  of  gastric 
carcinoma.  We  have  also  observed  a some- 
what similar  case  of  gastric  carcinoma  in 
which  the  presenting  symptomatology  for 
a considerable  period  of  time  was  due  en- 
tirely to  involvement  of  the  prevertebral 
sympathetic  chain,  posterior  nerve  roots, 
and  adjacent  blood  vessels.  Autopsy  dis- 
closed a previously  unsuspected  silent  car- 
cinoma of  the  stomach  with  extensive 
metastases. 

*From  the  Medical  Service  of  the  Veterans  Ad- 
ministration Hospital,  Alexandria,  Louisiana.  The 
author  is  a member  of  the  Utah  State  Medical  Asso- 
ciation. 

Published  with  the  permission  of  the  Medical  Di- 
rector, Veterans  Administration,  who  assumes  no 
responsibility  for  the  opinions  expressed  or  the  con- 
clusions drawn  by  the  authors. 


CASE  REPORTS 

The  patient  a 55-year-old  white  male  veteran, 
was  admitted  to  the  Veterans  Administration 
Hospital,  Alexandria,  Louisiana,  on  October  3, 
1947,  complaining  of  burning  and  aching  pain  in 
both  legs.  About  ten  days  before  admission  to 
the  hospital  the  patient  developed  a severe  burn- 
ing pain  in  the  dorsum  of  the  right  foot.  This 
came  on  late  in  the  afternoon  and  the  patient 
ankle  joint  was  not  involved.  The  pain  was  con- 
tinuous and  did  not  improve  with  the  passage 
had  not  injured  the  foot  in  any  way.  There  was 
swelling  but  no  redness  in  the  foot,  and  the 
of  time,  although  he  could  secure  some  relief 
by  lying  down  and  elevating  his  foot  on  a pillow. 
Attempts  at  walking  were  exceedingly  painful 
and  he  had  been  unable  to  walk  since  the  onset 
of  his  illness.  The  pain  gradually  became  more 
severe  and  seemed  to  progress  up  the  posterior 
portion  of  his  right  leg  to  the  inner  side  of  the 
right  buttock.  He  described  the  pain  as  a “deep 
muscular  ache.”  During  the  first  week  of  his 
illness  this  aching  pain  was  entirely  in  the  right 
leg,  then  the  left  leg  gradually  became  involved. 
He  did  not  recall  exactly  as  to  whether  the  pain 
in  the  left  leg  started  in  the  left  foot  and  pro- 
gressed upward  or  whether  it  started  in  the  left 
buttock  and  progressed  downward,  but  the  left 
leg  became  involved  in  much  the  same  way  as 


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the  right,  and  he  had  pain  from  his  feet  to  his 
buttocks  in  both  legs.  The  anterior  half  of  each 
leg  did  not  seem  to  bother  him  particularly,  and 
the  pain  was  almost  entirely  in  the  back  of  the 
legs.  From  the  onset  of  the  illness  he  had  a 
constant  fever  but  no  chills.  His  appetite  was 
very  pcnr,  he  had  been  drinking  very  little  wa- 
ter and  believed  that  he  had  lost  at  least  twenty 
pounds  in  weight  in  ten  days.  Constipation  was 
present  but  the  patient  denied  rectal  inconti- 
nence, urinary  incontinence,  urinary  frequency 
or  dysuria. 

The  patient  was  first  admitted  to  this  hospital 
on  October  5,  1936,  for  treatment  of  skin  cancers 
of  the  face.  He  first  noticed  a small  wart-like 
lesion  in  the  left  temporal  region  some  seven  or 
eight  years  previously  which  had  become  pro- 
gressively larger  and  spread  to  other  areas  of 
the  face.  He  was  transferred  to  the  Veterans 
Administration  Hospital,  Hines,  Illinois,  where 
his  condition  was  diagnosed  as  epithelioid  car- 
cinomas of  the  face.  The  involved  areas  were 
surgically  excised  and  irradiated.  He  was  ad- 
mitted to  the  Hines  Veterans  Administration 
Hospital  seven  times  between  1936  and  1947  for 
treatment  of  these  recurring  skin  lesions.  The 
past  history  was  otherwise  essentially  negative. 

Physical  examination  on  admission  revealed  a 
moderately  well  nourished,  fairly  well  developed, 
middle-aged  white  male  who  appeared  older  than 
his  stated  age  and  appeared  to  be  chronically  ill. 
He  was  mentally  alert  and  cooperative  and  com- 
plained only  of  pain  in  both  legs  especially  on 
movement.  Temperature  on  admission,  99.6  de- 
grees F.,  pulse  94,  respiration  28,  heights  5 feet 
7 inches  and  weight  128  pounds.  Positive  phy- 
sical findings  on  admission:  There  were  multiple 
foci  of  scar  tissue  covering  the  face,  back  of  neck 
and  the  right  ear.  These  were  evidently  the 
sites  of  previous  surgery  and  irradiation.  A small 
draining  rodent  ulcer  about  the  diameter  of  a 
penny  was  just  lateral  to  the  right  nares.  Eyes 
normal  except  for  some  A-V  nicking  on  fundo- 
scopic  examination.  The  upper  half  of  the  right 
ear  was  absent.  Heart  and  lungs,  normal.  B.P., 
158/90.  Examination  of  the  abdomen  was  nega- 
tive. The  peripheral  vessels  were  tortuous  and 
of  pipe-stem  consistency.  The  prostate  was  en- 
larged to  twice  its  normal  size,  symmetrical  but 
boggy  in  consistency.  The  upper  extremities  and 
back  were  normal.  There  was  tenderness  in  the 
calves  of  both  legs  and  in  the  posterior  thigh  and 
buttock  muscles  of  both  sides.  These  muscles 
were  soft  and  flabby,  with  no  infiltration  or  in- 
flammation. There  was  good  muscle  power  in 
both  legs.  The  deep  reflexes  of  both  lower  ex- 
tremities were  markedly  exaggerated  with  posi- 
tive ankle  clonus  (unsustained)  bilaterally. 
Marked  pain  radiated  up  both  legs  to  the  lower 
back  when  the  test  for  ankle  clonus  was  made. 
No  areas  of  anesthesia  or  change  in  sensory  per- 
ception. There  were  small  areas  of  well  cir- 
cumscribed epithelioid  carcinomas  on  the  dorsal 
surfaces  of  both  hands.  Nc  lymphadenopathy. 
R.B.C.,  4,000,000;  W.B.C.,  33,500;  HGB,  11.5  gms.; 
polymorphonuclears,  91  per  cent  and  lympho- 
cytes, 9 per  cent;  sedimentation  rate,  22  mm/hr.; 
urinalysis,  normal;  serology,  negative;  blood 
cholesterol,  194  mg.  per  cent;  alkaline  serum 
phosphatase,  5.3  Bodansky  units;  blood  calcium, 
10.8  mg.  per  cent;  inorganic  phosphorus,  5.5  mg. 
per  cent.  Chest  x-ray  was  essentially  negative. 
X-ray  of  the  pelvis  showed  a minor  degree  of 
osteoporosis  and  hypertrophic  changes  of  both 
acetabuli  with  no  evidence  of  metastatic  lesions. 
X-ray  of  the  dorsal,  lumbar,  and  sacral  spine  re- 
vealed “calcification  within  the  wall  of  the  ab- 
do'minal  aorta,  minimal  hypertrophic  changes  of 


the  thoracic  spine  and  moderate  hypertrophic 
changes  of  the  lumbar  spine.” 

The  initial  impression  was  that  the  patient  had 
either  a malignant  or  inflammatory  lesion  of  the 
cauda  equina  because  of  the  persistent  pain  in 
both  legs  and  the  neurological  findings.  Whether 
or  not  his  condition  was  secondary  to  the  long 
standing  and  recurrent  carcinomatous  lesions  of 
the  face  and  hands  was  entirely  debatable. 

Approximately  twenty-four  hours  after  admis- 
sion to  the  hospital,  the  patient  became  febrile 
with  daily  irregular  temperature  elevations  rang- 
ing from  100  degrees  F.  to  102  degrees  F.  He  was 
treated  empirically  with  penicillin  50,000  U. 
every  three  hours,  which  was  started  November 
10,  1947.  He  showed  no  response  whatever  to 
this  treatment  and  on  December  11,  1947,  the 
penicillin  was  increased  to  200,000  U.  every  three 
hours.  During  the  time  the  patient  was  receiving 
penicillin,  he  developed  a thrombophlebitis  of  the 
left  leg,  which  later  migrated  to  the  left  arm  and 
after  a few  days  to  the  right  leg.  As  the  acute 
sv/elling,  redness,  increased  heat,  and  pains  mi- 
grated to  another  extremity  the  process  would 
resolve  to'scme  extent,  leaving  only  the  swelling 
in  the  area  first  affected.  On’ December  15,  1947, 
the  penicillin  was  discontinued  and  there  was 
never  any  acute  inflammatory  reaction  in  the 
extremities  thereafter.  Repeated  urinalyses  were 
negative  and  repeated  white  blood  counts  ranged 
from  17,000  to  30,000  with  high  polymorphonu- 
clear counts.  Lumbar  puncture  was  performed 
on  December  9,  1947,  and  resulted  in  the  re- 
covery of  an  entirely  normal  spinal  fluid.  Three 
separate  blood  cultures  between  November  3, 
1947,  and  December  31,  1947,  showed  no  growth 
after  two  to  four  weeks  incubation.  Agglutina- 
tions for  E.  Typhosa,  B.  Melitensis,  Tularemia 
and  Proteus  OX-19  revealed  insignificant  titres. 
A series  of  five  thick  drops  smears  for  malaria 
failed  to  reveal  plasmodia.  A complete  blood 
count  on  December  23,  1947,  with  special  em- 
phasis on  cell  morphology  revealed  a slight 
polychrdmatophilia  and  rare  nucleated  erythro- 
cytes. The  platelet  count,  bleeding  time,  clotting 
time,  and  tourniquet  test  were  all  normal  values 
or  negative.  The  prothrombin  time  was  normal. 
A blood  culture  for  histoplasmosis  was  negative. 

Blood  transfusions  of  500  c.c.  of  whole  blood 
on  November  21,  1947,  January  10  and  31,  1948, 
failed  to  have  any  significant  effect  on  the  clin- 
ical course.  A repeat  chest  x-ray  showed  blunt- 
ing of  the  right  costo-phrenic  angle  with  a slight 
pulmonary  reaction  above  it  indicative  of  pleu- 
risy. A flat  plate  of  the  abdomen  revealed 
marked  distention  of  the  entire  large  bowel  with 
some  increased  gas  in  small  bowel  with  no  fluid 
levels  or  evidence  of  air  beneath  either  dia- 
phragm. Sigmoidoscopic  examination  revealed 
only  a few  small  internal  hemorrhoids. 

The  patient  displayed  signs  and  symptoms  of 
a gradual  obstruction  of  the  inferior  vena  cava 
with  lymphedema  of  both  lower  extremities  and 
distension  of  the  superficial  abdominal  veins. 
There  was  at  no  time  any  scrotal  or  penile 
edema,  ascites  or  clinical  jaundice.  Icterus  index 
on  two  occasions  was  14.  He  occasionally 
complained  of  pain  on  pressure  in  the  perium- 
bilical area,  but  there  were  never  any  well  de- 
fined gastro-intestinal  signs  or  symptoms.  The 
appetite  was  relatively  good  until  approximately 
two  weeks  before  death,  but  the  patient  showed 
progressive  weight  loss,  emaciation  and  cachexia. 
At  that  time  he  stopped  taking  nourishment  of 
any  kind  and  became  very  dehydrated.  On  Jan- 
uary 26,  1948,  a small  distinctly  nodular  tender 
mass  was  palpated  in  the  left  lobe  of  the  liver. 
ITve  days  later  he  suddenly  developed  marked 
convulsive  twitchings  of  his  right  arm  and  turned 


jor  March,  1949 


211 


his  head  upward  and  to  the  right.  These  seiz- 
ures lasted  about  forty-five  seconds  and  occurred 
approximately  every  two  to  three  minutes.  Both 
lungs  became  filled  with  coarse  bubbling  rales 
and  the  patient  expired  after  another  three  days. 

The  clinical  impression  was  that  of  vena  caval 
obstruction,  cause  undetermined,  and  generalized 
carcinomatosis,  primary  site  undetermined. 

Necropsy  was  performed  one  hour  after  death. 
No  gross  pathology  was  evident  in  the  brain.  In 
addition  to  the  scars  and  rodent  ulcer  of  the 
face,  the  pathological  findings  consisted  of  a 
freely  movable,  large  fungating,  nodular  mass, 
7x8  cm.  in  size,  along  the  greater  curvature  of 
the  fundus  of  the  stomach.  This  mass  was  in- 
corporated in  the  wall  of  the  stomach  and  had 
infiltrated  the  gastric  wall  for  a small  distance 
beyond  the  apparent  limits  of  the  tumor.  It  did 
not  extend  through  the  gastric  serosa.  The  liver 
surface  contained  many  umbilicated  nodular 
growths,  1 to  6 cm.  in  diameter.  The  cut  surface 
of  the  left  lobe  revealed  a yellowish- white,  nodu- 
lar growth  10  cm.  in  diameter  which  replaced 
much  of  the  liver  tissue.  Lymph  nodes  in  the 
niesentery,  along  the  aorta,  and  about  both  com- 
mon iliac  arteries  were  enlarged,  matted  to- 
gether, rubbery  in  consistency,  and  yellowish 
white  in  color.  An  attempt  was  made  to  dissect 
out  the  lumbar  sympathetic  trunks  on  both  sides. 
This  was  exceedingly  difficult  as  the  right  lum- 
bar sympathetic  trunk  and  the  nerve  roots  from 
the  level  of  the  second  lumbar  nerve  to  the 
fourth  sacral  nerve  appeared  to  be  surrounded, 
compressed,  and  infiltrated  by  densely  adherent 
and  apparently  fibrotic  masses  of  glandular  tis- 
sue. The  same  condition  was  evident  on  the  left 
side,  but  to  a somewhat  lesser  degree,  and  the 
most  involvement  was  evident  from  the  level  of 
the  fifth  lumbar  to  the  third  sacral  nerve.  A soft 
necrotic,  yellowish-brown  fibrinous-like  throm- 
bus completely  occluded  the  inferior  vena  cava 
up  to  the  level  of  the  second  lumbar  vertebra 
and  extended  downward  into  both  common  iliac 
veins. 

Microscopic  examination  of  the  tumor  in  the 
v/all  of  the  stomach  showed  an  adenocarcinoma 
consisting  of  masses  of  undifferentiated,  hyper- 
chromatic  and  pyknotic  cells.  There  was  no 
definite  glandular  formation  but  there  was  evi- 
dence of  an  attempt  by  the  cell  masses  to  form 
glandular  structure.  Similar  cells  were  found 
in  several  sections  of  the  retroperitoneal  lymph 
nodes.  A microscopic  section  of  the  inferior  vena 
cava  showed  an  organized  thrombus  consisting 
of  cellular  debris,  red  blood  cells,  white  blood 
cells,  fibrin,  and  many  tumor  cells  resembling 
those  found  in  the  sections  of  the  gastric  tumor 
and  the  lymph  nodes.  A section  of  the  rodent 
ulcer  of  the  face  was  typical  of  a basal  cell  car- 
cinoma of  low  malignancy. 

The  pathological  diagnoses  were:  1.  Adenocar- 
cinoma of  the  stomach  (greater  curvature  and 
fundus)  with  metastases  to  liver  and  regional 
lymph  nodes.  2.  Occlusion  of  the  inferior  vena 
cava  and  common  iliac  veins  by  malignant  in- 
filtration. 3.  Basal  cell  carcinoma  of  the  face. 

Discussion 

The  exact  determination  of  the  duration 
of  a gastric  carcinoma  is  exceedingly  diffi- 
cult^ as  with  the  exception  of  lesions  at  the 
cardia  and  at  the  pylorus,  symptoms  are 
often  entirely  absent  until  ulceration,  bleed- 
ing, obstruction,  secondary  infection,  con- 
stitutional phenomena  or  metastatic  symp- 


toms occur.®  To  wait  for  significant  diges- 
tive disturbances  before  considering  the  pos- 
sibility of  the  existence  of  a gastric  malig- 
nancy is  often  fallacious.^  Retroperitoneal 
glandular  metastases  may  occur  early  in 
gastric  carcinoma  and  the  nodes  along  the 
abdominal  aorta  as  well  as  the  iliac  vessels 
may  be  involved.®  Metastases  to  the  brain 
before  any  significant  gastric  symptoms  oc- 
cur is  also  not  uncommon  and  Eusterman 
and  Wilbur®  have  emphasized  that  occasion- 
ally a patient  with  gastric  carcinoma  is  ad- 
mitted to  the  hospital  neurological  service 
because  of  focal  neurological  signs  and 
symptoms  resulting  from  a cerebral  meta- 
static lesion.  Obviously  in  the  event  of  the 
complete  absence  of  gastric  symptoms,  an 
early  diagnosis  of  carcinoma  of  the  stomach 
is  impossible  except  by  periodic  health  ex- 
aminations at  relatively  short  intervals  of 
time.  In  this  connection,  Bockus®  is  of  the 
opinion  that,  theoretically  at  least,  every 
person  over  40  years  of  age  should  have  a 
gastro-intestinal  x-ray  series  every  three 
months.  In  the  present  development  of  our 
civilization  such  a program  is  obviously  im- 
possible because  of  the  lack  of  facilities,  the 
expense  involved,  and  the  necessity  for  a 
preliminary  education  of  our  entire  popula- 
tion concerning  the  necessity  and  value  of 
such  detailed  periodic  health  examinations. 

In  our  case,  the  initial  symptom  of  the  # 
presence  of  carcinoma  of  the  stomach  was 
the  development  of  a severe  pain  in  the 
dorsum  of  the  right  foot.  At  that  time  the 
patient  must  of  necessity  already  have  had 
well  advanced  metastatic  involvement  of 
the  retroperitoneal  lymph  glands  with  be- 
ginning pressure  upon  or  infiltration  of  the 
right  lumbar  sympathetic  chain  and/or  one 
or  more  nerve  roots.  Certainly  the  devel- 
opment of  the  initial  lesion  in  the  stomach 
antedated  for  some  unknown  period  of  time 
the  development  of  these  metastatic  mani- 
festations. Various  diagnoses  were  succes- 
sively entertained.  Our  attention  was  first 
centered  upon  the  possible  presence  of  a 
cauda  equina  lesion  (either  malignant  or 
inflammatory)  but  the  patient  failed  to  de- 
velop any  sensory  changes  or  the  motor 
changes  so  commonly  found  in  cauda  equina 


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Rocky  Mountain  Medical  Journal 


lesions.  The  chronicity  of  the  disease,  the 
daily  febrile  course,  the  sustained  leuko- 
cytosis, and  the  high  polymorphonuclear 
differential  count  suggested  the  presence  of 
bacteremia  or  some  insidious  type  of  rare 
infection  such  as  a histoplasmosis  but  the 
presence  of  none  of  these  varied  possibili- 
ties could  be  substantiated.  As  the  case 
progressed  it  was  definitely  evident  that  an 
obstruction  of  some  type  to  the  return  flow 
of  blood  through  the  inferior  vena  cava  was 
developing,  but  the  exact  nature  and  cause 
of  such  an  obstruction  could  only  be  in- 
ferred. In  the  latter  weeks  of  the  patient’s 
illness,  it  became  evident  that  a malignant 
condition  must  of  necessity  be  considered, 
but  the  initial  lesion  consisting  of  a large 
adenocarcinoma  of  the  fundus  of  the  stom- 
ach was  revealed  only  at  necropsy.  In  this 
connection,  it  is  well  worth  emphasizing  that 
although  the  patient  complained  of  loss  of 
appetite  and  loss  of  weight  prior  to  ad- 
mission to  the  hospital,  these  complaints 
practically  disappeared  in  their  entirety  as 
soon  as  adequate  sedation  was  instituted  for 
the  control  of  the  burning,  aching  pain  in  his 
legs.  After  such  pain  control  was  instituted 
his  daily  consumption  of  food  without  any 
complaints  referable  to  his  stomach  was 
quite  satisfactory  to  the  attending  physi- 
cians until  shortly  before  his  demise.  The 
long  history  of  repeated  episodes  of  epithe- 
lioid carcinoma  of  the  face  with  extensive 
treatment  naturally  centered  our  attention 
upon  this  factor  as  a possible  etiological  ba- 
sis for  a widespread  metastatic  involvement, 
but  at  no  time  were  we  able  to  demonstrate 
any  involvement  of  the  superficial  lymph 
nodes  and  such  an  explanation  as  a basis 
for  his  clinical  condition  was  abandoned 
after  thorough  discussion  because  of  the 
known  rarity  of  extensive  metastatic  le- 
sions in  epithelioid  facial  carcinoma.  Cer- 
tainly, however,  this  case  aptly  emphasizes 
the  necessity  for  suspecting  the  basic  pres- 
ence of  a silent  carcinoma  of  the  stomach 
whenever  the  clinician  is  confronted  by  an 
obscure  neurological  picture  of  undeter- 
mined etiology  with  bizarre  symptoms,  un- 
usual pain  radiation,  and  few  localizing 
signs. 


Summary 

1.  A case  is  presented  in  which  the  pri- 
mary manifestations  of  a silent  gastric  car- 
cinoma were  due  to  metastatic  lesions  in- 
volving the  sympathetic  chain  and  the  nerve 
roots  of  the  lumbar  and  sacral  region.  Sub- 
sequently, the  inferior  vena  cava  was  in- 
volved in  a thrombotic  metastatic  process. 

2.  There  has  been  considerable  material 
in  the  literature  concerning  the  symptom- 
atology of  gastric  carcinomas  but  rela- 
tively little  concerning  the  neurological 
manifestations  of  metastatic  lesions  result- 
ing from  silent  gastric  carcinoma.  The 
importance  of  suspecting  the  presence  of 
such  a silent  gastric  lesion  is  stressed. 

3.  In  bizarre  neurological  syndromes  the 
possibility  of  silent  carcinoma  of  the  stom- 
ach as  an  etiological  factor  is  seldom  con- 
sidered, but  it  is  highly  probable  that 
patients  such  as  this  one  presenting  unusual 
clinical  manifestations  are  either  often  mis- 
diagnosed or  not  diagnosed  at  all.  The  cor- 
rect diagnosis  in  this  case  was  established 
only  after  careful  necropsy  examination. 

4.  The  only  possible  means  of  early  and 
adequate  diagnosis  in  cases  of  silent  gastric 
carcinoma  consists  of  repeated  gastric  x-ray 
examinations  at  relatively  short  intervals  of 
time.  This  is  particularly  true  in  individ- 
uals over  40  years  of  age.  Under  present 
conditions  such  a program  is  not  a feasible 
one. 

REFERENCES 

^Wikler,  A.,  Wiesel,  C.,  and  Maxwell,  E.  S. : Sym- 
pathetic Paralysis  Due  to  Metastasis  as  Initiai  Sign 
of  Gastric  Carcinoma.  Annals  of  Int.  Medicine,  March, 
1948,  pp.  648-651. 

^Ewing,  J.,  Neoplastic  Diseases.  Philadelphia,  W. 
B.  Saunders  Company,  1940,  p.  713. 

^Bockus,  H.  L. : Gastroenterology.  Philadelphia,  W. 
B.  Saunders  Company,  1946,  pp.  655-658. 

^Berlin,  E.  J. : Metastasis  to  Bone  as  the  First 
Symptom  of  Cancer  of  the  Gastrointestinal  Tract. 
Am.  Jr.  of  Roent.  and  Rad.  Therapy,  1944,  li,  pp. 
614-622. 

®Eusterman,  G.  B.,  and  Wilbur,  D.  L. : Carcinoma  of 
the  Stomach  With  Cerebral  Metastasis.  M.  Clin.  North 
Am.  15  (1) ; 7 (July)  1931. 


TEXAS  RHEUMATISM  ASSOCIATION 

The  Texas  Rheumatism  Association  will  hold 
its  first  annual  scientific  session  May  2,  1949, 
in  San  Antonio.  The  association  was  founded 
in  1948  and  is  affiliated  the  the  American 
Rheumatism  Association  for  the  purpose  of 
arranging  postgraduate  programs  covering  the 
arthritides.  The  first  annual  session  of  the  Texas 
group  will  include  a number  of  Texas  physicians 
on  the  program  in  addition  to  four  guest  speak- 
ers, Drs.  W.  Paul  Holbrook  of  Tucson,  Ariz.; 
Paul  R.  Lipscomb  of  Rochester,  Minn.;  J.  O. 
Finney  of  Gadsen,  Ala.,  and  W.  K.  Ishmael  of 
Oklahoma  City. 


for  March,  1949 


213 


CERTAIN  ASPECTS  OF  THE  UTERINE  CERVIX  CANCER  PROBLEM 

IN  COLORADO* 

C.  B.  INGRAHAM,  M.D.,  E.  STEWART  TAYLOR,  M.D.,  and  ELEANOR  SINTON,  M.D. 

DENVER 


This  presentation  deals  with  an  impor- 
tant gynecological  condition  that  seems  to 
be  poorly  handled  among  the  indigent  of 
Colorado. 

Cancer  of  the  cervix  is  probably  the  most 
unsatisfactory  disease  with  which  the  gyne- 
cologist has  to  contend.  Numerically,  it  is 
very  important.  Gynecologists  and  radiolo- 
gists have  reached  an  impasse  in  the  man- 
agement of  cervical  carcinoma.  There  has 
not  been  a contribution  in  therapy  during 
the  past  fifteen  years  that  has  increased  our 
ability  to  prolong  the  hfe  of  these  patients. 
Periodically,  such  men  as  Lynch®,  Morton®, 
Taussig®,  and  now  Meigs®,  have  revived  sur- 
gical procedures  designed  to  improve  cure 
rates.  Bonney^,  in  London,  never  did  for- 
feit surgery  for  radiation  in  operable  cases. 
Between  1903,  when  Margaret  Cleaves®  in- 
troduced radium  for  the  treatment  of  car- 
cinoma of  the  cervix,  and  today  many  modi- 
fications of  radiation  have  come  and  passed. 
At  present  many  capable  men  and  many 
busy  clinics  are  using  their  own  special  va- 
rieties of  radiation  treatment.  If  certain 
principles  are  followed,  all  capable  men  get 
approximately  the  same  results.  The  prin- 
ciple of  radiation  is  to  deliver  to  the  tumor 
tissue  as  large  a dosage  of  radiation  as  is 
possible.  The  principle  is  only  modified  by 
the  necessity  of  limiting  the  dosage  to  what 
the  surrounding  vital  organs  can  tolerate 
without  incurring  irreparable  damage. 

Representative  clinics*,  % *®,  reporting 
throughout  the  country,  report  five-year 
salvage  rates  for  carcinoma  of  the  cervix 
as  being  between  25  and  35  per  cent;  most 
cure  rates  generally  fall  around  30  per  cent. 
The  biggest  single  factor  in  the  success  of 
any  group  treating  cancer  of  the  cervix  is: 
what  was  the  extent  of  the  disease  when 
the  patient  presented  herself  for  treatment? 
Where  the  disease  is  limited  to  the  cervix, 
the  capable  radiologist  and  the  capable  ra- 

‘Presented  at  the  Denver  Sectional  Meeting  of  the 
American  College  of  Surgeons,  March  2,  1948.  From 
the  Bonfils  Tumor  Clinic  and  the  Department  of 
Obstetrics  and  Gynecology,  University  of  Colorado 
Medical  Center. 


dical  surgeon  do  equally  well  and  save  ap- 
proximately 75  per  cent  of  the  cases.  When 
tumor  tissue  has  spread  beyond  the  limits 
of  the  cervix,  the  wise  radical  surgeon  sug- 
gests radiation  management.  The  prognosis 
of  the  patient  becomes  increasingly  poor  in 
direct  relationship  to  the  involvement  of 
parametrial  tissue  up  to  the  point  where  a 
clinical  Group  IV  carcinoma  of  the  cervix  is 
perfectly  hopeless. 

In  order  to  analyze  our  problem  at  the 
Medical  Center  in  regard  to  cancer  of  the 
cervix,  we  have  reviewed  the  records  of 
these  cases  admitted  to  the  gynecological 
service  between  January,  1937,  and  Janu- 
ary, 1947.  There  are  a total  of  170  cases 
whose  records  permit  adequate  study.  These 
cases  were  classified  as  to  extent  of  growth 
as  follows: 


CHART  I 

Admission  Pelvic  Findings  Upon.  170  Patients, 
1937-1947 


Clinical  No.  Per 

Group  Explanation  of  at  Cent  in 

(Schmitz)  Gross  Findings  Cases  Group 


I Lesion  confined  to  cervix, 

not  larger  than  1 cm 11  6V2 

II  Still  confined  to  cervix, 

no  parametrial  in- 
volvement — 47  21 V2 

III  Extended  into  either  side 

of  parametrium  with- 
out fixation  of  pelvis  52  30 

IV  Fixation  of  pelvis  with  or 

without  involvement  of 

other  organs  60  36 


TOTAL  - 170  100 


Thirty-six  per  cent  of  our  170  cases  were 
perfectly  hopeless  from  the  standpoint  of 
curability.  Another  30  per  cent  fell  into 
Group  III  and  here  the  best  reports  tabu- 
late 25  to  28  per  cent  five-year  survival 
rates.  Group  II  cases  generally  permit  60 
per  cent  survivals.  Group  I cases  should  be 
around  90  per  cent  curable.  It  is  obvious 
that  the  most  serious  problem  to  us  is  get- 
ting patients  for  treatment  before  they  have 
reached  hopeless  stages.  Our  five-year  sal- 
vage rate  for  those  cases  treated  more  than 


214 


Rocky  Mountain  Medical  Journal 


five  years  ago  is  only  15  per  cent,  one-half 
of  what  it  should  be.  We  must  be  critical 
of  our  results  and  investigate  the  factors 
involved.  To  us,  there  are  five  critical  as- 
pects of  this  problem: 

1.  The  advanced  stage  of  the  disease  when 
seen  initially. 

2.  A high  proportion  of  Spanish-American 
patients. 

3.  Indigency  and  all  that  it  denotes;  such 
as  poor  education,  inaccessibility  of  medi- 
cal aid  until  late,  social  carelessness  and 
lack  of  patient  initiative. 

4.  Poor  medical,,  surgical  and  social  man- 
agement. 

5.  The  disadvantages  of  not  being  able  to 
treat  the  cases  referred  completely. 

One  hundred  and  thirty-six  of  the  170 
patients  studied  had  their  treatment  en- 
tirely at  the  Colorado  General  Hospital.  Ini- 
tial examination  classified  them  as  follows: 


CHART  II 

Clinical  Group 

No.  of 

Per  Cent  in 

(Schmitz) 

Cases 

Each  Group 

I 

7 

5 

II 

36 

26 

III 

44 

32 

IV 

49 

37 

TOTAL  

.136 

100 

Fifty-eight  of  the  136  patients  treated  en- 
tirely at  the  Colorado  General  Hospital 
were  registered  in  the  Tumor  Clinic  be- 
tween January  1,  1937,  and  January  1,  1942, 
and,  therefore,  permit  inspection  of  five- 
year  survival  rates.  These  cases  were  di- 
vided as  follows  upon  admission,  and  after 
five  years  follow-up,  present  the  following 
results: 


CHART  in 


Per 

Per  Cent 

Clinical  No.  Cent  in  Alive  Sur- 

Group  of  Each  After  5 vival 

(Schmitz)  Cases  Group  Years  Rate 


I  4 7 4 100 

II  10  17  4 40 

III  18  31  3 17 

IV  26  45  0 0 

TOTAL  58  100  11  19 


Fifty-eight  cases  is  too  small  a series 
from  which  to  draw  comparative  conclu- 


sions. However,  comparing  our  local  prob- 
lem with  that  at  the  Rhode  Island  Hospi- 
taP^,  the  University  of  Michigan’’,  and  oth- 
ers, we  have  approximately  twice  as  many 
patients  in  Group  IV  as  they.  One  aspect 
of  our  cervical  cancer  problems  and  one  of 
the  reasons  that  our  end  results  are  poor 
is  that  45  per  cent  of  our  clinical  material 
falls  into  a relatively  hopeless  clinical  cate- 
gory when  first  seen  (Group  IV). 

Of  the  original  170  patients  under  con- 
sideration, enough  time  has  elapsed  to  per- 
mit inspection  of  eighty-four  patients  as  to 
survival  five  years  after  initiation  of  treat- 
ment. The  eighty-four  cases  include  pa- 
tients treated  completely  by  ourselves  and 
those  referred  to  us  where  treatment  had 
been  partially  undertaken  on  the  outside. 
These  eighty-four  patients  present  a sur- 
vival rate  of  only  15  per  cent.  Considering 
fifty-eight  patients  treated  exclusively  at 
Colorado  General  Hospital,  a 19  per  cent 
five-year  salvage  rate  is  seen. 

The  next  interesting  aspect  of  Colorado’s 
cervical  cancer  problem  is  in  relation  to 
national  origins.  Forty-nine  or  28 Vz  per 
cent  of  our  170  cases  were  of  Spanish-Amer- 
ican extraction.  One-third  of  the  Spanish- 
American  patients  were  under  the  age  of  40 
at  the  time  their  cancer  was  diagnosed.  The 
remaining  patients,  which  include  all  other 
nationalities,  had  but  one  in  six  cases  under 
the  age  of  40  at  the  time  the  diagnosis  was 
made.  We  are  unable  to  explain  this  ob- 
servation. Certainly,  this  particular  group 
is  the  most  underprivileged  of  this  region. 
They  suffer  heavily  from  all  the  diseases 
associated  with  poverty,  lack  of  proper 
housing,  and  malnutrition.  So  far  as  we 
can  see,  their  indigency  has  no  obvious 
bearing  upon  their  early  age  incidence  of 
cervical  carcinoma.  Young  patients  of  this 
nationality  have  become  fatalities  rapidly 
and  have  added  materially  to  our  mortality 
rate. 

In  a discussion  of  indigency  as  one  of  the 
facets  in  our  local  problem,  we  call  atten- 
tion to  the  following  points:  Many  of  our 
patients  did  not  see  us  until  several  months 
after  the  initial  symptoms  of  cervical  can- 
cer developed.  In  152  of  the  170  cases,  data 


jor  March,  1949 


215 


as  to  the  latent  period  between  the  onset 
of  symptoms  and  the  patient’s  first  contact 
with  medical  care  are  noted.  Ninety  or  59  per 
cent  of  these  patients  saw  no  doctor  until 
symptoms  had  been  present  for  four  months 
or  more.  Bonney^  has  said,  “If  bleeding  has 
been  present  for  as  long  as  six  months,  the 
case  is  most  likely  inoperable.”  One-third 
of  our  cases  did  not  present  themselves 
until  symptoms  and  signs  had  been  present 
for  at  least  six  months.  With  this  degree 
of  poor  public  enlightenment,  inaccessibility 
of  medical  care,  social  carelessness,  lack  of 
patient  initiative,  or  a combination  of  the 
above  factors,  there  is  room  for  improve- 
ment. We  received  seventeen  patients  that 
had  had  symptoms  for  fourteen  to  forty- 
eight  months  before  seeking  medical  aid. 
Something  must  be  done  to  correct  such 
delays.  Medical  care  must  be  easily  ac- 
cessible at  the  family  doctor  level  and  the 
examination  must  be  complete.  Medical 
care  at  the  specialist  level  is  abundantly 
available  through  the  charitable  institutions 
offering  medical  care.  However,  these 
agencies  are  only  available  when  the  patient 
is  properly  referred.  This  all  takes  time 
and  effort  on  the  part  of  many,  including 
the  patient.  Usually,  the  patient  is  not 
hospitalized  unless  the  disease  is  unmis- 
takable and  advanced.  The  City  and  Coun- 
ty of  Denver  has  provided  for  years  a large 
excellently  staffed  hospital,  as  has  the  State 
of  Colorado.  Both  of  these  institutions  are 
for  the  indigent.  In  the  case  of  the  Denver 
General  Hospital,  there  has  not  been  until 
recently  adequate  out-patient  service  avail- 
able for  the  patient  who  complains  of  early 
possible  signs  of  cancer.  The  hospital  main- 
tains excellent  facilities  for  taking  care  of 
the  patient  who  presents  herself  in  the 
emergency  room  with  hemorrhage  from  an 
advanced  cancer  of  the  cervix,  but  there 
had  been  no  way  for  the  patient  to  receive 
early  and  skilled  diagnosis  for  an  early  can- 
cer of  the  cervix. 

The  Colorado  General  Hospital  maintains 
and  operates  a large  and  adequate  out- 
patient department.  This  is  available  to  all 
indigent  who  wish  to  use  it.  Since  October 
1,  1947,  a system  of  referring  cases  from  the 
Denver  General  Hospital  to  the  Medical 


Center  for  out-patient  care  and  diagnosis 
has  been  affected  by  an  agreement  between 
the  City  and  County  of  Denver  and  the  Uni- 
versity of  Colorado.  The  Colorado  General 
Hospital  fails  as  a state  institution  in  that 
it  can  only  provide  out-patient  facilities 
readily  to  people  living  in  Denver.  There- 
fore, something  must  be  done  to  bring  can- 
cer education  to  the  indigent  and  provide 
means  for  them  to  have  adequate  out-pa- 
tient service  so  that  they  will  see  doctors 
early.  This  is  a matter  for  organized  medi- 
cine and  those  individuals  responsible  for 
care  of  the  indigent  to  undertake. 

In  a further  effort  to  understand  our  poor 
results  with  cancer  of  the  cervix,  a certain 
amount  of  the  responsibility  seems  to  lie 
with  doctors.  Among  136  cases,  where  a 
statement  could  be  found  as  to  when  med- 
ical care  was  first  sought,  we  found  that 
thirty-two  patients  or  23  per  cent  were 
either  given  no  treatment  or  ineffectual 
treatment  by  their  local  doctor  which  de- 
layed initiation  of  coordinated  treatment 
for  from  one  month  to  two  years.  Of  these, 
eighteen  cases  were  delayed  from  six 
months  to  two  years  in  their  quest  for  a 
cure.  We  have  in  this  series  seven  patients 
referred  to  us  by  other  doctors  who  had 
done  total  hysterectomies  upon  these  pa- 
tients, then  sent  them  to  us  for  radiation 
therapy.  These  patients  were  done  a great 
disservice  by  their  doctors.  They  were  de- 
nied radium  and  received  an  unnecessary 
and  incomplete  operation.  This  may  be 
corrected  by  such  an  organization  as  the 
American  College  of  Surgeons.  Our  sug- 
gestions are  that  this  body  lay  down  cer- 
tain standards  in  regard  to  the  treatment  of 
all  cancer,  and  insist  that  the  various  hos- 
pitals live  up  to  these  standards.  There  is 
a place  for  surgery  in  the  treatment  of  cer- 
tain cases  of  early  cervical  cancer,  limited 
to  the  cervix.  The  surgery  acceptable  is 
not  a total  hysterectomy  of  the  “garden  va- 
riety;” it  must  be  the  radical  Wertheim  op- 
eration with  pelvic  lymphadenectomy.  We 
believe  that  we  are  correct  wh^n  we  say 
that  such  an  operation  is  not  being  done  by 
surgeons  of  Colorado  at  this  time. 

Other  omissions  in  treatment  for  which 
the  patients  suffered  were  insufficient  ra- 


216 


Rocky  Mountain  Medical  Journal 


dium  and  x-ray  dosages,  failure  to  recognize 
the  lesion,  or  even  worse,  failure  to  look  at 
the  cervix.  In  three  cases,  the  doctor 
treated  the  abnormal  bleeding  with  intra- 
muscular injections,  failing  to  do  a pelvic 
examination  at  any  time. 

Of  the  entire  170  cases  studied,  thirty-five 
of  them  received  either  inadequate  or  in- 
correct treatment  outside  the  institution  be- 
fore being  referred  for  care.  Nine  additional 
cases  failed  to  receive  a complete  course  of 
treatment  due  to  our  inability  to  get  the 
patient  back  to  finish  treatment.  These  are 
considered  failures  attributable  to  our  own 
follow-up  system.  A social  service  worker 
has  now  been  added  as  an  indispensable  ad- 
junct to  satisfactory  management  of  cancer 
patients.  Somehow,  patients  are  unable  to 
comprehend  the  importance  of  returning  for 
prolonged  radiation  treatment. 

For  the  past  year  and  a half,  cancer  of  the 
cervix  has  been  treated  at  the  Medical  Cen- 
ter according  to  the  following  plan; 

1.  All  cases  are  examined  and  appraised 
jointly  by  a radiologist  and  gynecologist 
after  biopsy  has  proved  the  diagnosis. 

2.  A physical  examination  and  complete 
history  is  done  for  each  patient.  A com- 
plete blood  count,  urinalysis,  cystoscopic 
examination  and  proctoscopic  exaihination 
is  performed  before  therapy  is  started. 

3.  If  the  hemoglobin  is  less  than  10  grams, 
the  patient  is  given  blood  transfusions  until 
the  anemia  is  corrected.  Patients  who  are 
anemic  do  not  tolerate  x-ray  therapy  well, 
locally  or  systemically. 

4.  Deep  x-ray  therapy  is  given  prior  to 
radium  therapy.  These  patients  receive 
6,000  roentgen  units  of  external  irradiation, 
delivered  through  four  portals;  each  portal 
is  12x15  cm.  in  dimension.  Obese  patients 
receive  a somewhat  larger  dosage.  In  thin 
patients,  300  roentgen  units  is  the  standard 
daily  dosage.  The  patient  is  treated  each 
day,  except  Sundays,  until  the  total  6,000 
roentgen  units  are  given.  This  takes  almost 
one  month.  A 220  K.V.  radiotherapy  ma- 
chine is  used  at  a 50  cm.  target-skin  dis- 
tance. Filtration  is  accomplished  by  Vz  mm. 
of  copper  plus  1 mm.  of  aluminum. 

5.  During  the  course  of  treatment,  a.  week- 


ly examination  of  the  patient  is  carried  out. 
Pyometra  is  prevented  by  weekly  sounding 
of  the  uterine  cavity.  If  the  hemoglobin 
falls  below  10  grams  during  treatment,  the 
patient  is  readmitted  to  the  hospital  for 
blood  transfusion. 

6.  After  external  radiation  is  completed, 
the  patient  is  sent  home  for  a month’s  rest. 

7.  Following  the  month’s  rest,  the  radium 
treatment  is  given.  Our  radium  treatment 
consists  of  180  mgm.  of  radium  screened  to 
the  equivalent  of  1.5  mm.  of  platinum  plus 
one  layer  of  non-metallic  rubber,  applied 
simultaneously  as  follows: 

a.  84  mgm. — intracervical. 

b.  38  mgm. — to  each  lateral  fornix. 

c.  20  mgm. — against  the  vaginal  os  of  the 
cervix. 

The  radium  is  left  in  place  for  thirty  and 
one-half  hours,  providing  a total  dosage  of 
5,500  mgm.  hours  of  radium. 

8.  All  patients  are  followed  for  as  long  as 
they  live  at  six-month  intervals. 

By  following  such  a plan  of  treatment, 
our  results  will  compare  favorably  with 
those  from  other  institutions,  provided  that 
our  45  per  cent  admission  rate  of  clinical 
Group  IV  cervical  carcinoma  is  reduced  by 
one-half  and  that  cases  are  treated  properly 
and  promptly  by  referring  doctors  if  they 
decide  to  initiate  treatment. 

If  we  are  to  surpass  the  standard  35  per 
cent  five-year  salvage  rate  reported  by  other 
institutions,  it  will  be  because  patients  are 
being  diagnosed  while  the  disease  is  lim- 
ited to  the  cervix.  This  means  that  the 
average  latent  period  between  patient  to 
doctor  must  be  reduced  from  over*  seven 
months  of  symptoms  to  one  month  of  symp- 
toms. 

Conclusions 

Ten  years’  experience  in  the  management 
of  cervical  cancer  patients  at  the  Colorado 
General  Hospital  is  presented. 

The  five-year  survival  rate  is  15  per  cent, 
about  one-half  of  what  it  should  be. 

These  results  can  only  be  improved  by 
cases  being  referred  to  us  earlier,  and  by 
physicians  treating  cancer  of  the  cervix  by 
using  the  best  possible  technics  available. 


for  March,  1949 


217 


Incomplete  surgery,  ill-timed  surgery,  and 
poorly  directed  radiation  are  condemned  for 
they  make  our  problem  worse. 

The  Medical  Center’s  plan  of  treatment 
for  cancer  of  the  cervix  is  presented. 

REFEIREJVCES 

'Bonney,  Victor:  J.  Obstet.  & Gynaec.  Brit.  Emp., 
48:421,  1941. 


^Bonney,  Victor:  Personal  Communication,  Chelsea 
Woman’s  Hospital,  London. 

^Cleaves,  M.  A.:  Med.  Record,  64:601,  1903. 
^Kamperman,  G.:  Surg.,  Gynec.  & Obstet.,  72:384, 
1941. 

®Lynch,  P.  W. : Am.  J.  Obstet.  & Gynec.,  22:550,  1931. 
«Meigs,  J.  V.:  Am.  J.  Obstet.  & Gynec.,  49:542,  1945. 
’Miller,  N.  P.:  Am.  J.  Obstet.  & Gynec.,  46:625,  1943. 
®Morton,  D.  G.:  Am.  J.  Obstet.  & Gynec.,  49:19,  1945. 
“Taussig,  P.  J. : Am.  J.  Obstet.  & Gynec.,  45i:733, 
1943. 

“Ward,  G.  G.:  Surg.,  Gynec.  & Obstet.,  56:434,  1933. 
“Waterman,  G.  W.,  and  DiLeone,  R.:  Am.  J.  Obstet. 
& Gynec.,  50:482,  1945. 


PNEUMATIC  RUPTURE  OF  THE  BOWEL 

JOHN  A.  WEAVER,  JR.,  M.D. 

GREELEY,  COLORADO 


For  the  past  forty-two  years  there  have 
been  repeated  warnings  in  medical  litera- 
ture of  the  danger  of  ruptured  bowel  from 
the  seemingly  innocuous  introduction  of  air 
into  the  rectum  and  large  bowel  via  the 
anus.  Over  eighty  cases  of  pneumatic  rup- 
ture of  the  colon  have  been  described  since 
Stone  reported  an  early  death  from  this 
cause  in  1904. 

Most  of  these  “accidents”  occur  in  large 
cities  where  compression  hammers  and  oth- 
er tools  are  operated  by  compressed  air. 
These  are  usually  from  pranks  with  the  de- 
sire to  scare  or  “goose”  some  fellow  worker. 
Other  cases  have  been  reported  as  a result 
of  dusting  off  of  the  clothes.  Some  have 
been  definitely  malicious. 

The  case  reported  here  shows  the  danger 
from  any  small  town  filling  station  tire 
hose.  As  a matter  of  fact  it  becomes  a po- 
tentially more  dangerous  weapon  because 
of  its  greater  pressure.  The  average  pres- 
sure in  the  hose  of  a pneumatic  or  compres- 
sion hammer  is  from  seventy-five  to  ninety 
pounds.  This  is  about  one-half  the  pressure 
in  a filling  station  hose  used  for  inflating 
tires.  Here  the  pressure  is  from  130  to  150 
pounds.  Truck  tires  carry  from  eighty  to 
ninety  pounds  of  pressure;  consequently 
greater  pressure  is  needed  to  inflate  them. 
The  potential  of  a misdirected  stream  of  air 
thus  becomes  very  great. 

The  mechanics  involved  was  pointed  out 
by  Andrews  as  early  as  1911.  The  thighs, 
buttocks,  and  perineum  join  to  form  a crude 
funnel  which  directs  the  air  to  the  anus. 
Compressed  air  readily  enters  small  aper- 
tures and  the  anal  sphincter  is  no  imped- 
iment, even  though  the  nozzle  is  several 


inches  away  and  even  though  several  layers 
of  clothing  may  intervene. 

The  sigmoid  colon  is  the  most  frequently 
involved  as  its  redundency  and  angulation 
temporarily  retards  the  force  of  air.  Fecal 
masses,  strictures,  and  other  obstructions 
such  as  splenic  or  hepatic  flexures  tend  to 
slow  the  upward  progress  of  the  air  and  thus 
subject  the  lower  segments  to  the  greatest 
stress. 

The  ileo-cecal  valve  is  the  greatest  ob- 
struction to  further  retrograde  progress  of 
gas.  Although  it  has  been  shown  experimen- 
tally that  in  only  50  per  cent  of  the  cases 
studied,  the  ileo-cecal  valve  was  competent, 
yet  in  the  cases  reported,  only  a few  showed 
signs  of  -varying  amounts  of  gas  in  the  small 
intestine;  but  in  one  case  even  the  gallblad- 
der was  tensely  distended  with  air.  The 
cecum  thus  becomes  the  second  most  vul- 
nerable point  to  explosive  accidents  of  this 
nature. 

It  is  believed  that  the  younger  the  victim 
the  more  likely  the  injury  to  the  cecum  and 
the  less  likely  to  the  sigmoid,  because  of 
greater  flexibility  of  the  intestine,  the  less 
angulation  and  redundancy  at  the  various 
flexures,  and  the  less  likelihood  of  stric- 
tures and  fecal  masses.  Consequently  when 
the  air  is  stopped  by  the  ileo-cecal  valve, 
the  cecum  builds  up  the  greatest  pressure 
and  may  sustain  the  greatest  damage. 

The  bowel  will  rupture  with  a pressure  of 
from  50  to  60  cm.  of  water  and  the  ileo-cecal 
valve  will  generally  hold  greater  pressure. 
Rupture  of  the  bowel  usually  occurs  along 
the  longitudinal  bands  on  the  anti-mesen- 
teric  border.  Often  the  rupture  is  incom- 
plete as  the  serosa  and  muscularis  suffer 


218 


Rocky  Mountain  Medical  Journal 


the  greatest  damage,  while  the  mucuous 
membrane  may  remain  intact.  In  incom- 
pletely perforated  cases  the  bowel  is  still 
distended;  whereas  in  perforated  cases 
there  is  very  little  or  no  air  in  the  bowel, 
and  pneumo-peritoneum  with  fecal  odor, 
and  peritoneal  contamination  of  varying 
degrees  is  present.  Burt  demonstrated  that 
the  pressure  necessary  to  rupture  the  colon 
is  surprisingly  low.  The  outer  coats  rupture 
with  a pressure  of  3.49  pounds  per  square 
inch,  but  4.07  pounds  are  necessary  to  pro- 
duce complete  perforation. 

Physical  signs  and  symptoms  vary  with 
the  amount  of  air  introduced.  Profound 
shock  or  unconsciousness  may  occur  imme- 
diately. The  abdomen  is  usually  distended, 
tympanitic  throughout,  with  domed  dia- 
phragms and  costal  margins  contracted  by 
diaphragmatic  pull.  Hernia,  if  present, 
usually  protrude  tensely.  The  respirations 
are  rapid,  shallow,  and  thoracic  in  type.  The 
heart  is  accelerated  and  weak.  There  may 
be  subcutaneous  emphysema.  Occasionally 
pneumo-peritoneum  is  found  with  no  perfor- 
ation in  evidence.  This  case  may  have  re- 
troperitoneal lacerations.  Andrews  "de- 
scribed a case  of  retroperitoneal  perfora- 
tion at  the  splenic  flexure.  Other  cases 
have  been  noted  of  this  nature. 

Lapp  reviewed  seventy-eight  cases  in 
1945.  Ten  of  these  cases  were  incomplete, 
five  of  which  were  operated,  with  one  dead. 
Sixty-eight  had  complete  perforations.  Only 
thirty-eight  of  these  were  operated,  of 
which  twenty-two  were  saved — 32  per  cent 
of  all  cases  of  complete  perforation.  The 
high  mortality  was  attributed  to  late  diag- 
nosis or  delay  in  surgical  intervention.  A 
paracentesis  of  the  abdomen  may  allow 
surgery  on  an  otherwise  moribund  case.  He 
also  noted  that  the  elapsed  time  limit  be- 
tween accident  and  surgery  is  very  clear 
cut,  i.e.,  a six  hour  limit.  All  seventeen  cases 
operated  within  that  time  recovered,  and 
only  one  case  survived  which  was  oper- 
ated after  the  six  hour  period. 

Following  initial  shock  treatment,  sulfon- 
amide and  penicillin  therapy,  together  with 
supportive  therapy  such  as  intravenous 
fluids,  plasma  or  blood  as  indicated,  early 


diagnosis  and  surgery,  should  cut  mortality 
to  almost  nil. 

CASE  REPORT 

H.  L.,  white  male  boy,  aged  10,  was  admitted 
to  the  Weld  County  Hospital  at  7 p.m.  April  5, 
1947.  Patient  was  in  partial  shock  and  was  suf- 
fering with  severe  generalized  abdominal  pain. 
He  gave  a history  of  playing  in  a filling  station 
at  2 p.m.  when  the  son  of  the  owner  of  the  filling 
station  suddenly  caught  him  and  placed  the  noz- 
zle of  the  air  hose  near  his  buttocks  but  outside 
of  his  clothes  (two  pairs  of  pants  and  under- 
wear) and  allowed  the  air  to  escape  from  the 
hose  with  full  force.  He  had  sudden  pain  in  the 
abdomen  and  passed  considerable  air  from  the 
rectum.  One  hour  later  he  became  suddenly 
nauseated  and  vomited  profusely.  He  was  taken 
to  a physician  who  placed  a catheter  into  the 
rectum  and  additional  air  was  expelled,  but  pain 
was  not  relieved.  Two  hours  later  he  was  again 
taken  to  the  physician  and  catheter  reinserted 
with  additional  expulsion  of  gas.  Pain,  however, 
became  steadily  greater  and  patient  was  trans- 
ferred to  the  hospital. 

He  was  seen  in  consultation  at  7:30  p.m.  His 
temperature  was  99,  pulse  106,  and  respiration 
28.  The  laboratory  findings  were:  white  blood 
count  28,000;  97  per  cent  polymorphonuclear  and 
3 lymphocytes.  Red  count  4,770,000  with  83  per 
cent  hemoglobin.  The  urine  was  negative.  Blood 
pressure  was  88/56.  Examination  revealed  a 
moderately  distended  abdomen  with  extreme 
tenderness  throughout,  although  he  was  especial- 
ly tender  in  both  lower  quadrants,  and  the  right 
lower  quadrant  was  so  tender  that  careful  pal- 
pation was  impossible. 

Under  general  anethesia  the  abdomen  was  en- 
tered through  a lower  midline  incision.  The 
abdomen  was  filled  with  bloody  fluid  and  it  was 
necessary  to  aspirate  the  fluid  from  the  pelvis 
before  examining  the  viscera.  Three  longi- 
tudinal tears  of  the  serosa  and  muscularis  coats 
of  the  recto-sigmoid  and  sigmoid  were  found, 
one  of  the  descending  colon  and  one  of  the 
transverse  colon.  The  cecum  and  ascending 
colon  were  found  to  have  sustained  the  greatest 
injury.  The  serosa  and  muscularis  were  in 
shreds  and  the  cecum  almost  stripped  clean  ex- 
cept for  the  mucuous  membrane.  There  was  one 
long  laceration  extending  from  the  cecum  to  the 
hepatic  flexure  with  more  than  6 cm.  between 
the  borders  of  the  outer  layers.  The  entire  as- 
cending colon  was  badly  distended  with  air 
which  could  not  be  expressed  even  with  the  aid 
of  hot  packs.  No  complete  rupture  of  the  bowel 
could  be  found  and  the  mucuous  membranes 
seemed  intact  at  all  lacerated  points.  The  lacer- 
ations were  all  on  the  anti-mesenteric  border, 
except  at  the  cecum  where  the  multiple  lacera- 
tions extended  from  the  viscero-parietal  fold  of 
peritoneum  to  the  mesentery  with  only  longi- 
tudinal shreds  between.  Ail  lacerations  were 
sutured  with  gastro-intestinal  suture,  using  dou- 
ble rows  in  many  places.  It  was  necessary  to 
placate  the  cecum  because  of  the  gross  destruc- 
tion of  the  two  outer  coats.  The  abdomen  was 
closed  tightly.  Patient  returned  to  room  in  poor 
condition.  Plasma  was  started  on  the  table. 

It  is  interesting  to  note  that  the  pulse  rose  as 
the  time  neared  the  six-hour  deadline,  from 
108  at  admittance  to  about  160  forty-five  min- 
utes later  just  preceding  surgery,  and  stayed 
almost  that  high  for  three  days.  The  first  three 
postoperative  days  were  stormy.  The  patient 
cried  constantly  with  pain  from  distension  which 
persisted  in  spite  of  hot  stupes,  prostigmin,  rec- 
tal tube  and  other  anti-flatulance  measures.  On 


for  March,  1949 


219 


the  fourth  day  less  distension  was  noted  and  the 
pain  immediately  subsided.  Pulse  came  down  to 
108.  By  the  eighth  day  there  was  no  distension 
and  the  patient  then  made  an  uneventful  re- 
covery. He  was  discharged  on  the  fourteenth 
day  recovered. 

Although,  while  the  patient  was  in  the  hospital, 
he  could  not  have  a bowel  movement  without  an 
enema,  subsequent  follow-up  showed  that  normal 
defication  began  about  two  weeks  later  with  no 
further  sequelae. 


Conclusions 

1.  Common  filling  station  air  hoses  can  be 
dangerous  instruments  if  used  carelessly  or 
maliciously. 

2.  Every  case  with  a history  of  possible 
air  injection  into  the  large  bowel  should 
have  opportunity  for  immediate  surgery. 

3.  Six  hours  is  the  deadline  between  ac- 
cident and  operation  for  good  prognosis. 


CLINICAL  INVESTIGATION  OF  OENETHYL  MUCATE 

HAROLD  I.  GOLDMAN,  M.D.* 

DENVER 


Oenethyl  mucatet  is  a new  salt  of  a 2 
methylaminoheptane,  which  has  been  de- 
veloped for  the  symptomatic  treatment  of 
chronic  bronchial  asthma.  D.  E.  Jackson, 
who  has  reported  on  the  pharmacologic  ac- 
tion of  the  hydrochloride  salt  of  this  drug, 
stated  that  the  drug  acts  as  a sympathicomi- 
metic  amine,  but  had  distinct  differences 
from  epinephrin.  He  found  that,  in  general, 
within  therapeutic  limits  there  was  a negli- 
gible effect  on  the  central  nervous  system; 
that  there  was  a rapid  rise  in  the  blood  pres- 
sure, which  was  persistent  even  when  the 
action  of  epinephrin  was  minimized  by  er- 
gotoxin;  that  when  measured,  the  ampli- 
tude of  the  heart  action  was  increased;  that 
when  broncho-constriction  was  produced  by 
injecting  esserine,  the  drug  caused  a bron- 
cho-dilatation of  a moderate  degree,  not  in- 
creased by  further  doses  and  not  affecting 
the  ganglia,  but  rather  the  broncho-dilator 
nerve  endings.  All  of  this  work  was  animal 
experimentation.  R.  C.  Batterman  of  New 
York  University  College  of  Medicine  re- 
ported on  twenty-five  cases  of  chronic 
bronchial  asthma  in  which  the  mucate  salt 
of  the  drug  was  exhibited  orally.  He  found 
a low  incidence  of  side  reactions,  and  those 
usually  after  long  continued  medication. 

The  author  is  reporting  on  the  use  of 
oenethyl  mucate  by  the  oral  route  in  thirty 
selected  cases  of  chronic  bronchial  asthma. 
The  cases  were  drawn  from  the  following 
four  sources:  the  Allergy  Clinic  of  the  Uni- 

*Assistant in  Medicine,  Allergy  Clinic,  University 
of  Colorado  Medical  School  of  Denver. 

tThe  supply  of  oenethyl  mucate  used  in  this  study 
was  contributed  by  the  Bilhuber-Knoll  Corporation 
of  New  Jersey. 


versity  of  Colorado  Medical  Center,  the  Al- 
lergy Service  of  the  Fort  Logan  Veterans 
Administration  Hospital,  the  National  Home 
for  Jewish  Children  at  Denver  (most  of  the 
children  at  this  institution  have  chronic  in- 
tractable bronchial  asthma),  and  the  au- 
thor’s private  practice. 

There  were  twelve  males,  twelve  females, 
and  six  children.  All  of  the  cases  had  a 
history  of  a long-standing  chronic  bronchial 
asthma.  In  all  of  the  patients  the  following 
therapeutic  measures  had  been  used  prior 
to  this  study:  epinephrin  either  by  injection 
or  nebulization,  aminophyllin  both  by  the 
intravenous  route  and  per  rectum,  ephe- 
drine  and  ephedrine-like  products,  and  al- 
lergic management  and  treatment.  All  had 
oxygen  used  for  severe  exacerbations  of 
their  chronic  asthma. 

Doses  of  400  mg.  per  day  in  divided  doses 
were  given  to  the  adult  patients,  200  mg. 
per  day  to  the  pediatric  cases.  The  results 
were  classified  as  good,  when  the  patients 
were  so  symptomatically  improved  that  no 
other  supportive  medication  was  needed 
while  the  drug  was  exhibited;  fair,  when  ad- 
ditional supportive  medication  was  needed; 
poor,  when  no  beneficial  effect  was  ob- 
tained from  the  drug. 

Ten  adult  patients  reported  no  improve- 
ment whatsoever  and  were  classified  as 
poor.  All  of  the  pediatric  cases  were  classi- 
fied as  poor.  Nine  adults  reported  consider- 
able improvement  and  were  classed  as  good. 
Five  cases  were  classified  as  fair.  Two  of  the 
patients  classed  as  good  have  reported  con- 
tinued benefit  after  fJ  ve  and  one-half 


220 


Rocky  Mountain  Medical  Journal 


months  of  continuous  therapy.  Six  of  the 
good  cases  reported  that  their  symptomatic 
relief  from  the  drug  waned  on  continued 
use,  indicating  a possible  tolerance  effect. 
There  were  no  symptoms  which  could  be 
attributed  to  withdrawal  effect  in  any  case. 
One  case  with  a good  result  died  during  the 
period  of  study  from  a pulmonary  hemor- 
rhage due  to  a reactivation  of  pulmonary 
tuberculosis. 

Nine  adults  reported  increased  nervous- 
ness while  the  drug  was  exhibited,  which 
disappeared  as  soon  as  the  drug  was  dis- 
continued. Spot  checks  of  all  of  the  cases 
showed  no  significant  variation  of  the  blood 
pressure.  No  headaches  or  visual  disturb- 
ances were  reported.  None  of  the  cases 
which  had  acute  exacerbations  of  their  asth- 
ma during  the  period  of  this  study  were 
relieved  by  the  administration  of  the  drug 
during  the  attack. 

It  is  of  interest  to  note,  and  the  author 
has  no  explanation  to  offer  for  it,  that  none 
of  the  pediatric  cases  were  benefited  by 
oral  use  of  this  drug.  At  the  present  time 
the  hydrochloride  salt  is  being  used  to 
coimpare  the  effect. 

Summary 

Results  of  a clinical  investigation  of  a 
new  drug,  oenethyl  mucate,  a 2 methyl- 
aminoheptane,  in  thirty  selected  cases  of 
chronic  bronchial  asthma  are  reported.  Six- 
teen cases  were  classified  as  having  poor 
results,  five  as  fair,  nine  as  good.  There  was 
one  death  in  the  series  which  could  not  be 
attributed  to  the  effect  of  the  drug.  No 
serious  side  effects  were  noted  in  this  small 
series.  The  number  of  cases  is  too  small  to 
draw  any  definite  conclusions  as  to  the  ef- 
ficaciousness of  the  drug,  but  it  appears  to 
have  some  value  in  selected  cases. 


Vaccination  with  BCG  must  not  be  regarded 
as  a substitute  for  approved  health  measures 
nor  can  the  vaccination  of  the  general  population 
be  recommended  at  the  present  time  except  for 
carefully  controlled  investigative  programs,  sev- 
eral of  which  are  now  under  way. — Nat.  Tuberc. 
A.  Bull.,  March,  1948. 


Case  Reports 


CONGENITAL  TRACHEO  ESOPHAGEAL 
FISTULA 

HENRY  SWAN,  M.D.* 

DENVER 

One  of  the  most  gratifying  advances  in 
the  realm  of  pediatric  surgery  in  recent 
years  has  been  the  successful  solution  of  the 
problems  associated  with  congenital  tra- 
cheo-esophageal  fistula.  Whereas  ten  years 
ago  this  condition  was  considered  com- 
pletely hopeless,  with  advances  in  the  tech- 
nics of  anaesthesia,  better  methods  of 
esophageal  anastomosis,  and  greater  under- 
standing of  the  surgical  handling  of  thoracic 
problems  in  infants,  now  this  condition  is 
being  successfully  cured  by  surgical  inter- 
vention in  many  clinics  throughout  the 
country.  In  fact,  one  clinic  has  recently 
reported  thirty-six  successful  repairs  in  the 
last  forty-one  cases. 

Within  the  last  two  years  a case  report 
was  made  in  this  Journal  in  which  the  state- 
ment was  made  that  “surgery  was  not  con- 
sidered feasible  . . . He  died  four  days 
later.”  It  seems  desirable,  therefore,  to  call 
the  attention  of  the  profession  to  the  newer 
and  very  hopeful  outlook  which  surgery 
now  offers  patients  born  with  this  not  un- 
common congenital  anomaly. 

CASE  HISTORY 

The  patient,  a four-day-old  Mexican  male  in- 
fant, was  admitted  to  the  Pediatric  Surgical 
Service  on  October  16,  1947,  having  been  brought 
by  plane  from  Albuquerque,  New  Mexico.  The 
child  had  been  born  of  a normal  term  delivery 
in  the  parent’s  home.  On  the  second  day  of  life, 
when  attempt  was  made  to  feed  the  baby,  he  had 
a choking  spell  and  became  cyanotic.  Three  or 
four  subsequent  feeding  attempts  were  met  with 
the  same  result.  On  the  third  day  of  life,  he  was 
seen  by  Dr.  Robert  Trombley,  of  Albuquerque, 
who  immediately  suspected  the  cause  of  the 
symptoms,  confirmed  the  diagnosis  by  x-ray 
studies,  gave  the  infant  glucose  and  saline  solu- 
tion by  clysis,  and  referred  the  patient  to  this 
hospital. 

On  admission,  about  6 o’clock  in  the  evening, 
physical  examination  revealed  a relatively  nor- 
mal appearing  male  infant  in  no  acute  distress. 
His  weight  was  6 pounds  6 ounces,  respirations 
60,  pulse  100,  temperature  98.2.  Auscultation  of 
the  chest  revealed  diminution  of  breath  sounds 
over  the  right  upper  chest  posteriority. 

*From  the  Department  of  Surgery,  University  of 
Colorado  Medical  Center.  The  author  is  Associate 
Professor  of  Surgery.  Submitted  for  publication 
April  8,  1948. 


jor  March,  1949 


221 


The  patient  was  taken  to  x-ray  where  a small 
soft  rubber  catheter  was  inserted  through  the 
mouth  into  the  upper  esophagus.  It  met  re- 
sistance a short  way  down  and  a film  of  the  child 
was  taken  with  the  catheter  in  place.  (Fig.  1). 
The  curving  back  of  the  catheter  demonstrated 
the  esophageal  atresia  and  the  presence  of  air 
in  the  stomach  indicated  a communication  be- 
tween the  trachea  and  the  distal  end  of  the 
esophagus.  The  right  upper  lung  field  showed 
diffuse  opacity  compatible  with  pneumonitis. 
Thus  an  accurate  anatomical  diagnosis  could  be 
made  without  running  the  risk  of  aspiration  of 
barium  or  lipiodol  and  thus  increasing  the  degree 
of  pneumonitis"  which  is  invariably  present.  The 
patient  was  given  a clysis  of  60  c.c.  of  glucose- 
saline-lactate  solution  and  an  intravenous  trans- 
fusion of  60  c.c.  of  blood.  He  was  taken  at  once 
to  the  operating  room  where  operation  was  per- 
formed at  8:00  p.m.,  two  hours  after  admission. 


Fig.  1.  Pre-operative  film  showing  soft  rubber  cath- 
eter coiling  back  in  the  upper  esophagus,  thus 
demonstrating  the  point  of  esoijhageal  atresia.  The 
presence  of  air  in  the  stomach  demonstrates  a 
fistula  between  the  trachea  and  the  lower  seg- 
ment of  esophagus. 

Anaesthesia  was  administered  by  Dr.  Thomas 
Parry,  assisted  by  Miss  Kassanchuk.  An  infant 
face  mask  was  used  to  maintain  positive  pressure 
and  cyclopropane  with  as  much  oxygen  as  pos- 
sible was  given.  The  lungs  were  re-inflated  reg- 
ularly at  ten  minute  intervals  throughout  the 
procedure.  Respirations  ceased  twice  during  the 
operation,  but  on  each  occasion,  resuscitative 
measures  were  effective. 

An  L-shaped  incision  was  made  over  the  right 
posterior  thorax  and  sections  of  the  third,  fourth, 
and  fifth  ribs  were  resected  sub-periosteally.  The 
pleura  was  stripped  from  the  posterior  wall  ap- 
proaching the  mediastinum  extra-pleurally.  The 
azygos  vein  was  identified,  ligated,  and  cut.  The 
fistulous  connection  between  the  lower  end  of 
the  esophagus  and  the  carina  was  identified, 
freed,  and  cut.  The  tracheal  end  was  closed  with 
interrupted  silk  sutures.  The  blind  upper  end  of 
the  esophagus  was  freed  up  to  the  neck,  pulled 


downward,  and  opened.  An  end-to-end  anasto- 
mosis was  made  without  undue  tension  between 
the  upper  and  lower  esophageal  segments  using 
a double  row  of  4-0  silk  interrupted  sutures.  An 
anchoring  suture  of  silk  was  placed  to  relieve 
tension  and  a rubber  wick  was  left  through  the 
wound  to  the  mediastinum  as  the  wound  was 
closed. 

The  patient’s  condition  immediately  postoper- 
atively  was  good,  but  because  of  some  blood  loss 
during  operation,  another  60  c.c.  transfusion  was 
given.  For  the  first  six  days,  nutrition  was 
maintained  by  parenteral  fluids.  Small  feedings 
of  sweetened  water  were  begun  on  the  seventh 
day.  On  the  eleventh  day,  through  the  course  of 
the  previously  removed  rubber  wick  drain,  some 
greenish  pus  appeared  in  the  wound  which  cul- 
tured B.  pyocyaneous.  Shortly  thereafter,  small 
amounts  of  the  feedings  appeared  in  the  wound 
dressing,  and  it  was  apparent  that  a small  fistula 
was  present.  The  infection  was  treated  with 
rapid  response  by  streptomycin  parenterally.  On 
November  10,  1947,  a Witzel  gastrostomy  was  done 
to  put  the  esophagus  at  rest.  The  patient  was  fed 
through  the  gastrostomy  for  about  four  weeks, 
during  which  time  the  fistula  through  the  back 
healed  completely.  He  was  started  again  on  oral 
feedings  in  December,  the  gastrostomy  tube  was 
removed  and  the  gastrostomy  closed  rapidly. 

He  was  discharged  in  good  condition  weighing 
8 pounds  and  4 ounces  on  December  27,  1947.  A 
film  with  barium  in  the  esophagus  taken  just 
before  closure  of  the  gastrostomy  revealed  slight 
kinking,  but  no  obstruction  at  the  site  of  anasto- 
mosis (Fig.  2). 

The  patient  returned  to  Alameda,  where  he  has 
been  under  the  observation  and  guidance  of  Dr. 
Trombley.  He  has  had  no  difficulty  with  his 
feedings,  and  at' last  report  on  Morch  1,  1948,  at 


Fig.  2.  Postoperative  film  taken  in  lateral  position 
showing  barium  in  the  reconstructed  esophagus. 
Although  there  is  some  angulation,  there  is  no 
narrowing  at  the  site  of  anastomosis. 


222 


Rocky  Mountain  Medical  Journal 


the  age  of  four  and  one-half  months,  he  weighs 
11  pounds  and  12  ounces. 

Summary 

1.  A patient  with  congenital  tracheo- 
esophageal fistula  which  was  repaired  sur- 
gically is  presented. 

2.  Any  new-born  infant  who  has  choking 
or  cyanotic  attacks  with  feedings  should  be 
suspected  of  this  condition. 

3.  The  diagnosis  can  be  readily  made  by 
x-ray  examination  using  a soft  rubber  cath- 
eter in  the  upper  esophagus.  Contrast  media 
should  be  avoided  because  of  the  danger  of 
aspiration  pnuemonitis. 

4.  The  condition  should  be  considered  as 
a surgical  emergency,  since  immediate  oper- 
ation will  lessen  the  period  of  progressing 
pneumonitis. 

5.  The  condition  must  no  longer  be  con- 
sidered hopeless.  In  experienced  hands  the 
prognosis  is  now  good  if  surgical  interven- 
tion is  undertaken  early. 


MASSIVE  RESECTION  OF  THE  SMALL 
INTESTINE  DUE  TO  VOLVULUS 
WITH  MULTIPLE  DIVERTICULA 
OF  THE  JEJUNUM 

KENNETH  C.  SAWYER,  M.D.,  LOUIS  W. 

SOLAND,  M.D.,  and  RAY  G.  WITHAM,  M.D. 

DENVER 

According  to  Williams,  there  have  been 
only  three  cases  reported  in  which  jejunal 
diverticula  have  been  associated  with  acute 
or  chronic  intestinal  obstruction.  There  was 
no  apparent  relationship  between  the  small 
bowel  diverticula  and  the  massive  gangrene 
due  to  volvulus  in  this  case  under  consid- 
eration. However,  this  combination  of  path- 
ologic entities  did  assume  surgical  impor- 
tance in  the  decision  to  remove  all  involved 
intestine. 

In  1935  Raymond  made  an  exhaustive 
review  of  257  collected  cases  of  massive 
resection  of  the  small  intestine.  His  article 
has  been  quoted  frequently  and  still  stands 
as  the  best  statistical  study  on  the  subject. 
Cogswell,  Prioleau  and  Raymond  agree 
that  removal  of  200  cm.  or  more  of  the 
small  intestine  is.  considered  massive  re- 
section. Cogswell  rightly  emphasizes  that 
intestinal  length  is  subject  to  great  varia- 
tion, and  that  the  total  length  removed  is 
not  as  significant  as  the  percentage  re- 


moved. Todd,  et  al.  have  recorded  a physi- 
ological study  of  a man  with  all  but  three 
feet  of  small  intestine  removed  surgically. 
They  report  that  99  per  cent  of  the  carbo- 
hydrate, 75  per  cent  of  the  protein,  and 
65  per  cent  of  the  fat  was  utilized.  This 
is  in  accord  with  Raymond’s  opinion  that 
the  best  diet  for  these  patients  is  one  that 
is  fat  poor,  protein  adequate,  and  rich  in 
carbohydrate. 

It  has  been  stated  that  removal  of  50 
per  cent  of  the  small  bowel  is  the  maximum 
consistent  with  surgical  safety,  although 
Cogswell  was  successful  in  removing  80 
per  cent  in  his  case.  In  deciding  to  remove 
large  segments  of  the  small  bowel,  the 
surgeon  is  quite  naturally  influenced  to  a 
considerable  extent  by  the  fact  that  mas- 
sive resection  of  the  proximal  gut  consti- 
tutes a greater  hazard  than  massive  distal 
gut  resection. 

Although  mortality  rates  in  reported 
cases  average  only  33.5  per  cent,  we  be- 
lieve that  the  actual  mortality  figures 
would  be  much  higher  if  all  such  cases 
were  known  and  evaluated.  However,  a de- 
cision to  remove  massive  sections  of  small 
bowel  in  cases  similar  to  the  following  one 
is  almost  mandatory  when  an  obvious  100 
per  cent  mortality  would  result  without 
such  heroic  surgery.  From  a survey  of  the 
literature  and  a study  of  our  own  case, 
we  believe  that  radical  measures  in  such 
cases  are  always  indicated. 

CASE  REPORT 

Mrs.  E.  W.,  a 74-year-old  white  female,  en- 
tered Presbyterian  Hospital  on  March  22,  1948, 
at  12:45  p.m.,  with  chief  complaint  of  pain  in 
the  abdomen  and  vomiting.  The  patient  stated 
that  the  pain  had  begun  the  afternoon  previous 
to  admission.  It  was  located  across  the  upper 
abdomen  and  had  been  constant  and  moderately 
severe  since  the  onset.  There  had  been  nausea 
and  vomiting  on  several  occasions  in  the  past 
twenty-four  hours.  She  had  a normal  bowel 
movement  on  the  day  previous  to  admission, 
but  no  stool  since  then,  nor  had  she  passed  any 
gas  since  the  onset  of  pain.  However,  she  had 
been  belching  large  quantities  of  gas.  Her  ap- 
petite had  been  poor  for  several  weeks,  and 
she  had  noticed  considerable  bloating  off  and 
on.  A review  of  the  past  history  revealed  that 
she  had  abdominal  surgery  six  years  ago  for 
intestinal  obstruction,  and  following  this  she 
had  bilateral  phlebitis  and  congestive  heart 
failure  with  some  periodic  ankle  edema.  Fur- 
thermore, she  had  noted  a chronic  cough  pro- 
ductive of  frothy,  white  sputum  for  the  past 
six  weeks. 

The  physical  examination  revealed  a rather 


for  March,  1949 


223 


poorly  nourished  white  female  appearing  to  be 
of  stated  age,  weighing  an  estimated  110  pounds, 
and  appearing  to  be  in  acute  abdominal  distress. 
The  tongue  was  dry  and  the  skin  showed  a loss 
of  turgidity.  Breath  sounds  were  depressed  bi- 
laterally and  there  were  rhonchi  over  both 
lower  lobes.  The  blood  pressure  was  160/80, 
and  the  pulse  rate  was  82  per  minute.  The 
PMI-  was  at  the  sixth  left  interspace  in  the  mid- 
clavicular  line.  No  murmurs  were  heard  and 
the  rhythm  was  regular.  As  was  greater  than 
Ps.  The  abdomen  was  distended  and  tympanitic. 
There  was  moderate  generalized  tenderness  and 
rigidity.  No  bowel  sounds  were  heard.  There 
was  quite  a marked  loss  of  elasticity  of  the 
peripheral  arteries. 

Scout  films  of  the  abdomen  revealed  several 
loops  of  small  intestine  which  were  dilated  with 
gas  and  believed  to  present  a partial  small  in- 
testinal obstruction  on  a dynamic  basis.  Con- 
siderable gas  in  the  colon  indicated  that  the 
obstruction  was  not  complete.  Urinalysis  re- 
vealed a specific  gravity  of  1.022,  2 plus  albu- 
men, 1 plus  acetone,  and  2 to  3 pus  cells  per 
high  power  field.  The  hemoglobin  was  13  gm. 
Erythrocytes  were  5,040,000  per  cmm.  The  white 
cells  were  14,700  per  cmm.,  with  a neutrophile 
count  of  89  per  cent  and  a lymphocyte  count  of 
11  per  cent.  The  blood  urea  nitrogen  was  20.4 
mg.  per  cent.  The  blood  sugar  was  178  mg.  per 
cent.  An  electrocardiogram  was  interpreted  as 
showing  coronary  arteriosclerotic  heart  disease. 

After  admission  to  the  hospital  the  patient 
became  gradually  worse.  It  became  evident 
that  immediate  surgical  intervention  was  im- 
perative in  spite  of  her  poor  general  condition 
and  the  past  history  of  heart  failure.  One 
thousand  c.c.  of  whole  blood  was  obtained  from 
the  blood  bank.  The  patient  was  given  digalen 
and  aminophyllin.  Approximately  seven  hours 
after  admission  the  patient  was  taken  to  sur- 
gery. The  operation  was  performed  under  care- 
fully supervised  spinal  pontocaine  and  intra- 
venous pentothal  anesthesia.  The  systolic  blood 
pressure  at  the  start  was  52  and  a diastolic  read- 
ing could  not  be  obtained.  Intravenous  neo- 
synephrine  was  given  throughout  the  operation 
which  would  transiently  raise  the  blood  pressure 
to  120/76.  Blood  and  oxygen  were  administered 
throughout  the  operative  procedure. 

The  abdomen  was  opened  through  a left  rectus 
incision,  revealing  a large  quantity  of  bloody 
fluid.  Many  coils  of  distended,  foul  smelling, 
gangrenous  small  bowel  were  presented  in  the 
wound  (Fig.  1).  Multiple  diverticula  of  the 
small  intestine  were  noted.  They  varied  in  size 
from  3 mm.  to  8.1  cm.  in  diameter,  both  on  the 
mesenteric  and  the  anti-mesenteric  surfaces. 
It  was  impossible  to  demonstrate  the  cause  or 
causes  of  the  volvulus.  It  seemed  to  be  around 
one  of  the  large  superior  mesenteric  vessels. 
The  mesentery  was  clamped,  divided  and  ligated 
with  a suture  ligature.  About  ten  feet  of  the 
intestine  was  removed  and  a primary  closed 
type  anastomosis  over  a Rankin  clamp  was  ac- 
complished. It  was  estimated  at  this  time  that 
well  over  one-half  of  the  intestine  was  removed. 
Two  rows  of  sutures  were  used — one  fine  gas- 
trointestinal suture,  and  one  layer  of  cotton 
musculoserosal.  The  clamp  was  removed  and 
the  spur  was  broken  down  by  pressure.  The 
lumen  readily  admitted  a thumb.  The  mesen- 
tery was  closed  with  interrupted  cotton.  It  was 
noted  at  this  time  that  the  diver’ticulosis  extended 
throughout  the  small  intestine.  The  stomach 
was  somewhat  dilated  and  a constricting  type  of 
duodenal  ulcer  was  noted  at  its  outlet.  The 


abdomen  was  closed  with  through  and  through 
tension  sutures. 


Fig.  1.  Ten  feet  of  small  bowel  showing  massive 
gangrene  and  multiple  diverticula. 


The  immediate  postoperative  condition  of  the 
patient  was  much  better  than  at  time  of  com- 
mencing operation.  Postoperatively  she  was 
given  penicillin  in  large  doses,  continuous  duo- 
denal drainage,  and  the  remainder  of  the  1,000 
c.c.  of  whole  blood.  She  was  given  nothing  by 
mouth  for  three  days.  The  fluid  balance  was 
quite  adequately  maintained  by  means  of  in- 
travenous fluids.  Her  urine  output  in  the  first 
twenty-four  hours  was  under  1,000  c.c.,  but  hy- 
dration corrected  itself  within  four  days.  She 
was  given  digalen  1 ampule  daily,  and  dicumarol 
was  administered  prophylactically.  She  was  al- 
lowed to  “dangle”  on  the  second  postoperative 
day.  The  duodenal  tube  was  removed  on  the 
fifth  postoperative  day  and  the  patient  was 
ambulatory. 

There  was  an  interesting  sidelight  on  the  fifth 
postoperative  day;  although  a soft  diet  had  been 
ordered,  the  patient  was  found  to  be  eating  a 
large  portion  of  ground  beef  without  apparent 
discomfort.  We  have  been  unable  to  carry  out 
an  adequate  follow-up  on  this  patient,  but  on 
last  report,  the  family  stated  that  everything 
was  “going  fine.”  She  was  eating  small  amounts 
frequently,  but  seemed  to  be  maintaining  her 
nutritional  state. 

Pathological  Report:  “Ten  feet  (300  cm.)  of 
gangrenous  small  intestine  present  web-shaped 
representative  portion  of  mesentery.  Proximal 
twelve  inches  is  moderately  distended,  present- 
ing a diameter  of  from  5 to  7 c.c.  and  here 
presents  rather  prominent  varied  sized  diverticu- 
lum ranging  from  a few  mm.  up  to  6 cm.  in 
diameter.  There  arise  from  the  mesentery  at- 
tachment diverticula  ranging  also  from  a few 
mm.  to  a maximum  of  3 cm.  Proximally  there 
is  clear  cut  line  of  demarcation  with  that  bowel 
distally  starting  twelve  inches  from  the  proximal 
position  presenting  a dark  gangrenous  change. 
This  congestion  and  gangrenous  change  are  also 
represented  in  the  attached  mesentery.  Diverticu- 
la are  also  present  in  the  gangrenous  segment, 
but  are  not  as  obvious  as  in  that  portion  previ- 
ously described.  The  distal  six  inches  show 
likewise  a normal  colored  type  of  intestinal  tract 
and  this  ranges  between  2 and  3 c.c.  in  diameter. 
Diverticula  are  not  detected  in  this  portion. 
Mid-portion  of  the  gangrenous  part  presents  a 
(Continued  on  Page  232) 


224 


Rocky  Mountain  Medical  Journal 


BRONCHIAL 

ASTHMA 


AM 


"Aminophyllin  has  in  recent  years  taken 
a definite  place  in  the  armamentarium  of 
asthmatic  medication.  Physiologically  it 
acts  hy  relaxing  the  bronchial  muscles.  It 
is  also  extremely  valuable  in  relieving  pa- 
tients of  an  adrenalin  fastness  and  is  less 
contraindicated  in  cases  with  cardiac  dis- 
•ders  or  hypertension.”^ 

y relaxing  the  bronchial  musculature, 
improving  ventilation,  increasing  vital 
capacity  and  promptly  reducing  both  in- 
trathecal and  venous  pressures. 


PHYLLIN 


exerts  a favorable  influence  on  the  rate 
and  volume  of  respiration  in  bronchial 
asthma  as  well  as  in  paroxysmal  dyspnea 
and  Cheyne-Stokes  respiration. 


SEARLE 


ORAL  . . . PARENTERAL  . . . RECTAL 
DOSAGE  FORMS 


*SearIe 

drous 


at  least  80%  of  anhy- 
G.  D.  Searle  & Co.,  Chicago  80, 


SEARLE  RESEARCH  IN  THE  SERVICE  OF  MEDICINE 


1.  Mountain,  G.  E.:  Bronchial  Asthma,  J.  Iowa  M. 
Soc.  35:324  (Aug.)  1945. 


for  March,  1949 


225 


Organization 

National  Affairs  - Proceedings  - Programs  - Society  Notices  - News  - Auxiliary 


COLORADO 

State  Medical  Society 

WESTERN  COLORADO  SPRING  CLINICS 

531  Rood  Avenue 
Grand  Junction,  Colorado 

PROGRAM 

Saturday,  April  23,  1949 
MORNING  SESSION 

9:30 — Official  Meeting,  Board  of  Trustees,  Colo- 
rado Medical  Society. 

10:30-12:30 — Registration. 

12:35 — Luncheon,  Green  Room,  LaCourt  Hotel. 
Presentation  of  Board  of  Trustees.  (E.  D. 
Munro,  M.D.,  Grand  Junction,  Presiding). 

AFTERNOON  SESSION 
(H.  R.  Bull,  M.D.,  President,  Mesa  County 
Medical  Society,  Presiding) 

2:00-2:45 — “Diverticulosis  and  Diverticulitis,” 
Phil  Brown,  M.D.,  Rochester,  Minn. 

2:45-300 — Discussion  opened  by  Henry  H.  Ziegle, 
M.D. 

3:00-3:45 — “Jaundice,”  Phil  Thorek,  M.D.,  Chi- 
cago. 

3:45-4:00 — Discussion  opened  by  F.  V.  Colombo, 
M.D. 

4:00-4:45 — Intermission. 

4:00-4:50 — “The  Use  of  Anti  Coagulants  in  Car- 
dio-Vascular  Disease,”  George  C.  Griffith, 
M.D.,  Pasadena. 

4:50-5:00 — ^Discussion  opened  by  G.  P.  Smith, 
M.D. 

6:30 — Social  Hour,  Green  Room,  LaCourt  Hotel. 
7:30 — Dinner  Dance,  Green  Room,  LaCourt 
Hotel. 

.Sunday,  April  24,  1949 

7 :30 — Breakfast. 

MORNING  SESSION 
(N.  A.  Brethouwer,  M.D.,  Presiding) 
8:45-9:15 — Greetings  From  the  Colorado  State 
Medical  Society. 

“Newer  Responsibilities  of  Organized  Medi- 
cine” (15  minutes),  Lester  L.  Ward,  M.D., 
Vice  President. 

“Recent  Developments  in  the  New  AMA 
Program”  (15  minutes),  Harvey  T.  Seth- 
man.  Executive  Secretary. 

9:15-10:00 — “Tumors  of  the  Breast,”  Geno  Sac- 
comanno,  M.D.,  Grand  Junction. 
10:00-10:15— Discussion  opened  by  E.  H.  Munro, 
M.D. 

10:15-11:00 — Pre-  and  Post-Operative  Care” — 
Phil  Thorek,  M.D.,  Chicago. 

11:00-11:15 — Discussion  opened  by  Paul  J.  White, 
\M.D. 


11:15-12:00 — “The  Diagnosis  and  Clinical  Sig- 
nificance of  Acidosis  and  Alkalosis  in  Child- 
hood,” Mariana  Gardner,  M.D.,  Denver. 

12:00-12:15 — Discussion  opened  by  R.  J.  Groom, 
M.D. 

12:30 — Luncheon  with  Qestion  and  Answer  Pe- 
riod. All  speakers  participating.  (Paul  E. 
Stidham,  M.D.,  Presiding). 

AFTERNOON  SESSION 
(James  P.  Rigg,  M.D.,  Presiding) 

2:00-2:45 — “Thoracic  Pain — Differential  Diag- 
nosis,” George  C.  Griffith,  M.D.,  Pasadena. 

2:45-3:00 — Discussion  opened  by  H.  M.  Tupper, 
M.D. 

3:00-3:45 — “Chronic  Suppurative  Lung  Diseases,” 
Fred  Harper,  M.D.,  Denver. 

3:45-4:00 — Discussion  opened  by  L.  L.  Hicks, 
M.  D. 

4:00-4:45 — “Management  of  Constipation  and 
Non  Specific  Diarrhea,”  Phil  Brown,  M.D., 
Rochester. 

4:45-5:00 — Discussion  opened  by  H.  C.  Graves, 
M.D. 

5:00 — Refreshments  and  Informal  Discussions 
with  the  guest  speakers. 


DENVER  CHILDREN’S  HOSPITAL 
SUMMER  CLINICS 

The  Professional  Staff  of  the  Children’s  Hos- 
pital of  Denver  is  nearing  completion  of  its  pro- 
gram plans  for  the  meetings  to  be  held  in  the 
hospital  auditorium  on  June  29,  June  30,  and 
July  1,  1949.  Notices  will  be  mailed  to  all 
physicians  in  the  Rocky  Mountain  area  within 
the  next  few  weeks. 

Members  of  all  the  Specialty  Staffs  of  the 
hospital  will  comprise  the  Summer  Chnics  Fac- 
ulty, presenting  and  discussing  current  pediatric 
methods  based  upon  studies  at  The  Children’s 
Hospital  in  Denver,  and  in  other  pediatric  centers. 

Three  distinguished  guest  speakers  — Dr. 
Mitchell  I.  Rubin,  Professor  of  Pediatrics  at  the 
University  of  Buffalo  and  Medical  Director  of  the 
Buffalo  Children’s  Hospital;  Dr.  Wolf  W.  Zuelzer, 
Pathologist  for  the  Children’s  Hospital  of  Michi- 
gan and  Professor  of  Pediatric  Research  at 
Wayne  University,  and  Dr.  Willis  J.  Potts,  Sur- 
geon-in-Chief  of  the  Children’s  Memorial  Hos- 
pital in  Chicago — will  take  part  in  the  daily 
program  which  is  designed  as  a comprehensive 
review  of  practical  diagnostic  and  therapeutic 
procedures  in  the  management  of  diseases  in 
infancy  and  childhood. 

A feature  of  this  summer’s  program  will  be 
the  Question  Hour  during  the  luncheon  period 
in  Tammen  Hall.  Speakers  of  the  day  will 
answer  questions  pertaining  to  the  subjects  dis- 
cussed, and  an  opportunity  for  clarifying  any 
controversies  that  may  have  arisen  will  be  af- 
forded. 

Registration  is  limited  to  seventy-five.  A fee 
of  $25.00  has  been  established,  of  which  $5.00 
is  to  accompany  the  application.  Correspondence 
should  be  addressed  to  The  Chairman,  The  Sum- 
mer Clinics  Committee,  Children’s  Hospital,  Den- 
ver, Colorado. 


226 


Rocky  Mountain  Medical  Journal 


with  Immune 
Serum  Globulin 
““Cutter 


Help  build  natural  immunity-simultaneously  ! 


Measles  is  climbing  to  its  peak  right  noiv 
according  to  U.  S.  Public  Health  repoi’ts.  An 
important  consideration  for  your  small,  red- 
rashed  patients  is  modification  with  Immune 
Serum  Globulin  — Human  to  help  build  a 
natural  immunity  and  reduce  the  danger  of 
measles— resultant  complications. 

Now  is  a good  time  to  use  Cutter  Immune 
Serum  Globulin  fractionated  from  human 
venous  blood.  160  mgm.  per  cc.— this  known 
constant  gamma  globulin  content  permits 
low  volume,  adjustable  dosage. 

Keep  your  pharmacist  advised  of  your  needs 
for  gamma  globulin  — and  specify  Cutter. 


IT'S  THE  GAMMA  GLOBULIN  THAT  COUNTS  IN  CUTTER 


Cutter 

immune 

Serum 

Globulin- 

Human* 


Human*  means  venous  blood,  freshly  pooled 
from  normal  healthy  donors. 

Water  Clear  Solution,  hemolysis -free  and 
non-pyrogenic. 

Gamma  Globulin  concentration— 160  mgm. 
per  cc. — reduces  dosage  volume  with  con- 
stant globulin  potency— adjustable  for 
prevention  or  modification  of  measles. 


Blood 

Source 

Solution 

Appearance 

Gamma 

Globulin 

Content 

Modification 

Dosoge 

Fresh 

Normal 

VENOUS 

Blood 

Water 

Clear 

Hemolysis- 

Free 

1 60  mgm. 
Per  ce. 

0.3  — 0.4 

ec. 

CUTTER  LABORATORIES,  BERKELEY  10,  CALIFORNIA  ^ 

IMMUNE  SERUM  GLOBULII^ 


f 

a CUTTER 

L 


for  March,  1949 


227 


Obituary 

CRUM  EPLER 

Dr.  Crum  Epler,  well-known  surgeon  and  Past 
President  of  the  Colorado  State  Medical  Society, 
died  on  February  6,  1949,  at  the  age  of  78. 

Born  in  Pleasant  Plains,  Illinois,  Dr.  Epler 
was  a graduate  of  the  University  of  Tennessee 
College  of  Medicine,  receiving  his  degree  in  1894. 
Following  service  in  the  Spanish- American  War 
as  a major  in  the  Army  Medical  Corps,  Dr. 
Epler  came  to  Pueblo.  He  was  licensed  to  prac- 
tice in  Colorado  in  1899  and  became  a member 
of  the  Pueblo  County  and  Colorado  State  Medical 
Societies.  In  1922  Dr.  Epler  was  elected  Presi- 
dent of  the  State  Society. 

In  1928  he  purchased  Woodcraft  Hospital, 
which  he  operated  until  May,  1948. 

Widely  known  throughout  Colorado  Dr.  Epler’s 
passing  will  be  mourned  by  the  many  who  had 
come  to  know  and  respect  him. 


Auxiliary 

A new  project  is  being  inaugurated  for  all 
Press  Chairmen  or  Presidents  acting  in  behalf 
of  Press  Chairmen.  The  purpose  of  this  project 
is  for  the  exchange  of  ideas,  stressing  the  phil- 
anthropic work  being  done  in  your  community 
by  your  Auxiliary. 

All  Press  Chairmen  are  asked  to  write  one 
article  telling  of  your  activities  in  your  Auxiliary, 
for  publication  in  the  Medical  Journal,  and  that 
proper  notices  are  sent  to  the  local  press  of  your 
community,  preceding  each  meeting. 

General  instructions  for  Auxiliary  Press  Chair- 
men; 

Use  copy  paper  about  8%xll,  and  write  on 
one  side  of  the  paper  only. 

Use  a typewriter  if  possible,  and  always  double 
or  triple  space. 

At  the  top  of  the  page,  give  fuR  name  of  the 
organization,  the  name  of  the  Press  Chairman 
and  her  address. 

Send  future  rather  than  past  news.  If  both 
must  be  combined  in  one  story,  put  the  future 
news  first,  so  that  if  cutting  is  necessary,  the 
most  important  part  of  the  story  is  left.  News 
is  only  news  when  it  is  new.  State  it  simply 
and  be  sure  that  all  statements  are  accurate, 
and  all  names  and  initials  are  correct. 

In  your  first  paragraph,  tell  the  “Who,”  “What,” 
“When,”  “Where,”  and  “Why”  of  your  story, 
emphasizing  the  most  important  of  these  facts  in 
your  first  sentence  to  make  an  “eye-catching” 
lead. 

Remember  that  your  story  will  be  read  by 
the  general  public  as  well  as  the  members  of 
the  Auxiliary. 

Please  send  aU  press  correspondence  to  the 
Press  Chairman,  J^s.  Russell  J.  Evans,  3303 
East  Evans  Ave.,  Denver  10,  Colorado. 


WELD  COUNTY 

The  February  meeting  of  the  Weld  County 
Medical  Auxiliary  presented  a panel  of  speakers 
from  its  own  membership  on  the  subject,  “Com- 
pulsory Health  Insurance.”  They  plan  to  present 
the  same  type  of  program  to  other  club  ^oups 
in  Greeley  after  they  have  perfected  it  by 
trying  it  out  on  themselves.  They  plan  to  dis- 
tribute effective  literatiure  to  reirtforce  their 
appeal. 

Dr.  Ella  Mead,  physician  at  Greeley,  meets 
with  the  Auxiliary  and  acts  as  liaison  officer 


between  the  Auxiliary  and  the  Weld  County 
Medical  Society. 

The  State  Medical  Society  office  would  like 
a list  of  Auxiliary  members  who  can  capably 
speak  to  their  local  groups  on  the  threats  in 
compulsory  health  insurance  and  explain  the 
counter  proposals  from  AMA.  If  the  doctors 
and  doctors’  wives  who  volunteer  this  service 
can  have  a few  meetings  to  exchange  their 
thinking  and  experiences,  their  effectiveness 
would  no  doubt  be  greatly  increased. 

We  hope  that  you  and  yom-  children  are  en- 
joying those  fine  radio  programs  called,  “Dr. 
Tim,  Detective.”  A note  to  your  local  radio  sta- 
tion and  the  state  office  would  no  doubt  be 
appreciated. 

MRS.  WEARNER. 


ARAPAHOE  COUNTY 

Arapahoe  County  Auxiliary  has  held  four 
meetings  since  September,  1948.  Our  paid  mem- 
bership totals  twenty-four. 

On  February  11a  rummage  sale  was  sponsored 
under  the  direction  of  Mrs.  J.  C.  Wiedenmann 
of  Englewood,  netting  $100.00,  which  will  be 
used  for  the  nurses’  educational  fund,  mainte- 
nance of  our  loan  closet  of  medical  supplies,  and 
other  good  uses. 

At  the  last  meeting,  held  on  January  31  ,1949, 
at  the  home  of  Mrs.  John  Simon,  Jr.,  in  Engle- 
wood, Mrs.  A.  A.  Weamer,  State  Auxiliary  Presi- 
dent, spoke  on  “Socialized  Medicine  and  Health 
Education.”  Winifred  Evans,  R.N.,  of  the  Tri- 
County  Health  Department,  also  attended  this 
meeting  and  spoke  on  “Nurse  Recruiting.” 

The  next  meeting  is  scheduled  for  February 
28,  1949,  at  the  home  of  Mrs.  Homer  B.  Catron, 
in  Englewood. 

MRS.  S.  P.  ESPOSITO, 
President,  Arapahoe  County  Auxiliary. 


BOULDER  COUNTY 

The  Auxiliary  plans  to  meet  on  February  3 
with  Miss  Johannis  speaking  to  us  about  “Legis- 
lation for  Public  Health  in  Colorado.” 

The  chief  activity  this  year  is  to  provide  some 
needed  piece  of  equipment  for  some  hospital  in 
Boulder  County.  The  last  gift  was  a dressing 
cart  for  the  Longmont  Hospital,  and  the  next 
is  for  the  community  here  in  Boulder. 

The  Auxiliary  also  provided  a copy  of  Hygiea 
for  each  of  the  Public  Health  Nurses  in  our 
county. 

AMY  M.  BOWEN. 


EL  PASO  COUNTY 

The  El  Paso  County  Medical  Auxiliary  meets 
in  the  evening  on  the  second  Wednesday  of  each 
month  except  during  the  summer.  Our  first 
meeting  in  the  fall  is  usually  a tea. 

Our  project  this  year  is  cancer  pads.  We 
bought  a bolt  of  gauze  to  enable  us  to  continue 
our  project.  On  the  evenings  when  material 
is  not  available,  we  make  applicators,  fold  papers 
and  wrap  flats  for  autoclaving  for  the  V.N.A. 

Last  year  we  gave  a two-year  subscription  of 
Hygeia  to  the  Colorado  Springs  High  School,  and 
this  spring  we  plan  to  give  a two-year  sub- 
scription to  another  high  school  in  this  county. 


228 


Rocky  Mountain  Medical  Journal 


Nutritional  adjuvants  and  supplements 


The  extension  of  the  usefulness  of  vitamins, 
beyond  the  specific  deficiencies  which  they 
cure  and  prevent,  is  a therapeutic  phenom- 
enon of  the  past  decade.  Those  who  specialize 
in  nutritional  disease  have  frequently  empha- 
sized to  physicians  the  doctrine  that  every 
cell  in  the  body  needs  every  vitamin  all  of 


the  time.  Today,  fortunately,  physicians  are 
increasingly  realizing  the  importance  of  the 
nutritional  phase  of  medicine.  Lederle  has 
been  pre-eminent  in  the  vitamin  field  for 
many  years.  Its  list  of  vitamin  products 
includes  combinations  and  single  vitamins 
adequate  for  every  clinical  need. 


LEDERLE  LABORATORIES  DIVISION 


AMERICAX 


C^a/uunul 


COMPAVy 


30  ROCKEFELLER  PLAZA  • NEW  rORK  20.  N.V. 


/or  March,  1949 


229 


MONTANA 

State  Medical  Association 


Obituary 

EDWIN  M.  WILSON 

Dr.  Edwin  M.  Wilson,  79,  retired  Twin  Bridges 
physician,  died  January  3,  1949,  at  the  MacDonald 
Rest  Home  in  Alder,  where  he  had  been  a patient 
for  the  past  four  months. 

With  most  of  his  service  at  Twin  Bridges,  Dr. 
Wilson  practiced  medicine  more  than  fifty  years. 
Last  fall  the  veteran  doctor  received  a fifty-year 
certificate  and  pin  conferred  upon  him  by  the 
Montana  State  Medical  Association. 

Born  November  16,  1869,  in  Illinois,  he  re- 
ceived his  education  in  that  state.  He  first  prac- 
ticed medicine  in  Illinois  and  came  to  Montana 
a short  time  after  1895.  He  is  survived  by  a 
daughter,  Margaret,  and  a son,  Chnton,  in  Los 
Angeles. 

NEW  MEXICO 

Medical  Society 

1949  ANNUAL  MEETING  OF  NEW  MEXICO 
MEDICAL  SOCIETY 

Dr.  F.  R.  Keating,  Jr.,  Internist,  Rochester, 
Minnesota;  Dr.  M.  Edward  Davis,  Chief  of  Staff, 
Lying-in  Hospital,  Chicago,  Illinois;  Dr.  E.  S. 
Judd.,  Jr.,  Surgeon,  Rochester,  Minnesota;  Dr. 
T.  Leon  Howard,  Urologist,  Denver,  Colorado, 
and  Dr.  J.  Mackenzie  Brown,  Otalaryngologist, 
University  of  Southern  California,  will  be  guest 
speakers  at  the  1949  Annual  Meeting  of  the  New 
Mexico  Medical  Society. 

The  round  of  activities  will  begin  with  the 
House  of  Delegates  meeting  on  May  5,  to  be 
followed  that  afternoon  by  the  opening  of  the 
convention  with  scheduled  talks  by  the  featured 
speakers.  Thursday  evening  there  will  be  a 
smoker  for  the  men.  Entertainment  and  drinks 
will  be  supplied  at  the  Roswell  Country  Club. 
On  Friday,  May  6,  the  featured  speakers  will 
continue  their  educative  activities  ^hd  this  will 
be  supplemented  by  Medical,  Surgical  and  ENT 
luncheons  during  which  there  will  be  question 
and  answer  periods  for  the  benefit  of  those  at- 
tending. Friday  evening,  in  the  American  Le- 
gion Hut,  there  will  be  a banquet  for  the  men 
and  their  wives  which  will  be  topped  by  enter- 
tainment by  an  unannounced  speaker.  Saturday, 
May  7,  the  meeting  will  close  at  noon  and  there 
will  ge  a golf  tournament  for  those  interested. 

Appropriate  daily  entertainment  has  been  ar- 
ranged for  the  ladies  who  may  attend  the  con- 
vention with  their  husbands. 

A fine  group  of  technical  exhibits  is  already 
planned  and  most  of  the  booths  have  been  ar- 
ranged for.  The  meeting  will  be  held  in  the 
Roswell  Women’s  Club  Building  with  the  tech- 
nical program  being  held  upstairs  in  the  ball- 
room and  the  exhibits  will  be  shown  in  the 
basement  of  the  same  building.  The  luncheons 
and  other  entertainment  will  be  held  in  other 
locations  convenient  to  the  centrally  located 
Women’s  Club. 


Obituary 

ROBERT  OSGOOD  BROWN 

Dr.  Robert  Osgood  Brown  died  at  his  home  in 
Santa  Fe,  New  Mexico,  February  1,  1949.  Death 
was  of  cardiac  origin. 

Dr.  Brown  was  born  February  13,  1890,  in 
Chicago,  Illinois.  Following  his  early  education, 
he  graduated  from  the  University  of  Chicago  in 
1912  with  a R.S.  degree.  He  graduated  in  medi- 
cine from  Rush  Medical  College  in  June,  1914, 
and  served  his  internship  at  Cook  County  Hos- 
pital, Chicago,  until  June,  1916.  He  was  with 
the  Illinois  National  Guard  on  the  Mexican 
Border  in  1916,  when  pulmonary  tuberculosis 
was  discovered.  He  came  immediately  to  Santa 
Fe,  and  following  his  recovery,  lived  there  until 
his  death. 

Dr.  Brown  was  primarily  interested  in  internal 
medicine,  and  was  a member  of  the  American 
Medical,  the  New  Mexico  State  and  the  Santa 
Fe  County  Medical  Associations.  He  was  also 
a member  of  the  American  College  of  Physicians; 
the  American  College  of  Chest  Physicians;  the 
South  Western  Medical  Association  and  the  Tru- 
deau Society.  He  was  a member  of  the  Staff 
of  St.  Vincent  Hospital  since  its  inception  in 
1922,  having  been  Chief  of  Staff  over  several 
years. 

He  had  many  activities  in  the  field  of  medicine 
and  in  civic  affairs.  He  had  been  President  of 
the  State  Medical  Society;  of  the  State  Tuber- 
culosis Society  and  over  a long  period  was  closely 
associated  with  Public  Health  Work  in  New 
Mexico,  being  a member  of  the  Board  under 
several  administrations.  He  was  President  of 
the  County  Tuberculosis  Society  at  the  time 
of  his  death. 

Dr.  Brown’s  influence,  his  wisdom  and  judg- 
ment have  constantly  played  an  important  part 
in  the  betterment  of  medical  service  throughout 
the  state  and  in  the  adoption  of  legislation  for 
the  improvement  of  health  conditions. 

He  is  survived  by  his  widow  and  four  children, 
two  brothers,  Edward  Eagle  Brown  and  Dalton, 
and  two  sisters. 

" i 

AMERICAN  BOARD  OF  OBSTETRICS  AND 
GYNECOLOGY,  INC.,  EXAMINATIONS 

The  general  oral  and  pathology  examinations 
(Part  H)  for  all  candidates  will  be  conducted  at 
Chicago,  111.,  by  the  entire  Board  from  Sunday, 
May  8,  through  Saturday,  May  14,  1949.  The  Ho- 
tel Shoreland  in  Chicago  will  be  the  headquar- 
ters for  the  Board. 

Formal  notice  of  the  exact  time  of  each  candi- 
date’s examination  will  be  sent  him  several 
weeks  in  advance  of  the  examination  dates.  Ho- 
tel reservations  may  be  made  by  writing  direct 
to  the  Shoreland. 

Candidates  for  re-examination  in  Part  II  must 
make  written  application  to  the  Secretary’s  of- 
fice not  later  than  April  1,  1949. 

Candidates  in  military  or  naval  service  are 
requested  to  keep  the  Secretary’s  office  in- 
formed of  any  change  in  address. 

Applications  are  now  being  received  for  the 
1950  examinations.  Application  forms  and  bul- 
letins are  sent  upon  request  made  to  American 
Board  of  Obstetrics  and  Gynecology,  Inc.,  1015 
Highland  Building,  Pittsburgh  6,  Pa. 


230 


Rocky  Mountain  Medical  Journal 


WHEN 


S H E’S  TEMPTED  BY 


FORBIDDEN  FOODS... 


What’s  a woman  to  do?  She’s  tired  of  dieting.  The  vision  of  new  health 
and  a better  figure  faded  with  the  first  10  pounds  . . . and  now  all  she  can  see 
wherever  she  goes  is  food,  food,  tempting  food.  • To  depress 
her  appetite,  one  2.5-mg.  tablet  an  hour  before  breakfast  and  lunch 

is  usually  sufficient,  with  perhaps  a third  tablet  in  midafternoon  if  it  does  not 
cause  insomnia.  The  stimulating  action  of  Desoxyn  also  elevates  the  mood  and 
increases  the  desire  for  activity.  • Investigators  who  have  used  Desoxyn 
extensively  claim  that  it  has  these  advantages  over  other  sympathomimetic 
amines  in  producing  euphoria  and  stimulation  of  the 
central  nervous  system:  smaller  dosage,  quicker 
action,  longer  effect,  relatively  few  side-effects. 

• In  addition  to  its  usefulness  in  obesity, 

Desoxyn  has  a wide  variety  of  other  uses  — 
orally  in  the  treatment  of  narcolepsy  and  for  temporary 
use  as  a mental  stimulant,  parenterally 
to  maintain  blood  pressure 
during  surgery  under  spinal 
or  regional  block  anesthesia. 

• Desoxyn  Hydrochloride  is 
safe  and  effective  with  the 
correct  dosage.  Why  not  give 
it  a trial?  For  new  literature  on 
indications,  contraindications 
and  dosage,  write  to 
Abbott  Laboratories, 

North  Chicago,  Illinois. 


PRESCRIBE 


DESOXYN 


HYDROCHLORIDE 

(Methamphetomine  Hydrochloride,  Abbott) 


TABLETS,  2.5  and  5 mg. 

ELIXIR,  20  mg.  per  Buidounce* 

AMPOULES,  20  mg.  per  cc. 


1.  Ivy,  A.  C.,  and  Goetzl,  F.  R.  (1943),  d-Desoxyephedrine;  A Review,  War.  Med.,  3:60,  January. 

2.  Davidoff,  E (1943),  A Comparison  of  the  Stimulating  Effect  of  Amphetamine,  Dextroamphet- 
amine and  Dextro-N-Methy  I Amphetamine  (Dextro-Desoxyephedrine),  Med.  Rec.,  1 56  422,  July, 


jor  March,  1949 


231 


UTAH 

State  Medical  Association 

UTAH  SENATE  MEMORIALIZES  CONGRESS 
OPPOSING  STATE  MEDICINE 

The  Senate  of  Utah  State  Legislature,  by  a 16 
to  3 vote  with  no  prehminary  debate,  adopted  a 
resolution  urging  the  federal  government  to  en- 
courage private  cooperative  health  insrurance. 
The  resolution  termed  the  Wagner-Murray- 
Dingell  bill  as  being  offered  to  the  people  as  a 
solution  of  the  supposed  inadequate  medical  at- 
tention available  to  citizens.  But,  the  resolution 
stated,  “it  is  an  acknowledged  and  unquestioned 
fact  that  the  general  health  of  the  nation  is 
higher  than  that  of  any  other  nation  of  the 
world.” 

“Free  enterprise,”  the  resolution  continued, 
“individual  initiative  and  freedom  from  govern- 
ment interference  are  the  foundation  stones  upon 
which  the  practice  of  medicine  and  all  other 
great  enterprises  of  this  country  have  been  de- 
veloped. . . . Government  interference  and  regi- 
mentation in  the  field  of  medicine  will  destroy 
the  spirit  of  research  and  individual  initiative 
and  eventually  result  in  a breakdown  of  the 
present  high  standards  of  competency  now  prev- 
alent in  the  private  practice  of  medicine  in  this 
country.” 

The  Senate  resolution  further  contended  that 
proponents  of  compulsory  health  insurance  con- 
tinually stress  complete  medical  service  without 
cost  to  the  patients,  failing  to  take  into  accoimt 
the  increased  taxation  which  would  result  from 
the  inevitable  government  bureaucracy  that 
would  be  established  in  administering  such  a 
program. 

Copies  of  the  resolution  were  forwarded  by 
the  Utah  secretary  of  state  to  Utah  congressmen 
and  the  speaker  of  the  house  and  president  of 
the  Senate  in  Washington. 


TWENTY-FIRST  ANNIVERSARY  YEAR  OF 
HAROFE  HAIVRI 

The  Hebrew  Medical  Journal 
Volume  II,  1948 

With  the  appearance  of  Volume  II,  1948,  The 
Hebrew  Medical  Journal,  edited  by  Moses  Ein- 
horn,  M.D.,  concludes  its  21st  successful  year  of 
publication. 

In  publishing  the  Journal,  the  editors  aim  to 
meet  the  need  for  a medical  journal  written  in 
Hebrew,  with  English  summaries,  thus  aiding 
greatly  in  the  advancement  and  development  of 
Hebrew  medical  literature. 

This  issue  contains  an  article  on  Hypertensive 
Vascular  Disease  by  Benjamin  Jablons,  M.D. 
There  is  also  a discussion  on  clinical  observa- 
tions and  treatment  of  190  cases  of  malaria  in 
Palestine,  by  Dr.  P.  Ephrati  of  Tiberias. 

In  addition,  under  the  heading  of  “Personalia,” 
biographical  sketches  of  Professor  Heinrich  Fink- 
elstein,  great  pediatrician;  Professor  Max  Neu- 
burger,  renowned  medical  historian;  and  Dr.  Sol- 
omon Solis-Cohen  of  Philadelphia,  are  presented. 

For  further  information,  commtmicate  with  the 
Editorial  Office  of  The  Hebrew  Medical  Journal, 
983  Park  Avenue,  New  York  28,  N.  Y. 


CASE  REPORT— 

(Continued  From  Page  224) 

knuckled  twelve-inch  segment  which  presents 
sheaths  of  adhesions  that  require  sharp  dissec- 
tion for  separation.  This  apparently  was  a 
nucleus  for  ' the  volvulus.  Bowel  contents  are 
bloody  and  the  mucosa  shows  extensive  areas 
of  hemorrhagic  types  of  ulceration. 

“Sections  of  mesentery  show  extensive  hemor- 
rhage into  the  connective  tissues.  Arteries  and 
vessels  are  moderately  distended  with  some 
of  the  veins  presenting  some  antemortem  throm- 
bus without  evidence  of  organiation.  Mesenteric 
lymph  glands  also  are  markedly  congested.  The 
serosal  surface  is  obliterated  at  the  point  of 
previously  described  adhesions  and  beneath  this 
serosa  there  is  an  occasional  cystic  dilation 
lined  by  serosal  cells,  and  here  there  are  some 
nucleated  giant  cells  of  the  sub-serosa,  and  the 
serosa  with  muscle  strands  being  only  in  the 
bowel  wall. 

“Pathological  Diagnosis: 

“1.  Peritonitis,  fibrous,  adhesive,  chronic,  lo- 
calized. 

“2.  Volvulus,  small  intestine,  secondary  to 
No.  1. 

“3.  Diverticula,  jejunum,  multiple,  severe. 

“4.  Gangrene,  massive,  involving  300  cm.  of 
small  bowel,  secondary  to  No.  1 and  No.  2.” 

Comment 

Regarding  the  operative  procedtire  in  this 
case,  the  following  points  seem  highly  sig- 
nificant and  worthy  of  emphasis: 

1.  Carefully  supervised  anesthesia. 

2.  Blood  pressure  maintenance  at  safe 
levels  by  vaso-pressor  medication. 

3.  Transfusion  of  a large  amount  of  blood 
throughout  operation. 

4.  Oxygen  inhalation  throughout  opera- 
tion. 

It  is  also  significant  that  the  patient’s 
condition  was  appreciably  improved  imme- 
diately following  the  removal  of  the  exten- 
sive amount  of  gangrenous  bowel.  Although 
we  realize  that  massive  resection  of  the 
small  intestine  is  a formidable  procedure 
with  a high  operative  mortality,  yet  it  be- 
comes mandatory  as  a life-saving  measure 
in  cases  of  this  type  even  when  old  age, 
inanition,  and  a poor  cardiac  history  are 
added  hazards. 


VETERANS  ADMINISTRATION  ISSUES  NEW 
PRESCRIPTION  REGULATIONS 

The  Veterans  Administration  has  announced 
new  regulations  governing  payments  on  pre- 
scriptions for  veterans  which  will  safeguard 
pharmacists  against  losses  but  will  permit  re- 
covery on  claims  resulting  from  misrepresenta- 
tion by  the  veteran  or  unauthorized  certification 
by  the  prescribing  physician  or  dentist. 

Under  procedural  changes  ordered  by  the  VA 
in  Washington  and  announced  through  the 
Branch  Medical  Service  in  Denver,  payment  to 
the  pharmacist  will  be  authorized  by  any  “home- 
town” prescription  he  fills  for  a veteran  which 


232 


Rocky  Mountain  Medical  Journal 


PHYSICAL 
I REHABILITATION 


TREATMENT 


SOCIAL 

REHABILITATION  ii'' 


5itice  -„i«sively  v,  ni  \ \A  tVi^o^S 

social  te';*  ^,oWe®- 

holic  , ot  NAedicif'S 

d journo'  ° 3. 


OUC  ««"  ''7:,  „eC.c- 

tnC^cO  '““'r  26 


RECOGNIZED  BY  THE 


cdm 

I EMBER  OF 

UM 


Specialists  in  Therapy  for 

CHRONIC  AlCOHOLISM 

By  the  Conditioned  Reflex  and  Adjuvant  Methods 

7106  35th  AVE.  S.W.,  SEATTLE  6,  WASH.,  WEst  7232 
Cable  Address:  REFLEX 


jor  March,  1949 


233 


complies  with  provisions  of  contracts  between 
VA  and  the  state  pharmaceutical  societies. 

Strongly  emphasizing  that  the  prescription 
must  bear  certification  of  the  physician  or  dentist 
that  he  has  current  VA  authorization  to  prescribe 
for  that  particular  condition  for  which  the  pre- 
scription is  written,  VA  pointed  out  that  doctors 
who  misrepresent  this  authorization  will  be 
liable  for  the  cost  of  the  prescription.  In  the 
past,  payments  to  the  pharmacist,  through  the 
State  Pharmaceutical  Association,  was  disallowed 
if  the  prescription  was  found  to  have  been  issued 
by  a doctor  without  current  authority. 

Under  new  procedures,  the  pharmacist  will  be 
paid  but  VA  must  seek  recovery  from  the  doctor 
or  from  the  veteran,  whoever  is  deemed  at  fault. 

Dr.  C.  H.  Francis,  VA  Medical  Director  for 
Colorado,  Utah,  New  Mexico  and  Wyoming, 
stressed  that  no  claim  can  result  against  any 
physician  who  adheres  to  the  VA  requirement 
that  he  obtain  current  authority  from  the  VA 
regional  office  in  his  state  for  treatment  of  the 
veteran.  Any  prescription  written  under  such  au- 
thority will  be  allowed  without  question,  he  said. 

Dr.  Francis  pointed  out  that  the  new  pro- 
cedures to  emphasize  the  limitations  which  have 
always  been  in  effect  governing  hometown  med- 
ical care.  Doctors  are  allowed  to  prescribe  only 
for  the  specific  ailment  for  which  VA  has  ap- 
proved treatment. 

The  nev/  instructions  read  in  part; 

“In  those  instances  where  the  Chief  Medical 
Officer,  or  his  designate,  has  determined  that  the 
veteran  was  not  legally  entitled  to  the  service 
or  the  physician  was  not  authorized  to  treat  and 
prescribe  for  the  veteran,  an  exception  will  be 
listed  in  the  certificate  on  the  memorandum  copy 
of  the  voucher  and  will  show  the  veteran’s  name, 
C-number,  amount  of  prescription,  and  the  per- 
son from  whom  recovery  is  to  be  made  (physi- 
cian or  veteran). 

“Under  the  contracts  with  the  State  Pharma- 
ceutical Associations,  the  VA  will  pay  the  asso- 
ciation for  all  prescriptions  v^hich  are  properly 
completed  when  presented  to  the  pharmacy. 
Action  to  effect  collection  from  either  the  veteran 
or  physician,  as  indicated,  will  be  taken  simul- 
taneously with  the  certification  of  the  payment 
to  the  State  Pharmaceutical  Association.” 

Dr.  Francis  stressed  to  physicians  and  pharma- 
cists that  existing  regulations  continue  the  right 
of  doctors  to  prescribe  in  an  emergency  when 
the  VA  cannot  be  contacted  for  prior  authority. 
The  prescription  must  be  limited  to  the  treat- 
ment of  the  service-connected  condition  or  of  a 
non-service-cormected  condition  that  is  aggravat- 
ing the  disability  incurred  in  service.  Such  pre- 
scription should  bear  the  doctor’s  notation  that 
the  prescription  is  for  an  emergency,  but  need 
not  bear  the  doctor’s  authorization  to  prescribe. 
The  veteran  must  pay  the  druggist  and  obtain  a 
certified  true  copy  of  the  prescription  from  the 
druggist.  This  will  permit  him  to  claim  reim- 
bursement from  the  VA. 


EXTRA  PAY,  CHOICE  IN  ASSIGNMENT  OF- 
FERED BY  ARMY  TO  PHYSICIANS 
ACCEPTING  ACTIVE  RESERVE 
DUTY 

Physicians  who  volunteer  now  for  active  duty  in 
the  Army  Medical  Corps  Reserve  will  be  given 
opportunity  to  select,  within  limitations,  the 
place  they  wish  to  serve  and  the  type  of  duty 
they  desire,  according  to  a spokesman  for  the 
Sixth  Army. 

These  and  other  inducements  are  being  of- 


fered to  attract  volunteers  and  thus  avoid  the 
need  for  the  government  to  devise  other  means 
of  procui’ement. 

Increase  pay  to  offset  medical  education  ex- 
penses, initial  appointment  in  advanced  grades 
for  those  who  qualify,  a liberalized  system  of 
promotions,  arrangements  for  internships  and 
residences,  a minimum  of  administrative  “paper” 
work,  and  retirement  benefits  for  Reserve  of- 
ficers on  active  duty  equal  to  those  of  regular 
career  officers  for  the  proportionate  time  served, 
plus  some  additional  credits  for  time  on  inac- 
tive reserve  status — these  are  among  the  new 
inducements  offered. 

Seventy-three  physicians  are  needed  between 
now  and  September  1,  1949,  to  fill  Sixth  Army 
Area  requirements  alone.  The  Sixth  Army  Area 
comprises  the  states  of  Washington,  Oregon, 
Idaho,  Montana,  California,  Nevada,  Utah  and 
Arizona. 

Volunteers  may  sign  up  for  one,  two  or  three 
year  periods.  During  the  first  year  of  any 
volunteer  service  the  physician  will,  where  at 
all  possible,  be  assigned  to  a post  close  to  his 
home.  The  two  and  three  year  periods  offer 
the  opportunity  to  request  foreign  service  in  the 
theater  of  the  physician’s  choice.  A communi- 
cation from  Sixth  A^rmy  Headquarters  in  San 
Francisco  details  some  of  the  problem.s: 

“The  completion  of  the  tour  of  duty  of  the 
last  of  the  Army  School  Training  Program  for 
physicians  is  causing  a critical  shortage  of  physi- 
cians for  the  armed  forces.  To  meet  this  situa- 
tion, at  least  until  the  government  can  find  a 
satisfactory  solution,  we  will  need  the  active 
support  of  all  members  of  civilian  medicine. 

“We  require,  primarily,  physicians  for  profes- 
sional work  in  general  hospitals,  station  hos- 
pitals and  dispensaries.  It  is  highly  desirable, 
from  our  standpoint,  to  secure  these  professional 
men  on  an  officer  status,  and  for  a duty  period 
of  one  year  or  more  if  possible. 

“To  solve  this  (problem  of  meeting  the  quotas) 
we  must  secure  the  active  support  of  the  whole 
broad  base  of  medicine  in  this  country  . . . The 
opportunities  for  a professional  man  entering  the 
regular  service  are  better  than  at  any  previous 
time  in  the  Medical  Department’s  history.  We 
have  a professional  training  program  second  to 
none.  Physicians  on  extended  active  duty,  or 
in  the  Regular  Army,  receive  $100.00  a month 
additional  pay  as  compensation  for  previous 
professional  training.  Recently  a civilian  board 
of  outstanding  business  and  civic  leaders  com- 
pleted a study  of  armed  forces  pay  as  compared 
with  like  positions  of  responsibility  in  civilian 
occupations.  This  board  recommended,  and  the 
Secretary  of  War  approved,  upward  adjustments 
in  certain  grades  which,  if  enacted  by  the  Con- 
gress, would  materially  increase  the  financial 
remuneration  now  paid  Army  physicians. 

“We  are  utilizing  these  professional  men  en- 
tirely on  professional  work,  and  in  the  field 
of  medicine  which  they  most  desire  or,  at  least, 
have  received  training  for  in  civilian  life.  This 
is,  of  course,  professionally  desirable,  administra- 
tively feasible,  and  also  necessary  to  secure  the 
greatest  amount  of  professional  service  with  the 
minimum  of  personnel.  It  also  corrects  one  of 
the  major  criticisms  of  professional  men  who 
served  during  the  war. 

“For  information  on  this  subject,  it  is  desired 
that  you  write  the  Surgeon,  Headquarters,  Sixth 
Army,  Presidio  of  San  Francisco,  California,  or 
contact  the  Unit  Instructor,  328th  General  Hos- 
pital, Fort  Douglas,  Utah.” 


234 


Rocky  Mountain  Medical  Journal 


C^P  ANATOMIC|L  SUPPORT 
FOR  FAULTY  |pOYfMECHANICS 


PATIENT  OF  THIN  TYPE  OF  BUILD 


SKELETON  INDRAWN 


In  conditions  of  faulty  body  mechanics, 
the  nonuse  of  the  abdominal  muscles  al- 
lows the  pelvis  to  rotate  downward  and 
forward,  bringing  the  sacrum  up  and  back. 
There  results  an  increased  forward  lumbar 
curve  with  the  articular  facets  of  the  lum- 
bar spine  crowded  together  in  the  back. 

The  dorsal  spine  curves  backward  with 
compression  of  the  dorsal  intervertebral 
discs  and  the  cervical  spine  curves  forward 
with  the  articular  facets  in  this  region 


closer  together.  Therefore,  chronic  strain 
of  the  muscles,  ligaments  and  joints  of  the 
spine  and  pelvis  occurs. 

Camp  Anatomical  Supports  have  an  ad- 
justment by  means  of  which  their  lower 
sections  can  be  evenly  and  accurately 
brought  about  the  major  portion  of  the 
bony  pelvis.  When  the  pelvis  is  thus  stead- 
ied, the  patient  can  contract  the  abdominal 
muscles  with  ease  and  then  with  slight 
movement  straighten  the  upper  back. 


Relieving  back  strain  and  fatigue  due  to  faulty  body  mechanics  is  a feature  of  the 
Camp  Support  illustrated  and  other  types  for  Prenatal,  Postnatal,  Postoperative, 
Pendulous  Abdomen,  Visceroptosis,  Nephroptosis,  Hernia  and  Orthopedic  conditions. 

S.  H.  CAMP  AND  COMPANY  • JACKSON,  MICHIGAN 

World's  Largest  Manufacturers  of  Scientific  Supports 
Offices  in  New  York  • Chicago  • Windsor,  Ontario  • London,  England 


for  March,  1949 


235 


Juberculosis  Abstracts 

Issued  Monthly  by  the  National  Tuberculosis 
ssociation 

Vol.  XXII  FEBRUARY,  l»i9  No.  2 

Until  army  maneuvers  exposed  many  thousands  to 
the  disease,  coccidioidomycosis  was  confined  chiefly  to 
a few  scattered  areas  in  the  southwestern  part  of  the 
United  States.  Infected  individuals  are  now  widely 
disseminated  and  the  fact  that  the  pulmonary  lesions 
resemble  those  of  tuberculosis  with  which  it  may  bet 
coexistent  increases  the  difficulty  of  recognition. 


COEXISTING  PULMONARY 
COCCIDIOIDOMYCOSIS  AND  TUBERCULOSIS 

The  following  is  a case  report  in  which  caseous 
pneumonic  tuberculosis  with  cavitation  developed  in  a 
patient  with  coccidioidal  cavity  in  the  opposite  lung. 
Had  the  previous  medical  history  not  been  known, 
the  finding  of  tubercle  bacilli  in  the  sputum  together 
with  the  x-ray  picture  would  have  led  to  a diagnosis 
of  bilateral  cavity  tuberculosis,  and  the  coccidioidomy- 
cosis would  have  been  overlooked. 

This  case  raises  the  question  whether  it  would  not 
be  wise  to  do  routine  examinations  for  both  coccidioides 
immitis  and  tubercle  bacilli  in  all  cases  of  pulmonary 
disease  with  cavitation.  This  suggestion  is  in  line 
with  the  conclusions  reached  by  other  investigators. 

Case  Report 

1.  F.,  a 24-year-old  Negro,  was  admitted  to  the 
hospital  in  December,  1945.  Pulmonary  tuberculosis 
had  been  diagnosed  on  routine  x-ray  examination  at 
a separation  center  that  showed  infiltration  in  both 
apexes  and  in  the  right  anterior  interspace. 

During  the  war  the  patient  had  taken  part  in,  desert 
maneuvers  in  southern  California  from  June  to  Decem- 
ber, 1943,  but  had  had  no  respiratory  illness.  The 
past  medical  history  was  noncontributory.  The  family 
history  was  negative  for  tuberculosis. 

On  admission  the  only  complaint  was  intermittent, 
slight  pain  in  the  left  side  of  the  chest  for  the  past 
few  months.  Physical  examination  revealed  a well- 
developed  man  who  did  not  appear  ill.  There  was 
no  dyspnea  or  cyanosis,  and  examination  of  the  heart 
and  Itmgs  was  negative.  X-ray  examination  showed 
minimal  infiltration  in  both  apexes.  Planigrams  showed 
a small  thin'-walled  cavity  just  above  the  right  clavicle. 

Significant  laboratory  findings  were  as  follows;  A 
tuberculin  skin  test  using  purified  protein  derivative 
was  negative  in  the  first  strength  and  weakly  positive 
in  the  second  strength.  Coccidioidin  skin  test  in  a 
1:1000  dilution  was  negative  on  two  occasions.  Sputum 
concentrates,  examination  of  the  gastric  contents,  one 
sputum  culture  and  one  guinea-pig  inoculation  were 
negative  for  tubercle  bacilli.  One  72-hour  concentrate 
was  negative  for  fungi.  The  sedimentation  rate  was 
8 mm.  in  one  hour.  Urinalysis  showed  a trace  of 
albumin.  Blood  counts  were  within  normal  limits. 

The  patient  left  the  hospital  against  advice  in  March, 
and  the  discharge  diagnosis  was  chronic  pulmonary 
tuberculosis,  moderately  advanced. 

The  patient  returned  to  the  hospital  on  June  13,  with 
the  chief  complaint  of  bilateral  chest  pain  and  a slightly 
productive  cough.  Physical  examination  and  x-ray 
films  of  the  chest  showed  no  essential  change  since 
the  previous  admission.  There  was  the  same  isolated, 
thin-walled  cavity  in  the  right  apex  and  a small  area 
of  infiltration  in  the  left  apex. 

A coccidioidin  skin  test  was  positive  on  July  2 in  a 
1:1000  dilution  and  positive  on  July  5 in  a 1:100  di- 
lution. Sputum  studies  for  acid-fast  bacilli,  including 
seven  direct  smears,  five  concentrates  and  three  gastric 


lavages,  were  negative.  On  July  15  the  sputum  was 
found  to  contain  spherules  of  Coccidioides  immitis  on 
direct  smear,  and  this  was  confirmed  by  culture  on 
July  20.  Serologic  tests  for  active  coccidioidomycosis 
^vere  performed.  The  complement-fixation  test  was 
four  plus  in  1:2  and  1:4  dilutions.  The  precipitin  tests 
were  all  negative.  It  was  concluded  that  the  findings 
indicated  a coccidioidal  infection.  His  symptoms  sub- 
sided and  he  was  discharged  on  February  19,  1947. 
He  returned  seven  months  later  because  of  weight 
loss  and  hemoptysis.  X-ray  showed  cavitation  in 
both  upper  lobes.  Sputum  examination  showed  acid- 
fast  bacilli  on  both  smear  and  culture.  Serologic  tests 
for  coccidioidal  infection  were  repeated  at  this  time. 
The  complement-fixation  test  was  four  plus  in  dilutions 
of  1:2,  1:4  and  1:8  and  two  plus  in  a dilution  of  1:16. 
The  precipitin  tests  were  negative  in  all  dilutions. 
These  results  were  interpreted  as  not  being  high 
enough  to  indicate  a coccidioidal  dissemination.  C. 
immitis  was  again  found  in  the  sputum  on  smear  and 
culture. 

The  patient  left  the  hospital  against  advice  on  No- 
vember 1,  before  streptomycin  therapy  could  be  in- 
stituted. 

Summary 

A case  is  presented  in  which  coccidioidal  cavitation 
was  observed,  for  fifteen  months  in  a patient  who 
subsequently  developed  a caseous  cavity  tuberculosis 
in  the  opposite  lung,  with  a positive  sputum  test  for 
tubercle  bacilli. 

That  tuberculosis  and  coccidioidomycosis  may  both 
cause  pulmonary  cavitation  is  now  a well-known  fact. 
Since  the  diseases  may  coexist  in  the  same  patient, 
it  is  advisable  to  check  routinely  for  both  tubercle 
bacilli  and  Coccidioides  immitis  in  all  patients  with 
pulmonary  cavitation. 

Coexisting  Pulmonary  Coccidioidomycosis  and  Tu- 
berculosis, Lieutenant  Robert  S.  Study  (M.C.)  U.S. 
N.R.,  Philip  Morgenstern,  M.D.,  New  England  Journal 
of  Medicine,  June  10,  1948. 


A^ol  XXII  MARCH,  1949  No.  3 

The  decreasing  incidence  of  tuberculosis  in  the 
United  States  has  been  accompanied  by  changes  in  the 
epidemiology  of  the  disease  which  are  of  interest  and 
concern  to  all  physicians.  Primary  tuberculosis  among 
adults,  once  relatively  rare,  is.  now  increasing  and 
in  doing  so  presents  new  problems  for  clinicians  and 
public  health  workers. 


PRIMARY  INFECTION  AND  PROGRESSIVE 
TUBERCULOSIS 

In  the  pathogenesis  of  progressive  tuberculosis,  pul- 
monary or  extrapulmonary,  it  has  been  a general  as- 
sumption that  there  are  mainly  two  separate  danger 
periods.  The  first,  at  the  time  directly  following  pri- 
mary infection;  another,  dependent  on  a secondary 
exogenous  infection  or  an  endogenous  exacerbation  of 
lesions  formed  during  the  primary  infection  and  sep- 
arated by  a period  of  latency  from  the  primary  in- 
fection. Primary  infection  in  early  childhood  exacts 
a certain  toll  of  mortality  from  disseminated  tuber- 
culosis, miliary  or  otherwise,  from  meningitis  and  from 
direct  extension  from  the  primary  complex.  This  is 
generally  accepted  and  seems  well  substantiated  by 
the  early  peak  in  tuberculosis  mortality  before  the  age 
of  five.  Whether  this  hazard  from  the  primary  in- 
fection exists  only  during  childhood  or  continues 
throughout  life  is  difficult  to  know. 

The  problem  becomes  more  urgent,  of  course,  with 
the  decrease  of  childhood  infection  and  the  concurrent 
increase  of  primary  infections  in  adults.  Other  ques- 
tions are  whether  or  not  progressive  pulmonary  tuber- 
culosis in  adults  is  in  a significant  proportion  of  cases 
the  direct  consequence  of  primary  infection,  and,  if  so. 


236 


Rocky  Mountain  Medical  Journal 


LATEST  VITAMIN  FACTS 


From  Merck  — where  many  of  the  vitamin 
° factors  were  first  synthesized. 


PARTIAL  INDEX  OF  CONTENTS 


These  six  Merck  Vitamin  Reviews 
are  yours  for  the  asking  while 
the  editions  last.  These  concise 
reviews  contain  up-to-date,  au- 
thoritative facts  and  can  be  most 
useful  for  quick  reference.  Please 
address  requests  for  copies  to 
Merck  & Co.,  Inc.,  Rahway,  N.  J. 


• Factors  that  produce  avitaminosis. 

• Signs  and  symptoms  of  deficiency. 

• Daily  requirements  and  dosages. 

• Distribution  in  foods. 

• Methods  of  administration. 

• Clinical  use  in  specific  conditions. 


MERCK  & CO.,  Inc.  RAHWAY,  N.  J. 


for  March,  1949 


237 


whether  or  not  primary  progressive  pulmonary  tuber- 
culosis in  the  adult  can  be  differentiated  clinically  and 
roentgenologically  from  the  disease  which  is  caused 
by  a secondary  (endogenous  or  exogenous)  infection 
in  the  presence  of  a healed  primary  complex. 

In  an  impressive  series  of  reports  from  the  Scan- 
dinavian countries,  the  relation  between  primary  in- 
fection and  progressive  pulmonary  tuberculosis  in  adults 
has  been  studied.  Complete  unanimity  of  opinion  does 
not  exist,  but  most,  if  not  all,  contemporary  Scandina- 
vian authors  now  agree  that: 

( 1 ) Primary  infection  occurs  frequenty  after  the 
age  of  18  or  20. 

(2)  Primary  infection  in  adults  is  much  more  fre- 
quently accompanied  by  clinical  symptoms,  such  as 
grip-like  symptoms,  fever  and  malaise,  than  is  usually 
recognized  in  this  country. 

(3)  Primary  infection  in  adults  is  frequently  asso- 
ciated, particularly  in  young  women,  with  erythema 
nodosum  (in  Sweden,  erythema  and  nodosum  is  report- 
able  as  tuberculosis),  with  exudative  pleurisy  and  with 
parenchymal  changes  in  the  lung  demonstrable  by  x-ray 
examination. 

(4)  A large  proportion  of  all  cases  of  "genuine" 
(reinfection  type)  tuberculosis ' is  caused  directly  in 
primary  infection. 

(5)  While  primary  infection  can  be  diagnosed  with 
certainty  only  by  tuberculin  conversion,  erythema  no- 
dosum and  certain  roentgenological  changes  should 
strongly  suggest  the  diagnosis. 

Whether  or  not  the  Scandinavian  observations  are 
representative  for  conditions  in  the  United  States  is 
not  known  because  an  insufficient  number  of  studies 
concerned  with  this  problem  have  been  published  here. 

It  is  known  that  erythema  nodosum  in  association 
with  primary  tuberculosis  is  rare  in  this  country.  The 
shift  of  tuberculin  conversion  to  higher  age  groups  is 
as  well  known  here  as  in  Scandinavia.  For  the  rest, 
there  is  little  evidence  for  or  against  the  Scandinavian 
conclusions.  According  to  a few  reports,  a diagnostic 
differentiation  between  primary  and  secondary  tuber- 
culosis is  impossible  without  tuberculin  tests  proving 
recent  conversion.  This  should  not  imply  an  absence 
of  differences.  Competent  observers  state  that  es- 
sentially the  same  anatomical  differences  exist  in  adults 
between  primary  and  post-primary  tuberculosis  as  in 
children.  Clinical  symptoms  and  objective  signs  of 
disease  seem  to  be  observed,  in  the  early  period  fol- 
lowing conversion,  more  frequently  in  Scandinavia  than 
in  the  United  States.  It  is  uncertain  whether  this 
difference  is  in  facts  or  in  interpretation. 

Most  mass  surveys  in  the  United  States  have  been 
made  without  tuberculin  tests,  and  few  have  repeatedly 
examined  the  same  persons.  Serial  tuberculin  tests 
and  repeated  filming  are  necessary  for  disclosing  the 
relation  between  primary  infection  and  progressive 
tuberculosis.  It  is  hoped  that  the  large  study  on  nurses, 
now  being  carried  on  under  the  joint  auspices  of  the 
National  Tuberculosis  Association  and  the  U.  S.  Public 
Health  Service,  will  provide  material  suitable  for 
analysis  from  a pathogenetic  point  of  view. 

It  should  be  obvious  that  pathogenetic  knowledge  is 
not  of  academic  interest  only — it  is  unavoidably  the 
foundation  for  all  anti-tuberculosis  work  and  will  de- 
termine the  effectiveness  of  such  work. 

It  is  possible  that  what  is  true  in  Scandinavia  is  not 
true  in  the  United  States.  Tuberculosis  changes  with 
time  and  place.  Every  country  must  investigate  its 
local  epidemiological  conditions;  none  can  accept,  with- 
out proof,  the  findings  in  some  other  region. 

BCG  vaccination  is  the  logical  consequence  of  the 
epidemiological  situation  in  Scandinavia.  If  it  should 
prove  to  be  true  for  the  United  States  that  a large 
proportion  of  progressive  tuberculosis  in  adults  de- 
velops independently  of  a second  exogenous  infection, 
cur  present  strategy  of  anti-tuberculosis  work  would 
need  fundamental  reforms. 

Primary  Infection  and  Progressive  Tuberculosis,  Edi- 
torial, Max  Pinner,  M.D.,  The  American  Review  of 
Tuberculosis,  October,  1947. 


New  Books  Received 

Mayo  Clinic  Diet  Manual;  By  the  Committee  on  Die- 
tetics of  the  Mayo  Clinic.  W.  B.  Saunders  Com- 
pany, Pljiladelphia  and  London,  1949. 

Cancer  off  the  Elsopliagus  and  Gastric  Cardia:  Edited 
by  George  T.  Pack,  B.S.,  M.D.,  New  York,  N.  Y., 
Clinical  Professor  of  Surgery,  New  York  Medical 
College;  Attending  Surgeon,  the  Memorial  Hos- 
pital for  Cancer  and  Allied  Diseases.  Illustrated. 
192  pages.  The  C.  V.  Mosby  Company,  St.  Louis, 
1949.  Price,  $5.00. 


Clinical  Aspects  and  Treatment  of  Surgical  Infec- 
tions: By  Frank  Lament  Meleney,  M.D.,  P.A.C.S., 
Associate  Professor  of  Clinical  Surgery,  College  of 
Physicians  and  Surgeons.  Columbia  University; 
Associate  Visiting  Surgeon,  Presbyterian  Hos- 
pital, New  York  City.  With  a Foreword  by  Allen 
O.  Whipple,  M.D.  Illustrated.  Philadelphia  and 
London,  W.  B.  Saunders  Company,  1949. 


Vour  Child  or  Mine — The  Story  of  the  Ccrebral- 
Pal.sied  Child:  By  Mary  Louise  Hart  Burton  in 
collaboration  with  Sage  Holter  Jennings.  Coward- 
McCann,  Inc.,  New  York.  Price,  $1.25. 


Introduction  to  Physiological  and  Pathological 
Chemistry — With  Laboratory  Experiments:  By 

Earle  Arnow,  Ph.G.,  B.S.,  Ph.D.,  M.B.,  M.D.,  Direc- 
tor of  Research,  Medical  Research  Division,  Sharp 
Dohme,  Inc.,  Glenolden,  Pennsylvania;  Professor 
of  Chemistry,  Bryn  Mawr  College  Summer  School 
of  Nursing,  Bryn  Mawr,  Pennsylvania,  1941-1943, 
1945;  formerly  Assistant  Professor  of  Physiologi- 
cal Chemistry,  University  of  Minnesota  Medical 
School,  and  Lecturer  in  Physiological  Chemistry 
to  students  enrolled  in  the  University  of  Minnesota 
School  of  Nursing,  Minneapolis.  With  an  Intro- 
duction by  Katharine  J.  Densford,  R.N.,  B.A., 

M.A.,  D.Sc.,  Professor  of  Nursing  and  Director  of 
the  School  of  Nursing,  University  of  Minnesota, 
Minneapolis.  Third  Edition.  St.  Louis,  The  C.  V. 
Mosby  Company,  1949.  Price,  $4.00. 


Clinical  Case-Taking — Guides  for  the  Study  of  Pa- 
tients— History-Taking  and  Physical  Examina- 
tion or  Semiology- of  Disease  in  Various  Systems: 
By  George  R.  Herrmann,  M.D.,  Ph.D.,  Professor  of 
Medicine,  University  of  Texas.  Fourth  Edition. 
St.  Louis,  The  C.  V.  Mosby  Company,  1949.  Price, 
$3.50. 


Oral  Anatomy:  By  Harry  Sicher,  M.D.,  Professor  of 
Anatomy  and  Histology,  Loyola  University  School 
of  Dentistry,  Chicago  College  of  Dental  Surgery. 
With  310  Text  Illustrations,  including  24  in  color. 
St.  Louis,  The  C.  V.  Mosby  Company,  1949.  Price, 
$15.00. 


Obstetric  Analgesia  and  Anesthesia — Their  Effects 
Upon  Labor  and  the  Child:  By  Franklin  F.  Sny- 
der, M.D.,  Associate  Professor  of  Obstetrics  and 
Associaie  Professor  of  Anatomy,  Harvard  Medical 
.School.  Illustrated.  W.  B.  Saunders  Company, 
Philadelphia  & London,  1949. 


Blood  Transfusion:  By  Elmer  L.  DeGowin,  M.D.,  As- 
sociate Professor  of  Internal  Medicine,  State  Uni- 
versity of  Iowa;  Director,  Blood  Transfusion  Serv- 
ice, University  Hospitals;  Member  of  the  Commit- 
tee on  Blood  and  Blood  Derivatives,  National  Re- 
search Council;  Member  of  the  Advisory  Board  for 
Health  Services,  American  National  Red  Cross; 
Secretary  of  the  Subcommittee  on  Blood  Substi- 
tutes, National  Research  Council,  1940-45.  Robert 
C.  Hardin,  M.D.,  Assistant  Professor  of  Internal 
Medicine,  State  University  of  Iowa;  formerly 
Senior  Consultant  in  Blood  Transfusion)  and 
Shock  ip  the  European  Theater  of  Operations, 
U.  S.  Army,  and  Commanding  Officer  of  the  ETO 
Blood  Bank.  And  John  B.  Alsever,  M.D.,  Senior 
Surgeon.  U.  S.  Public  Health  Service;  Chief,  Pro- 
fessional Standards,  Hospital  Division,  U.S.P.H.S. ; 
Director  of  the  Syracuse  University  Blood  Trans- 
fusion Service,  1940-42;  Technical  Director  of  the 
Blood  Plasma  Section,  Medical  Division,  U.  S.  Of- 
fice of  Civilian  Defense,  1942-44;  Director  of  the 
Civilian  Blood  Donor  Service  and  Associate  Na- 
tional Director,  The  American  National  Red  Cross, 
1944-46.  Illustrated  With  200  Diagrammatic  Draw- 
ings. W B.  Saunders  Company,  Philadelphia  and 
London.  1949. 


238 


Rocky  Mountain  Medical  Journai 


"CHANGE  TO 
PHILIP  MORRIS 


OR... 


CUT  DOWN  YOUR 
SMOKING!” 

That  is  the  suggestion  of  many  of  the  country's 
leading  specialists  in  cases  of  throat  irritation.* 


Many  doctors  hove  among  their  patients 
some  who  they  believe  smoke  too  much.  But  the 
difficulty  of  persuading  such  smokers  to  cut  down 
is  familiar  to  everyone.  What  better  advice 
therefore  than  "Change  to  Philip  Morn's”. ..  the 
only  leading  cigarette  proved  definitely  and 
measurably  less  irritating. 

To  minimize  cigarette  irritants,  Philip  Morris 
are  made  by  a special  process  whose  advan- 
tages are  conclusively  shown  in  published 
studies.**  These  studies  may  convince  you  too 
that  the  most  effective  advice  for  patients  who 
smoke  is  "Change  to  Philip  Morris." 


PHILIP  MORRIS 

Philip  Morris  & Co.,  Ltd.,  Inc. 
119  Fifth  Avenue,  New  York 


ARE  YOU  A PIPE  SMOKER?  ...  We 

suggest  an  unusually  fine  new  blend  — 
Country  Doctor  Pipe  Mixture.  Made  by 
the  same  process  as  used  in  the  manu- 
facture of  Philip  Morris  Cigarettes. 


*Completely  documented  evidence  on  file. 

**Reprinis  on  request: 

Laryngoscope,  Feb.  1935,  Vo/.  XLV,  No.  2,  149-154;  Laryngoscope,  Jan.  1937,  Vo!.  XLVIl,  No.  I,  58-60; 
Proc.  Soc.  Exp.  Biol,  and  Med.,  1934.  32-241;  N.  Y.  Stale  Journ.  Med.,  Vo/.  35,  6-1-25,  No.  II,  590-592. 


for  March,  1949 


239 


Manual  of  Clinical  Laboratory  Methods;  By  Opal 
E.  Hepler,  Ph.D.,  M.D.,  Associate  Professor  of 
Pathology,  Northwestern  University  Medical 
School;  Director  of  the  Clinical  Laboratories  of 
the  Montgomery  Ward  Clinics  and  Passavant 
Memorial  Hospital;  Consultant  in  Clinical  Path- 
ology at  Children’s  Memorial  Hospital,  Chicago, 
Illinois.  With  a Foreword  by  James  P.  Simonds, 
Ph.D.,  M.D.  Fourth  Edition.  Charles  C.  Thomas, 
Publisher,  Springfield,  Illinois,  U.  S.  A. 


Anesthesia:  Principles  and  Practice.  A Presentation 
for  the  Nursing  Profession:  By  Alice  M.  Hunt.  G.  P. 
Putnam’s  Sons,  New  York.  Price,  $2.60. 


Cornell  Conferences  on  Therapy,  Volume  Three: 

Edited  by  Harry  Gold.  M.D.,  Managing  Editor, 
David  P.  Barr,  M.D.,  McKeen  Catte'll,  M.D.,  Eugene 
F.  DuBois,  M.D.,  "Walter  Modell  M.D.,  Ralph  R. 
Tompsett,  M.D.  New  York,  The  MacMillan  Com- 
pany, 1948.  Price,  $3.50. 


Adolescence  Problems.  A Handbook  for  Physicians, 
Parents,  and  Teachers:  By  William  S.  Sadler,  M.D., 
F.A.P.A.,  Chicago.  Consulting-  Psychiatrist,  Colum- 
bus Hospital;  Fellow  of  the  American  Psychiatric 
Association,  The  American  Medical  Association, 
The  A.merican  Association  for  the  Advancement 
of  Science;  Member  of  the  American  Psychopath- 
ological  Association.  St.  Louis,  The  C.  V.  Mosby 
Company,  1948.  Price,  $4.75. 


Lung  Dust  Lesions  Versus  Tuberculosis:  By  Lewis 
Gregory  Cole,  M.D.,  F.A.C.R.  Published  by  Amer- 
ican Medical  Films,  Inc.,  8 Church  Street,  White 
Plains,  New  York.  Price,  $10.00. 


Book  Reviews 


Heart:  A Physiologic  and  Clinical  Study  of  Cardio- 
vascular Diseases:  By  Aldo  A.  Luisada,  M.D.,  In- 
structor of  Physiology  and  Pharmacology,  Tufts 
College  Medical  School;  Lecturer  in  Medicine,  Post- 
graduate Division,  Tufts  College  Medical  School; 
Associate  in  Medicine,  Beth  Israel  Hospital,  Boston; 
Mass.;  former  Professor  of  Medicine,  Ferrara,  Italy. 
With  a Foreword  by  Herrman  L.  Blumgart,  Phy- 
sician-in-Chief,  Beth  Israel  Hospital;  Professor  of 
Medicine,  Harvard  Medical  School.  With  Illustra- 
tions. The  Williams  and  Wilkins  Company,  Balti- 
more. Price,  $10.00. 

The  volume  entitled  “Heart”  by  Aldo  A.  Luis- 
ada  of  Tufts  Medical  School  and  published  by 
Williams  and  Wilkins  is  an  exceptional  piece  of 
work.  The  text  reflects  the  essential  interest  of 
the  author  in  the  pathologic  physiology  of  car- 
diac functions.  Much  of  this  material  is  presented 
from  a fresh  viewpoint  that  attracts  and  holds 
the  attention  of  the  reader.  Despite  the  vast 
store  of  literature,  especially  from  American  and 
European  sources,  the  discussions  in  the  various 
chapters  are  concise. 

The  author  includes  numerous  figures  and  dia- 
grams to  better  depict  physiologic  events  in  the 
heart’s  function,  both  in  the  normal  state  and  in 
abnormal  conditions.  Some  diseased  states  of 
the  heart  are  perhaps  more  clearly  described  for 
the  student  than  in  any  other  compilative  work 
in  our  language.  Of  extreme  value  is  the  dis- 
cussion of  the  altered  physiology  which  accounts 
for  the  important  signs  and  symptoms  of  each 
condition.  Differential  diagnoses  and  the  in- 
clusion of  many  tabular  summaries  help  to  pre- 
sent a more  complete  picture.  The  author  offers 
descriptions  and  illustrative  examples  of  elec- 
trocardiograms, x-rays,  phonocardiograms  and 
pulse  tracings  throughout  the  chapters. 

Many  of  the  expressed  viewpoints  while  still 
sub  judice  are  useful  concepts  dealing  with  the 
subject  under  discussion.  Such  hypotheses  are 
vital  in  a work  of  this  sort,  not  only  for  clear 
understanding,  but  also  because  they  may  stimu- 
late interest  and  lead  to  further  progress. 

This  book  is  highly  recommended  to  all  phy- 
sicians who  are  students  of  heart  disease  and  of 
circulatory  physiology. 

H.  ALEXANDER  BRADFORD. 


A Doctor  Talks  to  Teen-Agers.  Aj  Psychiatrist’s  Ad- 
vice to  Youth:  By  William  S.  Sadler,  M.D.,  F.A.P.A., 
Chicago;  Consulting  Psychiatrist,  Columbus  Hos- 
pital; Fellow  of  the  American  Psychiatric  Asso- 
ciation, The  American  Medical  Association,  The 
American  Association  for  the  Advancement  of 
Science;  Member  of  the  American  Psychopatho- 
logical  Association.  379  pages.  The  C.  V.  Mosby 
Company,  St.  Louis,  Missouri,  1948.  $4.00. 

During  the  two  years  I served  as  psychiatric 
consultant  to  the  University  Student  Health  Serv- 
ice at  Boulder,  I saw  a good  many  teen-age 
youngsters  who  had  no  more  serious  difficulty 
than  the  ordinary  problems  that  most  adolescents 
have  to  face.  Often,  these  boys  and  girls  would 
be  surprised  that  their  particular  problem  was 
not  an  imusual  one  and  would  be  relieved  to 
know  that  they  were  not  alone  in  their  over- 
whelming misery.  Sometimes,  one  would  ask, 
“Isn’t  there  some  book  I could  read  about  these 
things?”  Similar  questions  would  often  arise 
in  conversations  with  interested  parents,  refer- 
ring doctors,  teachers,  etc.  It  is  always  difficult 
to  recommend  a book  which  will  answer  all  the 
questions;  it  is  an  especially  controversial  issue 
to  suggest  any  book  to  a patient  undergoing 
psychiatric  therapy.  How’ever,  there  are  occa- 
sional exceptions  and  William  Sadler’s  latest 
books  are  two  happy  examples. 

“A  Doctor  Talks  to  Teen-Agers”  can  safely  be 
recommended  to  the  average  adolescent  who  is 
taking  himself  too  seriously,  or  not  seriously 
enough;  who  is  maturing  too  rapidly  in  the 
physical  realm  and  not  rapidly  enough  in  the 
spiritual;  who  may  be  battling  the  windmills 
of  adolescent  fantasy  or  the  very  real  problem 
of  hostility  toward  one  or  both  parents.  Dr. 
Sadler  (famed  for  his  twenty-poimd  textbook 
of  psychiatry)  has  covered  the  field.  His  eye- 
catching chapter  heads  subtly  disguise  an  almost 
encyclopedic  treatise,  classifying  every  problem 
from  introversion  to  vitamin  addiction.  He  has 
presented  us  one  compact  volume  ■with  the  mod- 
ern version  of  “What  Every  Yoimg  Boy  (or  Girl) 
Should  Know”  in  much  more  realistic  fashion  than 
the  old,  word-mincing  Victorian  pamphlet.  He 
shows  keen  insight  into  the  problems  of  the  .very 
young,  who  are  often  simply  trying  to  be  very 
old,  or  at  least  to  grow  up  a little  faster  than 
nature  intended  them  to.  He  “talks  turkey” 
about  most  of  the  questions  faced  by  this  age 
group,  including  the  sex  question,  breaking  down 
taboos  by  plain  language  and  interspersing  fac- 
tual information  with  fatherly  advice.  His  book 
combines  the  best  features  of  Dale  Carnegie, 
Dorothy  Dix  and  Harry  Emerson  Fosdick  with- 
out managing  to  give  anyone  the  idea  that  he 
can  remake  the  world  by  his  own  beha’vior.  The 
only  word  of  warning  that  should  be  mentioned 
is  not  necessarily  a criticism  of  this  particular 
book,  but  is  essentially  a general  criticism  of 
the  whole  principle  of  recommending  books  to 
patients.  In  this  particular  age  group  are  so 
often  found  the  warning  signals  of  the  most 
serious  mental  disorder  of  any  age;  schizophrenia. 
No  book  should  ever  take  the  place  of  therapy, 
especially  when  we  may  be  dealing  with  any- 
thing so  serious,  even  in  its  beginnings.  It  is 
so  easy  a pitfall  for  a busy  doctor  to  have  a 
handy  book  to  recommend;  anyone  familiar  with 
the  common  problems  of  adolescence  should  have 
no  quarrel  with  the  general  principle  that  such 
a procedure  should  merely  be  incidental  to  the 
routine  of  good  therapy.  A good  rule  to  follow 
is:  the  more  serious  the  problem,  the  less  apt 
the  book  is  to  be  of  any  value,  and  the  more 
apt  it  is  to  be  of  some  harm. 

A<lole.<iiceiiee  Prolilems.  A Handbook  for  Physicians, 
Parents,  and  Teachers:  By  William  S.  Sadler,  M.D., 
F.A  P..\.,  Cliicag'O.  Consulting-  Psychiatrist,  Co- 
lumbus Hospital;  Fellow  of  the  American  Psy- 


240 


Rocky  Mountain  Medical  Journal 


M aid  in  treatment  of  specific  breast  conditions 

CORRECTIVE  RRASSIERES 

are  cnstom- fitted  to  prescription... 


Straps  adjusted  for  maximum  com* 
fort  with  gentle -yet -firm  support. 

H M M ■■  Back  width  designed  to 
encourage  good  posture. 

I mm  H Correct  bust  cup  selected  for 
proper  uplift  and  separation. 


Torso  htted  to  patient’s 
personal  measurements. 


'Proper  physiological  support,  for  the 
breast  is  a medical  problem,  and  patients  are 
grateful  to  the  physician  who  recogni2es  this 
fact.  Lov-e’s  extensive  therapeutic  line  of  breast 
supports  provides  remedial  support  for  specific 
breast  conditions.  From  more  than  500  bust-cup- 
torso  size  variations,  the  patient’s  correct  size  is 
selected,  then  fitted  to  her  individual  measure- 
ments by  specially  trained  Lov-e’  technicians, 
according  to  your  exact  instmctions. 

Lov-e  Brassieres  are  available  in  a wide-variety 
of  all  fine  fabrics  including  cottons,  rayon  jac- 
quards and  nylons.  Also  available:  sleeping  bras- 
sieres, hospital  binders,  artificial  breasts i muscle 
pads  and  maternity  garter  supports. 

The  May  Company 

LOV-E  SECTION, 

CORSET  DEPARTMENT, 

THIRD  FLOOR 

DENVER,  COLORADO 


MATERNITY 

— for  pre-natal  and 
post-natal.  Helps 
prevent  leakage. 
Adjusted  without 
charge  during  preg- 
nancy. 


HYPERTROPHIC 

— inner  pocket  for 
pendulous  bust. 
Built  up  back. 
Padded  shoulder 
straps.  Redistributes 
bust  weight. 


MASTECTOMY 

— fitted  with  Lov-e’ 
bust  pads  to  restore 
bust  contour.  Aids 
psychologically. 


for  March,  1949 


241 


Advertisement 

From  where  I sit 
^ Joe  Marsh 


Yes,  Sir, 

Insomnia’s  Contagious! 

Bud  Swanson  had  trouble  sleeping 
nights  last  summer.  Tried  to  get  over 
it  by  turning  up  the  radio  full  blast 
and  started  an  epidemic  of  insomnia 
all  down  the  block! 

Folks  finally  dropped  a hint  to  Bud 
that  he  close  the  windows  or  turn  the 
radio  a little  lower.  Bud  did — and 
that  was  the  quickest  cure  for  other 
folks’  insomnia  I’ve  ever  heard  of! 


chiatric  Association,  The  American  Medical  Asso- 
ciation, The  American  Association  for  the  Ad- 
vancement of  Science:  Member  of  the  American 
Psychopathological  Association.  St.  Louis:  The 
C.  V.  Mosby  Company,  1948.  Price,  ?4.75. 

The  companion  volume:  “Adolescence  Prob- 
lems: A Handbook  for  Physicians,  Parents  and 
Teachers”  is  about  one  hundred  pages  thicker 
and  is  even  more  encyclopedic  in  its  classifica- 
tion of  the  problems  under  study.  The  theme 
is  that  “adolescence  is  a transition  period  in 
which  the  young  folks  are  subjected  to  consid- 
erable mental  strain  and  emotional  stress;” 
variations  on  this  theme  intimate  that  practically 
everything  that  happens  to  an  individual  be- 
tween the  ages  of  eleven  and  sixteen  may  be  a 
problem,  depending  on  the  individual  and  how 
well  equipped  he  and  his  family  and  friends  are 
to  handle  it.  Dr.  Sadler  believes  that  if  more 
people  could  understand  the  adolescent  and  his 
particular  problems,  the  stormy  period  need  not 
cause  such  turmoil  and  misfortune.  His  book 
goes  a long  way  toward  dispelling  a great  deal 
of  the  ignorance,  superstition,  gloom  and  prej- 
udice surrounding  the  travails  of  adolescence. 
He  attempts  to  break  down  the  barriers  between 
different  generations  by  mutual  understanding, 
cooperation  and  the  simple  trick  of  persuading 
Dad  that  he  was  young  once,  and  allowing  Junior 
to  realize  it  too.  Any  knotty  problem  of  ordinary 
adolescence  (and  there  are  many)  may  be 
handled  adequately  by  interested  physicians,  par- 
ents, or  teachers  who  considt  Dr.  Sadler’s  book. 
It  is  not  meant  to  be  a handbook  of  therapy; 
most  of  his  youngsters  are  not  sick,  but  are  un- 
dergoing the  rigors  of  a universal  ailment:  grow- 
ing up.  They  need  help,  sympathy  and  under- 
standing; Dr.  Sadler’s  book  may  help  them  to 
get  it.  These  two  books  are  a real  contribution 
to  positive  mental  hygiene. 

HARRIOT  HUNTER. 


Not  that  any  of  us  object  to  the 
radio,  or  swing  bands,  or  anything 
else  that  helps  another  person  relax 
of  an  evening.  {Myself,  I like  a glass 
of  beer  with  a bit  of  cheese  before  I go 
to  bed.  I can’t  speak  for  you.) 

From  where  I sit,  good  neighborli- 
ness means  nothing  more  than  simply 
respecting  the  other  person’s  tastes 
and  rights — without  forcing  your  own 
tastes  or  opinions  down  his  throat. 
And  that  goes  for  Bud’s  radio,  my 
glass  of  beer,  or  whatever  temperate 
pleasure  you  happen  to  enjoy. 


Copyright,  191,8,  United  States  Brewers  Foundation 


Personal  and  Commnnity  Health:  By  C.  E.  Turner, 
A.M.,  Ed.M.,  D.Sc.,  Dr.P.H.,  Professor  of  Public 
Health  Emeritus,  Massachusetts  Institute  of  Tech- 
nology: Formerly  Associate  Professor  of  Hygiene 
in  the  Tufts  College  Medical  and  Dental  Schools: 
Sometime  Member  of  the  Administrative  Board  in 
the  School  of  Public  Health  of  Harvard  Univer- 
sity and  the  Massachusetts  Institute  of  Tech- 
nology: Formerly  Visiting  Professor  of  Health 
Education,  School  of  Public  Health,  University  of 
California.  Eighth  Edition.  565  pages.  The  C.  V. 
Mosby  Company,  St.  Louis,  Missouri,  1948.  $4.00. 

The  health  information  presented  by  this  book 
is  designed  to  meet  the  requirements  of  the 
average  college  student,  and  is  the  result  of  many 
years  of  teaching  experience  by  the  author  in 
one  of  our  leading  technical  institutions.  The 
book  is  classified  into  two  parts.  The  first  com- 
prises nineteen  chapters,  dealing  with  personal 
health  problems;  while  the  second  division  em- 
braces cpmmunity  health  measures  as  outlined 
in  twelve  chapter. 

Appendix  A deals  with  the  control  of  eighty- 
five  communicable  diseases — a list  furnished 
tlirough  the  courtesy  of  the  American  Public 
Health  Association.  Under  Appendix  B the  sub- 
jects of  disinfection  and  disinfectants  are  briefly 
discussed.  Dispersed  throughout  this  book  im- 
portant words,  phrases,  or  parts  of  sentences  are 
italicized,  a means  of  emphasis  which  adds  to  the 
value  of  this  publication.  The  various  illustra- 
tions have  been  carefully  selected  to  demon- 
strate the  subject  matter  under  discussion. 

Considered  as  a whole,  this  book  contains  much 
valuable  information  and  should  be  in  every 
public  health  library. 

Among  the  subjects  discussed  in  Part  I are 


242 


Rocky  Mountain  Medical  Journal 


I 

I 

i 


even  after  a woman  must  do  heavy  work... 


In  the  ranks  of  the  mop  and  pail  brigade  many  of 
the  recruits  ore  on  the  for  side  of  forty.  To  those  whose 
work  is  made  doubly  difficult  by  menopausal  symptoms, 
^'"Premarin"  may  bring  gratifying  relief.  The  prompt  remis- 
sion of  physical  symptoms  and  the  sense  of  well-being  usually 
experienced  following  the  use  of  ^^Premarin"  can  do  much  to 
restore  normal  efficiency  • • • Other  advantages  of  this  natu- 
rally-occurring, conjugated  estrogen  ore  oral  activity,  comparative 
freedom  from  side-effects  and  flexibility  of  dosage ..  .^^Premarin" 
is  available  in  tablets  of  four  different  potencies  and  in  liquid  form. 


While  sodium  estrone  sulfate  Is  the  principal  estrogen 
in  "Premarin,"  other  equine  estrogens  ...  estradiol, 
equilin,  equilenin,  hippulin are  probably  also  pres- 

ent in  varying  amounts  as  water-soluble  conjugates. 


ESTROGENIC  SUBSTANCES  (WATER-SOLUBLE) 
also  known  as  CONJUGATED  ESTROGENS  (equine) 


Ayerst,  McKenna  & Harrison  Limited  22  East  40th  Street,  New  York  1 6,  New  York 

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243 


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personal  hygiene  in  terms  of  “healthful  living;” 
nutrition  in  relation  to  digestion  and  selection  of 
proper  and  adequate  foods;  and  oral  hygiene, 
including  use  of  mineral  bearing  foods.  The 
digestive,  respiratory,  circulatory,  and  renal  sys- 
tems are  described,  and  various  related  disease 
problems  and  hygiene  care  methods  are  dis- 
cussed. In  addition,  the  metabolism  of  the  en- 
docrine glands  and  their  important  bodily  func- 
tions are  enumerated.  Three  chapters  are  de- 
voted to  the  sense  organs,  the  nervous  system, 
and  mental  hygiene  including  psychoneuroses 
and  mental  disorders  of  children.  The  abuse  of 
narcotics  and  stimulants,  adequate  sleep,  exer- 
cise, and  foot  care  are  treated  in  a helpful  man- 
ner. Discussions  of  Mendelian  heredity  and  en- 
vironment, reproduction  and  adult  hygiene,  and 
old  ag^,,  problems  conclude  Part  I. 

The  second  part  of  the  book  deals  with  en- 
vironmental or  communicable  diseases  arising 
outside  of  the  body.  A review  of  early  medical 
history  and  progress  in  medical  and  laboratory 
research  precedes  the  sections  on  sources  of 
infectious  diseases  and  modern  control  measures. 
Healthful  environment  is  emphasized  in  rela- 
tion to  water  supplies  and  purification  methods, 
waste  disposal,  rural  sanitation,  ventilation,  and 
heating.  The  functions  of  various  types  of  health 
agencies  are  listed,  and  health  programs  such 
as  maternal  and  child  care,  school  hygiene, 
health  examinations,  and  correction  of  physical 
defects  are  given  detailed  consideration.  The 
final  chapter  deals  with  hygienic  working  con- 
ditions, industrial  hazards,  child  labor,  and  dis- 
ease prevention  and  health  education  in  industry. 

In  a few  instances  factual  errors  mar  the  per- 
fection of  this  otherwise  excellent  publication. 
For  example,  on  pages  337  and  392,  the  United 
States  Department  of  Agriculture  is  credited  with 
the  enforcement  of  the  Federal  Food,  Drug,  and 
Cosmetic  Act  of  1938;  whereas  this  authority  was 
transferred  to  the  Federal  Security  Agency  on 
June  30,  1940. 

A correction  in  relation  to  an  important  health 
measure  also  should  be  made  on  page  342  as 
follows:  “One  reason  for  the  inspection  is  to 
see  that  the  animal  is  free  from  such  diseases 
as  tuberculosis,  anthrax,  trichinosis,  actinomy- 
cosis, tapeworm,  and  septic  and  pyemic  condi- 
tions.” On  the  same  page,  Trichinella  spiralis  is 
further  considered  but  insufficient  to  insure  the 
reader  against  pork  infestation  with  this  para- 
site. Mere  gross  inspection  of  a hog  carcass  does 
not  insure  freedom  from  trichina  infestation. 
Microscopic  examination  of  pork  was  discon- 
tinued by  the  Federal  B.A.I.  many  years  ago, 
and  one  of  two  measures  are  now  employed  to 


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Rocky  Mountain  Medical  Journal 


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destroy  trichina.  These  include  adequate  heat- 
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Occupational  Therapy  Source  Book:  Edited  by  Sidney 
Licht,  M.D.  With  introduction  by  C.  Charles  Bur- 
ling-ame,  M.D.,  Psychiatrlct-in-Chief,  The  Institute 
of  Living.  90  pages.  The  Williams  and  Wilkins 
Company,  Baltimore,  1948.  $1.00. 

In  this  collection  of  19th  Century  writings,  Dr. 
Sidney  Licht  has  presented  to  the  reader  the 
beginning  seeds  of  Occupational  Therapy  in  the 
treatment  of  the  m.entally  ill.  From  its  first 
recognition  more  than  100  B.C.  by  Asclepiades 
down  to  the  time  of  such  outstanding  men  in  the 
early  psychiatric  field  as  Philippe  Pinel,  F. 
Leuret  (author  of  the  first  book  entirely  de- 
voted to  O.T.),  Wm.  S.  Hallaran,  M.D.,  Johann 
Christian  Reil,  Samuel  Tuke,  and  Thomas  Kirk- 
bride,  M.D.,  work,  both  physical  and  mental,  was 
strongly  advocated  in  the  treatment  and  cure  of 
the  mentally  ill.  The  articles  by  these  men  and 
others  are  far  in  advance  of  their  times  and 
indicate  the  source  of  our  modern  concepts  of 
hospital  industry,  organization,  prescribed  ther- 
apy, recreation,  and  education  of  mental  pa- 
tients. In  his  opening  chapter.  Dr.  Licht  has 
well  summarized  the  evolution  of  Occupational 
Therapy  and  from  it  comes  the  quotation  made 
over  two  centuries  ago  (1786)  by  Philippe  Pinel, 
“Prescribed  physical  exercises  and  manual  oc- 
cupations should  be  employed  in  all  mental 
hospitals.” 

GLORIA  C.  RATH. 

Uc'tailed  At!a»i  of  tlie  Head  and  Week:  By  Raymond 
C.  Truex,  II. S.,  Ph.D.,  Associate  Professor  of  Anat- 
omy, College  of  Physicians  and  Surgeons,  Columbia 
University;  and  Carl  Ei.  Keliner,  Artist,  Depart- 
ment of  Anatomy,  College  of  Physicians  and  Sur- 
geons, Columbia  University.  With  162  pages  and 
135  illustrations.  New  York  Oxford  University 
Press,  1948.  Price,  $15.00. 

The  136  splendid  illustrations  which  comprise 
this  Atlas  will  be  very  useful  to  all  speciahsts 
who  are  concerned  with  the  anatomy  of  head  and 
neck.  The  reviewer  recommends  this  new  ad- 
dition to  the  gross  anatomical  literature  unre- 
servedly. 

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Soon  to  be  issued  in  book  form  are  the  Ciba 
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full  color  drawings  have  been  distributed  to  phy- 
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Number 

Full-Color 

Subject  Plates 

The  Lungs  and  Chest  36 

Injuries  to  the  Chest  12 

The  Esophagus  12 


246 


Rocky  Mountain  Medical  Journal 


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GENERAL  FEATURES 

1.  Climatic  advantages  not  excelled  in  United  States.  Beautiful  grounds  and  attractive  surrounding  country. 

2.  Indoor  and  outdoor  gymnastics  under  the  charge  of  an  athletic  director.  An  excellent  Occupational  Department. 

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for  March,  1949 


247 


Cook  County  Graduate 
School  of  Medicine 

ANNOUNCES  CONTINUOUS  COURSES 

SURGERY — Intensive  course  in  Surgical  Technique, 
two  weeks,  starting  March  21,  April  18,  May  16. 
Surgical  Technique,  Surgical  Anatomy  and  Clinical 
Surgery,  four  weeks,  starting  March  7,  April  4, 
May  2.  Surgical  Anatomy  and  Clinical  Surgery,  two 
weeks,  starting  March  21,  April  18,  May  16.  Sur- 
gery of  Colon  and  Rectum,  one  week,  starting  March 
7,  April  11.  Esophageal  Surgery,  one  week,  start- 
ing June  13.  Thoracic  Surgery,  one  week,  starting 
June  20.  Breast  and  Thyroid  Surgery,  one  week, 
starting  June  27. 

GYNECOLOGY — Intensive  course,  two  weeks,  starting 
March  21,  April  18,  June  20.  Vaginal  Approach 
to  Pelvic  Surgery,  one  week,  starting  April  4, 
May  1 6. 

OBSTETRICS — Intensive  course,  two  weeks,  starting 
March  7,  April  4. 

MEDICINE — Intensive  course,  two  weeks,  starting 
April  4.  Electrocardiography  and  Heart  Disease, 
four  weeks,  starting  March  1 6.  Personal  course  in 
Gastroscopy,  two  weeks,  starting  March  7,  May  1 6. 
Diagnosis  and  Treatment  of  Congenital  Malforma- 
tion of  Heart,  two  weeks,  starting  June  13. 

PEDIATRICS — Intensive  course,  two  weeks,  starting 
April  4. 

DERMATOLOGY — Formal  course,  two  weeks,  starting 
.May  2. 

CYSTOSCOPY — Ten  day  practical  course  every  two 
weeks. 

UROLOGY — Intensive  course,  two  weeks,  starting 
April  18. 

GENERAL,  INTENSIVE  AND  SPECIAL  COURSES  IN 
ALL  BRANCHES  OF  MEDICINE,  SURGERY  AND 
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TEACHING  FACULTY — ATTENDING  STAFF  OF 
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The  Stomach  19 

The  Duodenum  12 

The  Small  Intestine  20 

The  Colon  20 

Injuries  of  the  Abdomen 10 

The  Testicle  14 

The  Prostate  5 

The  Male  Breast  2 

The  Female  Breast 18 

The  Heart  and  Aorta 11 


The  illustrations  will  be  printed  on  80-pound 
gloss  enamel  paper  and  the  book  will  be  bound 
in  boards  with  blue  buckram  covering  and  the 
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Ne7V  Officers  of 
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in  the  Executive  Office  to  date  lists  the  follow- 
ing: 

Arapahoe  County:  W.  W.  Haercklein,  Engle- 
wood, President;  John  Simon,  Jr.,  Englewood, 
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Boulder  County:  David  W.  McCarty,  Long- 
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Physicians,  Surgeons,  Dentists  Exclusively 


$5,000.00  accidental  death  $8.00 

$25.00  weekly  lodenmlty,  accident  and  slcknees  Quarterly 

$10,000.00  accidental  death  $16.00 

$50.00  weekly  indemnity,  accident  and  sickness  Quarterly 

$15,000.00  accidental  death  $24.00 

$75.00  weekly  Indemnity,  accident  and  sickness  Quarterly 

$20,000.00  accidental  death  $32.00 

$100.00  weekly  Indemnity,  accident  and  sickness  Quarterly 

AI.SO  HOSPITAI.  EXPENSE  FOR  MEMBERS, 
WIVES  AND  CHILDREN 


85c  out  of  each  $1.00  gross  income  used  for 
members’  benefit 


$3,000,000.00  $15,000,000.00 

INVESTED  ASSETS  PAID  FOR  CLAIMS 

$200,000.00  deposited  with  State  of  Nebraska  for  protection  of  our  members. 
Disability  need  not  be  incurred  in  line  of  duty — 
benefits  from  the  beginning  day  of  disability 

PHYSICIANS  CASUALTY  ASSOCIATION 
PHYSICIANS  HEALTH  ASSOCIATION 

46  years  under  the  same  management 
400  First  National  Bank  Building,  Omaha  2,  Nebraska 


No  Test  Tubes  • No  Measuring  • No  Boiling 

Diabetics  welcome  “Spot  Tests”  (ready  to  use  dry 
reagents) , because  of  the  ease  and  simplicity  in  using. 

No  test  tubes,  no  boiling,  no  measuring;  just  a little 
powder,  a little  urine — color  reaction  occurs  at  once 
if  sugar  or  acetone  is  present. 

(DENCO) 

FOR  DETECTION  OF  FOR  DETECTION  OF 

SUGAR  IN  THE  URINE  ACETONE  IN  THE  URINE 


SAME  SIMPLE 
TECHNIQUE  FOR  BOTH 

1.  A LITTLE  POWDER 


COLOR  REACTION  IMMEDIATELY 


A carrying  case  containing  cne 
vial  of  Acetone  Test  (Denco) 
and  one  vial  of  Galatest  is  now 
available.  This  is  very  conven- 
ient for  the  medical  bag  or  for 
the  diabetic  patient.  The  case 
also  contains  a medicine  dropper 
and  a Galatest  color  chart.  This 
handy  kit  or  refills  of  Acetone 
Test  (Denco)  and  Galatest  are 
obtainable  at  all  prescription 
pharmacies  and  surgical  supply 
houses. 


Accepted  for  advertising  in  the  Journal  of  the  A,M.A» 
WRITE  FOR  DESCRIPTIVE  LITERATURE 


tSffceiofte  (DENCO). . 

The  DeiiTer  Cbemicai  Manafacturing  Co.,  inc. 

163  Varick  Street,  New  York  13,  N.  Y. 


Chaffee  County:  H.  D.  Smith,  Salida,  Presi- 
dent; L.  E.  Thompson,  Salida,  Secretary. 

Clear  Creek  Valley:  Stephen  Kallay,  Lake- 
wood,  President;  A.  M.  Markham,  Arvada,  Sec- 
retary. 

Delta  County:  W.  S.  Cleland,  Delta,  President; 
J.  J.  Connor,  Delta,  Secretary. 

Medical  Society  of  the  City  and  County  of 
Denver:  F.  H.  Good,  Denver,  President;  J.  Mer- 
idith  Perkins,  Denver,  Secretary. 

Eastern  Colorado:  L.  N.  Myers,  Cheyenne 
Wells,  President;  J.  C.  Straub,  Flagler,  Secretary. 

El  Paso  County:  Carl  S.  Gydesen,  Colorado 
Springs,  President;  L.  L.  Williams,  Colorado 
Springs,  Secretary. 

Fremont  County:  David  A.  Shoun,  Canon  City, 
President;  G.  C.  Christie,  Canon  City,  Secretary. 

Garfield  County:  R.obert  C.  Lewis,  Jr.,  Aspen, 
President;  Robert  Barnard,  Eagle,  Secretary. 

Huerfano  County:  P.  G.  Matthews,  Walsenburg, 
President;  N.  S.  Saliba,  Walsenburg,  Secretary. 

Lake  County:  Vincent  E.  Kelly,  Leadville, 
President;  F.  B.  Laneback,  Leadville,  Secretary. 

Larimer  County:  George  E.  Garrison,  Fort  Col- 
lins, President;  Robert  J Bliss,  Fort  Collins, 
Secretary 

Las  Animas  County:  E.  K.  Carmichael,  Trini- 
dad, President;  L.  J.  Beuchat,  Trinidad,  Secre- 
tary. 

Mesa  County:  Heman  R.  Bull,  Grand  Junction, 
President;  Margaret  E.  N.  Beaver,  Grand  Junc- 
tion, Secretary. 

Montrose  County:  E.  L.  Spangler,  Montrose, 
President;  T.  O.  Plummer,  Montrose,  Secretary. 

Morgan  County:  F.  A.  Rechnitz,  Brush,  Presi- 
dent; Donald  E.  Cowen,  Fort  Morgan,  Secretary. 

Northeast  Colorado:  J.  C.  Lundgren,  Julesburg, 
President;  E.  P.  Hummel,  Sterling,  Secretary. 

Northwestern  Colorado:  Dr.  Ben  Mayer,  Steam- 
boat Springs,  President;  Chester  Bliss,  Craig, 
Secretary. 

Otero  County:  J.  Allen  Shand,  La  Junta,  Pres- 
ident; Ward  C.  Fenton,  Rocky  Ford,  Secretary. 

Prowers  County:  H.  E.  McClure,  Lamar,  Pres- 
ident; K.  F.  Krausnick,  Lamar,  Secretary. 

Pueblo  County:  Harry  E.  Coakley,  Pueblo, 
President;  Robert  D.  Schilling,  Pueblo,  Secretary. 

San  Juan  Basin:  J.  G.  McKinley,  Durango, 
President;  James  W.  Clark,  Durango,  Secretary. 

San  Luis  Valley:  C.  W.  Vickers,  Del  Norte, 
President;  A.  P.  Ley,  Monte  Vista,  Secretary. 

Washington- Yuma  Counties:  Valentin  E.  Woh- 
lauer,  Akron,  President;  A.  T.  Waski,  Yuma, 
Secretary. 

Weld  County:  John  A.  Weaver,  Jr.,  Greeley, 
President;  F.  J.  T.  Roukema,  Greeley,  Secretary. 


250 


Rocky  Mountain  Medical  Journal 


YORK 

PHARMACY 

Denver’s  Finest  Prescription  Store 

Free  Delivery 

Phone  FR.  8837 

2300  East  Colfax  Avenue  at  York  Street 

Almay  Cosmetics 

Prompt,  Careful  and  Courteous 

Serving  Denver  25  Years 

Approved  by  Physicians  Generally 

18th  Ave.  at  Gilpin  St.,  Phone  EA.  7733 

yilba  Dairy 

Properly  Pasteurized  Milk 

Ice  Cream — Butter — Buttermilk 

a. 

Phone  1101  Boulder,  Colo 

T(IAB6 

Surgical  Supports  Expertly  Fitted. 

Miss  Mabel  P.  Cliff,  Authorized  Fitter 

^^enuer  ^ur^icai Supply  C^ontpan^ 

“For  better  service  to  the  profession.” 

1438-40  Tremont  Place  CHerry  4458 

Denver  2,  Colorado 

Let’s  exact  the  same  high  standard  of  purity  in  drinking  water  we 
do  in  foods,  medicines,  and  morals. 

“Good  health  deserves  it.  Bad  health  demands  the  best  water.” 

DEEP  ROCK  WATER  CO. 

Distributors  of 

MOUNTAIN  VALLEY  MINERAL  WATER 

614  27th  Street  From  Hot  Sorinss.  Arkansas  TAbor  5121 


for  March,  1949 


251 


American 

Ambulance 

Company 

THE  FINEST  OF 
CARE  AND  SERVICE 

Oxygen  Equipped 
Cadillacs 

Now  Radio  Telephone  Controlled 


2045  DOWNING  TAbor  2261 

DENVER 


The  Craving  for  Candy  Often  is 

A CALL  FOR  ENERGY 


Recommend  Brecht’s 

For  Your  Patients  . . . 


SUGAU  PLUMS  . . . tenderest  of  fruit-flav- 
ored Jelly  Candies,  made  with  sugar,  corn 
syrup,  dextrose,  citrus  fruit  pectin,  U.  S. 
Certified  Colors.  Cellophane-topped  Party 
Packages. 

PANTRIt  SHELF  . . . delicious  hard  candies 
in  many  flavors.  Refreshing  fruit  drops, 
crunchy  filled  wafers  . . . flavor  sealed — 
in  glass  jars. 

DAISfTV  STICKS  ...  so  delicious  and  pure. 
Made  from  sugar,  dextrose,  corn  syrup,  fin- 
est xlavorings,  U.  S.  Certified  Colors,  As- 
sorted flavors. 


JL 

BROWN  SCHOOLS 


For  Exceptional  Children 


Four  distinct  units.  Tiny  Tots  through 
the  Teens.  Ranch  for  older  hoys.  Spe- 
cial attention  given  to  educational  and 
emotional  difficulties.  Speech,  Music, 
Arts  and  Crafts.  Full  time  Psychologist. 
Under  the  daily  supervision  of  a Certi- 
fied Psychiatrist.  Registered  Nurses. 
Private  swimming  pool,  fireproof 
building.  View  Book.  Summer  Camp. 
Approved  by  State  Division  of  Special 
Education. 

BERT  P.  BROWN 

President 


Paul  L.  White,  M.D.,  F.A.P.A., 
Medical  Director 


P.  O.  Box  4008,  Austin,  Texas 


I^IJRSES 

OFFICIAL 

REGISTRY 

Established  to  Meet  the  Communitsr’s 
Every  Need  for  Nursing  Care 

-k  -K  -K 

GRADUATE  REGISTERED  NURSES 

Hourly  Nursing  Service  Positions 
Filled — Information  on  All 
Nursing  Service 

This  registry  is  endorsed  by  the 
Colorado  State  Graduate  Nurses’ 
Association  and  American  Nurses’ 
Association 

-K  -K  -K 

Undergraduates  and  Practical  Nurses 
Furnished  Upon  Request 

KEystone  0168 

ARGONAUT  HOTEL 


252 


Rocky  Mountain  Medical  Journal 


j 


COUNCIL  ACCEPTED 


! For  the  Failing  Heart  of  Middle  Life 

Prescribe  2 or  3 tablets  of  Theocalcin,  t.  i.  d.  After 
relief  is  obtained,  continue  with  smaller  doses  to  keep 
the  patient  comfortable.  Theocalcin  strengthens  heart 

Brand  of  theobromine-calcium  salicyiate*  ,•  ■•••i  t ii  i 

TradeMarkreg.  u.  s.  Pat.  Off.  actioo,  Giminishes  GyspHea  and  reduces  edema. 


for  March,  1949 


253 


RELIABLE  DRUGGISTS 


PATRONIZE  DENVER’S  INDEPENDENT  DRUGGISTS 


WE  RECOMMEND 

COUNTRY  CLUB 
PHARMACY 

PRESCRIPTION  SPECIALISTS 

1700  E.  6th  Ave.  EAst  7743 

Denver,  Colorado 

We  Recommend 

PFAB  PHARMACY 

JESS  L.  KINCAID,  Prop. 

Prescri pti onts,  BJ ologi cals 
and  Fine  Cosmetics 

5190  W.  Colfax  at  Sheridan 

Phone  TAbor  9931-0951 

DENVER,  COLORADO 

HATCH  PHARMACY 

PRESCRIPTIONS  OUR  SPECIALTY 
Drugs  — Sundries 

Free  Immediate  Deliveries  on  Prescriptions 

794  Colorado  Blvd.  Denver,  Colo. 

Phone  EAst  7718 

“When  in  Need  Think  of  Us  Indeed” 

We  Recommend 

EARNEST  DRUG  COMPANY 

T.  H.  BRAYDEIN,  Prop. 

PRESCRIPTION  SPECIALISTS 
Prompt  Delivery  Service 

1699  Broadway  Phone  KEystone  7237 

Denver,  Colorado 

“Conveniently  Located  for  the  Doctor” 

HYDE’S  PHARMACY 

ACCURATE  PRESCRIPTIONS 

Chas  W.  Hyde,  Prop. 

Rocky  Mountain  Distributor  for  Sherman 
Biologicals  and  Pharmaceuticals 

Free  Deliveries 

629  16th  St.  (Mack  Bldg.)  KE.  4811 

Doyle's  Pharmacy 

Parlicuiar 

East  17th  Ave.  at  Grant  KE.  5987 

21  Years  in  the  Heart  of  North  Denver 

GUIDO  SHUMAKE  DRUGS 

(Formerly  Otto  Drug  Co.) 

PRESCRIPTIONS  ACCURATELY 
COMPOUNDED 

Free  Delivery  Service 

West  38th  Ave.  and  Clay  Denver,  Colo. 

Phone  GRand  9934 

We  Recommend 

BONNIE  BRAE 

DRUG  COMPANY 

Alfred  C.  Andersen,  Owner  and  Manager 
Prescriptions  Accurately  Compounded 

Drugs Simdries 

FREE  IMMEDIATE  DELIVERIES 

ON  EMERGENCY  PRESCRIPTIONS 

763  South  University  Boulevard 

Phone  RAce  2874  — Denver,  Colorado 

WE  RECOMMEND 

Whittaker’s  Pharmacy 

“The  Friendly  Store” 

^y^ttention  . . . 

PHYSICIANS 

PRESCRIPTION  SPECIALISTS 

West  32nd  and  Perry,  Denver,  Colo. 
Phone  GLendale  2401 

f^aironize  ^our ...^Jli/ertiAepA 

254 


Rocky  Mountain  Medical  Journal 


RELIABLE  DRUGGISTS 

PATRONIZE  DENVER’S  INDEPENDENT  DRUGGISTS 


WALTERS  DRUG  STORE 
801  COLORADO  BLVD. 
Denver,  Colorado 

'A 

Telephone  FRemont  5391 

WE  RECOMMEND 

LAKEWOOD  PHARMACY 

R.  W.  Holtgren,  Prop. 

PRESCRIPTION  SPECIALISTS 

West  Colfax  at  Wadsworth 

Lakewood  Colorado 

Phone  Lakewood  65 

to  at  *\A)ti6i 

WEISS  DRUG 

PRESCRIPTION  SPECIALISTS 

A 

Colfax  and  Elm  Denver,  Colorado 

Phone  EAst  1814 

Downing  Street  Pharmacy 

GEORGE  M.  HILL,  Prop. 

PROFESSIONAL  PHARMACIST 

901  Downing  St.  Denver,  Colo. 

Phone  CHerry  2767 

Complete  Merchandise  Line 

Free  Delivery  on  Prescriptions 

We  Recommend 

VAN'S  PHARMACY 

THOS.  A.  VANDERBUR 

Prescrlptlona,  Drags,  Cosmetics,  Magazines 
Sundries  Excellent  Fountain  Service 

2659  Umatilla  St.,  Cor.  29th  Ave.  at  Umatilla 

GRand  7944  Denver,  Colo. 

East  Denver’s  Prescription  Drug  Store 

Bert  C.  Corgan,  Prop. 

3401  FRANKLIN  STREET 

KEystone  7241 

Dansberry’s  Pharmacy 

"New  Ultra  Modern  Prescription  Service" 

JAMES  F.  DANSBERRY 

Owner  and  Manager 

Champa  at  14th  Street  Denver,  Colorado 

Phone  KEystone  4269 

OVERSTAKE’S  PHARMACY 

Gail  E.  Overstake 

Prescription  Specialists 

DRUGS  — SUNDRIES  — 
COSMETICS  — CANDIES 

We  Deliver 

1000  So.  Gaylord  — RAce  4401 

Harl  Cleveland,  Owner 

CLEVELAND  PHARMACY 

W.  29th  Ave.  at  Speer  Ph.  GL.  9272 

Modem  Prescription  Department 
Registered  Pharmacist 

Drugs  — Sundries  — Soda  Fountain 

HOURS:  Week  Days,  8 a.m.  to  10  p.m. 

Sundays,  10  am.  to  1 p.m.,  S p.m,  to  9 p>m. 
Prescriptions  Delivered  Promptly 

PROFESSIONAL  MEN  RECOMMEND 

D.  MALCOLM  CAREY,  Pharmacist 

Phone  AComa  3711 

224  Sixteenth  Street  Denver,  Colorado 

for  March,  1949 


255 


Bonita  Pharmacy 

(Established  1921) 

Prescription  Pharmacists 

6th  Avenue  at  St.  Paul  Street 
“RICHT-A-WAY”  SERVICE 

GERALD  P.  MOORE.  Manager 

Phone  FRemont  2797 


YOU  ARE  INVITED  TO  VISIT  OUR 
NEW  MODERN  STORE 

Conveniently  Located  to  Meet  the  Needs 
of  the  Doctor 

DL 

f^lt^iictans  ^7'  ^uraeons  Suppiu  Co. 
Metropolitan  Bldg. 

221  Sixteenth  Street  TAbor  0156 

DENVER 


50  of  ^ikica  i Prescription 

Service  to  ike  ^^oclorS  of  ^ke^enne 


ROEDEL^S 

PRESCRIPTION  DRUG  STORE 

CHEYENNE,  WYOMING 


We  Welcome  Members  of  the 
Medical  Profession 

PLza  J4ohi 

Under  Management  of 
Mrs.  Addie  A.  and  Edward  A.  Miller 
Proprietors 

ALL  OUTSIDE  ROOMS 
Comer  15th  and  Tremont 
A Stone’s  Throw  to  Medical  Buildings 

TAbor  5101  DENVER 


FAIRFAX  SANITARIUM 

Kirkland,  Wash. 

Situated  one  mile  north  of  Juanita 

TREATING  NERVOUS  AND 
MENTAL  DISEASES 

Beautiful  and  restful  surroundings  affording 
recreational  facilities.  Cottage  plan  for  segre- 
gation of  patients.  Insulin  and  Electro-shock 
Therapy  when  indicated. 

Attending  Physicians 
FREDERICK  LEMERE,  M.D. 

NATHAN  K.  RICKLES,  M.D. 

JAMES  H.  LASATER,  M.D. 

MORTON  E.  BASSAN,  M.D. 

JACK  J.  KLEIN,  M.D. 

Manager:  A.  G.  HUGHES 
Route  2,  Box  365,  Kirkland 
Phone:  Kirkland  2391 


^ • Preferred  and  Common  Stocks 

* Industrial  Bonds 

* Public  Utility  Bonds 

* Railroad  Bonds 

* Municipal  Bonds 

* Government  Bonds 

Peters,  Writer  & Christensen 

Inc. 

Investment  Bankers 

601-8  U.  S.  National  Bank  Bldg.,  Denver 

MAin  6281  ^ 

256 


Rocky  Mountain  Medical  Journal 


Qolorado  Springs  ^Psychopathic  Hospital 

A Private  Hospital  for  Nervous  and  Mental  Diseases 

Situated  in  a beautiful  valley  two  miles  south  of  Colorado  Springs,  which  is  nationally  known  as  a health 
center.  New  building  for  mild  cases  of  Functional  Neurosis,  affording  complete  classification  of  patients. 
Home-like  surroundings,  scientific  medical  treatment  and  nursing  care.  Booklet  and  rotes  on  application. 

C.  F.  Rice,  Superintendent,  Colorado  Spiinse,  Colorado 


If  You  Send  Out  Statements 

ir  4 

ROCKMONT  Statement  Envelopes  save  time  in  your 
office  and  make  it  easy  for  the  patient  to  remit. 

The  statement  is  an  envelope  addressed  back  to  your 
office  and  goes  out  to  the  patient  in  a crystalite  window 
envelope,  thus  saving  one  complete  addressing  opera- 
tion, for  your  secretary.  All  the  patient  has  to  do  is 
simply  insert  check  and  mail. 

For  those  slow-pay  patients,  ROCKMONT 
COLLECTELOPES”  will  get  results.  Three  colors 
identify  the  message  of  collection.  Proved  copy  brings 
payment  in  fast,  without  offending. 


and 

SPEEDS  UP 
COLLECTIONS! 


SPECIAL  OFFER  . . . ask  for  Assortment  "X"  . . . 500  Statement  envelopes,  plus 
500  "Collectelopes"  plus  7,000  window  envelopes  ALL  FOR  ONLY  $20.26  postpaid! 

Price  includes  imprinting 


ROCKMONT  ENVELOPE  COMPANY 

Alameda  and  Cherokee  * PEari  2848  * Denver,  Colorado 


for  March,  1949 


257 


REAGENTS-MADE  TO  ORDER 

STAINS  (Liquid  or  Dry)  — STANDARD  SOLUTIONS 
REAGENTS  FOR  ALL  TYPES  OF  COLORIMETERS 
INDICATORS  — SPECIAL  SOLUTIONS 

With  our  competent  laboratory  staff,  we  stand  ready  to  offer  you  the  best 
solutions  obtainable  in  the  Rocky  Mountain  Region. 

Materials  prepared  in  our  laboratoi-y  are  quality  controlled.  They  are 
being  checked  independently  and  periodically. 

Order  with  confidence,  order  from: 

Denver  FireClayCompany 

DENVER  COLO.U.&A- 


COLVIN-Medical  Books 

Medical  Publications  of  All  Publishers 
Books  Sent  for  Examination  on  Request 
We  Maintain  This  Book  Store  for  Your  Convenience 
Books  Make  Fine  Christmas  Gifts 
Write  or  Come  to 
705-706  MAJESTIC  BUILDING 

Denver  2,  Colorado  Call  MAin  3866 


H.  C.  Stapleton  Drug  Company 

Service  Wholesalers  for  the  Prescription  Department 
RAPID— INTELLIGENT— SERVICE 

1252-54  Arapahoe  St.,  Denver,  Colo.  Phone  MAin  4152 


The  Fairhaven  Maternity  Hospital 

Mrs.  H.  E.  Lowther,  Superintendent 

Seclusion  for  the  unwed  mother.  Write  for  descriptive  booklet. 

1349  JOSEPHINE  EAst  9944  DENVER 


258 


Rocky  Mountain  Medical  Journal 


for 


Unusual 

superior 


features 

radiography 


For  any  diagnostic  requirement  ...  in  office, 
clinic  or  hospital  . . . the  Keleket  W-3  100 
Combination,  using  single  or  double  tube,  offers 
exceptional  convenience  and  economy. 

Among  features  not  usually  foimd  in  X-ray 
equipment  of  this  capacity,  the  W-3  100  unit 
includes  the  famous  Keleket  Multicron  100  gen- 
erator, double  rail-mounted  tube  stand  with 
telescopic  carriage  and  choice  of  hand  or  motor 
driven  tilt-table. 


The  table,  for  example,  is  easily  moved  from 
Trendelenburg  to  vertical  position — regardless 
of  patient’s  weight.  Angulating  scales  make  ex- 
act positioning  and  re-positioning  quick  and  easy, 
A positive  clutch  stops  the  table  at  any  point 
desired. 

Permitting  greatly  simplified  technics,  these 
and  other  Keleket  features  recommend  the  W-3 
100  Combination  for  your  practice.  Ask  your 
Keleket  Representative  for  complete  details  or 
write  for  literature. 


GEO.  BERBER!  & SONS,  INC. 

1524-1530  Court  Place 
Denver  2,  Colorado 


for  March,  1949 


259 


^lAJoodcro^t  J^oApitai—Jf^ueLloy  CoioraJti 


o 


A private  hospital  for  the  scientific  treatment  of  neuro-psychiatric  disorders,  including 
alcoholism  and  drug  addiction.  Beautiful  landscaping  and  home-like  surroundings  afford 
a restful  atmosphere.  Accommodations  vary  from  single  rooms  with  or  without  bath  to 
rooms  en  suite,  allowing  for  segregation  of  guests. 


Detailed  information  furnished  on  request. 


Karl  J.  Waggener,  M.D. 


Wendell  T.  Wingett,  M.D. 


THE  CHILDREN’S  HOSPITAL  ASSOCIATION 

of  DENVER 


NON-SECTARIAN NON-PROFIT 


Providing  medicinal  and  surgical  aid  to  sick  and  crippled  children  of  the  Rocky 
Mountain  Region  from  Birth  to  Maturity 

Every  modern  scientific  aid  available  to  the  physicians  and  surgeons 
of  Colorado  and  Wyoming 

Approved  by  the  American  Medical  Association  and  Full  Three-Year 

the  American  College  of  Surgeons  Nurses’  Training  Course 


260 


Rocky  Mountain  Medical  Journal 


THIS  IS  YOUR  SERVICE- 
WHY  NOT  USE  IT? 


Men  of  science  and  medicine  agree  that  the  functional  efficiency  of  any 
piece  of  technical  apparatus  depends  in  large  measure  upon  the  service 
^facilities  maintained  by  the  organization  selling  it. 


When  you  place  your  orders  for  scientific  instruments  with  us,  you  have 
the  assurance  that  experienced  technicians  will  always  be  available  to  pro- 
vide capable  service,  promptly  and  efficiently. 


We  list  below  just  a few  of  the  products  we  sell  and  service: 


Electrocardiographs 
Photoelectric  Colorimeters 
Warburg  Apparatus 
pH  Meters 
Microscopes 
Laboratory  Ovens 
Laborotory  Furniture 
Metabolators 
Operating  Room  Lights 
Woter  Stills 


Electroencephalographs 

Spectrophotometers 

Dubnoff  Metobolic  Shaking  Incubators 
Analytical  Balances 
Photomicrographic  Equipment 
Laboratory  Incubators 
Hospital  Furniture 
Resuscitators 

Autoclaves  and  Sterilizers 
Anesthesia  Apparatus 


Biological  and  Blood  Bank  Refrigerators 
X-Ray  Equipment — Diagnostic  and  Therapy 
X-Ray  Diffraction  Spectrometers 

Films — Dark  Room  Accessories — Protective  Equipment 
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for  March,  1949 


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Index  to  Advertisers 


Page 


Page 


Page 


Abbey  Rents 264 

Abbott  Laboratories 231 

Alba  Dairy 251 

American  Ambulance  Co 252 

American  Meat 185 

American  Medical  and  Dental 

Association 184 

Ayerst,  McKenna  & Harrison  243 

Baxter,  Don Cover  HI 

Berbet  & Sons,  Inc 259 

Bilhufer-Knoll  Corp 253 

Blair  Surgical  Supply 249 

Bonita  Pharmacy 256 

Bonnie-Brae  Drug , 254 

Borden  Co. 192 

Brecht’s ■ 252 

Brown  Schools 252 

Cambridge  Dairy 180 

Camel  Cigarette 183 

Camp  & Co.,  S.  H 235 

Capital  Chevrolet 180 

Capitol  Life  Insurance  Co 248 

Cascade  Laundry 246 

Children’s  Hospital 

Association 260 

City  Park  Dairy 186 

Cleveland  Pharmacy 255 

Coca-Cola  253 

Colburn  Hotel 246 

Colorado  Springs 

Psychopathic  Hospital 257 

Colvin  Medical  Books 258 

Cook  County  Graduate 

School  of  Medicine 248 

Corbin’s,  Ed  Drug  Store 248 

Country  Club  Pharmacy 254 

Cutter  Laboratories 227 

Dansberry’s  Pharmacy 255 

Deep  Rock  Water 251 

Denver  Chemical  Mfg.  Co 250 

Denver  Fire  Clay  Co. 258 

Denver  Oxygen  Co J8S 


Denver  Surgical  Supply  Co. — 251 


Dorr  Optical  Co 190 

Downing  Street  Pharmacy 255 

Doyle’s  Pharmacy 254 

Dryer  and  Astler 244 

Earnest  Drug'  Co 254 

Ehret  Engraving'Co 188 

Fairfax  Sanitarium 256 

Fairhaven  Maternity 

Hospital 258 

Franklin  Drug  Co 255 

Gabriel  Restaurant 246 

Glockner  Penrose 

Hospital 264 

Hatch  Pharmacy 254 

Holland  Rantos 191 

Hyde’s  Pharmacy 254 

Jackson's  Cut  Rate  Drug 244 

Karg  Paint  Co 246 

Kendrick-Bellamy  Co 178 

Lakewood  Pharmacy 255 

Lederle 229 

Lilly,  Eli  & Co. 

Insert  between 192-193 

Livermore  Sanitarium 1 247 

Lov-e  Brassiere  Co 241 

M & R Dietetic  Labs 179 

Mead,  Johnson 

& Co Cover  IV 

Merck  & Co..  Inc 237 

Mercy  Hospital 164 

Morning  Milk 169 

Nestles  Co. 187 

Newton  Optical  Co 244 

Nurses  Official  Registry 252 

Overstake’s  Pharmacy 255 

Park  Floral  Co 188 

Parke,  Davis  & Co Cover  II  177 

Peters,  Writer 

and  Christensen 256 

Pfab  Pharmacy 254 

Philip  Morris 239 


Physicians  and  Hospital 
Supply  Co 245 

Physicians  and  Surgeons 

Supply  256 

Physicians  and  Surgeons 

Telephone  Service  Exch 244 

Physicians  Casualty  Co 250 

Plaza  Hotel 256 

Professional  Pharmacy 255 

Public  Service  Co 262 


Roche  Ambulance  Service 251 

Rockmont  Envelope  Co 257 

Roedel’s  Prescription  Drug___256 

Sandoz  Chemical  Works 247 

Sobering  Corporation 189 

Searle  & Co.,  G.  D 225 

Shadel  Sanitarium 233 

Shaford-Fletcher  Optical  Co._186 

Shumake  Drug,  Guido 254 

Snow’s  Furniture  and 
Appliance  Co 244 

Stapleton  Drug  Co 25  8 

Stodghill’s  Imperial 
Pharmacy  ^86 

Taylor,  M.  F.,  Laboratories 244 

Technical  Equipment 
Corporation  261 


Telephoning  Answering 
Service  

Thornton,  George  R 

United  States  Brewing 


Industry  242 

Van’s  Pharmacy 255 

Van  Schaack  & Co 262 

Walters  Drug  Store 255 


Weiss  Drug 255 

Weiss,  Paul  264 

Western  Electric 

Hearing  Aids 264 

Western  Newspaper  Union 248 

Wheatridge  Farm  Dairy 244 

Whittaker’s  Pharmacy 254 

Winthrop-Stearns,  Inc 181 

W'oodcroft  Hospital 260 

York  Pharmacy 251 


for  March,  1949 


263 


OXYGEN  SERVICE 

MASKS  — CATHETERS  — CONE 


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Rocky  Mountain  Medical  Journal 


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IT 


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The  Chemotherapy  of  Cancer — B.  J.  Duffy,  Jr., 
M.D.,  New  York  City. 


Familial  Leg  Ache  in  Children — E.  M.  Jeppson, 
M.D.,  Salt  Lake  City. 

Acute  Intussusception  Due  to  Torsion  of 
Meckel’s  Diverticulum  — G.  J.  Harmston, 
M.D.,  and  W.  E.  Cragun,  M.D.,  Logan,  Utah. 

Management  of  Acute  Cholecystitis — Edgar  W. 
Barber,  M.D.,  Denver. 

The  Distribution  of  Physicians  and  Physicians’ 
Services  in  Colorado  in  1948 — H.  J.  Dodge, 
M.D.,  Merle  M.  Clapper,  and  Ward  Darley, 
M.D.,  Denver. 

Jejuno-Ileal  Diverticula — Randolph  E.  Watts, 
M.D.,  and  Samuel  M.  Ramer,  M.D.,  Silver 
City,  New  Mexico. 

Further  Experience  With  Methergine  as  an 
Oxytocic — M.  J.  Baskin,  M.D.,  Denver. 

(For  Complete  Table  of  Contents,  Turn  the 
First  Page) 


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Table  of  Contents 

VOLUME  46  NUMBER  4 

APRIL,  1949 


Editorials  Page 

Fourteenth  Annual  Midwinter  Clinics 281 

A Logical  and  Totally  Selfish  Deduction 281 

Medical  Service  to  the  Armed  Forces 282 

Silhouettes  From  the  A.M.A.  House  of 

Delegates  282 

Free  Medical  Care?  Insmance  Takes  Half 
Her  Salary  283 


Original  Articles 


The  Chemotherapy  of  Cancer,  B.  J.  Duffy, 

Jr.,  M.D 284 

Familial  Leg  Ache  in  Children,  E.  M.  Jepp- 

son,  M.D 288 

Acute  Intussusception  Due  to  Torsion  of 
Meckel’s  Diverticulum,  Operation  and 
Recovery,  G.  J.  Harmston,  M.D.,  and  W. 

E.  Cragun,  M.D 291 

Management  of  Acute  Cholecystitis,  Edgar 
W.  Barber,  M.D 293 


The  Distribution  of  Physicians  and  Physi- 
cians’ Services  in  Colorado  in  1948^  III, 
Other  Licensed  Practitioners  of  the  Heal- 
ing Arts  and  the  Effects  of  the  Colorado 
Basic  Science  Law,  H.  J.  Dodge,  M.D., 
Merle  M.  Clapper,  and  Ward  Darley, 


M.D 296 

Jejuno-Ileal  Diverticula,  A Review  of  the 
Literature  and  Case  Reports,  Randolph 
E.  Watts,  M.D.,  and  Samuel  M.  Ramer, 

M.D , 301 

Further  Experience  with  Methergine  as  an 
Oxytocic,  M.  J.  Baskin,  M.D 304 


Case  Report 

Surgical  Gastro -Ileostomy,  W.  R.  Cop- 

pinger,  M.D.,  and  P.  M.  Ireland,  M.D 306 

Recent  Impressions  of  Medical  Practice  in 
Great  Britain,  William  H.  Sweet,  M.D 307 

-t- 

Organization 

Colorado 

“Knave  of  Hearts”  Wins  duPont  Award..310 
Presidents  and  Secretaries  Meet  in  Den- 


ver   310 

Component  Societies  312 

Obituary  312 

Auxiliary 312 

New  Mexico 

New  Mexico  Medical  Society  Convention  314 
New  Mexico  Clinical  Society 316 

Utah 

The  Second  Cancer  Sympo.sium 318 

The  Ogden  Surgical  Society 319 

Wyoming 

Wyoming  Annual  Session 320 

Tuberculosis  Abstracts  322 

Book  Corner  326 


266 


Rocky  Mountain  Medical  Journal 


r 

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promotes 
rqtion  . . . free  «irainago; 
in  coids  ^ 


sinusitis 


Nasal  engorgement  and  hypersecretion 
accompanying  the  common  cold  and  sinusitis  are 
cpiickly  relieved  by  the  vasoconstrictive  action  of 


Nasal  membrane  showing  increased 
leukocytes  with  denudation  of  cilia. 


Normal  appearing  nasal  epithelium. 


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Relatively  nonirritating  . . . Virtually  no  central 
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ROCKY  MOUNTAIN  MEDICAL  JOURNAL 

Title  Registered.  U.S.  Patent  Office 
Publication  Office: 

835  Republic  Building  (1612  Tremont  Place),  Denver  2,  Colorado 
Telephone  C Kerry  5521. 

EDITORIAL  BOARD 

Colorado:  Douglas  W.  Macomber,  M.D.,  Scientific  Editor,  1820  Gilpin  St.,  Denver;  Lyman  W.  Mason, 
M.D.,  Associate  Editor,  1214  Republic  Bldg.,  Denver,  (Chairman  of  Editorial  Board). 

Montana:  Raymond  F.  Peterson,  M.D.,  Scientific  Editor,  Butte,  Mont.;  Herbert  T.  Caraway,  M.D., 
Associate  Editor,  Billings,  Mont. 

New  Mexico:  Carl  H.  Gellenthein,  M.D.,  Scientific  Editor,  Valmora,  New  Mexico;  Harold  L.  Janu- 
ary, M.D.,  Associate  Editor,  First  National  Bank  Bldg.,  Albuquerque,  New  Mexico. 

Utah:  Richard  P.  Middleton,  M.D.,  Scientific  Editor,  Boston  Bldg..  Salt  Lake  City;  W.  H.  Tibbals, 
Associate  Editor,  42  South  Fifth  East  St.,  Salt  Lake  City. 

Wyoming:  Earl  Whedon,  M.D.,  Scientific  Editor,  Sheridan;  Arthur  R.  Abbey,  Associate  Editor,  P.O. 
Box  897,  Cheyenne. 


Managing  Editor:  Harvey  T.  Sethman,  835  Republic  Bldg.,  Denver. 


Business  Manager:  Helen  Kearney,  835  Republic 

Ownership  and  Sponsorship:  The  Rocky  Mountain 
Medical  Journal  Is  owned  by  the  Colorado  State 
Medical  Society  and  Is  published  monthly  as  a non- 
profit enterprise  for  the  mutual  benefit  of  the  or- 
granlzatlons  which  Jointly  sponsor  it.  It  is  published 
under  the  direction  of  the  Board  of  Trustees  of  the 
Colorado  State  Medical  Society,  assisted  by  an  Edi- 
torial Board  representing:  the  sponsoring:  organiza- 
tions. It  is  the  Official  Journal  of  the  Colorado  State 
Medical  Society,  the  Montana  State  Medical  Associa- 
tion, the  New  Mexico  Medical  Society,  the  Utah 
State  Medical  Association,  the  Wyoming  State  Medi- 
cal Society,  the  Rocky  Mountain  Medical  Conference, 
and  the  Colorado  Hospital  Association. 

Manuscripts:  Scientific  Articles,  Case  Reports,  etc., 
from  any  state  for  which  this  is  the  Official  Journal 
should  be  submitted  to  the  Scientific  Editor  for  that 
state  as  named  in  the  Editorial  Board,  above.  Other 
material  from  any  participating  state  should  be  sub- 
mitted to  the  Associate  Editor  for  that  state  as 
named  above.  Manuscripts  from  outside  the  Rocky 
Mountain  area  should  be  sent  direct  to  the  Journal 
office.  Manuscripts  must  be  typewritten,  double  or 
triple  spaced,  using  only  one  side  of  each  sheet.  It 
is  the  policy  of  this  Journal  to  omit  bibliographies. 


Bldg.,  Denver. 

Advertising:  National  representatives:  The  Coop- 
erative Medical  Advertising  Bureau,  635  North  Dear- 
born Street,  Chicago  10,  111.  Local  advertising  from 
firms  in  the  Rocky  Mountain  area  should  be  submit- 
ted to  the  Associate  Editor  of  the  appropriate  state 
or  to  the  Journal  office.  Advertising  forms  close  on 
the  20th  of  the  month  preceding  publication;  allow 
ten  days  additional  to  insure  submitting  proofs  for 
approval. 

Subscription:  $2.50  per  year  in  advance,  postpaid  in 
the  United  States  and  its  possessions;  single  copy. 
25  cents  plus  postage.  Subscription  is  included  in 
medical  society  dues  of  sponsoring  state  medical 
organizations. 

Copyright;  This  Journal  is  copyright,  1949,  by  the 
Colorado  State  Medical  Society.  Requests  for  permis- 
sion to  reproduce  anything  from  the  columns  of  this 
Journal  should  be  addressed  to  the  Journal  office. 

Second  Class  Matter:  Entered  as  second  class  mat- 
ter Jan.  22,  1906,  at  the  Postoffice  at  Denver,  Colo., 
under  the  Act  of  Congress  of  March  3,  1879.  Accepted 
for  mailing  at  special  rates  of  postage  provided  for 
in  Section  1103,  Act  of  Oct.  3,  1917;  authorized  July 
17,  1918. 


Essential  Automobiles  Given  Priority — We  Recommend 

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Phone:  TAbor  5191  13th  Ave.  at  Broadway  to  Lincoln  Denver,  Colo. 


Don't  miss  important  telephone  calls 

Let  us  act  as  your  secretary  while  you  are  away,  day  or  night: 
our  kindly  voice  conscientiously  tends  your  telephone  business, 
accurately  reports  to  you  when  you  return. 

Telephone  ANSWERING  Service  CALL  ALpine  1414 


Cambridge  Dairy  Grade  “A”  Milk  Is  Produced  and  Processed  af  690  S.  Colo.  Blvd. 

We  do  not  handle  Shipped-in  Milk  produced  Where?  How  and  by  Whom?  Doctors  know  the  difference 
Now  Homogenized  Vitamin  D Milk  is  available  for  baby  feeding  and  family  use. 

We  Invite  Your  Inspection  and  Appreciate  Your  Recommendation. 


How  mild  can  a cigarette  he  ? 


According  to  a 

Adafionwie/e  surv^'. 

More  Doctors 


SMOKE  Camels 


than  any  other  cigarette 


Doctors  smoke  for  pleasure,  too!  And  when  three  leading  independent 
research  organizations  asked  113,597  doctors  what  cigarette  they  smoked, 
the  brand  named  most  was  Camel! 


j/^i  a recent  coast -to-coast 
test,  hundreds  of  men  and 
women  smoked  Camels — 
and  only  Camels — for  30 
consecutive  days.  These 
people  smoked  on  the  aver- 
age of  one  to  two  packs  a 
day.  Each  week,  during  the 
entire  test  period,  throat 
specialists  examined  these 
Camel  smokers.  A total  of 
2470  careful  examinations 
were  made.  The  doctors 
who  made  the  throat  exam- 
inations of  these  Camel 
smokers  reported: 

“NOT  ONE 
SINGLE  CASE  OF 
THROAT  IRRITATION 
due  to  smoking 
CAMELS!” 


Smoke  Camels  and  test  them  in  your 
own  “T-Zone”  — T for  taste,  T for 
throat.  If,  at  any  time,  you  are  not 
convinced  that  Camels  are  the  mildest 
cigarette  you  have  ever  smoked,  re- 
turn the  package  with  the  unused  1 

Camels  and  we  will  refund  its  full 
purchase  price,  plus  postage.  (Signed) 

R.  J.  Reynolds  Tobacco  Company, 
Winston-Salem,  North  Carolina. 


for  April,  1949 


269 


THE  COLORADO  STATE  MEDICAL  SOCIETY 


Next  Annual  Session:  Shirley-Savoy  Hotel,  Denver;  Sept.  20,  21,  22,  23,  1949 


OFFICERS 

Terms  of  Officers  and  Committees  expire  at  the  Annual  Session 
in  the  year  Indicated.  Where  no  year  is  indicated,  the  term 
is  for  one  year  only  and  expires  at  the  1919  Annual  Session. 

President:  Casper  F.  Hegner,  Denrer. 

President-elect:  Fred  A.  Humphrey,  Fort  Collins. 

Vice  President:  Lester  L.  Ward,  Pueblo. 

Constitutional  Secretary  (three  years) : George  B.  Buck,  Denrer,  1951. 
Treasurer  (three  years):  George  C.  Shivers,  Colorado  Springs,  1950. 

Additional  Trustees  (three  years):  Ervin  A.  Hinds,  Denver,  1949;  E,  H. 
Munro,  Grand  Junction,  1949;  S.  P.  Newman,  Denver,  1950;  Claude  D. 
Bonham,  Boulder,  1951. 

(The  above  nine  officers  compose  the  Board  of  Trustees  of  which  Dr. 
Ervin  A.  Hinds  is  the  1948-1949  Chairman.) 

Board  of  Councilors  (three  years):  District  No.  1:  Clemens  F.  Eaklns, 
Brush,  1951;  No.  2;  Ella  A.  Mead,  Greeley,  1951;  No.  3:  L.  G.  Crosby, 
Denver,  1951;  No.  4;  Lannlng  E.  Likes,  Lamar,  1950;  No.  5;  Guy  H. 
Hopkins.  Pueblo,  1950;  No.  6;  Lester  E.  Thompson,  Sallda,  1950;  No.  7; 
A.  L.  Burnett,  Durango,  1949;  No.  8;  Lawrence  L.  Hick,  Delta,  1949; 
No.  9:  W.  W.  Sloan,  Hayden,  1949  (Chairman  of  Board  for  1948-49). 

Board  of  Sopervison  (two  years):  A.  B.  GjeUum,  Del  Norte,  1949;  L.  W. 
Lloyd,  Durango,  1949;  B.  0.  Howlett,  Golden,  1949;  Scott  A.  Gale, 
Pueblo,  1949;  L.  D.  Dickey,  Fort  ColUns,  1949;  N.  A.  Madler,  Greeley, 
1949  (Chairman  of  Board  for  1948-49);  L.  D.  Buchanan,  Wray,  1950; 
W.  F.  Deal,  Craig,  1950;  0.  C.  Cary,  Grand  Junction,  1950;  W.  A. 
Campbell,  Colorado  Springs,  1950;  Balph  S.  Johnston,  Sr.,  La  Junta, 
1950;  William  A.  Liggett,  Denver,  1950. 

Delegates  to  American  Medical  Association  (two  years) : George  A.  Unfug, 
Pueblo,  1949  (Alternate:  Herman  C.  Graves,  Grand  Junction,  1949); 
William  H.  Halley,  Denver,  1960  (Alternate:  Kenneth  C.  Sawyer.  Denver, 
1950). 

Foundation  Advocate:  Walter  W.  King,  Demw. 

^kecutlve  Office  Staff:  Mr.  Harvey  T.  Setbman,  Executive  Secretary; 
Miss  Helen  Kearney,  Assistant  Executive  Secretary;  Mr.  Evan  A.  Edwards, 
Field  Secretary;  Miss  Mary  E.  McDonald,  Committee  Secretary;  835  Be- 
publlc  Building,  Denver  2,  Colo.,  Telephone  CHerry  5521. 

General  Counsel:  Mr.  J.  Peter  Nordlund,  Attomey-at-Law,  Denver. 

STANDING  COMMITTEES 
Credentials:  George  B.  Buck,  Denver,  Chairman,  ex-offielo;  others  to 
be  appointed. 

Public  Policy:  Kenneth  C.  Sawyer,  Denver,  Chairman;  McKlnnle  L. 
Phelps,  Denver,  Vice  Chairman;  John  S.  Bouslog,  Denver;  F.  B.  Calhoun, 
Denver;  Frank  B.  McGlone,  Denver;  T.  M.  Rogers,  Sterling;  Sidney  An- 
derson, Alamosa;  Blcbard  L.  Davis,  La  Junta;  Herman  C.  Graves,  Grand 
Junction;  John  L.  McDonald,  Colorado  Springs;  George  E.  Rice,  Pueblo; 
John  D.  Gillaspie,  Boulder.  Ex-Officio  members:  Casper  F.  Hegner,  Presi- 
dent: Fred  A.  Humphrey,  President-elect;  George  B.  Buck,  Constitutional 
Secretary. 

Sob-Committee  on  Legislation:  H.  I.  Barnard,  Denver,  Chairman;  others 
to  be  appointed. 

Health  Education  (two  years) ; A.  C.  Sudan,  Denver,  Chairman,  1949; 

J.  D.  Bartholomew.  Boulder,  1949;  R.  J.  Savage,  Denver,  1949;  R.  T. 
Porter,  Greeley,  1949;  Robert  B.  Bradshaw,  Alamosa,  1949;  L.  W.  Bortree, 
(kilorado  Springs,  1950;  F.  0.  Robertson,  Denver,  1950.;  J.  L.  Sadler,  Fort 
Collins,  1950;  Harold  T.  Low,  Pueblo,  1950;  John  H.  Amesse,  Denver, 
1950:  E.  H.  Munro,  Grand  Junction,  1950. 

Scientific  Work:  W.  B.  Condon.  Denver.  Chairman;  Robert  S.  Liggett, 
Karl  F.  Arndt,  Frank  T.  Joyce.  Marshall  G.  Nims,  Vincent  G.  Cedar- 
blade,  all  of  Denver. 

Sub-Committee  on  Scientific  Exhibits:  Frank  C.  Campbell,  Chairman; 
Nolle  Mumey.  Edgar  W.  Barber,  R.  W.  Vines,  all  of  Denver. 

Arrangements;  To  be  appointed. 

Medicoiegal  (two  years):  R.  W.  Arndt,  1960,  Chairman;  George  B. 
Packard,  Jr.,  1050;  K.  D.  A.  Allen,  1950.;  C.  S.  Bluemel,  1949;  Lyman 
W.  Mason,  1949;  Harry  C.  Hughes,  1949;  all  of  Denver. 

Medical  Education  and  Hospitals:  George  F.  Wollgast,  Denver,  Chairman; 
W.  W.  Sloan,  Hayden:  F.  R.  Pingrey,  Durango;  E.  B.  Mugrage,  Denver; 
D.  W.  McCarty,  Longmont;  A.  E.  Lubchenco,  Denver. 

Library  and  Medical  Literature:  A.  J.  Markley,  Denver,  Chairman;  T.  E. 
Beyer,  Denver;  J.  J.  Connor,  Delta;  H.  Dumont  Clark,  Denver. 

Medical  Service  Plans;  F.  H.  Good,  Denver,  Chairman;  C.  E.  Honsteln, 
Fort  Collins;  James  B.  Blair,  Denver;  Vernon  L.  Bolton,  Colorado  Springs; 
Scott  A,  Gale,  Pueblo;  John  A.  Weaver,  Jr.,  Greeley;  John  E.  ^land, 
Monte  Vista;  Thomas  K.  Mahan,  Grand  Junction. 

Necrology:  W.  H.  Wilson,  Denver,  Chairman. 

PUBLIC  HEALTH  COMMITTEES 

General  Committee  on  Public  Health:  Consists  of  the  chairmen  of  the 
following  eleven  public  health  subcommittees,  presided  over  by  Robert  W. 
Dickson,  Denver,  as  General  Chairman. 

Cancer  Control:  J.  C.  Mendenhall,  Denver,  Chairman;  John  B.  Grow, 
Denver;  S.  W.  Holley,  Greeley;  T.  Leon  Howard,  Denver:  James  B.  Mc- 
Naugbt,  Denver;  Roger  G.  Howlett,  Golden;  James  W.  McMullen,  Colorado 
Springs;  James  E.  Donnelly,  Trinidad;  Lanning  E.  Likes,  Lamar;  Thomas 

K.  Mahan.  Grand  Junction. 


Crippled  Children:  I.  E.  Hendryson,  Denver.  Chairman;  Mary  L.  Moore, 
Grand  Junction:  Richard  H.  Mellen,  Colorado  Springs;  Sidney  E.  Bland- 
ford.  Jr..  Denver;  Paul  R.  Hildebrand.  Brush;  Samuel  P.  Newman,  Denver. 

Industrial  Health:  R.  F.  Bell,  Louviers.  Chairman;  A.  R.  Woodbume, 
Denver;  Vincent  E.  Kelly,  Leadville;  D.  W.  Boyer,  Pueblo;  H.  G.  Harvey,  Jr., 
Denver:  Robert  Woodruff,  Denver;  Frank  J.  McDonough,  Grand  Junction. 

Local  Health  Units:  Monroe  R.  Tyler,  Denver,  Chairman;  Harold  E. 
Raymond,  Greeley;  R.  B.  Richards,  Fort  Morgan;  Nicholas  S.  Saliba,  Wal- 
senburg;  Marvel  L.  Crawford,  Steamboat  Springs;  B.  Sberwln  Johnston,  Jr., 
La  Junta. 

Maternal  and  Child  Health;  John  R.  Evans,  Denver,  Chairman;  Joseph 
H.  Lyday,  Denver;  John  M.  Nelson,  Denver;  Tracy  D.  Peppers,  Greeley; 
J.  H.  Woodbrldge,  Puebla;  M.  E.  Snyder,  Colorado  Springs. 

Mental  Hygiene:  Bradford  Murpbey,  Denver,  Chairman;  E.  James  Brady, 
Colorado  Springs;  Frank  H.  Zimmerman,  Pueblo;  Paul  A.  Draper,  Colorado 
Springs;  J.  P.  Hilton,  C.  S.  Bluemel,  John  M.  Lyon,  0.  H.  Ashley,  Lewis 
C.  Overholt,  Clarke  H.  Barnacle,  Harold  R.  Carter,  aU  of  Denver. 

Milk  Control:  George  W.  Stiles,  Denver,  Chairman;  Max  M.  Qlnsbuig, 
Denver;  N.  J.  Miller,  D.V.M.,  Eaton;  Millard  F.  Schafer,  Colorado  Springs; 
Robert  W.  Vines,  Denver;  Mr.  Wendell  Vincent,  Denver. 

New  Hospital  Construction:  D.  R.  Collier,  Wheatrldge,  Chairman; 
Henry  M.  Powell,  Colorado  Springs;  Mr.  John  B.  Peterson,  Fort  ColUni; 
Florence  R.  Sabin,  Denver;  Herbert  A.  Black,  Pueblo. 

Public  Water  Supplies:  E.  I.  Dobos,  Denver,  Chairman;  Robert  Barnard, 
Eagle;  William  C.  Shontz,  San  Luis;  Carl  W.  Maynard,  Pueblo;  W.  B. 
Crouch,  Colorado  Springs:  H.  D.  Palmer,  Denver;  E.  Robert  Orr,  Fruita. 

Tuberculosis  Control:  John  I.  Zarit,  Denver,  Chairman;  W.  J.  Hlnael- 
man,  Greeley:  H.  M.  .Van  Der  Schouw,  Wheatrldge;  John  P.  McGraw,  Pueblo; 
Arthur  Rest,  Denver;  H.  Calvin  Fisher,  Denver;  T.  D.  Cunnlngbam,  Denver. 

Venereal  Disease  Control:  Sam  W.  Downing,  Denver,  Chairman;  Paul  B. 
Stidham,  Grand  Junction;  H.  E.  Coakley,  Pueblo;  D.  E.  Newland,  Denver; 
Joseph  H.  Patterson,  Denver;  James  R.  McDowell,  Denver. 

SPECIAL  COMMITTTES 

Rocky  Mountain  Medical  Conference  (five  years) : L.  Clark  Hepp,  Denver, 
1953;  G.  P.  Lingenfelter,  Denver,  1952,  Chairman;  Ward  Darley,  Denver, 
1951;  L.  W.  Bortree,  Colorado  Springs,  1950;  George  H.  Gillen,  Denver, 
1949. 

Advisory  to  Auxiliary:  Fred  A.  Humphrey,  Fort  Collins,  Chairman;  Ervin 
A.  Hinds,  George  B.  Buck,  Denver. 

Midwinter  Clinics:  Samuel  B.  Childs,  Jr.,  Chairman;  Raymond  C.  Chat- 
field,  E.  L.  Binkley,  Jr.,  A.  J.  Kauvar,  Terry  J.  Gromer,  all  of  Denver. 

Rehabilitation:  W.  W.  Haggart,  Denver,  Chairman;  Atha  Thomas,  Den- 
ver; Lawrence  T.  Brown,  Denver;  J.  E.  A.  Connell,  I^eblo;  Thad  P.  Sean, 
Ft.  Logan;  Kenneth  C.  Sawyer,  McKlnnie  L.  Phelps,  (korge  B.  Bud, 
Bradford  Murpbey,  all  of  Denver. 

Advisory  to  the  Goodwill  Industries’  Rehabilitation  Program:  Lewla  C. 
Overholt,  Chairman;  William  H.  HaUey,  Maurice  Katzman,  Terry  J. 
Gromer.  Lorenz  W.  Frank,  William  B.  Lipscomb,  IrvlD  E.  Hendnmon, 
all  of  Denver. 

Rural  Hdalth  Commission:  Leonard  N.  Myers,  Cheyenne  Wella,  Chairman; 
V.  V.  Anderson,  Del  Norte;  James  S.  Orr,  Fruita;  Kdth  F.  Krauanlek, 
Lamar;  Robert  M.  Lee,  Fort  CoUlns.  Ex-officio  member:  Fred  A.  Hum- 
phrey, Fort  Collins. 

Medical  Disaster  Commission:  Foster  Matchett,  Denver,  Chairman;  Karl 
Arndt,  Denver,  Secretary:  Mark  S.  Donovan,  Harry  C.  Hughes,  Adolph  J. 
Kafka,  Roderick  J.  McDonald,  William  F.  Stanok,  Henry  Swan,  Karl  F. 
Sunderland,  K.  D.  A.  Allen,  aU  of  Denver;  Lawrence  W.  Holden,  Boulder; 
Richard  H.  Mellen.  Colorado  Springs;  Richard  H.  Altmlx,  Englewood;  Jacob 
0.  Mall,  Estes  Park;  Thad  P.  Sears,  Fort  Logan;  Donald  E.  Cowen,  Fort 
Morgan;  Kenneth  E.  Prescott,  Grand  Junction;  Walter  A.  Schoen,  Greeley; 
David  W.  McCarty,  Longmont;  David  W.  Boyer,  Pueblo;  J.  G.  Espey,  Craig; 
Leo  W.  Loyd,  Durango;  Keith  F.  Krausnlck,  Lamar;  Robert  M.  Lee,  Ft  Col- 
lins; George  H.  Lord.  Aurora;  J.  Gordon  Hedrick,  Wray;  James  P.  Bigg, 
Grand  Junction. 

Lay  Organization  Standards:  George  R.  Buck,  Fredrick  H.  Good,  Ken- 
neth C.  Sawyer,  Frank  B.  McGlone,  T.  D.  Cunningham,  Bradford  Murpbey, 
Casper  F.  Hegner,  John  S.  Bouslog,  all  of  Denver. 

Study  of  Child  Welfare  Clinics:  Balph  H.  Verploeg,  Denver,  Chairman; 
J.  W.  White,  Pueblo:  Jackson  L.  Sadler,  Fort  Collins;  L.  E.  Maurer, 
Boulder;  Harvey  M.  Tupper,  Grand  Junction;  Harvey  S.  Busk,  Pueblo. 

Advisory  to  U.M.W.  Welfare  Fund  (Executive  Committee,  three-year 
terms;  others,  one-year):  Executive:  W.  W.  Haggart,  1951,  Chairman; 
F.  H.  Good,  1951;  J.  S.  Bouslog,  1951,  all  of  Denver;  W.  H.  Halley, 
1950;  C.  F.  Hegner,  1950,  both  of  Denver;  R.  F.  Bell,  1950,  Louviers; 
McKinnie  Phelp.s.  1949,  Denver;  F.  A.  Humphrey,  1949,  Fort  Collins; 
J.  M.  Lamme,  1949,  Walsenburg.  Other  members;  K.  C.  Sawyer,  A.  C. 
Sudan,  Bradford  Murpbey,  aU  of  Denver;  C.  D.  Bonham,  Boulder;  J.  W. 
Craighead,  Pueblo;  J.  E.  Donnelly,  Trinidad;  Ligon  Price,  Mt.  Harris;  M.  J. 
McCallum,  Erie. 

Liaison  to  Colorado  State  Nurses  Association:  John  R.  Evans,  Samuel  P. 

Newman,  Denver. 

Liaison  to  Colorado  Bar  Association:  W.  8.  Dennis,  Chairman;  A.  C. 
Sudan,  B.  W.  Arndt,  all  of  Denver. 

Medical-Dental  Liaison:  Guy  W.  Smith,  Denver,  Chairman;  George  R. 
Warner,  Denver;  Calvin  N.  CaldweU,  Pueblo. 

Representative  to  Rocky  Mountain  Radio  Council:  William  E.  Hay, 
Denver;  (Alternate:  Chaunoey  A.  Hager,  Denver). 

Representative  to  Belle  Eonfils  Memorial  Blood  Bank:  0.  S.  Pbllpott, 
Denver. 

Representatives  to  Liaison  Council  on  Graduate  Education  (two  years) : 

L.  R.  Safarik,  Denver,  1949;  Harold  I.  Goldman,  Denver,  1950. 

Delegate  to  Colorado  Interprofessional  Council  (five  years):  K.  D.  A. 
Allen,  Denver,  1949;  (Alternate,  Carl  A.  McLauthUn,  Denver,  1949). 


270 


Rocky  Mountain  Medical  Journal 


by  far  the  most  potent 

ORAL  ESTROGEN 

available  clinically 

In  ex^'‘^dingly  minute  doses— as  little  as  0.02  mg. 
y i/3200  gr.)  daily— Estinyl*  maintains 
the  average  menopausal  patient  free  of 
symptoms.  Even  when  initiating  therapy 
and  in  the  more  severe  cases,  unusually 
small  dosage— measured  in  hundredths 
of  a milligram— has  been  found  Ifective. 


(ETHINYL  ESTRADIOL) 

Estinyl,  a derivative  of  the  ovarian  follicular 
hormone,  estradiol,  evokes  the  sense  of  well-being 
characteristic  of  natural  hormone  therapy.  It 
acts  rapidly,  often  completely  controlling  climacteric 
syrnptoms  within  a few  days.  In  therapeutic 
dosage  side  effects  are  notably  infrequent.  Unique 
response  to  minimal  dosage  permits  effective 
estrogen  therapy  at  low  cost  to  patients. 

DOSAGE:  One  Estinyl  Tablet  (0.02  mg.  ) or  one  teaspoon- 
ful of  Estinyl  Liquid  (0.03  mg.)  daily,  may  be  prescribed, 
reducing  dosage  as  symptoms  subside. 

ESTINYL  Tablets,  0.02  (buff)  or  0.05  mg.  (pink),  in  bottles 
of  100,  250  and  1000. 

ESTINYL  Liquid,  0.03  mg.  per  4 cc.  (teaspoonful),  in  bottles 
of  4 and  16  oz. 


CORPORATION  . BLOOMFIELD,  NEW  JERSEY 

IN  CANADA,  SCHERING  CORPORATION  LIMITED.  MONTREAL 


MONTANA  STATE  MEDICAL  ASSOCIATION 

Next  Annual  Session:  Finlen  Hotel,  Aug.  1,  2,  3,  4,  1949 


OFFICERS 

Terms  of  Officers  and  Committees  expire  at  the  Annual  Session 
In  the  year  indicated.  Where  no  year  is  indicated,  the  term  is 
for  one  year  only  and  expires  at  1949  Annual  Session. 

President:  Thomas  L.  Hawkins,  Helena. 

President-elect:  Thomas  F.  Walker,  Great  Falls. 

Vice-President:  K.  G.  Johnson,  Harlowton. 

Secretary-Treasurer:  Herbert  T.  Caraway,  Billings. 

Delepate  to  American  Medical  Association:  Raymond  F.  Peterson,  Butte, 
1950;  Alternate,  Thomas  B.  Moore,  KallspeU,  1950. 


STANDING  COMMITTEES 

Executive  Committee:  T.  L.  Hawkins,  Helena,  Chairman;  T.  F.  Walker, 
Great  Falls;  H.  T.  Caraway,  Billings;  L.  W.  Allard,  Billings;  M.  A. 
ShllUngton,  Glendlve. 

Economics  Committee:  J.  C.  Shields,  Butte,  Chairman;  C.  P.  Brooke,  St. 
Ignatius;  B.  B.  Dumin,  Great  Falls;  Leland  G.  Russell,  BiUlngs;  S.  D. 
Whetstone,  Cut  Bank. 

Legislative  Committee:  J.  M.  FUnn,  Helena,  Chairman;  F.  D,  Hurd, 
Gn.at  Falls;  P.  E.  Kane,  Butte;  J.  C,  MacGregor,  Great  Falls;  Claude 
M.  Mears,  Helena. 

Necrology  and  History  of  Medicine  Committee:  L.  W.  Brewer,  Missoula, 
Chairman;  I.  J.  Biidenstlne.  Missoula;  J.  H.  Irwin,  Great  Falls;  Claude 
M.  Mears,  Helena;  J.  P.  Ritchey,  Missoula. 

Public  Relations  Committee:  H.  W.  Gregg,  Butte,  Chairman;  W.  L,  DuBois, 
Cut  Bank;  B.  V.  Morledge,  BilUngs;  W.  H.  Stephan,  DiUon;  Dora  Walker, 
Great  Falls. 

Legal  Affairs  and  Malpractice  Committee:  J.  C.  MacGregor,  Great  Falls, 
Chairman;  Baymond  Eck,  Lewlstown;  W.  E.  Harris,  UvlDgston;  John  E. 
Hynes,  BUltngs;  R.  D.  Knapp,  Wolf  Point. 

Program  Committee:  C.  H.  Fredrickson,  Missoula,  Chairman;  H.  T. 
Caraway,  Billings'  H.  W.  Gregg,  Butte;  J.  J.  McCabe,  Helena;  E.  S. 
Murphy,  Missoula. 

Interprofessional  Relationship  Committee:  L.  W.  AUard,  Billings,  Chair- 
man; C.  B.  Canty,  Butte;  S.  A.  Cooney,  Helena;  S.  N.  Preston,  Missoula; 
F.  I.  Sabo,  Bozeman. 


Nominating  Committee:  H.  H.  James,  Butte,  Chairman;  B.  L.  Andereon, 
Fort  Benton:  B.  D.  Harper,  Sidney;  J.  J.  Malee,  Anaconda;  W.  B.  He- 
Elwee,  Townsend. 

Auditing  Committee:  E.  H.  Llndstrom,  Helena,  Chairman;  F.  H.  Crago, 
Great  Falls;  R.  D.  Harper,  Sidney;  G.  W.  Setzer,  Malta;  B.  0.  Johnson, 
Harlowton. 

Cancer  Committee:  Mary  E.  Martin,  BiUlngs,  Chairman;  W.  F.  Cash- 
more,  Helena;  C.  H.  Fredrickson,  Missoula;  R.  F.  Peterson,  Butte;  W.  C. 
Robinson,  Shelby. 

Maternal  and  Child  Welfare  Committee:  F.  L.  McPball,  Great  Falls, 
Chairman;  L.  W.  Brewer,  Missoula;  P.  L.  Eneboe,  Bozeman;  Maude  M. 
Gerdes,  BiUlngs;  D.  L.  Gillespie,  Butte;  A.  L.  Gleason,  Great  Falls;  E.  L. 
Hall,  Great  FaUs;  D.  S.  MacKenzie,  Jr.,  Havre;  B.  E.  Mattison,  BiUlngs; 
0.  M.  Moore,  Helena;  F.  W.  Paul,  KallspeU;  C.  W.  Pemberton,  Butte; 
S.  N.  Preston,  Missoula;  A.  E.  Bitt,  Great  FaUs. 

Tuberculosis  Committee:  F.  I.  Terrill,  Galen,  Chairman;  C.  B.  Craft, 
Bozeman;  E.  A.  Dolan,  Anaconda;  A.  R.  Kintner,  Missoula;  J.  A.  Layne, 
Great  FaUs. 

FCacture  and  Orthopedic  Committee:  J.  K.  Colman,  Butte,  Chairman;  L.  C. 
AUard,  BilUngs;  W.  H.  Hagen,  BllUngs;  S.  L.  Odgers,  Butte;  J.  C.  Wol- 
gamot.  Great  Palls. 

Rural  Health  Committee:  B.  C.  Farrand,  Jordan,  Chairman;  B.  A. 
Benke,  KaUspeU;  W.  A.  Lacey,  Havre;  W.  G.  TangUn,  Poison;  J.  H. 
WilUams,  Culbertson. 

Industrial  Welfare  Committee;  R.  B.  Richardson,  Great  Falls,  Chairman; 
M.  A.  Gold,  Butte;  P.  E.  Logan,  Great  FaUs;  D.  S.  MacKenzie,  Jr.,  Havre; 
R.  E.  Walker,  Livingston. 

Rheumatic  Fever  and  Heart  Committee:  F.  B.  Scbemm,  Great  Falls, 
Chairman;  D.  T.  Berg,  Helena;  H.  W.  Gregg,  Butte;  A.  R.  Kintner.  Mis- 
soula; P.  E.  Logan,  Great  FaUs;  F.  H.  Lowe,  Missoula;  J.  J.  Malee, 
Anaconda;  0.  M.  Moore,  Helena;  H.  W.  Power,  Conrad;  B.  E.  SmaUey, 
BilUngs. 

SPECIAL,  COMMITTEES 

Emergency  Medical  Service  Committee:  B.  F.  Peterson,  Butte,  Chairman; 
Paul  J.  Gans,  Lewistown;  J.  J.  McCabe,  Helena;  S.  aL  Olson,  Glendive; 
L.  G.  BusseU,  BilUngs. 

lAB  Fee  Schedule  Committee:  H.  H.  James,  Butte,  Chairman;  E.  H. 
Lindstrom,  Helena;  J.  J.  Malee,  Anaconda;  D.  S.  McKenzie,  Jr.,  Havre; 
F.  K.  Wanlata,  Great  FaUs. 


Collection 


of 


Accounts 


All  reports  show  a trend  toward  slower  and  harder  collections  in  the 
months  ahead. 

At  the  first  sign  of  neglect  you  will  save  money  if  they  are  turned  over 
to  us  for  collection. 

Comparison  of  collection  results,  hacked  hy  35  years  of  experience,  proves 
you  obtain  greater  results  at  less  cost,  when  you  list  your  accounts 

with 

The  American  Medical  and  Dental  Association 

Suite  524,  810  14th  St.  TAbor  2331  Denver,  Colorado 


272 


Rocky  Mountain  Medical  Journal 


During  the 

period... 
give  them 


. . . the  natural  vitamins  A and  D — in  tablets  so  remark- 
ably pleasant  tasting  that  children  delight  in  chewing  them. 


...  a well  tolerated  form — no  excess  calories,  appetite  is  not 
affected. 


. . . full  potency — each  tablet  is  equivalent,  in  vitamin  con- 
tent, to  one  teaspoonful  of  cod  liver  oil*  and  supphes  312 
units  of  vitamin  D,  wholly  derived  from  cod  liver  oil,  and 
3,120  units  of  vitamin  A supplied  by  cod  liver  oil  concen- 
trate adjusted  and  standardized  with  fish  liver  oils. 

. . . an  economical  preparation — especially  suited  to  main- 
taining antirachitic  protection  through  the  growth  years. 
Also  available  in  "drop-dosage”  Liquid  for  infants  and  in 
higher  potency  capsules. 

White  Laboratories,  Inc.,  Pharmaceutical  Manufacturers, 
Newark  7,  N.  J. 


Tablets 


One  of  White's  Integrated  Pediatric  Vitamin  Formulas 
*U.S.P.  Minimum  Requirements 


of 


low  incidence 
bleeding 


with 


DIENESTROL 


Recently,  Rakoff  and  co-workers*  have 
observed  that  the  incidence  of  uterine  bleeding 
is  significantly  low  when  menopausal  syndromes 
and  related  entities  are  treated  with  White’s 
Dienestrol  — a new,  highly  effective  estrogen. 

In  addition  Dienestrol  was  found  to  be  unusu- 
ally well  tolerated;  clinical  side  effects  are 
almost  nonexistent. 

Available:  dienestrol  tablets: 

0.1  mg.  (white)  and  0.5  mg. 
(red)  in  bottles  of  100 
and  1,000. 

AQUEOUS  SUSPENSION 

OF  dienestrol: 

In  10  cc.  rubber- 
stoppered  vials, 

5 mg.  of  Dienestrol 
per  each  cc. 


*Rakoff,  A.  E.;  Paschkis,  K.  E. 
and  Cantarow,  A.:  A Clinical 
Evaluation  of  Dienestrol,  a 
Synthetic  Estrogen,  J.  Clin. 
Endocrinol.,  7:688-700  (Oct.) 


DIENESTROL 


WHITE  LABORATORIES,  INC., 
Pharmaceutical  Manufacturers,  Newark  7,  N.  J. 


OIPHTHIRIA  TETANUS  PERTUSSIS 


SIMPLIFIED 

simultaneous 

immunization 


. a decrease  in  the  number  of  injections  will  go  far  to  make  the 
practice  of  pediatrics  more  tolerable.  ’ (Fischer:  j.  a.  m.  a.  I34:1064,  1947) 

Office  routine  simplified  . . . each  injection  is  the  same— 0.5  cc. 
Patient  discomfort  and  reactions  minimized 
Lower  expense  for  physicians  and  institutions 
Easier  injection  because  the  product  is  exceptionally  fluid 

1-5  ee.  v*af$— 7 comp/efe  I’mmuffilxaHon;  7.5  cc.  vSah  — 5 compfefe  immunizaf/ons, 

DIPHTHERIA 

and 

TETANUS  TOXOIDS 

Alum  Precipitated  and 

PERTUSSIS  VACCINE 
COMBINED  SQUIBB 


for  April,  1949 


273 


NEW  MEXICO  MEDICAL  SOCIETY 


Next  Annual  Session:  Roswell,  May  5,  6,  7,  1949 


OFFICERS  — 1948-1949 

President:  P.  L.  Travers,  Sants  Fe. 

President-Elect:  J.  W.  Hannett,  Albuquerque. 

Vice  President:  I.  J.  Marshall,  Roswell. 

Secretary-Treasurer:  H.  L.  Januarr,  Albuquerque. 

Cmncllon  (3  years):  W.  D.  Dabbs,  Cloris;  A.  C.  Shuler,  Carlsbad. 
Cenncllors  (2  years):  R.  0.  Brown.  Sants  Fe;  C.  H.  Oellenthlen,  Valmors. 
Councilors  (1  year):  Carl  Mulky,  Albuquerque;  L.  S.  Evans,  Las  Cruces. 

COMMITTEES  — 1948-1949 

Basic  Science:  W.  E.  Nlssen,  Albuquerque,  Chairman;  Le  Grand  Ward, 
Santa  Fe;  Vincent  Accardl,  Gallup. 

Rural  Medical  Serica  Service:  Stuart  W.  Adler,  Albuquerque,  Chairman; 
W.  B.  Cantrell,  Hot  Springs;  Samuel  R.  Zeigler,  Espanola;  A.  T.  Gordon, 
Tucumcarl;  L.  G.  Foster,  Reserve. 

Cancer:  Murray  M.  Friedman,  Santa  Fe.  Chairman;  Van  A.  Odle,  Boswell; 
J.  B.  Van  Atta,  Albuquerque;  J.  W.  Grossman,  Albuquerque;  R.  W.  Maher, 
Albuquerque. 


Venereal  Disease  Control:  Sam  Jelso,  Albuquerque,  Chairman;  V.  K. 
Berchtold,  Santa  Fe;  L.  M.  Miles,  Albuquerque;  L.  S.  Evans,  Las  Cruceo; 
H.  L.  January,  Albuquerque. 

Legislative:  Albert  Lathrop,  Santa  Fe,  Chairman;  W.  0.  Connor,  Albu- 
querque; W.  R.  Lovelace,  II,  Albuquerque;  Walter  A.  Sta^,  Las  Vegas; 
George  S.  Morrison,  Roswell;  R.  0.  Brown,  Santa  Fe. 

Public  Relations;  D.  A.  McKinnon,  Jr.,  Albuquerque,  Chairman;  James 
L.  McCrory,  Santa  Fe;  H.  M.  Mortimer.  Las  Vegas;  Frank  W.  Parker,  Jr., 
Gallup. 

Tuberculosis;  R.  0.  Brown,  Santa  Fe,  Chairman;  C.  H.  GeUenthlen, 
Valmora;  D.  0.  Shields,  Albuquerque;  H.  S.  A.  Alexander,  Santa  Fe. 

Advisory  Committee  on  Ins.  Compensation:  Eugene  W.  Flske,  Santa  Fe, 
Chairman;  John  F.  Conway,  Clovis;  A.  C.  Shuler,  Carlsbad;  R,  E.  Forbli, 
Albuquerque. 

Committee  on  National  Emergency  Medical  Service:  A.  E.  Beymont,  Santa 
Fe,  Chairman;  C.  M.  Thompson.  Albuquerque;  L.  G.  Rice,  Albuquerque; 
Walter  A.  Stark.  Las  Vegas. 


StodghiH's  Imperial  Pharmacy 

Prescriptions  Exclusively 

For  your  prescriptions  we  stock  a complete  line  of  ALMAY — non-allergic — cosmetics. 

Five  Pharmacists 

319  16th  St.  TAbor  4231  Denver,  Colo. 


Ocuilit  jPreicrlption  Service  ^xciuiiveii^ 

SHADFORD-FLETCHER  OPTICAL 

CO. 

Dispensing  Opticians 

228  16th  Street,  Denver,  Colo. 

AComa  261 T 

These  fine  Dairy  Cattle,  a portion  of  City  Park’s  large  herd  of  Guernsey  and  Holstein 
cows,  are  scientifically  fed  and  cared  for,  continuously  tested  by  competent  veterin- 
arians. Only  through  such  precise  watchfulness  does  City  Park  Milk  receive  Grade 
"A”  designation  which  it  enjoys.  Choose  City  Park’s  regular  Grade  “A”  Pasteurized 
or  Homogenized  milk  today  — - notice  the  particularly  clean,  fresh  flavor. 


’Phone 
EAst  7707 


Cherry  Creek 
Drive— Denver 


274 


Rocky  Mountain  Medical  Journal 


CHECK 
LIST 

for  choke  of 
a laxative 

Phospho-  type  of 

Soda  ^j^cTION 
(FIEIT) 

^ Prompt  action 
y'  Thorough  action 
^ Gent!®  action 


SIDE 

EFFECTS 

^ Fr®®  from 

Mucosal  Irritation 

Absence  of  Con- 
stipation Rebound 

^ Mo  Development 
of  Tolerance 

Sofe  from  Excessive 
Dehydration 

J/  Mg  Disturbance  of 
Absorption  of 
nutritive  Elements 

^ Causes  no 

Pelvic  Congestion 

1/  No  Patient 
Discomfort 


Nonhabituating 

^ Free  from 

Cumulative  Effects 


Judicious  Laxation 

...through  freedom  from 
undesirable  side  effects 

The  clinical  preference  for  Phospho-Soda  (Fleet)* 
stems  in  large  part  from  its  freedom  from  unde- 
sirable side  effects.  This  desideratum,  together 
with  its  controlled  action  and  ease  of  adminis- 
tration, assure  safe,  effective  anticostive  therapy 
from  every  prescription  of  this  "tried  and  true" 
laxative  agent.  Clinical  samples  on  request. 

C.  B.  FLEET  CO.,  INC,  * lynchburg,  Virginia 

"PHOSPHO-SODA'  ortd  'FLEET' 
ar^  registered  frgde^ftiQrks  of  C.  8*  Co./  inc. 


adminis- 

tration 

FlDxibli  Dosage 
y'  Uniform  Potency 
y'  PIsasorrt  Tost© 


PHOSPHO-SOOA 

CFtllTT 


Phosph®-So^&  (Flfeg'tl  :i$  e s©- 
fiction  ean-foinlng;  in  feoeh  I'D© 
?c,  sod'tym  b’lpKosphste  48  Gm. 
and  sodium  phosphate  18  Gm. 


ACCfiPfiP  FOR  ADVIRTlSiMO  BY  THl  JOURNAL  OF  THE  AMERICAN  MEDICAL  ASSOCIATION 


/or  April,  1949 


275 


THE  UTAH  STATE  MEDICAL  ASSOCIATION 


OFT'ICBRS  194S-i»4» 

President:  0.  A.  Ogilrle,  Salt  Lake  City. 

President-elect:  C.  H.  Jenson,  Ogden. 

Past  President:  J.  C.  Hubbard,  Price. 

Honorary  President:  0.  W.  French,  CoaMUe. 

First  Vice  President:  J.  0.  McQuarrie,  Ricbfield. 

Second  Vice  President:  ETzra  Cragun,  Lewiston. 

Third  Vice  President:  B.  W.  Farnsworth,  Cedar  City. 

Secretary:  Ray  T.  Woolsey,  Salt  Lake  City. 

Exeeetive  Secretary:  Mr.  W.  H.  Tibbals,  Salt  Lake  City. 

Treasnrer:  L.  B.  White,  Salt  Lake  City. 

Cogncllor  First  District:  J.  G.  Olson,  Ogden. 

Coanellor  Second  District:  V.  L.  Rees,  Salt  Lake  City. 

Cooneilor  Third  District:  L.  W.  Oaks,  Provo. 

Delegate  to  A.M.A.,  1948:  James  P.  Kerby,  Salt  Lake  City. 

Alternate  Delegate  to  A.M.A.,  1948:  J.  J.  Weight,  Proro. 

Editor  of  the  Utah  Section  of  the  Rocky  Moonnain  Medical  Journal: 
B.  P.  Middleton,  Salt  Lake  City. 

STANDING  COMMITTEES 
Rocky  Mountain  Medical  Conference  Continuing  Committee:  R.  P.  Mid- 
dleton, Chairman,  Salt  Lake  City,  1949;  K.  B.  Castleton,  Salt  Lake  City, 
1950;  Clark  Rich,  Ogden,  1951;  Noall  Z.  Tanner,  Layton,  1952;  T.  B. 
Seager,  Vernal,  1953. 

Scientific  Program  Committee:  Ray  T.  Woolsey,  Chairman,  Salt  Lake 
City;  Drew  M.  Peterson,  Ogden;  Stanley  N.  Clark,  Provo;  P.  M.  Howard, 
Salt  Lake  City;  V.  P.  White,  Salt  Lake  City;  L.  V.  Broadbent,  Cedar 
City;  Paul  A.  Pemberton,  Salt  Lake  City. 

Public  Pollcyi  and  Legislation  Committee:  F.  B.  King,  Chairman,  Price, 
1951;  Jesse  J.  Weight,  Provo,  1949;  M.  L.  CrandaU,  Salt  Lake  City, 
1949;  V.  L.  Stevenson,  Salt  Lake  City,  1949;  N.  F.  Hlcken,  Salt  Lake 
City,  1950;  Omar  Budge,  Logan,  1950;  John  Coletti,  Salt  Lake  City,  1950; 
W.  B.  West,  Ogden,  1951;  R.  V.  Larson,  Roosevelt,  1951. 

Medical  Defense  Committee:  W.  J.  Thomson,  Chairman,  Ogden,  1949; 
B.  W.  Owens,  Salt  Lake  City,  1949;  J.  L.  Hansen,  Vernal,  1949;  Homer 
Smith,  Salt  Lake  City,  1950;  L.  N.  Ossman,  Salt  Lake  City,  1950;  Erwin 

D.  Zeman,  Ogden.  1950;  Charles  W.  Woodruff,  Salt  Lake  City,  1951; 

James  Westwood,  Provo,  1951;  L.  H.  MerriU,  Hiawatha,  1951. 

Medical  Edocatlon  and  Hospitals  Committee:  I.  Bruce  McQuarrie,  Chair- 
man, Ogden,  1949;  L.  J.  Paul,  Salt  Lake  City,  1949;  0.  A.  Ogllvle, 
Salt  Lake  nty,  1949;  0.  G.  Richards,  Salt  Lake  City,  1950>;  Bay  T. 
Woolsey,  Salt  Lake  City,  1950;  T.  E.  Robinson,  Salt  Lake  CiW.  1950; 

Seth  E.  Smoot,  Provo,  1951;  George  H.  Curtis.  Salt  Lake  City,  1951; 

B.  0.  Porter,  Logan,  1951;  R.  H.  Young,  Ex-Officio,  Salt  Lake  City. 

Medical  Economics  Committee:  Russell  Smith,  Chairman,  Provo,  1949; 
A.  R.  Denman,  Helper,  1949;  W.  T.  Ward,  Salt  Lake  City,  1950;  W.  B. 
Merrill,  Brigham  Oty,  1951;  Ralph  Pendleton,  Salt  Lake  Oty,  1951. 


Public  Health  Committee:  John  R.  Bourne,  Chairman,  Roosevelt,  1949; 
F.  D.  Spencer,  Salt  Lake  City,  1950;  Ralph  EUls,  Ogden,  1951. 

Military  Affairs  and  Hational  Emergency  Committee:  Chrles  Woodruff, 
Chairman,  Salt  Lake  City;  L.  J.  Paul,  Salt  Lake  City;  Mazel  Skolfleld, 
Salt  Lake  City;  W.  M.  Gorishek,  StandardvlUe  L.  B.  CuUimore,  Orem; 
Ray  H.  Barton,  Magna;  D.  T.  Matron,  Price;  Riley  G.  Clark,  ^vo; 
Willis  Hayward,  Logan;  Dean  Tanner,  Ogden. 

Tuberculosis  and  Cardiovascular  Diseases  Committee:  Elmer  M.  Kil- 
patrick, Chairman,  Salt  Lake  City;  Bay  Bumel,  Salt  Lake  City;  D.  0.  N. 
Lindberg,  Ogden;  W.  C.  Walker,  Salt  Lake  City;  Donald  M.  Moore,  Ogden; 
Don  C.  Merrill,  Provo. 

Cancer  Committee:  0.  A.  Ogllvle,  Chairman,  Salt  Lake  City;  S.  W. 
Fennemore,  Price;  E.  D.  Zeman,  Ogden;  W.  G.  Noble,  Richmond;  Harold 
Austin,  Provo;  StatHey  G.  Rees,  Gunnison;  Paul  K.  Edmunds,  Cedar  City; 
F.  G.  Eskelson,  Vernal;  K.  B.  Castleton,  Salt  Lake  City. 

Fracture  Committee:  A.  M.  Okelberry,  Chairman,  Salt  Lake  City;  Clark 
Rich,  Ogden;  Roy  H.  Robinson,  Kenilworth;  S.  M.  Budge,  Logan;  Norman 
R.  Beck,  Salt  Lake  City;  Louis  Perry,  Ogden;  J.  G.  McQuarrie,  Richfield; 
D.  C.  Evans,  Fillmore. 

Necrology  Committee:  W.  T.  Hasler,  Chairman,  Provo;  L.  A.  Stevenson. 
Salt  Lake  City;  Jos.  A.  Phipps,  Salt  Lake  City. 

Industrial  Health  Committee:  Paul  S.  Richards,  Chairman,  Bingham 
Canyon;  L.  J.  Taufer,  Salt  Lake  City;  Frank  Gorishek,  Helper;  Byron  Daynea, 
Salt  Lake  City;  E.  B.  Kuhe,  Salt  Lake  City;  D.  C.  Barker,  Ogden. 

Advisory  Committee  to  the  Woman’s  AuxilFary:  Vernal  Johnson,  Chair- 
man, Ogden;  0.  P.  Heninger,  Provo;  L.  G.  Moench,  Salt  Lake  City;  James 

K.  Palmer,  Salt  Lake  City. 

Public  Relations  Committee:  R.  P.  Middleton,  Chairman,  Salt  Lake  City; 
Louis  P.  Matthci,  Ogden;  R.  W.  Farnsworth,  Cedar  City;  Quinn  A.  Whit- 
ing, Price;  Clyde  J.  Daines,  Logan;  Bay  E.  Spendlove,  Vernal;  H.  I. 
Goodwin,  Salt  Lake  City;  Gilbert  Wright,  Salt  Lake  City;  Boy  B.  Hammond, 
Provo. 

Inter-Professional  Committee:  J.  Leroy  Kimball,  Chairman,  Salt  Lake 
City;  C.  C.  Hetzel,  Jr.,  Ogden;  T.  E.  Bauman,  Park  City;  Paul  Clayton, 
Salt  Lake  City;  Ralph  G.  Rigby,  Salt  Lake  City. 

Mental  Hygiene  Committee:  Roy  A.  Darke,  Chairman,  Salt  Lake  City; 

L.  G.  Moench,  Salt  Lake  City;  Wm.  D.  Pace,  Salt  Lake  City;  George  Cochran, 
Salt  Lake  City;  E.  L.  Weimers,  Provo. 

Fee  Schedule  Committee:  K.  B.  Castleton,  Chairman,  Salt  Lake  City; 
Howard  K.  Beinap,  Ogden;  J.  E.  Trowbridge,  Bountiful;  U.  B.  Bryner, 
Salt  Lake  City;  W.  Leroy  Smith,  Salt  Lake  City;  J.  B.  Wherritt,  Heber 
City;  0.  W.  Budge,  Logan. 

Special  Committee  to  Study  Dues:  H.  B.  Beiebman,  Chairman,  Salt 
Lake  City;  EUot  Snow,  Salt  Lake  City;  Ezra  Cragun,  Lewiston. 

Rural  Health  Committee:  J.  J.  Weight,  Chairman,  Provo;  J.  G.  McQuarrie, 
Richfield;  J.  P.  Burgess,  Hyrum;  Noall  Z.  Tanner,  Layton. 


^*Utr  ^^tow0ri  at  l^eaionaLig 


ricti 


"Orders  Delivered  to  Any  City  by 
Guaranteed  Service” 

Special  attention  given  to  floral  tributes 
Also  Hospital  Flowers 

Call  KEy stone  5106 

Vark  3 [oral  Co.  Store 


1643  Broadway 


Denver,  Colo. 


^^eni/er  Ox^g.en  C^o,,  ^nc. 

Corner  10th  and  Lawrence  Sts. 
TAbor  5138 

Medical  Gas  Division 
MEDICAL  OXYGEN 
CARBON  DIOXIDE-OXYGEN 
MIXTURES 

AVIATORS’  BREATHING  OXYGEN 
WATER  COMPRESSED  NITROGEN 
WATER  COMPRESSED  AIR 
Twenty-Four  Hour  Service 


COLOR  PROCESS.  |V  Ijr/ 
LINE  & HALFTONE  J A -\ 
BEN  DAY  . ...  .rLH  U 
ILLU5TRATOR5-DESIGNERS 


PHOTO 

ENGRAVERS 


276 


Rocky  Mountain  Medical  Journal 


^a/alai/e 

S^c6  €ts  an  an^Ao^ei*^  cc^oi^  in  i^e 
pemctta/  A^€ipccAi^ic  acu/ 
^pcm  lie  ^Icwutei, 

^^ee ^om  ttMaieA  op  aMaime  taplis. 


FLUID  ANTACID 


AVIRAGE  DOSE— On«  or  two  toospoonfvlt 
(4  to  6 cc.)  undiMod  or  with  o litHo  wotor, 
to  bo  token  five  or  six  times  doily«  between 
meals  and  on  retiring. 


iM 

%:m. 


SHAKE  WELL 

KEEP  TIGHTLY  CLOSED 


-IN  THE  MEDICAL  MANAGEMENT  OF  PEPTIC  ULCER 


THE  WYOMING  STATE  MEDICAL  SOCIETY 

Next  Annual  Session:  Elks  Club,  Casper;  Sept.  12,  13,  14,  1949 


OFFICERS 

President:  George  E.  Baker,  Casper. 

President-Elect:  DeWitt  Dominick,  Cody. 

Vice  President:  K.  E.  Krueger,  Rock  Springs. 
Treasurer:  P.  M.  Schunk,  Sheridan. 

Correspond' no  Secretary:  George  H.  Phelps,  Cheyenne. 
Delegate  A M.A. : R.  H.  Reeve,  Casper. 

Alternate  Delegate  A.M.A.:  W.  A,  Bunten,  Cheyenne. 
Executive  Secretary:  Air.  Arthur  Abbey,  Cheyenne. 


COMMITTEES 

Rocky  Mountain  Medical  Conference:  Earl  Whedon,  Chairman.  Sheridan; 
George  N.  Phelps,  Cheyenne:  H.  L.  Harvey,  Casper;  C.  W.  Jeffrey,  Rawlins; 
L.  \V.  Storey,  Laramie. 

Syphilis  Committee:  N.  E.  Morad,  Chairman,  Casper;  G.  M.  Grosbart, 
Worland;  L.  H.  Wilmoth,  Lander;  L.  G.  Booth,  Sheridan;  P.  H.  Halgler, 
Midwest. 

Cancer  Committee:  Earl  Whedon,  Chairman,  Sheridan:  John  Gramllch, 
Cheyenne;  DeWitt  Dominiek,  Cody;  J.  R.  Newman,  Kemmerer;  E.  W.  New- 
man, Cheyenne. 

Medical  Economics  Committee:  C.  L.  Rogers,  Chairman,  Sheridan;  Nels 
A.  Vicklund,  Thermopolls ; R.  A.  Corbett,  Saratoga;  G.  R.  James,  Casper; 
S.  S.  Hellewell,  Evanston. 

Fracture  Committee:  Philip  Teal,  Chairman,  Cheyenne;  Silva  J.  Giovale, 
Cheyenne;  Robert  V.  Batterton,  Rawlins;  Lowell  D.  Kattenhorn,  Powell: 
Joseph  E.  Hoadley,  Gillette. 

Medical  Defense  Committee:  George  Baker,  Chairman,  Casper;  Andrew 
Bunten,  Cheyenne;  E.  W.  DeKay,  Laramie. 

Councillors:  Earl  Whedon,  Chairman,  Sheridan;  R.  J.  Boesel,  Cheyenne; 
E.  W.  DeKay,  Laramie;  George  Baker,  President,  Casper;  George  Phelps, 
Secretary,  Cheyenne. 

Advisory  to  Woman’s  Auxiliary:  John  R.  Bunch,  Chairman,  Laramie; 
Virgil  L.  Thorpe,  Newcastle;  H.  J.  Aldrich,  Sheridan;  G.  B.  Savory,  Chey- 
enne. 

Advisory  to  Workmen’s  Compensation  Department;  J.  D.  Shingle,  Chair- 
man, Cheyenne;  G.  H.  Phelps,  Cheyenne;  W.  A.  Bunten,  Cheyenne;  R.  H. 
Reeve,  Casper;  Albert  T.  Sudman,  Green  River:  P.  M.  Schunk,  Sheridan. 


Ind.ustrlal  Health  Committee:  K.  E.  Krueger,  Chairman,  Bock  Springs; 
Willard  Pennoyer,  Cheyenne;  Thomas  B.  Croft.  Lovell;  Eugene  Pelton, 
Laramie. 

Veterans’  Affairs  and  Military  Service  Committee;  A.  J.  AUegrettl,  Chair- 
man, Cheyenne;  Jack  Rowlett,  Laramie;  Everett  Ellis,  Cheyenne;  Bernard 
Sullivan,  Laramie;  0.  W.  Koford,  Cheyenne;  Bernard  Stack,  Thermopolis; 
J.  W.  Sampson,  Sheridan;  DeWitt  Dominick,  Cody;  Paul  B.  Holtz,  Lander; 
George  E.  Baker,  President,  Casper;  George  Phelps,  Secretary,  Cheyenne. 

Blue  Cross  Hospital  Committee:  B.  I.  Williams,  Chairman,  Cheyenne,  1950; 
W.  A.  Bunten,  Cheyenne,  1949;  E.  W.  DeKay,  Laramie,  1951;  Cedric 
Jones,  Cody,  1952. 

Public  Policy  and  Legislation:  George  Phelps,  Chairman,  Cheyenne: 
Andrew  Bunten,  Cheyenne;  George  Baker,  President,  Casper;  G.  W.  Koford, 
Cheyenne;  E.  W.  DeKay,  Laramie;  G.  W.  Henderson,  Casper. 

National  Physicians  Committee:  George  Phelps,  Chairman,  Cheyenne; 
Andrew  Bunten,  Treasurer,  Cheyenne;  E.  W.  DeKay,  Laramie;  George  Baker, 
Casper. 

Poliomyelitis  Committee:  H.  L.  Harvey,  Chairman,  Casper;  N.  A.  Vicklund, 
Thermopolis:  Leo  Keenan,  Torrlngton:  DeWitt  Dominick,  Co^;  Philip  Teal, 
Cheyenne;  Franklin  Yoder,  Cheyenne;  F.  A.  Mills,  Rawlins. 

State  Institutions  Advisory  Committee:  J.  F.  Whalen,  Chairman,  Evans- 
ton; George  Phelps,  Cheyenne;  C.  W.  Jeffrey,  Rawlins;  Earl  Whedon,  Sheri- 
dan; G.  M.  Groshart,  Worland;  R.  H.  Kanable,  Basin. 

Necroiogy  Committee:  Earl  Whedon.  Chairman,  Sheridan;  John  B. 
Krahl,  Torrlngton;  Franklin  Yoder.  Cheyenne. 

Rurai  Hdaith  Committee;  Paul  Holtz,  Chairman,  Lander;  Andrew  Bun- 
ten, Cheyenne:  Samuel  Worthen,  Alton;  Wm.  K.  Bosene,  Wheatland;  Claude 
Raffl,  Basin. 

Public  Health  Department  Liaison  Committee:  E.  C.  Ridgeway,  Chair- 
man, Cody;  R.  P.  Fitzgerald,  Casper;  R.  V.  Batterton,  Rawlins;  J.  W. 
Sampson,  Sheridan;  R.  C.  Stratton,  Green  River;  Willard  Pennoyer, 
Cheyenne. 

Child  Health  Committee:  Paul  W.  Emerson,  Chairman,  Cheyenne;  John 
Gramllch,  Cheyenne;  Thomas  Croft,  Lovell;  Bernard  Sullivan,  Laramie; 
Paul  B.  Holtz,  Lander;  Geo.  E.  Baker,  Casper;  A.  B.  Abbey,  Cheyenne. 

Council  on  National  Emergency  Medidal  Service:  George  H.  PheltB, 
Chairman,  Cheyenne;  R.  H.  Reeve,  Casper;  DeWitt  Dominick,  Cody;  E.  W. 
DeKay,  Laramie;  K.  S.  Krueger,  Rock  Springs;  P.  M.  Schunk,  Sheridan. 


COLORADO  HOSPITAL  ASSOCIATION 


OFFICERS 

President:  Hubert  W.  Hughes,  St.  Anthony  Hospital,  Denver. 

President-Elect:  Walter  G.  Christie.  Presbyterian  Hospital,  Denver. 

Treasurer:  M.  A.  Moritz,  Denver  General  Ho.spital,  Denver. 

Trustees:  Roy  R.  Prangley,  St.  Luke’s  Hospital.  Denver  (1949);  James 
P.  Dixon,  M.D.  Denver  General  Hospital.  Denver  (1949);  Louis  Liswood, 
National  Jewish  Hospital,  Denver  (1950);  DeMoss  Taliaferro,  Children's 
Hospital,  Denver  (1950);  Roy  R.  Anderson.  Pre.sbyterian  Hospital.  Den- 
ver (1951);  Rev.  AlUn  H.  Erb.  Mennoiiite  Hospital,  La  Junta,  Colo.  ^ 
(1951). 

Delegate  to  the  American  Hospital  Association:  Herbert  A.  Black,  M.D., 
Parkview  Hospital,  Pueblo. 

Alternate:  Msgr.  John  R.  l^Iulroy.  Catholic  Hospitals,  Denver. 

STANDING  COMMITTEES 

Auditing:  R W.  Pontow,  Chairman  (1949),  Colorado  General  Hospital, 
Denver;  Rev.  E.  J.  Friedrich  (1950’),  Lutheran  Sanatorium,  WTieatridge; 
Karl  Mortensen  (1951),  St.  Luke's  Hospital.  Denver. 

Constitution  and  Rules:  Samuel  S.  Golden.  M.D.,  Chairman,  Beth  Israel 
Hospital,  Denver;  Henry  H.  Hill,  Weld  County  Hospital,  Greeley;  Sister 
M.  Johanna.  Sacred  Heart  Hosptal,  Lamar. 

Legislative:  Msgr.  John  R.  Mulroy,  Chairman,  Catholic  Hospitals.,  Den- 
ver; DeMoss  Taliaferro,  Children's  Hospital.  Denver;  Carl  Ph.  Schwwalb, 
Denver:  Herbert  A.  Black,  M.D.,  Parkview  Hospital,  Pueblo. 

Membership:  Sister  M.  Alphonsus  Chairman,  Mercy  Hospital,  Denver; 
Roy  R.  Prangley,  St.  Luke’s  Hospital,  Denver. 

Resolutions:  Walter  G.  Christie,  Chairman,  Presbyterian  Hospital,  Denver; 
Carl  Pli.  Schwalb,  Denver. 

Nominating:  Msgr.  John  R.  Mulroy.  Chairman  (1949),  Catholic  Hos- 
pitals, Denver;  Herbert  A.  Black,  M.D.  (1950),  Parkview  Hospital,  Pueblo; 

C.  S.  Bluemel,  M.D.  (1951),  Mount  Airy  Sanatorium,  Denver. 

Program:  George  A.  W.  Currie,  M.D.,  Chairman,  University  of  Colorado 
Medical  Center,  Denver;  Roy  Anderson.  Presbyterian  Hospital,  Denver. 


Nursing:  DeMoss  Taliaferro,  Chairman,  Children's  Hospital,  Denver; 
Sister  M.  Hugolina,  St.  Anthony  Hospital,  Denver;  Margaret  E.  Paetznlck, 
Director  of  Nurses,  Denver  General  Hospital,  Denver;  Sister  Maria  Gratia, 
B.N.,  Glockner  Sanatorium.  Colorado  Springs;  S.  Russ  Denzler,  M.D., 
Colorado  Hospital,  Canon  City. 

Public  Education:  Owen  B.  Stubben,  Chairman,  Denver  CJeneral  Hospital, 
Denver;  Mr.  Torgersen,  Longmont  Hospital  and  Clinic,  Longmont;  Ward 
Darley,  M.D.,  Director,  University  of  Colorado  Medical  Center,  Denver; 
Chas.  Levine,  J.C.R.S. , Spivak. 

SPECIAL  COMMITTEES 

Public  Relations:  James  P.  Dixon,  M.D.,  Chairman,  Denver  General 
Hospital,  Denver;  Sister  Mary  Lioa,  St.  Francis  Hospital,  Colorado  Springs. 

Rates  and  Charges:  Roy  Anderson,  Chairman,  Presbyterian  Hospital, 
Denver;  Msgr.  John  R.  Mulroy,  Catholic  Hospitals,  Denver;  Roy  R, 
Prangley,  St.  Luke’s  Hospital,  Denver;  Walter  G.  Christie,  Presbyterian 
Hospital  Denver;  DeMoss  Taliaferro,  Children's  Hospital,  Denver;  Ben 
M.  Blumberg,  General  Rose  Memorial  Hospital,  Denver. 

State  Board  of  Health  Advisory:  Msgr.  John  R.  Mulroy.  Chairman, 
Catholic  Hospials,  Denver;  DeMoss  Taliaferro,  Children’s  Hospital,  Denver; 
Herbert  A.  Black,  M.D.,  Parkview  Hospital,  Puebo. 

Committee  on  Hospital  Licensing  Regulations  and  Standards:  Msgr.  John 
R.  Mulroy,  Chairman.  Catholic  Hospitals,  Denver;  Boy  R.  Prangley,  St 
Luke’s  Hospital,  Denver;  Owen  B.  Stubben,  Denver  General  Hospital,  Denver; 
DeMoss  Taliaferro,  Children's  Hospital,  Denver;  Roy  Anderson,  Presbyterian 
Ho.spital,  Denver. 

Premature  Infant  Care:  DeMoss  Taliaferro,  Chairman,  Chidlren’s  Hos- 
pital, Denver;  Roy  Anderson,  Presbyterian  Hospital,  Denver. 

Rehabilitation  Center:  James  P.  Dixon,  M.D.,  Denver  General  Hospital, 
Denver;  Msgr.  John  R.  Mulroy,  Catholic  Hospitals,  Denver;  Louis  M. 
Liswood,  National  Jewish  Hospital.  Denver. 

Inter-Professional  Council:  Hubert  W.  Hughes,  St.  Anthony  Hospital, 
Denver. 


rtion 


eruice 


ccurac^  and  ^peed  in  J^reScrip 

DORR  OPTICAL  COMPANY 


421  16th  Street 


Denver,  Colorado 


KEystone  5511 


278 


Rocky  Mountain  Medical  Journal 


Prophetic  — -« 
even  for  bountiful  America, 


rThat  is  why  vitamin 
supplementation,  in  conjunction 
with  a balanced  diet,  is  now 
^ recognized  as  the  best  assurance 
of  adequate  vitamin  intake. 

There  is  no  lack  of  forms  end 

of  dosages  through  which  the 
abundance  of  vitamin  adequacy 
can  be  assured  both 
for  prophylaxis 
for  therapy. 


Upjohn  prescription  vitornins 
are  available  in  a full  rang©  of 
potencies  and  formulas 
to  meet  all  the  requirements  of 
modern  practice. 


UPJOHN  VITAMINS 


Upjohn 


Fine 

pharnioceuhcals 
since  1 886 


for  April,  1949 


279 


BECAUSE  WIDELY  APPLICABLE 


Ovaltine  in  milk,  a multiple  dietary 
supplement,  is  eminently  useful  in  pre- 
venting malnutrition  referable  to  nutri- 
tionally incomplete  diets  or  to  restricted 
food  intake.  This  flavorsome  food  drink 
is  widely  applicable  in  dietotherapy  of 
illness  and  convalescence,  and  for  cor- 
recting inadequate  nutrient  intake  in 
persons  of  all  ages. 

1.  The  protein  of  this  delicious  food 
drink — Ovaltine  in  milk — is  of  high 
biologic  value,  supplies  all  the  indis- 
pensable amino  acids  required  for  tissue 
maintenance  and  growth  and  other 
physiologic  needs. 

2.  Its  contained  vitamins  and  min- 


erals provide  excellent  amounts  of  vit- 
amins A and  D,  ascorbic  acid,  niacin, 
riboflavin,  thiamine,  calcium,  copper, 
iron,  and  phosphorus. 

3.  Its  carbohydrate  energy  is 
promptly  available  for  utilization. 

4.  Its  easy  digestibility  makes  for 
ready  absorption  of  its  valuable 
nutrients. 

5.  Its  delicious  flavor^  appealing 
alike  to  children,  adults,  and  the  aged, 
makes  it  acceptable  even  when  other 
foods  may  be  refused. 

6.  Its  multiple  nutrients,  in  kind 
and  amount,  make  Ovaltine  in  milk  a 
highly  efficient  dietary  supplement. 


THE  WANDER  COMPANY,  360  N.  MICHIGAN  AVE.,  CHICAGO  1,  ILL. 


Three  servings  daily  of  Ovalline,  each  made  of 
Vi  oz.  of  Ovaltine  and  8 oz.  of  whole  milk,*  provide: 


CALORIES 

. . 6/6 

VITAMIN  A 

3000  I.U. 

PROTEIN 

. . 32  Gm. 

VITAMIN  Bi 

1.16  mg. 

FAT 

. . 32  Gm. 

RIBOFLAVIN  

2.0  mg. 

CARBOHYDRATE  . . 

. . 55  Cm. 

NIACIN 

6.8  mg. 

CALCIUM  

. . 1.12  Gm. 

VITAMIN  C 

30.0  mg. 

PHOSPHORUS  . . . 

. . 0.94  Gm. 

VITAMIN  D 

417  I.U. 

IRON  

COPPER  

0.5  mg. 

*Based  on  average  reported  values  for  milk. 


280 


Rocky  Mountain  Medical  Journal 


WlllllltllllllHltllllllllHIIlIJillllS’ 


external  use 


tincture 


Mcreuri  Thio^ 


Alcohol  50  Ptrceot 


, Alcohol  50 

Afcoh<rf-Ac«tone*A<li"^ 

Gm.wirh  jUjS 

C^***oI  Sft* *^n* the aree of  *PP  ,u**d> 
^ •id  aIT  *'•.  wetone  10  ec..  n»on®^ 
lo  mak«  100  «•  ^ 
^ for  pfe*ufg“**  ^ 

antisepsis.  tt^k 

^•f|ti4^  *»«nbinali©ii  with  ®'^i. 


*^!i!!M»iiiiiiiiiiiiiiiiiiWiiiii!!l!!!^ 


>tl5SS“AiE".< 

Bthyj  Kdcrcigfi  Thioeal***'®^^^ 

*'*  MoooefhaooUmio* 
organic  mtrc*i*Y 

I,.  •fae^^^etioB  with  or 

*»»•  satt»  of  heavy  mr***** 
•“‘•'•eted  hy  the  phy»<**"* 


Antibacterial  Action  Is  Not  Enough 


Many  compounds  are  antibacterial.  If  killing  or  inhibiting 
bacterial  growth  were  the  only  consideration,  there  would  be  no 
problem.  Unfortunately,  most  antibacterial  agents  possess  disadvan- 
tages which  limit  their  range  of  usefulness. 

In  selecting  an  antibacterial  preparation  for  general  clinical  use, 
physicians  are  guided  by  several  important  considerations.  The 
compound  must  provide  both  a quick  and  a sustained  antibacterial 
action.  It  must  be  compatible  with  body  tissues  and  fluids.  It 
must  be  nonirritating.  It  should  not  be  inactivated  by  soap  or  in  the 
presence  of  serum.  These  important  requisites  are  met  by  ‘Merthiolate’ 
(Sodium  Ethyl  Mercuri  Thiosalicylate,  Lilly),  which  may  be  used 
effectively  and  safely  on  any  part  of  the  human  body. 

Preparations  of ‘Merthiolate’  include  Tincture,  1:1,000;  Solution, 
1:1,000;  Jelly,  1:1,000;  Ointment,  1:1,000;  Suppositories,  1:1,000; 
and  Ophthalmic  Ointment,  1:5,000. 


ELI  LILLY  AND  COMPANY,  INDIANAPOLIS  6,  INDIANA,  U.S.A. 


Pathogenic  bacteria  soon  intrude  on  sterile  surroundings  in 
their  endless  search  for  a favorable  environment  in  which 
to  grow  and  multiply.  Even  after  the  most  painstaking 
aseptic  precautions  have  been  taken,  elusive  micro-organisms 
sometimes  attack  when  least  expected.  Surgeons  usually 
employ  an  effective,  well-tolerated  antibacterial  agent  to 
minimize  the  chance  of  postoperative  infection. 

Continuous  research  is  directed  toward  elimination  of 
infection.  Chemists  synthesize,  bacteriologists  test,  and  clinicians 
continue  to  evaluate  promising  compounds.  Search  is 
made  for  more  effective  preparations  which  are  lethal  to 
bacteria  but  harmless  to  delicate  tissue  cells. 

In  the  Lilly  Research  Laboratories,  qualified  specialists  are 
concerned  with  various  phases  of  antisepsis.  Some  devote 
their  attention  to  activities  that  insure  the  high  quality 
of  the  antibacterial  agents  now  produced.  Others  are  searching 
for  and  testing  new  compounds.  In  this  way  are  reliable 
products  made  available  to  the  medical  profession. 


MICROBES  NEVER  SLEEP 


LILLY  SPECIALISTS  SERVE  THE  MEDICAL  PROFESSION 


SKocky 

Colorado 
Montana 
New  Mexico 
Utah 
Wyoming 


APRIL 

1949 


y^ountain 

y^edical  Journal 

E-d  L to  rial ^ 


Fourteenth  Annual 
Midwinter  Clinics 

'^HE  Annual  Midwinter  Postgraduate 
Clinics  are  a self-supported  enterprise 
sponsored  by  the  Colorado  State  Medical 
Society.  The  project  was  begun  in  1933, 
interrupted  by  the  war,  and  resumed  in 
1946.  They  have  found  a permanent  place 
in  the  postgraduate  medical  education  pro- 
gram of  the  Rocky  Mountain  States.  The 
1949  Clinics  held  in  Denver  March  1 to  4 
registered  1,018.  Of  this  number  563  were 
practicing  physicians;  297  interns,  residents 
and  students,  88  exhibitors;  17  lay  visitors; 
45  auxiliary,  and  8 guest  speakers.  The 
meeting  was  most  successful.  Daily  press 
coverage  was  good  and  several  fine  edi- 
torials, most  complimentary  to  doctors  in 
private  practice,  appeared  during  the  week. 
Responsible  for  planning  and  conducting 
the  clinics  were  Drs.  Samuel  B.  Childs,  Jr., 
Chairman;  Terry  J.  Gromer,  E.  L.  Binkley, 
Raymond  C.  Chatfield,  and  A.  J.  Kauver. 

The  program  was  directed  primarily  to 
the  general  practitioner,  but  specialists 
found  many  items  worthwhile.  Two  other 
medical  meetings  brought  doctors  to  Denver 
the  same  week — The  American  College  of 
Physicians  Sectional  meeting  and  the  An- 
nual Conference  of  Component  Society 
Presidents  and  Secretaries. 

Among  the  features  of  the  Clinics  were 
the  Annual  Smoker,  the  Dinner-Dance,  and 
Round  Table  Luncheons.  Outstanding  guest 
speakers  who  had  conducted  morning  clin- 
ics were  questioned  during  these  periods 
and  valuable  discussions  ensued.  Technical 
exhibits  of  commercial  firms  displayed  the 
newest  in  technical  aids  necessary  to  the 
practice  of  good  progressive  medicine. 

Doctors  of  the  Rocky  Mountain  region 


may  look  with  pride  upon  this  progressive 
educational  enterprise.  It  has  come  to  be 
recognized  as  one  of  the  important  medical 
meetings  and  we  believe  that  its  importance 
among  our  educational  projects  will  be 
progressive  and  in  keeping  with  the  in- 
creasing national  significance  of  these  states 
in  the  national  medical  picture. 

<4  <4 

A Logical  and  Totally 
Selfish  Deduction 

QOME  members  in  out  profession  have 
been  placing  the  following  sticker  to 
each  statement  that  has  gone  out  from  their 
offices:  “As  Your  Personal  Physician,  I op- 
pose compulsory  health  insurance  because 
it  would  cost  you  more  and  give  you  less 
than  voluntary  plans,  and  would  deny  both 
you  and  me  our  freedom.  If  you  agree, 
please  write  your  Congressman.  If  you  need 
more  information,  ask  me.”  A few  interest- 
ing, amusing,  or  thought-provoking  com- 
ments have  come  in  from  some  of  the  pa- 
tients. For  example,  one  of  them  has  penned 
this  note  by  the  sticker,  “Thanks  for  advice. 
After  thorough  study  am  urging  Congress- 
men to  vote  for  compulsory  health  insur- 
ance.” He  underscored  the  “vote  for.” 

Referring  to  his  record,  we  find  that  he 
owes  a balance  of  fifty  against  a bill  of 
two  hundred  and  fifty  dollars.  This  charge 
was  made  for  a major  operation  performed 
upon  a member  of  his  family  nine  months 
ago.  The  operation  was  successful  and  has 
relieved  a condition  which  would  have  been 
an  insurmountable  handicap  to  the  patient 
socially  and  professionally  for  the  rest  of 
his  life.  Furthermore,  the  wage-earner  is 
an  employee  of  the  Social  Security  Board. 
No  payment  had  been  made  on  the  account 


for  April,  1949 


281 


for  four  months  and  a courteous  “may  we 
please  hear  from  you”  had  been  placed 
upon  the  statement  by  the  secretary. 

Implications  of  this  patient’s  reaction  are 
far-reaching  and  significant.  Here  is  an 
average  government  employee  with  a good 
job  and  small  family.  His  budget  is  none 
too  adequate  for  today’s  expenses.  An  un- 
anticipated surgical  and  hospital  expense 
has  pinched  a bit — and  he  resents  it.  To 
him  it  represents  bad  luck  that  he  neither 
invited  nor  deserved,  and  for  which  he  had 
not  provided  in  advance.  Wouldn’t  it  be 
nice  if  Uncle  Sam  would  pay  his  bills? 
The  expenses  would  be  distributed  among 
other  taxpayers  and  he  would  get  back 
more  than  his  share!  Furthermore,  his  job 
is  with  a governmental  organization  direct- 
ly under  the  influence  of  Mr.  Ewing  and 
the  Federal  Security  Administration.  The 
lines  of  communication  are  well  greased 
and  propaganda  is  flowing  freely  at  tax- 
payer’s expense.  Employees  thereof  know 
which  side  their  bread  is  buttered  upon. 
They’d  better  vote  right,  or  else! 

Logical,  isn’t  it?  Nevertheless,  we  have  it 
to  meet  and  we  have  it  to  beat.  Let’s  not 
stop  now. 

^ 

Medical  Service  to  the  Armed  Forces 

J^R.  JAMES  SARGENT,  Chairman  of  the 
Council  on  National  Emergency  Med- 
ical Service,  A.M.A.,  has  commented  upon 
the  balance  of  potential  medical  manpower 
in  event  of  another  national  medical  emer- 
gency. National  health  and  security  must 
never  again  be  undermined  by  stripping 
many  areas  of  their  doctors.  A dangerous 
situation  also  exists  in  the  abhorrence  of 
any  form  of  military  service  still  beating  in 
the  minds  of  thousands  of  doctors.  Secre- 
tary of  Defense  Forrestal  has  approved  a 
board  of  civilian  and  military  physicians  to 
cooperate  in  supplying  future  needs  and 
training  replacements  in  civil  and  military 
posts.  The  balance  of  medical  manpower 
thus  appears  to  reside  in  capable  hands. 

War  or  no  war,  our  military  prepared- 
ness is  here  to  stay  and  thousands  of  doc- 
tors are  going  into  uniform — voluntarily  or 


involuntarily.  If  we  are  true  to  our  heri- 
tage, it  must  be  voluntarily.  Soldiers 
don’t  want  to  be  served  by  disgruntled  con- 
scripted doctors  any  more  than  civilians 
should  depend  upon  dissatisfied  regi- 
mented doctors.  Thus  military  medicine 
must  be  made  attractive  to  the  best  talent 
that  our  profession’s  resources  can  provide. 
Voluntary  enlistments  cannot  remain  at 
snail’s  pace,  and  many  of  the  2,000  doctors 
scheduled  to  leave  military  service  during 
the  first  eight  months  of  1949  should  carry 
on  in  our  armed  forces.  Otherwise  invol- 
untary enlistments  under  pressure  of  Con- 
gressional act  will  inevitably  follow. 

First  among  doctors  to  be  conscripted,  if 
conscripted  they  must  be,  should  be  those 
who  have  received  their  medical  education 
at  government  expense  and  have  not  served 
the  armed  forces.  Next  should  be  some  of 
those  who  should  have  served  before,  but 
for  one  vague  reason  or  other  did  not.  Fi- 
nally, there  would  be  the  reserve  of  eligible 
and  able-bodied  doctors  of  military  age  who 
should  do  their  duty,  voluntarily  or  invol- 
untarily. 


SILHOUETTES 

from  the  A.M.A.  House  of  Delegates 


It  has  not  been  emphasized,  sufficiently,  that 
the  educational  program  of  the  American  Medi- 
cal Association  must  be  a permanent  policy. 
Those  who  visualize  a brief,  intensive,  enthu- 
siastic, concerted  effort  with  the  prospect  of 
prompt  and  lasting  victory  are  sowing  the  wind. 
We  are  engaged  in  a struggle  against  avarice 
and  cunning.  And  avarice  and  cunning  have 
been  known  to  prevail. 

News  reports,  March  1949,  are  to  the  effect 
that  hearings  on  compulsory:  health  bills  may 
begin  before  congressional  committees  in  “about 
a month.”  The  proponents  of  compulsory  health 
taxation  may  believe  that  they  can  dictate  when 
hearings  shall  be  held  and  who  shall  be  heard. 
Judging  by  their  squeals  we  are  doing  a rather 
good  job  of  fighting  our  enemies,  so  far.  It 
might  be  advisable  to  devote  more  energy  to 
cultivating  our  friends.  This  task,  which  should 
be  a pleasant  one,  cannot  be  performed  wholly 
by  any  committee  or  public  relations  adviser.  It 
has  been  stated,  frequently,  that  public  rela- 
tions, or  what  people  think  of  us,  stems  from 
the  physician  and  his  daily  contacts.  Such  a con- 
clusion is  reasonable.  We  must  bring  into  the 


282 


Rocky  Mountain  Medical  Journal 


consciousness  of  the  people  the  fact  that  the 
American  Medical  Association  is  composed  of 
140,000  physicians  who  are  just  like  their  own 
physiciairs'.  Individually,  physicians  are  con- 
sidered at  least  semi-human,  and  they  have 
many  devoted  friends  and  patients.  Collectively, 
however,  the  medical'  profession  seems  to  be 
visualized  as  an  odd  monster  like  the  platypus 
or  the  dodo. 

A few  moments  v/ith  an  adding  machine  pro- 
duces the  undeniable  conclusion  that  the  fifty- 
three  constituent  associations  of  the  American 
Medical  Association  together  spend  more  than 
one  million  dollars  per  year  for  executive  secre- 
taries, assistant  secretaries,  public  relations  di- 
rectors and  office  personnel  pertaining  to  secre- 
tarial and  allied  activities.  Or,  expressed  other- 
wise, the  medical  profession  of  this  country  hires, 
pays  for  and  has,  to  be  used  for  the  realization 
of  practical  ideals,  a million-dollars-a-year 
worth  of  alert  and  loyal  brains.  Are  we  using 
this  potential  wisely  or,  like  the  antibiotics,  are 
we  wasting  much  of  it  in  unnecessary  and  ill 
conceived  therapy? 

In  opposition , to  a government-controlled  com- 
pulsory health  insurance  racket — a tax  racket — 
the  American  Medical  Association  has  embarked 
upon  what  we  choose  to  call  an  educational  pro- 
gram. It  is  a public  relations  program,  pure 
and  simple.  A brief  review  will  lay  a back- 
ground. The  Rich  Associates  pointed  the  way 
in  a national  public  relations  survey  report  in 
1946  (not  to  be  confused  with  the  “Colorado 
Rich  Report”  a year  later).  In  spite  of  the  fact 
that  the  A.M.A.  House  of  Delegates  approved 
thirty-two  of  the  thirty-four  recommendations 
made  by  the  Rich  Associates,  the  program  was 
sabotaged.  First,  by  withholding  funds;  second, 
by  the  National  Physicians  Committee.  Or,  first 
and  second,  by  the  National  Physicians  Commit- 
tee. The  “old  crony”  stuff  as  indicated  by  inter- 
locking Boards  of  Trustees  of  the  A.M.A.  and 
the  N.P.C.  has  not  paid  dividends.  Remembering 
that  they  several  times  pushed  through  the 
House  of  Delegates  a vote  approving  the  activi- 
ties of  the  National  Physicians  Committee  (by 
voice  vote,  never  a recorded  vote)  it  is  pleasing 
and  heartening,  but  baffling,  to  read  in  the 
Journal  A.M.A.,  February  26,  1949,  page  588,  a 
repudiation  of  the  National  Physicians  Commit- 
tee! A certain  person  who  is,  regretably,  an 
influential  officer  of  the  A.M.A.  was  reported  to 
have  said  in  July,  1946,  in  San  Francisco  that 
“when  the  public  relations  program  of  the  Rich 
Associates  falls  on  its  face,  I will  be  there  to 
pick  up  the  pieces.”  The  program,  fell  on  its  face, 
surely , because  it  was  deliberately  tripped.  Some 
of  the  pieces  were  salvaged  and  have  now  been 
placed  in  the  lap  of  another  public  relations 
firm.  However,  when  the  large  and  belated  ef- 
fort of  instituting  an  educatinal  program  was 
approved  by  the  House  of  Delegates,  we  rushed 
to  California  for  still  another  public  relations 


outfit.  Past  history,  yes.  Some  wise  men  have 
judged  the  future  by  the  past. 

Now  then,  just  how  much,  if  at  aU,  is  the  new 
and  latest  national  public  relations  mentor  of 
the  A.M.A.  using  that  already-mentioned  mil- 
lion dollars  worth  of  brains?  Not  to  be  cryptic 
let  the  question  be  asked  in  another  way:  What 
national  use  is  being  made  of  our  state  execu- 
tive secretaries,  who  are  our  outstanding  public 
relations  contacts,  in  a program  in  which  they 
are  eminently  fitted  to  take  a leading  part? 
How  many  of  them  have  been  consulted  by  our 
national  Coordinating  Committee?  How  many 
of  them  are  included  in  the  new  Committee  of 
fifty-three?  Or  have  we  started  the  national 
game  with  the  second  team? 

It  should  be  realized  that  the  state  executive 
secretaries  devote  all  of  their  time  and  thought 
and  energies  to  the  solution  of  our  profession’s 
problems.  Fmlher,  it  should  be  appreciated 
that  they  know  our  problems,  with  their  in- 
finite local,  state  and  national  ramifications,  bet- 
ter than  we.  Practically,  if  we  cannot  use  the 
services  of  our  executive  secretaries  in  a na- 
tional emergency,  why  do  we  spend  a million 
dollars  annually  to  employ  them  and  their  staffs? 
They  should  be  more  than  mere  scenery  for  this 
national  program,  more  than  mere  distribution 
centers  for  each  state.  They  will  carry  out  in- 
structions willingly,  promptly,  and  efficiently.  If 
invited,  they  will  respectfully  present  sugges- 
tions and  counsel  with  the  value  of  firing-line 
experience.  When  is  the  A.M.A.  going  to  seek 
their  experience,  knowledge,  and  judgment? 

History  tells  of  army  commanders  who  could 
maneuver  a battalion  superlatively,  but  who 
could  not  make  full  use  of  an  army.  They  were 
hopelessly  and  congenitally  inadequate.  Lim- 
ited vision,  limited  perspective.  Never  organ- 
ized a staff.  Are  we  employiing  our  full  poten- 
tialities? Are  we  rising  on  stepping  stones  of 
our  dead  selves  to  higher  things?  We  stopped 
buying  and  selling  gold  bricks  in  Colorado  when 
Chicago  silk  hats  were  still  riding  horse  cars. 

WILLIAM  H.  HALLEY,  M.D. 


Free  Medical  Care? 

Insurance  Takes 
Half  Her  Salary* 

^ONNINGTON,  England,  Dec.  14.— AP— 
^ Mrs.  Thomas  Murdon  has  been  cleaning 
this  village’s  public  telephone  booth  daily 
for  10  years. 

Her  pay:  one  shilling  (20  cents)  a week. 
Now  the  government  wants  half  of  that 
— a sixpence  (one  dime) — under  the  Na- 
tional Health  Insurance  Plan. 

She’s  thinking  of  quitting. 

•(From  the  Rocky  Mountain  News.  December  15, 
1948.  Used  by  permission). 


for  April,  1949 


283 


Original  Articles 


THE  CHEMOTHERAPY  OF  CANCER* 

B.  J.  DUFFY,  JR.,  M.D. 

NEW  TORK  CITY 


Surgery  and  x-ray,  the  classical  methods 
for  the  treatment  of  cancer,  have  obvious 
limitations.  Modern  developments  in  anti- 
biotics and  replacement  therapy  have  made 
possible  more  aggressive  surgical  pro- 
cedures but  they  remain,  in  essence,  ap- 
plicable only  to  a wider  extension  of  local 
disease.  Radio  isotopes  offer  hope  for  the 
control  of  metastatic  disease  but,  as  yet, 
significant  localization  of  the  radioactive 
element  in  the  tumor  areas  has  not  been 
achieved.  Even  in  the  seemingly  ideal  case 
of  thyroid  cancer,  the  majority  of  cases  are 
refractory  to  treatment  with  radioiodine. 
This  situation  is  being  altered  with  in- 
creasing knowledge  of  the  physiology  of 
cancer  of  the  thyroid.  Meanwhile  the  search 
for  effective  cancer  chemotherapeutic 
agents  is  being  intensified.  This  review 
will  attempt  to  summarize  those  agents 
said  to  have  some  degree  of  practical  ap- 
plication for  the  general  practitioner  in  the 
treatment  of  cancer. 

Nitrogen  Mustard 

Work  with  this  drug  stemmed  from  toxic 
effects  noted  from  the  use  of  mustard  gas. 
With  the  lifting  of  war-time  restrictions  an 
ficient  data  have  appeared  to  permit  the 
tribution  of  HN^  was  begun.  Since  then  suf- 
official  statement  was  published  and  dis- 
following  general  observations.  HN^  is  dis- 
tributed as  a fine  crystalline  product  which 
is  readily  soluble.  The  dosage  employed  is 
.1  mg. /kg.  of  body  weight  daily  for  four 
days  for  a total  of  .4  mg. /kg. 

•Read  at  the  Wyoming-  Medical  Society  Meeting, 
Laramie,  Wyoming,  September  1,  1948.  Prom  the  De- 
partment of  Clinical  Investigation,  The  Sloan-Ket- 
tering  Institute,  Memorial  Cancer  Center,  New  York, 
New  York.  An  extensive  reference  list  has  been 
omitted  because  of  lack  of  space. 

The  author  gratefully  acknowledges  the  advice 
and  cooperation  of  Dr.  D.  A.  Karnofsky  of  the 
Sloan-Kettering  Institute  in  the  preparation  of  this 
paper. 

For  a definitive  presentation  of  the  entire  field 
of  cancer  chemotherapy,  the  reader  is  referred  to: 
Karnofsky,  D.  A.,  The  New  England  Journal  of 
Medicine,  239:299-304,  August,  1948. 


When  treating  hospitalized  patients  and 
nausea  and  vomiting  may  be  controlled, 
two  “double  doses”  of  .4  mg./kg.  or,  in  se- 
lected cases,  a single  dose  of  .2  mg./kg.  have 
been  employed.  When  x-ray  therapy  is  to 
be  employed  with  HN^,  laboratory  experi- 
ments have  indicated  that  the  HN2  therapy 
should  precede  irradiation. 

The  immediate  post-injection  sequelae  of 
HNo  therapy  are  nausea  and  vomiting. 
These  occur  in  50  per  cent  of  the  patients 
within  one  to  eight  hours  following  ad- 
ministration. The  complication  is  usually 
self-limited,  however,  and  relieved  with 
sedation  and  clysis.  Thrombosis  of  the  in- 
jected vein  occurs,  but  this  may  be  some- 
what lessened  by  instilling  the  HN,  quickly 
into  the  tubing  of  a freely  flowing  intra- 
venous infusion. 

The  principal  hazard  in  HN,  therapy  is 
depression  of  the  hematopoietic  system. 
Within  seven  to  fourteen  days  following  ad- 
ministration of  .4  mg./kg.  a characteristic 
leucopenia  results.  The  WBC  may  drop  to 
1,000  but  there  usually  is  prompt  recovery. 
The  platelets  may  be  slightly  depressed, 
but  the  hemoglobin  is  usually  unaffected. 
Bone  marrow  studies  reveal  changes  which 
parallel  those  in  the  peripheral  blood. 
Aplastic  anemia  has  been  reported  in  a few 
cases  with  excessive  HN,  with  widespread 
bleeding,  anemia,  prostration.  Blood  trans- 
fusions and  penicillin  are  the  only  treat- 
ment for  this  complication. 

Hodgkins’  Disease 

The  case  most  favorable  for  HN2  therapy 
is  the  generalized  Hodgkins’  patient  with 
systemic  symptoms  such  as  fever,  malaise, 
pain,  pruritis,  and  digestive  disturbances. 
In  80  per  cent  of  such  patients  a clinical 
improvement  may  be  expected  following  a 
single  course  of  HN,.  This  improvement 
is  manifested  in  a detoxification  of  the  pa- 


284 


Rocky  Mountain  Medical  Journal 


tient  with  a fall  in  fever  and  increased 
well-being.  Objectively,  there  may  be  a 
decrease  in  the  size  of  nodes,  liver,  spleen, 
and  the  absorption  of  ascitic  and  pleural 
fluid.  The  average  clinical  remission  lasts 
from  six  to  eight  weeks,  but  active  disease 
in  some  cases  has  been  controlled  for  six 
months  to  a year  following  a single  course 
(.4  mg./kg.)  of  treatment.  The  longer  the 
duration  of  remission  the  more  favorable 
the  outlook  for  subsequent  therapy. 

Some  patients  have  received  as  much  as 
ten  courses  of  treatment  with  repeated  re- 
mission but  without  evidence  of  cumulative 
bone  marrow  depression.  The  average  case 
relapses,  however,  and  becomes  refractory  to 
subsequent  HN,.  It  must  be  stated  that 
there  is  no  evidence  that  HN,  alters  sig- 
nificantly the  course  of  hodgkins’  disease, 
but  it  is  of  proved  value  in  the  palliation 
of  the  patient. 

So-called  “x-ray  fast”  patients  may  re- 
spond to  HN2  therapy.  This  due  to  the 
method  of  action  of  nitrogen  mustards 
which  may  influence  areas  of  active  disease 
not  accessible  to  radiation.  There  is  no 
evidence  that  HN2  adversely  affects  sub- 
sequent x-ray  therapy.  Actually,  as  has 
been  stated  above,  HN2  followed  by  irradia- 
tion might  have  an  additive  effect. 

Lymphosarcoma 

Some  patients  with  lymphosarcoma  will 
derive  decided  benefit  from  HN2  with  a 
rapid  decrease  in  the  size  of  nodes,  liver, 
and  spleen  and  subjective  improvement. 
This  is  not  a consistent  response,  however, 
and  in  general,  x-ray  therapy  is  more  satis- 
factory. 

Leukemia 

Acute  leukemia  does  not  respond  to  HN, 
although  a temporary  fall  in  the  white  cell 
count  can  be  produced.  As  with  other 
chemo-therapeutic  agents  here  reported 
there  is  no  significant  effect  on  acute  leu- 
kemia. 

Chronic  myelogenous  leukemia  treated 
with  HN2  will  respond  for  a period  of  two 
to  three  months  but  relapse  is  fairly  rapid. 
There  is  little  evidence  that  HN,  will  help 
patients  who  have  not  responded  to  ade- 
quate x-ray  therapy.  For  localized  disease 


due  to  leukemia,  x-ray  would  still  be  the 
treatment  of  choice.  As  Wintrobe  points 
out,  chronic  lymphatic  leukemia  patients 
who  are  in  good  condition  respond  best  to 
HN2  therapy.  Those  in  poor  condition  due 
to  lymphadenopathy  and  anemia  do  not 
respond  well. 

Carcinoma  of  Lung 

Probably  one  of  the  most  striking  actions 
of  HN2  is  in  the  treatment  of  inoperable  can- 
cer of  the  lung.  In  advanced  lung  carcinoma 
some  75  per  cent  of  the  patients  treated 
with  HN2  will  show  definite  clinical  and 
radiological  evidences  of  improvement.  Re- 
lief from  pain,  decrease  in  the  size  of  the 
lung  lesions,  absorption  of  pleural  fluid  and 
alleviation  of  symptoms  from,  caval  ob- 
struction are  possible. 

The  effects  only  last  from  two  weeks  to 
two  months,  however,  and  relapse  can  be 
expected.  There  is  no  indication  that  HN2 
prolongs  the  life  of  the  lung  carcinoma  pa- 
tient. It  is,  however,  a valuable  palliative 
agent. 

Multiple  Myeloma 

HNj  will  produce  striking  relief  of  bone 
pain  in  occasional  cases  of  plasma  cell 
myeloma.  These  remissions  are  similar  to 
those  reported  following  stilbamidine  ther- 
apy. We  have  also  seen  marked  diminution 
of  soft  tissue  tumors  following  single  in- 
jections of  HNj. 

Urethane 

Due  to  leucopenic  effects  noted  with 
urethane  in  the  treatment  of  miscellaneous 
tumors,  Paterson  first  used  the  drug  in  the 
treatment  of  leukemia.  Urethane  (ethyl 
carbamate)  is  a colorless,  readily  soluble 
crystalline  compound.  It  is  given  orally 
in  doses  of  2 to  4 gm.  daily  for  two  to 
six  weeks  or  until  therapeutic  results  ap- 
pear. Within  one  to  three  weeks  after  be- 
ginning urethane  treatment  for  chronic 
myelogenous  leukemia  there  usually  results 
a definite  remission.  This  consists,  in  most 
cases,  of  a fall  in  the  WBC  with  a shift  in 
the  differential  toward  normal,  a rise  in 
the  hemoglobin  and  a reduction  in  the  size 
of  the  spleen. 

Nausea  and  vomiting  are  mild  initial  se- 
quelae of  urethare  administration.  The 


for  April,  1949 


285 


hematopoietic  depression  is  not  as  marked 
with  HN2  but,  since  the  cumulative  dosage 
may  be  in  excess  of  200  to  300  mg.,  the 
blood  picture  must  be  clearly  watched  dur- 
ing treatment.  No  evidence  has  been  pre- 
sented that  urethane  causes  pulmonary 
adenomas  in  man  as  has  been  reported  in 
animals. 

Chronic  myelogenous  leukemia  is  most 
responsive  to  urethane.  Acute  leukemia  is 
not  affected.  Chronic  lymphatic  leukemia 
occasionally  is  benefited,  but  there  is  no 
consistent,  predictable  response. 

A few  cases  of  advanced  prostatic  cancer 
unresponsive  to  estrogens  have  been  treated 
with  urethane  with  temporary  benefit. 

In  general,  its  use  is  restricted  to  chronic 
leukemia,  and  here  it  may  be  expected  to 
produce  remissions  similar  to  x-ray,  radio- 
active phosphorus,  and  HN2.  Its  action, 
however,  is  not  as  reliable  as  the  more  toxic 
agents. 

Stilbamidine 

Stilbamadine  and  a derivative  pentami- 
dine were  first  found  effective  in  the  treat- 
ment of  kala  azar.  Since  the  neoplastic 
disease  multiple  myeloma  often  has  a high 
serum  globulin.  Snapper  empirically  tested 
the  drug  on  cases  with  this  disease.  The 
drug  is  prepared  as  a water  soluble,  rela- 
tively stable,  di-isethionate  salt  which  is 
given  intravenously  or  intramuscularly. 
The  solution  must  be  prepared  fresh  prior 
to  injection.  Aged  solutions  have  been 
said  to  produce  liver  and  kidney  disease. 

The  recommended  course  of  therapy  is 
a first  injection  of  50  mg.,  a second  of  100 
mg.,  and  150  mg.  per  dose  thereafter.  The 
injections  are  usually  given  on  alternate 
days  to  a total  dosage  of  4 to  6 gm.  over 
a four  to  five-month  period. 

The  principal  unpleasant  side-effect  of 
stilbamidine  therapy  is  the  development  of 
facial  neuropathy  due  to  the  toxic  degener- 
ation of  the  sensory  nucleus  of  the  trigemi- 
nal nerve.  Ten  out  of  eighteen  patients  in 
Arai  and  Snapper’s  series  developed  this 
syndrome.  It  usually  occurs  several  months 
after  treatment.  The  symptoms  slowly 
subside,  but  the  dissociated  anaesthesia  may 
persist.  Stilbamidine  should  be  reserved 
for  the  multiple  (plasma  cell)  myeloma  pa- 


tient with  severe  bone  pain.  Gibson  and 
Pogge  reviewed  a series  of  186  cases  of 
multiple  myeloma  treated  with  stilbami- 
dine. Approximately  25  per  cent  were  said 
to  have  complete  relief  of  pain,  the  pre- 
dominating symptom. 

Estrogens 

Removal  of  the  source  of  androgens  by 
castration  in  the  normal  male  causes  the 
prostate  to  involute.  The  cancerous  pros- 
tate apparently  retains  a varying  degree 
of  this  physiological  response.  Huggins  first 
showed  that  estrogens  were  equally  ef- 
fective in  their  ability  to  inactivate  or  di- 
minish the  supply  of  androgens. 

Since  estrogens  have  therapeutic  effects 
equal  to  castration,  their  use  is  preferred. 
When  immediate  effects  are  required,  or- 
chiectomy is  preferred  since  the  response 
is  then  elicted  within  thirty-six  hours 
whereas  estrogens  require  one  to  two  weeks. 

Estrogens  now  used  are  stilbesterol  1 to 
5 mg.  a day  and  ethinyl  estradiol  .1  to  .5  mg. 
daily.  No  significant  toxic  effects  result 
from  estrogen  therapy.  Stilbesterol  has  a 
more  frequent  tendency  to  produce  nausea 
and  vomiting.  Side-effects  from  estrogen 
therapy  are  signs  of  feminization,  particu- 
larly enlargement  and  tenderness  of  the 
breasts  and  a decreased  libido. 

The  chief  problem  at  present  in  estrogen 
treatment  of  advanced  cancer  of  the  pros- 
tate is  to  establish  the  proper  therapeutic 
regime.  Herger  and  Sauer  believe  that 
estrogen  therapy  is  of  no  prophylactic  value 
in  slowly  progressing,  asymptomatic  but 
inoperable  carcinoma  of  the  prostate,  and 
they  suggest  that  its  early  use  may  destroy 
the  subsequent  estrogen  sensitivity  of  the 
disease.  Recent  reports  indicate  that  estro- 
gen therapy  might  have  a place  in  the  prep- 
aration of  locally  inoperable  prostatic  can- 
cer into  operative  cases. 

It  is  interesting  to  speculate  on  the  re- 
lapses under  therapy.  These  may  be  due 
to  adrenal  testoids  or  to  the  survival  of 
resistant  or  modified  cancer  cells.  Further 
investigation  is  proceeding,  studying  the 
role  of  the  pituitary.  The  use  of  massive 
estrogenic  therapy  is  also  being  studied  in 
the  hope  of  destroying  the  prostatic  cells 
before  possible  adaptation  occurs. 


286 


Rocky  Mountain  Medical  Journal 


In  the  treatment  of  cancer  of  the  breast, 
estrogens  are  restricted  to  the  post-meno- 
pausal group  with  soft  tissue  metastases. 
About  25  per  cent  of  these  cases  receive 
benefit  from  doses  of  between  5 to  20  mg. 
of  stilbesterol  daily.  Subjective  improve- 
ment and  regression  of  local  and  metastatic 
tumors  may  occur.  Large  doses  may  re- 
sult in  gastro-intestinal  disturbances,  uter- 
ine bleeding,  and  skin  eruptions. 

Androgens 

Cutler  has  recently  reported  the  use  of 
testosterone  proprionate  in  the  treatment  of 
advanced  mammary  carcinoma.  In  a series 
of  twenty  cases,  four  patients  had  transient, 
subjective  improvement,  and  four  others 
definite  objective  benefit.  Adair  and  Mel- 
lors  have  treated  seventy  cases.  In  the 
pre-menopausal  group  with  bone  lesions  ap- 
proximately 20  per  cent  were  benefited. 

If  favorable  results  occur,  they  usually 
develop  within  two  or  three  weeks  of  treat- 
ment and  continue  for  variable  periods  of 
from  two  to  six  months. 

The  therapeutic  regime  involves  the  in- 
tramuscular injection,  three  times  weekly, 
of  100  mg.  of  testosterone  proprionate.  Mas- 
culinizing effects  of  the  androgen  and  hy- 
percalcemic  effects  must  be  watched  for. 

In  general  the  treatment  of  breast  cancer 
with  testosterone  is  not  as  reliable  as  es- 
trogenic therapy  for  prostatic  cancer.  In 
both  types  subjective  improvement  and 
weight  gain  may  be  due  to  the  nitrogen 
retention  caused  by  the  hormone  and  not 
due  to  any  effect  on  the  tumor  itself. 

Folic  and  Anti-Folic  Compounds 

There  has  been  such  a welter  of  confusion 
concerning  the  new  folic  acid  compounds 
and  their  effect  on  cancer  that  a few  state- 
ments are  in  order.  Folic  acid  is  an  essential 
constituent  of  cellular  metabolism.  Folic 
compounds  are  those  conjugates  of  folic 
acid  (pteroyl  monoglutamic  acid)  known 
clinically  as  “diopterin”  and  “teropterin.” 
Anti-folic  compounds  are  those  compounds 
which  have  close  structural  similarity  to 
folic  acid  but  which  differ  radically  in  their 
bio-chemical  reactions.  In  1944  Leuchten- 
berger  and  Lewisohn  reported  that  the  in- 
jection of  a crude  extract  with  the  proper- 


ties of  folic  acid  resulted  in  the  inhibition 
of  a mouse  sarcoma.  This  work  has  never 
been  confirmed. 

Farber  published  the  first  report  on  the 
use  of  teropterin  (pteroyl  triglutamic  acid) 
in  the  treatment  of  human  cancer.  Sub- 
jective improvement  was  noted  in  some  of 
the  patients  but  no  beneficial  action  on  the 
tumor  was  recorded.  The  recent  summary 
of  the  reports  concerning  teropterin  in  the 
J.A.M.A.  v/ould  indicate  that  the  drug  has 
not  been  shown  to  have  any  anti-cancer 
effect.  This  was  also  the  experience  of 
those  testing  this  agent  in  a large  series  of 
patients  at  Memorial  Hospital.  At  the 
New  York  Academy  of  Science  Forum  in 
1947,  it  was  noted  that  the  use  of  a folic 
acid  antagonist  (aminopterin)  had  some 
beneficial  action  in  a case  of  leukemia.  This 
same  type  of  case  had  shown  an  “accelera- 
tion phenomenon”  when  treated  with 
teropterin. 

The  use  of  aminopterin  C4  4 amino- 
pteroylglutamic  acid  was  reported  by  Far- 
ber in  the  treatment  of  acute  leukemia  in' 
children.  He  reported  encouraging  results  in 
five  out  of  sixteen  caases  treated.  Burchenal 
has  also  used  aminopterin  in  the  treatment 
of  acute  leukemia.  In  sixteen  patients  given 
the  drug,  he  noted  no  complete  clinical 
remissions  although  two  patients  were  tem- 
porarily improved. 

Aminopterin  remains  an  extremely  toxic 
drug  which  is  being  carefully  investigated. 
Further  modifications  in  chemical  structure 
may  result  in  more  specific  action  on  the 
cancerous  cell  with  sparing  of  the  host. ' 

Conclusion 

Cancer  chemotherapy  is  not  a new 
science,  but  the  developments  here  discussed 
are  new.  Nitrogen  mustards,  estrogens,  and 
folic  antagonists  have  been  applied  to  the 
treatment  of  cancer  for  a brief  period  of  the 
recent  past.  If  there  is  frankly  no  curative 
agent,  it  is  heartening  that  temporary  con- 
trol and  real  palliation  have  been  effected. 

In  a very  real  sense  all  cancer  treatment 
is  new.  The  significant  surgical  and  radio- 
logical advances,  which  have  made  present 
day  cancer  to  a large  extent  a curable  dis- 
ease, have  developed  only  since  the  turn 


for  April,  1949 


287 


of  the  century.  Many  have  resulted  from  the  present  intensive  research  in  the  chemo- 
work  of  the  past  two  decades.  therapeutic  field  will  make  increasingly 

It  is  therefore  not  utopian  to  hope  that  possible  the  medical  treatment  of  cancer. 


FAMILIAL  LEG  ACHE  IN  CHILDREN 

E.  M.  JEPPSON,  M.D. 

SALT  LAKE  CITY,  UTAH 


With  children,  the  symptom  of  leg  ache  is 
probably  as  common  as  any  other.  In  most 
instances  little  is  done  due  to  the  frequency 
and  lack  of  evident  seriousness  of  the  com- 
plaint. The  history  of  the  child  usually  re- 
veals the  leg  ache  symptom  originating 
months  before  the  first  consultation.  Gener- 
ally, the  parent  gives  little  attention  to  the 
complaint  because  of  a childhood  recollec- 
tion of  similar  leg  pains.  Repeated  com- 
plaints, however,  cause  parental  concern  re- 
garding the  possibility  of  rheumatic  fever, 
hence  medical  advice  is  sought. 

In  the  Rocky  Mountain  Region,  rheumatic 
fever  is  a prevalent  disease,  being  the  chief 
cause  of  death  among  children  5 to  15  years 
of  age.  Since  leg  ache  is  a common  symp- 
tom of  this  malady,  it  is  natural  for  parents 
to  exercise  concern  regarding  its  presence. 
If  rheumatic  fever  exists,  it  is  imperative 
that  therapy  be  instituted  immediately,  but 
if  it  does  not  exist  it  is  also  necessary  that 
the  fears  of  the  family  be  allayed.  The 
majority  of  cases  examined  entering  the  of- 
fice or  seen  at  home  with  the  complaint  of 
leg  ache,  I have  diagnosed  other  than  rheu- 
matic fever.  Since  this  is  the  case,  I felt 
it  advisable  to  study  further  the  problem  of 
leg  ache  to  determine  whether  all  cases  in- 
dicate disease  such  as  rheumatic  fever,  fo- 
cal infection,  the  arthritides,  foot  disorders, 
efc.  Careful  examination  of  children  with 
leg  ache  revealed  that  75  per  cent  of  all 
cases  had  no  demonstrable  disorder  but  did 
have  a positive  family  history;  either  the 
mother  or  father  had  as  a child  experienced 
leg  ache.  For  this  disorder,  because  of  the 
absence  of  other  etiological  factors  and  the 
positive  family  history,  I suggest  the  name 
“familial  leg  ache.” 

Etiology 

Exposure  to  cold  is  a common  cause.  In 
some  instances  walking  into  cold  rooms 


will  induce  leg  ache.  The  usual  experience 
is  that  walking  to  and  from  school  in  cold 
weather  produced  pain.  Running  and  jump- 
ing in  games  and  sports  cause  leg  ache  fre- 
quently. The  pain  seems  to  occur  in  late 
evening  following  these  activities.  Dancing 
in  adolescent  ages  is  all  too  frequently 
feared  by  these  children  because  of  painful 
experiences  in  the  subsequent  hours.  Phy- 
sical activity  and  exposure  to  cold  are  the 
two  main  factors  concerned  in  the  etiology 
of  familial  leg  ache.  It  has  not  been  my 
experience  to  find  this  in  a child  without 
there  being  a similar  experience  in  the  lives 
of  one  or  both  parents. 

Symptomatology 

Characteristic  symptoms  of  familial  leg 
ache  are  afternoon  or  evening  pain  in  the 
calves  of  the  legs,  usually  interfering  with 
sleep.  There  are  no  other  symptoms  ex- 
cept the  irritability  and  restlessness  which 
arise  from  the  pain.  I have  noticed  that 
these  leg  aches  usually  follow  strenuous 
playing,  dancing,  running  or  onset  of  cold 
weather.  There  are  several  cases  of  fa- 
milial leg  ache  which  I have  seen  that  are 
so  severe  and  symptoms  so  easily  induced 
that  the  slightest  running  or  jumping  will 
make  the  child  scream  with  pain  in  two  or 
three  hours  and  will  last  until  therapy  is 
instituted. 

Unlike  fibrositis,  familial  leg  ache  has  no 
stiffness  or  limitation  of  motion  after  rest- 
ing. Pain  persists  with  or  without  activity. 
It  is  peculiar  that  leg  ache  rarely  is  pres- 
ent after  a night  of  sleep  and  yet  may  occur 
four  to  five  hours  after  the  patient  has  re- 
tired. 

The  child  complains  of  a steady  aching 
which  extends  from  the  ankle  to  the  knee 
joints  and  may  extend  to  the  thigh.  I do 
not  recall  ever  having  seen  a case  complain- 


288 


Rocky  Mountain  Medical  Journal 


ing  of  pain  in  any  joint.  The  aching  is 
usually  constant.  Some  have  noted  severe 
knife-like  pains  but  these  are  very  few.  The 
ache  may  continue  for  several  hours,  some- 
times lasting  the  entire  night.  As  the  child 
grows  older  the  leg  ache  tends  to  become 
less  acute.  The  usual  age  at  which  it  first 
appears  is  between  the  third  and  fourth 
years.  In  some  instances  it  continues 
through  life,  though  usually  by  the  twen- 
tieth year  there  are  no  recurrences. 

Diagnosis 

Familial  leg  ache  must  be  differentiated 
from  rheumatic  fever,  fibrositis,  arthritis, 
foot  disorders,  etc.  Rheumatic  fever  has  the 
characteristic  cardiac,  blood  and  electro- 
cardiographic changes,  erythema,  joint  dis- 
turbances, temperature  elevation,  increased 
pulse  rate,  and  presence  of  subcutaneous 
nodules.  There  are,  of  course,  obscure  cases 
but  these  are  detected  by  repeated  exam- 
inations. It  is  not  impossible  for  a child  to 
have  both  familial  leg  ache  and  rheumatic 
fever,  one  case  of  which  I have  seen,  and 
thereby  cause  the  physician  considerable 
concern  and  tax  his  diagnostic  acumen. 

Fibrositis  is  usually  peri-articular,  made 
worse  by  rest,  and  occasionally  has  palable 
subcutaneous  nodules.  It  is  my  belief  that 
many  cases  diagnosed  as  fibrositis  are  not  of 
inflammatory  origin  as  the  name  implies 
but  are  familial  leg  ache.  Joint  stiffness  is 
common  in  fibrositis  and  rarely  seen  in 
familial  leg  ache.  Rheumatoid  arthritis 
presents  joint  changes,  blood  changes,  mus- 
cle atrophy,  etc.,  none  of  which  is  present 
in  familial  leg  ache. 

Flat  feet  and  other  foot  disorders  may 
produce  pain  similar  to  familial  leg  ache, 
but  repeated  examination  will  reveal  the 
cause  and,  of  course,  corrective  arches, 
shoes,  and  exercises  for  the  feet  give  relief 
to  the  patient. 

With  the  elimination  of  such  conditions, 
leg  pain  with  tendency  to  recurrence  and 
a positive  family  history  justifies  the  diag- 
nosis of  familial  leg  ache. 

CASE  1 

Mrs.  S.  brought  her  child  into  the  office  with 
great  anxietj^  as  to  whether  it  had  rheumatic 
fever.  The  local  school  nurse  and  school  doctor 


diagnosed  rheumatic  fever  because  of  the  child’s 
leg  aches  and  demanded  that  she  seek  the  care 
of  the  private  physician.  Upon  examination  the 
child  was  found  to  have  normal  temperature, 
sedimentation  rate  10  mm.  in  one  hour,  W.B.C. 
8,000,  R.B.C.  4.20,  Hgb.  75  per  cent,  E.C.G.  nor- 
mal, pulse  rate  80,  and  exercise  tolerance  test 
normal.  Complete  physical  examination  was  nor- 
mal. In  discussing  the  complete  history,  it  was 
brought  out  that  the  mother  has  five  children 
above  four  years  of  age,  all  of  whom  complain 
of  similar  leg  ache.  The  leg  ache  is  below  the 
knee  and  involves  the  front  and  back  parts  of 
the  legs.  It  is  m.ost  intense  from  8:00  till  10:00 
p.m.,  especially  after  the  child  retires.  The 
mother  is  one  of  five  children,  four  of  whom, 
including  herself,  had  similar  leg  ache  when 
children.  Each  of  the  mother’s  brothers  and 
sisters,  with  the  exception  of  one,  have  four  or 
more  children  over  four  years,  all  of  whom  like- 
wise have  familial  leg  ache.  The  first  brother, 
who  had  no  leg  ache,  has  five  children,  three  of 
whom  are  over  four  years  of  age,  and  only  one 
child  has  familial  leg  ache.  The  patient’s  grand- 
mother had  “growing  pains”  until  20  years  of  age. 
All  of  these  people  I have  examined  and  in  no 
instance  have  any  symptoms  of  rheumatic  fever 
(v/ith  the  exception  of  the  leg  ache)  been  foimd. 

CASE  2 

G.S.,  aged  seven,  was  brought  to  the  office  by 
his  mother.  Previous  medical  consultation  had 
resulted  in  a diagnosis  of  rheumatic  fever  and 
prolonged  bed  rest  was  advised.  The  history 
revealed  that  leg  ache  occurred  more  frequently 
in  the  cold  months  of  December,  January  and 
February,  especially  when  the  child  played  on 
the  way  home  from  school.  Summer  months  were 
free  from  pain  except  when  very  strenuous 
games  were  played.  It  was  also  noted  that  the 
mother  doubted  the  doctor’s  diagnosis  because  of 
her  experiences  as  a girl  with  leg  ache  almost 
identical  to  that  of  the  boy.  Examination  re- 
vealed normal  blood  count,  sedimentation  rate, 
temperature  and  E.C.G.  Pulse  rate  was  90,  with 
normal  exercise  tolerance  and  no  murmurs  noted. 
Observation  of  the  child  revealed  no  abnormali- 
ties except  repeated  leg  ache  which  was  re- 
lieved by  massage.  Five  grains  of  aspirin  al- 
lowed a night  of  rest  and  sleep  with  complete 
relief  from  pain.  It  was  felt  that  the  child  had 
familial  leg  ache  instead  of  rheumatic  fever. 

Treatment 

Prophylaxis  is  difficult  since  the  age  in- 
volved is  the  most  active  age  of  the  person. 
It  is  practically  impossible  to  prevent  chil- 
dren from  running  and  jumping.  However, 
symptoms  are  easily  relieved  by  aspirin  or 
phenacetin,  from  2'^k  grains  to  5 grains  as 
often  as  necessary.  It  has  been  my  obser- 
vation that  children  under  four  years  re- 
quire about  2y2  grains  and  from  four  to  12 
years  about  5 grains,  and  10  grains  from  12 
years  and  up.  This  amount  will  usually  re- 
lieve the  patient  and  permit  a restful  night. 
Symptoms  then  will  not  recur  until  the 


for  April,  1949 


289 


causative  factors  are  again  brought  into 
play.  Massage  and  heat  will  also  bring 
immediate  relief  but  only  for  a short  time. 

Discussion 

Leg  ache  alone  is  not  an  indication  of 
rheumatic  fever.  It  is  usually  an  indica- 
tion that  the  child  has  been  indulging  in 
some  strenuous  activity  which  produced 
muscular  ache,  almost  always  involving  the 
calf  muscles  and  occasionally  the  muscles 
above  the  knee.  The  difficulty  is  relieved 
by  measures  as  outlined,  which  would  be 
inadequate  to  relieve  rheumatic  fever  pain. 
There  is  usually  a very  definite  family  his- 
tory which  can  be  elicited  and  is  a great 
aid  to  diagnosis.  In  about  10  per  cent  of  the 
cases,  I have  noted  an  associated  low-grade 
fever,  the  temperature  ranging  from  nor- 
mal to  100  degrees  F.  In  some  instances  I 
have  thought  this  low-grade  fever  may  be 
due  to  chronic  sinus  disease  or  chronic 
pharyngitis,  but  more  often  than  not  the 
cause  has  not  been  found;  neither  have  any 
had  leukocytosis,  increased  sedimentation 
rates,  local  areas  of  swelling,  or  erythema. 
In  family  histories  almost  without  excep- 
tion the  leg  ache  disappears  when  the  child 
has  passed  the  period  of  adolescence,  unless 
severe  muscular  strain  has  been  experi- 
enced. In  some  instances  arch  supports 
have  been  used  but  I did  not  find  any  who 
were  relieved  by  them. 

Inspection  of  the  aching  muscles  reveals 
a contracted  muscle  group  which  is  similar 
to  that  felt  in  a case  of  tetany.  Joint  areas 
are  found  normal  almost  without  exception. 
Only  in  the  very  severe  cases  do  the  joints 
ever  ache.  The  muscles  comprising  the 
calves  of  the  legs  are  the  ones  involved  in 
all  of  the  cases  I have  seen.  Sometimes  ad- 
ditional groups  are  affected,  as  the  ham- 
strings, but  always  the  calves  are  involved. 
With  this  complaint  of  leg  ache  it  is  ad- 
visable to  examine  the  child  thoroughly  and 
eliminate  the  diseases  from  which  this  must 
be  differentiated.  When  none  of  these  dis- 
eases is  found  and  the  family  history  is 
elicited,  familial  leg  ache  is  probably  the 
diagnosis.  This  condition  is  very  common 
and  yet  has  not  found  its  way  into  the  liter- 
ature. 


The  fact  that  so  often  it  follows  strenuous 
physical  activity  may  lead  one  to  consider 
traumatic  myositis,  but  patients  with  myo- 
sitis will  not  also  complain  with  exposure  to 
cold;  neither  is  there  a family  history  of 
leg  pain. 

It  is  observed  in  this  community  that 
some  children  have  been  put  to  bed  for  long 
periods  of  time  with  a diagnosis  of  rheu- 
matic fever  when  in  reality  the  condition 
was  familial  leg  ache.  For  this  reason,  also, 
it  is  important  that  the  physician  keep  in 
mind  this  common  disorder. 

Conclusion 

1.  Familial  leg  ache  is  suggested  as  a 
diagnosis  for  the  disorder  described  in  this 
paper.  It  is  a commonly  observed  com- 
plaint which  has  no  complications  and 
eventually  disappears. 

2.  There  is  no  relationship  between  rheu- 
matic fever  and  familial  leg  ache. 

3.  This  leg  ache  is  induced  by  activities, 
cold  weather,  change  of  barometric  pres- 
sure, and  often  occurs  with  no  evident  cause. 

4.  The  absence  of  other  disease  entities 
and  the  positive  family  history  make  the 
diagnosis. 


FORMATION  OF  NEW  AMERICAN  BOARD 

According  to  a letter  from  the  Secretary- 
Treasurer,  there  has  been  formed,  with  the  ap- 
proval of  the  Advisory  Board  for  Medical  Spe- 
cialties, and  the  Council  on  Medical  Education 
and  Hospitals  of  the  American  Medical  Associa- 
tion, an  American  Board  of  Preventive  Medicine 
and  Public  Health. 

In  addition  to  the  usual  quahfications,  certi- 
fication requires  special  training  and  experience 
in  preventive  medicine  and  public  health  of  at 
least  six  years  duration  following  interneship. 
Provision  is  also  made  for  a Foimders  Group, 
composed  of  practitioners  of  preventive  medi- 
cine and  public  health  who  have  attained  un- 
questioned eminence  in  the  field. 

Additional  information  is  contained  in  the 
Bulletin  of  the  Board,  which  is  on  file  in  the 
office  of  the  Colorado  State  Medical  Society,  or 
it  may  be  obtained  by  writing  to  the  Secretary- 
Treasurer,  Dr.  Ernest  L.  Stebbins,  615  North 
Wolfe  Street,  Baltimore  5,  Maryland. 


Eighteen  cases  of  tuberculosis  were  discov- 
ered by  the  Los  Angeles  City  Health  Depart- 
ment and  Board  of  Education  in  the  first  year 
of  routine  x-raying  of  all  applicants  for  posi- 
tions in  the  city’s  schools. — California’s  Health, 
July  15,  1948. 


290 


Rocky  Mountain  Medical  Journal 


ACUTE  INTUSSUSCEPTION  DUE  TO  TORSION  OF 
MECKEL’S  DIVERTICULUM* 

OPERATION  AND  RECOVERY 

G.  J.  HARMSTON,  M.D.,  and  W.  E.  CRAGUN,  M.D. 

LOGAN,  UTAH 


Intussusception  occurring  in  infancy  as  a 
result  of  the  torsion  and  invagination  of  a 
Meckel’s  diverticulum  accounts  for  only  a 
small  percentage  of  intussusceptions.  Ladd 
and  Gross  found  that  3 per  cent  were  due  to 
an  inverted  Meckel’s  diverticulum,  and  Ob- 
erhelman  and  Condon  found  in  a review  of 
seventy-eight  surgically  treated  cases  at  the 
Cook  County  Hospital,  that  six  presented 
this  anomaly.  Gibbs  and  Sutton  reported 
intussusception  to  be  primarily  a disease  of 
the  first  year  of  life.  Of  fifty-nine  patients, 
62  per  cent  were  less  than  eleven  months  of 
age.  Their  youngest  child  was  one  month 
and  twenty-eight  days,  and  the  oldest  was 
15  years.  No  age  is  exempt  however,  and 
Nedelec  describes  a case  in  a woman  aged 
52  years. 

The  pathologic  physiology  in  acute  in- 
tussusception is  uniform  and  progressive. 
As  the  head  of  the  intussusception  advances, 
the  mesentery  becomes  stretched  and  the 
veins  compressed;  local  congestion,  edema 
and  swelling  results.  If  reduction  is  not 
soon  accomplished  the  pressure  increases, 
the  arterial  supply  becomes  impaNed,  and 
gangrene  of  the  invaginated  bowel  results. 
This  cycle  may  occur  in  a few  hours  or  a 
few  days  and  accounts  for  the  presence  or 
absence  of  shock.  If  it  occurs  quickly, 
shock  is  severe;  where  it  is  slow  in  develop- 
ment, shock  may  be  minimal  or  absent. 

A carefully  elicited  history  is  so  typical 
that  the  diagnosis  can  be  made  in  nearly  all 
cases.  A previously  healthy  infant  is  sud- 
denly seized  with  severe  colicky  pain,  be- 
comes pale,  perspires  and  appears  in  shock; 
then  the  pain  may  disappear  as  suddenly 
as  it  began  and  the  infant  appear  perfectly 
well,  or  if  the  shock  element  is  great,  he 
will  be  limp  and  exhausted.  The  bowels 
may  move  with  the  first  few  attacks,  but 
presently  obstipation  occurs  and  only  blood 
and  mucus  is  evacuated. 

•From  the  Cache  Valley  L.  D.  S.  Hospital,  Logran, 
Utah. 


In  fifty-five  cases  reviewed  by  Wyatt  and 
Chisholm  over  90  per  cent  had  colicky  pain, 
60  per  cent  became  pale  and  perspired,  50 
per  cent  had  melena  and  50  per  cent  had 
vomiting. 

In  early  cases,  between  attacks,  the  ab- 
domen is  soft  and  a sausage-shaped  mass 
representing  the  head  of  the  intussusception 
is  palpable  in  about  65  per  cent  of  patients; 
this  mass  usually  located  in  the  epigastrium 
or  right  upper  quadrant.  The  rectal  ex- 
amination should  never  be  omitted  as  it 
may  reveal  the  head  of  the  intussusception 
in  the  ampulla.  In  late  cases  distention  and 
rigidity  resulting  from  obstruction  and  peri- 
toneal irritation  may  prevent  palpation  of 
the  mass. 

The  reduction  in  mortality  rate  has  been 
made  possible  by  recent  advances  in  pre- 
operative care.  Ladd  and  Gross  report  a 
drop  in  mortality  from  59  per  cent  in  1912 
to  14  per  cent  in  1938  at  Children’s  Hos- 
pital in  Boston.  Immediate  surgical  inter- 
vention is  mandatory,  but  before  this  is 
undertaken  dehydration,  shock,  and  gastric 
distention  must  be  relieved  as  completely 
as  possible  in  the  particular  case.  Dehydra- 
tion can  be  corrected  with  glucose  and  sa- 
line; shock  with  plasma  or  blood  if  neces- 
sary; and  gastric  intubation  should  be 
accomplished  before  the  operation  com- 
mences. Where  there  are  no  available 
superficial  veins,  one  should  promptly  be  cut 
down  upon  and  cannulated  or  a sternal  or 
tibial  puncture  done.  Only  in  this  manner 
can  sufficient  fluid  be  administered,  espe- 
cially in  severely  dehydrated  cases.  Prophy- 
lactic penicillin  should  be  administered  be- 
fore operation. 

Surgery  is  the  method  of  choice  in  all 
cases  and,  although  much  has  been  written 
on  reduction  by  barium  enema  of  air  insuf- 
flation, most  authorities  condemn  this  meth- 
od as  too  risky  and  uncertain.  In  general, 
the  sooner  operation  is  commenced  after 


for  April,  1949 


291 


shock,  dehydration  and  distention  is  re- 
lieved, the  lower  will  be  the  mortality. 

The  operative  procedure  is  usually  carried 
out  under  open  drop  ether  anesthesia  and  a 
lower  right  rectus  incision  is  employed;  the 
intussusception  is  reduced  by  milking  the 
head  of  the  intussusceptum  backward  out 
of  its  sheath.  The  viability  is  then  deter- 
mined and  if  necrosis  is  present  resection 
and  repair  by  end-to-end  or  side-to-side 
anastomosis  is  carried  out. 

The  postoperative  course  is  usually 
marked  by  a higher  temperature  for  the 
first  few  days  than  after  most  other  ab- 
dominal operations.  Temperatures  of  101 
to  104  degrees  are  common  for  the  first 
three  or  four  days  and  may  be  due  to  ab- 
sorption of  toxic  products  from  the  involved 
bowel.  The  first  bowel  movements  usually 
contain  blood,  then  become  loose  and  foul 
and  by  the  fourth  or  fifth  day  are  formed. 
The  main  problem  postoperatively  is  main- 
taining hydration  and  electroyle  balance. 
This  is  best  accomplished  by  giving  fluids 
intravenously  and  is  simplified  by  cannula- 
tion  of  a vein  before  operation. 

CASE  REPORT 

History:  The  patient,  a 20-month-old  white 
male,  was  first  seen  at  4:00  p.m.  on  September 
18,1948,  approximately  thirty-one  hours  after 
the  onset  of  acute  colicky  abdominal  pain.  The 
parents  reported  that  at  approximately  9:00  a.m. 
the  preceding  day,  the  patient  had  suddenly 
awakened  screaming  and  thereafter  preferred 
to  rest  in  a knee-chest  position.  Shortly  after 
this  first  attack  of  pain,  which  lasted  only  a few 
minutes,  he  vomited  some  greenish  material; 
tliereafter  no  vomiting  was  observed.  That  day 
he  was  extremenly  irritable  and  anorexic.  He 
had  several  loose  bowel  movements  in  the  morn- 
ing; these  were  at  first  normal  in  color;  after 
that,  they  were  composed  of  bright  red  blood 
and  “currant  jelly”  type  clots. 

Shortly  after  the  onset  of  pain,  the  parents 
noted  flushing  and  warmth  of  the  patient’s  body; 
this  persisted  and  was  present  on  examination. 

The  condition  progressed;  bloody  movements 
and  irritability  increased  and  the  patient  be- 
came listless,  occasionally  crying  out  and  then 
appearing  exhausted. 

Past  History:  Birth  was  normal;  patient  was 
breast-fed  until  he  was  seven  months  old,  when 
it  became  apparent  to  the  parents  that  he  was 
not  developing  well.  He  was  then  bottle-fed, 
seemed  to  do  better,  but  was  subject  to  frequent 
“colic.”  At  one  year  of  age  he  weighed  nineteen 
pounds.  Before  the  onset  of  the  present  illness 
he  was  just  learning  to  stand  and  weighed  but 
twenty-three  pounds. 

Physical  Examination:  On  examination  the 
child  was  pale  and  undernourished.  His  weight 


was  twenty-three  pounds.  He  feebly  resisted 
examination.  The  skin  revealed  moderate  de- 
hydration, the  pulse  was  rapid  (144)  and  strong. 
Examination  of  the  abdomen  revealed  disten- 
tion and  generalized  tenderness.  Peristalsis  was 
hypo-active  but  high-pitched  sounds  were  oc- 
casionally heard.  No  tmnor  mass  was  palpable. 
On  rectal  examination  the  head  of  the  intussus- 
ception could  be  felt  in  the  rectal  ampulla; 
“currant  jelly”  clots  and  free  blood  were  evacu- 
ated following  examination. 

Laboratory  examination  revealed  a concen-. 
trated  but  otherwise  normal  urine.  WBC  12,500, 
BBC  4.47  million,  Hbg  11.20  gms.;  a flat  plate 
of  the  abdomen  in  the  upright  position  showed 
distended  small  bowel  loops  with  fluid  levels 
creating  the  “step  ladder”  appearance  seen  in 
obstruction. 

Operation:  First,  the  left  great  saphenous  vein 
was  exposed  at  the  ankle  under  local  anesthesia 
and  cannulated..  Plasma  was  started  and  con- 
tinued during  operation;  this  route  was  also 
used  for  postoperative  hydration. 

Open  drop  ether  anesthesia  was  then  induced 
and  following  this  a sausage-shaped  mass  was 
easily  palpated  along  the  course  of  the  descend- 
ing colon.  A right  lower  para-rectus  incision 
was  made.  The  intussusception  was  located  in 
the  descending  colon  and  gently  milked  without 
difficulty  into  the  cecum..  Here,  due  to  edema 
and  swelling,  it  required  rather  severe  pressure 
to  reduce  the  mass  through  the  ileocecal  valve. 
About  one  inch  proximal  to  the  valve,  gangrene 
of  the  ileum  was  noted,  and  further  reduction 
was  impossible.  Resection  of  10  centimeters  of 
ileum  containing  the  unreduced  intussusception 
was  carried  out  and  end-to-end  anastamosis  by 
the  open  method  with  ooo  chromic  catgut  ac- 
complished. Before  the  abdomen  was  closed, 
one  million  units  of  penicillin  G and  1.5  grams 
of  sulfadiazene  powder  were  introduced. 

Postoperative  Course:  Postoperatively,  fluid 
intake  was  regulated  at  1,200  c.c.  daily  by  means 
of  10  per  cent  glucose  in  normal  saline  and  Ami- 
gen  solution.  Wagensteen  suction  was  continuous 
for  the  first  three  postoperative  days.  Penicillin 
1,300,000  units  daily  and  streptomycin  1 gm. 
daily  for  three  days  was  instituted.  The  first 
and  second  postoperative  days  only  blood  ap- 
peared at  the  anus.  The  third  postoperative  day 
oral  feedings  of  dilute  skim  milk  were  insti- 
tuted every  three  hours,  and  the  suction  was 
discontinued  at  intervals  and  withdrawn  on  the 
fourth  postoperative  day.  Stools  were  liquid  and 
frequent  during  this  time  but  by  the  sixth  day 
were  formed  and  regular.  At  this  time  a regular 
diet  of  pureed  food  w'as  begun  and  well  toler- 
ated. After  the  sixth  postoperative  day,  recov- 
ery was  rapid  and  uneventful.  The  weight  at 
this  time  was  twenty-one  and  one-quarter 
pounds. 

Pathological  Report:  This  was  given  by  Dr.  O. 
A.  Ogilvie  and  was  as  follows: 

Gross:  The  specimen  consists  of  10  cm.  of  small 
bowel  that  looks  like  ileum.  The  bowel  is  S- 
shaped  and  exhibits  an  intussusception  about 
4 cm.  from  one  end.  The  bowel  at  the  invagi- 
nated  end  is  collapsed  and  measures  IV2  cm.  in 
diameter,  while'  the  opposite  end  is  dilated  and 
measures  2-2  y2  cm.  in  diameter.  The  serosa  is 
relatively  smooth  and  tense  over  the  dilated 
portion,  and  light  brown  to  grayish-blue  in  color. 


292 


Rocky  Mountain  Medical  Journal 


All  vessels,  particularly  in  the  collapsed  portion, 
are  very  hyperemic.  Longitudinal  incision  re- 
veals a nodular  mass  about  6 cm.  in  length  and 
1 Vz  -2  cm.  in  diameter  in  the  lumen  of  the  dilated 
part  of  the  ileum.  Incision  of  this  mass  reveals 
it  to  be  a hollow  viscus  that  ends  as  a blind 
pouch — it  is  undoubtedly  a Meckel’s  diverticu- 
lum. The  ■ proximal  part  of  the  diverticulum  is 
rather  anemic,  while  the  distal  portion  is  very 
congested  and  hemorrhagic.  The  diverticulum 
is  imdergoing  ischemic  necrosis.  There  is  a nar- 
rowing of  the  intestine  at  the  base  of  the  diver- 
ticulum, and  the  walls  are  edematous  and  con- 
gested throughout.  The  diverticuliim  appears 
to  have  undergone  torsion,  and  has  been  with- 
drawn along  with  about  2 cm.  of  normal  bowel 
inside  the  dilated  portion. 

Microscopic:  Section  across  the  Meckel’s  di- 
verticulum shows  complete  degeneration  of  the 
lining  mucosa,  profound  congestion,  hemorrhage 
and  focal  lymphocytic  infiltration  with  edema. 
The  degeneration  is  so  complete  that  only  focal 
cellular  infiltration  can  be  made  out  along  with 
some  of  the  red  cells  in  the  dilated  capillaries 
and  vessels.  Section  of  the  ileum  shows  the 
usual  layers  of  small  bowel  in  which  there  is 
congestion  and  edema  of  the  serosa,  edema  of 
the  muscularis  and  some  congesetion,  hemor- 


rhage, edema,  and  neutrophilic  infiltration  of 
the  submucosa.  The  mucosa  is  flattened,  but 
enough  of  its  components  can  be  recognized  to 
know  that  it  is  ileum  distorted  and  changed  due 
to  the  intussusception.  Another  section  shows 
ileal  wall  that  exhibits  hyperplastic  lymph  nodes 
and/or  Peyer’s  patches  and  mild  lymphocytic 
infiltration  of  the  submucosa  which  is  also  some- 
what congested  and  edematous.  The  mucosa  is 
also  somewhat  edematous  and  locally  autolyzed. 

Diagnosis:  Meckel’s  diverticulum,  which  has 
undergone  torsion  and  has  produced  intussus- 
ception of  the  proximal  ileum;  the  intussuscep- 
tion being  gangrenous,  and  the  intussuscipiens 
being  congested,  edematous  and  compressed  in 
portions. 

Comment 

A case  of  ileo-ileo  and  ileocolic  intussus- 
ception precipitated  by  torsion  of  a Meckel’s 
diverticulum  is  presented.  Strict  detail  in 
treating  shock,  dehydration,  and  distention 
and  the  routine  use  of  antibiotics  can  result 
in  a higher  percentage  of  cure,  even  with 
resection  in  poor  risk  patients. 


MANAGEMENT  OF  ACUTE  CHOLECYSTITIS* 

EDGAR  W.  BARBER,  M.D. 

DENVER 


Whether  to  operate  as  soon  as  a diagnosis 
of  acute  cholecystitis  is  made,  or  wait  until 
the  initial  acute  symptoms  have  subsided, 
has  long  been  a moot  question  both  with 
surgeons  and  internists.  There  are  valid 
arguments  on  both  sides  of  this  controversy 
but  in  my  opinion  there  is  one  factor,  not 
often  appreciated,  in  favor  of  early  surgical 
interference.  That  factor  is  the  difficulty  in 
estimating  or  predicting  the  type  of  acute 
inflammation  to  be  found  if  surgery  is  de- 
layed beyond  the  first  forty-eight  hours  of 
the  initial  attack. 

Most  students  of  this  disease  agree  that 
the  large  majority  of  so-called  acute  chole- 
cystitis lesiofts  ;are  not  bacterial  infections 
at  the  start  but  chemical  inflammations, 
due  to  excessive  bile  salts,  pancreatic  en- 
zymes, or  acute  cystic  duct  obstructions. 
The  bile  contents  and  gallblader  wall  cul- 
tures are  nearly  always  negative  for  bac- 
terial culture  the  first  twenty-four  hours 
unless  they  have  been  the  seat  of  previous 
infection.  The  usual  findings,  if  surgery  is 
done  early,  is  edema  of  the  subserosal  coat 

’Read  before  surgical  staff,  Colorado  General  Hos- 
pital, November  3,  1947. 


with  marked  thickening  of  the  gallbladder 
wall  and  resultant  cystic  duct  closure.  Bac- 
terial infection  is  almost  surely  to  be  super- 
imposed after  a variable  time,  usually  one 
to  six  days  and  from  then  on  continues  as 
an  acute  cholecystitis,  empyema  of  the  gall- 
bladder, or  merges  into  chronic  cholecysti- 
tis. When  a surgeon  decides  to  allow  an 
acute  gallblader  to  “cool  off,”  that  is  delay 
a week  or  longer  following  the  onset,  he  not 
infrequently  enters  a highly  infected  field, 
finding  an  empyema  or  an  edematous  gall- 
bladder with  vascular  pericholecystic  ad- 
hesions, making  the  separation  of  the  gall- 
bladder from  surrounding  structures  ex- 
ceedingly difficult. 

The  majority  of  acute  attacks  of  gallblad- 
der disease  will  subside  without  surgery  but 
irreparable  damage  is  the  rule  to  the  deli- 
cate mucosal  lining  of  its  walls,  the  cystic 
duct  becomes  occluded,  stones  form  within 
the  gallbladder,  and  a chronic  cholecystitis 
ensue  along  with  a non-functioning  gall- 
bladder. A careful  bacterial  study  of  a 
chronic  gallbladder  wall  or  its  contents  will 
almost  always  reveal  pathogenic  bacterial 


for  April,  1949 


293 


invasion  and  there  are  few  of  the  most  con- 
servative internists  who  will  not  recom- 
mend removal  of  a definitely  diseased  gall- 
bladder. Socner  or  later  cholecystectomy  is 
indicated. 

The  removal  of  an  acute  gallbladder  is 
relatively  easy  within  the  first  twenty-four 
to  forty-eight  hours.  It  shells  out  easily,  the 
surgeon  is  working  in  a relatively  sterile 
field,  dense  pericholecystic  adhesions  are 
not  pronounced  and  the  surgeon  is  not 
tempted  to  drain  the  gallblader  because  of 
the  hazard  of  spreading  infection  from  the 
local  peritonitis  which  exists. 

Whipple’s  summary  of  the  gallbladder 
surgery  performed  at  Columbia-Presby- 
terian  Medical  Center  in  New  York  over  the 
past  ten  year  period  shows  that  only  about 
one  gallblader  in  ten  of  those  removed  are 
for  acute  cholecystitis.  The  remainder  are 
so-called  chronic  gallbladers  with  and  with- 
out stones.  It  might  be  well  to  define  here 
v^hat  we  mean  by  acute  cholecystitis:  Path- 
ologists make  this  diagnosis  when  polynu- 
clear lymphocytes  are  found  invading  the 
gallbladder  wall.  There  may  or  may  not  be 
exudation  on  the  serosal  or  mucosal  coats 
and  other  evidence  of  acute  inflammation 
such  as  edema  or  cloudy  swelling  of  the 
involved  tissues  exist  as  in  acute  appendici- 
tis histology.  We  must  not  lose  sight  of  the 
fact  that  the  majority  of  acute  gallbladders 
reaching  the  laboratory  are  superimposed 
on  old  chronic  gallblader  disease  often  with 
stones  because  the  gallbladder  like  the  ap- 
pendix is  very  prone  to  acute  exacerba- 
tions. 

A physician  does  not  have  to  encounter 
many  cases  of  acute  suppurative  pancrea- 
titis with  its  usual  fatal  sequelae  to  be  con- 
vinced that  biliary  tract  pathology,  often 
originating  in  the  gallblader,  is  frequently 
the  precursor  of  this  disease. 

Gallbladder  surgery  falls  into  disrepute 
when  a,  patient’s  symptoms  persist  or  are 
aggravated  by  the  surgery.  Most  surgeons 
have  noted  that  the  degree  of  relief  or  cure 
experienced  by  patients  subjected  to  chole- 
cystectomy is  usually  in  direct  proportion 
to  the  severity  of  the  symptoms  and  the 
amount  of  pathology  existing  in  the  gall- 
bladder. Recently,  Westphal  and  Wolfer 


have  shown  that  many  of  the  failures  fol- 
lowing cholecystectomy,  where  indigestion 
and  gallbladder  colic  persist,  can  be  traced 
to  a spasm  of  the  sphincter  of  Oddi — a re- 
flex mechanism  which  can  be  produced  by 
pancreatic  ferments  mixing  with  the  con- 
tents of  the  lower  biliary  tract  and  termed 
dyskinesia.  This  is  probably  as  good  an  ex- 
planation as  any  when  it  is  recalled  that 
in  most  individuals  there  is  normally  an 
intermingling  of  bile  and  pancreatic  juices 
where  the  common  bile  duct  unites  with  the 
pancreatic  or  duct  of  Wirsung  to  enter  the 
ampula  of  the  duodenum.  This  short  pas- 
sage from  the  union  of  the  two  ducts  to  the 
ampulla  of  Vater  is  called  Oddi’s  sphincter. 

In  the  May,  1947,  edition  of  “Surgery,” 
L.  J.  Lester  of  Mt.  Sinai  Hospital  compiled 
109  cases  of  acute  cholecystitis  occurring  at 
that  hospital  for  five  years  preceding  1945 
and  who  were  operated  early,  i.e.,  during 
the  acute  phase;  of  these  109  cases  some 
interesting  figures  were  obtained: 

1.  Ninety  per  cent  had  previous  gallblad- 
der disease  symptoms. 

2.  When  the  patient’s  temperature  ex- 
ceeded 102  and  the  white  blood  count  was 
15,000  they  always  found  a severe  acute 
cholecystitis  and  the  gallbladder  was  fre- 
quently gangrenous. 

3.  Ninety-six  had  cholecystectomy,  thir- 
teen had  cholecystostomy,  and  there  were 
two  deaths. 

4.  Nineteen  were  jaundiced,  and  common 
duct  stones  were  found  in  five. 

5.  Liver  function  tests  were  carried  out  in 
sixty  cases  consisting  of  cephalin  floccula- 
tion or  cholesterol  esters  or  both — 50  per 
cent  showed  liver  damage.  Eighty-five  of 
the  109  were  carefully  followed  up  for  one 
to  six  years.  Seventy  of  these  eighty-five 
v/ere  considered  cured  or  relieved  from  all 
symptoms,  nine  were  relieved  but  had  occa- 
sional bouts  of  indigestion,  six  were  rated 
poor  because  they  had  continued  pain  or 
indigestion  or  both. 

Thus  far  we  have  stressed  the  opinion 
that  acute  gallbladders  should  be  removed 
early  but  there  are  some  definite  contrain- 
dications to  cholecystectomy.  The  more  im- 
portant ones  are: 


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Rocky  Mountain  Medical  Journal 


1.  Normal  gallbladder,  where  diagnosis 
has  erred. 

2.  Acute  cholecystitis  with  marked  edema 
and  swelling  of  gastro-hepatic  omentum  or 
pericholecystic  abscess  exist.  In  these  cases 
drainage  is  safer. 

3.  Aged,  infirm  patients  with  cardiac, 
renal,  pancreatic  or  pulmonary  lesions  and 
extreme  obesity.  When  a patient  has  one 
or  more  of  these  symptoms  the  least  surgery 
compatible  with  relieving  the  emergency  is 
in  order. 

4.  Don’t  remove  a distended  gallbladder 
where  you  detect  obstruction  in  the  com- 
mon duct  or  ampulla  unless  you  can  correct 
the  obstruction  first.  You  may  need  the 
gallbladder  to  shunt  the  bile  by  anastomosis 
to  the  duodenum  or  stomach  when  an  ir- 
reparable condition  exists  in  the  common 
duct  blocking  the  flow  of  bile. 

Pre-operative  care  of  patients  with  acute 
cholecystitis  should  include  a restoration  of 
the  plasma  fluid  balance  when  this  has  been 
disrupted.  When  jaundice  is  present  a pro- 
thrombin determination  with  bleeding  and 
coagulation  readings  are  important  and  the 
patient  fortified  with  vitamin  K pre-oper- 
atively  and  postoperatively;  When  possible, 
it  is  wise  to  have  the  patient  accustom  her- 
self to  swallowing  a Wagensteen  tube.  Post- 
operatively they  are  far  more  comfortable 
if  the  stomach  is  kept  decompressed  from 
twenty-four  to  forty-eight  hours  by  suction 
syphonage.  When  there  is  any  doubt  about 
a patient’s  circulatory  or  cardiac  mechan- 
ism, it  is  wise  to  procure  a heart  consulta- 
tion. It  is  not  only  embarrassing  but  tragic 
to  operate  on  a person  with  a coronary  in- 
farct or  an  anginoid  attack  that  may  simu- 
late gallstone  colic. 

Since  streptococci  are  the  usual  infecting 
organisms  of  acute  cholecystitis,  many  clin- 
ics follow  the  routine  of  giving  penicillin  in 
doses  of  30,000  to  100,000  units  every  three 
to  four  hours  before  and  for  variable 
lengths  of  time  following  surgery.  They 
consider  it  good  insurance,  claim  better 
wound  healing,  and  get  fewer  respiratory 
complications  postoperatively. 


The  after-care  corresponds  to  that  of  any 
major  abdominal  procedure,  maintaining 
the  water  balance  with  intravenous  glucose, 
saline,  and/or  plasma.  Whole  blood  trans- 
fusions are  not  often  indicated  unless  hem- 
orrhage in  a jaundiced  case  is  anticipated  or 
bleeding  complicates  the  surgery.  Early 
deep  breathing,  passive  exercise,  and  am- 
bulation within  the  first  forty-eight  hours 
is  becoming  more  and  more  popular. 

Every  surgeon  has  his  pet  method  of  re- 
moving the  gallbladder  and  we  make  no 
suggestions  toward  altering  a method  that  is 
routinely  successful.  The  best  exposure,  I 
think,  is  obtained  by  an  upper  transverse  in- 
cision across  the  rectus  fibers  over  the  gall- 
bladder area.  More  of  the  intercostal  nerve 
filaments  supplying  the  abdominal  muscu- 
lature can  be  preserved  by  this  approach 
and  many  think  there  is  less  postoperative 
pain  at  the  site  of  incision.  Difficulty  in 
closure  will  be  encountered  through  a trans- 
verse incision  in  muscular  individuals,  es- 
pecially when  one  neglects  to  drop  the  ele- 
vator mechanism  of  the  operating  table  un- 
der the  gallbladder  area  when  closure  be- 
gins. 

Many  chronic  and  acute  gallbladders  are 
removed  and  the  abdomen  closed  without 
drainage.  Allen  Whipple,  in  discussing  this 
subject,  refers  to  a series  of  eighty-eight 
cases  he  followed  which  were  not  drained 
and  no  complications  ensued.  Later  he  saw 
three  cases  in  which  large  and  very  serious 
subphrenic  abscesses  filled  with  colon  bacil- 
lus infected  bile  resulted  from  non-drainage 
in  the  hands  of  very  capable  surgeons.  He 
advocates  that  a soft  rubber  or  cigarette 
drain  5 to  7 mm.  in  diameter  be  inserted 
into  Morrison’s  pouch.  Judd  followed  the 
same  procedure  and  warned  against  having 
the  drain  in  contact  or  pressing  on  the 
structures  in  the  gastro-hepatic  omentum 
because  a swollen  edematous  common  duct 
when  subjected  to  pressure  from  such  a 
foreign  body  is  prone  to  stricture  forma- 
tion. The  drain  is  good  insurance  and  does 
not  add  to  the  length  of  convalescene  or 
wound  healing  especially  when  brought 
out  through  a stab  wound  above,  below,  or 
to  the  side  of  the  operative  wound. 


for  April,  1949 


295 


THE  DISTRIBUTION  OF  PHYSICIANS  AND  PHYSICIANS’  SERVICES 

IN  COLORADO  IN  1948* 

III.  other  licensed  practitioners  of  the  healing  arts  and  the 

EFFECTS  OF  THE  COLORADO  BASIC  SCIENCE  LAW 

H.  J.  DODGE,  M.D.,  MERLE  M.  CI.APPER,  and  WARD  DARLEY,  M.D. 

DENVER 


A.  Other  Licensed  Practitioners  of  the 
Healing  Arts 

While  we  were  originally  concerned  in 
* this  series  of  papers^  ^ ® with  the  Doctors  of 
Medicine  in  Colorado,  it  is  now  necessary  to 
consider  other  practitioners  of  the  healing 
arts,  namely  Doctors  of  Osteopathy  and  Doc- 
tors of  Chiropractic.  In  the  minds  of  the 
public,  both  groups  serve  a legitimate  func- 
tion, as  evidenced  by  the  fact  that  there  are 
legal  provisions  for  licensure  and  control 
of  practice.  These  two  groups  together 
make  up  approximately  25  per  cent  of  all 
persons  licensed  to  practice  the  healing  arts 
in  Colorado.  As  of  January  1,  1948,  there 
was  record  of  200  Doctors  of  Osteopathy 
(D.O)  and  349  Doctors  of  Chiropractic, 
(D.C.),  resident  in  Colorado  and  licensed  to 
practice.  No  information  is  available  as  to 
whether  these  individuals  are  in  active 
practice  or  whether  they  limit  practice  to 
a special  phase  of  their  art.  In  the  distribu- 
tions which  follow  values  will  be  given  for 
all  three  groups  of  practitioners  (M.D.,  D.O., 
and  D.C.)  for  sake  of  comparison. 

Size  of  Community 

Table  I shows  the  distribution  of  practi- 
tioners by  the  size  of  the  community  in 
which  they  are  located.  It  would  appear 
that  the  osteopaths  tend  to  locate  in  the 
small  and  intermediate  size  communities  to 
a greater  extent  than  do  other  practitioners. 
Further  analysis,  as  in  Table  II,  indicates 
that  it  is  the  younger  osteopaths  who  are 
effecting  this  difference. 

There  is  a suggestion  that  the  younger 
chiropractors  are  locating  in  the  large  com- 
munities more  frequently  than  their  older 
colleagues,  but  the  difference  cannot  be  con- 
sidered significant.  . 

•From  the  Department  of  Public  Health  ajid  Pre- 
ventive Medicine  and  the  Office  of  the  Director, 
University  of  Colorado  Medical  Center,  Denver.  The 
other  articles  of  this  series  appeared  as  shown  in 
the  short  reference  list  at  the  conclusion  of  this 
article. 


TABLE  I 

Per  Cent  Distribution  of  Practitioners  by  Size 
of  Community 


Size  of  Type  of  Practitioner 

Community  M.D.  D.O.  D.C. 


Large*  64.6  52.5  66.0 

Intermediatef  18.9  24.5  18.0 

Smallt  16.5  23.0  16.0 


Total  100.0  100.0  100.0 


*Over  30,000  population. 

t5,000  to  30,000  population  plus  suburbs  of 
large  communities. 

+Less  than  5,000  population. 


Distribution  by  Age 

The  distribution  of  practitioners  by  age, 
without  regard  to  location  or  other  factors, 
is  given  in  Table  III.  It  will  be  seen  that 
the  chiropractors  are  appreciably  older  than 
the  other  two  groups.  The  typical  age  of 
the  chiropractors  will  be  slightly  greater 
than  their  mean  age,  whereas  the  typical 
ages  of  the  other  two  groups  will  be  smaller 
than  their  mean  ages.  The  osteopaths  are 
the  youngest  group  and  are  the  most  homog- 
enous as  to  age  (as  indicated  by  the  stand- 
ard deviation). 

Another  indication  of  age  differences  is 
the  fact  that  the  largest  single  age  category 
for  both  M.D.s  and  D.O.s  is  the  age  group, 
30  to  39  years.  The  largest  number  of 
chiropractors  fall  in  the  age  group,  50  to 
59  years. 

Distribution  of  Practitioners  in  Relation  to 
Social  and  Economic  Factors 

As  in  the  preceding  papers  of  the  series, 
distribution  of  practitioners  will  be  related 
to  some  measurable  factors  in  the  fourteen 
medical  service  areas  of  Colorado. 

The  relationships  will  be  expressed  as 
“persons  per  practitioner”  rates.  Because 
three  groups  of  practitioners,  varying  wide- 
ly in  total  nunibers,  are  being  considered, 
an  additional  ratio  will  be  given  to  make 
comparisons  easier.  This  will  be  the  ratio 


296 


Rocky  Mountain  Medical  Journal 


TABLE  n 

Per  Cent  Distribution  of  Practitioners  by  Age  and  Size  of  Community 


Age  in  Years 

Size  of  39  and  under  40  to  50  55  and  over 

Community  M.D.'  D.O.  D.C.  M.D.  D.O.  D.C.  M.D.  D.O.  D.C. 


Large  65.7  45.4  70.4  65.9  52.3  64.0  63.0  61.6  66.2 

Intermediate  19.6  28.0  14.8  19.6  21.5  19.4  17.6  23.4  17.9 

Small  14.7  26.6  14.8  14.5  26.2  16.6  20.4  15.0  15.9 


Total  100.0  100.0  100.0  100.0  100.0  100.0  100.0  100.0  100.0 


*As  in  Table  I. 


between  the  persons  per  practitioner  rate 
for  each  segment  of  the  state  and  the  per- 
sons per  practitioner  rate  for  the  entire 
state,  the  latter  being  expressed  as  unity. 

Comparison  of  the  ratio  columns  of  Table 
IV  would  indicate  that  so  far  as  urbaniza- 
tion is  concerned,  the  M.D.s  are  distributed 


In  the  relationship  demonstrated  by  Table 
V,  the  D.O.s  are  the  most  evenly  distributed 
group. 

No  attempt  was  made  to  relate  the  distri- 
bution of  practitioners  to  hospital  facilities, 
for  the  reason  that  the  hospital  facilities 
enumerated  for  this  series  of  studies  were 


TABLE  III 

Age  Distribution  of  Practitioners 


Age  Group 

Years 

N 

M.D. 

fumbei 

D.O 

D.C. 

M.D. 

Percent 

D.O. 

t 

D.C. 

Under  30  

134 

13 

6 

8.1 

6.5 

1.7 

30-39  

494 

62 

49 

29.8 

31.0 

14.0 

40-49  - 

347 

46 

86 

21.0 

23.0 

24.5 

50-59  

257 

39 

110 

15.5 

19.5 

31.6 

60-69  - 

215 

20 

63 

13.0 

10.0 

18.2 

70-79  

171 

17 

26 

10.3 

8.5 

7.4 

80  and  over  

39 

3 

1 

2.3 

1.5 

0.3 

No  Information  

1 

0 

8 

2.3 

Total  ... 

1658 

200 

349 

100.0 

100.0 

100.0 

Mean-years  

48.8 

47.7 

52.4 

S.D.  (-(-)  years  

15.7 

14.4 

18.3 

Median-years  

45.8 

44.6 

52.7 

in  the  most  nearly  uniform  fashion.  On  the 

those  available  only  to  M.D.s. 

When 

one 

other  hand,  the  D.C.s  are  concentrated  in 
the  more  highly  urbanized  areas.  However, 
when  one  relates  the  distribution  of  prac- 
titioners to  density  of  population,  as  in  Ta- 


considers  the  relationship  between  the  dis- 
tribution of  practitioners  and  consumer  buy- 
ing power,  some  interesting  contrasts  ap- 
pear, as  in  Table  VI. 


ble  V,  the  above  difference  is  no  longer  ap-  On  comparing  the  ratio  columns  it  ap- 
parent. pears  that  there  is  the  greatest  variation 


TABLE  IV 

Distribution  of  Practitioners  by  Urbanization  of  the  i Population 


Per  cent  of  Per  cent  of  Persons  per  Practitioner 

Population  State’s  M.D.  D.O.  D.C. 

In  Urban  Areas  Population  Nrnnber  Ratio  Number  Ratio  Number  Ratio 


0-24  22  1,290  2.0  53,760  9.7  54,980  17.2 

25-49  16  1,210  1.9  8,800  1.6  6,520  2.0 

50-74  22  630  1.0  6,620  1.2  3,450  1.1 

75-100  41  450  0.7  4,510  0.8  2,170  0.9 


State — 51  per  cent  101  650  1.0  5,510  1.0  3,190  1.0 


for  April,  1949  297 


TABLE  V 

Distribution  of  Practitioners  by  Density  of  Population 


Persons  Per  cent  of  Persons  per  Practitioner 

Per  State’s  M.D.  D.O.  D.C. 

Square  Mile  Population  Number  Ratio  Number  Ratio  Number  Ratio 

Under  10  31  1,300  2.0  6,690  1.2  5,910  1.8 

10-24  28  690  1.1  6,280  1.1  3,770  1.1 

25  and  over  41  450  0.7  4,510  0.8  2,170  0.7 


State — 10.5  per  cent  100  650  1.0  5,510  1.0  3,190  1.0 


in  the  distribution  of  chiropractors  and  the 
least  in  the  group  of  osteopaths;  hence  it 
would  appear  that  the  osteopaths  are  least 
influenced  by  measurable  economic  fac- 
tors. At  the  same  time,  neither  the  D.O.s 
nor  the  D.C.s  locate  as  frequently  in  the  top 
income  bracket  as  in  the  middle  income 
bracket  areas  of  the  state. 

B.  The  Effect  of  the  Basic  Science  Law 

The  Basic  Science  Law  of  Colorado  was 
passed  in  1937  and  became  effective  in  Sep- 
tember of  that  year.  It  provides  that  all 
persons  seeking  license  to  practice  any  of 
the  healing  arts  in  Colorado  must  give  evi- 
dence of  proficiency  in  certain  fields  of 
knowledge  fundamental  to  any  school  of 
healing  art.  Having  demonstrated  profi- 
ciency to  the  satisfaction  of  the  State  Board 
of  Examiners  in  the  Basic  Sciences,  the  in- 
dividual is  then  certified  to  the  licensing 
boards.  No  individual  may  take  licensure 
examinations  or  be  licensed  without  first 
being  certified  in  the  Basic  Sciences. 

All  individuals  in  the  course  of  profes- 
sional training  at  the  time  of  enactment  of 
the  law  were  specifically  exempt  from  the 
requirements  of  the  law.  Consequently,  the 
law  did  not  become  fulty  effective  until 
1941. 

For  the  purposes  of  this  study,  there  were 
selected,  as  of  January  1,  1948,  all  practi- 


tioners of  the  healing  arts  resident  in  and 
practicing  in  Colorado  who  were  first  li- 
censed in  1935  and  each  subsequent  year. 
The  numerical  distribution  by  year  and 
category  of  practitioner  follows  in  Table 
VII.  This  span  of  years  was  selected  so 
that  there  would  be  an  equal  number  of 
years  before  and  after  the  full  effectiveness 
of  the  Basic  Science  Law.  It  allows  for  the 
six  years  (1935-40  inch)  before  and  six  years 
(1942-47)  after  1941. 

It  will  be  seen  that  the  average  numbers 
licensed  per  year  in  this  thirteen-year  pe- 
riod were:  M.D.s — 60.7;  D.O.s — 7.2;  and 
D.C.s — 6.7.  To  assess  the  effect  of  the  Ba- 
sic Science  Law  one  may  compare  the  aver- 
age number  of  each  category  licensed  per 
year  during  the  six-year  period  before  and 
the  six-year  period  after  1941.  For  M.D.s 
these  average  numbers  were  41.6  and  83.8, 
an  increase  of  101  per  cent;  for  D.O.s — 10.3 
and  5.0,  a decrease  of  51  per  cent;  and  for 
D.C.s,  11.0  and  3.2,  a decrease  of  71  per  cent. 

In  order  to  demonstrate  the  trend,  that 
is  to  smooth  out  year  to  year  fluctuations, 
a five-year  moving  average  was  used  to 
compute  the  values  given  in  Table  VIII. 

The  relative  change,  as  shown  by  the 
three  columns  on  the  right  of  Table  VIII,  is 
of  the  same  order  as  noted  above. 

The  work  of  the  Colorado  State  Board  of 
Examiners  in  the  Basic  Sciences  is  summar- 


, TABLE  VI 

The  Distribution  of  Practitioners  by  Spendable  Income  of  Consumers 


Per-Capita  Per  cent  of  Persons  per  Practitioner— 

Net  Spendable  State’s  M.D.  D.O.  D.C. 

Income  per  Year  Population  Nurnber  Ratio  Number  Ratio  Number  Ratio 

Below  $800  4 1,890  2.9  14,510  2.6  14,510  4.5 

$ 800-$999  23  920  1.4  9,610  1.7  5,100  1.6 

$1000-$1119  64  580  0.9  4,640  0.8  2,640  0.8 

$1200  and  over  9 590  0.9  5,630  1.0  4,290  1.3 


State— $1078  100  650  1.0  5,510  1.0  3,190  1.0 


298 


Rocky  Mountain  Medical  Journal 


TABLE  VII 

Number  of  Practitioners  Licensed  in  Colorado  by 


Year 

(1935-47  incl.)  and  by  Type  of  Practice 

Year 

—Number 

D.O. 

Licensed- 

D.C. 

M.D. 

Total 

1935  

33 

8 

12 

53 

1936  

52 

9 

3 

64 

1937  

38 

12 

12 

62 

1938  

54 

13 

13 

80 

1939  

37 

12 

14 

63 

1940  

36 

8 

12 

"56 

1941  

45 

2 

2 

49 

1942  

44 

7 

3 

54 

1943  

53 

4 

2 

59 

1944  

89 

3 

1 

93 

1945  

62 

6 

2 

70 

1946  

140 

4 

2 

146 

1947  

115 

6 

9 

130 

Total  ... 

798 

94 

87 

979 

ized  in  Table  IX. 

This  information  was  sup- 

plied  through  the  courtesy  of  Dr.  Esther  B. 

Starks. 

Secretary-Treasurer  of  the  Board. 

Individuals  are  certified  by  the  Board  on 

four  bases: 


1.  Examination — Those  who  pass  the  ex- 
aminations successfully  on  the  first  attempt. 

2.  Re-examination — Those  who  fail  the 
first  attempt  but  are  successful  following 
one  or  more  re-examinations. 

3.  Reciprocity — Those  who  have  been  suc- 
cessful in  passing  the  examinations  of  Basic 
Science  Boards  in  other  states,  provided 
these  boards  have  reciprocity  agreements 
with  Colorado. 

4.  Waiver — Examination  in  the  basic  sci- 
ences was  waived  in  the  case  of  individuals 
who  were  licensed  in  Colorado  prior  to  1937 
to  practice  one  of  the  healing  arts  but  who 
allowed  their  licenses  to  lapse  and  then 


TABLE  VIII 

Trend  in  Licensing  of  Practitioners  of  the 
Healing  Arts  in  Colorado 

1935-1937,  Inch 


Five  Mid  Year  Average  Number  Lie. 
Year  of  Per  Year  Per  Period 

Period  Period  M.D.  D.O.  D.C. 


1935- 39  1937  42.8  10.8  10.8 

1936- 40  1938  43.5  10.8  10.8 

1937- 41  1939  42.0  9.4  10.6 

1938- 42  1940  43.2  8.4  8.8 

1939- 43  1941  43.0  6.6  6.6 

1940- 44  1942  53.4  4.8  4.0 

1941- 45  1943  58.6  4.4  2.0 

1942- 46  1944  77.6  4.8  2.0 

1943- 47  1945  91.8  4.6  3.2 


sought  reinstatement  after  1937.  Certifica- 
tion by  waiver  has  been  discontinued  ef- 
fective 1948,  by  ruling  of  the  Attorney 
General  of  Colorado. 

No  exact  breakdown  of  the  data  in  rela- 
tion to  the  three  schools  of  healing  art  is 
available.  The  Basic  Science  Board  has  no 
way  of  knowing  which  of  the  healing  arts 
the  candidate  intends  to  practice.  After  the 
individual  becomes  elgible  for  certification, 
he  designates  the  licensing  board  (either 
medical  or  chiropractic)  to  which  he  shall 
be  certified.  The  State  Board  of  Medical 
Examiners  licenses  both  M.D.s  and  D.O.s  so 
that  these  groups  cannot  be  separated  on 
the  basis  of  the  data  given  in  Table  IX.  The 
experience  of  the  three  groups  of  practi- 
tioners, then,  can  only  be  approximated.  It 
should  be  remembered  that  the  available 
data  deals  only  with  the  numbers  of  indi- 
viduals certified  and  does  not  imply  that  all 
of  these  individuals  were  subsequently  li- 
censed and  that,  further,  the  individual  does 
not  necessarily  apply  for  and  receive  license 
the  same  year  in  which  he  is  certified  in  the 
basic  sciences. 

Table  X shows  the  experience  of  the 
groups  certified  to  the  two  licensing  boards. 
Only  in  the  matter  of  certification  by  reci- 
procity is  there  any  similarity. 

The  experience  of  the  Basic  Science 
Board  with  regard  to  failures  in  its  exam- 
inations can  only  be  stated  in  the  most  gen- 
eral terms.  Until  the  individual  is  success- 
ful in  his  examinations,  the  Board  has  no 
way  of  knowing  the  healing  art  for  which 
he  wishes  to  be  licensed.  All  that  can  be 
said  is  that  in  the  eleven  years  experience 
covered  here  the  proportion  of  all  failures 
to  the  total  number  of  persons  eventually 
certified  was  14.2  per  cent.  Of  the  total  192 
failures,  60  per  cent  were  in  one  subject 
only,  and  40  per  cent  were  in  more  than 
one  subject.  It  should  be  kept  in  mind  that 
an  unknown  number  of  persons  failed  at 
more  than  one  sitting  of  the  examinations. 
How  much  of  a role  duplication  plays  can- 
not be  estimated.  Neither  is  it  possible  to 
estimate  how  many  persons  failed  one  or 
more  times  and  then  gave  up  any  further 
attempt  to  attain  certification. 


for  April,  1949 


299 


TABLE  IX 

Numbers  of  Persons  Certified  by  the  Colorado  State  Board  of  Examiners  in  the  Basic  Sciences  to 
Licensing  Boards,  by  Year  and  by  Basis  of  Certification 


Numbers  Certified  to: 

Medical  Licensing  Board,  Chiropractic  Licensing 

on  Basis  of;  Board,  on  Basis  of: 

Reci-  Reci- 

Re-  proc-  Re-  proc- 

Years  Exam.  Exam.  ity  Waiver  Exam.  Exam.  ity  Waiver  Total 


1937  9160  0 0 00  16 

1938  27  4 11  6 0 0 0 0 48 

1939  27  235  0 003  40 

1940  29  1 8 6 0 1 0 0 45 

1941  73  12  7 7 0 0 0 0 99 

1942  86  8 8 5 0 1 2 0 110 

1943  74  6 30  8 1 0 0 0 119 

1944  Ill  8 29  6 0 1 0 0 155 

1945  147  17  49  9 0 1 0 0 223 

1946  157  12  77  5 1 1 0 2 255 

1947  151  15  60  7 0 1 4 4 242 


Total  891  86  288  64  2 6 6 9 1352 


Summary 

On  the  basis  of  the  data  available  Janu- 
ary 1,  1948,  analysis  is  made  of  the  distribu- 
tion of  200  Doctors  of  Osteopathy  and  349 
Doctors  of  Chropractic  who  are  residents 
of  and  licensed  to  practice  in  Colorado.  The 
distribution  of  these  two  groups  is  com- 
pared with  that  of  1,658  Doctors  of  Medi- 
cine. 


TABLE  X 

Licensing  Boards  by  Basis  of  Certification 
Per  Cent  Distribution  of  Individuals  Certified  to 


Basis  for 
Certification 

Medical 

Licensing 

Board 

(M.D.  andD.O.) 

Chiropractic 

Licensing 

Board 

(D.C.) 

Examination  

67.1 

8.7 

Re-examination  . 

6.5 

26.1 

Reciprocity  

21.6 

26.1 

Waiver  

4.8 

39.1 

Total  

.....100.0 

100.0 

When  related  to  size  of  community,  the 
distribution  of  the  osteopaths  shows  the 
smallest  variation.  The  other  two  groups 
have  substantially  the  same  variation. 

The  younger  the  osteopaths,  the  more  they 
tend  to  locate  in  the  intermediate  sized  and 
small  communities.  In  general,,  the  reverse 
is  true  of  the  chiropractors,  but  the  varia- 
tion is  not  so  marked.  The  chiropractors 
are  appreciably  the  oldest  group  as  to  typ- 
ical age  and  have  the  greatest  variation 
in  age  within  the  group.  As  a group,  the 
osteopaths  are  slightly  younger  than  the 


M.D.s,  and  are  the  most  homogenous  as  to 
age.  When  related  to  population  aggrega- 
tion in  the  state,  the  M.D.s  are  the  most 
uniformly  and  the  chiropractors  the  least 
uniformly  distributed  groups. 

When  related  to  economic  status  of  state’s 
population,  the  osteopaths  are  the  most  uni- 
formly distributed  group,  and  the  chiro- 
practors the  least.  Both  the  osteopaths  and 
chiropractors  tend  to  concentrate  in  the 
areas  making  up  the  middle  economic  brack- 
ets rather  than  the  high  income  bracket 
areas. 

The  effect  of  the  Colorado  Basic  Science 
Law  on  licensure  of  practitioners  of  the 
healing  arts,  in  the  years  1935  to  1947,  in- 
clusive, has  been  assessed. 

Comparison  of  the  average  number  of 
practitioners  licensed  per  year  for  the  six 
years  before  with  the  six  years  following 
full  effectiveness  of  the  Basic  Science  Law 
shows  an  increase  of  100  per  cent  in  M.D.s, 
a decrease  of  50  per  cent  in  D.Q.s,  and  a de- 
crease of  70  per  cent  in  D.C.s  licensed. 

Since  the  enactment  of  the  Basic  Science 
Law  in  1937,  the  Basic  Science  Board  has 
certified  twenty-three  persons  to  the  Colo- 
rado State  Board  of  Chiropractic  Exam- 
iners. Of  this  number,  39.1  per  cent  were 
certified  on  the  basis  of  waiver,  26.1  per  cent 
on  the  basis  of  reciprocity,  26.1  per  cent  on 
the  basis  of  re-examination,  and  the  re- 
maining 8.7  per  cent  on  the  basis  of  success 
on  fii’st  examination. 


300 


Rocky  Mountain  Medical  Journal 


On  the  other  hand,  1,329  persons  (both 
M.D.s  and  D.O.s)  have  been  certified  to  the 
Colorado  State  Board  of  Medical  Exami- 
ners. These  were  distributed  as  to  basis  for 
certification  as  follows:  first  examination, 
67.4  per  cent;  reciprocity,  21.6  per  cent;  re- 


examnation,  6.5  per  cent;  and  waiver,  4.8 
per  cent. 

REFERENCES 

^''Preliminary  Report.”  Rocky  Mountain  Medical 
Journal  45:557,  1948. 

2‘‘I.  Specialization.”  Rocky  Mountain  Medical  Jour- 
nal 45:765.  1948. 

3”II.  Age  Factors.”  Rocky  Mountain  Medical 
Journal  45:1113,  1948. 


JEJUNO-ILEAL  DIVERTICULA* 

A REVIEW  OF  THE  LITERATURE  AND  CASE  REPORTS 
RANDOLPH  E.  WATTS,  M.D.,  and  SAMUEL  M.  RAMER,  M.D. 

SILVER  CITY,  NEW  MEXICO 


With  the  increase  of  roentgenologic  stud- 
ies of  the  gastro-intestinal  tract,  the  dis- 
covery of  jejuno-ileal  diverticula  is  be- 
coming more  frequent.  Most  of  these  di- 
verticula continue  to  be  discovered  acci- 
dentally on  routine  examination  of  the  gas- 
tro-intestinal tract  or  on  investigation  for 
vague  or  puzzling  symptoms.  Case  encoun- 
tered five  cases  in  a series  of  6,847  barium 
meal  studies  and  Edwards  reported  four 
cases  among  4,631  such  studies.  All  men 
who  have  contributed  to  the  literature  on 
the  subject  are  agreed  that  it  is  almost 
impossible  to  predict  their  presence  since 
the  symptomatology  is  so  obscure  and  in- 
definite. The  frequency  with  which  cases 
are  being  reported  should  give  impetus  to 
the  idea  of  including  a study  of  the  small 
intestine  for  abdominal  complaints  rather 
than  confining  the  study  to  the  stomach  and 
duodenum  as  is  so  often  done  for  one  rea- 
son or  another.  The  disease  has  been  re- 
ported in  a patient  as  young  as  two  years 
of  age  and  as  old  as  91  years  of  age.  No 
studies  have  been  made  of  sex,  race,  or 
geographic  distribution.  Diverticulum  of 
the  jejunum  was  first  described  by  Sir 
Astley  Cooper  in  1844.  Case  reviewed  the 
literature  from  1854  to  1920  and  was  able 
to  collect  only  seventeen  cases.  Bockus 
cites  figures  Which  indicate  that  the  chances 
of  discovery  of  diverticula  of  the  small  in- 
testine are  from  three  to  seven  times  great- 
er at  autopsy  than  following  barium  meal 
studies.  In  the  report  of  the  Mayo  Clinic 
most  of  their  cases  were  found  at  necropsy, 
only  sixteen  of  their  122  reported  cases 
were  found  on  roentgenographic  examina- 
tion of  the  small  intestine.  The  ratio  of  di- 

*Prom the  Watts  Clinic,  Silver  City,  New  Mexico. 


verticula  found  in  the  jejunum  to  those 
found  in  the  ileum  is  greater  than  five  to 
one.  Golden  states  that  diverticula  of  the 
ileum  are  rare  and  he  encountered  only 
two  such  cases. 

Incidence 

Exact  figures  on  the  incidence  of  jejuno- 
ileal diverticula  have  not  been  established, 
but  figures  have  been  variously  quoted  by 
those  interested  in  the  subject.  Dodson 
stated  that  nearly  all  cases  are  in  patients 
over  50  because  of  an  intrinsic  weakness  in 
the  walls  of  the  small  intestine  and  subse- 
quent strain  from  different  causes.  In  their 
excellent  comprehensive  review  of  the  sub- 
ject, Benson,  Dixon  and  Waugh  found 
about  200  cases  reported  in  the  literature 
and  added  122  cases  found  at  the  Mayo 
Clinic  from  1909  to  1943.  Of  their  122  cases 
there  were  100  that  involved  the  jejunum, 
seventeen  were  limited  to  the  ileum  and 
in  five  both  portions  of  the  small  intestine 
were  involved.  They  were  found  in  all  age 
groups.  There  were  seven  cases  among 
children  less  than  10  years  of  age.  There  is 
a higher  rate  of  discovery  of  jejuno-ileal 
diverticula  on  autopsy  examination  than 
there  is  on  roentgenologic  examination. 
One  author  discovered  five  cases  among 
881  cadavers  and  two  others  found  sixteen 
cases  among  8,000  autopsies. 

Etiology  and  Pathology 

There  are  two  types  of  jejuno-ileal  di- 
verticula, the  congenital  and  the  acquired. 
The  congenital  type,  which  is  frequently 
found,  is  said  to  be  caused  by  abnormal 
embryonal  development.  They  have  all 
the  anatomical  layers  of  the  small  intestine 
in  their  walls.  Kozinn  and  Jennings  re- 


fer April,  1949 


301 


ported  a case  of  jejunal  diverticulitis  in  a 
2-year-old  child  who  came  to  autopsy  and 
found  a true  congenital  type  of  diverticu- 
lum. It  was  in  1869  that  Klebs  first  pub- 
lished his  classic  observation  on  the  forma- 
tion of  diverticula  of  the  small  intestine. 
He  noted  that  they  occur  at  the  mesenteric 
border  where  the  main  blood  vessels  pierce 
the  bowel  wall.  These  perforating  branches 
of  the  mesenteric  vessels  tend  to  weaken 
the  intestinal  wall.  When  these  potential 
areas  of  weakness  are  subjected  to  such 
further  strain  as  increased  intra- jejunal 
pressure,  distention  of  the  vascular  bed, 
degeneration  of  the  circular  fibers,  chronic 
coughing  and  severe  straining  from  consti- 
pation, the  possibility  of  herniation  is  great- 
ly increased.  Many  authors  have  elabo- 
rated on  the  mechanism  of  diverticula  for- 
mation but  the  fundamental  concept  of 
Klebs  still  stands  firm  and  unchanged.  The 
acquired  diverticula  consist  only  of  mucosa 
and  serosa  with  an  absence  of  muscular 
layers  or  fibers.  The  outpocketings  once 
started  continue  to  enlarge  if  the  strain 
persists  or  becomes  greater. 

As  in  diverticula  of  other  parts  of  the 
gastro-intestinal  tract  those  in  the  small 
intestine  are  subject  to  complications.  The 
more  common  ones  are: 

1.  Acute  mechanical  intestinal  obstruc- 
tion. 

2.  Chronic  intestinal  obstruction. 

3.  Inflammatory  disturbances  varying 
from  mild  inflammation  to  gangrene  re- 
sulting in  perforation  and  peritonitis. 

4.  Intestinal  hemorrhage. 

5.  Rupture  of  diverticulum. 

6.  Foreign  bodies. 

7.  Neoplastic  disease. 

Symptomatology  and  Diagnosis 

Autopsy  and  surgical  reports  would  indi- 
cate that  the  great  majority  of  jejuno-ileal 
diverticula  are  asymptomatic  since  they  are 
accidental  findings.  However,  some  cases 
present  many  distressing  symptoms  and  it 
is  these  cases  which  require  treatment  by 
medical  or  surgical  means.  Diverticula  of 
the  small  intestine  cause  no  clear-cut,  well- 
defined  groups  of  symptoms  which  can  be 
welded  together  into  a specific  syndrome. 


It  is  the  protean  nature  of  the  complaint 
which  makes  it  next  to  impossible  to  pre- 
dict the  presence  of  jejuno-ileal  diverticula 
on  purely  clinical  grounds.  The  symptoms 
most  commonly  complained  of  are  those 
usually  found  in  many  other  derangements 
of  function  of  the  gastro-intestinal  tract 
and  its  appendages.  Uncomplicated  cases 
may  have  pain,  fullness,  bloating,  gas  rum- 
bling, eructations,  gastric  distress  and  a 
nagging  abdominal  discomfort  which  has 
little  relationship  to  meals.  In  complicated 
cases  the  symptoms  are  determined  by  the 
complicating  factor  such  as  hemorrhage, 
perforation,  or  infection.  Patients  with 
symptomatic  diverticula  wander  from  doc- 
tor to  doctor  and  try  various  and  sundry 
remedies  until  roentgenologic  examination 
brings  to  view  the  underlying  pathology. 

It  is  the  consensus  of  opinion  that  the 
diagnosis  can  only  be  made  by  roentgenolo- 
gic study.  Case  was  the  first  to  demonstrate 
a diverticulum  of  the  small  intestine  by 
such  means.  In  1920  he  reported  a case  of 
diverticulosis  of  the  jejunum  diagnosed  by 
x-ray  study  and  proved  at  operation.  He 
said  at  the  time  that  probably  never  will  a 
case  came  to  the  roentgenologic  examina- 
tion with  a correct  tentative  diagnosis  of 
jejuno-ileal  diverticulosis.  In  his  original  re- 
port he  said,  “With  the  patient  in  the  erect 
position,  the  diagnosis  will  be  based  upon 
the  discovery  of  one  or  more  persisting 
barium  shadows,,  hemispherical  in  outline, 
each  hemispherical  shadow  presenting  a 
fluid  level,  surmounted  by  gas.”  He  further 
stated  that,  “Only  rarely  can  one  make  a 
diagnosis  of  diverticula  of  the  small  intes- 
tine when  the  patient  is  studied  only  in 
the  horizontal  position.”  Many  diverticula 
can  be  picked  up,  however,  with  the  patient 
in  the  horizontal  position.  The  diverticula 
so  clearly  depicted  in  the  photographs 
were  made  from  films  taken  in  the  hori- 
zontal position.  The  diverticula  picked  up 
on  roentgenographic  study  may  appear  as 
oval,  circular,  cup  or  flask-shaped  projec- 
tions from  the  barium  filled  bowel  lumen 
provided  they  can  be  brought  into  the  tan- 
gential views.  The  diverticulum  may  con- 
tain barium  after  the  affected  segment  of 
bowel  is  empty.  The  neck  of  the  sac  may 


302 


Rocky  Mountain  Medical  Journal 


be  wide  or  narrow.  For  reasons  not  well 
understood,  diverticula  may  fail  to  visual- 
ize, yet  may  be  found  on  surgery  or  at 
autopsy. 

Treatment 

It  is  generally  agreed  that  all  patients 
with  uncomplicated  symptomatic  divertic- 
ula should  have  a trial  of  medical  manage- 
ment. Such  management  should  include  in- 
forming the  patient  of  the  nature  of  his 
disease,  advising  adequate  rest  periods, 
strict  dietary  regime,  the  use  of  antispas- 
modics,  bismuth  or  kaolin,  and  a mild  lu- 
bricant. The  nature  of  the  response  should 
determine  the  length  of  time  the  patient 
should  be  carried  along  on  such  treatment. 
Of  course,  all  attempts  should  be  made  to 
rule  out  the  existence  of  disease  of  other 
organs  of  the  gastro-intestinal  tract.  If  the 
patient  fails  to  make  a satisfactory  rasponse 
to  adequate  medical  management,  or  if  his 
circumstances  are  such  that  he  cannot  ad- 
here to  such  a regimen,  then  surgery  should 
be  seriously  considered.  The  type  of  sur- 
gery will  be  largely  determined  by  the  ex- 
tensiveness of  the  process.  With  acute 
complications  such  as  intestinal  obstruc- 
tion, diverticulitis  or  rupture  of  a diver- 


ticulum, surgical  intervention  is  often  im- 
perative. 

CASE  REPORTS 

Case  1.  A.  J.  E.,  aged  69,  white,  male,  retired, 
reported  to  the  clinic  oh  November  6,  1947, 
complaining  of  diffuse  abdominal  distress,  flat- 
ulence, gas  rumbling,  weakness  and  loss  of 
weight.  On  physical  examination,  the  only  find- 
ing of  note  was  a diffusely  tender  abdomen. 
Blood  count,  urinalysis,  and  x-ray  of  the  chest 
were  not  remarkable.  Roentgenologic  study  of 
the  gastro-intestinal  tract  revealed  the  presence 
of  several  jejunal  diver ticuli.  He  was  advised 
of  his  condition  and  placed  on  a routine  of 
bland  diet,  rest,  antispasmodics,  sulfasuxadine 
and  mineral  oil.  His  response  to  this  routine 
varied  considerably  until  he  reached  the  stage 
a month  later,  when  he  became  desperate  for 
relief.  On  January  14,  1948,  he  was  explored 
and  found  to  have  three  jejunal  diverticula.  The 
diverticula-bearing  portion  of  the  jejunum  was 
resected  and  an  end  to  end  anastomosis  was  per- 
formed. The  patient  made  an  uneventful  recov- 
ery. Follow-up  visits  to  the  clinic  showed  him 
to  be  much  improved. 

Case  2.  S.  C.,  aged  46,  white,  housewife,  re- 
ported to  the  clinic  on  July  7,  1947,  with  a history 
of  having  had  abdominal  surgery  six  months 
previously  for  diverticulosis  of  the  duodenum 
and  jejuno-ileum.  Her  chief  complaint  prior  to 
the  surgery  was  prolonged  abdominal  distress 
of  varying  intensity  and  constipation.  She  was 
advised  to  have  surgery  to  correct  the  pathology 
of  the  small  intestine.  She  had  a laparotomy  in 
April,  1947,  at  which  time  several  of  the  diver- 
ticula were  resected.  The  diverticulosis  was  so 
extensive,  however,  that  she  was  advised  that 
more  would  have  to  be  resected  at  a later  date. 


Fig.  1,  Case  1.  Roentgenogram  showing  several 
jejunal  diverticuli. 


Fig.  2,  Case  2. 
juno-ileum. 


Diverticulosis  of  duodenum  and  je- 


for  April,  1949 


303 


She  refused  the  second  surgery  and  reported  to 
the  clinic  for  advice  and  treatment.  She  was  put 
on  a medical  regime  of  sedation,  antispasmodics, 
kaolin,  and  general  supportive  therapy  with  a 
satisfactory  response. 

Case  3.  E.  E.,  aged  35,  white,  housewife,  re- 
ported to  the  clinic  on  April  3,  1947,  complaining 
of  pains  and  burning  in  the  abdomen  of  five 
months’  duration.  The  pains  varied  in  inten- 
sity, were  worse  after  meals  and  came  on  at  any 
time  of  the  day  or  night.  Physical  examination 
was  essentially  negative  except  for  mild,  diffuse 
abdominal  tenderness.  Examination  of  the  blood, 
urine  and  x-ray  of  the  chest  were  negative. 
Roentgehologic  examination  of  the  gastro-intes- 
tinal  tract  revealed  a large  single  diverticulum 
of  the  proximal  jejunum.  She  was  informed  of 
her  pathology  and  put  on  a medical  regime  of 
reassurance,  sedation,  antispasmodics,  bland  diet 
and  bowel  lubricant.  Up  to  the  time  of  the 
writing  of  this  paper,  she  has  made  a good 
response  to  the  treatment  outlined. 


Summary  and  Conclusions 
A brief  review  of  the  literature  of  the 
jejuno-ileal  diverticulosis  , is  presented. 
With  the  increase  of  roentgenologic  studies 
of  the  gastro-intestinal  tract,  more  cases 
of  this  disease  are  being  found.  Complete 
studies  should  be  made  to  avoid  overlook- 
ing the  presence  of  diverticula  of  the  small 
intestine.  It  is  essentially  a roentgenologic 
diagnosis.  Uncomplicated  symptomatic 
cases  should  be  given  a trial  of  thorough 
medical  management.  If  the  response  of 
the  patient  is  poor  after  a fair  trial  of 
medical  management,  then  surgery  should 
be  advised.  Three  cases  of  diverticula  of 
the  jejunum  are  presented. 


FURTHER  EXPERIENCE  WITH  METHERGINE  AS  AN  OXYTOCIC* 

M.  J.  BASKIN,  M.D. 

DENVER 


In  a previously  reported  study ^ of  181 
cases,  Methergine  (d-lysergic  acid  d 1 hy- 
droxybutylamide  2)  partially  synthesized 
by  Stoll  and  Hofmann^,  and  investigated 
pharmacologically  by  E.  Rothlin  and  by 
Kirchhof  et  al'\  was  given  intravenously, 
each  ampul  containing  0.2  mg.,  in  115  cases 
at  the  iristant  the  shoulders  deliver,  and  in 
sixty-six  cases  Methergine  was  given  intra- 
vaneously  after  the  expulsion  of  the  pla- 
centa. During  the  puerperium,  each  pa- 
tient received  one  tablet  of  Methergine, 
containing  0.25  mg.  three  times  daily  for 
three  days.  In  this  series,  Methergine  had 
a more  pronounced  and  sustained  effect 
than  natural  ergonovine,  the  third  stage  of 
labor  was  shortened,  repair  of  episiotomy 
was  easier  by  a comparatively  dry  field  due 
to  firm  contraction  of  the  uterus,  and  no 
side  effects  wer  observed.  These  clinical 
^observations  are  similar  to  those  reported 
iby  Tollefson"*,  Tritsch  and  Schneider®, 
Brougher®,  Janke^,  Cartwright  and  Rogers®, 
GilP,  Roberts^®,  Williams^\  Gipstein^^,  and 
d’Ernst'®.  Farber^^,  BrougheU®,  reported 
good  results  with  Methergine  for  the  induc- 
— ^ i 

*Limited  space  prjfecludes  inclusion  of  the  refer- 
ences in  this  Journal;  they  will  appear,  however,  on 
the  author’s  reprints. 

tPurnished  by  Sandoz  Chemical  Works,  Inc.,  San 
Francisco,  California. 

304 


tion  of  labor  and  Brunner®®,  reported  favor- 
able results  in  uterine  inertia. 

Another  series  of  536  cases  were  ob- 
served to  gather  additional  data  concern- 
ing this  new  partial  synthetic  ergot  elka- 
loid  (Methergine)  t which  promises  to  re- 
place natural  ergonovine. 

In  this  group  of  cases,  each  patient  was 
given  1 c.c.  of  Methergine  intravenously  as 
soon  as  the  head  is  born,  and  one  tablet  of 
Methergine  was  administered  three  times 
daily  for  three  days  in  the  puerperium.  The 
average  time  of  the  expulsion  of  the  pla- 
centa was  three  minutes.  The  average 
blood  loss,  which  was  measured  by  the  es- 
timated method,  was  85  c.c.-  There  were 
no  cases  of  postpartum  hemorrhage,  the 
field  was  usually  dry,  facilitating  the  re- 
pair of  episiotomy,  no  packing  was  required 
and  involution  was  much  faster. 

After  birth,  there  is  usually  no  internal 
bleeding.  After  two  or  three  minutes,  there 
is  slight  bleeding  and  the  cord  which  is  left 
hanging  with  hemostat  attached,  begins  to 
descend.  At  this  time  slight  pressure  is 
made  on  the  lower  uterine  segment,  which 
delivers  the  placenta. 

After  delivery,  the  uterus  is  globular  and 
softens  as  the  placental  separation  is  occur- 
ring. As  soon  as  it  is  completed,  the  uterus 

Rocky  Mountain  Medical  Journal 


again  becomes  globular  and  rises  to  about 
the  level  of  the  naval.  Slight  pressure  just 
above  the  pubis  then  expells  the  placenta. 
If  the  placenta  is  still  in  the  uterus,  this 
pressure  will  cause  the  uterus  to  rise  in  the 
abdomen  and  the  cord  to  be  drawn  inward. 
The  fundus  should  not  be  handled  or 
squeezed.  In  all  cases  the  episiotomy  wound 
was  sutured  after  the  delivery  of  the  pla- 
centa. Since  the  delivery  of  'the  placenta 
occurs  in  about  three  minutes,  it  is  always 
delivered  first  and  then  the  repair  is  ac- 
complished in  a dry  field.  Where  Mether- 
gine  is  not  used,  it  has  been  necessary  to 
wait  ten  to  twenty  minutes  for  expulsion, 
and  tendency  is  to  repair  the  episiotomy  be- 
fore the  placental  delivery.  This  necessi- 
tates working  in  a bloody  field  with  the 
cord  in  the  way  and  occasionally,  during 
the  delivery  of  the  placenta,  stitches  are 
torn  lose.  Methergine  used  as  described 
above  prevents  these  difficulties  and  saves 
the  patient  valuable  minutes  under  anes- 
the.=ia. 

It  is  interesting  to  mention  that  Mether- 
gine was  of  special  value  in  abortion  with 
placental  retention.  In  most  cases,  intra- 
venous injection  of  1 c.c.  Methergine  expels 
the  placenta.  If  the  placenta  is  not  ex- 
pelled the  first  day  it  is  reinforced  by  Meth- 
ergine orally  every  four  hours  and,  if  nec- 
essary, an  intravenous  injection  is  repeated 
the  next  day  without  untoward  results  and 
expulsion  of  the  placenta  follows.  In  sec- 
ondary bleeding,  Methergine  orally  and  in- 
travenously is  effective. 

Cesarean  Section 

I 

As  the  incision  is  being  made  into  the 
uterus,  Methergine  is  injected  intravenous- 
ly. The  expulsion  of  the  placenta  may  be 
watched  and,  usually  follows  within  one  to 
three  minutes  after  extraction  of  the  fetus. 
Th  uterus  becomes  hard  and  the  bleeding  is 
slight.  Methergine  is  then  given  orally  for 
three  days,  three  times'  daily.  In  this  series 
of  fourteen  cases,  it  has  never  been  neces- 
sary to  repeat  the  intravenous  injection. 

Discussion 

Methergine  in  our  hands  proved  to  pos- 
sess a more  sustained  and  prolonged  action 


on  the  uterus  than  natural  ergonovine.  One 
of  the  most  striking  effects,  resulting  from 
the  use  of  this  partial  synthetic  substance, 
is  the  reduction  of  normal  blood  loss.  There 
were  no  cases  of  retained  or  incarcerated 
placenta.  Blood  loss  was  estimated  and  all 
efforts  were  made  to  eliminate  inaccuracy, 
which  was  accomplished  by  delegating  one 
individual  to  measure  blood  loss.  As  in 
our  previous  study,  the  blood  was  measured 
as  preplacental,  placental  and  postplacental. 

Conclusions 

1.  In  this  series  of  536  cases,  Methergine 
in  our  hands  proved  to  be  a reliable  and 
safe  oxytocic. 

2.  It  produces  a more  rapid  and  sustained 
effect  than  natural  ergonovine. 

3.  The  third  stage  was  shortened  and  the 
normal  blood  loss  was  reduced. 

REFERENCES 

'Baskin,  M.  J.,  Harvey,  E.  L.,  and  McEndaffer,  D. 

M.  : Rocky  Mt.  Med.  Jour.,  March,  1947. 

'Stoll,  A.,  and  Hofmann,  A.:  Helvetica  Chimica 
Acta  26:944,  1943. 

'Kirchof,  A.  C.,  Racely,  C.  A.,  Wilson,  W M.,  David, 

N.  A.:  West.  Jour,  of  Sur.,  Obs.  & Gyn.,  May,  1947. 

'Tollefson,  D.  G. : West.  Jour,  of  Sur,  Obs.  & Gyn., 

September,  1944. 

'Tritsch,  J.  E.,  and  Schneider,  E.;  Amer.  Jour,  of 
Obs.  & Gyn  , October,  1945. 

®Broug-her,  J.  C.:  West.  Jour,  of  Sur.,  Obs.  & Gyn., 
August,  1945. 

'Janke,  G.-  “Zentralblatt  fur  Gynakologie,"  Bd.  66, 
S.  1071  (1942,  Nr.  27). 

'Cartwright,  E.  W.,  and  Rogers,  W.  C.:  West.  Jour, 
of  Sur.,  Obs.  & Gyn,  February,  1946. 

'Gill,  R.  C.:  Jour,  of  Obs.,  54,  482  (1947,  No.  4). 

"Roberts,  P.  C. ; West.  Jour,  of  Sur.,  Obs.  & Gyn., 
September,  1944. 

"Williams,  B.  C. : Rocky  Mt.  Med.  Jour.,  March, 
1947. 

"Gipstein,  B.  L. : Amer.  Jour.  Obs.  & Gyn.,  Decem- 
ber, 1947. 

"d’Brnst,  J.  P. : Schweiz.  Med.  Wschr.,  76,775,  1946. 

"Farber,  E.  P. : Amer.  Jour.,  of  Obs.  & Gyn.,  June, 
1946. 

"Brougher,  J.  C. : West  Jour,  of  Sur.,  Obs.  & Gyn., 
July,  1947. 

"Brunner,  C. : Gynaecologia,  122,  114,  1946. 


SCIENTIFIC  EXHIBITS 

Members  of  the  Colorado  State  Medical 
Society  planning  scientific  exhibits  for  the 
Annual  Session  in  September  are  urged  to 
get  in  touch  with  the  Chairman  of  the  Com- 
mittee on  Scientific  Exhibits.  Your  com- 
mittee feels  that  these  exhibits  contribute 
materially  to  the  success  of  the  meeting 
and  would  appreciate  hearing  from  inter- 
ested exhibitors. 

FRANK  C.  CAMPBELL,  M.D. 

Chairman. 


for  April,  1949 


305 


Case  Report 


SURGICAL  GASTRO-ILEOSTOMY* 

W.  R.  COPPINGER,  M.D.,  and  P.  M.  IRELAND, 
M.D. 

FORT  LOGAN,  COLORADO 

The  formation  of  a gastro-ileostomy  is  a 
rare  surgical  error;  Brown,  Col  vert,  and 
Brush^  reviewed  the  literature  and  found 
twenty-two  reported  cases  and  presented 
three  additional  cases.  Of  these  reported 
cases,  only  two  followed  a partial  gas- 
trectomy; therefore,  it  is  considered  of  in- 
terest to  report  such  a case. 

CASE  REPORT 

The  patient,  a 36-year-old  white  veteran  of 
World  War  II,  was  admitted  to  the  Veterans 
Administration  Hospital,  Fort  Logan,  Colorado, 
on  December  31,  1946,  complaining  of  weakness, 
fatigability,  diarrhea,  and  weight  loss  of  four- 
teen months’  duration.  In  1944,  ,the  patient  de- 
veloped a duodenal  ulcer  while  in  the  Armed 
Forces  and  subsequently  received  a medical  dis- 
charge after  several  recurrent  episodes  of  ulcer 
disability.  After  discharge,  the  patient  had  a 
recurrence  of  symptoms  and  a partial  gastrec- 
tomy and  a gastro-enterostomy,  described  as  a 
gastrojejunostomy,  was  performed  at  another 
hospital.  Immediately  after  the  operation,  the 
patient  developed  diarrhea  with  eight  to  ten 
loose  yellow  stools  daily.  Despite  a hearty  ap- 
petite, there  was  a weight  loss  of  sixty-five 
pounds  in  the  succeeding  sixteen  months.  At 
no  time  was  there  a recurrence  of  pain.. 

Physical  examination  revealed  an  emaciated 
white  male  who  was  obviously  anemic.  No  ab- 
dominal masses  or  tenderness  were  present. 

The  laboratory  findings  were  as  follows:  RBC, 
3,020,000;  Hemoglobin,  12.5  gm..;  WBC,  6,200; 
Neutrophils,  64  per  cent;  Lymphocytes,  33  per 
cent;  Monocytes,  2 per  cent;  Basophils,  1 per 
cent.  A moderate  anisocytosis  was  present.  Col- 
or index,  1.3  per  cent;  volume  index,  1.3;  packed 
cell  volume,  37.0.  On  January  6,  1947,  the  total 
serum  protein  was  7.7  gm.;  5.0  gm.  albumin;  2.7 
gm.  globulin;  A/G  Ratio,  1.8. 

On  January  3,  1947,  a barium  meal  was  given 
which  revealed  a partial  gastric  resection  and 
an  unusual  union  of  stomach  and  small  bowel, 
with  a rapid  transit  of  barium  into  the  large 
bowel  from  the  small  bowel,  suggesting  either 
an  anastomosis  or  a fistula  between  the  stomach 
and  distal  small  intestine.  Fluoroscopic  exam- 
ination on  January  9,  1947,  revealed  a large 
tortuous  colon  requiring  two  gallons  of  barium 
to  fill,  but  no  demonstrable  enterocolic  fistula. 
On  January  12,  1947,  the  gastro-intestinal  roent- 

*From the  Surgical  Service,  Veterans  Administra- 
tion Hospital  Port  Logan,  Colorado.  Published  with 
permission  of  the  Branch  Medical  Director,  Depart- 
ment of  Medicine  and  Surgery,  Veterans  Administra- 
tion, Branch  No.  13,  who  assumes  no  responsibility 
for  the  opinions  expressed  or  conclusions  drawn  by 
the  author. 


gen  study  was  repeated  and  the  barium  was  vis- 
ualized rapidly  traversing  obliquely  across  the 
abdomen  to  the  right  lower  quadrant  and  then 
splitting  into  two  channels.  One  stream  went 
to  the  right  and  assumed  a large  bowel  pattern. 
The  channel  to  the  left  apparently  was  in  the 
small  intestine  and  became  lost  in  indistinguish- 
able loops.  From  this  examination,  the  roent- 
genologist concluded  that  there  was  a gastro- 
ileostomy  approximately  eight  inches  from  the 
ileocecal  valve. 

After  a regimen  of  high  protein  intake,  orally 
and  parenterally,  and  several  whole  blood  trans- 
fusions, a lap'arotomy  was  done  on  January  20, 
1947.  An  anterior  gastro-ileosotomy  was  found 
with  the  distal  segment  of  ileum  eighteen  inches 
in  length  and  the  distal  loop  of  ileum  was  at- 
tached to  the  lesser  curvature  of  the  stomach.  A 
de-anastomosis  was  performed  by  removing  a 
narrow  cuff  of  stomach  proximal  to  the  junction 
and  removing  a segment  of  ileum  proximal  and 
distal  to  the  anastomosis.  An  end-to-end  ap- 
proximation of  the  severed  ileum  and  a posterior 
gastrojejunostomy  was  then  done.  The  post- 
operative course  was  uncomplicated  and  charac- 
terized by  rapid  weight  gain.  At  the  time  of 
discharge  from  the  hospital  thirty-seven  days 
after  operation,  the  patient  had  gained  27 
poimds.  When  last  seen,  fifteen  months  after 
operation,  there  was  a total  weight  gain  of  50 
pounds. 

The  resected  specimen  of  ileum  and  stomach 
grossly  showed  some  thickening  of  the  ileal  wall 
and  a small  mucosal  ulceration  distal  to  the 
anastomosis.  Microscopically,  the  mucosa  was 
eroded  and  replaced  by  necrotic  debris  overlying 
a chronic  inflammatory  fibrosis. 

Discussion 

It  was  evident  immediately  after  the  ini- 
tial operation  that  normal  nutrition  was 
impaired  in  some  manner  and  the  rapid 
weight  loss  and  diarrhea  suggested  an  intra- 
abdominal fistula.  Though  the  type  of  gas- 
tro-enterostomy present  was  not  known 
prior  to  exploration,  a gastrocolic  fistula 
would  be  the  suspected  lesion,  but  this  was 
readily  disproved  by  the  x-ray  studies  and 
the  presence  of  a gastro-ileostomy  shown. 
With  such  a short-circuited  small  intestine, 
the  weight  loss,  anemia,  and  dehydration 
would  be  expected,  due  to  the  loss  of  the 
absorbing  portion  of  the  intestinal  tract. 
Undoubtedly,  the  colon  had  made  an  at- 
tempt to  assume  the  small  bowel  function 
as  evidenced  by  the  dilatation.  It  is  of 
interest  that  the  patient  passed  consider- 
able flatus  of  a “sour-milk”  odor,  probably 
due  to  the  rapid  transit  of  food  into  the 
large  intestine. 

« 

The  ileac  ulcer  present  would  be  expected 
with  the  continued  bathing  of  the  ileum  by 


306 


Rocky  Mountain  Medical  Journal 


gastric  secretion.  The  interesting  phenom- 
enon was  the  lack  of  pain  from  the  ulcer, 
which  was  probably  due  to  the  constant 
flow  of  intestinal  secretions  from  the  prox- 
imal loop.  Brown,  Colvert,  and  Brush^  in 
their  discussion  cite  nausea,  vomiting  and 
anorexia  as  being  common  symptoms,  par- 
ticularly in  those  cases  where  the  pyloric 
ring  and  operative  stoma  were  malfunction- 
ing. Absence  of  these  symptoms  in  this 
patient  presumes  a well-functioning  stoma 
which,  in  turn,  predisposed  to  diarrhea. 

A study  of  the  cases  reported  indicates 
certain  essential  differences  in  the  onset  of 
the  rapid-emptying  syndrome.  The  major- 
ity of  cases  had  the  onset  of  symptoms  a 
variable  length  of  time  following  the  opera- 
tion, in  some  instances  being  a number  of 
months  or  years.  Smith  and  Rivers^,  in 
their  series  of  case  reports,  include  a case 
following  partial  gastric  resection  in  which 
the  symptoms  were  present  immediately 
postoperatively.  The  obvious  explanation 
for  the  onset  time  differences  is  the  pres- 
ence or  lack  of  a patent  functioning  pyloric 
orifice.  Despite  the  presence  of  a gastro- 
enterostomy stoma,  the  bulk  of  the  gastric 
contents  will  pass  through  the  pyloric  open- 
ing due  to  the  physiology  peristaltic  mo- 
tion.® With  a partial  gastric  resection,  the 
pyloric  opening  is  eliminated  and  a well 
conceived  artificial  stoma  will  function  in 
such  a manner  that  the  gastric  contents  are 
immediately  passed  into  the  short  distal 
loop  and  the  lengthy  proximal  small  bowel 
is  completely  out  of  the  participating  intes- 
tinal tract.  Thus,  it  behooves  every  sur- 
geon to  suspect  such  a mistake  if  there  is 
immediate  diarrhea,  weight  loss,  and 
emaciation  following  a gastric  resection. 

Summary 

A case  of  surgical  gastro-ileostomy  fol- 
lowing a partial  gastric  resection  is  pre- 
sented; in  the  available  literature  only  two 
similar  cases  are  found. 

REFERENCES 

’Brown,  C.  H.,  Colvert,  J.  R.,  and  Brush,  B.  E.: 
Gastroenterology,  8:  71,  1947. 

’Smith,  I,.  A.,  and  Rivers,  A.  B.;  Surg.,  Gyn.  and 
Obst.,  76:  110,  1943. 

’Dragstedt,  L.  R.:  Ann.  Surg.,  102:  563,  1935. 


RECENT  IMPRESSIONS  OF  MEDICAL 
PRACTICE  IN  GREAT  BRITAIN 

WILLIAM  H.  SWEET,  M.D. 

BOSTON 

Editors  Note:  Abstracted,  by  permission  o[  the 
Editor,  from  the  February  3,  1949,  issue  of  the  New 
England  Journal  of  Medicine,  Boston.  The  author  is 
School;  lecturer  in  neurosurgery.  Tufts  College  Med- 
ical School;  associate  visiting  neurosurgeon,  Mas- 
sachusetts General  Hospital.  Dr.  Sweet  spent  two 
years  as  an  Oxford  medical  undergraduate,  four 
years  at  London  and  Birmingham  during  the  war  as  a 
practicing  surgeon  employed  by  the  Ministry  of 
Health  for  most  of  the  time,  and  more  recently  en- 
gaged in  a period  of  work  at  a large  hospital  in 
Engand. 

Many  physicians  have  hitherto  regarded 
only  with  casual  interest  the  controversy 
over  the  organization  of  medical  practice  in 
this  country.  I,  myself,  for  example,  have 
assumed  that  a faculty  member  of  the  staff 
of  a teaching  hospital  could  be  little  af- 
fected by  any  of  the  bruited  changes — a 
notion  that  has  been  sharply  challenged  by 
observations  of  the  current  status  of  phy- 
sicians in  this  and  other  categories  in  Great 
Britain.  Severely  jarred  is  my  complacen- 
cy by  what  I have  seen.  . . . 

British  physicians  in  all  types  of  work 
have  been  profoundly  affected  by  the  legis- 
lation of  His  Majesty’s  government,  and  we 
here  would  do  well  to  realize  that  none  of 
us  are  necessarily  immune  to  the  conse- 
quences of  radical  departures  in  medical 
administrative  procedure. 

The  latest  of  the  items  of  legislation  gov- 
erning medical  practice  in  Great  Britain 
finally  came  into  force  on  July  5,  1948.  It 
is  important  to  recognize,  however,  that  this 
is  only  the  culminating  step  in  a series  of 
laws  that  began  ...  in  1912.  ..  . The  war- 
time level  of  taxation  and  the  rising  costs  of 
living  made  it  apparent  to  all  during  the 
war  that  there  would  be  insufficient  volun- 
tary donors  to  support  the  privately  en- 
dowed hospitals  after  the  war  and  that  a 
major  reorganization  of  the  conditions  of 
medical  practice  would  be  needed. 

Conferences  between  the  medical  profes- 
sion and  the  Minister  of  Health  in  Mr. 
Winston  Churchill’s  coalition  government 
resulted  in  tentative  agreement  for  the 
provision  under  the  auspices  of  the  Minister 
of  Health  for  a service  to  cover  all  aspects 


for  April,  1949 


307 


of  medical  care  for  almost  the  whole  nation. 
The  general  election  of  1945  placed  the  La- 
bor Party  in  power  and  this  agreement  was 
ostensibly  scrapped  by  the  new  minister  of 
health.  . . . Bevan  announced  he  would 
present  a measure  to  Parliament  without 
bothering  to  have  full  discussion  with  any 
representative  of  the  British  Medical  Asso- 
ciation. . . . 

It  was  a foregone  conclusion  . . . three 
and  a half  years  ago  . . . that  the  central 
government  would  be  in  control  of  the  con- 
ditions of  medical  practice.  All  the  major 
hospitals  have  continued  to  receive  indis- 
pensable financial  support  from  the  govern- 
ment since  the  war,  the  use  of  this  money 
being  subject  to  continuous  governmental 
surveillance.  The  physician  in  general  prac- 
tice in  England  today  is  swamped  by  a 
volume  of  work  that  makes  it  possible  for 
him  to  only  rarely  take  a clinical  history 
or  make  a physical  examination  in  the  fash- 
ion that  is  attempted  in  this  country.  . . . 
The  British  general  practitioner  must  now 
in  the  course  of  a single  day  see  in  his  office 
and  in  visits  to  homes  an  average  of  at 
least  fifty  patients  if  he  has  the  average 
panel  of  2,000  persons — or  100  patients  if  he 
has  the  maximum  panel  of  4,000.  . . . 

There  is  one  physician  per  875  inhabi- 
tants in  Great  Britain  as  compared  with  one 
per  720  in  this  country.  The  load  in  Eng- 
land appears  to  arise  not  from  a great  short- 
age of  physicians  there  but  because  the 
physician  is  expected  to  carry  out  many 
functions  that  Americans  would  not  con- 
sider a part  of  his  task. 

Many  people  with  minor  complaints  . . . 
present  themselves.  Even  though  they  may 
recognize  the  triviality  of  the  disorder,  they 
often  wish  to  obtain  medication  which  is 
provided  free  of  charge  with  the  doctor’s 
prescription,  so  they  sit  about  in  his  office 
and  wait  for  a handout.  The  Labor  govern- 
ment’s innumerable  restrictions  on  the  lives 
of  every  person  also  result  in  countless 
daily  appeals  to  the  doctor  for  escape.  The 
employee  may  not  be  absent  from  work 
without  an  excuse  ...  a note  from  the 
physician  is  the  easiest  justification  . . . the 
worker  tells  the  doctor  he  has  had  diarrhea 


for  two  or  three  days  . . . the  doctor  signs 
a form  he  has  ready  for  the  occasion.  . . . 

Many  people  seeking  to  evade  food  ra- 
tioning restrictions  seek  a doctor’s  certifi- 
cate for  more  eggs,  milk,  meat  and  cheese. 
The  fact  that  house  calls  are  now  free  re- 
moves the  one  useful  restraint  from  the 
patient  who  . . . waits  until  midnight  to 
call  a doctor.  Failure  of  a physician  to 
answer  an  emergency  call  not  only  may  un- 
fairly lose  him  the  patronage  of  the  patient 
but  also  is  the  basis  for  disciplinary  action 
by  an  agency  of  the  government.  The  so- 
called  patient’s  free  care  extends  to  the 
dispensing  of  such  needed  appliances  as 
braces  and  eyeglasses.  . . . The  government 
is  now  the  only  purchaser  of  protheses  and 
braces  and  is  driving  out  of  business  all 
firms  the  Minister  of  Health  does  not  see 
fit  to  support. 

And  what  is  the  lot  of  the  consultant 
group?  In  1945  a distinguished  man  in  this 
category  told  me  what  striking  improve- 
ments the  reorganization  would  bring  . . . 
each  major  medical  school  would  be  the 
center  of  a region  of  the  nation  . . . exer- 
cising a salutary  continuing  influence  over 
the  actual  medical  practice  . . . three  years 
later  this  man,  like  his  colleagues,  is  work- 
ing under  handicaps.  Construction  has  not 
been  completed.  The  activities  of  the  most 
distinguished  worker  in  this  hospital  con- 
tinue to  be  carried  out  with  the  same  primi- 
tive facilities  which  burden  the  remainder 
of  the  staff. 

Final  decisions  regarding  salary  scales 
for  consultants  has  not  even  been  made. 
However,  the  present  salaries  of  three  col- 
leagues and  personal  friends  bear  mention. 
They  are  consultants  with  extended  com- 
plete postgraduate  training  in  a surgical 
specialty,  and  they  now  hold  full-time  ap- 
pointments in  major  hospitals.  Each  of 
these  men  with  a family  is  paid  about  $2,500 
per  year  after  income  tax  deductions.  . . . 
This  is  representative  for  such  men  under 
40  years  of  age.  This  permits  a scale  of 
living  similar  to  that  which  one  would  ob- 
tain in  this  country  on  such  income  . . . but 
the  startling  fact  is  the  relation  to  other 
groups  in  the  country  ...  it  is  a smaller 


308 


Rocky  Mountain  Medical  Journal 


yearly  income  than  that  of  a skilled  me- 
chanic in  England. 

On  the  basis  of  the  foregoing  statements 
. . . a personal  opinion  will  be  ventured  on 
the  significance  of  these  facts  to  the  medical 
profession  of  the  United  States.  In  the  first 
place,  the  sorry  plight  of  our  British  col- 
leagues appears  to  be  due  to  their  having 
been  compelled  to  accept  terms  imposed  by 
nonmedical  members  of  the  nation.  Had 
they  analyzed  the  defects  in  their  system, 
presented  a well  conceivd  plan  for  improve- 
ments, and  then  stood  fast  against  ill  ad- 
vised changes,  the  British  people  might 
now  be  receiving  better  medical  care  and 
the  physicians  might  be  happier. 

American  physicians  are  or  should  be 
familiar  with  the  shortcomings  of  the  pres- 
ent scheme  here  . . . unless  they  come  up 
with  a constructive  program  correcting 
these  faults — perhaps  even  if  they  do — they 
can  expect  outside  imposition  of  laws  that, 
the  British  experience  suggests,  will  at  least 
in  some  aspects  be  detrimental  to  the  best 
interests  of  the  patient  and  his  doctor. 


POSTGRADUATE  COURSE:  PROBLEMS  OF 
NEWBORN  INFANTS,  PREMATURE 
AND  FULL  TERM 

A postgraduate  course  on  the  Problems  of 
Newborn  Infants,  Premature  and  Full  Term, 
sponsored  by  the  University  of  Colorado  School 
of  Medicine  and  the  Colorado  State  Department 
of  Health,  will  be  given  at  the  University  of 
Colorado  Medical  Center,  Denver,  Colorado, 
April  7,  8,  9,  1949.  The  course  is  for  the  purpose 
of  orienting  the  practicing  physicians  in  the 
problems  of  newborn  infants,  both  premature 
and  full  term.  Lectures,  panel  discussions  and 
demonstrations  will  be  given  by  members  of  the 
faculty  on  subjects  such  as:  obstetric  aspects  of 
prematurity,  resuscitation,  nutrition,  iso-immu- 
nization, psychological  problems  in  prematrurely 
born  infants,  community  planning,  the  problem 
of  infections,  and  the  interpretation  of  laboratory 
findings  in  the  newborn. 

The  guest  lecturer  of  the  course  is  Herbert  C. 
Miller,  M.D.,  Professor  of  Pediatrics,  University 
of  Kansas  School  of  Medicine.  The  course  is 
open  to  graduates  of  medical  schools  approved 
by  the  American  Medical  Association. 

The  registration  fee  is  $5.00  and  the  tuition 
is  $10.00.  Interns  and  residents  are  invited  to 
attend  without  charge. 

Inquiries  should  be  directed  to  John  Lichty, 
M.D.,  Director  of  the  course. 


COURSE  IN  INDUSTRIAL  MEDICINE 

The  University  of  Colorado  Medical  Center  is 
offering  a three  year  fellowship  in  industrial 
medicine.  The  course  is  designed  to  give  ad- 
vanced training  in  the  specialty  of  industrial 
medicine  and  the  degree  Doctor  of  Industrial 
Medicine  will  be  granted  on  successful  comple- 
tion of  the  course.  The  stipends  will  be  $1,800 
and  $2,400  for  the  first  and  second  years  re- 
spectively. Appointments  are  made  January  1, 
and  July  1.  This  course  is  approved  by  the  Vet- 
erans Administration  for  candidates  who  are 
eligible  under  the  GI  Bill  of  Rights. 

The  first  two  years  will  consist  of  didactic 
work  and  will  include  the  study  of  occupational 
diseases  and  their  etiology,  toxicology,  disability 
measurements  and  evaluation,  and  labor  and 
management  problems.  Time  and  facilities  for 
research  will  be  provided  and  a thesis  will  be 
required.  The  third  year  will  be  spent  in  train- 
ing in  industry  imder  supervision.  The  amount 
of  stipened  for  this  year  will  be  announced  at 
a later  date.  The  clinical  aspects  of  industrial 
medicine  are  emphasized  in  addition  to  the  study 
of  environmental  hygiene. 

Requirements:  Graduation  from  an  approved 
Medical  School,  at  least  one  year  of  internship 
training,  and  preferably  at  least  one  year  of 
residency  training  in  one  of  the  specialties  or 
one  or  more  years  of  practice  of  Medicine. 

For  further  inquiries  write  Frank  Princi,  M.D., 
Director,  Division  of  Industrial  Medicine,  Uni- 
versity of  Colorado  Medical  Center,  Denver, 
Colorado. 


PHYSICIAN-ARTISTS,  BEWARE! 

If  you  plan  to  exhibit  at  the  Atlantic  City 
Exhibition  (American  Medical  Association, 
June  €-10,  1949 — Now  is  the  time  to  write  for 
entry  blanks,  rules,  shipping  labels,  etc. 

Haste  is  necessary  because  your  entries  must 
reach  Atlantic  City  between  April  15  and  May  9. 

For  details,  please  write  airmail  to  Francis  H. 
Redewill,  M.D.,  Secretary,  American  Physicians 
Art  Association,  Flood  Building,  San  Francisco, 
California. 


AMERICAN  BOARD  OF  OBSTETRICS  AND 
GYNECOLOGY,  INC. 

The  general  oral  and  pathology  examinations 
(Part  H)  for  all  candidates  will  be  conducted  at 
Chicago,  Illinois,  by  the  entire  Board  from 
Sunday,  May  8,  through  Saturday,  May  14,  1949. 
The  Flotel  Shoreland  in  Chicago  will  be  the 
headquarters  for  the  Board.  Formal  notice  of 
the  exact  time  of  each  candidate’s  examination 
will  be  sent  him  several  weeks  in  advance  of 
the  examination  dates.  Hotel  reservations  may 
be  made  by  writing  direct  to  the  Shoreland. 

Candidates  for  re-examination  in  Part  II  must 
make  written  application  to  the  Secretary’s  of- 
fice not  later  than  April  1,  1949. 

Candidates  in-  military  or  Naval  Service  are 
requested  to  keep  the  Secretary’s  office  in- 
formed of  any  change  in  address. 

Apphcations  are  now  being  received  for  the 
1950  examinations.  Application  forms  and  Bul- 
letins are  sent  upon  request  made  to  American 
Board  of  Obstetrics  and  Gynecology,  Inc.,  1015 
Highland  Building,  Pittsburgh  6,  Pennsylvania. 


for  April,  1949 


309 


Organization 

National  Affairs  - Proceedings  - Programs  - Society  Notices  - News  - Auxiliary 


COLORADO 

State  Medical  Society 

^^Knave  of  Hearts’’ 

Wins  (iuPont  Award 

National  honor  came  to  the  Colorado  State 
Medical  Society  and  to  Station  KLZ  of  Denver 
on  March  12  in  New  York  City  when  announce- 
ment was  made  of  the  Alfred  I.  duPont  awards 
for  meritorious  public  service  in  radio.  One  of 
the  three  annual  awards  was  given  to  KLZ  for 
the  medical  series  “Knave  of  Hearts.” 

Mr.  Hugh  B.  Terry,  manager  of  KLZ,  was  in 
New  York  to  receive  the  duPont  Award.  It 
is  to  radio  what  the  Pulitzer  Prize  is  to  journal- 
ism, and  carries  with  it  a cash  prize  of  $1,000. 
It  was  the  first  time  a radio  station  in  the 
Rocky  Mountain  area  ever  won  the  famed 
award,  and  the  first  time  such  an  award  had 
been  given  for  a series  on  a medical  subject. 

In  his  address  of  acceptance,  Mr.  Terry  said 
in  part; 

“One  of  the  responsibilities  of  a radio  station 
is  that  of  translation  ...  of  bringing  out  from 
scientific  organizations  their  contributions  to 
mankind,  and  presenting  that  information  in  a 
way  that  has  real  meaning  to  the  people  of  our 
land.  The  essential  element  in  such  an  en- 
deavor is  one  of  cooperation  and  mutual  confi- 
dence between  broadcaster  and  scientific  organ- 
ization, plus  an  agreement  on  common  objec- 
tives. KLZ’s  “Knave  of  Hearts,”  for  which  this 
award  is  made,  is  the  result  of  such  a joint 
effort  with  the  Colorado  State  Medical  Society 
and  the  many  fine  doctors  who  contributed  so 
much  to  this  series  . . . programs  dedicated  to 
better  health,  and  a longer,  happier  life  through 
knowledge  and  understanding.” 

KLZ  won  the  “small  station”  award.  It  is  a 
5;000-watt  affiliate  of  the  Columbia  Broadcasting 
System.  The  duPont  award  for  a “large  station” 
went  to  station  WLS  of  Chicago,  and  the  third 
award,  for  an  individual  news  commentator, 
went  to  Henry  J.  Taylor.  The  ceremonies  at- 
tending the  awards  were  broadcast  over  a na- 
tion-wide hook-up  by  the  American  Broadcasting 
Company. 

The  idea  of  “Knave  of  Hearts”  originated  with 
Mr.  Terry  early  last  year.  He  discussed  it  with 
Dr.  John  S.  Bouslog,  then  President  of  the  State 
Society,  who  soon  obtained  official  approval 


from  the  Public  Policy  Committee  and  named  a 
special  committee  of  cardiologists  to  work  with 
the  KLZ  staff  in  developing  the  series.  The 
Committee  was  composed  of  Dr.  Edgar  Durbin, 
Chairman,  and  Drs.  Carl  J.  Josephson  and  Ed- 
ward L.  Binkley,  Jr. 

The  series  went  on  the  air  May  2,  1948,  and 
ran  for  eighteen  weeks.  It  soon  attracted  na- 
tional attention  and  was  even  cited  in  Congress 
by  Senator  Ed  C.  Johnson.  The  series  was  com- 
pleted dramatized,  and  presented  the  major 
causes  and  effects  of  heart  diseases.  Although 
purely  educational,  the  series  kept  up  a high 
level  of  listener  interest. 

Mr.  Terry  was  elected  by  the  House  of  Dele- 
gates of  the  Colorado  State  Medical  Society  in 
September,  1948,  to  receive  the  Society's  Certi- 
ficate of  Service  awarded  annualy  to  a non- 
member for  distinguished  public  service. 

Presidents  and  Secretaries 
Meet  in  Denver 

The  second  annual  conference  of  Presidents 
and  Secretaries  of  Component  Societies,  held  in 
Denver  just  prior  to  the  Mid-Winter  Clinics, 
attracted  a good  attendance.  All  but  four  of  the 
component  societies  were  represented  and  the 
group  enpoyed  an  interesting  program  which 
induced  considerable  discussion. 

Dr.  Guy  C.  Cary,  Grand  Junction,  Conference 
Chairman,  kept  the  conference  moving  on  sched- 
ule. The  Presidents  and  Secretaries  were  guests 
of  the  State  Society  at  the  luncheon,  and  heard 
a splendid  talk  by  Jack  Foster,  editor  of  the 
Rocky  Mountain  News.  Mr.  Foster  praised  the 
public  relations  and  community  service  activities 
of  Colorado  physicians. 

High-lighting  the  mormng  session  were  talks 
by  Dr.  William  H.  Halley  on  the'  American  Med- 
ical Association’s  educational  program;  by  Dr. 
William  Dorsey  on  the  United  Mine  Workers’ 
activities  and  plans  in  the  health  field,  and  by 
Drs.  Atha  Thomas  and  Theodore  L.  Williams  on 
Blue  Cross  and  Blue  Shield. 

E.  D.  Whittlesey,  Denver,  President  of  Re- 
search Services  Inc.,  included  in  his  talk  on  pub- 
lic relations  some  new  figures  from  a survey  by 
the  National  Public  Opinion  Research  Founda- 
tion. The  report  showed  that  people  hold  the 
physician  in  high  esteem.  Asked  their  opinion 
of  most  doctors,  46  per  cent  said  they  are  “well 
trained  and  competent.”  And  57  per  cent  do  not 
think  doctors  are  too  interested  in  making 
money. 


310 


Rocky  Mountain  Medical  Journal 


paroxysmal  dyspnea... 


"When  an  acute  attack  of  paroxysmal  dyspnea 


sets  in,  Aminophyllin  administered  intravenously 


In  paroxysmal  dyspnea,  bronchial  asthma,  selected  cardiac 
cases  and  Cheyne-Stokes  respiration, 

AMINOPHYLLIN 


acts  by  relaxing  the  bronchial  musculature,  encouraging 
resumption  of  a .more  normal  type  of  respiration  and  re- 
ducing the  load  placed  upon  the  heart. 

Searle  Aminophyllin  is  available  in  tablet,  ampul,  pow- 
der and  suppository  forms. 

*Searle  Aminophyllin  contains  at  least  80%  of  anhydrous  theophylline. 

G.  D.  Searle  & Co.,  Chicago  80,  Illinois 


SEARLE  RESEARCH  IN  THE  SERVICE  OF  MEDICINE 


1.  Murphy,  F.  D.:  Treatment  of  Cardio- 
vascular Emergencies  in  the  Home, 
Wisconsin  M.  J,  42:169  (Aug.)  1943 


for  April,  1949 


311 


Dr.  L.  L.  Ward,  Vice  President  of  the  State 
Society,  speaking  for  President  C.  F.  Hegner, 
disciissed  the  organization’s  program  and  its 
value  in  relation  to  the  fight  against  compulsory 
health  insurance.  Dr.  John  S.  Bouslog,  Educa- 
tional Campaign  Chairman,  reported  on  activities 
planned  for  the  state  under  the  CAP  program. 

The  value  of  a speaker’s  bureau  to  a Coimty 
Society  was  stressed  by  Dr.  William  A.  Campbell 
of  Colorado  Springs.  Harvey  T.  Sethman,  Exec- 
utive Secretaryi  of  the  State  Society,  discussed 
modernization  of  County  Societies’  constitutions 
and  by-laws.  Wallace  Taber,  of  The  Denver 
Post  spoke  on  “The  Challenge  of  Community 
Health  Problems.” 

The  conference  approved  the  report  of  its 
Nominating  Committee,  composed  of  Dr  Fred- 
rick H.  Good,  Denver,  Dr.  N.  S.  Saliba,  Wal- 
senburg,  and  Dr.  Heman  Bull,  Grand  Junction. 
The  committee  chose  Dr.  Fred  A.  Humphrey,  Ft. 
Collins,  as  1950  conference  chairman.  The  1950 
Program  Committee  for  the  conference  will  be 
Dr.  Stephen  L.  Kallay,  Lakewood,  chairman;  Dr. 
Lester  L.  Williams,  Colorado  Springs;  Dr.  J. 
Meredith  Perkins,  Denver,  and  Dr.  David  W. 
McCarty,  Longmont. 

County  society  officers  were  guests  of  the 
State  Society  in  the  evening  at  a dinner  meet- 
ing of  the  Denver  Medical  Society.  The  speaker 
was  Dr.  LeRoy  H.  Sloan,  clinical  professor  of 
medicine.  University  of  Illinois,  who  spoke  on 
“Diagnosis  and  Therapy  of  Anemias  in  Daily 
Practice.”  The  guests  also  attended  the  annual 
Mid-Winter  Clinics  smoker  later  in  the  evening. 


Component  Societies 

DELTA  COUNTY 

Dr.  W.  E.  Brown  of  Paonia  was  the  principal 
speaker  at  the  March  11  meeting  of  the  Delta 
County  Medical  Society.  Dr.  Brown  talked  on 
“What  the  Civilian  Doctor  Can  Do  to  Prepare 
for  Atomic  Casualties.” 

J.  J.  CONNOR,  M.D.,  Secretary. 


EL  PASO  COUNTY 

The  regular  meeting  of  the  El  Paso  County 
Medical  Society  was  held  Wednesday^  March  9, 
at  the  El  Paso  Club.  A dinner  preceded  the 
scientific  meeting.  Dr.  John  S.  Bouslog  and  Mr. 
Evan  A.  Edwards  of  Denver  were’  guest  speakers. 
They  discussed  the  A.M.A.  assessment,  the  C.A.- 
P.  plan  and  our  fight  against  compulsory  health 
insurance.  Dr.  W.  C.  Service  reported  that  the 
proposed  amendment  permitting  establishment 
of  a well-organized  City-County  health  unit  has 
secured  a place  on  the  ballot  of  the  municipal 
election  in  April. 

LESTER  L.  WILLIAMS,  Secretary. 


Obituary 

CHARLES  M.  SPICER 

Dr.  Charles  M.  Spicer,  well-known  Denver 
orthopedist,  died  on  February  13,  1949,  at  the 
age  of  67. 

Bom  in  Ellsworth,  Kansas  on  April  1,  1882,  Dr. 
Spicer  graduated  from  the  University  of  Kansas 
Medical  School.  He  served  his  internship  at 
Johns  Hopkins  Hospital  in  Baltimore  and  Chil- 
dren’s Hospital  in  Boston.  In  1911  he  came  to 
Denver,  where  he  had  practiced  since. 

Dr.  Spicer  was  a member  of  the  Denver  Coun- 
ty and  Colorado  State  Medical  Societies.  He  at 
one  time  served  as  an  instructor  in  the  depart- 
ment of  orthopedics  at  Colorado  University  Med- 
ical School. 

A practicing  surgeon  in  Denver  for  almost 
forty  years.  Dr.  Spicer  had  won  the  respect  and 
admiration  of  the  laity  and  profession  alike.  He 
will  be  greatly  missed  by  all  who  had  come  to 
know  him. 


Auxiliary 

AUXILIARY  NEWS 

The  Colorado  State  Medical  Society  has  re- 
quested that  each  County  Auxiliary  President 
send  in  a list  of  members  who  are  wilhng  and 
able  to  answer  requests  by  local  groups  for 
speakers  on  compulsory  health  insurance  ver- 
sus voluntary  prepaid  medical  service  or  re- 
lated subjects.  A similar  request  has  gone  to 
Medical  Societies  for  a list  of  physicians  who 
will  also  be  available  for  this  service. 

If  these  two  groups  of  speakers  could  have 
some  joint  meetings  to  exchange  thinking  and 
experience  it  should  have  valuable  results.  Then, 
too,  if  for  each  speaking  engagement  a friend 
could  go  along  to  record  written  and  oral  ques- 
tions and  comments  from  the  audience  and  other 
speakers,  some  interesting  data  would  be  ac- 
cumulated. 

Let  us  view  each  audience  as  past,  present 
and  future  patients  and  remember  that  what- 
ever changes  and  improvements  are  made  in  the 
practice  of  medicine,  they  should  be  made  by 
the  combined  thinking  of  patients  and  physi- 
cians as  co-builders  of  better  health  for  the 
individual  and  the  community. 

Your  President, 

MRS.  ARTHUR  A.  WEARNER. 


DENVER  COUNTY 

The  Women’s  Auxiliary  to  the  Denver  County 
^Medical  Society  is  enjoying  a busy  and  a useful 
winter  season. 

Mrs.,  Whitney  Porter,  Membership  Chairman, 
reports  the  largest  membership  on  record,  286 
active  members.  Due  to  the  fact  that  both  No- 
tional and  State  Auxiliaries  raised  dues  this 
year,  and  that  Denver  Coimty  did  not,  it  was 
impossible  to  give  as  much  money  to  philan- 
thropic work  of  the  commimity  as  has  been 
our  past  pleasure.  However,  we  are  very  proud 
of  the  following  gifts:  Studept  Loan  Fund,  Colo- 


312 


Rocky  Mountain  Medical  Journal 


of  baby  . . . 2.5cc  hypertussis 

concentrated  human  anti-pertussis  globulin 
-protects  exposed  infants -treats  critical 
cases.  When  whooping  cough  attacks  small 
patients,  the  hazards  of  massive  repeated 
dosage  present  a serious  problem  to  every 
thoughtful  physician. 

2.5  cc  Hypertussis 
provides  the  specific 
solution  for  therapy  or 
passive  prevention. 
The  advantages 
are  evident: 


for  10- fold  concentrafion  in  small  volume  dosage 
-specify  CUTTCR  2. See  HYPBttTUSSIS 
Anfi - Pertussis  Serum  (Human) 


for  a handful 


Concentrated  Potency; 

2.5  ce  concentrated  by  fractionation  to 
contain  the  antibody  equivalent  of 
25  cc  hyperimmune  human  serum. 

2.5  ce  delivers  consistent  gamma  globulin 
potency  in  constant  measured  doses. 

Small  Volume  Dosage: 

2.5  ce  concentrated  gamma  globulin  re- 
duces dosage  volume  75!o-minimizes 
injection  trauma -permits  repetition 
when  required. 

Homologous,  sensitivity-free: 

2.5  ce  clear  liquid  homologous  protein, 
Hypertussis  is  ready  for  intra- 
muscular injection -avoids  danger  of 
reactions  and  serum  sensitivity. 


02.5c<  HYPERTUSSIS 

highly  concentrated  and  puri- 
fied gamma  globulin  of  pooled 
human  serum  from  healthy 
donors  hyperimmunized  with 
Super-Concentrate  Phose  I 
Pertussis  Vaccine 


The  Specific  Cutter  Blood  Fraction  for  Whooping  Cough...  ^ 


for  April,  1949 


313 


rado  University  School  of  Medicine,  $150;  Colo- 
rado State  Auxiliary  Health  Education  Program, 
$150;  Achievement  Award,  Senior  Medical  Stu- 
dent, University  of  Colorado  School  of  Medi- 
cine, $25;  Booth  Memorial  Hospital,  $20;  Visiting 
Nurses’  Association,  $25. 

In  addition  to  the  giving  of  money,  our  mem- 
bership has  done  a great  deal  in  the  way  of 
personal  service.  Our  Hygea  Chairman,  Mrs.  A. 
W.  Mayer,  has  placed  subscriptions  to  Hygea 
Magazine  in  thirty-four  High  Schools  and  Junior 
High  Schools  of  this  area.  Mrs.  Lumen  Daniels 
and  Mrs.  L.  W.  Lee  have  sponsored  a group  who 
work  one  day  of  each  month  making  cancer 
dressings.  These  chairmen  also  attend  various 
conventions  scheduled  to  meet  in  Denver  hotels 
and  they  supply  health  hterature  to  those  dele- 
gates who  wish  it.  Another  group,  under  the 
direction  of  Mrs.  Charles  Smith  and  Mrs.  Irvin 
Hinds  are  completing  layettes  which  our  Aux- 
iliary is  donating  to  Crittenden  Home  in  response 
to  a call  for  these  garments.  Mrs.  A.  J.  Kafka 
has  represented  us  at  many  meetings  to  which 
we  were  asked  to  send  a member.  Mrs.  J.  M. 
Perkins  has  kept  us  informed  on  legislation  and 
has  instructed  a group  of  women  who  are  willing 
to  speak  at  various  meetings  in  answer  to  calls 
made  to  our  State  Society. 

Much  interest  in  our  work  has  been  sustained 
by  the  quality  of  our  monthly  programs  which 
Mrs.  George  Pattee  has  so  successfully  arranged. 
They  have  been  informative  and  entertaining, 
v/hich  is  in  large  part  responsible  for  the  splen- 
did attendance  at  meetings  this  year.  Sharing 
equal  honors  is  Mrs.  Dean  Hodges  whose  tea 
tables  have  added  festivity  and  delight,  making 
each  gathering  a really  congenial  get-to-gether. 

The  strength  and  loyalty  which  permeates  our 
group  seems  to  be  the  result  of  so  many  active 
workers.  The  organization  is  made  up  of  inter- 
ested women,  eager  and  willing,  each  to  contrib- 
ute toward  the  community  in  which  she  lives, 
and  through  her  favorite  avenue,  the  Auxiliary. 
MRS.  LAWRENCE  WHITRIDGE  GREENE, 

President. 


AMERICAN  COLLEGE  OF  CHEST 
PHYSICIANS 

The  Board  of  Examiners  of  the  American  Col- 
lege of  Chest  Physicians  announces  that  the  next 
oral  and  written  examinations  for  Fellowship 
will  be  held  in  Atlantic  City,  June  2,  1949.  Can- 
didates for  Fellowship  in  the  College,  who  would 
like  to  take  the  examinations,  should  contact 
the  Executive  Secretary,  American  College  of 
Chest  Physicians,  500  North  Dearborn  Street, 
Chicago  10,  Illinois. 

The  Fifteenth  Annual  Meeting  of  the  Amer- 
ican College  of  Chest  Physicians  will  be  held  at 
the  Ambassador  Hotel,  Atlantic  City,  June  2-5, 
1949.  An  interesting  scientific  program  has  been 
arranged  for  this  meeting,  and  speakers  from 
several  other  countries  are  scheduled  to  ap- 
pear. 


NEW  MEXICO 

Medical  Society 

NEW  MEXICO  MEDICAL  SOCIETY 
CONVENTION 

Roswell,  New  Mexico 
May  5-6-7,  1949 

Guest  Speakers: 

J.  Mackenzie  Brown,  M.D.,  Processor  of  Oto- 
laryngology, University  of  Southern  California 
Medical  School,  Los  Angeles,  California. 

M.  Edward  Davis,  M.D.,  Joseph  B.  DeLee, 
Professor  of  Obstetrics  and  Gynecology,  Chicago, 
Illinois. 

T.  Leon  Howard,  M.D.,  Associate  Professor 
Urology — University  of  Colorado,  Denver,  Colo- 
rado. 

E.  Starr  Judd,  Jr.,  M.D.,  Head  of  Section  in 
Division  in  Surgery,  Mayo  Clinic,  Rochester, 
Minnesota. 

F.  T.  Keating,  Jr.,  M.D.,  Division  of  Medicine, 
Mayo  Clinic,  Rochester,  Minnesota. 

Earl  D.  McBride,  M.D.,  Associate  Professor 
Orthopedic  Surgery,  University  of  Oklahoma 
School  of  Medicine. 

Armand  J.  Quick,  M.D.,  Department  of  Bio- 
chemistry, Marquette  University  of  School  of 
Medicine,  Milwaukee,  Wisconsin. 

(A  complete  program  has  been  arranged  for 
entertainment  of  visiting  doctors’  wives.) 

THURSDAY,  MAY  5 

9:00  a.m. — Meeting  House  of  Delegates.  Opening 
Address:  P.  L.  Travers,  M.D.,  President  New 
Mexico  State  Medical  Society. 

Welcoming  Address — Van  A.  Odle,  M.D., 
President  Chavez  County  Medical  Society. 
Order  of  Business: 

P.  L.  Travers,  M.D.,  Presiding 
2:00-2:45  p.m. — Subject:  Deafness.  Speaker,  J. 

Mackenzie  Brown,  M.D. 

2:45-3:00  p.m. — Discussion:  Maurice  Spearman, 
M.D.,  El  Paso,  Texas. 

3:00-3:45  p.m. — Subject:  Disability  Evaluation. 

Speaker,  Earl  D.  McBride,  M.D. 

3:45-4:00  p.m. — Discussion:  Dr.  Edward  Parnall, 
Albuquerque,  N.  M. 

4:00-4:45  p.m. — Subject:  Venous  Thrombosis. 

Speaker:  Armand  J.  Quick,  M.D. 

4:45-5:00  p.m. — Discussion:  Angus  McKinnon, 
M.D.,  Albuquerque,  N.  M. 

FRIDAY,  MAY  6 

J.  W.  Hannett,  M.D.,  Presiding 

9:00-9:45  a.m. — Subject:  The  Broadening  Scope 
of  Gastric  Resection.  Speaker:  E.  Starr  Judd, 
Jr.,  M.D. 

9:45-10:00  a.m. — Discussion:  John  F.  Conway, 
M.D.,  Clovis,  N.  M. 

10:00-10:45  a.m. — Subject:  Cystitis.  Speaker:  T. 
Leon  Howard,  M.D. 

10:45-11:00  a.m. — Discussion:  A.  W.  Multhauf, 
M.D.,  El  Paso,  Texas. 

11:00-11:45  a.m. — Subject:  The  Clinical  Diagnosis 
of  Hyperthyroidism.  Speaker,  F.  R.  Keating, 
Jr.,  M.D. 


314 


Rocky  Mountain  Medical  Journal 


REFINING  THE  TOOLS  TO  DO  THE  JOB 


While  medical  men  are  occupied  with  enlarging 
their  knowledge  of  disease  and  treating  its  manifes- 
tations, the  makers  of  ethical  drugs  concentrate  on 
developing  and  improving  the  "tools”  to  facilitate 
treatment. 

Toward  that  end,  the  Smith-Dorsey  Company  has 
expanded  its  research  facilities,  secured  increased 
research  grants  and  added  research  personnel. 

Our  objective — tools  worthy  of  the  finest  work- 
man . . . 


THE  SMITH-DORSEY  COMPANY  • Lincoln,  Nebrasko 


RRANCHES  AT  LOS  ANGELES  AND  DALLAS 


MANUFACTURERS  OF 

AQUEOUS  SUSPENSION  OF  ESTROGENIC  SUBSTANCES  • DORSEY 
AMINOPHYLLINE  SUPPOSITORIES  • DORSEY 


jor  April,  1949 


315 


11:45-12:00  a.m. — Discussion:  Ross  W.  Rissler, 
M.D.;  El  Paso,  Texas. 

Luncheon: 

C.  H.  Gellenthein,  M.D.,  Presiding 
Medical — Drs.  Keating,  Quick;  Surgical — 
Drs.  Davis,  Howard,  Judd,  McBride;  ENT — 
Dr.  Brown. 

Leland  Evans,  M.D.,  Presiding 
2:00-2:45  p.m. — Subject:  Emergency  Surgical 
Procedures  on  Intestinal  Lesions.  Speaker, 

E.  Starr  Judd,  Jr.,  M.D. 

2:45-3:00  p.m. — Discussion:  Robert  C.  Derby- 
shire, M.D.,  Artesia,  New  Mexico. 

3:00-3:45  p.m. — Subject:  Pain  in  the  Arm  and 
Shoulder.  Speaker,  Earl  D.  McBride,  M.D. 
3:45-4:00  p.m. — Discussion:  Open. 

4:00-4:45  p.m. — Subject:  Management  of  the 
Placental  Stage  of  Labor  and  the  Preven- 
tion of  Hemorrhage.  Speaker,  M.  Edward 
Davis,  M.D. 

4:45-5:00  p.m. — Discussion:  Lee  Miles,  M.D.,  Al- 
buquerque, N.  M. 

8:00  p.m. — Banquet  doctors  and  their  ladies. 

SATURDAY  MAY  7 

A.  C.  Shuler  M.D.  Presiding 
9:00-9:45  a.m. — Subject:  Hematuria.  Speaker:  T. 

Leon  Howard  M.D. 

9:45-10:00  a.m. — Discussion:  Open. 

10:00-10:45  a.m. — Subjject:  Rationale  of  Endo- 
crine Therapy  in  Obstetrics  and  Gynecology. 
Speaker:  M.  Edward  Davis  M.D. 

10:45-11:00  a.m. — Discussion:  Open. 

11:00-11:45  a.m. — Subject:  Radioactive  Iodine  in 
the  Treatment  of  Thyroid  Disease.  Speaker: 

F.  R.  Keating  Jr.  M.D. 

11:45-12:00  a.m. — Discussion:  Open. 


SECTION  ON  OPHTHALMOLOGY  AND 
OTOLARYNGOLOGY 
THURSDAY,  MAY  5 

2:00-2:45  p.m. — Subject:  Defense.  Speaker:  J. 
Mackenzie  Brown,  M.D.,  Professor  of  Oto- 
laryngology, University  of  Southern  Califor- 
nia School  of  Medicine,  Los  Angeles,  Cali- 
fornia. 

2:45-3:00  p.m. — Discussion:  Maurice  Spearman, 
M.D.,  El  Paso,  Texas.  Place,  General  Assem- 
bly. 

3:00-4:00  p.m. — Diagnosis  of  Chronic  Simple 
Glaucoma,  a symposium  conducted  by:  Drs. 
Schuster,  Murphy  and  Peck.  Followed  by 
open  discussion. 

4:00-5:00  p.m. — Conservative  treatment  versus 
surgical  treatment  in  acute  congestive  and 
chronic  simple  glaucoma,  a symposium  con- 
ducted by:  Drs.  Schuster,  Murphy  and  Peck. 
Followed  by  open  discussion. 

FRIDAY,  MAY  6 

9:00-10:00  a.m. — Acute  Sinusitis  with  especial 
reference  to  the  Frontal,  J.  McKenzie 
Brown,  M.D.  Discussion:  Open. 

10:00-11:00  a.m. — Surgical  Management  of  Acute 
Congestive  and  Chronic  Simple  Glaucoma. 
Symposium  conducted  by  Drs.  Schuster, 
Murphy,  and  Peck.  Followed  by  open  dis- 
cussion. 

11:00-12:00  a.m. — Diagnosis  of  Otosclerosis  and 
Recent  Advances  in  Fenestration.  Speaker, 
J.  E.  Witcher,  M.D.  Discussion:  Open. 


12:00-2:00  p.m. — Luncheon  and  Round  Table  Dis- 
cussion. 

2:00-3:00  p.m. — Chronic  Sinusitis  and  Best 
Methods  of  Treatment  Therein.  Speaker,  J. 
Mackenzie  Brown,  M.D.  Discussion:  Open. 

3:00-4:30  p.m. — Diagnostic  Problems  of  Strabis- 
mus. Speaker,  Weldon  O.  Murphy,  M.D. 
Discussion:  Steven  A.  Schuster,  M.D.,  fol- 
lowed by  open  discussion. 

SATURDAY,  MAY  7 

9:00-10:00  a.m. — The  Tonsil  and  Adenoid  Prob- 
lem, J.  Mackenzie  Brown,  M.D.  Discussion: 
Open. 

10:00-11:00  a.m. — Diagnostic  Problems  of  Strabis- 
mus, Weldon  O.  Murphy,  M.D.  Discussion: 
Howard  Peck,  M.D.,  Albuquerque,  N.  M.,  fol- 
lowed by  open  discussion. 

9:30-11:00  a.m. — Surgical  Management  of  Stra- 
bismus, Steven  A.  Schuster,  M.D.  Discus- 
sion: Weldon  O.  Murphy,  M.D.,  Amarillo, 
Texas,  followed  by  open  discussion. 


NEW  MEXICO  CLINICAL  SOCIETY 

The  April  meeting  of  the  Society  will  be  pre- 
sented by  Dr.  Charles  L.  Martin,  Professor  of 
Radiology,  Southwestern  Medical  College,  Dal- 
las, Texas,  at  the  Veterans  Hospital  in  Albu- 
querque on  the  18th  of  April  at  8:00  p.m.  Dr. 
Martin  will  present  “The  Treatment  of  Cancer 
of  the  Face,  Lip  and  Mouth,  and  Metastatic 
Lymph  Node  With  Irradiation.”  Dr.  Martin  has 
made  many  kodachrome  films  of  unusual  and 
interesting  lesions  of  this  nature.  He  will  pre- 
sent them  at  his  lecture. 

Attention  is  called  to  the  fact  that  Dr.  Armand 
Quick  will  present  the  May  meeting  of  the  New 
Mexico  Clinical  Society  in  Roswell,  New  Mex- 
ico, on  Wednesday,  the  4th  of  May.  The  New 
Mexico  State  Medical  Society  meeting  will  fol- 
low from  May  5 to  7 in  Roswell.  It  is  antici- 
pated that  our  Society  will  invite  all  members  of 
the  State  Medical  Society  to  this  meeting. 


ADVERTISING 

Doctor,  when  you  peruse  the  advertising  pages 
in  our  journal,  remember  this:  All  ads  are  care- 
fully screened  — the  items,  services,  and  mes- 
sages presented  are  committee-accepted.  Our 
standards  are  of  the  highest.  The  advertisers 
like  our  journal— that’s  why  they  selected  it  for 
use  in  their  promotional  program.  They  seek 
your  patronage  and  your  response  encourages 
continued  use  of  our  publication.  In  turn,  the 
advertisers’  patronage  helps  us  to  produce  a 
journal  that  is  second  to  none  in  our  state. 
When  you  send  inquiries,  tell  them  that  you 
read  their  advertisement  in  the  Rocky  Moun- 
tain Medical  Journal. 


OREGON  ACADEMY  OF  OPHTHALMOLOGY 
AND  OTOLARYNGOLOGY 

The  Tenth  Annual  Spring  Postgraduate  Con- 
vention in  Ophthalmology  and  Otolaryngology 
will  be  held  in  Portland,  June  19-24,  1949.  An- 
other fine  program  has  been  arranged  by  the 
Oregon  Academy  and  the  University  of  Oregon 
Medical  School.  We  are  particularly  fortunate 
in  having  four  outstanding  men  in  their  respec- 
tive fields  as  guest  speakers.  Dr.  Lawrence  R. 
Boies,  Professor  of  Otolaryngology  at  University 
of  Minnesota  Medical  School,  Minneapolis;  Dr. 


316 


Rocky  Mountain  Medical  Journal 


'4 


I 

k 


YOUR  PATIENT’S  MONEY: 
Economic  conditions  have  shown 
many  swings  during  the  four  decades 
of  CAMP  history.  But  Camp  prices 
have  always  been  conscientiously 
based  on  intrinsic  value.  These  mod- 


THIS  EMBLEM  is  displayed  by  re- 
liable  merchants  in  your  community. 
Camp  Scientific  Supports  are  never 
sold  by  door‘to-door  canvassers. 
Prices  are  based  on  intrinsic  value. 
Regular  technical  and  ethical  trains 
ing  of  CAMP  fitters  insures  precise 
and  conscientious  attention  to  your 
recommendations. 


CAMP  SCIENTIFIC  SUPPORTS  are 
prescribed  and  recommended  in  many 
types  for  prenatal,  postnatal,  post- 
operative, pendulous  abdomen,  vis- 
ceroptosis, nephroptosis,  hernia,  ortho- 
pedic and  other  conditions.  If  you  do 
not  have  a copy  of  the  Camp  "Refer- 
ence Book  for  Physicians  and  Surgeons,” 
it  will  be  sent  upon  request. 


erate  prices  coupled  with  the  func- 
tional efficiency  and  superb  quality 
of  Camp  Scientific  Supports,  long 
recognized  by  the  profession,  mean 
true  economy  to  the  patient. 


S.  H.  CAMP  and  COMPANY,  JACKSON,  MICHIGAN 

World’s  Largest  Manufacturers  of  Scientific  Supports 
Offices  in  New  York  • Chicago  • Windsor,  Ontario  • London,  England 


for  April,  1949 


317 


Leland  Hunnicutt,  Associate  Clinical  Professor  of 
Otolaryngology  at  University  of  Southern  Cali- 
fornia, Los  Angeles;  Dr.  James  H.  Allen,  Pro- 
fessor of  Ophthalmology  at  Iowa  State  Univer- 
sity School  of  Medicine,  Iowa  City;  Dr.  Edmund 
B.  Spaeth,  Professor  of  Ophthalmology  at  Grad- 
uate School  of  Medicine,  University  of  Pennsyl- 
vania, Philadelphia.  There  will  be  lectures, 
clinical  demonstrations  and  ward  rounds.  Pre- 
liminary programs  will  be  out  about  May  1 and 
you  may  secure  yours,  and  further  information, 
from  Dr.  David  D.  DeWeese,  Secretary,  1216  S.W. 
Yamhill  Street,  Portland  5,  Oregon. 

UTAH 

State  Medical  Association 


The  Cancer  Teaching  Program  of  the  University  of 
Utah  College  of  Medicine  and  the  Bureau  of  Cancer 
Control  of  the  State  Department  of  Health  presents 

THE  SECOND  CANCER  SYMPOSroM 
Salt  Lake  City,  Utah 

APRIL  25-27,  1949 
Headquarters:  Hotel  Utah 

Guest  Speakers: 

George  T.  Pack,  M.D.,  Clinical  Professor  of 
Surgery,  New  York  Medical  College;  Attending 
Surgeon,  The  Memorial  Hospital  for  Cancer  and 
Allied  Diseases,  New  York  City. 

Charles  E.  McLennan,  M.D.,  Professor  and 
Head  of  the  Department  of  Obstetrics  and  Gyn- 
ecology, Stanford  University  College  of  Medicine, 
San  Francisco,  California. 

Henry  S.  Kaplan,  M.D.,  Professor  and  Head 
of  the  Department  of  Radiology,  Stanford  Uni- 
versity College  of  Medicine,  San  Francisco,  Cali- 
fornia. 

Rulon  W.  Rawson,  M.D.,  Chief,  Department  of 
Clinical  Investigation,  Sloan-Kettering  Institute 
for  Cancer  Research;  Associate  Professor  of  Med- 
icine, Cornell  University  Medical  College,  New 
York  City. 

Howard  L.  Richardson,  M.D.,  Assistant  Profes- 
sor of  Pathology,  University  of  Oregon  Medical 
School,  Portland,  Oregon. 

University  of  Utah  Speakers: 

Richard  H.  Young,  M.D.,  Dean,  College  of  Med- 
icine; Associate  Professor  of  Medicine. 

Orin  A.  Ogilvie,  M.D.,  Associate  Clinical  Pro- 
fessor of  Pathology;  President,  Utah  State  Med- 
ical Association. 

C.  H.  Hardin  Branch,  M.D.,  Professor  and  Head 
of  the  Department  of  Psychiatry. 

Chester  B.  Powell,  M.D.,  Clinical  Instructor  in 
Surgery.  (Neurosurgery). 

Ralph  R.  Meyer,  M.D.,  Assistant  Clinical  Pro- 
fessor of  Radiology. 

T.  C.  Bauerlein,  M.D.,  Assistant  Clinical  Pro- 
fessor of  Medicine. 

Ralph  G.  Rigby,  M.D.,  Assistant  Chnical  Pro- 
fessor of  Surgery. 

Henry  P.  Plank,  M.D.,  Assistant  Professor  of 
Radiology,  Acting  Head  of  the  Department  of 
Radiology. 

Ernest  J.  Eichwald,  M.D.,  Assistant  Clinical 
Professor  of  Pathology. 


Edwin  A.  Lawrence,  M.D.,  Professor  of  Sur- 
gery (Oncology). 

Richard  P.  Middleton,  M.D.,  Associate  Clinical 
Professor  of  Surgery. 

Lowell  A.  Woodbury,  Ph.D.,  Assistant  Pro- 
fessor of  Physiology. 

William  H.  Moretz,  M.D.,  Assistant  Professor 
of  Surgery. 

Emil  G.  Holmstrom,  M.D.,  Professor  and  Head 
of  the  Department  of  Obstetrics  and  Gynecology. 

Thomas  F.  Dougherty,  Ph.D.,  Professor  of 
Anatomy. 

Jean  H.  Dougherty,  M.D.,  Instructor  in  Path- 
ology. 

George  E.  Cartwright,  M.D.,  Assistant  Profes- 
sor of  Medicine. 

Maxwell  M.  Wintrobe,  M.D.,  Professor  and 
Head  of  the  Department  of  Medicine. 

PROGRAM 

MONDAY,  APRIL  25 

Morning 

Edwin  A.  Lawrence,  M.D.,  Chairman 

9 :30 — Registration. 

10:00 — Address  of  Welcome.  Richard  H.  Young, 
M.D.,  Dean. 

10:15 — “The  Resnonsibilitv  of  the  Medical  So- 
ciety and  the  Practicing  Physician  to  the 
Patient  with  Cancer.”  Orin  A.  Ogilvie, 
M.D. 

10:35 — “The  Psychiatric  Approach  to  Patients 
With  Malignant  Disease.”  C.  H.  Hardin 
Branch,  M.D. 

11:1 0 — Intermission. 

11:25 — “Diagnostic  and  Therapeutic  Methods  in 
the  Management  of  Intracranial  Neo- 
plasms.” Chester  B.  Powell,  M.D. 

Luncheon 

Afternoon 

Philip  B.  Price,  M.D.,  Chairman 

2:00 — “Carcinoma  of  the  Larynx.”  Ralph  G. 
Rigby,  M.D. 

2:30 — “Problems  in  the  Radiation  Therapy  of 
Cancer  of  the  Hypopharynx  and  Larynx.” 
Henry  P.  Plenk,  M.D. 

3:00 — “Malignant  Neoplasms  in  Children.”  Ern- 
est J.  Eichwald,  M.D. 

3 :30 — Intermission. 

3:45 — “Mediastinal  Tumors  of  a Surgical  Na- 
ture.” Edwin  A.  Lawrence,  M.D. 

4:15 — “Hormonal  Therapy  of  Prostatic  Cancer.” 
Richard  P.  Middleton,  M.D. 

Evening 

8:00 — “The  Role  of  the  Clinician  in  Cancer  Re- 
search.” Rulon  W.  Rawson,  M.D. 

(This  speech  will  be  presented  in  Room 
104,  Physics  Building,  University  of  Utah 
Campus,  in  cooperation  with  the  Salt  Lake 
County  Medical  Society.) 

TUESDAY,  APRIL  26 

Morning 

Kenneth  B.  Castleton,  M.D.,  Chairman 

9:00 — “The  Present  Use  and  Future  Possibilities 
of  Radioactive  Isotopes  in  the  Study  of 
Cancer.”  Lowell  A.  Woodbury,  Ph.D. 

9:30 — “Studies  With  Modern  Tools  on  the  Gen- 


318 


Rocky  Mountain  Medical  Journal 


-S 


u^^ica 


Make  Your  Reservations  at  Once  for  the 

^^ouftli  .^y^nnuai  If^eetim 


MAY  25  — 26  — 27,  1949 


Headquarters  — Hotel  Ben  Lomond,  Ogden,  Utah 
Scientific  Sessions  — Orpheum  Theatre,  Ogden 

Make  it  a date  to  take  time  off  from  your  practice  to  attend  this  enlightening  and  enjoyable 
meeting.  We  feel  confident  that  you  will  find  another  outstanding  program  being  offered 
during  these  three  days.  If  you  have  attended  any  of  the  previous  sessions,  you  will  appre- 
ciate the  wide  variety  of  topics  discussed.  The  following  speakers  have  been  chosen  for 
the  scientific  presentation; 


DR.  ALTON  OCHSNER,  New  Orleans,  Tulane  University. 

DR.  ROGER  ANDERSON,  Seattle,  University  of  Washington. 

DR.  CHARLES  W.  MAYO,  Rochester,  Mayo  Foundation. 

DR.  JAMES  T.  PRIESTLEY,  Rochester,  Mayo  Foundation. 

DR.  LYON  H.  APPLEBY,  Vancouver,  British  Columbia. 

DR.  WILLIS  J.  POTTS,  Chicago,  Children's  Memorial  Hospital. 
DR.  ANDREW  C.  IVY,  Chicago,  University  of  Illinois. 

DR.  PAUL  W.  GREELEY,  Chicago,  University  of  Illinois. 

DR.  DONALD  G.  TOLLEFSON,  Los  Angeles,  Moore-White  Clinic. 
DR.  ALFRED  E.  MAUMENEE,  Baltimore,  John  Hopkins  University. 
•DR.  HOWARD  C.  NAFFZIGER,  San  Francisco. 

DR.  HOWARD  B.  SPRAGUE,  Boston. 


REGISTRATION:  THERE  WILL  BE  NO  REGISTRATION  FEE.  As  usual,  the  meeting  is  pre- 
sented with  the  compliments  of  the  Ogden  Surgical  Society  and  is  open  to  all  physicians  of 
good  standing  in  their  respective  state  and  county  societies.  The  only  request  we  make  is 
that  everyone  attending  the  meetings  be  registered  at  the  registration  booth. 

PLACE:  All  the  scientific  presentations  will  be  held  in  the  comfortable  and  spacious  Orpheum 
Theatre.  The  noon  luncheons  and  the  round  table  discussions  will  be  held  in  the  Hotel  Ben 
Lomond. 

ENTERTAINMENT:  There  will  be  an  enjoyable  variety  of  entertainment  for  the  ladies  during 
these  three  days.  BE  SURE  AND  BRING  YOUR  WIFE. 

On  Wednesday  night  there  will  be  a cocktail  party  at  the  Ogden  Golf  and  Country  Club  and 
on  Thursday  night  a buffet  and  musical  program  at  the  Weber  College. 

RESERVATIONS:  The  Committee  on  Reservations  request  that  the  reservation  card  be  filled 
out  and  mailed  at  your  earliest  convenience  to  enable  them  to  anticipate  your  wishes. 

We  extend  a hearty  welcome  and  look  forward  to  seeing  you  on  these  dates — May  25-26-27. 
A complete  and  detailed  program  will  be  mailed  at  a later  date. 

PROGRAM  COMMITTEE 

DR.  C.  H.  JENSON ..President 

DR.  V.  L.  WARD President-Elect 

DR.  E.  R.  DUMKE Past  President 

DR.  C.  L.  RICH Second  Past  President 

DR.  F.  K.  BARTLETT Vice-President 

DR.  W.  J.  WILSON ■- Treasurer 

DR.  DEAN  TANNER  and  DR.  I.  B.  McQUARRIE 
• DR.  G.  M.  FISTER Secretary 


for  April,  1949 


319 


esis  and  Function  of  Tumors  of  the  Thy- 
roid.” Rulon  W.  Rawson,  M.D. 

10:00 — “Problems  in  the  Surgical  Management  of 
Thyroid  Tumors.”  William  H.  Moretz, 
M.D. 

10:30 — Discussion. 

11 :00 — Intermission. 

11:15 — “Carcinoma  of  the  Vulva.”  Charles  E. 
McLennan,  M.D. 

Luncheon 

Afternoon 

N.  Frederick  Hicken,  M.D.,  Chairman 

2:00 — “Studies  in  Gastric  Neoplasia.”  Henry  S. 
Kaplan,  M.D. 

2:30 — “The  X-ray  Diagnosis  of  Gastric  Can- 
cer.” Ralph  R.  Meyer,  M.D. 

3:00 — “The  Use  of  the  Gastroscope  in  the  Study 
of  Gastric  Carcinoma.”  T.  C.  Bauerlein, 
M.D. 

3 :30 — Intermission. 

3:45 — “The  Cytohistology  of  Gastric  Washings 
as  a Means  of  Studying  Gastritis,  Ulcer  and 
Gastric  Cancer.”  Howard  L.  Richardson, 
M.D. 

4:15 — “The  Surgery  of  Gastric  Cancer.”  George 
T.  Pack,  M.D. 

Discussion 

Evening 

7:30 — Banquet.  “Studies  in  Metabolism  on  Pa- 
tients With  Malignant  Neoplasms.”  George 
T.  Pack,  M.D. 

WEDNESDAY,  APRIL  27 

Morning 

Francis  D.  Gunn,  M.D.,  Chairman 

9:00 — “Carcinoma  of  the  Uterine  Cervix.”  Emil 
G.  Holmstrom,  M.D. 

9:30 — “Carcinoma  of  the  Endometrium.”  Charles 
E.  McLennan,  M.D. 

10:00 — “A  Comparative  Study  of  the  Vaginal 
Smearing  Technic  to  the  Cytohistological 
Method.”  Howard  L.  Richardson,  M.D. 

10:30 — Discussion. 

1 1 :00 — Intermission. 

11:15 — “The  Extension  of  Radical  Surgery  in  the 
Treatment  of  Cancer.”  George  T.  Pack, 
M.D. 

Luncheon 

Afternoon 

G.  Gill  Richards,  M.D.,  Chairman 

2:00 — “The  Induction  of  Leukemia  in  Experi- 
mental Animals.”  Thomas  F.  Dougherty, 
Ph.D. 

2:30 — “The  Use  of  Animals  in  the  Study  of 
Chemotherapeutic  Agents.”  Jean  H. 
Dougherty,  M.D. 

3:00 — “Experimental  and  Clinical  Studies  in  the 
Treatment  of  Leukemias  With  Radiation 
Therapy.”  Henry  S.  Kaplan,  M.D. 

3 :30 — Intermission. 

3:45 — “The  Treatment  of  Acute  Leukemias  With 
Anti-Folic  Acid  Compounds.”  George  E. 
Cartwright,  M.D. 

4:15 — “The  Treatment  of  Lymphomas  With  Ni- 
trogen Mustard  and  Urethane.”  Maxwell 
M.  Wintrobe,  M.D. 

Discussion 

There  will  be  no  registration  fee. 

All  meetings  will  be  held  in  the  Junior  Ball- 
room of  the  Hotel  Utah  unless  otherwise  stated. 

The  seating  capacity  for  the  banquet  will  be 


limited  to  125.  Tickets  will  cost  $4.00  and  will 
be  on  sale  at  the  registration  desk. 

There  will  be  no  formal  program  during  the 
luncheon  hours. 


WYOMING 

State  Medical  Society 


WYOMING  ANNUAL  SESSION 

The  Medical  Society  of  the  State  of  Wyoming 
wishes  to  announce  its  annual  meeting  of  the 
House  of  Delegates  and  its  scientific  session  will 
be  held  in  Casper,  Wyoming,  at  the  Elks  Club  on 
September  12,  13,  and  14,  1949. 

CARBON  COUNTY 

Carbon  County  Medical  Society  met  on  Mon- 
day^  January  31.  The  Society  unanimously 
agreed  to  support  the  A.M.A.  in  its  efforts  to 
care  for  the  interests  of  medicine  and  the  pub- 
lic. Every  member  of  the  Society  paid  the  $25 
assessment  of  the  A.M.A.  as  well  as  their  Wyo- 
ming State  Medical  Society  dues  for  1949.  Can 
any  County  Society  in  the  U.  S.  beat  this 
record?  We  challenge. 

F.  A.  MILLS,  M.D.,  Secretary. 


FIRST  W'E  STERN  INSTITUTE  ON  EPILEPSY 

The  First  Western  Institute  on  Epilepsy  will 
m.eet  in  Denver  at  the  University  of  Colorado 
Medical  Center,  May  16,  17  and  19.  Members  of 
the  medical  profession,  as  well  as  social  workers, 
psychologists  and  interested  laymen,  are  invited 
to  attend.  Lectures,  clinics,  and  round  table  dis- 
cussions on  Epilepsy  will  be  held,  led  off  by  Dr. 
Jerry  Price  of  the  Neurological  Institute  as  key- 
note speaker.  Institute  fees  will  be  $5.00.  Write 
for  information  to:  Director,  Epilepsy  Service, 
University  of  Colorado  Medical  Center,  Denver, 
Colorado. 


SOUTH  ATLANTIC  ASSOCIATION  OF 
OBSTRETRICIANS  AND  GYNECOLOGISTS 

The  South  Atlantic  Association  of  Obstetri- 
cians and  Gynecologists  announces  the  establish- 
ment of  “The  Foundation  Prize.”  Authors  of 
papers  on  obstetrical  or  gynecological  subjects 
desiring  to  compete  for  the  prize  may  obtain  in- 
formation from  Dr.  E.  D.  Colvin,  Secretary- 
Treasurer,  1259  Clifton  Road,  N.  E.,  Atlanta, 
Georgia. 


THE  ROCKY  MOUNTAIN  DERMATOLOGIC 
SOCIETY 

The  Rocky  Mountain  Dermatologic  Society 
met  at  the  Broadmoor  Hotel  in  Colorado 
Springs  on  March  18  and  19. 

Attendance  was  excellent,  members  attending 
from  Denver,  Colorado  Springs,  Pueblo,  Salt 
Lake  City,  Reno  and  Wichita.  Visitors  from 
St.  Louis,  Cincinnati,  Oklahoma  City,  Tulsa  and 
Colorado  Springs  were  guests  of  the  Society. 

The  next  meeting  is  to  be  held  in  Wichita, 
Kansas,  in  October  or  November. 


320 


Rocky  Mountain  Medical  Journal 


IT’S  NEW! 


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facilities,  Borden's  Prescription  Products  now  brings 
to  the  physician  the  New  Improved  Biolac  — now 
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The  New  Improved  Biolae 
is  better  nutritionally: 

A moderate  amount  of  especially  combined  fats 
provide  all  the  essential  fatty  acids,  with  a minimum 
of  the  volatile  fraction. 

Its  carbohydrate  content  provides  completely  for 
the  infant's  carbohydrate  needs,  with  balanced  pro- 
portions of  milk  sugar  (lactose)  and  vegetable 
sugars  for  more  satisfactory  absorption  — no  fur- 
ther carbohydrate  addition  is  necessary. 

Its  protein  content  is  in  higher  concentration  than 
in  human  milk,  yielding  small,  readily  digestible 
curds— and  less  allergenic  than  untreated  cow's  milk. 

High  levels  of  iron,  calcium,  phosphorus  and 
vitamins  A,  Bi,  B2  and  D are  provided;  only  vitamin 
C need  be  added. 


Full  caloric  requirements  of  the  infant  are  sup- 
plied—20  calories  per  fluid  ounce  standard  dilution. 

The  New  Improved  Biolae 
is  better  physically: 

The  most  modern  manufacturing  equipment  gives 
the  New  Improved  Biolac  a higher  and  more  stable 
degree  of  emulsification  . . . facilitates  digestion. 

Preparation  for  feeding  is  easily  calculated  . . . 
quickly  completed...!  fl.  oz.  New  Improved  Biolac 
to  1 ’/a  fl.  oz.  water  per  pound  of  body  weight. 

You  can  rely  on  the  New  Improved  Biolac: 

Clinical  tests  show  its  nutritional  and  digestional 
superiority.  It  can  be  used  interchangeably  with  the 
former  Biolac  which  has  the  same  percentage  com- 
position of  nutritional  factors. 

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conies  of  no  increase  in  cost! 

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if  she  is  one  of  your  patients... 

...She  depends  on  your  help  for  a speedy  return  to  gainful  occupation. 

Women  seeking  employment  who  are  nervous,  apprehensive  and  generally 
distressed  by  symptoms  of  the  climacteric,  may  find  it  difficult  to  meet 
competition.  ^''Premarin"  offers  a solution.  Many  thousand  physicians 
prescribe  this  naturally-occurring,  oral  estrogen  because... 

7 . Prompt  symptomatic  improvement  usually  follows  therapy. 

2.  Untoward  side-effects  are  seldom  noted. 

3.  The  sense  of  well-being  so  frequently  reported  tends  to  quickly 
restore  the  patient's  confidence  and  normal  efficiency. 

4.  This  "Plus"  (the  sense  of  well-being  enjoyed  by  the  patient) 
is  conducive  to  a highly  satisfactory  patient-doctor  relationship. 

5.  Four  potencies  provide  flexibility  of  dosage;  2.5  mg.,  1.25  mg., 

0.625  mg.  and  0.3  mg.  tablets;  also  in  liquid  form,  0.625  mg. 
in  each  4 cc.  (1  teaspoonful). 

f^T\T\T11f  I T\T1T99 

While  sodium  esfrone  su/fafe  is  the  principal  estrogen 
in  "Premarin,"  other  equine  estrogens ..  .estradiol, 
equilin,  equilenin,  hippulin  . . . are  probably  also  pres- 
ent in  varying  amounts  as  water-soluble  conjugates. 

Ayerst,  McKenna  & Harrison  Limited  22  East  40th  Street,  New  York  16,  New  York 

49H 


ESTROGENIC  SUBSTANCES  (WATER-SOLUBLE) 
also  known  as  CONJUGATED  ESTROGENS  (equine) 


for  April,  1949 


321 


The  Case 
Against 
Socialized 
Medicine 

By  Lawrence  Sullivan 

• This  book  tells  the  story  of  Social- 
ized Medicine  in  easy,  non-techni- 
cal  language.  It  exposes  the  gov- 
ernment propaganda  machine  in 
Washington.  It  tells  what  happens 
to  medical  and  hospital  services 
when  the  citizen  loses  the  right  to 
select  his  own  doctor. 

• Socialized  Medicine  would  add  a 
million  full-time  payrollers  to  the 
federal  budget  . . . would  create 
a U.  S.  medical  bureaucracy  twice 
the  size  of  the  Post  Office  Depart- 
ment. Doctors  would  be  appointed 
like  postmasters. 

At  All  Bookstores,  $1.50 

Mail  orders  shipped  same  day 
Delivery  Guaranteed 

THE  STATESMAN  PRESS 
NATIONAL  PRESS  BUILDING 
WASHINGTON  4,  D.  C. 


Juberculosis  Abstracts 

Issued  Monthly  by  the  National  Tuberculosis 
ssociation 

Vol.  XXII  APRIIi,  1949  No.  4 

Routine  chest  X-rays  of  all  hospital  admissions  is 
a "mass-survey"  method  of  great  importance — com- 
parable in  numbers  of  subjects  available  only  to  sur- 
veys of  industries,  communities  or  the  armed  serv- 
ices. While  used  primarily  to  find  cases  of  tuber- 
culosis, such  surveys  also  uncover  other  lung,  heart, 
and  chest  lesions  and  increase  hospital  efficiency. 


THE  CURRENT  STATUS  OF  ROUTINE  CHEST 
X-RAYING  IN  GENERAL  HOSPITALS 
OF  THE  UNITED  STATES 

The  x-raying  of  general  hospital  admissions 
started  in  1935  when  the  Wisconsin  General  Hospital 
and  the  University  Hospital  in  Michigan  began  x-ray- 
ing  all  admissions  for  a trial  period.  In  1938  no  hos- 
pital was  taking  chest  films  of  all  patients  but  by 
1943,  fifty-six  teaching  hospitals  professed  to  be 
taking  routine  chest  x-rays  and  in  1945  8 per  cent 
of  general  hospitals  indicated  that  they  were  taking 
routine  films. 

The  Current  Survey 

When  information  on  the  subject  was  sought  in 
the  spring  of  1948,  the  data  available  from  groups 
such  as  the  National  Tuberculosis  Association,  the 
Public  Health  Service,  the  American  Hospital  Asso- 
ciation and  the  Veterans  Administration  were  in- 
complete. It  was  decided,  therefore,  to  proceed  with  an 
independent  survey  which,  even  if  incomplete,  might 
show  trends  and  supplement  the  information  already 
at  hand. 

It  seemed  wisest  to  seek  information  from  the  State 
Health  Departments,  forty-two  of  which  now  have 
Tuberculosis  Divisions  and  Control  Directors,  many 
of  whom  are  working  closely  with  the  Public  Health 
Service.  Miraculously,  reports  were  received  during 
August,  1948,  from  every  one  of  the  forty-eight  states. 
Additional  help  was  received  from  physicians  and 
from  officials  of  tuberculosis  associations. 

A brief  questionnaire  was  used  to  obtain  the  data 
and  to  explain  the  purpose  of  the  survey.  One  ques- 
tion was  stressed  as  being  most  important — “Which 
general  hospitals  in  your  state  are  now  taking  rou- 
tine chest  x-rays  of  all  admissions?"  Other  questions 
were  aimed  at  finding  out  whether  plans  were  under 
way  for  an  increased  use  of  the  method;  what  size 
film  was  being  used;  who  paid  for  the  original  equip- 
ment and  for  maintenance;  and  whether  cost  data 
were  yet  available. 

The  term  "general  hospital”  was  used  advisedly. 
There  were  6,276  registered  ho.spitals  in  the  United 
States  in  1947,  of  which  4,539  were  general  in  type; 
specialty  and  federal  hospitals  were  excluded.  The 
patients  of  general  hospitals,  moreover,  included  93 
per  cent  of  the  15,829,514  patients  admitted  to  all 
hospitals,  even  though  they  had  only  42  per  cent  of 
the  bed  capacity.  It  is  this  population — 14,665,000 
patients,  plus  another  huge  number  of  outpatients 
each  year — which  it  would  be  most  logical  to  exam- 
ine routinely,  and  about  which  we  would  like  to 
know. 

Of  the  4,539  general  hospitals  in  the  United  States, 
247  replied  that  they  were  taking  routine  chest  x-rays. 
Several  additional  hospitals  stated  that  they  had 
plans  and  equipment  for  starting  such  a program.  The 
equipment  for  routine  chest  x-rays  was  provided  by 
the  hospital  in  thirty-three  instances;  by  the  state 
for  110  hospitals,  by  the  federal  government  for 


322 


Rocky  Mountain  Medical  Journal 


The  FIRST  Estrogenic  Preparation 


providing 
in  a SINOLE 
infection 


J 1.  RAPID  ESTROGENIC  EFFECT 
^ 2.  PROLONGED  DEPOT  ACTION 


Established  1894 

Box  2038 MILWAUKEE  1,  WISCONSIN 


*Exclusive  trademark  of  Kremers-Urban  Co. 


• Dissolved  estrogens  for  rapid  action  — plus  a central  implant  for  an 
effect  lasting  approximately  a month. 

g Parenteral  therapy  with  estrogenic  substances  derived  from  natural 
sources  at  a cost  no  greater  than  that  of  oral  medications. 

• Permits  gradual  adjustment  to  postmenopausal  estrogen  levels  . . . 
avoiding  minimal  likelihood  of  withdrawal  bleeding. 

• Unique  vehicle —dry  syringe  not  required  . . . syringes  easily  cleaned 
after  use  . . . microplatelets  pass  readily  through  a 26-gauge  needle. 

SUPPLIED;  ESTRUGENONE*  50,000  I.U.  estroDC  (5  mg.)  per  cc.:  5-cc.  multi- 
ple-dose vials.  ESTRUGENONE  20,000  I.U.  estrone  (2  mg.)  per  cc.:  5-cc.  vials; 

1-cc.  ampuls,  boxes  of  25. 


ESTRUGENONE 


saTul 


(Estrogenic  Substances,  Water  Insoluble) 
50,000  I.U.  estrone  (5  mg.)  per  cc. 
with  benzyl  alcohol  2% 


Response  In  48  hours 


Subjeetive^^  Relief  in  24  hours 

I*  ^ 


FREEDOM  FROM  SUBJECTIVE  SYMPTOMS  FOR  APPROXIMATELY  A MONTH 


for  April,  1949 


323 


Advertisemen  t 

From  where  I sit 
Joe  Marsh 


Get  The  Truth! 

Called  on  my  good  friend  “Cappy” 
Miller,  who  edits  the  County  Bee,  just 
the  other  day.  And  hanging  up  on  the 
wall  of  Gappy' s office  I noticed  this 
slogan  for  his  paper: 

“Remember  there  are  always  two 
sides  to  every  question.  Get  both  sides. 
Then  be  truthful.” 

A good  slogan  . . . not  just  for  a 
newspaper — for  people,  too.  Because 
there'll  always  be  two  sides  to  every 
question:  the  side  of  those  who  vote 
one  way,  and  those  who  vote  another 
— the  side  of  those  who  enjoy  a tem- 
perate beverage  like  beer  or  ale,  and  of 
those  who  swear  by  nothing  but  cider. 

And  from  where  I sit,  once  you’ve 
got  both  sides — and  faced  them  truth- 
fully, you  reahze  that  these  differences 
of  opinion  are  a precious  part  of  what 
we  call  Democracy — the  right  of  the 
individual  to  vote  as  he  believes,  to 
speak  his  mind,  to  choose  his  own 
beverage  of  moderation,  whether  beer 
or  cider. 


Copyright,  19 U8,  Uvited  States  Brev'ers  Foundation 


forty-nine  and  by  the  city  and  county  for  four.  The 
funds  for  equipment  for  forty  hospitals  were  sup- 
plied by  tuberculosis  associations.  The  survey  was 
supported  by  the  hospital  in  ninety-two  instances,  by 
the  state  in  fifty-nine,  and  by  the  city  or  county  in 
eleven.  All  or  part  of  the  cost  was  borne  by  the 
tuberculosis  association  in  nine  instances  and  by  a 
direct  charge  to  the  patient  in  twenty  instances. 

The  best  data  for  costs  in  a large-scale  operation 
and  the  best  evidence  that  a low  cost  is  possible  come 
from  the  Johns  Hopkins  Hospital.  The  operating  ex- 
pense for  a 70  mm.  unit,  including  all  factors,  was 
34  cents  per  patient  when  1,400  films  a month  were 
taken,  and  25  cents  when  2,100  were  taken.  In  com- 
munity-wide surveys,  which  compete  in  some  ways 
with  hospital  surveys,  the  Public  Health  Service  has 
found  the  usual  cost  to  be  about  55  cents  per  person. 

The  actual  efficiency  of  the  method  in  the  hos- 
pitals is  highly  variable.  The  term  "routine”  is  a 
misnomer.  Factors  which  contribute  to  this  partial 
usage  include  difficulties  of  administration,  technical 
inconvenience,  lack  of  an  interested  director,  oppo- 
sition of  staff  members,  and  the  exclusion  of  certain 
patient  groups  (infants,  obstetrical  patients,  very  ill 
patients,  surgical  patients  and  private  patients).  Ad- 
ministration is  a more  difficult  obstacle  than  tbe  cost 
of  equipment.  Since  the  actual  efficiency  of  the  cam- 
era film,  the  4x5  film,  the  14x17  single  film,  and 
paper  x-rays  is  said  to  be  practically  the  same,  cost 
and  convenience  are  the  real  criteria  for  choice. 

Summary  and  Conclusions 

A survey  has  been  made  to  determine  the  current 
use  of  routine  chest  x-rays  in  general  hospitals  of  the 
United  States.  State  Boards  of  Health  were  used 
as  the  principal  source  of  information.  Two  hun- 
dred and  forty-seven  of  the  4,539  general  hospitals  in 
the  United  States  are  reported  to  have  a program 
in  action.  Numerous  other  hospitals  have  equipment 
or  plans  for  starting  a program.  The  number  of  hos- 
pitals now  taking  routine  films  is  double  the  number 
said  to  be  doing  so  in  1945.  Few  of  the  hospitals  in- 
clude all  of  their  patients  in  these  “routine”  surveys. 
Use  of  the  method  must  be  extended  to  more  hospitals, 
and  to  more  of  the  registrants  of  the  hospitals  if  it 
is  to  approach  its  real  value.  The  source  of  funds  for 
equipment  is  largely  civic,  with  voluntary  groups 
giving  valuable  assistance.  The  "drive”  bas  come 
from  federal,  voluntary,  and  hospital  groups.  Funds 
for  maintenance  of  routine  x-raying  come  from  both 
subsidies  and  charges.  Not  enough  data  are  avail- 
able yet  to  determine  the  cost  of  taking  the  various 
kinds  of  x-rays  under  the  diversity  of  conditions. 
Charges,  where  made,  are  not  yet  based  on  an  ac- 
curate estimation  of  costs.  There  is  evidence  that 
costs  may  be  decreased.  Lack  of  funds,  lack  of  in- 
formation, inertia,  and  the  chores  of  administration 
are  the  barriers  to  wider  usage  of  the  method.  For 
each  of  these  problems,  there  seems  to  be  a solution. 

The  Current  Status  of  Routine  Chest  X-raying  in 
General  Hospitals  of  the  United  States,  William  H. 
Oatway,  Jr.,  M.D.,  Arizona  Medicine,  January,  1949. 


One  of  the  most  significant  recent  advances  of 
the  improved  tuberculosis  case-finding  proce- 
dure is  the  program  to  give  a routine  chest  film 
to  all  hospital  admissions.  As  people  enter  hos- 
pitals for  reasons  of  illness,  a higher  incidence 
of  tuberculosis  than  that  found  in  the  general 
population  may  be  expected.  The  U.  S.  Public 
Health  Service  reports  this  to  be  twice  as  much. 
Approximately  10  per  cent  of  the  general  popu- 
lation are  annually  admitted  to  public  hospitals. 
This  large,  easily  accessible  group  offers  an  ideal 
opportunity  for  the  discovery  of  unsuspected  tu- 
berculosis.— S.  A.  Rolling,  M.D.,  Canad.  J.  Pub. 
Health,  Jan.,  1949. 


324 


Rocky  Mountain  Medical  Journal 


P4 


erfumes  an 


d C^oiog^ned  Ly,  cjCuziei^ 


The  use  of  perfume  is  such  an  intimately  personal  and  individual  subject  that  it  eludes 
generalization.  Discreetly  used,  perfume  seems  to  become  a very  part  of  personality,  so 
that  one  associates  the  person  with  a lovely  fragrance  rather  than  with  the  wearing  of 
perfume.  The  chances  are  that  the  fragrance  which  appeals  to  you  is  the  one  you  should 
wear.  Certainly  no  cosmetic  service  can  be  considered  complete  without  a few  choice  per- 
fumes and  colognes.  Among  our  selection  we  believe  you  will  find  a fragrance  (perhaps  two 
or  three)  with  which  you  will  wish  to  be  associated. 


LUZIER’S  FINE  COSMETICS  AND  PERFUMES 


Are  Distributed  in  Colorado  and  Wyoming  by: 

BURBRIDGE  & BURBRiDGE,  Divisional  Distributors 
519-20  Continental  Bank  Building 
Lincoln,  Nebraska 


Elizabeth  Haskin 

649  Adams 
Denver,  Colo. 


District  Distributors 

Baker  & Baker  Cecile  Armstrong 

Delta,  Colo.  1352  Jasmine  St. 

Denver,  Colo. 


Catherine  Phelps 

Sterling  Hotel 
Greeley,  Colo. 


Nellye  Knight 
P.  O.  Box  156 
Casper,  Wyo. 


Irene  K.  Reece 
1337  Madison 
Denver,  Colo. 


Local  Distributors 

Joyce  Kilgore 
250  Collins 
Pueblo,  Colo. 


Sylvia  Rath 

1254  Cook  St. 
Denver,  Colo. 


Funderburk  & Funderburk 

324  So.  7th  St. 

Grand  Junction,  Colo. 


Selma  Sol  lee 
1426  Grand  Ave. 
Pueblo,  Colo. 


Phil  and  Fern  Pliley 
P.  O.  Box  902 
Laramie,  Wyo. 


Cecelia  Jenkins  Charldean  J.  Hamm 

911  San  Pedro  4360  So.  Lincoln  St. 

Trinidad,  Colo.  Englewood,  Colo. 


for  April,  1949 


325 


Book  Review 


IVrRSES 

OFFICIAL 

REGISTRY 

Established  to  Meet  the  Community’s 
Every  Need  for  Nursing  Care 

-K  -K  -K 

GRADUATE  REGISTERED  NURSES 

Hourly  Nursing  Service  Positions 
Filled — Information  on  All 
Nursing  Service 

This  registry  is  endorsed  by  the 
Colorado  State  Graduate  Nurses’ 
Association  and  American  Nurses’ 
Association 

■K  -K  -K 

Undergraduates  and  Practical  Nurses 
Furnished  Upon  Request 

KEystone  0168 

ARGONAUT  HOTEL 


Mayo  Olinic  Diet  Manual:  By  the  Committee  on 
Dietetics  of  the  May9  Clinic.  W.  B.  Saunders  Com- 
pany, Philadelphia  and  London,  1949. 

The  dietary  procedures  outlined  in  this  book 
were  developed  for  the  guidance  of  physicians, 
fellow  dietitians,  dietetic  interns  and  nurses  of 
the  Mayo  Foundation,  the  Mayo  Clinic  and  the 
hospitals  of  Rochester,  Minnesota.  These  diets 
represent  the  convergent  trend,  but  not  unamin- 
ity  of  o^jinion  of  the  physicians  of  the  clinic. 
They  are  designed  for  use  by  persons  with 
training  in  medicine  or  dietetics  and  are  not 
intended  for  direct  distribution  to  patients.  A 
degree  of  empiricism  continues  to  be  unavoid- 
able in  dietotherapy.  With  contemplated  de- 
velopments in  the  science  of  nutrition,  frequent 
revisions  of  the  book  are  contemplated. 

The  bulk  of  the  book  is  made  up  of  a discus- 
sion of  the  several  diets  employed  at  the  Mayo 
Clinic.  Each  of  the  diets  is  discussed  imder 
several  headings.  An  example:  The  standard 
hospital  diets  are  discussed  under  approximate 
composition,  adequacy  of  diets,  general  descrip- 
tion of  diets,  foods  included  and  excluded,  die- 
tary pattern  and  sample  diets.  The  same  type 
of  discussion  is  given  to  gastric  ulcer  diet, 
chronic  ulcerative  cohtis  diet,  etc. 

An  appendix  gives  excellent  material  for  the 
chemical  and  nutritional  consideration  of  diets 
in  general. 

This  manual  is  an  excellent  guide  for  those 
interested  in  prescribing  or  dispensing  hospital 
diets. 

HARRY  GAUSS. 


OL 

BROWN  SCHOOLS 


For  Exceptional  Children 

Four  distinct  units.  Tiny  Tots  through 
the  Teens.  Ranch  for  older  hoys.  Spe- 
cial attention  given  to  educational  and 
emotional  difficulties.  Speech,  Music, 
Arts  and  Crafts.  Full  time  Psychologist. 
Under  the  daily  supervision  of  a Certi- 
fied Psychiatrist.  Registered  Nurses. 
Private  swimming  pool,  fireproof 
building.  View  Book.  Summer  Camp, 
Approved  hy  State  Division  of  Special 
Educatioh. 


BERT  P.  BROWN 

President 

Paul  L.  White,  M.D.,  F.A.P.A., 
Medical  Director 

P.  0.  Box  4008,  Austin,  Texas 


To  the  Doctors  of  the 
State  Medical  Society 

The  doctors  of  the  Boulder 
Medical  Center  regret  that 
due  to  conditions  beyond  our 
control,  our  invitation  to 
you  to  inspect  our  new  Clin- 
ic Building  may  not  have 
reached  you  prior  to  the 
opening  date.  We  are  there- 
fore taking  this  opportunity 
to  inform  you  that  you  are 
ivelcome  to  visit  us  at  any 
time. 


326 


Rocky  Mountain  Medical  Journal 


YORK 

PHARMACY 

Denver’s  Finest  Prescription  Store 

Free  Delivery 
Phone  FR.  8837 

2300  East  Colfax  Avenue  at  York  Street 
Almay  Cosmetics 


W.^./eocL 

Ambulance 
Service 

Prompt,  Careful  and  Courteous 
Serving  Denver  25  Years 

Approved  by  Pbysiciana  Generally 

18th  Ave.  at  Gilpin  St.,  Phone  EA.  7733 


Surgical  Supports  Expertly  Fitted. 

Miss  Mabel  P.  Cliff,  Authorized  Fitter 


2)  enuer  ^ur^icai Supply  dompani^ 

“For  better  service  to  the  profession.” 

1438-40  Tremont  Place  CHerry  4458 

Denver  2,  Colorado 


yllba  X)airy 

Properly  Pasteurized  Milk 

Ire  Cream — Biilter Biitlermilk 


Phone  1101 


Boulder,  Colo 


The  Complete 

RENTAL  SERVICE 


Cooler  — Water  — Cups 
Modernize  Your  Office  With 

PURE  DEEP  ROCK 

Artesian  Water 


COLD  STORAGE  SPACE 

For  Biological  Supplies 


ICE  CUBES 

A Generous  Supply 

ELEC.  WATER  COOLERS 

All  Types  and  Makes 


FOR  RENT  OR  FOR  SALE 


DEEP  ROCK  WATER  CO. 

614  27th  St.  TAbor  5121 


for  April,  1949 


327 


We  Recommend 

K ARC’S  PAINT  CO. 

Lowe  Bros.  Paints  Kem-Tone 

Wall  Paper  Painters’  Supplies 

Art  Supplies 

FREE  DELIVERY  

Phone  CHerry  3779 

620  Santa  Fe  Drive  Denver 

NEWTON  OPTICAL  COMPANY 

GUILD  OPTICIANS 

V.  C.  NORWOOD,  Monager 

309-16th  Street  Denver 

Phone  KEystone  0806 

Cataring  to  Modical  Ptoiassion  Patronaga 

Denver’s  Fireproof 

COLBURN  HOTEL 

D.  B.  Cerise  is  the  genial  Host  and  Manager 

• CONVENIENT  — Located  only  a ten-minute  woUc 
from  the  heart  oi  the  city. 

• PLEASANT  — Away  from  — above  the  noise  and 
rush  of  downtown  Denver. 

• EXCELLENT  FOOD  — Dining  that  has  satisfied  the 
demanding  tastes  of  all  patrons. 

• Visit  Our  New  Cocktoil  Lounge. 

TENTH  AVE.  at  GRANT  ST. 

Phone  MAin  6261  Denver,  Colo. 

A TELEPHONE  SERVICE 
THAT’S  INVALUABLE 

TO  PROFESSIONAL  MEN 

The  Physicians  & Surgeons  Exchange 

965  Gas  & Electric  Bldg.  KE.  8173 

We  take  your  phone  calls — get  them 
to  you.  On  the  job  24  hours  every  day. 

RESTAURANT  240 

MISS  M.  E.  GABRIEL,  Prop. 

SERVING  TRADITIONALLY  GOOD 
FOOD  AT  MODERATE  PRICES 

HOURS:  11:00  A.M.— 2:00  P.M.  4:30—7:30  P.M. 
SUNDAYS:  12  Noon  to  7:00  P.M. 

Closed  Wednesdays 

240  Broadway  Denver,  Colo. 

SPruce  2182 

WHEATRIDCE  FARM  DAIRY 

COMPLETE  LINE  OF  GRADE  A 

DAIRY  PRODUCTS 

Special  Milk  for  Babies 
DELIVERED  TO  YOUR  DOOR 

We  Have  Our  Own  Cows 

8000  West  44th  Ave. 

GL.  1719  ARVADA  220 

We  Cater  to  the  Medical  Profession 

CASCADE  LAUNDRY 

10  Per  Cent  Discount  I£  You  Bring  Your 
Laundry  in 

HAND  DRY  CLEANING 
“Deserving  of  Your  Patronage” 

1621  Tremont  Denver  TAbor  6379 

Charge  Accounts  Invited 

We  Recommend 

Jackson’s  Cut  Rate  Drags 

LIQUORS— SUNDRIES 
PRESCRIPTIONS 

X 

Call  SP.  3445 

DOWNING  and  ALAMEDA 

We  Recommend 

ED.  CORBIN’S  DRUG  STORE 

(Evergreen  Drug  Store) 

PRESCRIPTION  SPECIALISTS 
DRUGS  — SUNDRIES 

Evergreen,  Colorado  Altitude 

U.  S.  A.  7,039  Feet 

Phone  Evergreen  22 

patronize  l^our 

328 


Rocky  Mountain  Medical  Journal 


If  You  Send  Out  Statements 


We 

(Colorado  Springs  ^Psyckopathic  Hospital 

A Private  Hospital  for  Nervous  and  Mental  Diseases 

Situated  in  a beautiful  valley  two  miles  south  of  Colorado  Springs,  which  is  nationally  known  as  a health 
center.  New  building  for  mild  coses  of  Functional  Neurosis,  affording  complete  classification  of  patientt. 
Home-like  surroundings,  scientific  medical  treatment  and  nursing  care.  Booklet  and  rates  on  application. 

C.  K.  Rice,  Superintendent,  Colorado  Sprin^rs,  Colorado 


SPECIAL  OFFER  . . . ask  for  Assortment  "X"  . . . 500  Statement  envelopes,  plus 
500  "Coilectelopes"  plus  1,000  window  envelopes  ALL  FOR  ONLY  $20.26  postpaid! 

Price  includes  imprinting 


ROCKMONT  Statement  Envelopes  save  time  in  your 
office  and  make  it  easy  for  the  patient  to  remit. 

The  statement  is  an  envelope  addressed  back  to  your 
office  and  goes  out  to  the  patient  in  a crystalite  window 
envelope,  thus  saving  one  complete  addressing  opera- 
tion, for  your  secretary.  All  the  patient  has  to  do  is 
simply  insert  check  and  mail. 

For  those  slow-pay  patients,  ROCKMONT 
"COLLECTELOPES”  will  get  results.  Three  colors 
identify  the  message  of  collection.  Proved  copy  brings 
payment  in  fast,  without  offending. 


and 

SPEEDS  UP 
COLLECTIONS! 


ROCKMONT  ENVELOPE  COMPANY 

Alameda  and  Cherokee  * PEarl  2484  * Denver,  Colorado 


for  April,  1949 


329 


ACCIDENT  - HOSPITAL  - SICKNESS 

INSURANCE 

For 

Physicians,  Surgeons,  Dentists  Exclusively 


PREMIUMS 

COME  FROM 


$5,000.00  accidental  death  $8.00 

$25.00  weekly  iBdemnlty,  accident  and  sickness  Quarterly 

$10,000.00  accidental  death  $16.00 

$50.00  weekly  Indemnity,  accident  and  sickness  Quarterly 

$15,000.00  accidental  death  $24.00 

$75.00  weekly  Indemnity,  accident  and  sickness  Quarterly 

$20,000.00  accidental  death  $32.00 

$100.00  weekly  Indemnity,  accident  and  sickness  Quarterly 


ALSO  HOSPITAL  EXPENSE  FOR  MEMBERS, 
WIVES  AND  CHILDREN 


85c  out  of  each  $1.00  gross  income  used  for 
members’  benefit 

$3,700,000.00  $ 1 5,700,000.00 

INVESTED  ASSETS  PAID  FOR  CLAIMS 

$200,000.00  deposited  with  State  of  Nebraska  for  protection  of  our  members. 

Disability  nt-eci  not  be  incurred  in  line  of  duty — 
benefits  from  the  beginning  day  of  disability 

PHYSICIANS  CASUALTY  ASSOCIATION 
PHYSICIANS  HEALTH  ASSOCIATION 

47  years  under  the  same  monagement 
400  Rir*if  (Vnrionni  Bnildins*  Omaha  li.  Nebraska 


E & J Folding 
WHEEL  CHAIRS 


Everest  & Jennings  folding  Wheel  Chairs  are 
LIGHTEST  AND  STRONGEST  of  all! 
They  fold  compactly  for  travel,  work,  play. 
Beautifully  designed  of  chromium  plated 
tubular  steel.  Insist  on  a genuine  E & J Light- 
weight Wheel  Chair.  America’s  finest. 

EVEREST  & JENNINGS  Dept.7i 

761  NOkTH  HIGKUND  IVfNUf  ■ lOS  INGEIES  38.  CAIIF. 


Used  by  thousands  for 
TRAVEL,  WORK,  PLAY 


MEDICAL  CENTER 
PHARMACY 

Located  in  the  New  Medical  Building 

3701  East  Colfax  DExter  5467 

DENVER,  COLO. 

Prescriptions  and  Medical  Supplies 

Wm.  K.  VAN  SANT,  Mgr. 

Free  Delivery 


CAPITOL  LIFE 
Insurance  Co. 

Clarence  J.  Daly,  President 

DALY  INSURANCE 

All  Forms  of  Insurance 
Capitol  Life  Insurance  Bldg. 

16th  and  Sherman  Denver,  Colorado 

KEystone  2211 


^,^itenHon  . . , 

PHYSICIANS 

J^a  tronize  ^our 


rEMEHK 


Inorganic  and  Organic  Chemicals 
Biological  Stains  • Solutions 
Chemical  Indicators  • Test  Papers 

Distributed  by 

Physieum  and  Laboratory  Supply  ffoiues 

The  COLEMAN  & BELL  COMPANY,  Inc. 

HANUFACTVRINC  CHEMISTS  NORWOOD,  OHIO.  O.  S.  A. 


COLEMAN  & BELL 


330 


Rocky  Mountain  Medical  Journal 


THIS  IS  YOUR  SERVICE- 
WHY  NOT  USE  IT? 


Men  of  science  and  naedicine  agree  that  the  functional  efficiency  of  any 
piece  of  technical  apparatus  depends  in  large  measure  upon  the  service 
facilities  maintained  by  the  organization  selling  it. 


When  you  place  your  orders  for  scientific  instruments  with  us,  you  have 
the  assurance  that  experienced  technicians  will  always  be  available  to  pro- 
vide capable  service,  promptly  and  efficiently. 


We  list  below  just  a few  of  the  products  we  sell  and  service: 


Electrocardiographs 
Photoelectric  Colorimeters 
Warburg  Apparatus 
pH  Meters 
Microscopes 
Laboratory  Ovens 
Laboratory  Furniture 
Metabolators 
Operating  Room  Lights 
Water  Stills 


Electroencephalographs 

Spectrophotometers 

Dubnoff  Metabolic  Shaking  Incubators 
Analytical  Balances 
Photomicrographic  Equipment 
Laboratory  Incubators 
Hospital  Furniture 
Resuscitators 

Autoclaves  and  Sterilizers 
Anesthesia  Apparatus 


Biological  and  Blood  Bonk  Refrigerators 
X-Ray  Equipment— Diagnostic  ond  Therapy 
X-Ray  Diffraction  Spectrometers 

Films- — Dark  Room  Accessories-^ — Protective  Equipment 
Fenwall  System  for  the  Preporotion  of  Parenteral  Medications 

When  considering  the  purchase  of  scientific  equipment,  send  us  your  In- 
quiries. Pay  no  more,  but  have  the  assurance  of  professional  maintainance 
facilities. 


TECHNICAL  EQUIPMENT  CORPORATION 

2548  West  29th  Avenue 
Denver  1 1 , Colo. 

Telephone  GLendale  4768 

FEATURING  INSTRUMENTATION  IN  MODERN  ANALYSIS 


for  April,  1949 


331 


Bonita  Pharmacy 

(Established  1921) 

Prescription  Pharmacists 

6th  Avenue  at  St.  Paul  Street 

“RICHT-A-WAY”  SERVICE 

GERALD  P.  MOORE,  Manager 

Phone  FRemont  2797 


50  y.a»  of  £tk  icai  ^reicriplion 

Service  to  the  ^^octors  of  die^enna 


ROEDEL^S 

PRESCRIPTION  DRUG  STORE 

CHEYENNE,  WYOMING 


YOU  ARE  INVITED  TO  VISIT  OUR 
NEW  MODERN  STORE 

Conveniently  Located  to  Meet  the  Needs 
of  the  Doctor 


3L 


&’Su 


Sunpiu  (^o. 


f^li^diciand  CT"  ^ur^eonS 

Metropolitan  Bldg. 

221  Sixteenth  Street  TAbor  0156 

DENVER 


We  Welcome  Members  of  the 
Medical  Profession 

PLza  Motet 

Under  Management  of 
Mrs.  Addie  A.  and  Edward  A.  Miller 
Proprietors 

ALL  OUTSIDE  ROOMS 
Comer  15th  and  Tremont 
A Stone’s  Throw  to  Medical  Buildings 

TAbor  5101  DENVER 


Cook  County  Graduate 
School  of  Medicine 

ANNOUNCES  CONTINUOUS  COURSES 

SURGERY — Intensive  course  in  Surgical  Technique, 
two  weeks,  starting  April  18,  May  16,  June  20. 
Surgical  Technique,  Surgical  Anatomy  and  Clinical 
Surgery,  four  weeks,  starting  April  4,  May  2, 
June  6.  Surgical  Anatomy  and  Clinical  Surgery, 
two  weeks,  starting  Ap'il  18,  May  16,  June  20. 
Surgery*  of  Co'on  and  Rectum,  one  week,  starting 
April  11,  May  16,  June  13.  Esophageal  Surgery, 
one  week,  starting  June  13.  Thoracic  Surgery,  one 
week,  starting  June  20.  Bmost  and  Thyroid  Sur- 
gery, one  week,  starting  June  27. 

GYNECOLOGY — Intensvie  course,  two  weeks,  starting 
April  18,  June  20.  Vaginal  .Approach  to  Pelvic 
Surgery,  one  week,  starting  April  4,  May  16, 
June  13. 

OBSTETRICS — Intensive  course,  two  weeks,  starting 
April  4,  May  16. 

MEDICINE — Intensive  course,  two  weeks,  starting 
June  13.  Electrocardiography  and  Heart  Disease, 
two  weeks,  starting  Julv  18.  Gastroenterology,  two 
weeks,  starting  June  27.  Personal  course  in  Gas- 
troscopy, two  weeks,  starting  May  16,  June  13. 

PEDIATRICS — Intensive  course,  two  weeks,  starting 
April  4.  Diagnosis  and  Treatment  of  Congenital 
Maltormations  of  Heart,  two  weeks,  startnig  June  13. 

DERMATOLOGY — Formal  course,  two  weeks,  starting 
May  2.  Informal  clincial  course  every  two  weeks. 

CYSTOSCOPY — Ten-day  practical  course  every  two 
weeks. 

U ROLOGY — I ntensi  ve  course,  two  weeks,  starting 
April  18. 

GENERAL,  INTENSIVE  AND  SPECIAL  COURSES  IN 
ALL  BRANCHES  OF  MEDICINE,  SURGERY  AND 
THE  SPECIALTIES 

TEACHING  FACULTY— ATTENDING  STAFF  OF 
COOK  COUNTY  HOSPITAL 


Address;  Registrar,  427  South  Honore  Street, 
Chicago  12,  Illinois 


f^roduction  .Si 


eruice 


ELECTROTYPES 

MATRICES 

STEREOTYPES 

PRINTING 

TYPOGRAPHY 


Denver  - 
New  York  - 
Chicago  - - 


Veu,. 


'dpapet 


U 


nion 


- - 1830  Curtis  St. 

- - - 310  East  45th  St. 

- - 210  So.  Desplaines  St. 


And  33  Other  Cities 


■t 


4- 


332 


Rocky  Mountain  Medical  Journal 


Use  of  a diaphragm  introducer  is  favored  by  many 
patients  who  find  manual  manipulation  objection- 
able or  diflBcult.  It  facihtates  the  insertion  and  correct 
placement  of  the  diaphragm,  as  well  as  its  removal. 

The  “RAMSES”*  Diaphragm  Introducer  provides 
the  following  features: 

• Simplicity  and  convenience  in  use 

• Safety  — design  minimizes  possibility  of  injury  to 
the  cervix  or  accidental  insertion  into  the  urethra 


• Smooth  surface  lessens  bacterial  prohferation  — 
makes  for  easy  cleaning 

• Ease  of  removal  assured  by  bluntly  hooked  end 

The  “RAMSES”  Diaphragm  Introducer  is  supplied 
in  the  Physician  s Prescription  Packet  No.  501,  with- 
out charge 


TRADEMARK  REG.  U.S.  PAT.  OFF. 

PHYSICIAN’S  PRESCRIPTION  PACKET  NO.  501 


A complete  unit  for  conception  control.  Contains  (1)  a 
“RAMSES”  Flexible  Cushioned  Diaphragm  of  the  prescribed  size,  (2)  a “RAMSES”  Dia- 
phragm Introducer  of  corresponding  size,  and  (3)  a tube  of  “RAMSES”  Vaginal  Jelly t 
(regular  size). 


“The  word  “RAMSES”  is  a registered  trademark  of  Julius  Schmid,  Inc 

f Active  Ingredients:  Dodecaethyleneglycol  Monolaurate  5%; 

Boric  Acid  1%;  Alcohol  5%. 


gyn0€ofogkal  division 


423  West  55th  Street,  New  York  19,  N.  Y. 
qualify  first  since  1883 


“RAMSES”  Vaginal  Jelly  is  accepted 
by  the  Council  on  Pharmacy  and 
Chemistry  of  the  American  Medical 
Association.  The  “RAMSES”  Dia- 
phragm and  Diaphragm  Introducer 
are  accepted  by  the  Council  on 
Physical  Medicine  of  the  American 
Medical  Association. 


for  April,  1949 


333 


RELIABLE  DRUGGISTS 


PATRONIZE  DENVER’S  INDEPENDENT  DRUGGISTS 


WE  RECOMMEND 

COUIVTRY  CLUB 
PHARMACY 

PRESCRIPTION  SPECIALISTS 

☆ 

1700  E.  6th  Ave.  EAst  7743 

Denver,  Colorado 

We  Recommend 

PFAB  PHARMACY 

JESS  L.  KINCAID,  Prop. 

PrescriptioTis,  Biologicals 
and  Fine  Cosmetics 

5190  W.  Colfax  at  Sheridan 

Phone  TAbor  9931-0951 

DENVER,  COLORADO 

HATCH  PHARHACY 

PRESCRIPTIONS  OUR  SPECIALTY 
Drugs  — Sundries 

Free  Immediate  Deliveries  on  Prescriptions 

794  Colorado  Blvd.  Denver,  Colo. 

Phone  EAst  7718 

“When  in  Need  Think  of  Us  Indeed” 

We  Recommend 

EARIYEST  DRUG  COMPANY 

T.  H.  BRAYDiEIN,  Prop. 

PRESCRIPTION  SPECIALISTS 
Prompt  Delivery  Service 

1699  Broadway  Phone  KEystone  7237 

Denver,  Colorado 

“Conveniently  Located  lor  the  Doctor” 

HYDE’S  PHARMACY 

ACCURATE  PRESCRIPTIONS 

Chas  W.  Hyde,  Prop. 

Rocky  Mountain  Distributor  for  Sherman 
Biolog^cals  and  Pharmaceuticals 

Free  Deliveries 

629  16th  St.  (Mack  Bldg.)  KE.  4811 

Doyle's  Pharmacy 

‘^lie  particuiar 

East  17th  Ave.  at  Grant  KE.  5987 

21  Years  in  the  Heart  of  North  Denver 

GUIDO  SHUMAKE  DRUGS 

(Formerly  Otto  Drug  Co.) 

PRESCRIPTIONS  ACCURATELY 
COMPOUNDED 

Free  Delivery  Service 

West  38th  Ave.  and  Clay  Denver,  Colo. 

Phone  GRand  9934 

We  Recommend 

BONNIE  BRAE 

DRUG  COMPANY 

Alfred  C.  Andersen,  Owner  and  Manager 
Prescriptions  Accurately  Compounded 

Drugs Sundries 

FREE  IMMEDIATE  DELIVERIES 

ON  EMERGENCY  PRESCRIPTIONS 

763  South  University  Boulevard 

Phone  RAce  2874  — Denver,  Colorado 

WE  RECOMMEND 

Whittaker’s  Pharmacy 

“The  Friendly  Store” 

PRESCRIPTION  SPECIALISTS 

West  32nd  and  Perry,  Denver,  Colo. 
Phone  GLendale  2401 

22  Years  in  North  Denver 

OTTO  DRUG  COMPANY 

TRY  US  FIRST 

Prescriptions  Accurately  Compounded 

Free  Delivery  Service 

(New  Location) 

5070  Federal  Boulevard  Denver,  Colorado 

Phone  GRond  9832 

334 


Rocky  Mountain  Medical  Journal 


RELIABLE  DRUGGISTS 


PATRONIZE  DENVER’S  INDEPENDENT  DRUGGISTS 


WALTERS  DRUG  STORE 
801  COLORADO  BLVD. 
Denver,  Colorado 

☆ 

Telephone  FRemont  5391 


'MJht  to  i3u^  at  lAJehi 

WEISS  DRUG 

PRESCRIPTION  SPECIALISTS 

'A 

Colfax  and  Elm  Denver,  Colorado 

Phone  EAst  1814 


We  Recommend 

VAN'S  PHARMACY 

THOS.  A.  VANDERBUR 

Prescriptions,  Dmgrs,  Cosmetics,  Magazines 
Sundries  Excellent  Fountain  Service 

2859  Umatilla  St.,  Cor.  29th  Ave.  at  Umatilla 
GRand  7944  Denver,  Colo. 


Dansberry’s  Pharmacy 

“New  Ultra  Modern  Prescription  Service” 

JAMES  F.  DANSBERRY 
Owner  and  Manager 

Champa  at  14th  Street  Denver,  Colorado 
Phone  KEystone  4269 


Harl  Cleveland,  Owner 

CLEVELAND  PHARMACY 

W.  29th  Ave.  at  Speer  Ph.  GL.  9272 

Modem  Prescription  Department 
Registered  Pharmacist 

Dmgs  — Sundries  — Soda  Fountain 

HOURS:  Week  Days.  8 a.m.  to  10  p.m. 

Sundays,  10  am.  to  1 p.m.,  5 p.m.  to  8 pmi. 

Prescriptions  Delivered  Promptly 


WE  RECOMMEND 

LAKEWOOD  PHARMACY 

R.  W.  Holtgren,  Prop. 
PRESCRIPTION  SPECIALISTS 


West  Colfax  at  Wadsworth 
Lakewood  Colorado 

Phone  Lakewood  65 


Downing  Street  Pharmacy 

GEORGE  M.  HILL,  Prop. 

PROFESSIONAL  PHARMACIST 

901  Downing  St.  Denver,  Colo. 

Phone  CHerry  2767 

Complete  Merchandise  Line 
Free  Delivery  on  Prescriptions 


East  Denver’s  Prescription  Drug  Store 


Bert  C.  Corgan,  Prop. 

3401  FRANKLIN  STREET 
KEystone  7241 


OVERSTAKE’S  PHARMACY 

Gail  E.  Overstake 
Prescri pti on  S pecialists 

DRUGS  — SUNDRIES  — 
COSMETICS  — CANDIES 

We  Deliver 

1000  So.  Gaylord  — RAce  4401 


PROFESSIONAL  MEN  RECOMMEND 


D.  MALCOLM  CAREY,  Pharmacist 

Phone  AComa  371 1 

224  Sixteenth  Street  Denver,  Colorado 


for  April,  1949 


335 


^lAJooJcto^t  J^oApitai—’jf^ueLioy  C^oiotado 

A private  hospital  for  the  scientific  treatment  of  neuro-psychiatric  disorders,  including 
alcoholism  and  drug  addiction.  Beautiful  landscaping  and  home-like  surroundings  afford 
a restful  atmosphere.  Accommodations  vary  from  single  rooms  with  or  without  bath  to 
rooms  en  suite,  allowing  for  segregation  of  guests. 


Detailed  information  furnished  on  request. 


Karl  J.  Waggener,  M.D. 


Wendell  T.  Wingett,  M.D. 


THE  CHILDREN’S  HOSPITAL  ASSOCIATION 

of  DENVER 

NON-SECTARIAN NON-PROFIT 

Providing  medicinal  and  surgical  aid  to  sick  and  crippled  children  of  the  Rocky 
Mountain  Region  from  Birth  to  Maturity 

Every  modern  scientific  aid  available  to  the  physicians  and  surgeons 
of  Colorado  and  Wyoming 

Approved  by  the  American  Medical  Association  and  Full  Three-Year 

the  American  College  of  Surgeons  Nurses’  Training  Course 


336 


Rocky  Mountain  Medical  Journal 


GlINDAte 


RESEAB 


collecting 


banking 


Five-Fold  Utility 
in  Blood  Handling 


dispensing 


sedimenting 


centrifuging 


TRANSFUSO-VAC 

The  Baxter  F-9S  Transfuse- Vac  is  finding  ever-increasing  favor 
among  hospitals  and  blood  banks  because  of  its  five-purpose  usefulness 
and  the  resultant  economy  in  time  and  expense.  It  is  supplied  with  120  cc. 
of  anti-coagulant  (modified  A.C.D.  Solution)  and  is  used  with  equal  effect- 
iveness for  blood  collection,  banking,  administering,  sedimenting  or  centrifuging 
For  uniformity  and  simplification  in  your  blood  banking  procedure 
specify  the  all-purpose  Baxter  F-9S  Transfuso-Vac. 


CTION  LABORATORIES 


IVSFU?? 


'20cc.A.CD. 


Citric  Acid,  Oertrose 


EocK* 


Soluti 


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lUTion 

modified) 


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THE  ANSWER  TO  YOUR 

^(mcL 


PROBLEMS 


HZ'.y  V-18s 
-KPENDABuE 


§ TOP  worries  of  interrupted  fiow  during  blood 
infusions  by  using  this  ingenious  new  admin- 
istration set.  Its  slotted  strainer  pre-strains  blood 
before  it  leaves  the  container.  Easily  inserted 
through  stopper,  the  long  strainer  allows  release 
of  every  usable  drop,  eliminating  blood  waste; 
even  excessive  amounts  of  fibrinous  masses  will 
settle  harmlessly  at  its  base. 

Also  newly  designed,  the  filter  in  the  drip 
housing  is  fine  mesh  nylon  of  uniform  weave, 
and  provides  ample  filtering  surface  for  free 
flow  of  blood  or  plasma. 

Economical  and  highly  efficient,  this  new 
set  is  entirely  expendable  after  one-time  use— ■■ 
;'ou  waste  no  valuable  time  in  cleaning  and  as- 
''sembling.  V-18S  Vacosets,  packed  sterile,  non- 
pyrogenic  and  ready  for  immediate  use,  are  now 
available  from  your  regular  Baxter  supplier. 


distributed  by 

THE  DENVER  FIRE  CLAY  CO. 

^ Dhnver,  Colorado,  U.S.A. 

1 Lake  City — 22*)  W.  South  Temple  St. 


DON  BAXTER,  INC.,  SLENDALi,  CALIFORNIA 


¥ 

the  new  air  conditioned  MEDICAL  CENTER  BUILDING 


now  being  completed  at  E.  Colfax  Avenue  and  Garfield  Street, 

is  the  most  modern  and  best  equipped  medical  building  constructed  to  date. 

¥ WITHIN  A 2'/2  MILE  RADIUS  OF  ALL  BUT  2 OF  DENVER  HOSPITALS 

limtlect  ^^lace  i<i  a va^/ciS/e 

/ea^e  /o  a/i^iA<>v€€l fnet/tcei/ 

for  information  coll 

A.  C.  DUERR 


724  Seventeenth  Street 


REALTOR 


Denver  2,  Colorado 


NATURE 
PROVIDES  A 
DEPENDABLE 
SOURCE 


Especially  developed 
for  infant  feeding. 

Special  Morning  Milk 
is  fortified 
(from  natural  sources) 
with  400  U.S.P.  units 
vitamin  D and  2000  U.S.P. 
units  vitamin  A per 
reconstituted  quart. 


MORNING 


MILK 


for  April,  1949 


337 


FAIRFAX  SANITARIUM 


Kirkland,  Wash. 

Situated  one  mile  north  of  Juanita 

TREATING  NERVOUS  AND 
MENTAL  DISEASES 

Beautiful  and  restful  surroundings  offording 
recreational  facilities.  Cottage  plan  for  segre- 
gation of  patients.  Insulin  and  Electro-shock 
Therapy  when  indicated. 

Attending  Physicians 

FREDERICK  LEMERE,  M.D. 

NATHAN  K.  RICKLES,  M.D. 

JAMES  H.  LASATER,  M.D. 

MORTON  E.  BASSAN,  M.D. 

JACK  J.  KLEIN,  M.D. 

Manager;  A.  G.  HUGHES 
Route  2,  Box  365,  Kirkland 
Phone:  Kirkland  2391 


SOME  of  the  exclusive  features  of  this 
new  Vacuum  Tube  Hearing  Aid  are: 
Sealed  Crystal  Microphone — gives  same 
dependable  service  under  all  conditions  of 
temperature  and  humidity.  Stabilized  Feed- 
back — amplification  without  distortion. 
No  sudden  blast  from  loud  sounds  when 
volume  is  turned  up. 

For  othor  iniormation  writ*  or  ccdl 

M.  F.  Taylor  Laboratories 

721  Republic  Building 
MAin  1920  Denver,  Colo. 


SERVICE 

QUALITY 

PAUL  WEISS 

PRESCRIPTION 

OPTICIAN 

1620  ARAPAHOE  ST.  DENVER 

MAin  1722 

WESTERN  ELECTRIC 

HEARING  AIDS 

Engineered  by  Bell  Telephone  Laboratories 


Winning  Health 

in  the 

Pikes  Peak  Region 


COLORADO  SPRINGS 


Inquiries  Solicited 


GLOCKNER  PENTROSE  HOSPITAL 

Sisters  of  Charity 

HOME  OF  MODERN  SANATORIA 


338 


Rocky  Mountain  Medical  Journal 


1- 


WAR  SURPLUS  SAVES  YOU  $$$ 

X-RAY  — VICTOR  MODEL  3580 

Complete  with  stainless  steel  table,  Bucky  and  Fluoro- 

scope  screen.  Used,  good  condition $375.00 

Bi-Plane  Markers  and  Reorientation  Device 

For  locating  foreign  objects  in  the  body.  Brand 
new,  in  individual  cases.  Cost  the  government 

$1295.00  each.  Our  price  only $95.00  each 

Zimmer’s,  Enclosed  Oxygen  Tents  (Ice  Type) 

Used,  good  condition  $57.50  each 

Instrument  Sterilizers,  Electric 

Manufactured  by  Peiten,  American,  Castle, 

complete  with  trays.  Used,  good  condition. .$27. 50  to  $35.00  ea. 


Autoclaves,  New 

Gasoline  burning,  1 6"x32" $75.00  each 

Cabinets,  White  Instrument  With  Glass  Panels 

5'  high,  3'  wide,  1 8"  deep,  used,  good $22.50  each 

New  Stokes  Litters,  $5.00  each 

Few  folding  canvas  litters  for  your  car. 

Make  a good  camp  cot $1.95  each 


For  the  hospital.  New  bed  pan  sterilizers,  $22.50.  Drinkwoter  food  carts,  $75.00  complete 
with  boxes.  New  army  36"  Hospital  cots,  $4.75;  complete  with  renovated  inner-spring  mat- 
tress, $12.95,  2 for  $25.00.  New  four-drawer,  letter  size,  steel  filing  cabinets,  $35.00  each. 
Splints,  iodine  swabs,  etc.,  at  less  than  Vz  price. 

SAXON  DISTRIBUTING  COMPANY 

46th  at  Franklin  St.  Telephone  AComa  5926  Denver  16,  Colo. 


LIVERMORE  SANITARIUM 


• The  Hydropathic  Department 
devoted  to  the  treatment  of  gen- 
eral diseases,  excluding  surgical 
and  acute  infectious  cases.  Special 
attention  given  functional  and  or- 
ganic nervous  diseases.  A well 
equipped  clinical  laboratory  and 
modern  X-ray  Department  are  in 
use  for  diagnosis. 


• The  Cottage  Department  (for 
mental  patients)  has  its  own  fa- 
cilities for  hydropathic  and  other 
treatments.  It  consists  of  small 
cottages  with  homelike  surround- 
ings, permitting  the  segregation  of 
patients  in  accordance  with  the 
type  of  psychosis.  Also  bungalows 
for  individual  patients,  offering 
the  highest  class  of  accommoda- 
tions with  privacy  and  comfort. 


1.  Climatic  advantages  not  excelled  in  United  States.  Beautiful  grounds  and  attractive  surrounding  country. 

2.  Indoor  and  outdoor  gymnastics  under  the  charge  of  an  athletic  director.  An  excellent  Occupational  Department. 

3.  A resident  medical  staff.  A large  and  well-trained  nursing  staff  so  that  each  patient  is  given  careful  individual  attention. 

Information  and  circulars  upon  request.  CITY  OFFICES : 

Address:  O.  B.  JENSEN,  M.D. 

Superintendent  and  Medical  Director  San  Francisco  Oakland 

Livermore,  California  450  Sutter  Street  1624  Franklin  Street 

Telephone  313  GArfield  1-5040  GLencourt  1-5988 


for  April,  1949 


339 


REAGENTS-MADE  TO  ORDER 

STAINS  (Liquid  or  Dry)  — STANDARD  SOLUTIONS 
REAGENTS  FOR  ALL  TYPES  OF  COLORIMETERS 
INDICATORS  — SPECIAL  SOLUTIONS 

With  our  competent  laboratory  staff,  we  stand  ready  to  offer  you  the  best 
solutions  obtainable  in  the  Rocky  Mountain  Region. 

Materials  prepared  in  our  laboratory  are  quality  controlled.  They  are 
being  checked  independently  and  periodically. 

Order  with  confidence,  order  from: 

Tbe  Denver  FireCiayCompany 

DENVER  COLO.U.&A. 


I 


WANT  ADS 


FOR  SAL.E1 — Beck  tonsil  snare,  suction  machine, 
portable  suction  machine,  Burdick  rhythmic  os- 
cillator, emesis  basins,  Jos.  Leiter  laryngoscope, 
sinus  transillumnator,  etc.  Mrs.  F.  N.  McHugh, 
669  Ninth  Ave.,  Salt  Lake  City  3,  Utah. 


YOUNG,  well-trained  general  practitioner  desires 
position  with  older  physician  in  Colorado.  Avail- 
able July  1,  1949.  Call  Dr.  D.  H.  Werner,  TAbor 
1331. 


FOR  SALE 

maternity  hospital  building  and  equip- 
ment. The  only  private  maternity  hospital  in 
Denver  and  surrounding  area  under  the  same 
management  for  24  years.  Ideal  for  single  pur- 
chaser or  group  of  doctors.  Purpose  can  be  al- 
tered to  meet  your  needs.  Can,  be  sold  on  liberal 
terms.  Write  for  brochure.  V.  J.  DUNTON  REAL- 
TY CO..  402  Midland  Savings  Building,  Denver. 


YOUNG,  well-trained  general  practitioner  desires  i 
position  with  older  physician  in  Colorado.  Will  : 
be  available  July  1,  1949.  Call  Dr.  G.  W.  Lockwood,  , 
TAbor  1331. 


COLVm-Medical  Books  I 

Medical  Publications  of  All  Publishers  ' 

Books  Sent  for  Examination  on  Request 
We  Maintain  This  Book  Store  for  Your  Convenience 
Books  Make  Fine  Christmas  Gifts 

Write  or  Come  to  -i 

705-706  MAJESTIC  BUILDING 

Denver  2,  Colorado  Call  MAin  3866 


The  Fairhaven  Maternity  Hospital 

Mrs.  H.  E.  Lowther,  Superintendent 

Seclusion  for  the  unwed  mother.  Write  for  descriptive  booklet. 

1349  JOSEPHINE  EAst  9944  DENVER 


Rocky  Mountain  Medical  Journal  '»■ 


340 


MR.  BRUNCHER  IS  A 


ONUT-MUNCHER 


7^ 


Skip  breakfast?  Not  Bruncher. 

Not  if  you  consider  coffee-and  at  10  a.m. 
as  breakfast,  that  is.  Of  course,  this  kills  his 
appetite  for  lunch,  but  he  can  always  make 
that  up  by  an  afternoon  visit  to  the  cruller  counter, 
which  kills  his  appetite  for  dinner  . . . 

And  thus  does  Bruncher  meal-skimp  his 
way  to  a subclinical  vitamin  deficiency. 

Your  own  experience  with 
these  half-sick,  half-well  cases 
indicates  that  the  first  and  wisest 
move  is  dietary  reform.  And  isn't  it 
also  wise  to  prescribe,  addition- 
ally, a vitamin  supplement 
— to  assure  adequate 
intake  just  in  case  a 
patient  strays  from 
the  prescribed  diet? 

For  your  prescrib- 
ing convenience, 
there’s  an  Abbott  vita- 
min product  to  answer  nearly  every  vitamin  need — 

for  supplementary  or  therapeutic  levels  of  dosage,  for  oral  or  parenteral 

administration.  All  are  rigidly  standardized  to  conform  with  label  listings. 
SPECIFY  They  are  available  at  pharmacies  everywhere. 

ABBOTT  LABORATORIES,  North  Chicago,  Illinois. 


ABBOTT  \ ITAMIN  PRODUCTS 


for  April,  1949 


PHYSICAL 

REHABILITATION 


TREATMENT 


4 


SOCIAL 

REHABILITATION  ii'' 


Eog'o'^'i  26,  '948- 

*?3t33" -333^^^9. 


RECOGNIZED 


BY  THE 

c^TM 

MEMBER  OF 

M 


Specialists  in  Therapy  for 

CHRONIC  ALCOHOLISM 

By  the  Conditioned  Reflex  and  Adiuvant  Methods 

7106  35th  AVE.  S.W.,  SEATTLE  6,  WASH..WEst  7232 
Coble  Address:  REFLEX 


342 


Rocky  Mountain  Medical  Journal 


Index  to  Advertisers 

Page  Page 


Abbott  Laboratories  341 

Alba  Dairy 327 

American  Medical  and  Dental 
Association  272 

Ayerst,  McKenna  & Harrison_321 

Baker  Laboratories  344 

Baxter,  Don 

Insert  Between  336-337 

Bonita  Pharmacy  332 

Bonnie-Brae  Drug  334 

Borden  Co., 

Insert  Between  320-321 

Brown  Schools  326 

Cambridge  Dairy  268 

Camel  Cigarette 269 

Camp  & Co.,  S.  H. . 319 

Capital  Chevrolet 268 

Capitol  Life  Insurance  Co. 330 

Cascade  Laundry 328 

Children’s  Hospital 

Association  336 

City  Park  Dairy 274 

Cleveland  Pharmacy 335 

Colburn  Hotel  328 

Coleman  & Bell 330 

Colorado  Springs 

Psychopathic  Hospital 329 

Colvin  Medical  Books 340 

Cook  County  Graduate 

School  of  Medicine 332 

Corbin’s,  Ed  Drug  Store 328 

Country  Club  Pharmacy 334 

Cutter  Laboratories ^ 313 

Dansberry’s  Pharmacy - 335 

De'ep  Rock  Water 327 

Denver  Fire  Clay  Co 340 

Denver  Oxygen  Co 276 

Denver  Surgical  Supply  Co 327 

Dorr  Optical  Co 278 

Downing  Street  Pharmacy 335 

■Doyle’s  Pharmacy 334 


Earnest  Drug'  Co 334 

Ehret  Engraving  Co 276 

Everest  & Jennings 330 

Fairfax  Sanitarium  337 

Faihaven  Maternity 

Hospital  - 340 

Fleet,  C.  B.  & Co.,  Inc 275 

Franklin  Drug  Co 335 

Garden  Grove 

Sanitarium Cover  III 

Glockner  Penrose  Hospital 338 

Hatch  Pharmacy  334 

Hyde’s  Pharmacy  334 

Jackson’s  Cut  Rate  Drug 328 

Julius  Schmid,  Inc.  333 

Karg  Paint  Co 328 

Kendrick-Bellamy  Co.  266 

Kremers-TJrban  Co. 323 

Lakewood  Pharmacy  355 

Lilly,  Ell  & Co. 

Insert  between 280-281 

Livermore  Sanitarium  339 

Luzier’s  325 

Mead,  Johnson  & Co .Cover  IV 

Medical  Center  Pharmacy 326 

Morning  Milk : 337 

Newton  Optical  Co, 328 

Nurses  Official  Registry_i_^- 3 26 

Otto  Drug  CO 334 

Overstake’s  Pharmacy  335 

Park  Floral  Co 276 

Parke,  Davis  & Co. -Cover  11-265 

Pfab  Pharmacy 334 

Physicians  and  Surgeons 

Supply  332 

Physicians  and  Shrgeons 

Telephone  Service  Exch 328 

Physicians  Casualty 

Association  - 330 

Plaza  Hotel 332 


Page 


Professional  Pharmacy 335 

Restaurant  240  328 

Roche  Ambulance  Service 327 

Rockmont  Envelope  Co. 329 

Roedel’s  Prescription  Drug 332 

Scherlng  Corporation 271 

Searle  & Co.,  G.  D 311 

Shadel  Sanitarium  342 

Shaford-Fletcher  Optical  Co._274 

Shumake  Drug,  Guido 334 

iSmith  Dorsey  Co 315 

Statesman  Press,  The ^_322 

StodghiU’s  Imperial 

Pharmacy 274 

Squibb,  E.  R.  & Sons 273 

Technical  Equipment 

Corporation  331 

Telephone  Answering 

Service  268 

Thornton,  George  R 266 

United  States  Brewing 

Industry  324 

Upjohn  Co.,  the 279 

Van’s  Pharmacy 335 

Van  Schaack  & Co 337 

Walters  Drug  Store 335 

Wander  Co.  280 

Weiss  Drug 335 

Weiss,  Paul 338 

Western  Electric 

Hearing  Aids  338 

Western  Newspaper  Union 332 

Wheatridge  Farm  Dairy 328 

White  Laboratories 

Insert  Between  272-273 

Whittaker’s  Pharmacy 334 

Wlnthrop-Stearns,  Inc 267 

Woodcroft  Hospital 336 

Wyeth,  Inc.  277 

York  Pharmacy 327 


jor  April,  1949 


343 


vigorous  Growth  in  Infants 
when  doctors  prescribe 

BAKER’S 
MODIFIED 
MILK 

brings  fast-growing 
use  of 


# POWDER 

Start  with  either  and 
change  from  one  to  the 
other,  to  meet  individual 
requirements. 

^ LIQUID 


this  highly  nutritious  bottle-feeding  diet 


BAKER’S  Modified  Mdk  contiaues  to  grow 
in  favor  among  doctors  who  prescribe  it, 
because  it  contains  the  essentials  which  any 
physician  woidd  want  to  include  in  a com- 
plete formula  for  infant  feeding  . . . because  it 
is  well  tolerated  by  both  prematm-e  and  full- 
term  infants  . . . because  it  closely  conforms 


to  human  milk  . . . because  it  may  be  used 
either  complemental  to  or  in  place  of  human 
milk  . . . because  for  the  normal  healthy  baby 
it  requires  no  changing  of  formula  (except 
an  increase  in  quantity)  as  the  baby  grows 
older.  Complete  information  and  samples 
will  be  mailed  on  request. 


BAKER’S  MODIFIED  MILK 


THE  BAKER  lABORATORIES  INC.  Cleveland,  Ohio 


'’'^foicITP 


344 


Rocky  Mountain  Medical  Journal 


This  baby’s  mother  learned 
about  Mead’s  Oleum  Percomor' 
phum  from  her  physician,  not  from 
public  advertising  or  displays. 

"Servamus  Fidem” 


HOW  mu(h  sun  does 
the  infant  really  get? 


Not  very  much:  (l)  When  the  baby  is  bun- 
dled to  protect  against  weather  or  (2)  when 
shaded  to  protect  against  glare  or  (3)  when 
the  sun  does  not  shine  for  days  at  a time. 
Mead’s  Oleum  Percomorphum  is  a pro- 
phylactic against  rickets  available  365j 
days  in  the  year,  in  measurable  potency  and 
in  controllable  dosage.  Use  the  sun,  too. 


Mead  Johnson  & Co.,  Evansville,  Ind.,  ll.S.A 


A Psychiatrist  Looks  at  Compulsory  Health  In- 
surance— Franklin  G.  Ebaugh,  M.D.,  Denver. 

Trauma  as  Alleged  Cause  of  Appendicitis  in 
Compensation  Cases — Harold  Clark  Thompson, 
L.L.B.,  Denver. 

Prolonged  Labor — Edwin  J.  DeCosta,  M.D.,  Chi- 
cago. 

Fluid,  Electrolyte  and  Protein  Balance  in  the 
Surgical  Patient — C.  L.  Holmes,  M.D.,  Butte, 
Montana. 

Montana  House  of  Delegates — Minutes  of  the 
Interim  Meeting. 

(For  complete  Table  of  Contents 
turn  the  first  page) 


25c  Per  Copy 


$2.50  Per  Year 


with  BENADR^ 


Contact  of  a sensitized  body  cell  with  an  allergen  and 
■i;  subsequent  release  of  histamine  is  considered  to  be  the 

J mechanism  of  allergic  disorders. 

\ 

> Blocking  the  action  of  histamine,  BENADRYL  prevents  reaction 

in  cells  that  have  been  sensitized.  Relief  of  symptoms  is 
I ■ gratifyingly  rapid,  usually  occurring  within  an  hour  or 

two  after  the  first  dose.  And  treatment  with  BENADRYL 
is  simple,  convenient,  and  iiiexpensive. 

BENADRYB 

I ' BENADRYL  has  been  found  highly  effective  in  a wide  variety  of 

I allergic  states,  ranging  from  seasonal,  such  as  hay  fever,  to 

i;  the  non-seasonal,  such  as  acute  and  chronic  urticaria,  angioneurotic 

f edema,  vasomotor  rhinitis,  contact  dermatitis,  erythema  multiforme, 
pruritic  dermatoses,  dermographism,  serum  sickness,  food  allergy, 
I and  sensitization  to  drugs,  such  as  penicillin  and  the  sulfonamides. 

BENADRYL  hydrochloride  (diphenhydramine  hydrochloride,  Parke-Davis)  is  available 
r in  a variety  of  forms  to  facilitate  individualized  dosage  and  flexibility  of 

i'  administration,  including  Kapseals®,  Capsules  and  a palatable  Elixir. 

The  usual  dosage  of  BENADRYL-is  25  to  50  mg.  repeated  as  required.  Children  up 
|s  » to  12  years  of  age  may  be  given  1 to  2 teaspoonsful  of  Elixir  Benadryl. 


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• PROTECTS  FLOORS,  CARPETS 

• COVERS  WORN  SPOTS 


Heavy  fibre  Vi-inch  thick. 
Edges  finished,  rounded. 


STATIONERY  CO.  W 


KEystone  0241 

1641  California  Sf.  Denver  2,  Colorado 


Qeo-.  R.. 

Orthopedic  Brace 
and  Appliance  Co. 

1628  Court  Place  MAin  3026 

Write  for  Measuring  Chart 


Table  of  Contents 

VOLUME  46  NUMBER  5 


MAY,  1949 


Editorials 

Clear  Speaking  Better  Than  Debates 361 

Indemnity  Plans  362 

Silhouettes  From  the  A.M.A.  House  of 
Delegates 363 


Original  Articles 

A Psychiatrist  Looks  at  Compulsory  Health 
Insurance,  Franklin  G.  Ebaugh,  M.D 364 

Trauma  as  Alleged  Cause  of  Appendicitis 
in  Compensation  Cases,  Harold  Clark 
.Thompson,  L.L.B’ 367 

Prolonged  Labor,  Edwin  J.  DeCosta,  M.D...  371 

Fluid,  Electrolyte  and  Protein  Balance  in 
the  Surgical  Patient,  C.  D.  Holmes,  M.D...  377 


-t- 


Organization 

National 

Presidents  to  Meet  in  Atlantic  City 384 

Colorado 

Sixty  Attend  Cancer  Conference 384 

Component  Societies  384 

Obituaries  386 

Auxiliary 386 

List  of  Component  Society  Officers 388 

New  Mexico 

Joint  Meeting  With  Cancer  Society 390 

Utah 

Auxiliary 390 

Colorado  State  Health  Department  | 

Routine  Prophylactic  Treatment  of  New- 
borns’ Eyes  390 

Medical  School,  Colorado 
Trudeau  Course  in  Chest  Diseases 390 

Montana  ^ 

Minutes  of  the  Interim  Meeting 392  * 

Tuberculosis  Abstract  406 

Book  Corner 408 


346 


Rocky  Mountain  Medical  Journal 


Paiticulaily  in 
obstetiics,  the  power 
of  DEMEROL 
hydrochloride 
to  allay  pain,  usually 
without  depressing 
respiration  or 
endangering  mother 
or  child,  is  of  the 
highest  order 
of  significance. 
DEMEROL 
hydrochloride 
is  a specific  for  pain. 

Average  adult  dose: 
100  mg. 

Ampuls  of  2 cc. 

(100  mg.);  vials  of 
30  cc.  (50  mg./cc.); 
tablets  of  50  mg. 
and  100  mg. 

Winthrop-Steorns  Inc. 
New  York  13,  N.  Y. 
Windsor,  Ont. 


DEMEROL 

HYDROCHLORIDE 


Demerol,  trodemark  reg.  U.  S.  & Canoda,  brand  of  meperidine  (($onipe«aine)  hydrochloride.. 


WARNING:  May  be  habit  forming. 
Narcotic  blank  required. 


for  May,  1949 


347 


ROCKY  MOUNTAIN  MEDICAL  JOURNAL 

Title  Registered,  U.S.  Patent  Office 


Publication  Office: 

835  Republic  Building  (1612  Tremont  Place),  Denver  2,  Colorado 
Telephone  CHerry  5521. 

EDITORIAL  BOARD 

Colorado:  Douglas  W.  Macomber,  M.D.,  Scientific  Editor,  1820  Gilpin  St.,  Denver;  Lyman  W.  Mason, 
M.D.,  Associate  Editor,  1214  Republic  Bldg.,  Denver,  (Chairman  of  Editorial  Board). 

Montana:  Raymond  F.  Peterson,  M.D.,  Scientific  Editor,  Butte,  Mont.;  Herbert  T.  Caraway,  M.D., 
Associate  Editor,  Billings,  Mont. 

New  Mexico:  Carl  H.  Gellenthein,  M.D.,  Scientific  Editor,  Valmora,  New  Mexico;  Harold  L.  Janu- 
ary, M.D.,  Associate  Editor,  First  National  Bank  Bldg.,  Albuquerque,  New  Mexico. 

Utah:  Richard  P.  Middleton,  M.D.,  Scientific  Editor,  Boston  Bldg.,  Salt  Lake  City;  W.  H.  Tibbals, 
Associate  Editor,  42  South  Fifth  East  St.,  Salt  Lake  City. 

Wyoming:  Earl  Whedon,  M.D.,  Scientific  Editor,  Sheridan;  Arthur  R.  Abbey,  Associate  Editor,  P.O. 
Box  897,  Cheyenne. 

I L.l  

Managing  Editor:  Harvey  T.  Sethman,  835  Republic  Bldg.,  Denver. 

Business  Manager:  Helen  Kearney,  835  Republic  Bldg.,  Denver. 


Ownership  and  Sponsorship;  The  Kocky  Mountain 
Medical  Journal  Is  owned  by  the  Colorado  State 
Medical  Society  and  is  published  monthly  as  a non- 
profit enterprise  for  the  mutual  benefit  of  the  or- 
ganizations which  Jointly  sponsor  it.  It  is  published 
under  the  direction  of  the  Board  of  Trustees  of  the 
Colorado  State  Medical  Society,  assisted  by  an  Edi- 
torial Board  representing  the  sponsoring  organiza- 
tions. It  is  the  Official  Journal  of  the  Colorado  State 
Medical  Society,  the  Montana  State  Medical  Associa- 
tion, the  New  Mexico  Medical  Society,  the  Utah 
State  Medical  Association,  the  Wyoming  State  Medi- 
cal Society,  the  Rocky  Mountain  Medical  Conference, 
and  the  Colorado  Hospital  Association. 

Manuscripts;  Scientific  Articles,  Case  Reports,  etc., 
from  any  state  for  which  this  is  the  Official  Journal 
should  be  submitted  to  the  Scientific  Editor  for  that 
state  as  named  in  the  Editorial  Board,  above.  Other 
material  from  any  participating  state  should  be  sub- 
mitted to  the  Associate  Editor  for  that  state  as 
named  above.  Manuscripts  from  outside  the  Rocky 
Mountain  area  should  be  sent  direct  to  the  Journal 
office.  Manuscripts  must  be  typewritten,  double  or 
triple  spaced,  using  only  one  side  of  each  sheet.  It 
is  the  policy  of  this  Journal  to  omit  bibliographies. 


Advertising;  National  representatives;  The  Coop- 
erative Medical  Advertising  Bureau,  535  North  Dear- 
born Street,  Chicago  10,  111.  Local  advertising  from 
firms  in  the  Rocky  Mountain  area  should  be  submit- 
ted to  the  Associate  Editor  of  the  appropriate  state 
or  to  the  Journal  office.  Advertising  forms  close  on 
the  20th  of  the  month  preceding  publication;  allow 
ten  days  additional  to  insure  submitting  proofs  for 
approval. 

Subscription;  $2.50  per  year  in  advance,  postpaid  in 
the  United  States  and  its  possessions;  single  copy, 
25  cents  plus  postage.  Subscription  is  included  in 
medical  society  dues  of  sponsoring  state  medical 
organizations. 

Copyright;  This  Journal  is  copyright,  1949,  by  the 
Colorado  State  Medical  Society.  Requests  for  permis- 
sion to  reproduce  anything  from  the  columns  of  this 
Journal  should  be  addressed  to  the  Journal  office. 

Seconil  Class  Matter:  Entered  as  second  class  mat- 
ter Jan.  22,  1906,  at  the  Postoffice  at  Denver,  Colo., 
under  the  Act  of  Congress  of  March  3,  1879.  Accepted 
for  mailing  at  special  rates  of  postage  provided  for 
in  Section  1103,  Act  of  Oct.  3,  1917;  authorized  July 
17,  1918. 


The  Fairhaven  Maternity  Hospital 

Mrs.  H.  E.  Lowther,  Superintendent 

Seclusion  for  the  unwed  mother.  Write  for  descriptive  booklet. 

1349  JOSEPHINE  EAst  9944  DENVER 


Don't  miss  important  telephone  calls 

Let  us  act  as  your  secretary  while  you  are  away,  day  or  night: 
our  kindly  voice  conscientiously  tends  your  telephone  business, 
accurately  reports  to  you  when  you  return. 

Telephone  ANSWERING  Service  call  ALpine  mm 


Cambridge  Dairy  Grade '“A”  Milk  Is  Produced  and  Processed  at  690  S.  Colo.  Blvd. 

We  do  not  handle  Shipped-in  Milk  produced  Where?  How  and  by  Whom?  Doctors  know  the  difference 
Now  Homogenized  Vitamin  D Milk  is  available  for  baby  feeding  and  family  use. 

We  Invite  Your  In>spection  and  Appreciate  Your  Recommendation. 


Here’s  what  throat  specialists 


reported  about  Camel  Mildness 


any  ^ 

mUdest  cigarette 

age  with  the  nn 

purchase 
Tobacco  Comr 


According  to  a Ahtionmde  suro^'. 

More  Doctors  smoke  Camels 


Doctors  smoke  for  pleasure,  too!  And  when 
three  leading  independent  research  organiza- 
tions asked  113,597  doctors  what  cigarette 
they  smoked,  the  brand  named  most  was  Camel  I 


than  any  other  cigarette 


for  May,  1949 


349 


THE  COLORADO  STATE  MEDICAL  SOCIETY 


Next  Annual  Session:  Shirley-Savoy  Hotel,  Denver;  Sept.  20,  21,  22,  23,  194» 


OFFICERS 

Terms  of  Officers  and  Committees  expire  at  tbe  Annual  Session 
in  tbe  year  indicated.  Where  no  year  Is  indicated,  tbe  term 
is  for  one  year  only  and  expires  at  tbe  1949  Annual  Session. 

President;  Casper  F.  Hegner,  Denver. 

President-elect:  Fred  A.  Humphrey,  Fort  Collins. 

Vice  President:  Lester  L.  Ward,  Pueblo. 

Constltotlonal  Secretary  (three  years):  George  B.  Buck,  Denrer,  1951. 
Treasurer  (three  years) : George  C.  Shivers,  Colorado  Springs,  1950. 

Additional  Trustees  (three  years):  Ervin  A.  Hinds,  Denver,  1949;  E.  H. 
Munro,  Grand  Jurction,  1949;  S.  P.  Newman,  Denver,  1950;  Claude  D. 
Bonham,  Boulder,  1951. 

(The  above  nine  officers  compose  the  Board  of  Trustees  of  which  Dr. 
Ervin  A.  Binds  is  the  1948-1949  Chairman.) 

Board  of  Cooncllors  (three  years):  District  No.  1:  Clemens  F.  Eakins, 
Brush,  1951;  No.  2:  Ella  A.  Mead,  Greeley,  1951;  No.  3:  L.  G.  Crosby, 
Denver,  1951;  No.  4:  Lanning  E.  Likes,  Lamar,  1950;  No.  5:  Guy  H. 
Hopkins,  Pueblo,  1950;  No.  6:  Lester  E.  Thompson,  Sallda,  1950;  No.  7: 
A.  L.  Burnett,  Durango,  1949;  No.  8:  Lawrence  L.  Hick,  Delta,  1949; 
No.  9:  W.  W.  Sloan.  Hayden,  1949  (Chairman  of  Board  for  1948-49). 

Board  of  Sopervlson  (two  years) : A.  B.  GjeUum,  Del  Norte,  1949;  L.  W. 
Lloyd,  Dnrango,  1949;  B.  G.  Hewlett,  Golden,  1949;  Scott  A.  Gale, 
Pneblo,  1949;  L.  D.  Dickey,  Fort  Collins,  1949;  N.  A.  Hadler,  Greeley, 
1949  (Chairman  of  Board  for  1948-49);  L.  D.  Buchanan,  Wray,  1950; 
W.  F.  Deal,  Oalg,  1950;  G.  C.  Cary,  Grand  Junction,  1950;  W.  A. 
CampbeU,  Colorado  Springs,  1950;  Balpb  S.  Johnston,  Sr.,  La  Junta, 
1950;  William  A.  Liggett,  Denver,  1950,  Secretary. 

Delegates  to  American  Medical  Association  (two  years) : George  A.  Dnfug, 
Pueblo,  1949  (Alternate:  Herman  C.  Graves,  Grand  Junction,  1949); 
William  H.  Halley.  Denver,  1960  (Alternate:  Kenneth  C.  Sawyer,  Denver, 
1950). 

Foundatios  Advocate;  Walter  W.  King,  Demr. 

Executive  Office  Staff:  Mr.  Harvey  T.  Setbman,  Executive  Secretary; 
Miss  Helen  Kearney,  Assistant  Executive  Secretary;  Mr.  Evan  A.  Edwards, 
Field  Secretary:  Miss  Mary  E.  McDonald,  Committee  Secretary;  835  Be- 
pnbllc  Building,  Denver  2,  Colo.,  Telephone  CBerty  5521. 

General  Counsel:  Mr.  J.  Peter  Nordlund,  Attomey-at-Law,  Denver. 

STANDING  COMMITTEES 

Credentials:  George  R.  Buck,  Denver,  Chairman,  ex-officio;  Harold  E. 
Haymond,  Greeley;  E.  C.  Likes,  Lamar;  Scott  A.  Gale,  Pueblo;  J.  L. 
McDonald,  Colorado  Springs. 

Pobllc  Policy:  Kenneth  C.  Sawyer,  Denver,  Chairman;  McKinnie  L. 
Phelps,  Denver,  Vice  Chairman;  John  S.  Bouslog,  Denver;  F.  B.  Calhoun, 

Denver;  Frank  E.  McGIone,  Denver;  Lloyd  Anderson,  Sterling;  Sidney  An- 
derson, Alamosa;  Bicbard  L.  Davis,  La  Junta;  Herman  C.  Graves,  Grand 
Junction;  John  L.  McDonald,  Colorado  Springs:  George  E.  Bice,  Pueblo; 
Duane  Hartshorn,  Fort  Collins;  John  D.  Gillaspie,  Boulder.  Ex-Officio 
members:  Casper  F.  Hegner,  President;  Fred  A.  Humphrey,  President-elect: 
George  E.  Buck,  Constitutional  Secretary. 

Sub-Committee  on  Legislation:  H.  I.  Barnard,  Denver,  Chairman. 

Health  Education  (two  years):  A.  C.  Sudan,  Denver,  Chairman,  1949: 

J.  D.  Bartholomew,  Boulder,  1949;  B.  J.  Savage,  Denver,  1949;  B.  T. 
Porter,  Greeley,  1949;  Robert  B.  Bradshaw,  Alamosa,  1949;  L.  W.  Bortree, 
Colorado  Springs,  1950;  F.  0.  Robertson,  Denver,  1950.;  J.  L.  Sadler,  Fort 
CoUins,  1950;  Harold  T.  Low,  Pueblo,  1950;  John  H.  Amesse,  Denver, 
1950:  E.  H.  Munro,  Grand  Junction.  1950. 

Scientific  Work:  W.  B.  Condon,  Denver,  Chairman;  Robert  S.  Liggett, 
Karl  F.  Arndt,  Frank  T.  Joyce.  MarshaU  G.  Nims,  Vincent  G.  Cedar- 
blade,  aU  of  Denver. 

Sub-Committee  on  Scientific  Exhibits;  Frank  C.  CampbeU,  Chairman; 
Nglle  Mumey,  Edgar  W.  Barber,  B.  W.  Vines,  all  of  Denver. 

Arrangements:  To  be  appointed. 

Medicolegal  (two  years):  R.  W.  Arndt,  1960,  Chairman;  George  B. 
Packard,  Jr.,  1950;  K.  D.  A.  Allen,  1950.;  C.  S.  Bluemel,  1949;  Lyman 
W.  Mason,  1949;  Harry  C.  Hughes,  1949;  all  of  Denver. 

Medical  Education  and  Hospitals;  George  F.  Wollgast,  Denver,  Chairman; 
W.  W.  Sloan,  Hayden;  F.  R.  Plngrey,  Durango;  E.  B.  Mugrage,  Denver; 
D.  W.  McCarty,  Longmont;  A.  E.  Lubchenco,  Denver. 

Library  and  Medical  Literature:  A.  J.  Markley,  Denver,  Chairman;  T.  E. 
Beyer,  Denver;  J.  J.  Connor.  Delta;  H.  Dumont  Clark,  Denver. 

Medical  Service  Plans;  F.  H.  Good,  Denver,  Chairman;  C.  E.  Honsteln, 
Fort  CoUlns;  James  B.  Blair,  Denver;  Vernon  L.  Bolton.  Colorado  Springs; 
Scott  A.  Gale,  Pueblo;  John  A.  Weaver,  Jr.,  Greeley;  John  E.  Hyland, 
Monte  Vista;  Thomas  K.  Mahan,  Grand  Junction. 

Necrology:  W.  H.  Wilson,  Denver,  Chairman. 

PUBLIC  HEALTH  COMMITTEES 

General  Committee  on  Public  Health:  Consists  of  the  chairmen  of  tbe 
following  eleven  public  health  subcommittees,  presided  over  by  Robert  W. 
Dickson,  Denver,  as  General  Chairman. 

Cancer  Control:  J.  C.  Mendenhall,  Denver,  Chairman;  John  B.  Grow, 
Denver;  S.  W.  HoUey,  Greeley;  T.  Leon  Howard,  Denver;  James  B.  Mc- 
Naugbt,  Denver;  Roger  G.  Hewlett,  Golden;  James  W.  McMuUen,  Colorado 
Springs;  James  E.  Donnelly,  Trinidad:  Lanning  E.  Likes,  Lamar;  Thomas 

K.  Mahan,  Grand  Junction. 


Crippled  Children:  I.  E.  Hendryson,  Denver,  Chairman;  Mary  L.  Moore, 
Grand  Junction;  Blchard  H.  MeUen,  Colorado  Springs;  Sidney  E.  Bland- 
ford,  Jr.,  Denver;  Paul  R.  Hildebrand,  Brush;  Samuel  P.  Newman,  Denver. 

Industrial  Health:  R.  F.  Bell.  Louviers.  Chairman;  A.  R.  Woodbume, 
Denver:  Vincent  E.  Kelly.  LeadvlUe;  D.  W.  Boyer,  Pueblo:  H.  G.  Harvey,  Jr., 
Denver;  Robert  Woodruff,  Denver;  Frank  J.  McDonough,  Grand  Junction. 

Local  Health  Units:  Monroe  R.  Tyler,  Denver,  Chairman;  Harold  E. 
Haymond.  Greeley:  R.  B.  Richards.  Fort  Morgan:  Nicholas  S.  SaUba,  Wal- 
senburg;  Marvel  L.  Crawford,  Steamboat  Springs:  R.  Sherwln  Johnston,  Jr., 
La  Junta. 

Maternal  and  Child  Health:  John  R.  Evans,  Denver,  Chairman;  Joseph 
H.  Lyday,  Denver;  John  M.  Nelson,  Denver;  Tracy  D.  Peppers.  Greeley; 
J.  H.  Woodbrldge,  Pueblo;  M.  E.  Snyder,  Colorado  Springs. 

Mental  Hygiene:  Bradford  Murphey,  Denver,  Chairman;  E.  James  Brady, 
Colorado  Springs;  Frank  H.  Zimmerman,  Pueblo;  Paul  A.  Draper,  Colorado 
Springs:  J.  P.  Hilton,  C.  S.  Bluemel,  John  M.  Lyon,  G.  H.  Ashley,  Lewis 
C.  Overholt,  Clarke  H.  Barnacle,  Harold  R.  Carter,  all  of  Denver. 

Milk  Control:  George  W.  Stiles,  Denver.  Chairman;  Max  M.  CUnsburg, 
Denver;  N.  J.  Miller.  D.V.M.,  Eaton;  Millard  F.  Schafer,  Colorado  Springs; 
Robert  W.  Vines,  Denver:  Mr.  Wendell  Vincent,  Denver. 

New  Hospital  Construction;  D.  R.  ColUer,  Wheatrldge,  Chairman; 
Henry  M.  Powell,  Colorado  Springs;  Mr.  John  R.  Peterson,  Fort  Collins; 
Florence  R.  Sabin,  Denver:  Herbert  A.  Black,  Pueblo. 

Public  Water  Supplies:  E.  I.  Dobos,  Denver,  Chairman;  Robert  Barnard. 
Eagle:  WilUam  C.  Shontz,  San  Luis;  Carl  W.  Maynard,  Pueblo;  W.  B. 
Crouch,  Colorado  Springs:  H.  D.  Palmer,  Denver;  B.  Robert  Orr.  Frulta. 

Tuberculosis  Control:  John  I.  Zarlt,  Denver,  Chairman;  W.  J.  Hlniel- 
man,  Greeley;  H.  M.  Van  Der  Schouw,  Wheatrldge;  John  P.  McGraw,  Pueblo: 
Arthur  Rest,  Denver;  H.  Calvin  Fisher,  Denver;  T.  D.  Cunningham,  Denver. 

Venereal  Disease  Control:  Sam  W.  Downing,  Denver,  Chairman;  Paul  B. 
Stidham,  Grand  Junction;  H.  E.  Coakley,  Pueblo;  D.  E.  Newland,  Denver; 
Joseph  H.  Patterson,  Denver,  James  R.  McDoweU,  Denver. 


SPECIAL  COMMITTTES 

Rocky  Mountain  Medical  Conference  (five  yean) : L.  Clark  Hepp,  Denver, 
1953;  G.  P.  Llngenfelter,  Denver,  1952,  Chairman;  Ward  Darley,  Denver, 
1951;  L.  W.  Bortree,  Colorado  Springs.  I960:  George  H.  Gillen.  Denver, 
1949. 


Advisory  to  Auxiliary:  Fred  A.  Humphrey,  Fort  CoUins,  Chairman;  Ervin 
A.  Hinds,  George  B.  Buck,  Denver. 

Midwinter  Clinics:  Samuel  B.  Childs,  Jr.,  Chairman;  Raymond  C.  Chat- 
field,  E.  L.  Binkley,  Jr.,  A.  J.  Kauvar,  Terry  J.  Gromer,  aU  of  Denver. 


Rehabilitation:  W.  W.  Haggart,  Denver,  Chairman;  Atha  Thomas,  Den- 
ver: Lawrence  T.  Brown,  Denver;  J.  E.  A.  Connell,  Piieblo;  Thad  P.  Sears, 
FL  Logan;  Kenneth  C.  Sawyer,  McKinnie  L.  Phelps,  (korge  R.  Buck, 
Bradford  Murphey.  aU  of  Denver. 

Advisory  to  the  Goodwill  Industries’  Rehabilitation  Program:  Lewis  C. 
Overholt,  Chairman;  WlUiam  H.  Halley,  Maurice  Katzman,  Terry  J. 
Gromer.  Lorenz  W.  Frank,  William  R.  Lipscomb,  Irvin  B.  Hendryson, 
all  of  Denver. 

Rural  Hdalth  Commission:  Leonard  N.  Myers,  Cheyenne  Wells,  Chairman; 
V.  V.  Anderson,  Del  Norte;  James  S.  Orr,  Frulta;  Keith  F.  Krausnlck, 
Lamar;  Robert  M.  Lee,  Fort  Collins.  Ex-officio  member:  Fred  A.  Hum- 
phrey, Fort  Collins. 

Medical  Disaster  Commission:  Foster  Matchett,  Denver,  Chairman;  Karl 
Arndt,  Denver,  Secretary;  Mark  S.  Donovan,  Harry  C.  Hughes,  Adolph  J. 
Kafka,  Roderick  J.  McDonald,  William  F.  Stanok,  Henry  Swan,  Karl  F. 
Sunderland,  K.  D.  A.  Allen,  all  of  Denver;  Lawrence  W.  Holden,  Boulder; 
Richard  H.  Mellen.  Colorado  Springs;  Richard  H.  Altmix,  Englewood:  Jacob 
0.  Mall,  Estes  Park;  Thad  P.  Sears,  Fort  Logan:  Donald  E.  Cowen,  Fort 
Morgan:  Kenneth  E.  Prescott,  Grand  Junction;  Walter  A.  Schoen,  Greeley; 
David  W.  McCarty,  Longmont:  David  W.  Boyer,  Pueblo;  J.  G.  Espey,  Craig; 
Leo  W.  Loyd,  Durango;  Keith  F.  Krausnlck,  Lamar;  Robert  M.  Lee,  PL  Col- 
lins; George  H.  Lord,  Aurora;  J.  Gordon  Hedrick.  Wray;  James  P.  Rigg, 
Grand  Junction. 

Lay  Organization  Standards:  George  R.  Buck,  Fredrick  H.  Good,  Ken- 
neth C.  Sawyer,  Frank  B.  McGIone,  T.  D.  Cunningham,  Bradford  Murphey, 
Casper  P.  Hegner,  John  S.  Bouslog,  all  of  Denver. 

Study  of  Child  Weifare  Cilnics:  Ralph  H.  Verplocg,  Denver,  Chairman; 
J.  W.  White,  Pueblo:  Jackson  L.  Sadler,  Fort  Collins;  L.  E.  Maurer, 
Boulder;  Harvey  M.  Tupper,  Grand  Junction;  Harvey  S.  Rusk,  Pueblo. 

Advisory  to  U.M.W.  Welfare  Fund  (Executive  Committee,  three-year 
terms;  others,  one-year):  Executive:  W.  W.  Haggart,  1951,  Chairman: 
F.  H.  Good,  1951;  J.  S.  Bouslog,  1951,  aU  of  Denver;  W.  H.  HaUey, 
1950;  C.  F.  Hegner,  1950,  both  of  Denver;  R.  F.  Bell,  1950,  Louviers; 
McKinnie  Phelps.  1949,  Denver;  F.  A.  Humphrey,  1949,  Fort  Collins; 
J.  M.  Lamme,  1949,  Walsenburg.  Other  members;  K.  C.  Sawyer,  A.  C. 
Sudan,  Bradford  Murphey,  all  of  Denver;  C.  D.  Bonham,  Boulder;  J.  W. 
Craighead,  Pueblo;  J.  E.  Donnelly,  Trinidad;  Ligon  Price,  Mt.  Harris;  M.  J. 
McCaUum,  Erie. 

Liaison  to  Colorado  State  Nurses  Association;  John  R.  Evans,  Samuel  P. 


Newman,  Denver. 

Liaison  to  Colorado  Bar  Association ; W.  S.  Dennis.  Chairman;  A.  C. 
Sudan,  R.  W.  Arndt,  aU  of  Denver. 

Medical-Dental  Liaison:  Guy  W.  Smith,  Denver,  Chairman;  George  B. 


Warner,  Denver;  Calvin  N.  CaldweU,  Pueblo. 

Repr6sentative  to  Rocky  Mountain  Radio  Council:  WilUam  E.  Hay, 
tter.ver;  (Alternate:  Chauncey  A.  Hager,  Denver). 

DAfiracmnf  atiua  Rallff  RAnfllC  MalllflPifll  BiQOd  Bank!  0.  S.  PllilDOtti 


ucuver.  . . » 

Representatives  to  Liaison  Council  on  Graduate  Education  (two  years)  ■ 

L.  R.  Safarik,  Denver,  1949;  Harold  I.  Goldman.  Denver,  1950. 

Delegate  to  Colorado  Interprofessional  Council  (five  years):  K.  D.  A. 
Allen,  Denver,  1949;  (Alternate,  Carl  A.  McLauthlin,  Denver,  1949). 


350 


Rocky  Mountain  Medical  Journal 


Ju^ljlA£4iCe> 

iA 

Trimeton 


(brand  of  propheiipyridainine) 


Trimeton*  differs  from  most  other  antiliistaminic 
agents  in  not  being  a derivative  of  ethanolamine  or 
ethylenediamine.  This  difference  is  noteworthy  and  is 
responsible  for  the  gratifying  clinical  results  obtained. 
In  one  study  of  227  patients  with  various  allergic 
conditions^ 

83%  obtained  benefit  from  Trimeton 

Side  effects,  common  to  all  antihistaminics,  occur  with 
Trimeton,  but  only  a few  patients  find  that  they  cannot 
tolerate  the  drug.^ 

Relief  from  allergic  symptoms  is  usually  obtained  with 
one  Trimeton  25  mg.  tablet  three  times  daily;  in  some 
patients  half  this  dosage  is  sufficient.  Tlie  action  of 
Trimeton  lasts  from  four  to  six  hours." 

PACKAGING : Trimeton  ( 1-plienyI-l-  ( 2-pyiidyl ) -S-dimethyla- 
minopropane)  is  available  in  25  mg.  tablets,  scored,  in  bottles  of 
100  and  1000. 

BIBLIOGRAPHY:  1.  Brown,  E.  A.:  Ann.  Allergy  6 -.39 3,  1948.  2.  Wiltich,  E.  W.: 
Ann.  Allergy  6:497,  1948. 

*TRi.MEroN  trade-mark  of  Schering  Corporation 

CORPORATION  - BLOOMFIELD,  NEW  JERSEY 

IN  CANADA,  SCHERING  CORPORATION  LIMITED,  MONTREAL 


TRIMETON 


MONTANA  STATE  MEDICAL  ASSOCIATION 

Next  Annual  Session:  Finlen  Hotel,  Butte:  Aug.  1,  2.  3,  4,  1949 


OFFICESRS 

Terms  of  Officers  and  Committees  expire  at  the  Annual  Session 
in  the  year  indicated.  Wbere  no  year  is  indicated,  the  term  is 
for  one  year  only  and  expires  at  1949  Annual  Session. 

President:  Thomas  L.  Bavkins.  Helena. 

President-elect:  Thomas  F.  Walker,  Great  Falls. 

Vice-President:  E.  G.  Johnson,  Harlowton. 

Secretary-Treasurer:  Herbert  T.  Caraway,  Billings. 

Delegate  to  American  Medical  Association:  Baymond  F.  Peterson,  Butte, 
1950;  Alternate,  Thomas  B.  Moore,  KallspeU,  1950. 


STANDING  COMMITTEES 

Execntive  Committee:  T.  L.  Hawkins,  Helena,  Chairman;  T.  F.  Walker, 
Great  Falls;  M.  T.  Caraway,  BiUings;  L.  W.  Allard,  Billings;  H.  A. 
ShllUngton,  Glentfre. 

Economics  Committee:  J.  C.  Shields,  Butte,  Chairman;  C.  P.  Brooke,  SL 
Ignatius;  B.  B.  Diirnln,  Great  Falls;  Leland  G.  Bussell.  BlUlngs;  8.  D. 
Whetstone,  Cut  Bank. 

Legislative  Committee:  J.  M.  Fllnn,  Helena,  Chairman;  F.  0.  Hurd, 
Gnat  FalLs;  P.  E.  Kane,  Butte;  J.  C.  MacGregor,  Great  Falls;  Claude 
M.  Mears,  Helena. 

Necrology  and  History  of  Medicine  Committee:  L.  W.  Brewer,  Missoula, 
Chairman;  1.  J Brldenstlne.  Missoula;  J.  H.  Irwin,  Great  Falls;  Claude 
M.  Mears.  Helena'  J.  P.  BItchey,  Missoula. 

Public  Relations  Committee:  H.  W.  Gregg.  Butte,  Chairman;  W.  L.  DuBols, 
Cut  Bank;  B.  V.  Murledge,  BlUlngs;  W.  H.  Stephan.  Dillon;  Dora  Walker, 
Great  Falls. 

Legal  Affairs  and  Malpractice  Committee:  J.  C.  MacGregor,  Great  Falls, 
Chairman;  Ruyr-.ond  Eck.  Lewlstown;  W.  B.  Harris,  Living^n;  John  E, 
Hynes,  BllUngs;  B.  D.  Knapp,  Wolf  Point. 

Program  Committee:  C.  H.  Fredrickson,  Missoula,  Chairman;  H.  T. 
Caraway,  BlUlngs  H.  W.  Gregg,  Butte;  J.  J.  McCabe,  Helena;  E.  8. 
Murphy.  Missoula. 

Interprofessional  Relationship  Committee:  L.  W.  AUard,  BiUlngs,  Chair- 
man; C.  B.  C.nnty.  Butte;  S.  A.  Cooney,  Helena;  S.  N.  Preston,  Missoula; 
F.  I.  Sabo,  Bozeman. 


Nominating  Committee:  H.  H.  James,  Butte,  Chairman;  E.  L.  Andereon, 
Fort  Benton;  B.  D.  Harper,  Sidney;  J.  J.  Malee,  Anaconda;  W.  B.  Me- 
Elwee,  Townsend. 

Auditing  Committee:  E.  H.  Llndstrom,  Helena,  Chairman;  F.  H.  Crago, 
Great  Falls;  B.  D.  Harper,  Sidney;  G.  W.  Setzer,  Malta;  B.  G.  Jobmon, 
Harlowton. 

Cancer  Committee:  Mary  E.  Martin,  Billings,  Chairman;  W.  F.  Caeb- 
more,  Helena;  C.  H.  Fredrickson,  Missoula;  B.  F.  Peterson,  Butte;  W.  C. 
Robinson,  Shelby. 

Maternal  and  Child  Welfare  Committee:  F.  L.  McPhail,  Great  Falls. 
Chairman;  L.  W.  Brewer,  Missoula;  P.  L.  Eneboe,  Bozeman;  Maude  M. 
Gerdes,  Billings;  D.  L.  Gillespie,  Butte;  A.  L.  Gleason,  Great  Falls;  E.  L. 
Hall,  Great  Falls;  D.  S.  MacKenzle,  Jr.,  Havre;  R.  E.  Mattlson,  Billings; 
0.  M.  Moore,  Helena;  F.  W.  Paul,  Kalispell;  C.  W.  Pemberton.  Butte; 
S.  N.  Preston,  Missoula;  A.  E.  Bitt,  Great  Falls. 

Tuberculosis  Committee;  F.  I.  Terrill,  Galen,  Chairman;  C.  B.  Craft, 
Bozeman;  E.  A.  Dolan,  Anaconda;  A.  R.  Klntner,  Missoula;  J.  A.  Layne, 
Great  Falls. 

Fracture  and  Orthopedic  Committee:  J.  K.  Colman,  Butte,  Chairman;  L.  C. 
Allard,  Billings;  W.  H.  Hagen,  BlUlngs;  S.  L.  Odgers,  Butte;  J.  C.  Wol- 
gamot.  Great  Falls. 

Rural  Health  Committee:  B.  C.  Farrand,  Jordan,  Chairman;  B.  A. 
Benke,  Kalispell;  W.  A,  Lacey,  Havre;  W.  G.  langUn,  Poison;  J.  H. 
WllUams,  Culbertson. 

Industrial  Welfare  Committee:  R.  B.  Richard.son,  Great  Falls.  Chairman; 
M.  A.  Gold,  Butte;  P.  E.  Logan.  Great  Falls;  D.  S.  MacKenzle,  Jr.,  Havre; 
R.  E.  Walker,  Livingston. 

Rheumatic  Fever  and  Heart  Committee:  F.  R.  Schemm,  Great  Falls, 
Chairman;  D.  T.  Berg,  Helena;  H.  W.  Gregg.  Butte;  A.  R.  Klntner,  Mis- 
soula; P.  E.  Logan,  Great  Falls;  F.  H.  Lowe,  tUssoula;  J.  J.  Malee, 
Anaconda;  0.  M.  Moore,  Helena;  H.  W.  Power,  Conrad;  B.  E.  SmaUey, 
Billings. 

SPECIAL  COSHUITTEES 

Emergency  Medical  Service  Committee:  R.  F.  Peterson,  Butte,  Chairman; 
Paul  J.  Gans,  Lewlstown;  J.  J.  McCabe,  Helena;  8.  A Olson,  Glendlve; 
L.  G.  BusseU,  BllUngs. 

lAB  Fee  Schedule  Committee:  H.  H.  James.  Butte,  Chairman;  E.  B. 
Lindstrom,  Helena;  J.  J.  Malee,  Anaconda;  D.  8.  McKenzie,  Jr.,  Havre; 
F.  K.  Waniata,  Great  Falls. 


Collection 


of 


^OUt 


Accounts 


All  reports  show  a trend  toward  slower  and  harder  collections  in  the 
months  ahead. 

At  the  first  sign  of  neglect  you  will  save  money  if  they  are  turned  over 
to  us  for  collection. 

Comparison  of  collection  results,  backed  by  35  years  of  experience,  proves 
you  obtain  greater  results  at  less  cost,  when  you  list  your  accounts 

with 

The  American  Medical  and  Dental  Association 

Suite  524,  810  14th  St.  TAbor  2331  Denver,  Colorado 


352 


Rocky  Mountain  Medical  Journal 


0 5 10  15  20  25  30  35  40 

MINUTES 

The  reaction  rate  of  Amphojel  and  its  component  gels. 


the  double  action  of  AMPHOJEf 


antacid 

demulcent 


Amphojel  — Aluminum  Hydroxide  Gel,  Alu- 
mina Gel  Wyeth  — is  unique  because  it  is  a 
colloidal  mixture  of  two  essentially  different 
types  of  alumina  gel,  one  having  an  antacid 
effect  . . . the  other  a demulcent  action. 

The  “antacid  gel”  instantly  stops  gastric 
corrosion  and  establishes  a mildly  acid 
environment. 

The  “demulcent  gel”  provides  a prolonged 
local  protective  effect,  and  might  be  likened 
to  a “mineral  mucin.” 

Thus,  through  its  double  action,  Amphojel 
gives  you  an  ideal  preparation  for  use  in  the 
management  of  peptic  ulcer. 


WYETH  INCORPORATED,  PHILADELPHIA  3,  PA. 


for  May,  1949 


353 


NEW  MEXICO  MEDICAL  SOCIETY 


Next  Annual  Session:  Roswell,  May  5,  6.  7,  1949 


OFFICERS  — 1948-1949 

Prtsident:  P.  L.  Travers,  Santa  Fe. 

President-Elect:  J.  W.  Hannett,  Albuquerque. 

Vies  President:  I.  J.  Marshall,  Roswell. 

Secretary-Treasurer:  H.  L.  January,  Albuquerque. 

Coanellors  (3  years):  W.  D.  Dabbs,  Clovis;  A.  C.  Shuler,  Carlsbad 
Councilors  (2  years):  R.  0.  Brown,  Sants  Fe;  C.  11.  Gellenthlen.  Valmora. 
Coanellors  (1  year):  Carl  Mulky,  Albuquerque;  L.  S.  Evans.  Las  Cruces. 

COMMITTEES  -—  1948-1949 

Basle  Science:  W.  E.  Nlssen,  Albuquerque,  Chairman;  Le  Grand  Ward, 
Santa  Fe;  Vincent  AccardI,  Gallup. 

Rural  Medical  Serica  Service:  Stuart  W.  Adler,  Albuquerque,  Chairman: 
W.  B.  Cantrell,  Hot  Springs;  Samuel  R.  Zeigler,  Espanola;  A.  T.  Gordon. 
Tucumcari;  L.  G.  Foster,  Reserve. 

Cancer:  Murray  M.  Friedman,  Santa  Fe,  Chairman;  Van  A.  Odle,  Roswell: 
J.  R.  Van  Atta,  Albuquerque;  J.  W.  Grossman,  Albuquerque;  B.  \V.  Maher, 
Albuquerque, 


Venereal  Disease  Control:  Sam  Jelso,  Albuquerque,  Chairman:  V.  E. 
Berchtold,  Santa  Fe;  L.  M.  Miles,  Albuquerque;  L.  S.  Evans,  Las  Cruceo; 
H.  L.  January,  Albuquerque. 

Legislative:  Albert  Lathrop,  Sants  Fe,  Chairman:  W.  0.  Connor,  Albu- 
querque; W.  R.  Lovelace,  II,  Albuquerque;  Walter  A.  Stark,  Las  Vegas; 
George  S.  Morrison,  Boswell;  R.  0.  Brown,  Santa  Fe. 

Public  Relations:  D.  A.  McKinnon,  Jr.,  Albuquerque,  Chairman;  James 
L.  McCrory,  Santa  Fe;  H.  M.  Mortimer,  Las  Vegas;  Frank  W.  Parker,  Jr., 
Gallup. 

Tuberculosis:  R.  0.  Brown,  Santa  Fe,  Chairman;  C.  H.  Gellenthlen, 
Valmora;  D.  0.  Shields,  Albuquerque;  H.  S.  A,  Alexander,  Santa  Fe. 

Advisory  Committee  on  Ins.  Compensation;  Eugene  W.  Fiske,  Santa  Fe, 
Chairman;  John  F.  Conway,  Clovis;  A.  C.  Shuler,  Carlsbad:  B.  E.  ForblJ, 
Albuquerque. 

Committee  on  National  Emergency  Medical  Service:  A.  E.  Reymont,  Santa 
Fe,  Chairman:  C.  M.  Thompson,  Albuquerque;  L.  G.  Rice,  Albuquerque; 
Walter  A.  Stark,  Las  Vegas. 


StodgKilTs  Imperial  Pharmacy 

Prescriptions  Exclusively 

For  your  prescriptions  we  stock  a complete  line  of  ALMAY — non-allergic — cosmetics. 

Five  Pharmacists 

319  16th  St.  TAbor4231  Denver,  Colo. 


Ocuiidt  f^redcription  Service  ^xciudivei^ 

SHADFORD-FLETCHER  OPTICAL 

CO 

Dispensing  Opticians 

228  16th  Street,  Denver,  Colo. 

AComa'  261 T 

These  fine  Dairy  Cattle,  a portion  of  City  Park’s  large  herd  of  Guernsey  and  Holstein 
cows,  are  scientifically  fed  and  cared  for,  continuously  tested  by  competent  veterin- 
arians. Only  through  such  precise  watchfulness  does  City  Park  Milk  receive  Grade 
“A”  designation  which  it  enjoys.  Choose  City  Park’s  regular  Grade  “A”  Pasteurized 
or  Homogenized  milk  today  — notice  the  particularly  clean,  fresh  flavor. 


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Drive — Denver 


354' 


Rocky  Mountain  Medical  Journal 


MEAT... 

and  Physical  Rehabilitation 

Any  marked  loss  of  weight  in  the  nonobese  patient  deprives  the 
organism  of  a considerable  amount  of  protein,  apt  to  lead  to  severe 
protein  deficiency.  A weight  loss  of  5 Kg.  does  not  appear  large  as 
such.  Yet  it  is  estimated  that  it  may  well  entail  a simultaneous  loss  of 
as  much  as  900  Gm. — or  two  pounds — of  tissue  protein,*  taken  from 
the  scant  protein  stores  of  the  body,  from  the  muscles,  liver  and  other 
viscera.  Prevention  of  such  large  protein  losses  or  rapid  replacement 
of  depleted  protein  stores  is  imperative.  Nitrogen  balance  must  be 
re-established  as  quickly  as  possible  to  promote  local  healing  and 
general  recovery  in  many  surgical  conditions,  in  severe  burns,  in 
metabolic  disturbances,  and  following  overwhelming  infections. 

Meat  as  the  primary  source  of  protein  affords  a number  of  special 
advantages  in  the  period  of  actual  dietotherapy  as  well  as  during 
recovery  and  rehabilitation.  It  is  of  excellent  digestibility  so  that  it 
can  be  easily  eaten  two  or  three  times  a day  to  satisfy  increased  pro- 
tein requirements. 

The  appetizing  taste  appeal  encourages  simultaneous  intake  of 
other  valuable  foods,  especially  desirable  in  the  presence  of  anorexia. 

All  meat  is  notably  rich  in  biologically  complete  protein,  from  17 
to  20  per  cent  of  its  uncooked  and  from  2 5 to  30  per  cent  of  its  cooked 
weight.  Furthermore,  meat  ranks  with  the  best  sources  of  B-complex 
vitamins  and  iron,  important  nutrient  factors  in  physical  rehabilitation. 

’i'Meyer,  K.  A.,  and  Kozoll,  D.D.:  Progress  in  the  Treatment  of  Carcinoma  of 
the  Stomach  and  Esophagus,  South  Dakota  J.  Med.  & Pharm.  2:39  (Feb.)  1949. 


The  Seal  of  Acceptance  denotes  that  the  nutri- 
tional statements  made  in  this  advertisement 
are  acceptable  to  the  Council  on  Foods  and 
Nutrition  of  the  American  Medical  Association. 

American  Meat  Institute 

M~in  Office,  Chicago... Members  Throughout  the  United  States 


for  May,  1949 


355 


THE  UTAH  STATE  MEDICAL  ASSOCIATION 

Next  Annual  Session:  Salt  Lake  City,  Sept.  1,  2,  3,  1949 


OmCERS  1M8-1949 
Frwldent:  0.  A.  OgilTle,  Salt  Lake  City. 

President-elect:  C.  H.  Jenson,  Ogden. 

Past  President:  J.  C.  Hubbard,  Price. 

Honorary  President:  0.  W.  French,  Coalrtlle. 

First  Vice  President:  J,  0.  McQuarrle,  Richfield. 

Second  Vice  President:  Ezra  Cragun,  Lewiston. 

Third  Vice  President:  B.  W.  Farnsworth,  Cedar  City. 

Secretary:  Ray  T.  Woolsey,  Salt  Lake  City. 

Executive  Secretary:  Mr.  W.  H.  Tlbbals,  Salt  Lake  City. 

Treasorer:  L.  B.  White,  Salt  Lake  City. 

Councilor  First  District:  J.  G.  Olson,  Ogden. 

Councilor  Second  District:  V.  L.  Rees,  Salt  Lake  City, 

Councilor  Third  District:  L.  W.  Oaks,  Provo. 

Delegate  to  A.M.A.,  1948:  James  P.  Kerby,  Salt  Lake  City. 

Alternate  Delegate  to  A.M.A..  1948:  J.  J.  Weight,  Provo. 

Editor  of  the  Utah  Section  of  the  Rocky  Mounnain  Medical  Journal: 
R.  P.  Middleton,  Salt  Lake  City. 

STANDING  COMMITTEES 
Rocky  Mountain  Medical  Conference  Continuing  Committee:  R.  P.  Mid- 
dleton, Chairman,  Salt  Lake  City,  1949;  K.  B.  Castleton,  Salt  Lake  City, 
1950;  Clark  Rich,  Ogden,  1951;  NoaU  Z.  Tanner,  Layton,  1952;  T.  R. 
Seager,  Vernal,  1953. 

Scientific  Program  Committee:  Ray  T.  Woolsey,  Chairman,  Salt  Lake 
City;  Drew  M.  Peterson,  Ogden;  Stanley  N.  Clark,  Provo;  P.  M.  Howard, 
Salt  Lake  City;  V.  P.  White,  Salt  Lake  City;  L.  V.  Broadbent,  Cedar 
City;  Paul  A.  Pemberton,  Salt  Lake  City. 

Public  Policy  and  Legislation  Committee:  F.  R.  King,  Chairman,  Price, 
1951;  Jesse  J.  Weight,  Provo,  1949;  M.  L.  Crandall,  Salt  Lake  City, 
1949;  V.  L.  Stevenson,  Salt  Lake  City,  1949;  N.  F.  Hlcken,  Salt  Lake 
City,  1950;  Omar  Budge,  Logan,  1950;  John  Colettl,  Salt  Lake  City.  1950; 
W.  B.  West,  Ogden,  1951;  B.  V.  Larson,  Roosevelt,  1951. 

Medical  Defense  Committee:  W.  J.  Thomson,  Chairman,  Ogden,  1949; 
R.  W,  Owens,  Salt  Lake  City,  1949;  J.  L.  Hansen,  Vernal,  1949;  Homer 
Smith,  Salt  Lake  City,  1950;  L.  N.  (^sman.  Salt  Lake  City,  1950;  Erwin 

D.  Zeman,  Ogden.  1950;  Charles  W.  Woodruff,  Salt  Lake  City,  1961; 

James  Westwood,  Provo,  1951;  L.  H.  Merrill,  Hiawatha,  1951. 

Medical  Education  and  Hospitals  Committee;  I.  Bruce  McQuarrle,  Chair- 
man, Ogden,  1949;  L.  J.  Paul,  Salt  Lake  City,  1949;  0.  A.  OgUvle, 
Salt  Lake  City,  1949;  0.  G.  Richards,  Salt  Lake  City,  1950.;  Bay  T. 
Woolsey,  Salt  Lake  City,  1950;  T.  E.  Robinson,  Salt  Lake  City,  1950; 

Seth  E.  Smoot,  Provo,  1951;  George  H.  Curtis,  Salt  Lake  City,  1951; 

R.  0.  Porter,  Logan,  1951;  R.  H.  Young,  Ex-Officio,  Salt  Lake  City. 

Medical  Economics  Committee:  Russell  Smith,  Cbsdrman,  Provo,  1949; 
A.  R.  Denman,  Helper,  1949;  W.  T.  Ward,  Salt  Lake  City,  1950;  W.  R. 
Merrill,  Brigham  City,  1951;  Ralph  Pendleton,  Salt  Lake  City,  1951. 


Jiotvari  at  l^euionaLlt  j^i 


rices 


"Orders  Delivered  to  Any  City  by 
Guaranteed  Service" 

Special  attention  given  to  floral  tributes 
Also  Hospital  Flowers 

Call  KEy stone  5106 

Vark  3loral  Co.  Store 


1643  Broadway 


Denver,  Colo. 


Public  Health  Committee:  John  R.  Bourne,  Chairman,  Roosevelt,  194t; 
F.  D.  Spencer,  Salt  Lake  City,  1950;  Ralph  Ellis,  Ogden,  1951. 

Military  Affairs  and  National  Emergency  Committee:  Chrles  Woodruff, 
Chairman,  Salt  Lake  City;  L.  J.  Paul,  Salt  Lake  City;  Mazel  Skolfield, 
Salt  Lake  City;  W.  M.  Gorishek,  StandardviUe  L.  B.  Cullimore,  Orem; 

Ray  H.  Barton,  Magna;  D.  T.  Madson,  Price;  Riley  G.  Clark,  Provo; 

Willis  Hayward,  Logan;  Dean  Tanner,  Ogden. 

Tuberculosis  and  Cardiovascular  Diseases  Committee:  Elmer  M.  KU- 
patrick.  Chairman,  Salt  Lake  City;  Ray  Rumel,  Salt  Lake  City;  D.  0.  N. 
Lindberg,  Ogden;  W.  C.  Walker,  Salt  Lake  City;  Donald  M.  Moore,  Ogden; 
Don  C.  Merrill,  Provo, 

C'ancer  Committee:  0.  A.  Ogilvle,  Chairman,  Salt  Lake  City;  S.  W. 

Fennemore,  Price;  E.  D.  Zeman,  Ogden;  W.  G.  Noble,  Richmond;  Harold 

Austin,  Provo;  Stanley  G.  Rees,  Gunnison;  Paul  K.  Edmunds,  Cedar  (Hty; 
F.  G.  Eskelson,  Vernal;  K.  B.  Castleton,  Salt  Lake  City. 

Fracture  Committee:  A.  M.  Okelberry,  Chairman,  Salt  Lake  City;  Clark 
Rich,  Ogden;  Roy  H.  Robinson,  Kenilworth;  S.  M.  Budge,  Logan;  Norman 
R.  Beck,  Salt  Lake  City;  Louis  Perry,  Ogden;  J.  G.  McQuarrie,  Richfield; 
D.  C.  Evans,  Fillmore. 

Necrology  Committee:  W.  T.  Hasler,  Chairman,  Provo;  L,  A.  Stevenson, 
Salt  Lake  City;  Jos.  A.  Phipps,  Salt  Lake  City. 

Industrial  Health  Committee:  Paul  S.  Richards,  Chairman,  Bingham 
Canyon;  L.  J.  Taufer,  Salt  Lake  City;  Frank  Gorishek,  Helper;  Byron  Daynee, 
Salt  Lake  City;  E.  B.  Kube,  Salt  Lake  City;  D.  C.  Barker,  Ogden. 

Advisory  Committee  to  the  Woman’s  Auxilfary:  Vernal  Johnson,  Chair- 
man, Ogden;  0.  P.  Heninger,  Provo;  L.  G.  Moench,  Salt  Lake  City;  James 

K.  Palmer,  Salt  Lake  City. 

Public  Relations  Committee:  R.  P.  Middleton,  Chairman,  Salt  Lake  City; 
Louis  P.  Matthei,  Ogden;  R.  W.  Farnsworth,  Cedar  City;  Quinn  A.  Whit- 
ing, Price:  Clyde  J.  Daines,  Logan;  Bay  E.  Spendlove,  Vernal;  H.  L 
Goodwin,  Salt  Lake  City;  Gilbert  Wright,  Salt  Lake  City;  ^y  B.  Hammond, 
Provo. 

Inter-Professional  Committee;  J.  Leroy  Kimball,  Chairman,  Salt  Lake 
City;  C,  C.  Hetzel,  Jr.,  Ogden;  T.  E.  Bauman,  Park  City;  Paul  Clayton, 
Salt  Lake  City;  Ralph  G.  Rigby,  Salt  Lake  City. 

Mental  Hygiene  Committee:  Roy  A.  Darke,  Chairman,  Salt  Lake  City: 

L.  G.  Moench,  Salt  Lake  City;  Wm.  D.  Pace,  Salt  Lake  City;  George  Cochran, 
Salt  Lake  City;  E.  L.  Weimers,  Provo. 

Fee  Schedule  Committee:  K.  B.  Castleton,  Chairman,  Salt  Lake  City; 
Howard  K.  Belnap,  Ogden;  J.  E,  Trowbridge,  Bountiful;  U.  B.  Bryner, 
Salt  Lake  City;  W.  Leroy  Smith,  Salt  Lake  City;  J.  R.  Whenltt,  Heber 
City;  0.  W.  Budge,  Logan. 

Special  Committee  to  Study  Dues:  H.  B.  Reichman,  Chairman,  Salt 
Lake  City;  Eliot  Snow,  Salt  Lake  City;  Ezra  Cragun,  Lewiston. 

Rural  Health  Committee:  J.  J.  Weight,  Chairman,  Provo;  J.  G.  McQuanle, 
Richfield;  J.  P.  Burgess,  Hyrum;  Noall  Z.  Tanner,  Layton. 


Ox^g.en  ^hc. 

Corner  10th  and  Lawrence  Sts. 
TAbor  5138 

Medical  Gas  Division 
MEDICAL  OXYGEN 
CARBON  DIOXIDE-OXYGEN 
MIXTURES 

AVIATORS’  BREATHING  OXYGEN 
WATER  COMPRESSED  NITROGEN 
WATER  COMPRESSED  AIR 
Twenty-Four  Hour  Service 


COLOR.  PROCESS. 

LINE  & HALFTONE 
BEN  DAY  ...... 

ILLUSTRAT0R5-DESIGNERS 


PHOTO 

ENGRAVERS 


356 


Rocky  Mountain  Medical  Journal 


V 


.»"v  'jr.. 

companion  ^ cternotes  for  individu««> 

assuring  the  pa  len  j Koromex  Jeliy 

persona,  preference.  T.mete^ 

and  Koromex  Crea  ...  ^^„,.„ent  with 

.,„gcedients  and  same^^  dependable 

”m  instantly  spermicidal  on  contact 

barrier  film . . • tn*  vaginal  biology. 

...will  not  interfere  with  norma.  V 

. «« these  features  which  max 

After  consideration  cream  outstanding 

Koromex  Jelly  and  oro  ^bese  ster- 

contraceptives,the^aM>ro^ 

,i„g  produrts  IS  1 to  Koromex. 

more  physicia  oxyquinolin 

^^""":sunABU.euvo.c«.AMS.s.s. 


...eASSS.0tOBAVAaAS..O.SS,O.. 

comprehensive  data 

koromb 

0 1 » * « ‘ . e o . S . 1 « E 0 

J R A 0 £ 


uiteRaiuRE- 


physicians  *' 


HOUAND-RANTOS  COMPANY.  INC..  145  HUDSON  STREET.  NEW  YORK  13,  N.  Y- 


MERIE  l.  YOUNGS  • 


PRESIDENT 


THE  WYOMING  STATE  MEDICAL  SOCIETY 

Next  Annual  Session:  Elks  Club,  Casper;  Sept.  12,  13,  14,  1949 


OFFICERS 

President:  George  E.  Baker,  Casper. 

President-Elect:  DeWitt  Dominick,  Cody. 

Vice  President:  K.  E.  Krueger,  Rock  Springs. 
Treasurer:  P.  M.  Schunk.  Sheridan. 

Correspondino  Secretary:  George  H.  Phelps,  Cheyenne. 
Delegate  A M. A.:  E.  H.  Reeve,  Casper. 

Alternate  Delegate  A.M.A.:  W.  A.  Bunten.  Cheyenne. 
Executive  Secretary:  Mr.  Arthur  Abbey,  Cheyenne. 


COMMITTEES 

Rocky  Mountain  Medical  Conference:  Earl  Whedon,  Chairman.  Sheridan; 
George  N.  Phelps,  Cheyenne;  H,  L,  Harvey,  Casper;  C.  W.  Jeffrey,  Rawlins; 
L.  W.  Storey,  Laramie, 

Syphilis  Committee:  N.  E.  Morad,  Chairman,  Casper;  G.  M.  Groebart, 
Worland;  L.  H,  Wilmoth,  Lander;  L,  G,  Booth,  Sheridan;  P,  H.  Halgler, 
Midwest. 

Cancer  Committee:  Earl  Whedon,  Chairman,  Sheridan;  John  Gramllcb, 
Cheyenne;  DeWitt  Dominick,  Cody;  J.  R.  Newman,  Kemmerer;  E.  W.  New- 
man, Cheyenne. 

Medical  Economics  Committee:  C.  L.  Rogers,  Chairman,  Sheridan;  Nels 
A.  Vicklund,  ThermopoUs;  R.  A.  Corbett,  Saratoga;  0.  R.  James,  Casper; 
S.  S.  Hellewell,  Evanston. 

Fracture  Committee:  Philip  Teal,  Chairman,  Cheyenne;  Silva  J,  Glovale, 
Cheyenne;  Robert  V.  Batterton,  Rawlins;  Lowell  D.  Kattenhom,  Powell; 
Joseph  E,  Hoadley,  Gillette, 

Medical  Defense  Committee;  George  Baker,  Chairman,  Casper;  Andrew 
Bunten.  Cheyenne;  E.  W.  DeKay,  Laramie. 

Councillors:  Earl  Whedon,  Chairman,  Sheridan;  R.  J.  Boesel,  Cheyenne; 
E.  W.  DeKay,  Laramie;  George  Baker,  President,  Casper;  George  Phelps, 
Secretary,  Cheyenne. 

Advisory  to  Woman’s  Auxiliary:  John  R.  Bunch,  Chairman,  Laramie; 
Virgil  L.  Thorpe,  Newcastle;  H.  J.  Aldrich,  Sheridan;  G.  B.  Savory,  Chey- 
enne. 

Advisory  to  Workmen’s  Compensation  Department:  J.  D.  Shingle,  Chair- 
man, Cheyenne;  G.  H.  Phelps,  Cheyenne;  W,  A.  Bunten,  Cheyenne;  R.  H. 
Reeve,  Casper;  Albert  T.  Sudman,  Green  River;  P.  M.  Schunk,  Sheridan. 


Industrial  Health  Committee:  K.  E,  Krueger,  Chairman,  Sock  Springs; 
WiUard  Pennoyer,  Cheyenne;  Thomas  B,  Croft,  Lovell;  Eugene  Pelton, 
Laramie. 

Veterans’  Affairs  and  Military  Service  Committee:  A.  J.  AUegrettl,  Chair- 
man, Cheyenne:  Jack  Rowlett,  Laramie;  Everett  Ellis,  Cheyenne;  Bernard 
Sullivan,  Laramie;  0.  W.  Koford,  Cheyenne;  Bernard  Stack,  ThermopoUs; 
J.  W.  Sampson,  Sheridan;  DeWitt  Dominick,  Cody;  Paul  R.  Holtz.  Lander; 
George  E.  Baker,  President,  Casper;  George  Phelps,  Secretary,  Cheyenne. 

Blue  Cross  Hospital  Committee:  R.  I.  WllUams,  Chairman,  Cheyenne,  1950; 
W.  A.  Bunten,  Cheyenne,  1949;  E.  W.  DeKay,  Laramie,  1951;  Cedric 
Jones,  Cody,  1952. 

Public  Policy  and  Legislation:  George  Phelps,  Chairman,  Cheyenne; 

Andrew  Bunten,  Cheyenne;  George  Baker,  President,  Casper;  G.  W.  Koford, 
Cheyenne;  E.  W.  DeKay,  Laramie;  G.  W.  Henderson,  Casper. 

National  Physicians  Committee:  George  Phelps,  Chairman,  Cheyenne; 

Andrew  Bunten,  Treasurer,  Cheyenne;  E.  W.  DeKay,  Laramie;  George  Baker, 
Casper. 

Poliomyelitis  Committee:  H.  L.  Harvey,  Chairman,  Casper;  N.  A.  Vicklund, 
ThermopoUs;  Leo  Keenan,  Torrlngton;  DeWitt  Dominick,  Cody;  PblUp  Teal, 
Cheyenne;  FrankUn  Yoder,  Cheyenne;  F.  A Mills,  RawUns. 

State  Institutions  Advisory  Committee:  J.  F.  Whalen,  Chairman,  Evans- 
ton; George  Phelps,  Cheyenne;  C.  W.  Jeffrey,  RawUns;  Earl  Whedon,  Sheri- 
dan; G.  M.  Grosbart,  Worland;  R.  H.  Kanable,  Basin. 

Necrology  Committee:  Earl  Whedon.  Chairman,  Sheridan;  John  B. 
Krahl,  Torrington;  FrankUn  Yoder,  Cheyenne. 

Rural  Hdaith  Committee:  Paul  Holtz,  Chairman,  Lander;  Andrew  Bun- 
ten, Cheyenne;  Samuel  Worthen,  Afton;  Wm.  K.  Bosene,  Wheatland;  Claude 
Raffl,  Basin. 

Public  Health  Department  Liaison  Committee:  E.  C.  Ridgeway,  Chair- 
man, Cody;  R.  P.  Fitzgerald,  Casper;  R.  V.  Batterton,  RawUns;  J.  W. 
Sampson,  Sheridan;  R.  C.  Stratton,  Green  River;  WlUard  Pennoyer, 
Cheyenne. 

Child  Health  Committee:  Paul  W.  Emerson,  Chairman,  Cheyenne;  John 
GramUch,  Cheyenne;  Thomas  Croft,  Lovell;  Bernard  SulUvan,  Laramie; 
Paul  R.  Holtz,  Lander;  Geo.  E.  Baker,  Casper;  A.  B.  Abbey,  Cheyenne. 

Council  on  National  Emergency  Medidal  Service:  George  H.  PheII», 
Chairman,  Cheyenne;  R.  H.  Reeve,  Casper;  DeWitt  Dominick,  Cody;  E.  W. 
DeKay,  Laramie;  K.  S.  Krueger,  Rock  Springs;  P.  M.  Schunk,  Sheridan. 


COLORADO  HOSPITAL  ASSOCIATION 


OFFICERS 

President:  Hubert  W.  Hughes,  St.  Anthony  Hospital,  Denver. 
President-Elect:  Walter  G.  Christie.  Presbyterian  Hospital,  Denver. 
Treasurer:  M.  A.  Moritz,  Denver  General  Hospital,  Denver. 

Trustees:  Roy  R.  Prangley,  St.  Luke’s  Hospital,  Denver  (1949);  James 
P.  Dixon,  M.D.  Denver  General  Hospital,  Denver  (1949);  Louis  Liswood, 
National  Jewish  Hospital,  Denver  (1950);  DeMoss  TaUaferro,  Children’s 
Hospital,  Denver  (1950);  Roy  R.  Anderson,  Presbyterian  Hospital,  Den- 
ver (1951);  Rev.  AUen  H.  Erb,  Mennonite  Hospital,  La  Junta,  Colo. 
(1951). 

Delegate  to  the  American  Hospital  Association;  Herbert  A Black,  M.D., 
Parkview  Hospital,  Pueblo. 

Alternate:  Msgr.  John  R.  Mulroy,  CathoUc  Hospitals,  Denver. 

STANDING  COMMITTEES 
Auditing:  R W.  Pontow,  Chairman  (1949),  Colorado  General  Hospital, 
Denver:  Rev.  E.  J.  Friedrich  (1950.),  Lutheran  Sanatorium,  Wheatridge; 
Karl  Mortensen  (1951),  St  Luke’s  Hospital,  Denver. 

Constitution  and  Ruies:  Samuel  S.  Golden,  M.D.,  Chairman,  Beth  Israel 
Hospital,  Denver;  Henry  H.  HiU,  Weld  County  Hospital,  Greeley;  Sister 
M.  Johanna,  Sacred  Heart  Hosptal,  Lamar. 

Legislative:  Msgr.  John  R.  Mulroy,  Chairman,  CathoUc  Hospitals.,  Den- 
ver; DeMoss  Taliaferro,  ChUdren’s  Hospital,  Denver;  Carl  Ph.  Schwwalb, 
Denver:  Herbert  A.  Black,  M.D.,  Parkview  Hospital,  Pueblo. 

Membership:  Sister  M.  Alphonsus  Chairman,  Mercy  Hospital,  Denver; 
Roy  R.  Prangley,  St.  Luke’s  Hospital,  Denver. 

Resolutions:  Walter  G.  Christie,  Chainnan,  Presbyterian  Hospital,  Denver; 
Carl  Ph.  Schwalb,  Denver. 

Nominating:  Msgr.  John  R.  Mulroy,  Chairman  (1949),  CathoUc  Hos- 
pitals, Denver;  Herbert  A.  Black,  M.D.  (1950),  Parkview  Hospital,  Pueblo; 
C.  S.  Bluemel,  M.D.  (1951),  Mount  Airy  Sanatorium,  Denver. 

Program:  George  A.  W.  Currie,  M.D.,  Chairman,  University  of  Colorado 
Medical  Center,  Denver;  Roy  Anderson,  Presbyterian  Hospital,  Denver. 


Nursing:  DeMoss  TaUaferro,  Chairman,  Children’s  Hospital,  Denver; 
Sister  M.  HugoUna,  St.  Anthony  Hospital,  Denver;  Margaret  E.  Paetznlck, 
Director  of  Nurses,  Denver  General  Hospital,  Denver;  Sister  Maria  Gratia, 
R.N.,  Glockner  Sanatorium,  Colorado  Springs;  S.  Russ  Denzler,  M.D., 
Colorado  Hospital,  Canon  City. 

Public  Education:  Owen  B.  Stubben,  Chairman,  Denver  General  Hospital, 
Denver;  Mr.  Torgersen,  Longmont  Hospital  and  CUnic,  Longmont;  Ward 
Darley,  M.D.,  Director,  University  of  Colorado  Medical  Center,  Denver; 
Chas.  Levine,  J.C.R.S.,  Spivak. 

SPECIAl,  COMMITTEES 

Public  Relations:  James  P.  Dixon,  M.D.,  Chairman,  Denver  General 
Hospital,  Denver;  Sister  Mary  Lina,  St.  Francis  Hospital,  Colorado  Springs. 

Rates  and  Charges:  Roy  Anderson,  Chairman,  Presbyterian  Hospital, 
Denver:  Msgr.  John  R.  Mulroy,  Catholic  Hospitals,  Denver;  Boy  R. 
Prangley,  St.  Luke’s  Hospital,  Denver;  Walter  G.  Christie,  Presbyterian 
Hospital  Denver:  DeMoss  Taliaferro,  ChUdren’s  Hospital,  Denver;  Ben 
M.  Blumberg,  General  Rose  Memorial  Hospital,  Denver. 

State  Board  of  Health  Advisory;  Msgr.  John  R.  Mulroy,  Chairman, 
CathoUc  Hospials,  Denver;  DeMoss  TaUaferro,  CJiildren’s  Hospital,  Denver; 
Herbert  A.  Black,  M.D.,  Parkview  Hospital,  Puebo. 

Committee  on  Hospital  Licensing  Regulations  and  Standards;  Msgr.  John 
R.  Mulroy,  Cl'.airman,  Catholic  Hospitals,  Denver;  Roy  R.  Prangley,  St. 
Luke’s  Hospital,  Denver;  Owen  B.  Stubben,  Denver  General  Hospital,  Denver; 
DeMoss  Taliaferro,  Children's  Hospital,  Denver;  Roy  Anderson,  Presbyterian 
Hospital,  Denver. 

Premature  Infant  Care:  DeMoss  TaUaferro,  Chairman,  Chldlren’s  Hos- 
pital. Denver;  Roy  Anderson,  Presbyterian  Hospital,  Denver. 

Rehabilitation  Center;  James  P.  Dixon.  M.D.,  Denver  General  Hospital, 
Denver:  Msgr.  John  R.  Mulroy,  CathoUc  Hospitals,  Denver;  Louis  M. 
Liswood,  National  Jewish  Hospital,  Denver. 

Inter-Professional  Council:  Hubert  W.  Hughes,  St.  .Anthony  Hospital, 
Denver. 


eruice 


^^ccuracu  anct  ^peect  in  f^rescription 

DORR  OPTICAL  COMPANY 


421  16th  Street 


Denver,  Colorado 


-KEystone  5511 


358 


Rocky  Mountain  Medical  Journal 


safe . . . rational . . . effective 


in  the  treatment  of 


Harris,  Ivy  and  Searle  conclusively  proved  that  'Benzedrine’  Sulfate 
safely  depresses  the  overweight  patient’s  appetite — and  when 
caloric  intake  is  sufficiently  lowered,  weight  reduction  is  facilitated. 
After  a comprehensive  series  of  functional  tests,  these  same 
investigators  conclude:  "No  evidence  of  deleterious  effects  of  the  drug 
(amphetamine  sulfate)  were  observed.”  (J.A.M.A.  134:1468,  1947). 


Benzedrine*  Sulfate  tcbie,, . enxi. 


{racemic  amphetamine  sulfate^  S.K.F.) 

one  of  the  fundamental  drugs  in  medicine 


Smith,  Kline  & French  Laboratories,  Philadelphia  *t.m.  Reg.  u.s.  Pat  Off. 


ANNOUNCING:  First  Television,  in  Natural  Color,  of 
Surgical  and  Medical  Procedures  while  under  way.  Arranged 
and  presented  by  Smith,  Kline  & French  Laboratories  — 
AMA  Convention,  June  6,  7,  8 & 9,  at  Atlantic  City. 


The  ever-moving 
frontier 


Research  on  vitamin  knowledge  in  the  field  of 
nutrition  has  come  a long  way  since  the  early 
published  researches  of  McCollum,  Mendel 
and  Funk.  The  science  of  nutrition  is  no 
longer  the  stepchild  of  medicine,  nor  the  poor 
relation  of  agriculture.  In  particular,  our  under- 
standing of  the  need  for  vitamins  in  human 
nutrition  has  enormously  increased.  Vitamins 
constitute  in  the  aggregate  the  sine  qua  non 
for  cellular  respiration,  reproduction,  growth 
and  repair. 


For  the  past  25  years,  biochemists  have  pressed 
forward  a continually  moving  frontier  of 
scientific  discovery  in  the  field  of  nutrition.  In 
recent  years,  Lederle  has  been  in  the  vanguard 
of  this  movement,  its  investigators  being  well 
known  for  their  achievements  with  folic  acid, 
pyridoxine,  biotin,  the  pantothenates,  liver 
extract,  and  allied  substances.  There  will  be  no 
slackening  in  the  efforts  of  this  organization  to 
uncover  additional  aids  to  better  health  and 
better  living. 


lEDERLE  LABORATORIES  DIVISIOM 


AMERICAN 


Gianandd 


COMPANY 


30  ROCKEFELLER  PLAZA  • NEW  YORK  20.  N.  Y. 


360 


Rocky  Mountain  Medical  Journal 


Palvules 

► AMYTAL  ^ 
SODIUM 

(Amobiirbital  Sodium,  Lilly) 

0.»  Oin.  (s  grs.) 

WARNING-M.vb.libi, 


►AMYTAL 

Sodium 


COMPANY 

“<dianapous.  U.  S.  a. 


Gentle  Sedation,  Safe  Hypnosis 


To  the  obstetrician,  ‘Amytal  Sodium’  (Amobarbital 
Sodium,  Lilly)  means  dependable  amnesia. 

To  the  surgeon,  it  means  safe  basal  anesthesia.  To 
medical  practitioners  generally,  ‘Amytal  Sodium’  is  a 
versatile  barbiturate  for  securing  all  degrees  of  relaxation, 
from  mild  sedation  to  deep  hypnosis.  The  moderately  long 
duration  of  action  characteristic  of  ‘Amytal  Sodium’  tends 
to  insure  uninterrupted  sleep. 

Whenever  a reliable  barbiturate  is  indicated,  prescribe 
‘Amytal  Sodium.’  ‘Amytal  Sodium’  is  supplied  in  a large 
variety  of  dosage  forms  and  is  available  on  prescription  at 
drug  stores  everywhere. 


ELI  LILLY  AND  COMPANY,  INDIANAPOLIS  6,  INDIANA,  U.S.A. 


Thanks  to  prenatal  care,  better  nutrition,  and  the  knowledge 
and  skill  of  the  physicians  engaged  in  obstetrical  practice, 
maternal  mortality  and  morbidity  continue  to  decline. 

Products  of  medical  research  have  helped  to  solve  some 
of  the  obstetrician’s  problems.  For  prenatal  care,  the 
vitamins,  calcium,  well-tolerated  iron  salts,  and  preparations 
of  liver  extract  have  been  found  useful.  Administration  of 
the  shorter-acting  barbiturates  during  labor  has  made 
the  experience  less  trying  for  the  mother,  with  little 
danger  of  damaging  effect  upon  the  infant.  Postpartum 
care  has  been  simplified  with  ergonovine  maleate.  These 
are  but  a few  of  the  contributions  of  research  scientists 
to  maternal  and  infant  welfare.  At  the  Lilly  Research 
Laboratories,  work  goes  on  apace  to  improve  existing 
products  and  to  seek  answers  to  the  problems  yet  unsolved. 
That  improvements  will  come  seems  a certainty;  and  when 
they  do,  you,  the  physician,  will  be  the  first  to  be  informed. 


iCCii 


y 


LILLY  SPECIALISTS  SERVE  THE  MEDICAL  PROFESSION 


SRocky  yVlountain  1949 

Colorado 
Montana 
New  Mexico 
Utah 
Wyoming 

* Editorial 


y^edicat  Journal 


Clear  Speaking 
Better  Than  Debates 

'^HE  voice  of  former  Congressman  Forest 
A.  Harness  from  Indiana  over  the  air 
in  behalf  of  the  A.M.A.  program  to  combat 
socialized  medicine  has  been  much  more 
effective  in  prepared  speech  than  in  debate. 
On  March  11,  he  was  heard  over  Station 
KMYR,  Denver  in  a talk  before  the  Cham- 
ber of  Commerce.  He  spoke  of  the  manner 
in  which  this  empire  was  hewn  from  the 
wilderness.  Its  vast  contribution  to  prog- 
ress of  the  world  has  been  due  to  energy 
unhampered  by  any  governmental  regi- 
mentation of  talent  or  control  of  resources. 
We  should  pledge  our  lives,  if  necessary, 
to  guarantee  our  children  the  same  oppor- 
tunity. Business  and  industrial  leaders 
have  come  together  to  assist  the  medical 
profession  in  combating  socialization  of  our 
doctors  and  institutions.  They  realize  that 
such  would  be  an  entering  wedge  against 
this  nation’s  freedom.  Governmental  agen- 
cies have  propagandized  the  American  pub- 
lic, at  taxpayer’s  expense. 

It  can  be  demonstrated  that  some  seventy- 
five  million  government  dollars  and  75,000 
government  employees  have  been  used  in 
the  effort  to  mould  public  opinion  in  favor 
of  socialized  medicine  and  to  try  to  convince 
the  people  that  it  is  a duty  of  the  govern- 
ment to  foster  the  enterprise.  Mr.  Harness 
referred  to  the  Federal  Security  Agency  as 
a “sprawling  department.”  It  has  been  the 
chief  advocate  of  the  government’s  program 
to  institute  State  Medicine.  Its  workers  and 
representatives  have  been  hand-picked  and 
its  drive  has  been  persistent.  At  the  Na- 
tional Health  Assembly  last  May  these  rep- 
resentatives “found”  what  they  were  ex- 
pected to  find  and  the  report  convinces  us 


that  a glowing  package  can  be  wrapped  up 
to  appeal  to  the  majority  of  people.  They 
came  together  at  the  call  of  Mr.  Ewing,  the 
Federal  Security  Administrator.  They  ig- 
nored the  failure  of  plans  elsewhere  in  the 
world  and  deceived  people  into  thinking 
that  our  national  state  of  health  is  deplor- 
able. This  is  easily  refuted;  any  thinking 
person  would  realize  that  no  agency  of  the 
government  can  cure  imbecility  or  flat  feet. 

A large  percentage  of  Americans  advo- 
cate a powerful  government,  as  it  exists 
today;  they  look  to  Washington  to  solve 
their  problems.  However,  it  is  time  for  us 
to  descend  to  the  hard  ground  of  reality. 
Surely  a majority  of  our  people  will  oppose 
anything  which  rejects  their  freedom.  Many 
have  accepted  controls  as  safety  factors 
against  inflation,  and  a political  campaign 
which  promised  everybody  everything  suc- 
ceeded. The  people  were  swayed  by  prom- 
ised ends  and  demonstrated  the  fundamen- 
tal selfishness  of  human  beings — themselves 
first,  other  people  and  the  government  last. 

The  speaker  went  on  to  point  out  the 
incalculable  cost  of  governmental  medicine, 
which  would  be  a sure  way  to  bankrupt  the 
nation  and  to  destroy  individual  incentive 
and  our  free  institutions.  All  of  the  -isms 
on  earth  have  enforced  a system  of  State 
Medicine  and  all  have  been  followed  by 
governmental  regimentation  of  education, 
the  press,  transportation,  radio  and  other 
means  of  communication  and  the  System 
itself  has  been  a consistent  failure. 

The  answer  to  the  great  controversy 
should  come  from  the  medical  profession 
and  its  schools  aided  by  promulgation  of  the 
truth  by  our  press.  We  need  to  improve  our 
public  relations.  The  A.M.A.  and  a number 
of  its  constituent  societies  have  made  con- 
structive studies  of  this  problem.  At  last 


for  May,  1949 


361 


the  A.M.A.  has  offered  a program  of  its  own 
and  we  have  come  to  grips  with  those  who 
oppose  it.  It  will,  of  course,,  take  time  for 
such  an  immense  program  to  be  worked  out. 
While  the  process  is  evolving,  the  public 
must  be  shown  that  there  is  no  more  reason 
for  the  government  to  control  and  adminis- 
ter its  medical  service  than  for  it  to  provide 
legal  talent,  groceries,  or  even  to  pay  our 
rent.  They  must  realize  that  no  spearhead 
toward  complete  socialization  of  America 
must  be  admitted,  for  America  is  the  only 
remaining  sanctuary  of  freedom  on  the  face 
of  the  earth. 

Mr.  Forest  Harness  has  amply  demon- 
strated that  he  is  a strong,  forceful,  sincere 
and  effective  speaker.  His  feet  are  on  the 
ground  and  he  is  not  a radical.  His  value  to 
a cause  lies  in  his  quality  as  a man,  the 
soundness  of  his  investigations,  and  the 
truth  of  his  convictions.  He  should  not  be 
subjected  to  the  smartiness  and  prattle  of 
left  wing  adversaries  in  debates.  Let  us 
apply  talent  such  as  his  to  its  very  best 
advantage. 

V 

Indemnity  Plans 

'^HE  people  must  be  convinced  that  “free” 
medical  service  is  not  the  answer  to  their 
health  requirements.  In  fact,  like  cheap 
merchandise,  it  is  in  the  long  run  most  ex- 
pensive. Any  plan,  governmental  or  other- 
wise, should  cover  catastrophic  illness  but 
not  lower  standards  of  medical  care. 

Physicians,  as  well  as  patients,  must  be 
satisfied  with  the  principles  and  manage- 
ment of  any  new  method  of  meeting  essen- 
tial needs  of  the  public,  if  the  new  method 
is  to  succeed.  Physicians  are  not  unreason- 
able and  have  given  ample  demonstration 
of  their  willingness  to  cooperate  with  large 
scale  enterprises  which  are  actuarily  sound 
and  do  not  lower  standards  of  care.  Paren- 
thetically, we  might  add  that  doctors  ap- 
preciate dealing  with  those  who  do  not  re- 
quire filling  out  innumerable  blanks.  Such 
is  not  one  of  the  attributes  of  governmental 
agencies. 

Indemnity  plans  seem  to  be  the  most  feas- 
ible from  many  standpoints.  Such  is  Ohio 


Medical  Indemnity,  Inc.;  it  has  grown  to 
serve  1,400,000  subscribers.  Physicians  of 
that  state  for  the  most  part  accept  the  in- 
demnity as  full  payment  in  lower  income 
groups.  There  are  few  complaints  from 
patients  or  from  doctors  and  thousands  of 
grateful  subscribers  have  freely  expressed 
their  satisfaction.  Such  organizations  are 
doing  a great  deal  toward  solving  America’s 
needs  for  coverage  of  catastrophic  illnesses. 
Their  survival  and  rapid  growth  provide 
the  most  logical  answer  to  the  threat  of 
governmental  intervention. 

A survey  in  Michigan  has  shown  that  80 
to  88  per  cent  of  the  population,  at  least  un- 
til recently,  has  an  annual  income  under 
$2,500  per  family.  Perhaps  this  may  serve  as 
an  index  to  the  national  situation.  These 
families  should  be  served  by  a plan  which 
cares  for  the  total  expense  of  illness,  not 
incurring  the  obligation  of  an  additional 
charge  by  physicians. 

Family  incomes  between  $2,500  and  $4,000 
should  without  hardship  be  able  to  meet 
reasonable  expenses  above  those  covered 
by  an  indemnity  plan.  Doctors  are  entitled 
to  all  sources  of  information  regarding  the 
financial  status  of  their  patients  and  in  turn 
should  adhere  without  pressure  to  the  eth- 
ical plans  which  are  geared  to  answer  the 
national  need  and  demand.  Their  success  is 
in  the  hands  of  doctors — and  unless  they 
work  and  survive,  far  less  desirable  conse- 
quences are  bound  to  follow. 

One  large  organization  reports  only  sev- 
enty-five complaints  out  of  a million  claims. 
Of  these,  less  than  two  dozeh.  appeared  to 
be  justified  and  a word  to  the  doctor  in  each 
instance  solved  the  controversy  amicably. 

When  a plan  is  sponsored  by  a state  med- 
ical society,  a non-participating  doctor  has 
the  same  opportunity  as  a participating 
member  to  have  his  voice  heard  through 
the  House  of  Delegates.  Thus  there  is  no 
justified  reason  for  anything  but  coopera- 
tion from  any  doctor  or  medical  organiza- 
tion toward  the  medical  service  institutions 
thus  conceived  and  managed.  Voluntary 
plans  satisfactory  to  doctor  and  patient  are 
mandatory,  for  there  is  no  common  meeting 
ground  of  voluntary  and  compulsory  meth- 
ods of  dispensing  medical  care. 


362 


Rocky  Mountain  Medical  Journal 


SILHOUETTES 

from  the  A.M.A.  House  of  Delegates 


From  a recent  broadcast — Mr.  Spivak:  “Mr. 
Ewing,  I would  like  to  ask  you  a practical  ques- 
tion. Suppose  most  of  the  180,000  doctors  refuse 
to  join  your  system — what  then?  What  are  you 
going  to  do  about  that?”  Mr.  Ewing;  “You  mean 
a doctors’  strike,  a refusal  to  do  the  thing?  I 
just  don’t  think  that  such  a thing  wordd  happen.” 

And  why  not?  In  1948  Dr.  Ralph  S.  Johnston 
offered  a suggestion,  in  all  seriousness,  that  the 
medical  profession  become  unionized.  Further, 
that  we  should  consider  requesting  a charter  in 
one  of  the  large  labor  organizations.  Courts 
have  ruled  that  the  medical  profession  is  a trade 
organization.  We  are  law-abiding  and  sub- 
servient to  legal  dictate  and  opinion.  We  should 
trim  our  sails  to  existing  breezes.  As  a trade 
organization  we  would  have  the  right  to  bargain 
collectively  and  the  right  to  strike.  Such  a pro- 
cedure would  be  legal  and  justifiable.  It  might 
serve  to  curb  bureaucratic  hysteria  and  political 
bulldozing. 

Naturally,  following  labor  organization  tech- 
nic, we  would  have  a “maintenance  crew.” 
The  mine  would  not  be  flooded;  fire  hazards 
would  be  protected.  And  would  be  available 
for  emergencies.  What  are  some  of  these  emer- 
gencies? First,  semi-intoxicated  human  beings 
who  knife  or  bludgeon  each  other.  Second,  auto 
driving  morons,  drunk  or  sober.  Third,  and 
really  important,  biological  tragedies  as  fulmin- 
ating illnesses,  acute  abdominal  conditions, 
cardiac  and  cerebral  thromboses,  the  woman  in 
labor,  prostatic  obstruction  (particularly  in  poli- 
ticians), massive  hemorrhage,  etc.  Fourth,  and 
equally  important,  the  injuries  of  citizens  in  in- 
dustry. 

The  enactment  of  the  compulsory  health  in- 
surance tax  bill  would  render  the  medical  pro- 
fession the  harried  and  humble  servant  of  some 
hammer-head,  in  Washington  or  Denver,  whose 
knowledge  of  medical  principles  and  practice 
would  not  enable  him  to  distinguish  between 
penicillin  and  peruna.  He  would  be  the  cook 
and  the  captain  bold  and  the  mate  of  the  Nancy 
brig.  Government  (or  politics),  what  crimes  are 
committed  in  thy  name! 

* * « « 

The  American  Medical  Association  is  Big  Busi- 
ness. At  headquarters  the  cost  is  about  one  and 
one-third  millions  of  dollars  annually.  Addition- 
ally, publications,  the  Journal  A.M.A.  leading, 
account  for  about  three  million  more  dollars  per 
year.  The  total  being  more  than  four  millions  of 
dollars  per  year  for  headquarters  operations. 
The  “business  income”  of  the  members  of  the 


American  Medical  Association  in  the  U.S.A.  has 
been  estimated  as  totaling  three  billion  dollars, 
gross.  There  are  deductible  expenses  incident 
to  being  in  business.  The  American  Medical 
Association  was  organized  and  is  maintained  to 
guard  and  promote  the  advancing  standards  of 
medical  care  in  the  public  interest. 

We  have  a three  billion  dollar-a-year  business 
with  a four  million  dollar-a-year  expenditure 
in  the  headquarters.  To  contemplate  a multi- 
billion dollar  business  is  breath-taking.  What  of 
management?  Twice  yearly  the  stockholders 
(House  of  Delegates)  meet,  discuss  and  vote  on 
matters  of  policy.  The  Directors  (Board  of 
Trustees)  meet  quarterly  for  a day  or  two  and 
strive,  heroically,  to  extract  a modicum  of  horse 
sense  out  of  uncoordinated  reports  of  councils, 
bureaus  and  committees  none  of  which  knows, 
apparently,  what  any  other  is  doing  or  why. 

We,  the  rank  and  file  of  the  A.M.A.,  are  not 
generous  with  our  Directors.  The  Association 
pays  their  car-fare  and  about  one-fourth  of  in- 
cidental expenses.  We  are  grateful  but  we  are 
not  practical.  It  is  a coveted  honor  to  be  a 
Director  (member  of  the  Board  of  Trustees)  but 
honor  cannot  be  deposited  in  the  First  National 
Bank.  The  sacrifices  we  accept  and  appear 
to  expect  from  our  Trustees  are  shameful.  Were 
they  multi-millionaires,  a self-respecting  organi- 
zation should  not  countenance  largesse. 

Our  Board  of  Trustees  should  be  reimbursed 
generously.  Then,  and  then  only,  could  mem- 
bersi  of  the  A.M.A.  make  certain,  suggestions, 
even  demands.  We  could  insist  that  our  Trus- 
tees meet  more  frequently,  that  they  assume 
more  responsibility,  that  the  Secretarj^  and  Gen- 
eral Manager  be  given  adequate  authority,  that 
an  analysis  of  operations  at  headquarters  be 
made  by  experts  in  business  administration,  that 
there  be  some  coordination  between  bureaus  and 
committees,  that  a little  “firing”  be  instituted, 
that  the  Augean  stable  be  cleansed.  There  is 
a suspicion  abroad  that  the  Association  is  sirf- 
fering  frorn  faulty  management  and  that  in- 
ternal relations  are  on  the  cat  and  dog  level. 
Our  colossus  has  feet  of  clay. 

* * * * 

Best  News  of  the  Month 

The  Board  of  Trustees  of  the  National  Physi- 
cians Committee  has  ordered  that  hybrid  organ- 
ization to  suspend  operations  April  1,  1949,  “in  an 
orderly  manner.”  Thus  is  shed  a giant  barnacle 
from  the  ship  of  progress.  Hooray. 

Best  Laugh  of  the  Month 

A release  by  the  Committee  for  the  Nation’s 
Health  (Channing  Frothingham,  Mike  Davis, 
et  ah,  with  Boas  smirking  approbation).  A week 
after  the  annormcement  of  the  happy  death  of 
the  National  Physicians  Committee,  the  Commit- 
tee for  the  Nation’s  Health  accuses  the  A.M.A. 
and  the  N.P.C.  of  “holding  hands  again.”  A belly 
laugh.  WILLIAM  H.  HALLEY,  M.D. 


for  May,  1949 


363 


Orig  inai  yirticles 


A PSYCHIATRIST  LOOKS  AT  COMPULSORY  HEALTH  INSURANCE 

FRANKLIN  G.  EBAUGH,  M.D. 

DENVER 


Good  health  for  Americans  is  a goal  upon 
which  agreement  is  general.  While  the  phy- 
sician’s professional  concern  with  this  goal 
does  not  lead  him  to  consider  himself  as  the 
sole  instrument  for  its  realization,  yet  wis- 
dom about  it  should  be  most  available  to 
him.  Human  motivations  and  personality 
will  finally  determine  the  outcome  what- 
ever the  plan.  No  system  can  function  at  a 
higher  level  than  the  people  who  partici- 
pate in  it.  Congress  cannot  legislate  a re- 
sult; it  can  only  legislate  a plan.  Regardless 
of  the  board  humanitarian  objectives  of  the 
plan,  if  it  is  not  geared  to  the  motivational 
factors  in  American  behavior  it  will  be  un- 
successful. 

On  this  premise  let  us  examine  the  per- 
sonality needs  and  motives  involved  in  a 
proposal  for  compulsory  health  insurance. 
This  can  be  best  approached  by  contrasting 
the  present  with  the  proposed  situation.  The 
first  basic  change  involves  simple  arithme- 
tic. There  are  two  participants  in  the  pres- 
ent medical  relationship,  the  physician  and 
the  patient;  three  in  the  proposed  situation, 
the  physician,  the  patient  and  the  govern- 
ment agency.  Psychiatric  experience,  psy- 
chological experimentation  and  common 
knowledge  agree  that  the  greater  the  num- 
ber of  relationships  the  greater  the  com- 
plexity of  problems.  A person  to  person 
relation  involves  one  major  interpersonal 
variable.  A three  person  situation  involves 
three  interpersonal  variables  and  three  re- 
actions to  the  interaction  of  the  two  other 
persons — a total  of  six  variables.  This  rep- 
sents  a six-fold  increase  in  complextiy. 
When  we  are  dealing  with  three  groups, 
inter-relations  of  astronomical  proportions 
develop. 

Now  let  us  contrast  the  probable  motiva- 
tions involved  in  the  present  medical  situ- 
ation with  those  in  the  compulsory  health 


insurance  proposal.  Our  present  system  in- 
cludes primarily:  (1)  A patient  who  is  at- 
tempting to  regain  or  maintain  adequate 
health.  This  patient’s  economic  security, 
self-esteem  and  social  prestige  depend  on  a 
successful  outcome;  (2)  a physician,  who 
personally  or  by  professional  referral,  is  in 
a favorable  position  to  help.  The  physi- 
cian’s self-esteem,  economic  security,  social 
prestige  and  altruistic  needs  are  directly 
dependent  upon  how  adequately  he  can 
help.  Thus  both  the  patient’s  and  the  phy- 
sician’s motives  converge  toward  the  thera- 
peutic goal.  Both  persons  are  anxious  to 
relieve  the  health  problem.  The  likelihood 
of  favorable  results  is  maximal. 

Patients’  Motivations 

Contrast  the  present  situation  with  the 
probable  result  of  the  compulsory  health 
proposal.  (1)  The  patient  will  view  the 
physician  as  a public  servant  who  has  al- 
ready been  paid  for  his  services  and  who 
is  hence  obligated  to  treat  even  a non- 
significant problem;  (2)  he  will  tend  to  feel 
that  his  deducted  taxes  need  to  be  repaid 
in  some  way  and  will  insist  on  being  repaid. 
This  will  probably  result  in  unnecessary 
calls,  overly  long  illness  disability  and  hos- 
tility toward  the  government  agency  and 
the  physician  when  efficient  termination  of 
disability  is  attempted;  (3)  the  patient  is 
likely  to  develop  a strong  dependency  re- 
lationship with  extravagant  expectations 
for  help  and  extreme  annoyance  at  failure. 
In  our  culture  the  emphasis  upon  self-re- 
liance, and  personal  initiative  makes  the 
dangers  of  dependency  greater  than  else- 
where. Dependency  is  generally  disap- 
proved here,  and  in  any  society  results  in 
deterioration  and  refusal  to  accept  respon- 
sibility. 

While  the  foregoing  can  be  inferred  from 
the  motivational  analysis  we  need  not  de- 


364 


Rocky  Mountain  Medical  Journal 


pend  exclusively  upon  this  reasoning.  Ex- 
perience in  Great  Britain,  Germany,  the 
U.  S.  Armed  Forces  and  Veterans  Admin- 
istration demonstrate  that  the  patients’  mo- 
tivations work  in  this  fashion.  These  ex- 
periences demonstrate  that  the  patient  (1) 
makes  unnecessary  and  picayune  demands 
for  attention;  (2)  has  excessively  long  and 
frequent  minor  illnesses  and  disabilities; 
(3)  becomes  excessively  and  inappropriately 
critical  of  medical  and  governmental  serv- 
ice with  resultant  loss  of  faith  in  the  phy- 
sician’s ability  to  cure  his  illness. 

Physicians’  Motivations 

Now  let  us  examine  the  probable  shift 
in  the  physician’s  motivations.  Currently 
he  is  concerned  with  professional  and  ther- 
apeutic adequacy  for  reasons  of  self-es- 
teem, social  prestige,  economic  security  and 
personal  service.  Currently  he  deals  with 
a patient  who  attempts  active  cooperation 
for  much  the  same  reasons.  The  satisfac- 
tion of  both  persons  depends  upon  their 
ability  to  solve  the  therapeutic  problem. 
Under  compulsory  health  insurance  the  phy- 
sician’s motivations  would  be  shifted: 
(1)  He  will  be  dealing  with  a pa- 
tient whose  demands  have  become  picayune 
and  excessive;  whose  cooperation  is  re- 
duced and  whose  hostility  has  increased. 
The  physician  can  legitimately  be  expected 
to  have  less  interest  in  the  patient  just  be- 
cause of  these  changes;  he  will  also  have 
less  time  for  the  patient’s  real  problems. 
The  physician  may  also  be  expected  to  de- 
velop a reactive  hostility  with  a further 
deterioration  in  therapeutic  adequacy;  (2) 
supplementing  the  foregoing  basis  for  “the 
brush-off”  the  physician  would  have  an 
added  incentive  under  (a)  a salary  system, 
to  do  as  httle  as  possible  for  the  greatest 
financial  return  or,  (b)  under  a per  capita 
system,  to  see  as  many  patients  as  minimal- 
ly as  possible  for  the  maximal  financial  re- 
turn; (3)  since  the  physician’s  responsi- 
bility is  no  longer  directly  to  the  patient  he 
would  tend  to  feel  less  keenly  than  he  now 
does  the  need  for  complete  adequacy;  (4) 
since  the  physician  would  no  longer  be 
completely  responsible  for  the  patient,  but 


would  share  responsibility  with  a govern- 
ment agency  his  personal  pride  in  profes- 
sional excellence  would  tend  to  diminish; 
(5)  since  the  incentive  system  to  which  our 
present  generation  of  physicians  is  accus- 
tomed would  be  grossly  changed  they  would 
be  less  adequately  motivated;  (6)  an  in- 
tense resentment  of  the  noncreative  pos- 
sibilities of  their  work,  the  minor  com- 
plaints and  hostilities  of  their  patients,  the 
irksome  dependency  and  submission  to  a 
government  agency,  and  the  lowering  of 
the  prestige  level  of  the  profession  might  be 
expected  to  develop;  (7)  the  high  type  of 
person  drawn  to  medicine  by  our  present 
incentives  of  humanitarian  service,  social 
and  self-esteem,  and  economic  adequacy 
might  no  longer  choose  the  medical  profes- 
sion. This  change  would  result  from  the 
poorer  quality  of  performance  possible,  the 
tendency  of  government  to  underpay  public 
servants,  and  the  lack  of  opportunities  for 
personal  initiative  and  gratification  under 
government  service.  Hence  the  intellectual 
and  personal  qualities  of  newer  doctors 
would  probably  be  lower  than  the  present 
levels. 

The  foregoing  psychologically  derived  ob- 
servations about  physician  motivations  have 
also  been  demonstrated  by  experience.  Va- 
rious U.  S.  publicly  supported  and  man- 
aged programs,  and  foreign  governments 
with  compulsory  health  insurance  have 
found:  (1)  that  the  quality  of  medical  serv- 
ice deteriorates;  (2)  that  the  physician  sub- 
stitutes for  the  development  of  clinical  ma- 
turity a tendency  to  blame  others  and  shift 
responsibility;  (3)  that  the  physician  tends 
to  reduce  his  adequacy  of  treatment  of  all 
patients  for  both  practical  and  motivational 
reasons;  (4)  that  hostility  toward  both  the 
government  and  the  patient  develops  with 
a consequent  loss  of  personal  satisfaction 
and  professional  effectiveness.  All  of  these 
factors  are  reflected  in  a higher  cost  of  and 
lower  quality  of  medical  service. 

Government  Agency  Motivations 

The  third  group  whose  motivations  com- 
plicate the  compulsory  health  insurance 
picture  is  the  administering  governmental 


for  May,  1949 


365 


bureau.  The  phenomenal  growth  of  gov- 
ernment bureaus  in  the  past  few  years,  and 
the  tendency  for  each  to  expand  its  activi- 
ties and  personnel  illustrates  part  of  the 
problem  from  this  area.  The  sheer  clerical 
work  added  to  the  doctor’s  already  over- 
loaded program  would  be  a source  of  dis- 
ruptive irritation.  Beyond  this,  the  desire 
of  non-medical  administrators  to  run  things 
would  tend  to  harass  and  antagonize  phy- 
sicians. This  would  further  facilitate  a de- 
terioration in  the  physician’s  sense  of  re- 
sponsibility and  capacity  for  quality  service. 
Experience  with  non-medical  administrators 
of  health  problems  has  shown  that  their 
lack  of  capacity  to  understand  the  ramifi- 
cations of  the  problems  and  their  desire  to 
usurp  control  leads  to  restrictive  interfering 
rules  and  red-tape.  These  inevitably  result 
in  deterioration  of  service.  At  the  same 
time  the  physician  subjected  to  these  con- 
trols develops  some  apathy  about  his  own 
adequacy  and  permits  his  service  to  deteri- 
orate because  he  is  unable  to  do  anything 
about  it.  Dependency  feelings  may  be  ex- 
pected to  develop  in  physicians  under  these 
circumstances.  He  is  no  longer  a responsi- 
ble, self-reliant  individual  because  the 
agency  shares  the  control  of  the  patient. 

Cost  of  Service 

Finally  the  motivational  problems  dis- 
cussed would  have  a direct  and  extreme 
effect  upon  the  cost  of  service.  With  in- 
crease in  patient  demands,  decrease  in  pa- 
tient cooperation  and  deterioration  of  phy- 
sician service  we  might  expect  a situation 
of  rising  medical  costs  and  deteriorating 
medical  service.  The  increased  costs  would 
constitute  an  additional  motivational  haz- 
ard for  both  physicians  and  patient.  Both 
would  be  frustrated  by  the  increasing  dis- 
crepancy of  service  and  cost. 

This  situation  has  also  been  demonstrated 
in  countries  which  have  adopted  compul- 
sory health  insurance.  In  Germany  between 
1885  and  1939  the  cost  of  insurance  per 
member  multiplied  eight  times.  In  New 
Zealand  the  cost  has  risen  from  less  than 
$8  million  in  1942  to  $20  million  in  1947. 


One  can  maintain  that  these  increased  costs 
are  equally  shared,  but  the  stated  objective 
of  compulsory  health  insurance  is  to  help 
people  avoid  the  disastrous  economic  effects 
of  illness,  not  to  bring  equal  disaster  to 
everyone. 

In  summary  it  appears  on  motivational 
grounds  that  the  complexity  of  health  prob- 
lems would  be  increased,  that  disabling 
sickness  would  be  prolonged,  that  the  quali- 
ty of  medical  service  would  deteriorate,  that 
personal  satisfaction  and  clinical  maturity 
for  the  physician  would  be  reduced,  and 
that  the  progress  of  medical  science  would 
be  slowed  as  a result  of  compulsory  health 
insurance.  Whether  this  deteriorated  and 
inflated  medical  service  would  become  more 
widely  available  can  be  evaluated  on  sim- 
ilar grounds. 

The  foregoing  contrast  has  somewhat 
over-idealized  our  present  system  of  med- 
ical services.  That  there  are  plenty  of  con- 
temporary problems  is  quite  apparent. 
These  defects  are  now  being  remedied, 
however,  by  the  adoption  of  voluntary 
health  insurance,  by  improved  medical  edu- 
cation and  quality  of  services,  and  a better 
distribution  of  physicians. 


CANCER  FILM 

A new  film,  titled  “Cancer:  The  Problem  of 
Early  Diagnosis,”  which  has  received  the  ap- 
proval of  the  American  Medical  Association’s 
Committee  on  Medical  Motion  Pictures,  was 
made  available  to  the  medical  profession  this 
week.  Through  the  efforts  of  its  co-sponsors, 
the  American  Cancer  Society  and  the  National 
Cancer  Institute  of  the  United  States  Public 
Health  Service,  prints  for  single  showings  may 
be  borrowed  from  State  Cancer  Society  offices, 
State  Health  Departments,  and  four  regional 
offices  of  Association  Films  located  in  New  York 
City;  Chicago,  Illinois;  Dallas,  Texas,  and  San 
Francisco,  California.  The  film,  designed  for 
general  practitioners,  is  based  on  the  premise 
that  if  cancer  were  diagnosed  early  and  effec- 
tively treated  the  death  rate  might  be  reduced 
by  admost  50  per  cent.  “Cancer:  The  Problem 
of  Early  Diagnosis”  is  the  first  in  a series  of 
six  films  to  deal  with  the  subject.  Prints  of  the 
film  are  also  available  for  purchase  through 
Audio  Productions,  Inc.,  630  Ninth  Avenue,  New 
York  19,  N.  Y.,  the  company  which  produced  the 
film.  Prints  cost  $150  each,  and  may  be  or- 
dered from  Audio  Productions  for  preview  pend- 
ing purchase.  The  film  was  reviewed  in  the 
January  29th  issue  of  the  AMA  Journal.  The 
comment  was:  “The  photography,  animation  and 
narration  are  excellent.” 


366 


Rocky  Mountain  Medical  Journal 


TRAUMA  AS  ALLEGED  CAUSE  OF  APPENDICITIS  IN 
COMPENSATION  CASES 

HAROLD  CLARK  THOMPSON,  L.L.B.* 

DENVER 


Trauma  as  an  etiological  factor  in  cases 
of  appendicitis  has  long  been  a matter  of 
controversy.  In  fact,  almost  since  the  time 
that  appendicitis  became  recognized  as  a 
definite  entity  inquiring  minds  in  the  med- 
ical profession  have  sought  the  cause  of  the 
disease,  and  we  find  the  debate  as  to  wheth- 
er or  not  trauma  plays  a factor  beginning  to 
take  form  early  in  the  century.  In  the  be- 
ginning the  problem  was  more  or  less  an 
abstract  one,  but  with  the  development  of 
the  workmen’s  compensation  laws  and  liti- 
gation involving  the  interpretation  of  in- 
surance policies,  the  question  has  been  given 
ever  increasing  attention,  particularly  in 
the  medical-legal  field. 

In  private  practice  the  surgeon  is  not 
particularly  concerned  with  the  cause  of 
appendicitis  as  long  as  his  diagnosis  is  cor- 
rect and  he  can  undertake  the  necessary 
procedures  which  the  exigencies  of  the 
case  demand.  With  the  development  of 
workmen’s  compensation  laws  a new 
factor  was  injected  into  the  situation. 
Often  an  employee  would  be  stricken 
while  at  work,  and,  since  the  em- 
ployee was  entitled  to  compensation  and 
medical  benefits  for  any  condition  caused 
by  accidental  injury  arising  out  of  and  in 
the  course  of  his  employment,  there  began 
to  appear  in  the  reports  of  the  various 
bodies  and  the  courts  administering  the 
Compensation  Act  cases  where  it  was 
claimed  that  appendicitis  was  caused  or 
aggravated  by  trauma  received  in  the  em- 
ployment. While  judicial  determination 
does  not  decide  any  issue  from  the  purely 
scientific  standpoint,  the  discussions  pre- 
sented before  judicial  tribunals  in  an  at- 
tempt to  solve  the  riddle  of  cause  and  effect 
are  sometimes  of  value  in  the  general  con- 
sideration of  the  controversy  involved. 

With  that  in  mind,  we  have  made  a sur- 
vey of  some  of  the  claims  which  have  been 
presented  before  the  Industrial  Commission 

♦Director  of  Claims,  State  Compensation  Insurance 
Fund  of  Colorado. 


of  Colorado  wherein  trauma  was  asserted 
to  be  a factor  in  the  development  of  ap- 
pendicitis. The  majority  of  cases  discussed 
below  involved  employees  whose  employers 
were  insured  with  the  State  Compensation 
Insurance  Fund.  One  or  two  cases  where 
a private  insurance  carrier  was  involved, 
however,  have  been  added  to  the  collection, 
chiefly  for  the  purpose  of  getting  as  much 
data  on  the  situation  as  possible. 

Since  no  definite  statistics  are  kept  by  the 
Industrial  Commission  or  the  State  Com- 
pensation Insurance  Fund  on  the  types  of 
the  various  disabilities  compensated,  the 
collection  of  the  following  cases  was  ef- 
fected through  the  memory  of  the  personnel 
and  it,  therefore,  cannot  be  said  that  they 
include  all  of  the  appendicitis  cases  heard 
or  determined  by  the  Commission. 

Under  the  Workmen’s  Compensation  Act 
of  Colorado  a case  is  compensable  if  an  ac- 
cident either  causes  a disability  or  aggra- 
vates a pre-existing  disease  or  condition.  In 
considering  the  problem  of  trauma  and  ap- 
pendicitis, then,  we  are  faced  with  two  ques- 
tions— first,  did  trauma  cause  the  appendi- 
citis or,  second,  did  it  aggravate  a pre-exist- 
ing condition,  such  as  chronic  appendicitis, 
to  the  point  that  surgery  or  other  treatment 
or  interference  was  necessitated?  Further, 
the  cases  also  reveal  that  two  definite  types 
of  trauma  have  been  alleged  as  the  cause  of 
appendicitis — first,  direct  violence  or  trau- 
ma to  the  abdominal  wall  and  second, 
strain.  A review  of  the  testimony  taken  in 
the  several  cases  reveals  the  fact  that  a 
higher  percentage  of  the  experts  conceded 
the  possibility  of  trauma  as  an  etiological 
factor  in  those  cases  where  the  trauma  was 
direct  and  violent  than  in  those  cases  where 
strain  was  alleged  to  be  the  exciting  factor. 
Before  attempting  an  analysis  or  drawing 
conclusions,  a review  of  the  facts  of  each 
case  may  be  of  value. 

CASE  REPORTS 

No.  CF  9606.  Claimant  struck  in  right  side  by 
motor  crank  November  14,  1927.  Acute  pain. 


for  May,  1949 


367 


Exploratory  operation  same  day.  Postoperative 
diagnosis,  inflamed  appendix.  Compensated. 

No.  CF  9605.  Claimant  struck  in  abdomen  by 
end  of  plank,  November  25,  1927.  Immediate 
pain;  external  bruises  of  abdomen  still  present 
December  10,  1927,  when  first  seen  by  physician. 
Postoperative  diagnosis,  congested  appendix  with 
adhesions  and  local  inflammatory  condition. 
Compensated. 

No.  AF  35279.  Pain  followed  strain  of  lifting 
manhead  of  boiler  weighing  100  pounds  August 
15,  1929.  Claimant  operated  August  17,  1929. 
Ruptured  appendix  and  peritonitis  found.  Pa- 
tient died.  Compensation  denied.  Industrial  Com- 
mission vs.  Diveley,  88  Colo.  190. 

No.  CF  16115.  Claimant  struck  on  abdomen 
by  handle  of  plow  April  2,  1932.  Immediate  acute 
pain.  Operated  April  7,  1932.  Postoperative 
diagnosis,  acutely  inflamed  appendix,  bruise  of 
abdominal  wall,  hemorrhages  over  appendix  and 
cecum.  Compensated. 

No.  CF  16357.  Claimant  alleged  strain  of  right 
side  while  digging  frozen  clay  December  15, 
1932.  Operated  about  two  months  later  for  ap- 
pendicitis. Compensation  denied. 

No.  CF  18160.  Claimant  strained  himself  while 
helping  move  a 500-pound  cable  spool.  Imme- 
diate pain.  Operated  for  appendicitis  next  day. 
History  of  one  prior  attack.  Compensation  de- 
nied. 

No.  CF  24684.  Claimant  fell  against  handle  of 
drilling  machine  July  18,  1934.  Immediate  pain 
and  nausea.  Operated  July  19  for  ruptured  ap- 
pendix, expired  July  31,  1934.  Compensated. 

No.  AF  68591.  Claimant  felt  pain  while  bend- 
ing over  to  lift  scoop  shovel  full  of  grain,  Au- 
gust 17,  1934.  Operated  for  acute  appendicitis 
August  20,  1934.  Compensation  denied. 

No.  AF  74749.  Claimant  while  standing  on 
cross  arm  of  light  pole  fell  across  a higher  cross 
arm.  An  insulator  struck  him  in  abdomen 
over  region  of  appendix  September  10,  1934. 
Immediate  pain  and  nausea.  Operated  October 
5,  1934;  acute  gangrenous  appendix  full  of  pus 
found.  Operated  October  13,  1934,  for  locked 
bowel  and  again  February  18,  1935,  for  same 
condition.  Compensation  denied. 

No.  CF  20317.  Deceased  collapsed  at  home  Oc- 
tober 9,  1934,  after  having  complained  of  pain 
during  previous  week.  Deceased  died  October 
2i,  1934,  of  perforated  appendix  and  general 
peritonitis.  Claim  filed  alleging  condition  due 
to  constant  jolting  of  road  grader.  Claim  denied. 
No  evidence  of  accident. 

No.  AF  114835.  Claimant  fell  off  tractor  land- 
ing on  side,  breath  was  “knocked  out.”  Imme- 
diate intense  pain.  Operated  that  night,  acute 
appendix  found.  Attending  surgeon  gave  opin- 
ion that  condition  was  unrelated  to  accident. 
Claim  denied. 

No.  CF  20421.  Claimant,  a police  officer,  was 
shot  through  lower  right  abdomen,  March  11, 
1935.  Six  intestinal  wounds  and  wounds  in 
mesentery  closed.  Experienced  pain  and  nausea 
in  old  scar  June  7,  1938.  Operation  revealed 
rupture  of  an  acute  suppurative  appendix.  In- 
surance carrier  denied  hability.  Claim  dropped. 

No.  CF  28350.  Clahnant  suffered  abdominal 
pain  while  moving  furniture  October  5,  1937. 
History  of  previous  pain  October  1 with  a period 
of  relief  on  October  2.  Operated  October  5. 
Gangrenous  ruptured  appendix  foimd.  Death 
occurred  October  11.  Claim  denied. 

No.  CF  30412.  Claimant  experienced  severe 
pain  while  pulling  on  a root  October  22,  1938. 


Had  had  pain  in  stomach  several  days  previously. 
Operated  October  22.  Postoperative  diagnosis, 
chronic  appendicitis.  Claim  denied. 

No.  CF  30551.  Fireman  sprained  back  severely 
lifting  hose  October  15,  1938.  While  in  hospital 
for  back  injury  suffered  attack  of  acute  appen- 
dicitis November  19,  1938.  Operation  revealed 
acutely  inflamed  appendix.  Back  injury  com- 
pensated; compensation  and  medical  expenses 
for  appendicitis  denied. 

No.  IC  94927.  Claimant  noticed  abdominal  dis- 
tress while  hfting  bundle  of  laundry  October  7, 
1938.  Operated  October  10  for  acute,  gangrenous 
appendix.  Expired  October  13.  Claim  denied. 

No.  AF  144131.  Claimant  fell  over  a table 
striking  right  side  of  abdomen  February  7,  1939. 
Immediate  pain  and  vomiting.  No  evidence  of 
trauma  to  abdominal  wall  when  seen  by  phy- 
sician February  24.  History  of  prior  pain  in 
abdomen  for  one  year.  Diagnosis,  chronic  ap- 
pendicitis. Liability  refused  by  insurance  car- 
rier. Claim  dropped. 

No.  IC  104270.  Claimant  felt  sudden  pain  in 
abdomen  while  lifting  200-pound  gear  case  July 
12,  1938.  Operated  July  13  and  acute  gangrenous 
appendix  found.  Claim  denied. 

No.  536.  Claimant  severly  burned  in  gasoline 
explosion,  November,  1915.  On  March  14,  1917, 
he  was  operated  for  acute  appendicitis  and  died 
March  23,  1917.  Operation  also  revealed  numer- 
ous ulcers  of  stomach  and  intestines.  Held:  ap- 
pendicitis not  caused  by  burns  sustained  in  acci- 
dent of  November,  1915.  See  Weaver  v.  Indus- 
trial Commission,  69  Colo.  507  and  72  Colo.  79. 

No.  AF  147861.  Claimant  felt  pain  while  hft- 
ing on  100-pound  can  of  gasoline,  April  5,  1939. 
Severe  attack  of  pain  that  night.  Operated  next 
morning.  Acutely  inflamed  appendix  found.  No 
evidence  of  trauma.  Claim  denied. 

Claimant  had  severe  stabbing  pain  right  side 
while  at  work  December  12,  1931.  Operated  for 
ruptured  appendix  December  13,  died  December 
15.  History  of  alleged  accident  confiised.  Award 
for  compensation  to  widow  reversed  by  Supreme 
Court  because  based  on  hearsay  evidence.  See 
Lallier  Construction  Co.  v.  Industrial  Commis- 
sion, 91  Colo.  593. 

No.  31876.  Claimant  felt  pain  right  side  one 
hour  after  hfting  dead  sheep  from  ditch,  April 
14,  1939.  Operated  next  day  and  an  acute  badly 
infected  appendix  found.  No  evidence  of  traxima. 
Claim  denied. 

No.  CF  34802.  Claimant  strained  self  hfting 
fifty  pounds  April  26,  1940.  One  hoirr  later  be- 
came ill  and  nauseated.  Operated  April  28,  1940; 
acute  appendix  found.  Attending  physician  ad- 
vised claimant  condition  unrelated  to  strain. 
Claim  withdrawn. 

No.  CF  43827.  Claimant  twisted  and  severely 
strained  back  while  hfting  May  13,  1940.  While 
under  treatment  for  back  injury  he  developed 
severe  pains  in  abdomen  Operated  May  14,  1940, 
for  acute  appendicitis.  Compensation  granted 
for  back  injury,  denied  for  appendicitis. 

No.  CF  50446.  Claimant  accidentaUy  rammed 
handle  of  snow  shovel  into  an  old  inguinal  her- 
nia December  27,  1945.  Had  intense  pain.  Op- 
erated December  28.  Hernial  sac  was  fihed  with 
bloody  fluid.  Appendix  located  through  sepa- 
rate incision,  showed  evidence  of  trauma  at  base. 
Attending  physician  gave  opinion  that  appendix 
had  been  in  hernial  sac  at  time  of  accident.  Com- 
pensated. 

CF  56593.  Claimant  became  ill  while  unload- 


368 


Rocky  Mountain  Medical  Journal 


ing  kegs,  December  24,  1947.  Diagnosis:  acute 
appendicitis.  Operated  January  28,  1948.  In 
opinion  of  attending  physician  condition  unre- 
lated to  trauma.  Claim  denied. 

No.  CF  57306.  Claimant  suffered  lumbo-sacral 
strain  March  6,  1948.  Operated  for  appendicitis 
March  9,  1948.  Attending  physician  stated  in 
his  opinion  appendicitis  unrelated  to  injury. 
Back  injury  compensated;  claim  for  compensa- 
tion and  medical  expense  for  appendicitis  de- 
nied. 

CF  58483.  Claimant  crushed  between  steer  and 
fence  at  stockyards.  Pre-operative  diagnosis, 
hernia  and  infected  hematoma.  Postoperative 
diagnosis,  hernia  and  ruptured  retrocecal  ap- 
pendix— both  traumatic.  Compensated. 

It  will  be  noted  that  in  the  cases  men- 
tioned above  there  are  examples  of  both 
types  of  trauma,  i.e.,  direct  trauma  to  the 
abdominal  wall,  and  trauma  in  the  nature 
of  a strain.  Medical  testimony  in  the  va- 
rious cases  ran  generally  along  the  same 
lines.  Some  of  the  surgeons  appearing  be- 
fore the  Commission  took  the  position  that 
there  was  no  such  thing  as  traumatic  appen- 
dicitis, that  any  trauma  capable  of  produc- 
ing appendicitis  would  be  of  such  severity 
that  far  more  damage  would  be  done  to 
the  abdominal  wall  than  to  the  appendix 
itself. 

One  surgeon  testifying  in  one  of  the  cases 
stated  that  nothing  short  of  a rifle  shot  in 
the  region  of  the  appendix  could,  in  his 
opinion,  bring  about  a traumatic  rupture  of 
the  appendix.  Other  physicians  conceded 
the  possibility  that  direct  trauma  to  the 
abdomen  could  cause  appendicitis  or  ag- 
gravate a pre-existing  chronic  appendicitis, 
depending  upon  the  circumstances. 

For  example,  if  an  appendix  were  bound 
down  by  adhesions  so  that  it  was  not  freely 
movable,  a sharp  blow  in  the  region  directly 
over  the  appendix  might  cause  injury  to 
the  organ  or,  if  the  appendix,  because  of 
some  unusual  structure,  size  or  location, 
were  caught  between  a directly  applied 
force  and  the  bony  structure  of  the  pelvis, 
it  was  also  conceivable  that  direct  trauma 
could  cause  injury. 

With  respect  to  the  question  of  strain  and 
its  bearing  on  the  development  of  appen- 
dicitis, those  physicians  who  adhered  to  the 
theory  that  strain  was  an  etiological  factor 
relied  upon  Pascal’s  law  of  physics,  i.e., 
that  since  pressure  applied  to  a liquid  is 


equally  distributed  in  all  directions,  and 
since  the  abdominal  contents  may  be  said 
to  be  comparable  to  liquids  in  this  respect, 
the  increase  in  intra-abdominal  pressure  oc- 
casioned by  strain  would  cause  increasing 
pressure  inside  of  the  appendix,  with  re- 
sulting possibility  of  complete  rupture  of 
the  organ  or  injury  to  the  inner  structures 
of  the  appendix. 

The  manner  in  which  traumatic  appendi- 
citis could  be  brought  about  by  strain  was 
explained  in  various  ways  by  adherents  of 
this  theory.  One  theory  was  that  the  in- 
crease in  intra-abdominal  pressure  would 
cause  the  forcing  of  fecahths  and  other  in- 
testinal contents  into  the  appendix  to  the 
point  that  the  organ  would  become  over- 
extended, either  to  the  point  of  rupturing 
outright  or  to  the  point  of  breaking  the 
inner  lining  of  the  appendix  and  thus  fur- 
nishing a portal  of  entry  for  infectious  bac- 
teria. 

Those  who  opposed  the  theory  gave  it  as 
their  opinion  that  an  increase  in  intra- 
abdominal pressure  could  not  produce  ap- 
pendicitis, and  pointed  out  that  very  often 
considerable  pressure  is  exerted  on  the  ab- 
domen to  create  peristalsis  to  force  bismuth 
into  the  appendix  for  the  purpose  of  taking 
gastro-intestinal  x-rays,  and  that  there  is 
no  history  of  rupturing  of  an  appendix  fol- 
lowing such  a procedure.  Others  pointed 
out  that  the  increase  in  intra-abdominal 
pressure  caused  by  sneezing  or  coughing 
is  often  terrific,  and  yet  the  literature  fails 
to  reveal  reports  of  cases  of  appendicitis 
following  sneezing  or  coughing. 

Furthermore,  those  who  opposed  the 
theory  that  strain  or  increase  in  intra- 
abdominal pressure  can  cause  appendicitis, 
pointed  out  that  Pascal’s  law  of  physics  in- 
stead of  supporting  the  contention  that 
pressure  can  cause  appendicitis,  when  prop- 
erly understood  establishes  the  contrary 
theory.  In  other  words,  assuming  that  it  is 
true  that  force  applied  to  a liquid  medium 
is  equally  transmitted  in  all  directions, 
when  applying  the  law  to  the  human  ab- 
domen we  find  that  pressure  would  be 
equally  increased  throughout  the  abdomen 
both  inside  and  outside  of  the  appendix  and. 


for  May,  1949 


369 


consequently,  the  theory  that  pressure 
causes  the  engorging  or  over-extension  of 
the  appendix  is  a condition  which  cannot 
in  fact  exist  under  Pascal’s  law  because  the 
pressure  on  the  outside  of  the  membrane 
would  rise  in  the  same  proportion  as  the 
pressure  on  the  inside. 

Summary 

The  cases  above  mentioned  contain  the 
theory  of  three  different  schools  of  thought: 

1.  Those  who  deny  the  possibility  of  trau- 
matic appendicitis  entirely,  either  from  a 
strain  or  a blow. 

2.  Those  who  concede  the  possibility  of 
traumatic  appendicitis  as  a result  of  a di- 
rect blow  to  the  abdomen. 

3.  Those  who  adhere  to  the  opinion  that 
strain  also  can  cause  appendicitis. 

An  analysis  of  the  cases  set  forth  above 
will  show  that  but  six  of  them  were  held 
compensable,  and  that  insofar  as  the  record 
is  concerned  the  evidence  indicated  that  the 
alleged  trauma  in  each  case  was  a direct 
blow  or  a directly  applied  force.  None  of 
the  cases  involving  a simple  strain  was  com- 
pensated. 

It  must  be  borne  in  mind,  of  course,  that 
in  compensation  cases  the  decision  of  wheth- 
er or  not  a given  case  is  compensable  does 
not  decide  any  scientific  issue.  The  fact- 
finding body  merely  is  called  upon  to  make 
a decision  in  a disputed  question  of  fact 
upon  the  evidence  presented  before  it.  Con- 
sequently, for  any  doctor  or  any  lawyer  to 
urge  that  the  Industrial  Commission  or  the 
Supreme  Court  has  decided  that  appendi- 
citis can  be  caused  by  trauma  and  that, 
therefore,  a claimant  is  entitled  to  compen- 
sation, is  a fallacy.  All  that  can  honestly  be 
said  is  simply  that  a fact-finding  tribunal 
after  listening  to  and  reviewing  evidence 
which  has  been  presented  before  it  has 
decided  to  accept  the  view  of  certain  wit- 
nesses appearing  before  it  in  preference  to 
the  views  of  other  witnesses  holding  con- 
trary opinions,  and  that  having  so  accepted 
one  or  the  other  of  the  different  views  has 
accordingly  made  a finding  of  fact  and  a 
judicial  determination  thereon. 

In  all  human  controversies  in  a peaceful 


society  there  must  be  a decision  of  some 
kind  rendered  in  order  to  terminate  and 
settle  matters  in  dispute.  As  science  ad- 
vances it  very  often  appears  that  where 
judicial  determinations  have  involved  ques- 
tions of  science  the  judicial  determinations 
were  in  fact  errors;  for  example,  the  fa- 
mous witchcraft  trials  in  ancient  times. 
There,  juries  solemnly  found  as  a matter 
of  fact  that  certain  women  were  witches, 
and  bewigged  judges  imposed  sentence  ac- 
cordingly! The  advancement  of  knowledge 
has  since  proved  that  the  solemn  pronounce- 
ments of  the  courts  were  without  founda- 
tion in  fact  and  without  scientific  basis. 

So  with  the  situation  under  discussion. 
As  medical  science  develops,  someone  some- 
time may  be  able  to  prove  definitely  wheth- 
er or  not  trauma  can  or  does  cause  or  ag- 
gravate a condition  which  will  produce  ap- 
pendicitis, and  the  problem  is,  therefore, 
scientific  rather  than  judicial. 

In  the  meantime  judicial  and  administra- 
tive tribunals  charged  with  administering 
laws  where  questions  of  the  type  under 
discussion  are  being  raised  and  presented 
for  decision  must  necessarily  follow  the 
evidence  produced  before  them,  and  while 
in  compensation  cases  the  ironclad  rule  of 
precedent  is  not  rigidly  adhered  to,  still  cer- 
tain conclusions  can  be  drawn  from  the 
cases  so  far  presented. 

It  would  seem  from  an  analysis  of  the 
cases  that  the  Industrial  Commission  so  far 
has  followed  the  theory  of  the  second  group 
or,  in  other  words,  has  followed  the  middle- 
of-the-road  course.  It  has  not  taken  the 
position  that  there  is  no  such  thing  as 
traumatic  appendicitis  nor,  on  the  other 
hand,  has  it  let  down  the  bars  to  the  extent 
that  it  recognizes  as  compensable  those 
cases  where  the  onset  of  the  disease  is  coin- 
cident with  simple  strain. 

In  this  connection  it  must  be  borne  in 
mind  that  the  personnel  of  the  Commission 
is  not  permanent,  and  periodically  new 
members  are  added  to  the  Commission  as 
terms  of  former  members  expire.  It  may 
be  that  as  time  goes  oh  different  personnel 
will  take  different  views  of  the  testimony 
presented  in  cases  of  this  type.  It  is  equally 


370 


Rocky  Mountain  Medical  Journal 


possible  that  with  the  advance  of  medical 
science  more  exact  information  will  be  made 
available,  which  will  enable  the  fact-find- 
ing tribunal  to  arrive  more  accurately  at 
the  exact  truth  in  each  given  case. 

- From  a purely  legal  standpoint  the  ob- 
jective, of  course,  in  any  given  case  is  to 
arrive  at  the  exact  truth.  Where  this  ob- 
jective is  unattainable  because  science  has 
not  as  yet  reduced  the  problem  to  the  clar- 
ity and  exactness  of  a mathematical  equa- 
tion, then  the  tribunal  must  rely  on  opinion 
evidence  and  decide  which  of  a variety  of 
opinions  is  better  founded  on  sound  reason- 


ing and  knowledge  gained  by  past  experi- 
ence. 

Judging,  therefore,  from  the  cases  so  far 
presented  before  the  Commission  it  would 
seem  that  the  Commission  has  recognized 
as  sound  the  opinions  of  those  who  concede 
the  possibility  of  traumatic  appendicitis 
when  the  evidence  shows  the  condition  to 
have  followed  direct  violence  to  the  ab- 
dominal wall,  and  that  it  has  disregarded 
the  opinion  of  those  who  do  not  recognize 
traumatic  appendicitis  as  an  entity  under 
any  circumstances,  and  also  the  opinion  of 
those  who  see  a relationship  between  the 
disease  and  simple  strain. 


PROLONGED  LABOR* 

EDWIN  J.  DeCOSTA,  M.D. 
CHICAGO 


What  is  “prolonged  labor?”  An  answer 
cannot  be  given  without  a little  considera- 
tion. The  accepted  text  books  (Stander 
and  DeLee-Greenhill)  tell  us  that  in  the 
primigrabida  the  average  duration  of  labor 
is  eighteen  hours.  Calkins,  on  the  other 
hand,  finds  labor  to  average  only  thirteen 
to  fourteen  hours.  Accepting  the  fact  that 
averages  are  made  up  of  unders  and  overs, 
it  becomes  obvious  that  few  labors  should 
exceed  twenty-four  hours.  Labor  that  ex- 
ceeds the  normally  expected  duration  is 
considered  prolonged.  Reid  considers  this 
to  be  over  twenty  hours.  Some  authorities 
have  arbitrarily  chosen  twenty-four  hours. 
Others  have  selected  thirty  hours  while 
still  others  even  thirty-six  hours.  There  is 
no  unanimity  as  to  the  number  of  elapsed 
hours  that  constitutes  prolonged  labor.  Per- 
haps this  confusion  is  responsible  for  the 
variation  in  the  reports  of  incidence  of 
prolonged  labor  which,  even  under  manage- 
ment is  prevent  its  occurrence,  varies  from 
2 per  cent  to  6.3  per  cent  in  frequency. 

Before  further  discussion  of  prolonged 
labor,  it  will  be  helpful  to  consider  normal 
labor.  The.  cause  of  the  onset  of  labor  is 
not  known.  There  are  certain  observed 
facts,  however,  that  are  known.  Generally, 

•Read  before  the  Utah  State  Medical  Association 
Annual  Meeting  September,  1948.  From  the  Michael 
Reese  Hospital,  Chicago. 


280  days  after  the  first  day  of  the  last 
menstrual  period  the  uterus  develops 
rhythmic,  forceful,  and  painful  contractions 
that  lead  to  complete  effacement  and  di- 
latation of  the  cervix,  resulting  in  expul- 
sion of  the  fetus.  Yet  labor  may  occur  long 
before  the  accepted  end  of  gestation  and  be 
normal  in  all  other  respects. 

Rupture  of  the  membranes  at  any  time 
during  pregnancy  usually  does  something 
to  initiate  labor  within  a relatively  short 
time,  even  when  the  pregnancy  is  not  ma- 
ture. Intra-uterine  death  of  the  fetus  does 
not  necessarily  mean  that  labor  will  soon 
follow.  In  some  women,  the  cervix  has  be- 
come effaced  and  partially  dilated  long  be- 
fore the  onset  of  painful  contractions;  in 
others,  this  preparation  is  not  evident.  The 
patient  is  in  true  labor  only  when  there  is 
progressive  effacement  and  dilatation  of  the 
cervix.  False  labor  may  subjectively  close- 
ly resemble  true.  Even  the  duration,  fre- 
quency, and  intensity  of  contractions  may 
objectively  be  similar.  However,  descent 
of  the  presenting  part  and  bloody  show  gen- 
erally do  not  occur  with  false  pains.  Fur- 
thermore, false  pains  often  cease  complete- 
ly for  varying  periods  of  time.  Occasionally, 
false  labor  pains  change  abruptly  into  true 
labor  pains. 

The  diagnosis  of  prolonged  labor  can  be 


jor  May,  1949 


371 


made  when  labor  exceeds  an  arbitrary  pre- 
conceived number  of  hours.  Or  it  may  be 
made  by  observing  the  evolution  and  prog- 
ress of  labor  in  the  individual  patient.  In 
the  latter,  the  diagnosis  of  prolonged  labor 
will  depend  on  whether  or  not  progress  is 
as  anticipated  in  a particular  patient.  Ar- 
rest or  delay  may  occur  either  in  the  first 
or  second  stage,  though  practically  all  pro- 
longed labors  are  associated  with  prolonga- 
tion of  the  first  stage.  While  the  second 
stage  may  continue  to  several  times  the 
usual  one  to  three  hours,  in  prolonged  labor 
the  total  elapsed  time  in  the  second  stage 
must  always  be  a small  part  of  the  total 
labor.  Operative  interference  can  obvious- 
ly shorten  the  duration  of  the  second  stage. 
Thus  in  prolonged  labor  we  are  primarily 
concerned  with  the  first  stage. 

To  manage  labor  properly,  one  must 
know  the  patient  as  well  as  know  how  to 
perform  various  technical  maneuvers.  This 
“knowing”  begins  with  the  first  prenatal 
examination  and  continues  until  delivery 
is  satisfactorily  completed.  Unless  the  pa- 
tient is  first  seen  in  advanced  labor,  the 
management  of  prolonged  labor  begins  with 
proper  care  throughout  pregnancy.  There 
are  certain  specific  factors  to  which  atten- 
tion must  be  paid  in  predicting  the  prob- 
able evolution  of  labor.  These  factors, 
operating  singly  or  in  combination,  will 
influence  its  course.  Labor  will  be  pro- 
longed if  many  unfavorable  factors  are 
present.  Knowing  these  ahead  of  time,  we 
can  wait  with  complacence  or  act  quickly 
as  the  occasion  demands. 

The  age  of  the  patient  does  not  appear 
to  be  too  important  a factor.  However,  in 
primigravidas  over  35,  labor  frequently  ex- 
ceeds the  normal  average.  Parity  is  most 
important.  In  Reid’s  series,  96.6  per  cent  of 
labors  over  twenty  hours  occurred  in  pri- 
migravidas. The  general  physical  make-up 
of  the  patient  can  be  exceedingly  impor- 
tant. A short,  chunky,  muscular  habitus — 
the  so-called  dystocia  dystrophy  type — 
often  leads  to  poor  labor  while  a thin,  lithe 
habitus  is  usually  associated  with  easy  la- 
bor. The  general  health  of  the  patient 
plays  a minor  role  in  the  production  of 


prolonged  labor.  The  psychic  or  emotional 
constitution  is  of  tremendous  importance. 
The  well-educated,  introspective,  fearful 
patient  often  has  false  pains,  poor  pains 
and  prolonged  labor. 

The  size  of  the  baby  is  obviously  impor- 
tant, and  it  is  difficult  accurately  to  esti- 
mate the  fetal  size  either  by  abdominal 
palpation  of  x-ray  fetometry.  Presentation 
and  position  must  not  be  ignored.  Breech, 
particularly  frank,  and  occiput  transverse 
and  posterior  are  often  associated  with  pro- 
longed labor.  Errors  in  attitude  can  be  im- 
portant factors.  Duration  of  the  pregnancy 
must  be  kept  in  mind;  post-maturity  may 
lead  to  difficulties. 

The  state  of  the  membranes  at  the  onset 
of  labor  can  influence  its  course.  Prema- 
ture rupture  of  the  membranes  of  itself  is 
not  important  but  it  often  aggravates  the 
situation  when  associated  with  other  factors 
of  dystocia.  Artificial  rupture  of  the  mem- 
branes is  one  of  our  most  effective  methods 
of  inducing  labor  but  there  is  a great  dif- 
ference between  spontaneous  and  artificial 
rupture.  In  the  latter  the  trained  obstetri- 
cian insists  that  the  cervix  be  ripe,  par- 
tially effaced  and  dilated,  and  the  present- 
ing part  engaged  or  engaging.  He  effects 
rupture  at  the  most  dependent  portion  and 
completely  drains  off  the  liquor.  In  spon- 
taneous rupture,  the  cervix  may  be  long, 
closed  and  firm,  the  presenting  part  high 
and  the  drainage  incomplete. 

The  condition  of  the  cervix  at  the  onset 
of  labor  affects  the  duration.  Calkins,  who 
has  been  particularly  interested  in  the  state 
of  the  cervix,  has  shown  that  a firm  cervix 
in  the  primigravida  requires  about  three 
hours  longer  to  dilate  than  a soft  one.  Ef- 
facement  requires  an  additional  three  hours 
on  the  average.  A closed  cervix  requires 
more  time  to  open  than  one  already  par- 
tially dilated. 

The  station  of  the  head  at  the  onset  of 
labor  affects  the  duration  of  labor.  In  the 
absence  of  disproportion  a floating  head 
requires  at  least  an  hour  longer  than  does 
an  engaged  head.  Engagement  gives  the 
comforting  knowledge  that  there  is  no  inlet 
disproportion. 


372 


Rocky  Mountain  Medical  Journal 


The  size  and  configuration  of  the  entire 
pelvis  must  be  known.  Pelvic  capacity  is 
concerned  with  more  than/  knowledge  of 
just  the  bony  inlet  or  outlet.  There  are 
three  bony  barriers  to  the  advance  of  the 
fetal  head.  A practical  estimate  of  the  ade- 
quacy of  the  pelvis  may  be  summarized  as 
follows:  If  the  sacral  promentory  is  not  ac- 
cessible to  the  examining  finger  and  the 
sacrum  has  its  normal  biconcavity,  there  is 
usually  no  inlet  obstruction.  If  one  or  both 
spines  of  the  ischium  do  not  protrude  no- 
ticeably into  the  birth  canal,  there  is  no 
midplane  obstruction.  If  the  descending 
rami  of  the  pubic  bones  form  an  arch  and 
not  an  acute  angle  and  if  the  knuckles  of 
the  clenched  fist  can  be  accommodated  be- 
tween the  tuberosities  of  the  ischium,  there 
is  no  outlet  obstruction.  The  value  of  pel- 
vic measurements  is  well  known;  x-ray 
examination  of  the  pelvis  is  of  value  in 
establishing  pelvic  inlet  configuration.  To 
date,  x-ray  pelvimetry  has  not  been  of 
value  to  us  as  a means  of  estimating  pelvic 
capacity  nor  as  a means  of  forecasting  the 
proper  management  of  the  patient.  Mo- 
bility of  pelvic  joints  and  the  effect  of  the 
soft  tissues  can  only  be  estimated  by  com- 
petent observation  during  labor. 

The  influence  of  the  age,  size,  presenta- 
tion, position  and  attitude  of  the  fetus  on 
labor  is  more  or  less  predictable  before  the 
onset  of  labor.  The  most  important  fetal 
factor,  however,  is  the  extent  to  which  the 
head  will  be  molded.  A good  test  of  labor 
is  the  only  way  I know  to  determine  the 
degree  to  which  the  head  can  be  altered  to 
accommodate  itself  to  the  birth  passages. 
This  factor  is  of  paramount  importance  in 
relative  degrees  of  cephalopelvic  dispropor- 
tion and  in  unfavorable  position  and  presen- 
tation. 

So  far  little  mention  has  been  made  of 
the  most  outstanding  factor  in  the  evolution 
of  labor,  namely,  the  competence  of  the  ex- 
pulsive force.  The  uterine  musculature 
deserves  especial  consideration  because  the 
association  of  the  aforementioned  factors 
with  anomalies  of  uterine  function  leads  to 
dystocia.  We  do  not  know  the  causes  of 
primary  or  secondary  uterine  inertia,  but 


weak,  short  and  irregular  pains  are  cer- 
tainly often  observed  in  association  with 
other  deviations  from  the  normal.  Whether 
or  not  the  endocrines  are  responsible,  faulty 
uterine  development,  anomalies  of  innerva- 
tion or  what-not,  the  fact  remains  that  in 
subsequent  pregnancies  inertia  usually  does 
not  recur. 

The  essential  difference  between  the 
primi-  and  multi-gravida  lies  in  the  fact 
that  dilatation  of  the  cervix  and  of  the  birth 
canal  has  occurred  in  one  and  not  in  the 
other.  If  vaginal  delivery  has  been  success- 
ful, the  resistance  of  the  birth  canal  has 
been  tried  and  overcome. 

Most  authors  are  agreed  that  the  cervix 
per  se  is  rarely  a cause  of  prolonged  labor 
except  when  diseased,  as  by  new  growth 
or  extensive  scarring.  On  occasion,  with 
ruptured  membranes  and  moderate  cephalo- 
pelvic disproportion  the  cervix  may  become 
wedged  between  the  head  and  bony  ring, 
leading  to  edema  and  even  necrosis;  ulti- 
mately avulsion  may  occur.  Occasionallly, 
fine  circular  fibers  in  the  region  of  the  ex- 
ternal os  prevent  dilatation  even  though 
effacement  is  complete  and  contractions  are 
forceful.  This  condition  may  be  considered 
a type  of  conglutination  although  the  ex- 
ternal os  is  slightly  dilated.  Th^ position  of 
the  cervical  os  with  relation  to  the  present- 
ing part  seems  to  influence  the  time  re- 
quired for  effacement  and  dilatation.  Some- 
times the  os  lies  either  well  anterior  or 
posterior  to  the  line  of  force.  A shift  in  po- 
sition may  hasten  dilatation.  Finally  and 
more  commonly,  we  observe  a dysynergism 
whereby  the  lower  uterine  segment  and 
cervix  seem  to  oppose  the  contraction  of 
the  upper  segment.  Pain  is  intense  but 
progress  is  slow.  Ssychic  factors  seem  to 
predispose  to  dysynergism  and  probably 
play  an  important  role  in  its  production. 

Additional  factors  operate  during  the 
second  stage.  Among  these  are  a rigid 
pelvic  floor  due  to  anatomic  or  psychic 
causes,  poor  abdominal  muscles,  lack  of 
proper  use  of  these  muscles,  or  lack  of 
proper  instruction  of  and  cooperation  from 
the  patient. 

Let  us  now  put  our  knowledge  to  test. 


for  May,  1949 


373 


The  patient  was  a 36-year-old  para  4,  one 
week  past  term.  Previous  labors,  easy; 
largest  baby,  seven  pounds,  two  ounces.  She 
entered  the  hospital  with  ruptured  mem- 
branes and  in  early  labor.  Uterine  contrac- 
tions appeared  moderately  strong,  recurring 
regularly  every  three  minutes.  Yet  after 
sixteen  hours  of  such  pains,  she  was  still 
undelivered.  The  cervix  was  completely 
dilated  and  the  head  at  +1  station.  There 
had  been  no  evidence  of  progress  for  the 
past  two  hours.  Is  this  prolonged  labor? 
I would  unhesitatingly  answer  “yes”  for  the 
following  reasons:  This  patient  had  pre- 
viously given  birth  to  four  children  without 
undue  difficulty.  We  would  anticipate  a 
similar  experience  now,  and  yet  after  six- 
teen hours  of  good  labor  she  had  not  ac- 
complished what  we  expected  of  her.  When 
we  then  carefully  evaluated  the  pelvic  ca- 
pacity we  found  it  to  be  relatively  small, 
and  the  baby  quite  large  in  a deflexed  at- 
titude. Had  we  considered  all  factors  in 
advance  we  would  have  expected  a long 
drawn  out  labor.  Perhaps  our  management 
would  have  been  the  same,  but  at  least  we 
would  have  known  what  to  expect. 

Let  us  consider  another  patient.  A 28- 
year-old  primigravida  at  term.  She  had  en- 
joyed robust  health  and  in  all  respects 
appeared  quite  normal.  She  was  a college 
graduate,  a Phi  Beta  Kappa,  and  had  read 
several  books  on  childbirth.  At  each  pre- 
natal visit,  she  invariably  had  a long  list 
of  questions  and  generally  complained  of 
backache.  She  entered  the  hospital  having 
severe  seven  minute  contractions.  Position 
LOA,  membranes  intact,  station  O,  cervix 
long,  firm,  not  effaced  and  closed.  After  a 
few  hours  and  a warm  enema,  pains  be- 
came more  intense  and  recurred  every  five 
minutes.  At  the  end  of  eighteen  hours, 
however,  there  was  no  evidence  of  advance, 
cervical  effacement  or  dilatation.  The  pa- 
tient was  tired  out  and  her  family — father, 
mother  and  husband — were  convinced  that 
something  was  wrong.  Is  this  patient  really 
in  labor?  If  so,  what  is  wrong?  Should  we 
do  a caesarean?  Are  we  going  to  be  stam- 
peded into  unwarranted  and  ill-advised  in- 


terference? This  patient  is  having  false 
pains;  she  needs  sedation  and  rest.. 

It  becomes  obvious  that  the  management 
of  prolonged  labor  requires  understanding, 
patience,  and  stamina.  Prolonged  labor 
properly  managed  is  attended  by  slightly 
greater  danger  to  mother  and  baby  than 
normal  labor.  It  is  essential  to  distinguish 
early  between  true  and  false  pains.  If 
there  is  no  evidence  of  cervical  change 
within  a reasonable  period,  it  must  be  as- 
sumed that  the  pains  are  false.  The  treat- 
ment is  simple:  the  administration  of  ade- 
quate analgesia,  preferably  morphine  or 
demerol.  At  times  under  the  influence  of 
such  sedation,  false  pains  become  true  and 
labor  progresses  normally. 

Prolonged  labor  associated  with  good 
uterine  contractions  does  not  introduce 
serious  problems  if  we  understand  the  pa- 
tient. As  long  as  progress  is  definite  and 
mother  and  fetus  remain  in  good  condition, 
one  can  afford  to  wait.  During  this  period 
the  nutritional ' and  fluid  requirements  of 
the  mother  must  be  met  and  at  least  eight 
hours  rest  provided  in  each  twenty-four  by 
suitable  sedation.  If,  however,  progress  is 
not  obvious,  the  cause  of  delay  must  be 
determined. 

The  course  of  labor  has  been  followed  by 
abdominal  and  rectal  examination.  It  now 
becomes  necessary  to  examine  the  patient 
vaginally,  such  examination  being  made 
under  strict  aseptic  technic.  The  levator 
muscles,  the  bony  pelvis  and  the  cervix  are 
palpated.  The  presentation  and  position  of 
the  head  as  w;ell  as  the  station  are  de- 
termined. Further,  the  effect  of  the  contrac- 
tions on  both  the  presenting  part  and  cervix 
is  observed.  It  is  necessary  to  decide  wheth- 
er or  not  the  head  can  come  through  the 
pelvis.  The  impression  method  of  Mueller, 
or  a modification,  is  helpful  in  indicating 
cephalo-pelvic  disproportion. 

If  an  effaced  cervix  with  little  or  no  dila- 
tion is  found,  the  passage  of  the  finger 
through  the  external  os  may  rupture  the 
circular  fibers  that  can  so  effictively  inter- 
fere with  dilatation.  If  dilatation  has 
reached  5-6  cm.  with  an  engaged  head,  rup- 
ture of  the  membranes  may  permit  descent 


374 


Rocky  Mountain  Medical  Journal 


and  more  rapid  progress.  If  during  a con- 
traction little  pressure  is  exerted  on  the 
presenting  part  and  the  partially  dilated 
cervix  lies  loosely  over  the  presenting  part, 
the  possibility  of  constriction  ring  dystocia 
must  be  considered.  Although  rare,  a con- 
striction ring  is  a serious  problem.  If  it 
does  not  relax  under  anesthesia  and  adren- 
alin, abdominal  delivery  is  indicated.  If  the 
external  os  is  found  far  posterior  or  an- 
terior to  the  presenting  part,  an  attempt 
may  be  made  to  bring  the  cervix  into  the 
axis  of  the  birth  canal.  One  thing  must 
never  be  done:  that  is  manual  laceration  of 
the  cervix,  more  familiarly  called  manual 
dilatation.  If  for  some  reason  delivery  be- 
comes urgent  when  the  head  is  engaged  and 
the  cervix  is  dilated  6-7  dm.,  multiple  cer- 
vical incisions  (Duhrssens)  may  be  per- 
formed. 

We  will  now  consider  the  management  of 
the  group  of  patients  in  whom  prolonged 
labor  is  associated  with  ineffectual  uterine 
contractions — so-called  uterine  inertia.  As 
we  follow  these  patients,  we  have  the  feel- 
ing that  all  our  troubles  would  cease  if  they 
would  only  have  a few  good  pains.  Uterine 
inertia  may  be  manifest  from  the  onset  of 
labor — the  pains  are  not  effective,  as  a re- 
sult of  infrequency  or  lack  of  intensity,  and 
progress  is  slow.  Or  inertia  may  appear 
secondarily  after  effective  pains  have  been 
established.  Secondary  inertia  can  be  pro- 
duced by  too  early  and  injudicious  use  of 
analgesia  or  as  the  result  of  exhaustion. 
Here,  as  in  the  primary' type,  psychogenic 

There  are  two  distinct  approaches  to  the 
factors  play  a tremendous  role. 

treatment  of  these  patients.  One  is  based 
on  the  premise  that  eventually  the  patient 
will  deliver  if  given  sufficient  time.  Treat- 
ment is  primarily  supportive  — adequate 
fluids  and  rest  to  maintain  the  patient’s 
nutrition,  water  balance  and  strength.  This 
can  be  accomplished  most  safely  by  paren- 
teral 5 per  cent  glucose  solution.  In  the 
absence  of  specific  indication  for  inter- 
ference, this  policy  of  “hopeful  expectancy” 
is  generally  followed  throughout  the  coun- 
try with  brilliant  results,  such  as  those  re- 
ported by  Schmitz,  in  5,599  patients  the 


incidence  of  labor  lasting  over  24  hours  was 
only  4 per  cent.  There  was  not  a single 
high  forceps,  not  a single  Durhssens  incision 
for  prolonged  labor,  and  no  maternal  mor- 
tality! Delivery  was  not  attempted  in  any 
case  until  the  cervix  was  completely  di- 
lated. Only  6 per  cent  of  prolonged  labors 
exceeded  sixty  hours.  This  is  an  enviable 
record. 

The  second  approach  as  advocated  in  the 
literature  is  based  on  the  belief  that  once 
true  labor  has  started,  progress  should  be 
definite  and  sustained  until  delivery  is  ef- 
fected. The  uterus  is  stimulated  by  small 
doses  of  posterior  pituitary  extract  when- 
ever inertia  is  recognized,  without  respect 
to  the  stage  of  labor.  The  chief  limitation, 
according  to  Reid,  lies  not  in  the  danger  of 
its  usage  but  rather  in  the  lack  of  physi- 
ologic effect  in  some  patients;  they  just 
do  not  respond.  Reid’s  results  are  excellent. 
His  incidence  of  labor  lasting  over  twenty 
hours  is  only  2 per  cent.  However,  mid- 
forceps and  other  operative  procedures 
were  frequently  employed.  Caesarean  sec- 
tion was  used  in  12.9  per  cent  of  ward  pa- 
tients with  prolonged  labor.  Reid’s  infant 
mortality  in  clinic  patients  was  11.65  per 
cent,  Schmitz’s  only  6.4  per  cent.  Finally 
Reid  states  that  pituitrin  can  be  used  to  as- 
certain whether  one  can  expect  further 
progress.  He  assumes  that  the  uterus 
which  fails  to  respond  to  pituitrin  is  re- 
fractory to  further  progress  of  labor-  and 
hence  the  pregnancy  should  be  terminated 
by  suitable  means  (Duhrssens,  forceps,  or 
caesarean  section)  without  subjecting  the 
mother  to  further  useless  labor  and  the 
baby  to  irreparable  damage. 

If  Reid’s  logic  is  sound,  it  is  impossible  to 
reconcile  his  results  with  those  of  Schmitz, 
Calkins,  Cosgrove  and  others.  The  latter 
apparently  seldom  see  patients  in  whom 
time  and  care  will  not  lead  to  progress. 

To  recapitulate,  the  management  of  pro- 
longed labor  should  be  conservative.  The 
women  in  labor  will  be  cared  for  with  the 
understanding  that: 

1.  The  total  duration  of  labor  is  of  little 
importance  provided  that  the  patient  has 


for  May,  1949 


375 


been  carefully  evaluated,  intelligently  ob- 
served, and  well  managed. 

2.  Time  is  our  greatest  ally.  Delay  rarely 
leads  to  disaster  and  often  solves  or  simpli- 
fies difficult  problems. 

3.  Unwarranted  interference  may  lead  to 
irreparable  damage. 

4.  When  interference  is  indicated,  every 
effort  is  made  to  minimize  trauma. 

5.  Following  delivery,  all  birth  injuries 
are  repaired. 

The  great  majority  of  patients  will  de- 
liver spontaneously  or  with  a little  help 
well  within  the  expected  average  number 
of  hours  of  labor.  A small  group  of  pa- 
tients will  present  accidental  or  complicat- 
ing pathology  which  necessitates  radical 
interference  before  many  hours  have  gone 
by.  In  this  group  too  are  those  patients 
with  probable  feto-pelvic  disproportion. 
Here  elective  interference  limits  the  dura- 
tion of  labor.  Finally  there  is  the  group  in 
which  delivery  potential  is  considered  nor- 
mal but  in  which  labor  performance  is  not 
determined  until  the  duration  exceeds  the 
normal  average.  It  is  with  the  last  group 
that  we  are  specifically  concerned. 

Throughout  labor  six  sources  of  trouble 
should  be  continually  kept  in  mind.  Man- 
agement of  patients  should  be  directed  to 
reduce  the  danger  from  these  sources: 
FEAR  is  allayed  by  encouragement  and  re- 
assurance of  both  patient  and  family.  DE- 
HYDRATION is  controlled  by  fluid  re- 
placement, preferably  parenterally.  IN- 
ANITION is  combatted  by  giving  liquid 
nourishment,  again  preferably  parenteral- 
ly. FATIGUE  and  EXHAUSTION  are 
avoided  by  providing  adequate  rest  with 
sedative  drugs.  The  danger  from  HEMOR- 
RHAGE is  minimized  by  maintaining  fluid 
balance  and  avoiding  exhaustion.  In  addi- 
tion, it  is  advisable  to  type  the  patient  and 
have  blood  available  should  it  be  needed. 
Finally,  INFECTION  is  guarded  against  by 
avoiding  unnecessary  rectal  and  vaginal  ex- 
aminations. If  infection  is  probable,  or  if 
membranes  have  been  ruptured  a long  time, 
penicillin  should  be  given  prophylactically. 

All  details  should  be  carefully  rechecked 
and  every  effort  made  to  establish  the  cause 


of  delay.  If  progress  is  evident  and  mother 
and  baby  are  in  good  condition,  there  is  no 
reason  for  interference.  If  on  the  other 
hand  contractions  have  ceased  or  become 
desultory,  a real  rest  period  is  indicated. 
Following  the  rest,  if  pains  do  not  spon- 
taneously recim,  an  attempt  to  stimulate 
contractions  may  be  made  by  using  castor 
oil  and  warm  enemas.  Quinine  is  never 
used  to  stimulate  labor  because  it  occasion- 
ally leads  to  auditory  nerve  injury  and 
deafness.  In  rare  instances  quinine  seems 
to  have  caused  intra-uterine  fetal  death. 

On  occasions  at  the  Michael  Reese  Ma- 
ternity we  may  use  small  doses  {Vz  to  a 
maximum  of  2 minims)  of  pitocin  or  pitui- 
trin.  As  a general  rule,  pituitrin  is  used 
only  when  secondary  inertia  develops  in 
the  second  stage  and  the  head  is  well  en- 
gaged. Even  then  the  patient  is  prepared 
for  delivery  and  an  anesthetist  is  available, 
should  tetanic  contraction  occur. 

What  we  do  next  will  depend  upon  the 
indications,  conditions,  our  own  capabilities 
and  the  availability  of  hospital  facilities. 
Perhaps  from  the  re-evaluation  it  is  ap- 
parent that  vaginal  delivery  is  unlikely. 
Caesarean  section  should  be  performed.  Oc- 
casionally caesarean  section  may  have  to  be 
postponed  for  many  hours  or  cannot  be  car- 
ried out  at  all.  The  parturient’s  life  and 
future  health  should  not  be  jeopardized  by 
ill-advised  attempts  at  vaginal  delivery. 
Time  still  may  solve  the  problem.  At  worst, 
the  baby  may  be  sacrificed. 

If  hospital  facilities  are  readily  available 
and  abdominal  delivery  can  be  undertaken, 
we  possess  a method  of  terminating  preg- 
nancy when  the  head  is  not  engaged  and/or 
the  cervix  not  dilated.  The  choice  of  the 
type  of  caesarean  section  will  rest  some- 
what on  the  experience  of  the  operator.  At 
Michael  Reese,  the  classical  section  is  a 
curiosity  and  the  extraperitoneal  type  of 
caesarean  section  is  seldom  performed.  We 
find  the  low  cervical  section  meets  all  our 
needs,  even  when  the  patient  is  potentially 
infected  and  forceps  delivery  has  been  at- 
tempted and  failed.  The  frankly  infected 
mother  has  a much  better  chance  of  survi- 
val if  caesarean  hysterectomy  is  used. 


376 


Rocky  Mountain  Medical  Journal 


Perhaps  from  the  re-evaluation  it  is  ap- 
parent that  vaginal  delivery  of  a living 
child  can  be  accomplished.  In  the  absence 
of  indication  for  interference,  labor  is  per- 
mitted to  continue.  However  in  the  pres- 
ence of  indications,  the  method  of  interfer- 
ence will  depend  upon  the  existing  condi- 
tions. 

Let  us  assume  dilatation  is  not  quite  com- 
plete and  the  head  presents  no  dispropor- 
tion. Multiple  incision  of  the  cervix,  fol- 
lowed by  properly  applied  forceps  may 
save  the  baby’s  life.  If,  on  the  other  hand, 
dilatation  is  complete  and  the  head  is  en- 
gaged, the  baby  can  be  delivered  by  forceps 
and  episiotomy.  In  transverse  or  posterior 
position,  either  manual  or  instrumental  ro- 
tation may  be  necessary.  If  the  baby  is 
dead,  craniotomy  is  preferable  to  a difficult 
forceps  operation. 

If  progress  ceases  in  frank  breech  presen- 
tation, the  breech  is  dislodged  and  the  legs 
brought  down.  To  accomplish  this,  general 
anesthesia  must  be  used.  Forceps  may  be 
necessary  to  deliver  the  after-coming  head. 

The  third  stage  of  prolonged  labor  car- 
ries an  added  risk  of  postpartum  hemor- 
rhage. The  same  factors  which  have  pro- 


duced uterine  inertia  and/or  exhaustion 
continue  to  act,  thus  interfering  with  the 
normal  contraction  and  retraction  of  the 
uterine  muscle.  The  patient  should  be  ob- 
served for  at  least  one  hour  while  still  in 
the  delivery  room.  During  this  time  the 
uterus  is  frequently  palpated.  Blood  should 
be  available  for  immediate  use;  however, 
plasma  may  be  used  in  an  emergency  until 
proper  blood  can  be  obtained. 

Finally,  we  must  not  forget  the  infant. 
Asphyxia  is  common.  Tracheal  catheteriza- 
tion may  be  required.  These  babies  are  po- 
tentially and  often  actually  infected  at 
birth.  The  administration  of  penicillin  dur- 
ing the  first  week  of  life  will  lower  the 
neonatal  death  rate  from  this  cause.  The 
value  of  vitamin  K in  the  prevention  of 
cerebral  hemorrhage  is  doubtful  but  it  can 
do  no  harm.  It  may  be  administered  ante- 
partum to  the  mother  or  postpartum  to  the 
baby. 

The  guiding  principle  in  the  conduct  of 
prolonged  labor  is  intelligent,  conservative 
obstetrics,  irrespective  of  the  passage  of 
time.  Pressure  from  patient  or  family  must 
never  be  allowed  to  warp  the  judgment  of 
the  obstetrician. 


FLUID,  ELECTROLYTE  AND  PROTEIN  BALANCE  IN  THE 

SURGICAL  PATIENT* 

C.  L.  HOLMES,  M.D. 

BUTTE,  MONTANA 


The  subject  of  fluid  and  electrolyte  bal- 
ance, which  has  been  written  on  extensively 
during  the  past  fifteen  years,  is  one  that 
bears  repetition,  for  no  phase  of  pre-  and 
postoperative  care  is  more  important  in  the 
complex  surgical  case.  A basic  understand- 
ing of  physiological  factors  involved  in  fluid 
balance  and  the  ability  to  detect,  evaluate, 
and  correct  derangements  in  this  physiology 
richly  rewards  the  surgeon  and  his  patient. 
A fundamental  approach  to  this  problem 
does  as  much  as  any  other  to  lessen  mor- 
bidity, lower  mortality,  and  actually  broad- 
en the  scope  of  one’s  technical  ability, 
often  making  possible  adequate  eradicative 

*From  the  Department  of  Surgery,  The  Murray 
Clinic. 


surgery  of  extensive  disease.  As  rapid  as 
the  knowledge  in  this  field  has  developed, 
and  it  is  yet  incomplete,  the  clinical  appli- 
cation by  the  rank  and  file  of  practicing 
surgeons  has  not  kept  pace.  This  is  under- 
standable in  part,  as  the  great  majority  of 
surgical  patients  present  no  great  or  pro- 
longed need  for  precise  evaluation  of  fluid, 
electrolyte,  or  protein  concentrations,  and 
the  body’s  numerous  inherent  mechanisms 
for  correcting  departures  from  normal  are, 
as  a rule,  very  efficient.  Yet  it  is  theoreti- 
cally wrong,  and  practically  dangerous,  to 
ignore  certain  fundamental  principles  now 
established  simply  because  the  body  can 
usually  correct  the  imposition. 


for  May,  1949 


377 


Fluid  Balance 

Sources  of  Body  Water:  Under  normal 
conditions  the  body  derives  water  from 
three  sources — fluid  ingested,  fluid  derived 
from  foodstuffs,  and  fluid  derived  from  the 
oxidation  of  foodstuffs.  (Table  1.)  While 
the  amount  derived  from  the  first  two 
sources  will  vary  with  the  intake  of  fluids 
as  such,  and  foods,  the  amount  provided  by 
oxidation  of  food  material  is  constant  for 
a given  amount  of  diet  and  in  the  following 
proportions:  One  gram  of  protein  yields 
0.4  gram  of  water;  one  gram  of  carbohy- 
drate yields  0.6  gram  of  water;  and  one 
gram  of  fat^  yields  1.0  gram  of  water,  when 
completely  digested,  absorbed,  and  meta- 
bolized. 


TABLE  1 

Average  Daily  Fluid  Intake  in  Health 

Type 

Cubic  Centimeters 

Fluid  ingested  

Water  of  Food  

Water  of  Oxidation 

1,000-1,500 

800-1,000 

300-  400 

TOTALS  

2,100-2,900 

Avenues  of  Water  Loss: 

The  body  in 

the  course  of  normal  metabolic  processes 
utilizes  the  water  provided  through  the 
above  sources  and  through  secretions  and 
excretions  disposes  of  an  amount  equal  to 
that  ingested.  The  avenues  of  this  loss 
are  normally  the  skin,  lungs,  feces,  and 
urine.  The  amount  of  loss,  under  standard 
conditions,  from  the  first  three  of  these 
avenues  is  almost  constant,  leaving  a cer- 
tain amount  with  which  the  kidney  must 
accomplish  its  functions.  Any  infringe- 
ment on  the  optimal  amount  available  to 
the  body  results  in  the  burden  of  com- 
pensation being  placed  principally  on  the 
kidney.  Conversely,  any  excess  of  fluid 
over  that  necessary  adequately  to  cover 
the  basic  needs,  is  excreted  as  such  by  the 
kidneys.  Table  2 will  show  these  avenues 
of  fluid  loss  and  the  amounts  normally  lost 
through  these  channels.  It  will  be  noted 
the  total  loss  corresponds  exactly  with  the 
total  fluid  intake  and  if  this  seems  to  be 
too  exact,  it  is  well  to  remember  Coller’s^ 
observation  that  considering  the  kilograms 
of  material  ingested  and  excreted  daily,  the 


constancy  of  body  weight  is  quite  remark- 
able. As  he  points  out  this  perfect  balance 
may  not  exist  in  a single  day,  but  over  a 
period  of  days  it  is  obvious  this  balance  is 
precise. 

Fluid  Requirement  in  the  Postoperative 
State:  It  is  not  often  necessary  to  be 
acutely  concerned  about  the  state  of  hydra- 
tion in  the  average  postoperative  patient. 
The  requirements  are  simply  to  replace  by 
parenternal  routes  that  amount  of  fluid  nec- 
essary as  outlined  in  Table  1 for  perhaps  one 
to  three  days,  after  which  the  patient  can 
resume,  wholly  or  in  large  part,  his  own 
hydration.  Overhydration  and,  most  im- 
portant, overloading  with  sodium  chloride 
is  avoided  and  the  body  more  quickly  re- 
sumes its  normal  physiology.  In  certain 
surgical  conditions,  however,  fluid  balance 
presents  a problem,  one  that  can  rapidly 
become  acute  and,  if  properly  supervised, 
means  the  difference  between  fatality  or 
recovery. 


TABLE  2 

Avenues  of  Fluid  Loss 

Cubic  Centimeter? 

i. 

Skin*  .....  .. 

400-  600 

2. 

Lungs  

400-  600 

•5 

Feces  

100-  300 

I 

Kidneys  .. 

1,200-1,400 

TOTALS 

2,100-2,900 

In  addition  to  the  fluids  normally  intro- 
duced into  the  intestinal  tract  by  oral  di- 
gestion, there  are  many  liters  of  fluid  se- 
creted into  the  stomach  and  duodenum  and 
to  which  are  added  the  biliary  and  pan- 
creatic secretions,  all  containing  electro- 
lytes varying  but  little  from  that  of  plasma. 
These  are  normally  largely  resorbed  as  the 
flow  descends  the  intestinal  canal  but  in 
obstruction,  persistent  vomiting,  diarrhea, 
or  in  the  presence  of  biliary,  pancreatic  or 
enteric  fistulae,  the  loss  of  fluids  and  elec- 
trolytes can  be  rapid  and  fatal  if  unat- 
tended by  adequate  corrective  measures. 
These  measures  will  be  further  studied 
under  electrolyte  balance. 

•This  refers  to  insensible  loss  or  vaporization  loss. 
Frank  perspiration  in  hot  humid  conditions,  in 
hyperthyroidism  or  fever  results  in  a sensible  and 
visible  loss,  and  may  amount  to  several  liters. 


378 


Rocky  Mountain  Medical  Journal 


In  no  field  of  surgery  is  proper  fluid 
balance  of  more  immediate  importance  than 
in  the  postoperative  urological  patient.  This 
refers  principally  to  the  patient  under- 
going complicated  renal  surgery  whose  op- 
posite kidney  may  be  called  on  to  assume 
the  entire  load  of  waste  and  excretion  and 
which,  in  fact,  is  often  simultaneously  and 
extensively  diseased.  Blood  chemistry  de- 
terminations, weighing  of  the  patient,  and 
evaluation  of  specific  gravity  of  the  voided 
urine  with  accurate  clinical  observation  of 
the  patient  for  evidence  of  edema  is  neces- 
sary to  prevent  either  extreme  of  hydra- 
tion in  this  group. 

One  of  the  most  important  guides  to  the 
state  of  hydration  following  surgery  has  been 
the  twenty-four  hour  output  of  urine.  This 
has  been  based  on  the  ability  of  the  kidney 
to  excrete  any  excess  of  administered  fluids 
and  on  the  principle  that  all  other  normal 
demands  for  fluid  as  to  the  loss  by  vapori- 
zation from  the  lungs  and  skin  must  be  met 
initially  and  the  kidney  must  function  on 
what  remains.  The  volume  of  urine  which 
is  an  acceptable  minimum  in  the  postopera- 
tive patient  varies  with  different  investiga- 
tors, but  a twenty-four  hour  output  of  1,000 
cubic  centimeters  of  urine  is  generally  ac- 
cepted as  indicative  of  adequate  hydration. 
This  may  vary  according  to  the  condition 
of  the  kidneys,  however.  A normal  indi- 
vidual excretes  approximately  35-40  grams 
of  solids  daily  through  the  kidney.  It  is 
estimated  that  15  cubic  centimeters  of 
water  are  necessary  to  carry  each  gram  of 
solids  through  the  secretory  process.  This 
would  make  necessary  a minimal  output 
of  525  cubic  centimeters  of  urine  daily. 
However,  if  renal  function  is  suppressed  or 
extensive  bilateral  disease  of  the  kidneys  is 
present  it  may  require  as  much  as  45  grams 
of  water  to  carry  each  gram  of  solids.  This 
would  require,  for  adequate  renal  clearance, 
an  output  of  1,575  cubic  centimeters  of  urine 
daily. 

The  close  observation  of  urine  output  in 
excess  of  other  losses  with  similar  close 
attention  to  the  patient  for  evidence  of 
pre-tibial,  sacral,  pulmonary  or  cerebral 
edema  as  indicative  of  over-hydration,  re- 
mains one  of  the  most  reliable  means  of 


keeping  the  patient  in  balance.  I believe, 
however,  that  barring  some  cardiovascular 
disease,  the  above  named  signs  of  excess 
fluid  administration  should  not  be  seen 
except  for  rare  instances  in  which  the  total 
fluid  loss,  by  profuse  perspiration  and/or 
enteric  fistulae  is  very  large,  making  salt 
and  water  replacement  extremely  difficult 
to  gauge  accurately.  Then  such  signs  of 
edema  are  excusable  if  promptly  noted 
and  corrective  measures  taken. 

With  the  dangers  of  excess  fluid  and  salt 
administration  known  and  herein  pointed 
out,  it  is  also  wise  to  keep  in  mind  the 
potential  danger  of  fluid  excess  in  the 
cardiac  patient.  The  already  weakened  cir- 
culation may  be  overtaxed  by  the  increased 
burden  incidental  to  the  surgery  and  in- 
creased metabolism  and  therefore  unable 
to  cope  with  undue  additions  of  fluid.  In 
such  situations,  the  division  of  the  total 
fluid  required  into  an  intravenous  and  sub- 
cutaneous portion  has  advantages  over  pure- 
ly intravascular  injection.  The  treatment 
of  edema  in  postoperative  states  and  in 
cardiac  failure  by  the  introduction  of  large 
amounts  of  fluid  as  advised  by  Schemm® 
and  followed  by  others,  with  the  accurate 
control  of  the  total  base  administered 
whether  by  intravenous  fluids  or  dietetic 
means  or  both,  is  rational  and  gaining  wide 
following.  However,  I have  not  had  the 
courage  to  depend  too  greatly  on  the  ability 
of  the  circulation  and  kidneys  in  the  im- 
mediate postoperative  period  to  excrete 
quantities  in  excess  of  that  amount  actually 
determined  to  be  necessary  to  cover  losses 
and  insure  adequate  renal  clearance.  The 
question  of  sodium  chloride  administra- 
tion will  be  dealt  with  further  under  that 
heading. 

Sodiiun  Chloride  Balance 

Intake  and  Output:  The  normal  indi- 
vidual ingests  from  4 to  12  grams  of  so- 
dium chloride  daily,  only  a fraction  of 
which  is  utilized  in  the  body  metabolism. 
In  view  of  this  quantity  plus  the  chloride 
content  of  gastric,  biliary,  pancreatic  and 
enteric  secretions  which  go  into  the  in- 
testinal canal  daily,  the  absorption  and 
resorption  is  very  complete  as  less  than  .5 


for  May,  1949 


379 


gram  of  salt  appears  in  the  stool.  And  as 
the  sodium  chloride  lost  from  the  skin 
through  the  process  of  vaporization  is  very 
negligible  the  kidney  has  the  function  of 
eliminating  this  large  daily  excess.  When  one 
perspires  freely,  however,  the  sodium  chlo- 
ride. loss  may  be  quite  large.  In  such  situa- 
tion the  kidney  then  acts  to  conserve  salt 
and  will  excrete  very  small  amounts  es- 
pecially if  the  excess  loss  from  other  sources 
continues  very  long. 

Function  of  Sodium  Chloride:  Sodium 
chloride  has  two  important  functions.  It 
is  a determining  force  in  the  amount  and 
distribution  of  body  water  because  of  the 
osmotic  pressure  it  effects,  and  it  con- 
tributes to  acid-base  balance. 

It  is  important  to  recognize  in  the  first 
instance  that  neither  salt  nor  water  moves 
about  the  body  independently  but  in  con- 
junction with  each  other.  This  is  so  be- 
cause the  salt,  through  the  osmotic  pressure 
it  exerts,  attracts  water  until  an  isotonic 
solution  is  attained.  This  is  then  filtered 
from  the  capillaries  to  inter-cellular  spaces 
which  form  the  external  environment  of 
the  cell.  Any  alterations  in  the  state  of 
hydration  or  disturbance  in  electrolyte  bal- 
ance in  the  plasma  is  reflected  in  this  inter- 
cellular volume  of  fluid  by  a shift  of  water 
or  salt  to  or  from  itself  as  dictated  by  the 
needs  of  the  circulation  working  through  its 
own  osmotic  pressure  exerting  plasma  pro- 
teins or  its  own  buffer  combinations,  or 
both.  This  inter-cellular  volume  thus  is  a 
depot  of  water  and  salt  reserves  as  well 
as  a buffer  against  too  radical  shifts  in  the 
external  environment  of  the  cell  which 
would  produce  serious  internal  derange- 
ments and  disturbed  cell  function. 

Excess  Sodium  Chloride  Intake:  In  nor- 
mal individuals  the  kidney  is  capable  of 
disposing  of  tremendous  quantities  of  salt, 
taken  orally  or  given  parenterally.  However, 
the  sick  postoperative  patient  may  not  be 
so  well  equipped  to  handle  this  additional 
strain.  It  has  been  noted  there  is  a lag 
period  the  first  twenty-four  to  forty-eight 
hours  following  surgery  during  which  the 
urinary  output  is  in  quantities  unsatis- 
factory by  the  usual  standards  even  though 
the  amount  of  fluids  supplied  is  adequate. 


It  is  inadvisable  to  give  large  quantities  of 
saline  particularly  during  this  period  as  the 
chloride  accumulation  may  be  extreme  and 
edema — pulmonary,  cerebral,  or  peripheral 
— will  be  precipitated.  This  may  be  carried 
further  to  apply  to  fluids  void  of  sodium 
chloride  for  Wangensteen^®  has  observed 
that  efforts  to  provoke  diuresis  during  this 
period  is  poorly  tolerated  and  he  advises 
daily  weighing  of  the  patient  in  bed  to  de- 
termine the  state  of  hydration.  This  has 
real  merit  but  for  the  majority  of  us  this 
is  as  yet  impractical.  It  must  suffice  to 
realize  such  lag  occurs  and  not  overload  the 
patient  with  electrolytes  and/or  fluids. 

Having  mentioned  the  relatively  low  so- 
dium chloride  daily  requirement,  since  such 
a large  proportion  of  the  average  4-12  grams 
ordinarily  ingested  appears  in  the  urine, 
it  would  seem  falacious  and  courting  un- 
necessary dangers  to  include  in  the  daily 
quota  of  fluids  given  to  the  postoperative 
patient  more  than  that  amount  of  salt  re- 
quired to  cover  losses  we  know  to  occur. 
Under  anesthesia  and  during  febrile  periods 
perspiration  may  be  profuse,  vomiting  or 
gastroduodenal  suction,  enteric  fistulae,  and 
of  course  burns  may  represent  very  large 
daily  losses  of  chlorides.  Then  an  estimate, 
often  rough,  must  be  made  and  these  secre- 
tions and  excretions  covered  by  like  volume 
of  saline.  After  the  first  twenty-four  hours, 
except  in  extremely  febrile  cases,  the  losses 
by  sweating  are  usually  markedly  reduced; 
barring  fistulae  and  the  like,  sodium  chlo- 
ride needs  may  be  for  the  most  part  cov- 
ered by  500  cubic  centimeters  of  saline 
supplying  4.5  grams  of  sodium  chloride. 
Coller  and  Haddock*  use  daily  500  cubic 
centimeters  of  Ringers  solution  to  cover  the 
basic  needs  imposed  by  losses  from  the  skin 
through  vaporization,  which  are  minimal, 
and  from  the  stool,  also  minor.  With  this 
reasonable  supply  the  kidneys  may  be  de- 
pended on  to  excrete  any  modest  excess  of 
salt.  Beyond  this  the  fluid  supply  should 
be  in  the  form  of  5 per  cent  glucose  in 
distilled  water. 

Sodium  Chloride  Deficiency:  This  con- 
dition that  can  occur  only  in  instances  in 
which  the  chloride  loss  by  vomiting,  pan- 
creatic, biliary  or  enteric  fistulae,  excessive 


380 


Rocky  Mountain  Medical  Journal 


serous  drainage  or  exudation,  burns,  etc., 
exceeds  the  amount  provided  by  the  patient 
by  parenteral  means.  The  need  is  most 
often  for  chlorides  rather  than  sodium,  as 
the  loss  of  chlorides  can  be  for  a time  offset 
by  the  shift  of  bicarbonate  radicles,  created 
by  the  carbon  dioxide  formed  in  the  tissues, 
to  the  remaining  sodium.  Prolonged  loss 
of  chlorides  would  then  result  in  a rising 
total  loss  in  the  system  and  a hypochlo- 
remia.  This  results  clinically  in  nausea, 
V'eakness,  lassitude,  failing  renal  function 
and  decreased  general  resistance  appearing 
after  the  plasma  chlorides  have  dropped 
100  milligrams  per  cent  or  more.  Bartlett, 
Bingham,  and  Pederson^  feel  20  grams  of 
salt  are  needed  to  restore  100  milligrams 
per  cent  to  the  plasma  chlorides  and  they, 
with  Haddock  and  Coller®,  advise  that  for 
each  100  milligrams  of  plasma  chloride  de- 
ficiency per  100  cubic  centimeters  of  plasma, 
0.5  gram  of  sodium  chloride  per  kilogram 
of  body  weight  should  be  given. 

Plasma  Chloride  Determination:  The  de- 
termination of  the  plasma  chlorides  is  a 
valuable  test,  particularly  when  combined 
with  the  carbon  dioxide  combining  power 
and  frequently  the  urea  nitrogen.  But  this 
chloride  level  does  not  fall  immediately 
when  the  chloride  loss  begins  to  exceed  the 
intake.  Inherent  correcting  mechanisms, 
e.g.  the  withdrawal  of  fluids  and  salt  from 
the  extra-cellular  spaces,  will  hold  tem- 
porarily the  level  within  the  normal  range. 
If  this  depletion  is  large  or  prolonged  the 
chlorides  may  then  fall  precipitiously. 
However,  they  are  never  depleted  com- 
pletely. Very  severe  depletion  with  hypo- 
chloremia  goes  only  so  far,  after  which  com- 
plete deprivation  will  result  in  no  further 
fall  in  plasma  chlorides.  Some  reserve  is 
drawn  on  which  is  never  depleted,  or  rather 
death  intervenes  from  the  consequent  dis- 
turbed physiology  before  further  plasma 
chloride  fall  is  observed. 

On  the  other  hand,  the  plasma  chloride 
determination  is  not  a reliable  guide  in 
evaluating  the  upper  levels  of  plasma  chlo- 
rides, since  the  salt  and  the  water  it  attracts 
are  deposited  in  the  extra-cellular  spaces 
and  a hydremia  and  edema  is  the  result 


rather  than  an  elevated  plasma  chloride 
level  per  unit  volume. 

The  need  in  electrolyte  replacement  is 
most  often  for  sodium  chloride,  though  in 
an  excess  of  these  ions  it  is  the  sodium 
which  is  potentially  most  dangerous  be- 
cause of  its  tissue  retention.  However,  spe- 
cial needs  arise  in  which  other  ions,  cations 
in  particular,  are  indicated.  In  the  prolonged 
duodenal  fistulas  as  is  seen  in  the  not  in- 
frequent leak  of  the  duodenal  stump  after 
gastrectomy,  the  combined  loss  of  duodenal, 
biliary  and  pancreatic  fluids  make  the  ad- 
ministration of  sodium  chloride  plus  other 
elements  as  magnesium,  calcium,  and  po- 
tassium desirable.  These  duodenal  replace- 
ment fluids  are  commercially  available  in 
their  correct  proportions.  In  low  enteric 
fistulae  and  diarrheas,  in  which  the  loss  is 
principally  of  base,  sodium  is  needed  in 
excess  of  acid  radicals.  This  problem,  so 
frequent  in  the  diarrheas  of  children,  led 
Hartmann  to  advise  sodium  lactate  as  the 
corrective  agent  since  the  lactate  is  oxidized, 
leaving  an  excess  of  sodium  to  restore  the 
total  body  base. 

Protein  Balance 

The  advantages  accruing  from  the  main- 
tenance of  normal  protein  levels  in  the 
postoperative  state  have  only  recently  come 
to  be  appreciated.  They  are  the  proper 
hydration  of  the  patient,  increased  resist- 
ance to  infection  and  other  complications 
such  as  wound  disruption,  more  rapid  con- 
valescence, more  rapid  return  of  strength, 
and  sense  of  well-being. 

As  has  been  pointed  out  with  regard  to 
the  problems  of  fluid  and  electrolyte  bal- 
ance, with  which  protein  balance  is  in- 
timately related,  it  is  only  the  more  com- 
plex case  which  requires  much  concern  over 
depletion  of  protein  stores.  Madden  and 
Whipple®  have  suggested  there  are  three 
types  of  tissue  protein:  1.  A labile  protein 
reserve  against  which  the  body  may  draw 
to  maintain  plasma  proteins.  2.  A dis- 
pensible  reserve  which  is  less  available  but 
may  be  drawn  on  in  time  of  severe  de- 
pletion. 3.  An  indispensible  fixed  tissue 
protein  which  never  becomes  available  for 
such  usage.  This  concept  fits  the  observa- 


for  May,  1949 


381 


tion  of  Ravdin®  and  others  who  point  out 
that  body  proteins  may  be  appreciably  de- 
pleted before  circulating  plasma  proteins 
drop.  Ravdin  further  suggests,  as  most  of 
us  have  observed,  that  any  injected  protein 
replacement  must  be  used  to  replenish 
these  body  proteins,  as  a rise  in  circulating 
proteins  is  not  immediately  observed. 

The  ultimate  source  of  all  tissue  proteins 
is,  of  course,  the  diet.  This  being  out  of 
the  question  in  the  postsurgical  case,  we 
must  prevent  appreciable  or  severe  deple- 
tion of  these  stores.  A drop  in  circulating 
plasma  proteins  from  the  normal  level  of 
6-8  grams  per  100  cubic  centimeters  of 
plasma  to  approximately  5.2  grams,  or  the 
so-called  “critical  level,”  is  without  signs 
or  symptoms  as  a rule.  Very  large  amounts 
of  sodium  chloride  may  produce  edema,  even 
before  this  level  is  reached.  Beyond  this 
point  edema  may  become  manifest  through 
the  decreased  osmotic  pressure  of  the  plas- 
ma, which  is  then  less  capable  of  re-attract- 
ing the  extra-cellular  fluid.  At  this  point 
any  excess  of  sodium  chloride  becomes  es- 
pecially significant  in  the  production  of 
edema,  for  we  have  working  together  two 
factors,  decreased  osmotic  pressure  within 
the  capillary  and  increased  osmotic  pres- 
sure of  the  inter-cellular  fluids.  This  fluid 
therefore  holds  water  from  the  capillary 
and  attracts  fluid  from  within  the  cell, 
across  its  membrane.  Therefore  the  para- 
doxical situation  occurs  in  which  the  cell 
is  dehydrated  in  the  presence  of  an  excess 
of  fluid. 

In  this  important  relationship  of  plasma 
proteins  to  osmotic  pressure  all  of  the  frac- 
tions contribute  to  the  total  osmotic  pressure 
of  about  25  millimeters  of  mercury.  But  by 
far  the  most  important  is  the  albumin  frac- 
tion which  is  the  one  largely  depleted  fol- 
lowing extensive  surgical  procedures.  Serum 
globulin  exerts  an  osmotic  pressure  per  gram 
approximately  one-fourth  that  of  a gram 
of  serum  albumin.  And  with  all  this,  hypo- 
proteinemia  and  edema  are  only  warning 
signs  of  the  disturbed  nutrition  of  the  pa- 
tient which  is  basically  the  cause  of  all  the 
possible  complications  mentioned  which 
may  develop. 

For  many  years  the  transfusion  of  whole 


blood  was  the  only  way  this  hypo-protein- 
emia  could  be  prevented  or  treated,  but 
plasma  transfusion  then  developed  which 
permits  transfusion  of  serum  twice  as  fast 
as  with  whole  blood.  This  procedure  is  a 
distinct  gain  in  our  armamentarium,  yet 
we  know  from  experience  very  large  and 
frequent  plasma  transfusions  are  necessary 
to  raise  and  maintain  the  patient’s  body 
proteins  once  significant  depression  has  oc- 
curred, the  principal  reason  being  the  ne- 
cessity of  first  restoring  the  labile  body 
proteins  which  have  already  been  drawn  on 
heavily.  Also  the  daily  expenditure  in  the 
acclerated  metabolism  of  the  postoperative 
patient  makes  any  beneficial  effects  diffi- 
cult to  observe  unless  the  transfusions  are 
frequent  and  large. 

The  latest  development  in  this  problem 
of  protein  feeding  where  oral  feeding  is 
contraindicated  has  been  in  the  field  of  in- 
jectable amino  acids.  This  is  ordinarily  ac- 
complished by  the  use  of  two  infusions  of 
one  of  the  commercially  prepared  protein 
hydrolysates  containing  50  grams  of  amino 
acids  in  1,000  cubic  centimeters  of  5 per 
cent  glucose  in  distilled  water.  One  such 
infusion  supplies  the  patient,  in  addition 
to  the  50  grams  of  amino  acids  (the  es- 
sential acids  being  represented),  with  400 
calories.  Two  then  provides  the  patient 
with  800  calories  and  it  is  sometimes  cus- 
tomary to  add  to  each  infusion  one  ampoule 
of  50  cubic  centimeters  of  50  per  cent  glu- 
cose, thus  increasing  the  caloric  value  of 
each  intravenous  infusion  to  500  calories. 
In  this  way  the  patient  is  provided  the  basic 
caloric  intake  as  well  as  providing  the  pa- 
tient with  the  basic  amino  acids  from  which 
the  liver  may  resynthesize  body  and  plasma 
proteins.  This  often  does  not  work  dra- 
matically, in  which  case  we  must  remem- 
ber general  toxicity  may  have  suppressed 
liver  function  to  such  an  extent  that  the 
re-synthesis  of  amino  acids  to  proteins  by 
that  organ  is  temporarily  impossible.  The 
infusion  must  be  slow  to  prevent  untoward 
reactions  and  to  prevent  undue  spilling  of 
the  amino  acids  in  the  urine. 

No  method  of  parenteral  alimentation  can 
take  the  place  of  digestion,  yet  this  has 
proved  a great  help  in  preventing  serious 


382 


Rocky  Mountain  Medical  Journal 


protein  depletion  and  is  less  expensive  than 
massive  transfusion  of  plasma. 

Discussion  and  Conclusions 
In  the  utilization  of  the  many  facts  dis- 
covered relative  to  fluid,  electrolyte,  and 
protein  balance  in  the  last  few  years,  it  is 
necessary  to  use  them  with  the  patient 
always  the  center  of  gravity,  so  to  speak. 
There  are  as  yet  many  points  in  this  com- 
plex physiology  which  are  not  understood, 
many  yet  to  be  discovered.  It  is  wise  to 
follow  the  patients  cJosely  from  day  to 
day  and  no  routine  laid  down  for  a series 
of  days.  It  is  important  to  not  rely  on 
chemical  studies  exclusively  in  the  evalua- 
tion of  the  patient’s  hydration  or  nutrition. 
Abbott^  has  emphasized  this  point,  and  a 
summary  of  the  misleading  information 
often  derived  is  seen  in  his  article.  It  is 
important  to  think  of  total  body  water  and 
total  electrolytes  and  total  protein  rather 
than  hematocrit,  plasma  chlorides  and 
serum  proteins.  These  are  valuable,  as  is 
the  carbon  dioxide  combining  power,  in 
measuring  the  total  base;  but,  taken  alone, 
any  may  result  in  a disastrous  approach. 


Fig.’  1 (From  Abbott,  W.  E.*)  The  failure  of  the 
plasma  protein  concentration  to  denote  the  need 
for  therapy,  or  the  amount  of  total  circulating 
plasma  protein  present.  (The  closed  bar  equals  the 
red  cell  mass,  and  the  open  area  of  the  bar  the 
extent  of  the  plasma  volume.) 

From  the  contribution  of  Coller  and  Had- 
dock^ we  know  that  about  two  liters  daily 
of  fluid  are  lost  in  the  post-surgical  patient 
from  insensible  vaporization  from  the  skin 
and  lungs  and  the  perspiration  encountered, 
particularly  under  anesthesia.  To  this  re- 
placement we  must  add  adequate  fluids  to 
assure  the  patient  adequate  renal  clear- 
ance; thus  approximately  three  thousand 
cubic  centimeters  will  be  required  as  a 


‘Reprinted  by  permission  of  the  author  and  the 
American  Journal  of  Medicine  Sciences,  February, 
1946. 


rule,  but  much  more  i^  profuse  perspira- 
tion, drainage,  or  exudation,  enteric,  biliary, 
or  pancreatic  fistulae  are  present.  The 
volume  necessary  to  cover  such  loss  will, 
of  course,  depend  on  the  amount  lost  and 
some  approximation  will  be  necessary. 

Electrolytes,  except  for  high  enteric  or 
biliary  fistulae,  are  in  general  over-re- 
placed rather  than  insufficiently  so.  One 
liter  or  less  of  normal  saline  daily  will 
replace  in  the  vast  majority  of  patients  the 
sodium  chloride  lost,  with  some  to  spare. 
Fluid  requirements  beyond  that  volume 
should  be  in  the  form  of  glucose  in  dis- 
tilled water. 

Protein  balance,  not  even  as  well  under- 
stood as  the  fluid  and  electrolyte  balance, 
is  intimately  bound  to  the  latter  ques- 
tions. We  now  recognize  mortality  and  to 
an  even  greater  extent,  morbidity  is  re- 
duced by  adequate  attention  to,  and  re- 
placement of,  the  proteins  depleted  follow- 
ing complex  surgery  or  complicated  post- 
operative courses. 

No  laboratory  rule  or  findings  is  safe 
in  itself,  for  present  chemical  determina- 
tions cannot  evaluate  the  system  outside 
of  the  yascular  bed.  Tissue  turgor,  condi- 
tion of  the  tongue,  presence  or  absence  of 
edema,  degree  of  mental  depression,  vol- 
ume and  specific  gravity  of  urine,  or  other 
clinical  findings  with  the  aid  provided  by 
certain  laboratory  determinations  will,  on 
the  other  hand,  provide  one  with  the  in- 
formation necessary  to  meet  intelligently 
the  demands  of  the  patient’s  physiology  in 
its  attempt  to  restore  the  body  health. 

REFERENCES 

'Abbott,  W.  E.:  A Review  of  the  Present  Concepts 
on  Fluid  Balance.  Am.  J.  of  the  Med.  Soc.  211:233. 
(Feb.)  1946. 

'Bartlett,  R.  M.,  Bingham,  D.  L.  C..  and  Pederson, 
S. : Salt  Balance  in  Surgical  Patients.  Surgery 
4:441.  (Sept.)  1938. 

'Coller,  Frederick  A.,  and  Maddock,  W.  G. : Water 
and  Electroiyte  Balance.  Ann.  of  Surg.  98:952. 
(Nov.)  1933. 

'Coller,  Frederick  A.,  and  Maddock,  W.  G. : Water 
and  Electrolyte  Balance.  S.  G.  & O.  70:340  (Feb.) 
1940. 

'Madden,  A.  C.,  and  Whipple,  G.  H.:  Plasma  Pro- 
teins: Their  Source,  Production  and  Utilization. 

Physiol.  Rev.  20:194.  (April)  1940. 

'Maddock,  W.  G.,  and  Coller,  F.  A.:  Water  Balance 
in  Surgery.  J.  Amer.  Med.  Assn.  108:1.  (Jan.  2)  1937. 

'Nash,  Joseph:  Surgical  Physiology.  Springfield, 
Charles  C.  Thomas,  1942,  222  pp. 

'Ravdin,  I.  S.:  Hypoprotenemia  and  Its  Relation 
to  Surgical  Problems.  Ann.  Surg.  112:576-583.  1940. 

'Schemm,  F.  R. : A High  Fluid  Intake  in  the  Man- 
agement of  Edema.  The  Journal  Lancet.  Vol.  LXVI: 
50-54  (Feb.)  1946. 

“Wengensteen,  O.  H. : Care  of  Patient  Before  and 
After  Operation.  New  England  Med.  J.  236:191-196. 
(Feb.  6)  1947. 


for  May,  1949 


383 


Organization 

National  Affairs  - Proceedings  - Programs  - Society  Notices  - News  - Auxiliary 


NATIONAL  AFFAIRS 


Presidents  to  Meet 
In  Atlantic  City 

Discussion  of  compulsory  health  plans,  both 
for  medical  care  and  for  disability  compensation, 
will  highlight  the  fifth  annual  meeting  of  the 
Conference  of  Presidents  and  Other  Officers  of 
State  Medical  Associations  to  be  held  at  Atlantic 
City  Sunday  afternoon,  June  5.  The  meeting  will 
be  held  in  the  Rose  Room  of  the  Traymore  Hotel 
the  day  preceding  the  opening  of  the  AMA  gen- 
eral sessions,  and  it  will  be  open  to  all  physi- 
cians. 

Cecil  Palmer,  English  publisher,  author,  and 
journalist,  will  tell  of  the  impact  of  socialized 
medicine  on  the  British  doctor  and  his  patients. 
Palmer,  now  completing  a tour  of  America,  has 
been  a brilliant  spokesman  for  the  British  So- 
ciety for  Individual  Freedom.  An  American 
viewpoint  of  the  British  health  system  will  be 
given  by  W.  Alan  Richardson,  editor  of  Medical 
Economics,  now  in  England  for  a first-hand  study 
of  all  phases  of  the  program. 

With  compulsory  disability  compensation  pro- 
grams operating  in  three  states,  and  Washington 
and  New  York  the  latest  to  pass  such  laws,  the 
Conference  presents  two  speakers  on  this  ques- 
tion, Edward  H.  O’Connor,  managing  director  of 
the  Insurance  Economics  Society  of  America, 
will  discuss  the  legislation,  and  Dr.  Bert  S. 
Thomas,  medical  director  of  the  California  pro- 
gram, will  tell  of  the  medical  implications  of 
cash  sickness  compensation  acts. 

The  AMA  relationship  to  the  state  societies 
will  be  reviewed  by  Dr.  George  F.  Lull,  Secre- 
tary of  the  AMA,  and  the  problems  facing  the 
state  association  at  the  crossroads  will  be  the 
subject  of  a talk  by  Dr.  Clarence  Northcutt, 
President  of  the  Oklahoma  State  Medical  Asso- 
ciation. Plans  are  also  pending  for  the  presen- 
tation of  views  on  national  health  legislation  by 
a member  of  Congress. 


INTERNATIONAL  POSTGRADUATE  M E D- 
ICAL  ASSEMBLY  OF  SOUTHWEST  TEXAS 

The  International  Postgraduate  Medical  As- 
sembly of  Southwest  Texas  will  hold  its  annual 
meeting  January  24,  25,  26,  1950,  in  San  Antonio, 
Texas,  at  the  ^Municipal  Auditorium.  Dr.  D.  F. 
Lehmann,  President;  Dr.  John  J.  Hinchey,  Sec- 
retary-Treasurer, San  Antonio,  Texas. 

, ' i , 

384 

,4  ; , 


COLORADO 

State  Medical  Society 

Sixty  Attend 
Cancer  Course 

The  first  Northern  Colorado  Cancer  Refresher 
Course  under  sponsorship  of  the  Colorado  State 
Medical  Society  and  the  Cancer  Division,  State 
Department  of  Public  Health,  was  held  in  Ft. 
Collins  all  day  Sunday,  April  3.  A committee 
composed  of  representatives  of  the  three  north- 
ern coimty  medical  societies.  Weld,  Larimer  and 
Boulder,  arranged  the  program,  under  the  di- 
rection of  the  State  Society  Cancer  Control  Com- 
mittee. Serving  on  that  committee  were  Drs. 
Duane  F.  Hartshorn  and  Martin  G.  Van  Der 
Schouw,  Ft.  Collins;  Albert  J.  Helm,  Fred  J. 
Roukema  and  Sion  W.  Holley,  Greeley;  Harry 
D.  Jones,  Longmont,  and  Roy  E.  Wolfe,  Boulder. 
The  meeting  was  attended  by  about  sixty  doc- 
tors from  the  area  north  of  Denver  and  east  of 
the  Continental  Divide,  and  also  drew  doctors 
from  Cheyenne,  Salt  Lake  City  and  Phoenix. 

Dr.  Harold  D.  Palmer,  Pathologist  of  Chil- 
dren’s Hospital,  Denver,  presided.  Appearing  on 
the  program  at  fifteen-minute  intervals  were 
Drs.  Walter  T.  Wikle,  John  A.  Lichty  and  Ma- 
son Morfit  from  the  University  of  Colorado 
Medical  Center;  Dr.  S.  Z.  Draznin,  Cheyenne; 
Drs.  Jack  D.  Bartholomew  and  Carl  J.  Gilman, 
Boulder.  Discussion  leaders  were  Dr.  David  W. 
McCarty,  Longmont;  Dr.  Henry  M.  Russeli 
and  Eugene  Wiege,  Greeley;  Drs.  George  Garri- 
son and  James  F.  Hoffman,  Fort  Collins. 

This  was  the  second  Cancer  Refresher  Course 
sponsored  by  the  State  Society  and  the  Depart- 
ment of  Public  Health,  the  first  having  been 
held  last  year  in  Colorado  Springs  for  southern 
Colorado. 


Component  Societies 

DELTA  COUNTY 

Dr.  W.  S.  Cleland  was  the  principal  speaker 
at  the  April  1 meeting  of  the  Delta  County  Med- 
ical Society.  Dr.  Cleland  spoke  on  “How  to 
Manage  the  Financial  Side  of  Medical  Practice.” 
Dr.  L.  L.  Hick  discussed  a recent  trip  he  made 
to  the  American  Academy  of  General  Practice 
Convention  in  Cincinnati.  Delta  Coimty  has 
paid  the  AMA  assessment  100  per  cent.  All 
members,  both  active  and  emeritus,  have  paid 
this  assessment. 

J.  J.  CONNOR,  M.D.,  Secretary. 


Rocky  Mountain  Medical  Journal 


TREATMENT 
OF  CONSTIPATION 
IN 


mucous 

colitis 


JL  he  treatment  of  the  constipation  in 
mucous  colic  does  not  differ  from  the  treat- 
ment of  uncomplicated  constipation.  It  is, 
as  always,  of  great  importance  to  avoid  irri- 
tating aperients, ....  The  stools  should  be 
rendered  soft  and  more  bulky  and  therefore 
more  easy  to  expel  with  . . . and  unirritating 
vegetable  mucilages." 

— Hurst,  A.,  in  Portia,  S.  A.:  Diseases  of  the  Digestive  System, 
ed.  2,  Philadelphia,  Lea  & Febiger,  1944,  p.  692. 


MUCOUS  COLITIS.  In  this  x-ray  is  shown  the  distinctive  string-Kke 
appearance  of  the  descending  portion  of  the  lower  bowel  in 
mucous  colitis,  a condition  frequently  accomponying  severe  degrees 
of  spastic  or  atonic  colon.  In  the  sagittal  section  is  shown  the  over- 
secretion  of  mucus  adhering  to  the  bowel  wall. 


By  providing  soft,  demulcent,  water -retain- 
ing, mucilloid  bulk,  Metamucil  — the 
"smoothage”  treatment  of  constipation  — 
promotes  a return  to  normal  elimination. 


METAMUCIL®  is  the  highly  refined  mucilloid 

of  Plantago  ovata  (50%),  a seed  of  the 
psyllium  group,  combined  with  dextrose 
(50%),  as  a dispersing  agent. 


SEARLE 


Research  in  the  Service  of  Medicine 


G.  D.  SEARLE  & CO.,  CHICAGO  80,  ILLINOIS 


o? 


385 


May,  1949 


MESA  COUNTY 

The  Mesa  County  Medical  Society  held  a meet- 
ing April  5 at  the  La  Court  Hotel  in  Grand  Junc- 
tion. Dr.  Kenneth  Prescott  reported  on  the  first 
annual  meeting  of  the  American  Academy  of 
General  Practice  which  he  attended  in  Cincin- 
nati. Dr.  G.  Paul  Smith  gave  a brief  talk  on 
“Electrocardiography.”  The  Society  discussed 
plans  for  the  Spring  Clinics  to  be  held  April  23 
and  24  at  the  La  Court  Hotel  in  Grand  Jimction. 

MARGARET  R.  N.  BEAVER,  M.D.,  Secy. 


Obituaries 

ARTHUR  R.  LANNON 

Dr.  Arthur  R.  Lannon,  a practicing  Denver 
urologist  for  the  past  thirty-three’  years,  died 
March  24,  1949,  at  the  age  of  59.  He  had  been 
in  ill  health  for  several  months. 

Born  in  Washington,  Missouri,  on  September 
22,  1889,  Dr.  Lannon  received  his  early  educa- 
tion including  his  first  two  years  of  medicine  in 
Missouri.  In  1914  he  came  to  the  University  of 
Colorado  Medical  School  to  complete  his  last 
two  years  of  medicine,  receiving  his  degree  in 
1916.  He  remained  in  Denver  to  start  his  med- 
ical practice. 

Dr.  Lannon  was  a member  of  the  Denver 
County  and  Colorado  State  Medical  Societies, 
the  Denver  and  American  Urological  Societies 
and  the  Denver  Medical  Club.  He  gave  freely 
of  his  time  to  the  University  of  Colorado  Med- 
ical School,  Denver  and  Colorado  General  Hos- 
pitals. 

Respected  by  all  who  knew  him.  Dr.  Lannon 
gained  a high  point  of  prestige  in  Denver  and 
Colorado  medical  circles.  His  passing  will  be 
keenly  felt. 


MARY  REED  STRATTON 
Dr.  Mary  Reed  Stratton,  a retired  Denver 
ophthalmologist  and  otolaryngologist,  died  March 
19,  1949,  at  the  age  of  80,  of  a heart  attack. 

Born  in  Hudson,  Wisconsin,  on  February  1, 
1869,  Dr.  Stratton  spent  most  of  her  early  years 
in  Iowa.  She  attended  Northwestern  University 
Medical  School  and  graduated  in  1893. 

In  1896  her  husband,  Charles  Stratton,  was 
killed  in  a mining  accident.  Six  years  later  Dr. 
Stratton  moved  to  Denver,  where  she  practiced 
for  many  years  before  joining  the  staff  of  the 
State  Hospital  in  Pueblo.  In  1941,  on  retiring, 
she  returned  to  Denver,  where  she  maintained 
her  residence  until  her  death. 

Dr.  Stratton  was  a member  of  the  Colorado 
State  Medical  Society.  With  her  passing  the 
state  loses  one  of  its  true  pioneers  in  medicine. 


POSTGRADUATE  COURSE:  INDUSTRIAL 
MEDICINE 

A postgraduate  course  in  Industrial  Medicine 
will  be  given  at  the  University  of  Colorado 
Medical  Center,  Denver,  Colorado,  May  19-20, 
inclusive,  1949.  This  course  will  be  sponsored 
by  the  Colorado  State  Medical  Society  and  the 
University  of  Colorado  School  of  Medicine.  The 
purpose  of  the  course  is  to  orient  physicians  to 
the  principles  involved  in  the  practice  of  In- 
dustrial Medicine.  The  program  consists  of 
didactic  lectures  and  demonstrations  to  be  con- 
ducted by  members  of  the  faculty  and  practicing 
physicians. 

Admission  to  this  course  is  open  to  all  phy- 


sicians who  are  members  of  their  constituent 
medical  societies  or  the  American  Medical  Asso- 
ciation. No  tuition  will  be  charged,  but  a reg- 
istration fee  of  $10  is  required  of  all  applicants 
accepted  for  the  course.  Further  inquiry  should 
be  directed  to  Frank  Princi,  M.D.,  Director  of 
the  Division  of  Industrial  Medicine,  University 
of  Colorado  Medical  Center,  Denver,  Colorado. 


Auxiliary 

WOMAN’S  AUXILIARY  TO  THE  AMERICAN 
MEDICAL  ASSOCIATION 

Program  of  the  Twenty-Sixth  Annual  Meeting, 
Atlantic  City,  New  Jersey,  June  6-10,  1949 — 
Hotel  Haddbn  Hall 

Mrs.  Jam.es  H.  Mason,  Chairman,  Committee  on 
Arrangements 

A cordial  invitation  is  extended  to  all  members 
of  the  Woman’s  Auxiliary  to  the  American  Medi- 
ci Association,  their  guests  and  guests  of  physi- 
cians attending  the  convention  of  the  American 
Medical  Association,  to  participate  in  all  social 
functions  and  attend  the  general  sessions  of  the 
Auxiliary. 

Headquarters  will  be  at  Hotel  Haddon  Hall. 
Tickets  will  be  available  at  the  registration  desk. 
Please  register  early  and  obtain  your  badge  and 
program. 

PRECONVENTION  MEETINGS 
Sunday,  June  5 

12:00  M.  to  4:00  P.M. — The  members  of  the  Hos- 
pitality Committee  will  welcome  members  and 
guests  of  the  Woman’s  Auxiliary. 

Committee  Meetings 

1:00  P.M. — Nominating  Committee — Rowsley 
Room  (first  floor).  Mrs.  Jesse  D.  Hamer, 
chairman. 

8:00  P.M. — Finance  Committee — Bakewell  Room 
(first  floor).  Mrs.  Scott  C.  Applewhite, 
chairman. 

Monday,  June  6 

9:30  A.M. — Board  of  Directors — Room  134  (first 
floor).  Presiding,  Mrs.  Luther  H.  Kice,  Presi- 
dent. 

10:00  A.M. — Round  Table  Discussions  (Open  to 
state  officers  and  chairmen). 

12:00  M. — Luncheon  and  meeting  of  the  Board  of 
Directors — Bakewell  Room  (first  floor). 

3:00  P.M. — Revisions  Committee — Rowsley  Room 
(first  floor).  Mrs.  Roscoe  E.  Mosiman,  Chair- 
man. 

4:00  P.  M.  to  6:00  P.M. — Tea  honoring  Mrs. 
Luther  H.  Kice,  President,  and  Mrs.  David  B. 
Allman,  President-Elect,  for  the  members  of 
the  National  Board  of  Directors  and  State 
Presidents  and  Presidents-Elect  and  guests — 
Benjamin  West  Room.  Tickets,  $1.50.  All 
doctors’  wives  are  cordially  invited.  Hostesses: 
The  Woman’s  Auxiliary  to  the  Medical  Society 
of  New  Jersey. 

8:30  P.M. — Fashion  Show — Ballroom,  Conven- 
tion Hall. 

PROGRAM 
Tuesday,  June  7 

9:00  A.M. — Formal  opening  of  the  Twenty-sixth 
Annual  Meeting  of  the  Woman’s  Auxiliary  to 
the  American  Medical  Association,  Vernon 
Room.  (Lounge  Floor).  Presiding,  Mrs.  Luther 
H.  Kice,  President. 


386 


Rocky  Mountain  Medical  Journal 


Mhydroxr 


means 

ALUMINUM  HYDRUXIDE  AUSORBED 


"Alhydrox"  is  a handy  contraction  doctors  are 
also  using  oftener  these  days.  To  them  it  describes 
a p/us  value  in  Cutter  immunization  products. 


What  "Alhydrox"  does-The  selectivity 
of  aluminum  hydroxide  controls  the  adsorp- 
tion of  antigens,  thus  reducing  dosage  while 
maintaining  a high  antibody  concentration. 
After  injection  the''Alhydrox"adsorbed 
antigens  are  released  gradually,  prolonging 
stimulation  through  slow  absorption. 


What  "Alhydrox"  means  to  doctors  and 
their  patients -Alhydrox  assures  doctors  of 
high  antitoxin  levels  that  are  long  lasting. 
The  favorable  pH  of  aluminum  hydroxide 
lessens  pain  on  injection  and  cuts  side  reac- 
tion to  a minimum.  Rare  indeed  are  crying 
youngsters  and  nervous  mothers  (fathers, 
too)  who  complain  about  reactions  like  per- 
sistent nodules. 


CUTTER'S  NEW  CERTIFICATE  OF 

IMMUNIZATION  has  been  so  pop- 
ular with  doctors  and  nurses 
the  country  over  that  the  first 
big  quantity  printed  ran  out 
in  a hurry.  More  are  being  printed  now 
and  can  be  procured,  free  of  charge,  by 
asking  your  Cutter  detail  man  or  writing 
Cutter  Laboratories,  Berkeley,  California. 
Dept.  E-76 


• Pertussis  Phase  I Alhydrox 

30,000  million  H pertussis  per  cc. 

• Diphtheria  Toxoid  Alhydrox 

• Tetanus  Toxoid  Alhydrox 

• Diptussis  Alhydrox  ® 

Cutter  Diphtheria  Toxoid  plus  20,000  million 
H pertussis  per  cc.,  for  sirpultaneous  immu- 
nization against  pertussis  and  diphtheria. 

• Diphtheria  Toxoid-Tetanus  Toxoid  Alhydrox 

For  simultaneous  immunization  against 
diphtheria  and  tetanus. 

• Dip-Pert-Tet  Alhydrox* * 

Cutter  diphtheria,  pertussis,  tetanus  com- 
bined vaccine  for  simultaneous  immuniza- 
tion against  diphtheria,  pertussis,  tetanus. 

^Trademark 


"Alhydrox"  is  exclusive  with 


CUTTER 


for  May,  1949 


387 


Invocation — Reverend  Harvey  Bennett,  Pas- 
tor, First  Presbyterian  Church. 

Pledge  of  Loyalty  to  the  Woman’s  Auxiliary 
to  the  American  Medical  Association — Mrs. 
Eustace  A.  Allen. 

Greetings — Honorable  Joseph  Altman,  Mayor 
of  Atlantic  City;  Browne  Holoman,  M.D., 
President,  Atlantic  County  Medical  Society. 
Address  of  Welcome — Mrs.  Robert  B.  Walker, 
President,  Woman’s  Auxiliary  to  the  Medi- 
cal Society  of  New  Jersey. 

Response — Mrs.  John  S.  Bouslog,  Past  Presi- 
dent, Woman’s  Auxiliary  to  the  Colorado 
State  Medical  Society. 

Presentation  of  Convention  Chairman — Mrs. 
James  H.  Mason. 

Introductions — Mrs.  Luther  H.  Kice. 
Presentation  of  President-Elect — Mrs.  David 
B.  Allman. 

Roll  Call — Mrs.  George  Turner,  Constitutional 
Secretary. 

Minutes  of  the  Twenty-Fifth  Annual  Meeting 
Mrs.  George  Turner. 

Convention  Rules  of  Order — Mrs.  J.  K.  Avent. 
Credentials  and  Registration — Mrs.  Mathew 
Molitch. 

Address  of  the  President — Mrs.  Luther  H. 
Kice. 

Reports  of  Officers. 

12:30  P.M. — Luncheon  in  honor  of  the  Past  Presi- 
dents of  the  Woman’s  Auxiliary  to  the  Amer- 
ican Medical  Association,  Rutland  Room  (first 
floor).  Tickets,  $4.00.  Mrs.  Luther  H.  Kice, 
presiding. 

2:00  P.M. — Report  of  the  Board  of  Directors — 
Mrs.  Luther  H.  Kice. 

Reports  of  Chairmen  of  Standing  Committees. 
Report  of  Special  Committee — Reference  Mrs. 
Rollo  K.  Parkard. 

Report  of  the  Historian — Mrs.  Jesse  D.  Hamer. 
Report  of  the  Central  Office  and  Bulletin 
(!lirculation — Miss  Margaret  Wolfe. 

Report  of  the  Nominating  Committee  (first 
reading) — Mrs.  Jessie  D.  Hamer,  Chairman. 
Election  of  the  1950  Nominating  Committee. 

4:00  P.M. — Round  Table  Discussion  (continued). 

8:00  P.M. — Opening  meeting  of  the  American 
Medical  Association — Ballroom,  Convention 
Hall.  Members  of  the  Woman’s  Auxiliary  and 
guests  are  welcome. 

Wednesday,  June  8 

9:00  A.M. — General  Session  of  the  Woman’s  Aux- 
iliary to  the  American  Medical  Association, 
Vernon  Room,  Lounge  Floor. 

12:15  P.M. — Annual  Luncheon  in  honor  of  Mrs. 
Luther  K.  Kice,  President,  and  Mrs.  David  B. 
Allman,  President-Elect,  Rutland  Room  (first 
floor).  Tickets  $4.00.  Mrs.  Frank  N.  Haggard, 
presiding.  Guests  of  Honor:  Dr.  R.  L.  Sen- 
senich.  President,  American  Medical  Associa- 
tion; Dr.  Ernest  E.  Irons,  President-Elect;  Dr. 
Elmer  L.  Henderson,  Chairman,  Board  of 
Trustees;  Dr.  J.  J.  Moore,  Treasurer;  Dr. 
George  F.  Lull,  Secretary  and  General  Man- 
ager; Dr.  Morris  Fishbein,  Editor,  Journal  and 
Hygeia;  and  the  members  of  the  Advisory 
Council  to  the  Woman’s  Auxiliary. 

1:30 — Joint  meeting  of  the  Advisory  Council  of 
the  American  Medical  Association  and  the 
Board  of  Directors  of  the  Woman’s  Auxiliary, 
Garden  Room  (Lounge  Floor). 


Afternoon  Session 
3:00  P.M. — Unfinished  Business. 

New  Business. 

Report  of  the  Nominating  Committee — Mrs. 

Jesse  D.  Hamer. 

Election  of  Officers. 

Installation  of  Officers  and  Presentation  of 
President’s  Pin — Mrs.  David  W.  Thomas. 
Inaugural  Address — Mrs.  David  B.  Allman. 
Convention  Courtesy  Resolutions — Mrs.  Nor- 
man Nathanson. 

Minutes. 

Adjournment. 

Thursday,  June  6 

9:30  A.M. — Meeting  of  the  Board  of  Directors — 
Solarium.,  Lounge  Floor.  Mrs.  David  B.  All- 
man,  Presiding. 

10:30 — Conference  of  State  Presidents,  Presi- 
dents-Elect,  National  Officers  and  Chairmen 
of  Standing  Committees,  Solarium,  Lounge 
Floor. 

6:30  P.M. — Annual  Dinner  of  the  Woman’s  Aux- 
iliary for  members,  husbands  and  guests — 
Vernon  Room  (Lounge  Floor).  Mrs.- James  H. 
Mason,  presiding.  Formal.  Tickets,  $6.00. 

9:00  P.M. — Reception  and  ball  in  honor  of  the 
President  of  the  American  Medical  Associa- 
tion— American  Room,  Hotel  Traymore. 

Friday,  June  10 
Exhibits  at  Convention  Hall. 

New  Officers  of 
Component  Societies 

Now  that  virtually  all  the  component  societies 
in  Colorado  have  completed  their  elections  for 
1949,  it  is  timely  to  publish  the  list  of  current 
President  and  Secretaries.  Information  received 
in  the  Executive  Office  to  date  lists  the  follow- 
ing: 

Arapahoe  County:  W.  W.  Maercklein,  Engle- 
wood, President;  John  Simon,  Jr.,  Englewood, 
Secretary. 

Boiilder  County:  David  W.  McCarty,  Long- 
mont, President;  Harry  D.  Jones,  Longmont, 
Secretary. 

Chaffee  County:  H.  D.  Smith,  Salida,  Presi- 
dent; L.  E.  Thompson,  Salida,  Secretary. 

Clear  Creek  Valley:  Stephen  Kallay,  Lake- 
wood,  President;  A.  M.  Markham,  Arvada,  Sec- 
retary. 

Delta  County:  W.  S.  Cleland,  Delta,  President; 
J.  J.  Connor,  Delta,  Secretary. 

Medical  Society  of  the  City  and  County  of 
Denver:  F.  H.  Good,  Denver,  President;  James 
M.  Perkins,  Denver,  Secretary. 

Eastern  Colorado:  L.  N.  Myers,  Cheyenne 
Wells,  President;  J.  C.  Straub,  Flagler,  Secretary. 

El  Paso  County:  Carl  S.  Gydesen,  Colorado 
Springs,  President;  L.  L.  Williams,  Colorado 
Springs,  Secretary. 

Fremont  County:  David  A.  Shoun,  Canon  City, 
President;  G.  C.  Christie,  Canon  City,  Secretary. 

Garfield  County:  Robert  C.  Lewis,  Jr.,  Aspen, 
President;  Robert  Barnard,  Eagle,  Secretary. 


388 


Rocky  Mountain  Medical  Journal 


REFINING  THE 


TOOLS  TO  DO  THE  JOB 


While  medical  men  are  occupied  with  enlarging 
their  knowledge  of  disease  and  treating  its  manifes- 
tations, the  makers  of  ethical  drugs  concentrate  on 
developing  and  improving  the  "tools”  to  facilitate 
treatment. 

Toward  that  end,  the  Smith-Dorsey  Company  has 
expanded  its  research  facilities,  secured  increased 
research  grants  and  added  research  personnel. 

Our  objective — tools  worthy  of  the  finest  work- 
man . . . 


THE  SMITH-DORSEY  COMPANY  * Lincoln,  Nebraska 


BRANCHES  AT  lOS  ANGELES  AND  DALLAS 


MANUFAaURERS  OF 

AQUEOUS  SUSPENSION  OF  ESTROGENIC  SUBSTANCES  • DORSEY 
AMINOPHYILINE  SUPPOSITORIES  • DORSEY 


for  May,  1949 


389 


Huerfano  County:  P.  G.  Matthews,  Walsenburg, 
President;  N.  S.  Saliba,  Walsenburg,  Secretary. 

Lake  County:  Vincent  E.  Kelly,  Leadville, 
President;  F.  B.  Laneback,  Leadville,  Secretary. 

Larimer  County  : George  E.  Garrison,  Fort  Col- 
lins, President;  Robert  J.  Bliss,  Fort  Collins, 
Secretary. 

Las  Animas  County:  James  E.  Donnelly,  Trini- 
dad, President;  L.  J.  Beuchat,  Trinidad,  Secre- 
tary. 

Mesa  County:  Heman  R.  Bull,  Grand  Junction, 
President;  Margaret  E.  N.  Beaver,  Grand  Junc- 
tion, Secretary. 

Montrose  County:  E.  L.  Spangler,  Ouray, 
President;  T.  O.  Plummer,  Montrose,  Secretary. 

Morgan  County:  F.  A.  Rechnitz,  Brush,  Presi- 
dent; Donald  E.  Cowen,  Fort  Morgan,  Secretary 

Northeast  Colorado:  J.  C.  Lundgren,  Julesburg, 
President;  E.  P.  Hummel,  Sterling,  Secretary. 

Northwestern  Colorado:  Dr.  Ben  Mayer,  Steam- 
boat Springs,  President;  Chester  Bliss,  Craig, 
Secretary. 

Otero  County:  J.  Allen  Shand,  La  Junta,  Pres- 
ident; Ward  C.  Fenton,  Rocky  Ford,  Secretary. 

Prowers  County:  John  Nienhuis,  Lamar,  Pres- 
ident; K.  F.  Krausnick,  Lamar,  Secretary. 

Pueblo  County:  Harry  E.  Coakley,  Pueblo, 
President;  Robert  D..  Schilling,  Pueblo,  Secretary. 

San  Juan  Basin:  J.  G.  McKinley,  Durango, 
President;  James  W.  Clark,  Durango,  Secretary. 

San  Luis  Valley:  C.  W.  Vickers,  Del  Norte, 
President;  A.  P.  Ley,  Monte  Vista,  Secretary. 

Washington- Yuma  Counties:  Valentine  E.  Woh- 
lauer,  Akron,  President;  A.  T.  Waski,  Yuma, 
Secretary. 

Weld  County:  John  A.  Weaver,  Jr.,  Greeley, 
President;  F.  J.  T.  Roukema,  Greeley,  Secretary. 

NEW  MEXICO 

Medical  Society 

JOINT  MEETING  WITH  CANCER  SOCIETY 

A joint  meeting  of  the  Southwestern  Medical 
Association  Conference  and  the  New  Mexico  Di- 
vision of  the  American  Cancer  Society  will  be 
held  in  Albuquerque  November  9 to  12,  1949,  it 
has  been  announced  by  Dr.  H.  J.  Beck,  Secre- 
tary for  the  joint  meeting.  Headquarters  will 
be  at  the  Hilton  Hotel.  Committees  are  already 
planning  the  program,  which  will  be  announced 
in  the  near  future. 


Irnportant  messages  are  presented  in  the  ad- 
vertisements in  our  journal  each  month.  New 
products  are  announced  from  time  to  time  and 
information  is  presented  regarding  the  use  of 
products  featured.  Other  types  of  ads  empha- 
size services  rendered  and  commodities  offered 
that  may  be  used  in  your  practice,  in  your  of- 
fice, and  in  your  home.  Doctor,  you  can  rely  on 
the  statements  and  facts  presented.  We  aim  to 
include  only  ethical  advertisements  in  our  jour- 
nal. Please  tell  the  advertisers  that  you  saw 
their  ads  in  the  Rocky  Mountain  Medical  Jour- 
nal. 


UTAH 

State  Medical  Association 


AUXILIARY  NEWS 

The  Woman’s  Auxiliary  to  the  Utah  State 
Medical  Association  held  its  March  board  meet- 
ing at  the  home  of  the  President,  Mrs.  Glen  F. 
Harding,  in  Ogden,  Utah. 

Reports  of  the  President  and  chairmen  of  com- 
mittees showed  that  excellent  progress  has  been 
made  during  the  year  in  forwarding  the  ob- 
jectives of  the  organization. 

Under  the  direction  of  Mrs.  M.  J.  Seidner  of 
Ogden,  Utah,  the  Nurse  Recruitment  program 
has  gained  momentum  throughout  the  state. 

The  cancer  and  rheumatic  fever  programs  have 
been  given  attention  in  each  county. 

Newspapers,  schools,  and  other  organizations 
throughout  the  state  have  been  contacted  re- 
garding the  National  Essay  contest.  Work  on  this 
project  is  progressing  satisfactorily. 

The  unobtrusive,  yet  effective,  efforts  of  the 
Legislative  Committee,  composed  of  Mrs.  N.  F. 
Hicken  and  Mrs.  W.  R.  Middlemiss,  are  reaping 
results. 

More  explicit  details  of  the  Woman’s  Auxiliary 
program  will  be  presented  in  the  May  report  of 
the  President. 

Attention  of  Auxiliary  members  is  called  to 
the  National  Convention  in  Atlantic  City,  N.  J., 
June  6-10,  1949.  Headquarters  will  be  at  Hotel 

COLORADO 

State  Health  Department 

ROUTINE  PROPHYLACTIC  TREATMENT  OF 
NEWBORNS’  EYES 

In  the  1948  revision  of  Communicable  Disease 
Control  Regulations,  the  State  Board  of  Health 
and  the  State  Health  Department  of  Colorado 
stated  that  a 1 per  cent  solution  of  silver  nitrate 
“oi-  its  equivalent”  is  recommended  for  routine 
care  of  eyes  of  all  newborns.  This  conforms 
with  the  Session  Laws  of  Colorado  (Chapter 
163,  1937). 

Recent  experience  with  penicillin  solution  in- 
dicates that  this  product  may  prove  to  be  as 
effective  and  less  irritating  than  1 per  cent  silver 
nitrate.  It  was  with  this  in  mind  that  the  phrase 
“or  its  equivalent”  was  used,  but  for  the  present 
there  is  no  “equivalent”  for  the  1 per  cent  silver 
nitrate  solution.  Recently  the  National  Society 
for  the  Prevention  of  Blindness  has  stated  that 
although  penicillin  looks  like  a promising  sub- 
stitute for  the  silver  nitrate,  it  has  not  been 
given  a sufficient  trial  to  warrant  its  adoption 
as  a subsitute. 

The  State  Health  Department  of  Colorado  will 
be  constantly  on  the  alert  for  any  official  en- 
dorsement of  the  penicillin  solution,  either  by 
some  appropriate  National  organiation  or  by 
other  State  Health  Departments,  and  will  im- 
mediately notify  all  the  physicians  in  Colorado 
if  the  penicillin  solution  is  officially  approved. 
In  the  meantime,  physicians  are  urged  to  be 
sure  that  the  eyes  of  newborns  are  rinsed  out 
with  sterile  water  immediately  after  the  drop 
of  1 per  cent  silver  nitrate  has  been  used.  This 
technic  will  greatly  reduce  the  incidence  of 
chemical  conjunctivitis  in  the  newborn. 


390 


Rocky  Mountain  Medical  Journal 


NATIONAL  POSTURE  WEEK 

« will  be  observed  this  year  | 

« OCTOBER  17-22 

We  make  this  announcement  so  early  in  the  year  because  many 
hundreds  of  physicians,  surgeons,  industrial  physicians,  health 
officers  and  other  members  of  the  profession  have  over  the  last 
ten  years  scheduled  the  event  for  May. 


The  change  to  October  has  been  made  in  deference  to  requests 
from  schools,  colleges,  adult  education  groups  and  community 
welfare  organizations  like  the  “Y’s.”  They  now  look  forward 
to  wider  and  more  effective  participation  because  they  can  key 
the  event  into  their  health  education  and  physical  fitness  pro- 
grams early  in  the  school  term,  thus  avoiding  vacation  season 
interruptions. 


As  National  Posture  Week  enters  upon  its  second  decade,  it  is 
our  privilege  to  thank  the  many,  many  physicians  who  have  given 
it  their  approval  as  a worthy  contribution  to  public  health  edu- 
cation. We  pledge  ourselves  to  carry  on  in  the  future  as  we  have 
in  the  last  ten  years  with  National  Posture  Week  and  the  daily 
work  of  The  Samuel  Higby  Camp  Institute  for  Better  Posture. 
We  shall  do  this  to  the  limit  of  our  resources  in  accordance  with 
the  ethical  precepts  of  the  profession. 


S.  H.  CAMP  and  COMPANY  • JACKSON,  MICHIGAN 
World’s  Largest  Manufacturers  of  Scientific  Supports 
Offices  in  New  York  • Chicago  • Windsor,  Ontario  • London,  England 


Physicians  may  at  any  time  ask  for  good  posture  booklets  for  distribution  to  their 
patients  and  for  posters  suitable  for  office  and  instruction  display.  All  are 
authentic.  Details  and  descriptions  on  request  to — 


THE  SAMUEL  HIGBY  CAMP  INSTITUTE  FOR  BETTER  POSTURE 

Empire  State  Building,  New  York  1,  N.  Y.  (Founded  by  S.  H.  Camp  & Company,  Jackson,  MichJ 


for  May,  1949 


391 


Haddow  Hall.  An  excellent  and  varied  program 
has  been  arranged  and  all  doctors’  wives  are 
cordially  invited  to  attend. 

IRMA  G.  GOTTFREDSON, 

Press  and  Publicity  Chairman. 

COLORADO 

Medical  School  Notes 

Trudeau  Course 
In  Chest  Diseases 

A special  course  in  chest  diseases  will  be  given 
from  July  18  to  July  30,  1949,  at  the  University 
of  Colorado  Medical  Center  in  Denver,  jointly 
by  the  American  Trudeau  Society  and  the  Uni- 
versity. 

The  course  will  include  not  only  a review  of 
important  advances  in  tuberculosis  and  other 
chest  diseases,  but  also  phases  of  anesthesiology 
in  thoracic  surgery  and  the  relief  of  thoracic 
pain  by  varied  measures.  Two  anesthesiologists 
from  other  parts  of  the  country  will  be  guests 
speakers.  Additional  guest  speakers  will  in- 
clude Dr.  J.  Burns  Amberson  of  New  York  City, 
Dr.  David  Smith  of  Duke  University,  Dr.  Robert 
Bloch  of  Chicago,  and  Dr.  Joseph  Weinberg  from 
the  Birmingham  Veterans  Hospital. 

Any  physician  interested  in  chest  diseases  is 
eligible  to  take  the  course.  Detailed  information 
can  be  obtained  by  writing  to  Dr.  Robert  S. 
Liggett  or  Dr.  James  J.  Waring  in  care  of  the 
University  of  Colorado  School  of  Medicine. 

MONTANA 

State  Medical  Association 


MINUTES  OF  THE  INTERIM  MEETING, 
HOUSE  OF  DELEGATES,  MONTANA 
STATE  MEDICAL  ASSOCIATION 

The  first  session  of  the  Interim  Meeting  of  the 
House  of  Delegates,  Montana  State  -Medical  As- 
sociation, was  called  to  order  at  10:30  p.m.,  Jan- 
uary 28,  1949,  in  the  Banquet  Room  of  the  Placer 
Hotel,  Helena,  Montana,  by  Thomas  L.  Hawkins, 
M.D.,  President. 

Dr.  Hawkins  stated  that  the  routine  of  a regu- 
lar meeting  would  not  be  followed  inasmuch  as 
not  all  committees  would  be  called  upon  for  re- 
ports. He  emphasized,  however,  that  any  busi- 
ness the  delegates  felt  was  of  sufficient  impor- 
tance should  be  brought  up  for  discussion  as  the 
meeting  progressed.  He  also  stated  that  the 
Montana  Physicians’  Service  meeting  scheduled 
for  3:30  p.m.  was  an  open  meeting  for  all  mem- 
bers of  the  association.  The  Fee  Schedule  Com- 
mittee appointed  some  time  ago  by  the  President 
would  make  their  report  and  recommendations. 
No  action  was  taken  on  their  report  at  the  Board 
of  Trustees  meeting  held  that  morning  because 
the  Board  felt  that  by  discussing  this  matter 
frankly  at  an  open  meeting,  conclusions  and 
agreements  could  better  be  reached. 


Dr.  H.  T.  Caraway,  Secretary  of  the  association, 
called  the  roll  of  the  delegates  and  announced 
that  a quorum  consisting  of  thirty-eight  dele- 
gates representing  thirteen  societies  was  present 
for  doing  business. 

The  Secretary  moved  that  the  minutes  of  the 
previous  meeting,  published  in  the  Rocky  Moun- 
tain Medical  Journal,  be  approved.  The  motion 
was  seconded  and  unanimously  carried. 

Dr.  Hawkins,  in  bringing  up  the  first  matter 
of  business  before  the  House,  stated  that  the 
report  of  the  Rheumatic  Fever  and  Heart  Com- 
mittee made  at  the  Annual  Meeting  in  Billings 
in  June,  1948,  was  tabled  for  discussion  at  the 
Interim  Meeting,  with  the  provision  that  a copy 
be  sent  to  all  members  of  the  state  association 
for  their  information  and  in  order  that  the  mat- 
ter might  be  more  thoroughly  understood  for 
discussion  at  this  meeting.  Dr.  Hawkins  called 
on  Dr.  F.  R.  Schemm,  Chairman  of  the  Rheu- 
matic Fever  and  Heart  Committee,  to  open  the 
discussion  of  the  report  by  his  committee. 

Dr.  Schemm  stated  that  there  seemed  to  be 
some  misunderstanding  of  the  report  as  pre- 
viously made  by  the  committee.  He  stated  that 
what  was  proposed  was  a pilot  program  so  that 
the  profession  could  have  direction  and  take  ad- 
vantage of  certain  funds  available  for  starting 
a rheumatic  fever  program  in  Montana.  He  said 
that  there  are  such  programs  in  more  than 
thirty  of  the  forty-eight  states,  some  dating  back 
more  than  ten  years.  In  view  of  the  reactions  to 
the  report  previously  made,  the  greatly  enlarged 
committee  has  attempted  to  clarify  the  report 
and  recommends  at  this  time  that  the  state  as- 
sociation endorse  the  formation  of  a local  unit 
of  the  American  Heart  Association  for  Montana 
and  that  the  pilot  program  for  the  state  be 
started  in  Cascade  County. 

Dr.  H.  W.  Gregg  (Silver  Bow  County)  moved 
that  the  specific  recommendations  of  the  com- 
mittee be  a^;cepted.  The  motion  was  seconded 
and  in  the  discussion  which  followed  it  was 
brought  out  that  the  committee  had  tried  for 
several  years  to  start  a program  for  the  care  and 
treatment  of  rheumatic  fever  patients,  but  with- 
out success;  mostly  because  of  financial  reasons. 
The  money  for  this  program  would  be  available 
to  Montana  as  soon  as  a unit  of  the  American 
Heart  Association  is  formed  in  Montana  and  the 
pilot  program  started.  The  money  is  raised  by 
local  contributions,  national  campaigns,  etc.,  and 
is  allocated  by  states.  Seventy  per  cent  of  the 
money  needed  for  this  program  could  be  re- 
ceived from  the  American  Heart  Association  and 
additional  funds  would  probably  be  available  be- 
cause of  the  sparse  population  and  “poverty” 
of  the  state.  These  funds  would  be  comparable, 
if  not  a great  deal  more,  than  comes  into  the 
state  for  cancer  or  polio. 

The  question  was  raised  as  to  how  needy 
cases  are  now  taken  care  of,  and  it  was  brought 
cut  that  the  budget  of  the  Division  of  Crippled 
Children’s  Services  of  the  State  Board  of  Health 
provides  for  the  care  of  rheumatic  fever  patients 
and  that  the  counties  can  provide  care  for  in- 
digent patients,  but  for  a limited  time  only  and 
usually  not  as  long  as  is  necessary. 

The  program,  as  set  up  by  the  committee  re- 
port, provides  for  personnel  of  the  pilot  pro- 
gram to  be  selected  from  members  of  the  pro- 
fession who  are  certified  in  either  internal  med- 
icine or  pediatrics,  or  eligible  for  certification. 
However,  it  is  not  anticipated  that  this  provision 
can  be  adhered  to  if  the  pilot  program  is  a suc- 
cess and  the  program  spreads  over  the  state. 

The  interest  of  the  lay  personnel  of  the  state 


392 


Rocky  Mountain  Medical  Journal 


...Your  help  now  may  spell  the  difference  between  unprovided-for  old  age 
and  economic  security. 

Women  in  business  who  ore  nervous,  emotionally  unstable  and  generally 
distressed  by  symptoms  of  the  climacteric  almost  inevitably  experience 
a reduction  in  efficiency  as  well  os  earning  power. 

''Premarin"  offers  a solution.  Many  thousand  physicians  prescribe  this 
naturally-occurring,  oral  estrogen  because... 

7 . Prompt  symptomatic  improvement  usually  follows  therapy. 

2.  Untoward  side-effects  ore  seldom  noted. 

3.  The  sense  of  well-being  so  frequently  reported  tends  to 

quickly  restore  the  patient's  confidence  and  normal  efficiency. 

4.  This  "Plus"  (the  sense  of  well-being  enjoyed  by  the  patient) 
is  conducive  to  a highly  satisfactory  patient-doctor 
relationship. 

5.  Four  potencies  provide  ffexibility  of  dosage-.  2.5  mg., 

1 .25  mg.,  0.625  mg.  and  0.3  mg.  tablets;  also  in  liquid 
form,  0.625  mg.  in  each  4 cc.  (1  teaspoonful}. 


While  sodium  estrone  sulfate  is  the  principal  estrogen 
in  "Premarin,"  other  equine  estrogens ...  estradiol, 
equilin,  equilenin,  hippulin  . . . are  probably  also  pres- 
ent in  varying  amounts  as  water-soluble  con/ugafes. 


ESTROGENIC  SUBSTANCES  (WATER-SOLUBLE) 
also  known  as  CONJUGATED  ESTROGENS  (equine) 


Ayerst,  McKenna  & Harrison  Limited  22  East  40th  Street,  New  York  16,  New  York 
for  May,  1949  393 


was  also  brought  up  and  the  effect  it  would 
have  on  public  relations  if  this  program  was  not 
endorsed. 

The  motion  was  passed  by  a standing  vote  of 
twenty-two  for  and  sixteen  against. 

Executive  Secretary 

The  hiring  of  a full-time  Executive  Secretary 
was  the  next  matter  brought  up  for  discussion. 
The  Secretary  announced  that,  in  accordance 
with  instructions  received  from  the  Executive 
Committee,  all  societies  were  asked  to  discuss 
this  matter  and  the  raising  of  the  state  dues 
which  would  be  necessary  for  the  implementa- 
tion of  this  action.  To  date,  official  report  on 
this  matter  had  been  received  from  only  one 
society.  A poll  of  the  delegates  present  revealed 
that  six  associates  had  voted  in  favor  of  hiring 
a full-time  Executive  Secretary;  five  societies 
had  taken  no  action;  two  had  voted  against  the 
matter  and  two  societies  had  no  representation 
and  therefore  no  report. 

Subsequent  discussion  brought  out  the  fact 
that  the  members  of  the  various  component  so- 
cieties had  discussed  this  matter  before  the  in- 
terim meeting  of  the  House  of  Delegates  of  the 
American  Medical  Association  when  a $25  special 
assessment  was  levied  against  each  member  and' 
that  this  assessment  might  have  some  influence 
on  the  present  wishes  of  the  members  on  this 
matter. 

Dr.  Gregg  moved  that  the  individual  members 
be  polled  by  the  Secretary’s  office  between  the 
present  time  and  the  next  meeting  in  August 
and  that  a report  of  this  poll  be  brought  to  the 
House  of  Delegates  at  the  annual  meeting,  the 
matter  to  be  deferred  until  that  time.  The  mo- 
tion was  seconded  and  carried. 

United  Mine  Workers 

Dr.  Hawkins  then  spoke  of  a meeting  in  Den- 
ver in  November,  1948,  called  by  the  Colorado 
State  Medical  Society,  and  attended  by  represen- 
tatives of  the  Rocky  Mountain  States.  Represen- 
tatives of  the  United  Mine  Workers  Union  were 
also  present  at  this  meeting  and  offered  a pro- 
posal to  be  brought  back  to  the  various  state 
medical  societies  for  approval  and  endorsement. 
A twenty  cents  per  ton  levy  on  the  mining  of 
coal  has  been  set  aside  as  a welfare  fund  for  the 
miners.  The  United  Mine  Workers  Union  Wel- 
fare and  Retirement  Fund  wishes  to  buy  med- 
ical service  on  a fee  for  service  basis  for  their 
members  in  the  states  that  mine  coal.  They  do 
not  want  a contract.  They  do  not  want  to  es- 
tablish fee  schedules,  but  they  do  want  to  pay 
the  existing  rate  for  hospital  service  and  for 
doctor  and  specialist  services  in  the  various  lo- 
calities. A representative  of  the  United  Mine 
Workers  Union  was  also  present  at  a Medical 
Care  Plans  meeting  held  in  Portland  in  Novem- 
ber. 

Dr.  Hawkins  stated  that  the  problem  before 
the  House  was  whether  or  not  the  delegates 
would  desire  to  endorse  such  a program.  He 
stated  that,  from  any  viewpoint,  it  is  one  of  the 
most  outstanding  things  that  has  come  out  in 
opposition  to  Federal  compulsory  health  insur- 
ance. The  United  Mine  Workers  Union  does  not 
want  its  members  to  feel  that  they  are  not  get- 
ting exactly  the  same  type  of  service  that  any 
other  patient  gets.  They  want  a free  choice  of 
physicians  and  a free  choice  of  hospitals.  They 
insist  that  they  get  a fair  deal  on  the  basis  of 
fees  charged  by  doctors.  To  begin  with,  the 
program  would  go  slowly  and  would  be  limited 
to  aged  pensioners,  disabled  miners  and  depend- 
ents of  deceased  coal  miners.  Dr.  Hawkins 
brought  out  that  the  meetings  had  been  held 


confidential  at  the  wishes  of  the  United  Mine 
Workers  Union.  They  did  not  want  publicity 
then  and  they  do  not  want  it  yet. 

Dr.  Wayne  Gordon  (Yellowstone  Valley) 
moved  that  the  Montana  State  Medical  Associa- 
tion approve  in  principle  the  proposal  of  the 
United  Mine  Workers  Welfare  and  Retirement 
Fund  and  that  this  association  will  be  glad  to 
cooperate  as  long  as  the  principles  outlined  in 
their  proposal  are  maintained.  The  motion  was 
seconded  and  carried. 

Tuberculosis  Bill 

The  Chair  then  brought  up  the  matter  of  House 
Bill  No.  147,  introduced  by  Mr.  Loble  and  Mr. 
Hawks  in  the  Montana  State  House  of  Repre- 
sentatives, which  would  appropriate  $600,000  to- 
ward the  erection  of  additional  facilities  for  the 
care  and  treatment  of  tuberculosis  in  Montana. 
He  had  been  assured  that  if  Montana  evidenced 
an  interest  in  such  additional  facilities,  the  Fed- 
eral Government  would  also  appropriate  money 
for  tnis  purpose.  Dr.  |M.  A.  Shillington  (South- 
eastern) moved  that  the  House  of  Delegates  send 
a resolution  to  the  State  Legislature  in  favor  of 
the  bill  before  the  House  of  Representatives  to 
approprate  money  for  this  purpose. 

The  motion  was  seconded  and  in  the  discus- 
sion that  followed  it  was  brought  out  that  there 
are  now  no  facilites  in  the  state  for  the  care  and 
treatment  of  tuberculous  Indians  and  that  if  the 
additional  facilities  are  built  they  should  be  made 
available  to  the  Indian  Service  for  the  care  and 
treatment  of  tuberculous  Indian  patients.  It  was 
emphasized  that  it  would  not  be  a Federal  hos- 
pital and  that  the  Indian  Service  would  pay  on 
a per  diem  basis  for  the  Indian  patients. 

Upon  being  put  to  vote,  the  motion  was  car- 
ried and  the  chair  appointed  Drs.  Wayne  Gordon 
(Yellowstone  Valley),  C.  H.  Fredrickson  (West- 
ern Montana)  and  L.  G.  Russell  (Yellowstone 
Valley)  as  a committee  to  draw  up  a resolution 
to  be  presented  to  the  State  Legislature. 

Upon  motion  regularly  made,  duly  seconded 
and  unanimously  carried,  the  House  adjourned 
at  12:30  p.m. 


SECOND  SESSION 

The  second  session  of  the  House  of  Delegates 
of  the  Montana  State  Medical  Association  was 
called  to  order  at  2:00  p.m.,  January  28,  1949, 
in  the  Banquet  Room  of  the  Placer  Hotel, 
Helena,  by  Thomas  L.  Hawkins,  M.D.,  President. 

Dr.  Gordon  read  the  resolution  drawn  up  by 
the  special  committee.  The  resolution,  as  fol- 
lows, was  approved  by  the  House  of  Delegates 
upon  motion  regularly  made,  duly  seconded  and 
unanimously  carried: 

WHEREAS,  The  facilities  for  the  care  of  tuber- 
culous patients  in  the  State  of  Montana  are.  at  the 
present  time,  inadequate:  and 

WHEREAS,  No  facilities  exist  within  the  state  for 
the  care  of  tuberculous  Indians:  and, 

WHEREAS,  The  Federal  Government  has  offered 
to  make  funds  available  for  the  construction  of  ad- 
ditional facilities  for  the  care  of  tuberculous  patients 
in  Montana,  contingent  upon  the  appropriation  by  the 
State  of  Montana  of  a sum  toward  the  construction 
of  such  additional  facilities,  and  on  condition  that 
the  facilities  be  made  available  to  the  Indian  Serv- 
ice for  the  care  of  tuberculous  Indians;  be  it  there- 
fore 

RESOLVED,  That  the  House  of  Delegates  of  the 
Montana  State  Medical  Association  in  meeting  as- 
sembled this  28th  day  of  January,  1949,  approve 
and  recommend  the  passage  of  House  Bill  No.  147  as 
introduced  in  the  House  of  Representatives  of  the 
State  of  Montana  by  Mr.  Loble  and  Mr.  Hawks, 
which  is  a bill  to  appropriate  1600.00  toward  the 
construction  of  additional  hospital  facilities  for  the 
care  and  treatment  of  tuberculosis  patients  in  the 
State  of  Montana. 


394 


Rocky  Mountain  Medical  Journal 


WHY  A FIBRIN 


HYDROLYSATE 


? 

■ 


Aminosol  5%  with  Dextrose  5%  was  developed  as  a protein  hydrolysate 
after  much  research  work  on  different  source  materials.  Numerous  nutrition 
experiments  pointed  to  the  unique  role  of  fibrinogen  as  a normal  constituent 
of  the  body.  A recent  clinical  investigation!  indicates  that  peptides  in  a 
protein  hydrolysate  derived  from  fibrin  as  a source  material  are  retained 
better  and  are  excreted  to  a considerably  smaller  extent  than  are  the 
peptides  derived  from  other  protein  source  materials. 

Fibrin  was  selected  as  the  source  for  Aminosol  because  of  its  complete- 
ness as  a food  protein.  The  result  is  a hydrolysate  which,  after  stringent 
animal  and  human  use,  has  been  shown  to  have  high  biological  value  and 
stability.  Aminosol  is  assayed  for  the  absence  of  anaphylactic  properties  by 
a very  rigid  procedure.  Freedom  from  pyrogens  is  assured.  The  practical 
absence  of  sodium  ion  recommends  it  for  use  in  cardiac  and  renal  condi- 
tions where  a salt-free  diet  is  indicated. 

Aminosol  is  supplied  in  500-cc.  and  1000-cc.  Abbott  Intravenous  Solu- 
tion Containers,  ready  to  use.  Obtain  added  safety  and  convenience  in 
administration  by  using  the  sterile,  disposable  Venopak*  equipment. 
ABBOTT  LABORATORIES,  NORTH  CHICAGO,  ILLINOIS. 
*Trade  Mark  for  AbboWs  completely  disposable  venoclysis  unit. 


© 

5%  WITH  DEXTROSE  5% 

(Abbott’sModified  Fibrin  Hydrolysate  5%  with  Dextrose  5%) 


1 . Christensen,  H.  N.,  Lynch,  E.  L.,  Decker,  D.  G.,  and  Powers,  J.  H.  (1947),  The  Conjugated,  Non-Protein,  Amino  Acids  of  Plasma. 
IV.  A Difference  in  the  Utilization  of  the  Peptides  of  Hydrolysates  of  Fibrin  and  Casein,  J.  Clin.  Invest.,  26:849,  September. 


/or  May,  1949 


395 


Dr.  Hawkins  then  read  the  following  letter 
from  H.  B.  Viestenz,  Chairman,  Montana  Nurse 
Recruitment: 

“January  16th,  1949,  marked  the  date  of  the  an- 
nual Blue  Cross  meeting-,  which  was  held  at  Helena, 
Montana.  The  17th  of  January,  members  of  the 
Hospital  Association  were  present,  and  at  this  meet- 
ing a committee  of  the  Montana  Nurses  Association 
met  with  my  committee  and  discussed  the  Nurse  Re- 
cruitment Program.  We  all  realize  that  the  Schools 
of  Nursing  need  more  students,  in  order  to  meet  the 
demand  for  graduate  nurses  in  hospitals,  clinics  and 
for  doctors.  They  have  a very  fine  program  out- 
lined, but  the  main  problem  is:  How  to  finance  it? 
The  cost  of  this  program  is  approximately  ?4,500. 
The  hospitals  agreed  to  give  them  $1,375,  and  if 
the  medical  association  would  give  the  same  amount 
the  program  could  be  carried  out.  I would  appre- 
ciate it  very  much,  if  you  would  take  this  matter  up 
with  the  medical  association  at  your  meeting.” 

After  discussion  of  this  matter,  it  was  agreed 
that  this  was  a worthwhile  endeavor  and  should 
be  supported  by  the  medical  profession.  No  de- 
cision could  be  reached  at  this  time,  however,  as 
to  ways  and  means  and  a motion  was  made  by 
Dr.  L.  W.  Brewer  (Western  Montana)  that  the 
matter  be  tabled  for  the  present.  The  motion 
was  seconded  and  carried. 

Public  Health  League 

The  financial  support  given  the  Public  Health 
League  of  Montana  by  the  medical  association 
was  next  brought  up  for  discussion  by  Dr.  Haw- 
kins. Dr.  Caraway  stated  that  he  had  been  and 
still  was  an  ardent  supporter  of  the  Public 
Health  League.  He  felt  it  was  a big  thing  and 
could  be  bigger.  However,  he  felt  that  the  other 
organizations  in  the  League  could  and  should  be 
contributing  a larger  share  of  the  support  of  the 
League  and  thus  relieve  some  of  the  burden  from 
the  medical  association.  He  further  stated  that 
if  the  medical  association  dues  were  $60  or  $75 
a year  so  that  it  was  contributing  only  a tenth 
or  twelfth  of  its  income  it  would  be  a different 
matter.  It  is  now,  however,  contributing  nearly 
one-fourth  of  its  income.  He  added  that  he  had 
had  correspondence  from  several  doctors  in  the 
state  saying  they  thought  the  medical  associa- 
tion was  putting  too  much  of  its  income  into  the 
League  from  a comparative  standpoint,  and  he 
suggested  that  the  House  pass  a resolution  to 
that  effect  to  be  taken  to  the  Board  of  Directors 
,of  the  Public  Health  League  of  Montana. 

After  further  discussion  which  included  the 
question  of  the  public  relations  value  of  the 
League,  the  motion  was  made  by  Dr.  J.  C. 
Shields  (Silver  Bow  County)  that  the  matter 
be  tabled  until  such  time  as  Dr.  J.  M.  Flinn, 
President  of  the  Public  Health  League  of  Mon- 
tana, could  be  present  to  answer  questions  on 
the  subject.  The  motion  was  seconded  and  car- 
ried. 

Dr.  Hawkins  next  read  the  following  letter 
from  the  State  Board  of  Health: 

“At  their  meeting-  last  Saturday,  the  members  of 
the.  Board  of  Health  proposed  the  following  motion, 
and  requested  that  I send  you  a copy  of  the  same: 

“The  Board  of  Health  recommends  that  the 
proposed  legislation  introduced  in  the  present 
Leg-islation,  for  a change  in  the  organization 
of  the  State  Board  of  Health,  be  presented  be- 
fore the  House  of  Delegates  of  the  Montana 
State  Medical  Association  for  its  consideration 
and  action. 

B.  K.  KILBOURNE.  M.D., 

Executive  Officer.” 

Dr.  Thus.  F.  Walker  (Cascade  County)  related 
in  detail  the  steps  that  led  to  the  introduction  of 
this  bill  in  the  State  Legislature.  He  stated  it 
was  the  opinion  of  the  special  committee  ap- 
pointed to  study  this  matter  that  the  Board  of 
Health  is,  after  all,  for  the  health  of  the  people 
of  Montana  and  not  for  the  aggrandizement  of 
the  people  on  the  Board  and  that  the  general 


public  who  are  to  be  benefited  had  some  right 
to  sit  in  on  this  Board  of  Health.  The  recom- 
mendation of  the  committee  was  submitted  to 
the  Executive  Committee  and  approved  by  them. 

In  the  discussion  which  followed,  several  dele- 
gates expressed  their  disapproval  of  the  pro- 
posed change  in  the  personnel  of  the  Board.  Dr. 
Hawkins  brought  out  the  fact  that  this  proposed 
change  had  been  discussed  at  the  last  meeting  of 
the  House  of  Delegates  in  Billings  in  June,  1948, 
and  that  the  action  had  been  approved  by  the 
House.  He  also  stated  that,  from  a public  re- 
lations standpoint,  the  committee  felt  it  would  be 
wise  to  have  some  doctors,  some  other  qualified 
people,  and  some  laymen  on  the  Board,  but  that 
control  be  retained  by  professional  personnel. 

Dr.  Caraway  recalled,  for  the  Delegates,  the 
apprehension  of  the  profession  regarding  the 
survey  of  the  State  Board  of  Health  made  by 
Dr.  Carl  Buck  at  the  time  only  a few  doctors 
had  seen  it  and  many  had  heard  of  it;  and 
heard  that  it  was  such  a terrible  thing  and  what 
would  happen  if  it  came  to  hght.  Also  the  in- 
sistence that  the  report  be  studied  and  brought 
to  the  public.  The  report,  to  some  degree,  was 
a condemnation  of  the  fact  that  the  medical  as- 
sociation itself  was  the  State  Board  of  Health. 
That  was  one  point  that  the  committee  tried  to 
correct  and  in  which  they  had  the  support  and 
assistance  of  the  state  dental  association. 

After  discussion,  a motion  was  made  by  Dr.  T. 
W.  Cooney  (Lewis  & Clark  Coimty),  seconded 
by  Dr.  R.  O.  Lewis  (Lewis  & Clark  County), 
that  the  House  of  Delegates  of  the  Montana 
State  Medical  Association  reject  the  report  of 
the  special  committee,  the  action  of  the  House 
at  the  last  meeting,  and  oppose  the  changing  of 
the  State  Board  of  Health. 

After  more  discussion,  the  motion  was  put  to 
vote  and  lost. 

AMA  Assessment 

After  a brief  recess.  Dr.  R.  F.  Peterson,  (Mon- 
tana’s Delegate  to  the  American  Medical  Asso- 
ciation House  of  Delegates,  gave  a report  of  the 
Interim  Session  of  the  American  Medical  Associ- 
ation in  St.  Louis  on  November  30  to  Decem- 
ber 2. 

Dr.  F.  D.  Hurd  (Cascade  County)  moved  that 
the  report  of  the  delegate  be  accepted  and  that 
the  Montana  State  Medical  Association  House  of 
Delegates  go  on  record  as  unanimously  approv- 
ing the  $25  special  assessment  and  that  every 
member  be  urged  to  remit  his  assessment  to  the 
secretary  of  his  component  society.  The  motion 
was  seconded  and  carried  with  one  dissenting 
vote.  Dr.  R.  W.  Morris  (Lewis  & Clark  Coimty) 
quoted  figures  from  the  last  finarucial  report  of 
the  American  Medical  Association  and  stated 
he  did  not  see  the  necessity  of  raising  $3,500,000 
b5’’  a special  assessment  when  the  American  Med- 
ical Association  had  an  accumulated  surplus  of 
$4,500,000. 

The  Public  Health  League  of  Montana  was 
again  brought  up  for  discussion.  Dr.  W.  E. 
Harris  (Western  Montana)  made  a motion  that, 
according  to  the  judgment  of  the  President,  he 
appoint  a special  committee  or  have  the  Public 
Relations  Committee  consider  the  Public  Health 
League  of  Montana  and  report  back  to  the 
House  of  Delegates  at  the  next  meeting. 

The  chair  next  called  on  Dr.  H.  W.  Gregg  for 
the  Report  of  the  Public  Relations  Committee. 
(This  report  was  published  in  the  February  issue 
of  the  Rocky  Mountain  Medical  Journal.) 

The  report  of  the  Public  Relations  Committee , 
received  a round  of  applause  by  the  delegates 
and  visitors  and  upon  motion  by  Dr.  J.  C.  Shields 


396 


Rocky  Mountain  Medical  Journal 


a dietary  dilemma 


Problem:  When  casein  or  other  animal  protein 
sensitivity  renders  all  natural  or  processed  milks* 
contraindicated  in  the  pediatric  dietary,  because 
of  eczematous,  gastro-intestinal  or  other  reactions, 
how  can  allergy  be  avoided  and  proper 
infant  nutrition  still  be  maintained? 

Solution:  Replace  milk  with  Mull-Soy,  the  liquid 
hypoallergenic  soy  food— completely  free  of  offending 
animal  proteins.  Mull-Soy  is  a biologically  complete 
vegetable  source  of  all  essential  amino  acids,  and 
closely  approximates  whole  cow’s  milk  in 
fat,  protein,  carbohydrate,  and  mineral  content 
when  diluted  1:1  with  water.  It  is  quickly  prepared, 
palatable,  easily  digested  and  well-tolerated— equally 
desirable  for  infants,  children  or  adults. 

*Goat*s  milk  and  processed  cows*  milk  have  unmodified  casein  factors. 

BORDEN'S  PRESCRIPTION  PRODUCTS  DIVISION 

350  MADISON  AVENUE,  NEW  YORK  17,  N.  Y. 
try  Canada  write  The  Borden  Company,  limited,  Spadina  Crescent,  Toronto 


Mull-Soy  is  a liquid 
hypoallergenic  food  prepared 
from  water,  soy  flour,  soy 
oil,  dextrose,  sucrose,  calcium 
phosphate,  calcium  carbonate, 
salt,  and  soy  lecithin; 
homogenized  and  sterilized. 
Available  in  I5V2  A-  oz.  cans 
at  all  drugstores. 


ull-soy 


When  Milk  becomes 
"Forbidden  Food" 


for  May,  1949 


397 


(Silver  Bow  County),  duly  seconded  and  unan- 
imously carried,  the  report  was  accepted. 

Workmen’s  Compensation 

The  next  matter  of  business  brought  before 
the  House  was  a report  of  the  special  committee 
appointed  by  Dr.  Hawkins  to  meet  with  the  In- 
dustrial Accident  Board  and  given  by  Dr.  H.  H. 
James,  Chairman.  He  stated  that  the  committee 
had  felt  it  was  best  to  wait  with  this  matter 
until  the  proposed  changes  in  the  Montana  Phy- 
sicians’ Service  fee  schedule  had  been  discussed. 
The  change  in  the  personnel  of  the  Industrial 
Accident  Board  had  also  caused  some  delay,  but 
a meeting  will  be  held  in  the  near  future  and 
a complete  report  made  at  the  next  meeting. 

Dr.  R.  B.  Richardson,  Chairman  of  the  Indus- 
trial Welfare  Committee,  reported  for  his  com- 
mittee and  stated  that  at  the  present  time  there 
are  contemplated  changes  in  the  Workmen’s 
Compensation  Act  and  suggested  it  would  be 
well  for  the  association  to  pass  a resolution  fa- 
voring the  increase  in  maximum  medical  and 
hospital  fees  for  seriously  injured  workmen  from 
$500  to  $1,000,  thus  prolonging  the  time  during 
which  injured  workmen  may  receive  medical 
care. 

Dr.  Wayne  Gordon  (Yellowstone  Valley)  pro- 
posed the  following  resolution: 

WHEREAS.  In  view  of  the  fact  that  the  seriously 
injured  workman  is  not  provided  adequate  care  un- 
der the  present  Compensation  Act  of  the  State  of 
Montana;  therefore,  be  it 

RESOLVED,  That  the  House  of  Deegates  of  the 
Montana  State  Medical  Association  go  on  recod  as 
being  in  favor  of  liberalizing  the  Compensation  Act 
to  provide  more  adequate  care  for  the  seriously  in- 
jured workman. 

After  further  discussion,  the  resolution  was 
adopted  upon  motion  regularly  made,  duly  sec- 
onded and  unanimously  carried. 

School  Health  Services 

Dr.  W.  G.  Tanghn  (Flathead  County)  brought 
up  the  subject  of  the  Lake  County  School  Health 
Service  Demonstration  and  asked  for  the  opinion 
of  the  House.  He  stated  that  this  plan,  which 
had  been  presented  to  the  doctors  of  Lake  Coun- 
ty by  Dr.  B.  K.  Kilbourne  of  the  State  Board  of 
Health,  had  been  under  discussion  in  Lake  Coun- 
ty and  in  the  Western  jMontana  Medical  Society. 
He  stated  it  was  quite  comprehensive  and  since 
it  might  involve  the  whole  state,  the  doctors  of 
Lake  County  thought  it  would  be  well  to  present 
it  to  the  state  association;  at  least  for  their  in- 
formation, if  nothing  else.  He  stated  the  objec- 
tives of  the  program  were  as  follows: 

1.  To  determine  and  demonstrate  the  type  of  school 
health  service  that  will  best  meet  the  need  of  rural 
Montana. 

2.  To  make  adequate  health  service  available  in 
order  to  complemeht  a program  of  in-service  train- 
ing in  health  education. 

3.  To  furnish  resource  facilities  for: 

a.  The  state  committee  on  Teacher  Training  in 
Health  Education 

b.  Personnel  from  State  and  Local  Health  De- 
partments 

c.  Personnel  from  State  and  Local  Departments 
of  Education 

4.  To  demonstrate  the  feasibility  of  district  nurs- 
ing supervision. 

5.  To  demonstrate  more  efficient  cooperative  ef- 
fort between  heaith  department  services  and  the 
U.  S.  Indian  Service. 

6.  “To  secure  for  every  child,  dental  services  and 
education  to  prevent  pain,  infection,  malocclusion, 
the  premature  loss  of  teeth  and  to  compare  the  re- 
sults of  accidents — these  ideals  to  be  realized  through 
the  combined  efforts  of  all  those  interested  in  and 
concerned  with  child  health.” 

Dr.  F.  L.  McPhail  stated  that  this  program  is 
not  new;  that  it  had  been  studied  and  recom- 
mended by  a sub-committee  of  the  Maternal  and 
Child  Welfare  Committee  of  the  state  medical 


association.  He  stated  that  this  program  is  the 
result  of  a demand  on  the  part  of  the  population 
of  this  area  for  this  public  health  service,  which 
is  a routine  program,  in  many  of  the  full-time 
Health  Departments.  He  also  brought  out  that 
where  the  population  is  sparse,  this  program  can 
better  be  carried  out  in  this  manner  than  by 
trying  to  handle  it  through  an  outside  Public 
Health  service. 

After  considerable  discussion  of  this  matter, 
it  was  moved,  seconded  and  carried  that  the 
matter  be  tabled  until  the  next  meeting  of  the 
House  of  Delegates. 

Upon  motion  regularly  made,  duly  seconded 
and  unanimously  carried,  the  House  of  Dele- 
gates adjourned  at  4:00  p.m.,  to  immediately  re- 
convene as  the  Administrative  Body  of  the  Mon- 
tana Physicians’  Service. 


THIRD  SESSION 

The  third  session  of  the  House  of  Delegates  of 
the  Montana  State  Medical  Association  was 
called  to  order  at  9:30  a.m.,  January  29,  1949, 
in  the  Banquet  Room  of  the  Placer  Hotel,  Helena, 
by  Thomas  L.  Hawkins,  M.D.,  President. 

Dr.  Hawkins  called  on  Dr.  F.  D.  Hurd  to  give 
a report  of  the  meeting  of  the  Board  of  Trustees 
of  the  Montana  Physicians  Service  regarding  the 
changes  in  the  fee  schedule.  After  the  report. 
Dr.  Hawkins  suggested  that  the  delegates  coop- 
erate by  making  the  changes  known  so  there 
would  be  more  complete  understanding  of  what 
the  Blue  Cross-Blue  Shield  can  and  cannot  do. 
He  stated  that  with  complete  understanding,  a 
much  better  job  could  be  done. 

The  Chair  then  read  a letter  from  Dr.  Elmer 
Hess,  Chairman  of  the  Committee  on  Hospitals 
and  the  Practice  of  Medicine  of  the  American 
Medical  Association,  stating  in  part: 

“As  you  know,  for  the  past  twelve  years  there 
have  been  resolutions  presented  before  the  House  of 
Delegates  of  the  American  Medical  Association  con- 
demning the  practice  of  medicine  by  hospitals,  et  al., 
and  asking  that  certain  action  be  taken  against 
such  institutions  which  are  supposedly  guilty  of 
this  practcie. 

"The  Medical  Society  of  the  State  of  Pennsylvania 
created  a standing  committee  defined  as  the  Com- 
mittee on  Hospital  Relations.  The  object  of  this 
committee  is  to  attempt  to  settle  the  differences 
which  arise  between  hospitals,  hospital  manage- 
ments and  the  professional  staffs  at  the  state  level, 
providing  these  controversies  cannot  be  settled  at 
the/  local  county  level  under  the  broad  general 
principles  of  the  code  of  ethics  of  the  A.M,A. 

“It  occurred  to  me  that  your  state  might  or  does 
already  have  some  of  these  problems  and  that  you 
might  work  out  a system  similar  to  that  which  we 
are  using  in  Pennsylvania.  It  is  not  only  my  own 
personal  belief,  but  the  belief  of  members  of  my 
national  committee,  that  most  of  these  problems  are 
local  and  that  they  can  be  solved  at  the  level 
through  the  good  auspices  of  the  County  Medical 
Societies. 

“May  I urge  upon  your  House  of  Delegates  then 
the  advisability  of  such  a Standing  Committee  for 
the  express  purpose  of  attempting  to  iron  out  any 
of  these  controversies  which  may  occur  in  your  own 
state?” 

After  much  discussion  of  this  matter.  Dr.  Eu- 
gene Hildebrand  (Cascade  County)  moved  that 
since  a committee  had  been  appointed  in  the 
previous  meeting  to  consider  one  phase  of  this 
problem,  that  this  matter  be  referred  to  this 
same  committee  for  further  study  and  report. 
The  motion  was  seconded  and  carried. 

In  the  discussion  of  the  practice  of  medicine 
by  hospitals,  et  al.,  and  the  censoring  of  in- 
dividual physicians  in  the  state,  it  was  brought 
out  that  imder  the  present  laws  of  Montana  if 
a doctor  is  censored  and  his  membership  in  the 
state  medical  association  withdrawn,  he  could 
sue  the  association  and  the  courts  would  prob- 
ably decide  in  his  favor.  Dr.  Shillington  (South- 


398 


Rocky  Mountain  Medical  Journal 


BROUGHT  UP  TO  DATE 


Scientifically  Prepared 
ORANGE  JUICE 

brand  Orange  Juice  for  Babies  is  the  latest  scientific  develop- 
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techniques  perfeaed  in  the  BIB  laboratories  safeguard  natural 
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is  a sure  source  of  vitamin  C . . . the  carefully  seleaed  fruit 
contains  no  less  than  40mg/100  cc  when  packed.  BIB  is 
pasteurized  and  hermetically  sealed  in  sterilized  containers  under 
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Literature  and  professional  samples  on  request.  *T.  M.  Registered 

THE  BIB  CORPORATION  - LAKELAND,  FLORIDA,  U.  S.  A 


The  presence  of  this 
Seal  indicates  that 
BIB’S  high  standards 
of  production  and 
all  BIB  statements  in 
this  advertisement 
have  been  accepted 
by  the  Council  on 
Foods  and  Nutrition 
of  the  American 
Medical  Association. 


m 


for  May,  1949 


399 


eastern  Montana)  moved  that  the  officers  of  the 
state  association  consider  introducing  into  the 
State  Legislature  at  some  future  date  a law 
whereby  the  state  medical  association  could  cen- 
sor a physician  without  being  liable  for  suit. 
The  motion  was  seconded  and  carried. 

The  report  of  Montana’s  Delegate  to  the  As- 
sociation of  American  Physicians  and  Surgeons, 
Dr.  C.  H.  Fredrickson,  was  accepted  upon  motion 
made  by  Dr.  M.  A.  Shillington  (Southeastern 
Montana),  seconded  and  carried. 

Dr.  M.  A.  Gold  (Silver  Bow  County)  said,  that 
in  line  with  what  has  been  said  about  what  our 
state  medical  association  can  and  cannot  do  in 
disciplining  its  members,  he  felt  that  the  Legal 
Committee  of  the  Montana  State  Medical  Asso- 
ciation, in  conjunction  with  the  state  association, 
should  draw  up  a bill  for  the  next  session  of  the 
State  Legislature,  so  that  the  state  medical  asso- 
ciation can  censor  a man  or  drop  him  from 
membership  without  legal  penalties.  He  made 
his  suggestion  into  a motion,  which  was  sec- 
onded by  Dr.  Shillington  and  carried. 

Nurse  Recruitment 

The  subject  of  the  Nurse  Recruitment  Pro- 
gram was  again  brought  up  for  discussion  After 
considerable  discussion.  Dr.  Wayne  Gordon  (Yel- 
lowstone Valley)  moved  that  the  Montana  State 
Medical  Association  go  on  record  as  being  sym- 
pathetic with  the  program  and  that  individual 
doctors  be  urged  to  contribute;  also  that  the 
Public  Health  League  of  Montana  be  asked  to 
support  the  program  in  any  way  possible.  The 
motion  was  seconded  and  after  further  discus- 
sion, was  carried. 

Dr.  F.  L.  McPhail  suggested  that  since  the 
Montana  Physicians’  Service  will  probably  pub- 
lish an  official  organ,  which  will  carry  a con- 
siderable amount  of  educational  material,  this 
could  be  used  to  aid  in  the  program. 

Dr.  Walker  stated  that  the  Speaker  of  the 
House  had  discussed  with  him  the  licensing  of 
practical  nurses.  Such  a bill  is  now  before  the 
State  Legislature  and  Dr.  Walker  was  informed 
they  would  be  glad  to  have  an  official  represen- 
tative of  the  state  medical  association  appear 
before  the  committee  studying  the  bill  to  receive 
the  opinion  of  the  state  association.  Dr.  Walker 
stated  he  thought  the  association  should  take  ad- 
vantage of  this  request  to  let  the  Legislators 
know  the  opinion  of  the  medical  association  re- 
garding the  Board  of  Licensure  of  Practical 
Nurses.  Dr.  Hawkins  gave  a brief  history  of  the 
bill  now  before  the  Legislature  and  expressed 
the  opinion  that  it  would  not  be  for  the  best 
interests  of  the  people  of  Montana  for  two  sep- 
arate Boards  to  be  set  up;  one  for  nurses  and 
one  for  practical  nurses.  He  stated  he  felt  the 
present  bill  should  be  killed  and  that  a bill 
should  be  introduced  which  would  allow  them 
to  be  taken  care  of  in  one  Act. 

Dr.  M.  A.  Shillington  (Southeastern  Montana) 
moved  that  the  President  appoint  a member  to 
represent  the  state  medical  association  and  to 
meet  with  the  Legislature  and  express  the  opin- 
ion of  this  body  against  this  bill. 

Dr.  Thos.  F.  Walker  (Cascade  County)  offered 
an  amendment  to  Dr.  Shillington’s  motion  to  the 
effect  that  the  representative  appear  before  the 
committee  of  the  Legislature  in  opposition  to  the 
present  bill  and  offer  as  substitute  a single 
bill,  constituting  a single  Board  and  a single 
nursing  Act. 

Dr.  F.  D.  Hurd  (Cascade  County)  offered  a 
further  amendment  to  the  motion  to  the  effect 
that  the  President  act  as  a representative  of  this 
association. 


The  motion,  with  amendments,  was  seconded 
and  carried. 

The  Secretary  announced  that  since  the  next 
meeting  of  the  House  of  Delegates  would  be  held 
immediately  prior  to  the  meeting  of  the  Rocky 
Mountain  Medical  Conference  in  Butte,  jMon- 
tana,  in  August,  the  opinion  of  the  House  was 
asked  as  to  whether  all  business  to  come  before 
the  House  could  be  disposed  of  in  one  day, 
taking  into  consideration  the  twenty-four  hour 
requirement  of  the  Constitution  and  By-Laws 
on  certain  matters.  After  discussion,  it  was 
moved  by  Dr.  J.  C.  Shields  (Silver  Bow  County) 
that  the  House  of  Delegates  of  the  Montana  State 
Medical  Association  and  the  Board  of  Trustees 
of  the  Montana  Physicians’  Service  convene  on 
July  31;  the  time  to  be  announced  in  sufficient 
time  for  completion  of  the  business  to  come  be- 
fore the  House.  The  motion  was  seconded  and 
carried. 

Dr.  L.  W.  Brewer  (Western  Montana)  brought 
up  the  matter  of  the  School  Health  Service 
Demonstration  in  Lake  County  and  made  a mo- 
tion that  this  matter  be  referred  to  the  state 
committee  on  Maternal  and  Child  Welfare  for 
further  study  before  the  local  society  be  advised 
as  to  how  to  act  in  this  matter.  The  motion  was 
seconded  and  carried. 

Dr.  F.  D.  Hurd  (Cascade  County)  proposed  a 
resolution  of  thanks  to  the  local  committee  on 
arrangements,  the  hotel  management  and  others 
who  had  made  this  meeting  of  the  House  of 
Delegates  a success.  The  resolution  was  adopted 
in  the  regular  manner. 

Upon  motion  regularly  made,  duly  seconded 
and  unanimously  carried,  the  House  of  Delegates 
adjourned  at  10:45  p.m. 


REPORTS  PRESENTED  AT  THE  INTERIM 
MEETING 

RHEUMATIC  FEVER  AND  HEART  COMMITTEE 

The  report  of  the  Rheumatic  Fever  and  Heart 
Committee  was  tabled  at  the  meeting  last  summer. 
That  report  remains  the  report  of  this  committee 
with  the  following  elaborations  to  clarify  some  of 
the  points  which  were  in  question  at  that  time. 

1.  The  objective  of  this  program  is  to  make  avail- 
able the  necessary  medical  and  convalescent  care  to 
all  persons  with  rheumatic  fever  or  rheumatic  heart 
disease  who  are  certified  by  welfare  agents  as  un- 
able to  pay,  and  who  are  under  21  years  of  age. 
This  objective  is  aimed  to  prevent  and  care  for 
cardiac  crippling  in  the  same  manner  as  has  been 
applied  1o  orthopedic  crippling  in  this  state  for  the 
past  two  decades. 

2.  This  objective  will  be  reached  eventually 
through  statewide: 

a Diagnostic  Clinics  providing  consultative 
service. 

b.  Medical  and  hospital  care  for  those  unable 
to  pay. 

c.  Dissemination  of  educational  material. 

This  statewide  program  would  require  the  utili- 
zation of  all  interested  practitioners  willing  to  help, 
not  jfust  those  especially  trained. 

3.  As  demonstrated  by  experience  in  other  states, 
a small  local  pilot  program  is  the  logical  first  step 
in  starting  a program  which  ultimately  will  cover 
the  whole  state.  In  those  states  where  a rheumatic 
fever  program  has  been  successfully  instituted,  it 
has  been  found  that  the  magnitude  of  the  problem 
requires  that  experience  in  operating  such  a broad 
program  be  built  up  through  a modest  local  be- 
ginning; this  modest  beginning  can  then  be  ex- 
panded as  the  community  and  the  profession  be- 
comes interested  In  the  program.  Extension  of  the 
program  to  include  the  whole  state  must  follow 
success  of  the  local  pilot  program. 


400 


Rocky  Mountain  Medical  Journal 


Your  local  phar- 
macy  stocks 
Neo-Antergan 
in  25-mg.  and 
50-mg,  tablets, 
supplied  in  boxes 
of  100  and  bot- 
tles of  1,000. 


1*  EFFICACY  Neo-Antergan  has  provided  complete  or 
appreciable  symptomatic  relief  in  71  per  cent  of  an  accu- 
mulated series  of  more  than  500  cases  of  hay  fever. 


2.  WIDE  THERAPEUTIC  RANGE  Neo-Antergan  has 
proved  effective  in  relieving  allergic  symptoms  in  certain 
patients  who  had  failed  to  respond  to  other  therapeutic 
measures. 

3.  SAFETY  It  was  necessary  to  discontinue  Neo-Antergan 
therapy  only  in  approximately  3.5  per  cent  of  a series  of 
over  1,500  patients  because  of  imtoward  side  effects. 

MERCK  & CO»^  Inc*  RAHWAY,  N.  J* 


for  May,  1949 


401 


4.  No  lunds  have  been  found  by  the  committee  in 
three  years  of  search  for  setting  up  the  pilot  pro- 
gram except  those  offered  by  the  Division  of  Crip- 
pled Children.  The  Division  of  Crippled  Children 
offers  these  funds  under  the  same  rules  that  gov- 
ern the  orthopedic  program,  which  include  a rule 
that  the  guiding  personnel  of  tne  beginning  pilot 
program  be  certified  specialists  in  pediatrics  and/or 
internal  medicine,  or  that  they  be  eligible  for  certif- 
ication. 

5.  The  success  of  a local  pilot  program  will  make 
available  funds  for  further  extension  of  a general 
program  over  the  whole  state.  These  additional 
funds  could  come  from  nationwide  organizations 
and  their  local  affiliates  such  as  the  Ameiican  Heart 
Association  and  the  National  Society  for  Crippled 
Children  and  Adults.  The  American  Heart  Asso- 
ciation fund^  from  their  national  campaigns  become 
available  only  after  a successful  pilot  program  is 
established.  Such  funds  carry  no  restrictions  on  the 
training  of  professional  personnel.  Thus  the  ex- 
tension of  the  program  can,  and  will,  utilize  the 
services  of  practitioners  without  specialized  training 
in  order  to  cover  a statewide  program.  Actually  lay 
groups  have  forced  the  allocation  of  State  Crip- 
pled Childrens’  funds  to  the  care  of  indigent  cardiac 
cripples,  and  this  handicaps  the  orthopedic  program. 
Without  first  instituting  a pilot  program  no  addi- 
tional federal  funds  or  voluntary  funds  can  be  ob- 
tained. 

6.  Statewide  expansion  of  the  program  requires 
added  support  from  lay  sources.  The  best  of  these 
sources  will  be  the  American  Heart  Association.  In 
order  to  participate  in  their  program  and  benefit 
from  their  organization,  a local  affiliated  chapter 
of  the  American  Heart  Association  is  necessary.  No 
such  local  affiliation  can  be  formed  without  the 
prior  approval  of  the  medical  association. 

The  Rheumatic  Fever  and  Heart  Committee  rec- 
ommends that  the  House  of  Delegates  approve  and 
endorse: 

a.  The  inauguration  of  a pilot  program  for  pro- 
viding patients  with  rheumatic  fever  and  rheumatic 
heart  disease,  who  are  under  21  years  of  age  and 
unable  to  pay,  their  medical,  hospital  and  convales- 
cent care. 

b.  The  formation  of  local  county  or  state  affiliates 
of  the  American  Heart  Association  and  professional 
participation  therein. 

F.  R.  SCHEM,  M.D.,  Chairman. 

DEDEGATE  TO  THE  AMA 

Most  of  the  important  transactions  of  the  House 
of  Delegates  meeting  held  in  St.  Douis  in  November 
and  December  of  1948  are  now  general  knowledge, 
especially  of  the  American  medical  profession. 

It  has  been  stated  that  doctors  will  not  act  unless 
they  are  either  (1)  scared,  or  (2)  get  a kick  in  the 
pants.  The  many  actions  taken  at  this  House  of 
Delegates  Indicate  that  both  these  stimuli  have 
been  activated.  The  intense  interest  at  the  meeting 
can  be  illustrated  by  merely  naming,  some  of  the 
speakers: 

General  George  E.  Armstrong  (U.  S.  Army);  Rear- 
Admiral  Joe  T.  Boone  (U.  iS.  Navy);  Norvin  C. 
Kiefer,  M.D.  (Senior  Surgeon,  Office  of  the  Surgeon 
General,  U.  S.  Public  Health  Service);  Maurice  H. 
Friedman,  M.D.,  Washington,  D.  C.  (the  man  who 
tore  to  pieces  the  arguments  of  Senators  Murray, 
Wagner  and  Dingell  in  the  draft  figures  used  as  an 
argument  for  the  M-W-D  Bill);  Ellis  H.  Bauer, 
M.D.  (Secretary  of  the  World  Medical  Association); 
Dr.  Paul  Hawley  of  the  A.M.C.P.;  Representative 
Harness  of  Indiana  (Harness  Committee  fame); 
Marjorie  Shearon,  Ph.D.,  and  all  the  top  officers  of 
the  American  Medical  Association  and  most  state 
organizations. 

The  most  important  action  was  the  $25  assessment, 
the  first  in  A.M.A.  history,  to  all  members.  I think 
all  are  agreed  that  it  is  about  time  that  all  members 
hdlp  support  the  A.M.A.  in  its  actions.  The  fund  will 

402 


be  under  a planning  committee  of  ten  and  since  this 
was  organized,  Whitaker  & Baxter  of  San  Francisco, 
a Public  Relations  firm,  has  been  employed  to  direct 
the  campaign.  They  announced  that  this  public  at- 
tention campaign  will  be  built  around  the  following 
three  objectives; 

1.  To  awaken  the  people  to  the  danger  of  a po- 
litically controlled  compulsory  health  insurance  sys- 
tem. 

2.  To  acquaint  the  people  with  the  superior  ad- 
vantages of  American  medicine  over  the  govern- 
ment-dominated medical  systems  of  other  countries. 

3.  To  stimulate  the  growth  of  voluntary  health 
insurance  systems  and  prepaid  medical  care  plans 
to  take  the  economic  shock  out  of  illness  and  in- 
crease the  a.vailability  of  medical  care  to  the  Amer- 
ican people. 

Det’s  all  get  back  of  this  effort  100  per  cent. 

Enlargement  of  the  American  Medical  Association 
office  in  Washington  is  included  in  the  plan. 

Another  important  action  was  the  disapproval  of 
a national  insurance  company  proposed  by  the 
A.M.C.P.  They  did,  however,  approve  a national 
enrollment  agency  and  further  development  of  co- 
ordination of  and  reciprocity  among  the  local  plans. 

Other  actions  were  (1)  Emergency  Medical  Care — 
American  medicine  will  have  to  voluntarily  supply 
the  men  necessary  for  armed  medical  services  or 
the  draft  will  do  it  for  them.  It  will  probably  be 
necessary  to  draft  all  doctors  who  have  been  edu- 
cated under  the  federal  government,  anyway;  (2) 
over-building  of  veterans  hospitals,  and  the  prob- 
lem of  approximately  80  per,  cent  of  the  patients 
in  veterans  hospitals  being  non-service  connected; 
(3)  reaffirming  the  stand  against  rebates,  either 
giving  or  accepting  them,  and  recommending  legis- 
lation through  local  societies  for  its  control;  (4) 
voting  to  reaffirm  its  objections  to  federal  subsidy 
to  medical  schools,  which  was  aimed  primarily  at 
the  American  Academy  of  Pediatrics;  (5)  approving 
Diabetes  Week,  in  an  effort  to  discover  the  count- 
less undiscovered  cases  of  diabetes;  (6)  giving  con- 
tinued approval  to  the  furtherance  of  local  public 
health  units;  (7)  voting  to  continue  in  principle  ap- 
proval of  Red  Cross  Blood  Banks  if  operated  ac- 
cording to  agreement;  and  (8)  recomniending  that 
the  medical  department  of  the  Army  be  under  med- 
ical superviion  instead  of  under  logistics  as  at  the 
present  time. 

Quotes  from  various  sessions:  From  Forrest  A. 
Harness,  “The  medical  profession  does  not  use  shirt- 
sleeve politics — take  off  your  coat,  get  out  and 
work;”  "Medicine  is  mistaken  in  its  non-political 
attitude — medicine  should  be  nonpartisan  but  cer- 
tainly not  non-political;”  “Medicine  has  a chronical- 
ly bad  press  because  the  commonplace  medical  care 
and  advance  which  is  good  does  not  make  as  good 
news  as  bad  news  in  medicine.”  “If  a doctor  asks, 
what  is  the  A.M.A.  going  to  do  about  it,  the  answer 
is,  ‘You  are  the  A.M.A.!’”  “The  A.M.A.  has  weak- 
nesses, but  its  weaknesses  are  nothing  compared 
with  its  power,  strength  and  virtue.”  “Our  problems 
are  private  relations  as  well  as  public  relations.” 
“Those  w’ho  believe  that  the  danger  of  state  medi- 
cine is  over  w'ould  give  half  a grain  of  morphine 
to  a case  of  a ruptured  appendix” — General  Hawley. 
“I  don’t  hate  doctors,  I hate  liars” — Senator  Elbert 
Thomas  of  Utah.  “The  Army  wall  lose  2,150  doctors 
in  the  first  six  months  of  1949.  iShame  unto  the  sons 
of  Aesculopius  if  the  draft  should  be  necessary. 
Either  the  doctors  volunteer  or  a draft  will  result.” 
“No  amount  of  public  relations  will  do  you  any  good 
if  you  are  a stinker  at  heart.” 

R.  F.  PETERSON,  M.D., 
Delegate  from  Montana. 

EMERGENCY  MEDICAD  SERVICE  COMMITTEE 

Your  committee  reports  the  following  progress: 

Data  and  information  are  being  accumulated  for 
possible  emergencies  arising  out  of  atomic  warfare, 
guided  missiles,  bacterial  warfare  and  so  forth. 

This  is  being  done  in  cooperation  with  the  com- 

Rocky  Mountain  Medical  Journal 


20  CALORIES  pC/"  OUHCC 
...OR  30. ..OR  40 


wu/iA  '-JD^  Mmli  &hmmA 


''It  is,  at  times,  necessary  to  give  food  of  a consider- 
ably higher  caloric  value  than  would  be  anticipated.  Giving 
of  a food  of  a caloric  value  too  low  to  meet  the  infant’s  needs 
is  by  all  odds  the  chief  cause  of  failure  in  infant  feeding.”* 
When  feedings  of  higher  than  normal  caloric  value 
are  indicated,  how  simple  it  is  with  Similac!  You  merely  in- 
crease the  amount  of  Similac  powder  to  be  added  to  each 
ounce  of  water.  The  relation  of  all  the  nutritive  elements  to 
each  other  remains  the  same  as  in  normal  breast  milk.  And  the 
Digestive  Factor  does  not  change;  for  Similac  has  a consist- 
ently zero  curd  tension  like  breast  milk  — even  in  mixtures  of 
double  the  normal  caloric  value. 


^Page  31,  Infant  Nutrition:  Jeans  and  Mariott,  1947. 
One  measure  (included  in  each  can)  of  Similac 
added  to  two  ounces  of  water  makes  two  ounces 
of  the  normal  formula — 20  calories  per  ounce. 


SIMILAC  DIVISION  • M & R DIETETIC  LABS,  INC.  • COLUMBUS  16, 


^or  May,  1949 


OHIO 

403 


mittee  of  the  A.M.A.  in  Chicago.  There  are  two 
phases  of  this  emergency  medical  service;  (1)  The 
phase  directed  at  the  general  public;  and  (2)  the 
phase  of  informational  service  for  the  medical  pro- 
fession. 

The  committee  has  also  considered  medical  serv- 
ice required  for  the  armed  services  at  present  and 
also  should  an  emergency  occur.  We  are  studying 
ideas  put  forth  by  the  Forsyth  County  Medical  So- 
ciety of  North  Carolina,  which  are  as  follows; 

1.  To  keep  to  a minimum  the  number  of  physicians 
who  will  be  required  to  sef've  in  the  armed  forces. 

2.  To  avoid  Congressional  action  to  get  physicians 
into  the  armed  forces. 

3.  To  maintain  some  civilian  professional  control, 
even  though  indirect,  over  the  number  of  physicians 
taken  into  the  armed  forces. 

4.  To  provide  a definite  and  limited  term  of  serv- 
ice for  medical  officers. 

5;  To  set  up  a point  system  which  would  require 
service  from  physicians  in  the  following  order; 

a.  Those  trained  at  government  expense. 

b.  Those  not  trained  at  government  expense 
who  have  not  served  before. 

c.  Those  who  have  served  before — first  those 
with  short  terms  of  service,  and  last  those 
with  longer  terms. 

We  have  been  unable  to  find  out  whether  or  not 
Montana  has  a quota  of  physicians  at  present  or  in 
an  emergency,  but  it  appears  obvious  that  Mon- 
tana will  have  to  supply  some  in  the  present  national 
program.  R.  F.  PETERSON,  M.D.,  Chairman. 

PAUL  J.  GANS,  M.D., 

J.  J.  McCABE,  M.D. 

S.  A.  OLSON,  M.D., 

L.  G.  RUSSELL,  M.D. 

DELEGATE  TO  THE  A.A.P.S. 

As  delegates  for  Montana  to  the  House  of  Dele- 
gates of  the  Association  of  American  Physicians 
and  Surgeons,  the  undersigned  desire  to  submit  to 
this  body  a report  of  the  annual  assembly  of  the 
A.A.P.S.  held  October  1 and  2,  1948,  in  Akron,  Ohio. 
Montana  medicine  was  further  represented  at  the 
meeting  by  State  A.A.P.S.  Committee  Member,  Dr. 
Leonard  W.  Brewer  of  Missoula. 

The  program  was  replete  with  discussion  of  the 
inroads  of  government  into  the  practice  of  medicine 
and  all  other  forms  of  free  enterprise.  An  address  by 
United  States  Senator  Allen  J.  Ellender  of  Louisiana 
against  Federal  invasion  of  states  rights,  especially 
as  typified  in  the  National  Health  Insurance  Act, 
was  outstanding.  With  members  of  the  medical 
profession  in  his  family.  Senator  Ellender  proved 
himself  well  informed  and  a friend  of  medicine. 
Congressman  Ralph  Waldo  Gwinn  of  New  York 
furnished  food  for  thought  in  his  talk,  "Let’s  Quit 
Doing  What  the  Socialists  and  Communists  Teach.” 
Mr.  Leonard  E.  Reed,  President  of  the  Foundation 
for  Economic  Education,  in  his  address,  "General 
Practitioners  in  Liberty,”  described  the  progress  of 
socialism  in  all  forms  of  human  enterprise  and  the 
resultant  loss  of  freedom  in  this  country,  and  em- 
phasized the  point  that  efforts  to  socialize  medicine 
were  not  unlike  the  efforts  being  made  to  national- 
ize other  fields  of  business  and  professional  en- 
deavor. Dr.  Marjorie  Shearon,  Research  Analyst  of 
Washington,  wtth  her  wealth  of  facts  and  intimate 
knowledge  of  the  proponents  of  state  medicine,  made 
a plea  for  “Political  Action  by  the  Profession.” 

The  medical  profession  was  represented  by  emi- 
nently well  qualified  speakers  on  public  relations, 
medical  legislation  and  medical  economics.  Among 
these  should  be  mentioned;  Dr.  A.  A.  Brindley,  Pres- 
ident, Ohio  State  Medical  Association:  Dr.  Carl  A. 
Lincke,  President-elect,  Ohio  State  Medical  Associa- 
tion: Dr.  Elmer  Hess,  President,  Medical  Society  of 
Pennsylvania;  Dr.  James  E.  Buckley,  President- 
elect, Oregon  State  Medical  Society;  and  Dr.  L.  Fern- 
aid  Foster.  Secretary,  Michigan  State  Medical  So- 
ciety. 


Current  trends  and  future  prospects  in  legislation 
inimical  to  American  medicine  were  thoroughly  dis- 
cussed. The  political  situation  even  at  that  time 
offered  no  rest  from  battle  for  the  medical  profes- 
sion. The  platforms  of  all  political  parties  contained 
planks  for  socialized  medicine,  and  candidates  varied 
only  in  degree  of  color  in  their  advocacy  of  the  so- 
cialization program.  It  was  repeatedly  said  that 
should  the  Republican  Party  win  (and  the  odds  fa- 
vored that  party  in  October)  that  it  was  unlikely  that 
a new  Wagner-Murray-Dingell  bill  would  be  intro- 
duced, but  that  other  infiltration  tactics  would  be 
used  by  the  socializing  proponents  to  include  the 
broadening  of  the  base  of  social  security,  increasing 
social  security  benefits,  and  the  subsidizing  of  edu- 
cation in  medicine,  dentistry,  nursing  and  allied 
fields.  In  the  then  more  remote  event  that  the 
Democratic  Party  might  win  the  election,  the  situ- 
ation would  become  acutely  critical  for  organized 
medicine.  The  subsequent  months  have  proven  the 
truth  of  this  prediction.  Never  in  the  history  of 
medicine  have  more  critical  times  developed. 

In  the  discussion,  attention  was  called  to  the  ex- 
tensive volume  of  propaganda  for  state  medicine 
emanating  from  government  bureaus,  all  at  the  ex- 
pense of  the  taxpayer,  and  in  direct  violation  of 
Federal  law.  Numerous  violations  of  this  provision 
involving  many  important  bureaucrats  reported  to 
the  Attorney  General  by  Congressional  investigating 
committees  have  produced  no  action  up  to  the 
present  time. 

The  problem  of  medical  practice  by  hospitals, 
more  prevalent  in  the  East  and  in  larger  centers, 
came  up  for  its  share  of  discussion.  Here,  too,  the 
subsidizing  of  hospitals  by  the  Federal  government 
points  to  ultimate  control  by  the  state,  subsequent 
substitution  of  Federal  medical  staffs  and  final 
elimination  of  the  non-government  practitioners. 
The  American  Hospital  Association  by  its  actions 
has  taken  a definite  stand  for  socialized  medicine. 

The  proposed  uniting  of  the  Blue  Cross  and  Blue 
Shield  on  a'  national  basis  with  the  issuance  of  na- 
tional policies,  as  suggested  by  Dr.  Hawley,  was 
thoroughly  discussed  and  opposed.  It  was  clearly 
pointed  out  that  such  a system  too  closely  resem- 
bled the  W-M-D  plan,  contained  most  of  the  same 
faults,  and  would  facilitate  the  final  absorption  of 
all  voluntary  pre-payment  plans  by  the  Federal 
government. 

As  an  adjunct  for  the  improvement  of  public 
relations,  greater  stress  this  year  will  be  given  to 
the  National  Essay  Contest.  The  subject  remains 
unchanged;  “Why  the  Private  Practice  of  Medicine 
Furnishes  This  Country  With  the  Finest  Medical 
Care.”  Investigation  of  the  subject  by  the  partic- 
ipants, assisted  by  family  and  friends,  directs  the 
thoughts  of  many  to  the  true  status  of  medical  care 
and  a deeper  appreciation  of  our  present  type  of 
medical  practice.  Component  societies  in  the  state 
are  urged  to  appoint  local  Essay  Contest  Commit- 
tees and  in  conjunction  with  similar  committees  of 
the  Medical  Auxiliary,  conduct  local  contests,  sub- 
mitting the  winning  essays  in  the  national  contest. 

Now,  more  than  ever,  it  is  important  that  medical 
men  unite  in  the  fight  against  state  medicine. 
A.A.P.S.  membership  in  Montana  has  treRled  in  the 
past  twelve  months.  The  active  fight  that  A.A.P.S. 
has  waged  against  state  medicine  and  the  pledge 
of  non-pai  ticipation  in  government-controlled  med- 
icine are  potent  reasons  for  belonging  to  the  or- 
ganization. The  time  for  decision  has  passed.  Either 
one  believes  in  state  medicine  and  naturally  would 
do  nothing  to  oppose  its  advance,  or  one  is  against 
state  medicine  and  should  belong  in  A.A.P.S.  There 
is  no  compromise  on  principles.  There  is  no  middle 
ground.  C.  H.  FREDRICKSON,  M.D., 

H.  T.  CARAWAY,  M.D. 


404 


Rocky  Mountain  Medical  Journal 


THIS  SUGGESTION 
MAY  BE  OF  VALUE  FOR  YOUR 
THROAT  PATIENTS: 

When  cigarette  smoking  is  a factor  in  throat  irritation, 
many  leading  nose  and  throat  specialists  suggest* 
to  their  patients  a choice  of  3 alternatives: 

1 .  Stop  Smoking, 

2.  Smoke  less, 

3.  Change  to  Philip  Morris! 

• Philip  Morris  is  the  only  cigarette  proved  definitely  and  measurably 
less  irritating!**  Perhaps  you  too  will  find  it  worth  while  to  suggest 
"Change  to  Philip  Morris/'.  . . by  far  the  wisest  choice 
for  everyone  who  smokes. 


PHILIP  MORRIS 

Philip  Morris  & Co.,  Ltd.,  Inc. 

119  Fifth  Avenue,  N.  Y. 

DO  YOU  SMOKE  A PIPE?  We  suggest  an  unusually  fine 
blend  — Country  Doctor  Pipe  Mixture.  Made  by  the  same 
process  as  used  in  the  manufacture  of  Philip  Morris  Cigarettes. 

*Complefely  documented  evidence  on  file. 

**May  we  send  you  copies  of  these  published  studies: 

Laryngoscope,  Feb.  1935,  Vol.  XLV,  No.  2,  149-154;  Laryngoscope,  Jan.  1937,  Vo/.  XLVIl,  No.  I.  58-60; 
Broc.  Soc.  Exp.  Biol,  and  Med.,  1934,  32-241;  N.  Y.  State  Journ.  Med.,  Vol.  35,  6-1-25,  No.  II,  590-592. 


for  May,  1949 


405 


JuberculosLS  Abstracts 

Issued  Monthly  by  the  National  Tuberculosis 
ssociation 

Vol.  XXII  MAV,  1»4»  No.  5 

Medicine  and  its  associated  sciences  can  take  great 
pride  in  the  report  which  follows — it  gives  the  progress 
to  date  of  a large-scale  cooperative  endeavor  in  which 
many  individuals  and  diverse  agencies  pooled  skills 
and  resources  in  testing  a new  therapeutic  agent  — 
streptomycin,  against  an  old  disease — tuberculosis. 

STEEPTOMYCIN  IN  THE  TREATMENT  OF 
TUBERCULOSIS 

Pulmonary  Tuberculosis.  Streptomycin  has  a limited 
but  important  place  in  the  therapy  of  pulmonary  tu- 
berculosis, but  should  be  withheld  if  other  treatment 
is  available  and  likely  to  be  satisfactory.  Streptomycin 
therapy  is  not  advisable  in;  (a)  chronic  fibroid  or  fi- 
brocaseous  pulmonary  tuberculosis:  (b)  acute  de- 
structive and  apparently  terminal  tuberculosis,  except 
for  symptomatic  relief;  (c)  minimal  pulmonary  tuber- 
culosis with  a good  prognosis. 

Streptomycin  appears  to  be  most  effective  in  recent, 
acute,  fairly  extensive,  and  progressing  pulmonary 
tuberculosis  and  is  particularly  recommended  for  tu- 
berculous bronchopneumonia:  (b)  acute  bronchogenic 
spread,  particularly  if  the  acute  process  prevents  much 
needed  collapse  therapy,  and  (c)  chronic  disseminated 
finely  nodular  tuberculosis  without  large  confluent 
areas  of  destructive  disease. 

As  streptomycin  can  only  be  used  for  a few  months 
in  the  therapy  of  this  disease  because  of  the  emer- 
gence of  resistant  organisms,  it  is  imperative  that 
streptomycin  be  used  during  the  course  of  the  disease 
when  the  greatest  benefit  can  be  expected.  Streptomy- 
cin is  best  used  as  an  adjunct  and  should  be  worked 
into  an  over-all  plan  of  treatment  which  will  often  in- 
clude collapse  therapy  and  generally  includes  institu- 
tional care.  The  committee  looks  with  disfavor  on  the 
practice  of  utilizing  streptomycin  prior  to  institutional 
care  or  as  an  alternative  to  collapse  therapy. 

Ulcerating  Tuberculous  Lesions  of  Mucous  Mem- 
branes. Streptomycin,  preferably  administered  by  the 
parenteral  route,  is  recommended  for  laryngeal,  tracheal, 
bronchial,  oropharyngeal,  and  enteral  ulcerations,  and 
tuberculous  otitis  media.  It  is  less  effective  in  granu- 
lomatous lesions  in  this  area,  still  less  so  in  diffuse 
inflammatory  lesions  and  ineffective  in  cicatricial  le- 
sions. 

T uberculous  Sinuses  and  Fistulae.  Streptomycin 
is  recommended  in  the  treatment  of  draining  tuber- 
culous sinuses  and  fistulae.  Usually,  however,  superior 
results  are  obtained  only  with  streptomycin  and  suit- 
able surgery. 

Genito-urinary  Tract.  Streptomycin  is  recommended 
in  the  treatment  of  tuberculosis  of  the  gehito-urinary 
tract  usually  as  an  adjunct  to  other  therapy. 

Tuberculosis  of  Bone,  Joint  and  Cartilage.  Strep- 
tomycin is  advised  in  the  treatment  of  tuberculosis  of 
bone,  joint  and  cartilage  with  other  therapy.  Timing 
in  the  use  of  the  drug  is  important. 

T uberculosis  Meningitis.  Intensive  therapy  with 
streptomycin,  administered  both  parenterally  and  in- 
trathecally,  is  imperative  for  the  treatment  of  tuber- 
culous meningitis.  Two  grams  a day  should  be  given 
intramsucularly  for  from  four  to  six  months.  It  is 
recommended  that  not  more  than  50  mg.  of  streptomy- 
cin be  administered  intrathecally  every  second  or  third 
day  during  treatment.  This  may  be  given  daily  for 
the  first  week.  Frequent  and  serious  neurologic  com- 
plications many  arise  as  a result  of  this  regimen,  yet 
complete  clinical  remission  is  observed  in  an  appreci- 
able number  of  cases.  The  response  is  best  when 


treatment  is  early  so  it  need  not  await  bacteriologic 
confirmation  of  the  diagnosis.  However,  to  avoid 
treating  a nontuberculous  meningitis,  streptomycin 
should  be  used  only  when  an  active  tuberculous  focus 
is  present,  or,,  the  cerebrospinal  fluid  in  culture  is  neg- 
ative for  ordinary  pathogens  but  is  characteristic  of 
tuberculous  meningitis. 

Miliary  Tuberculosis.  Streptomycin  therapy  is  in- 
dicated in  the  treatment  of  acute  hematogenous  (mi- 
liary) tuberculosis  and  chronic  hematogenous  dis- 
seminated tuberculosis.  Good  clinical  judgment  is 
needed  to  differentiate  these  from  nontuberculous  pul- 
monary infiltrations  especially  in  the  early  stages. 
Early  treatment  is  desirable  and  in  some  cases  should 
be  started  before  bacteriologic  confirmation.  Bone 
marrow  biopsy  and  culture  may  aid  early  diagnosis. 
Treatment  should  continue  for  at  least  four  months. 
One  to  two  grams  a day  is  adequate  dosage.  In  acute 
miliary  tuberculosis,  development  of  tuberculous  men- 
ingitis is  common.  After  the  diagnosis  is  established, 
routine  lumbar  punctures  are  recommended.  Intrathecal 
therapy  should  be  added  whenever  the  cerebrospinal 
fluid  is  abnormal. 

Tuberculous  Lymphadenitis.  Streptomycin  may  be 
employed  in  the  treatment  of  tuberculous  lympha- 
denitis especially  in  the  acute  stage.  The  attendant 
toxicity  and  the  emergence  of  resistant  bacteria  are 
factors  limiting  its  use. 

T uberculous  Peritonitis  and  Pericarditis.  Streptomy- 
cin is  recommended  in  the  treatment  of  tuberculous 
peritonitis.  Clinical  remission  is  common  and  relapse 
relatively  infrequent  following  adequate  therapy. 
Streptomycin  may  not  be  expected  to  alter  the  sequelae 
of  tuberculous  pericarditis  but  appears  to  have  a bene- 
ficial effect  on  the  acute  process  itself. 

Dosage  and  Duration  of  Streptomycin  Therapy. 
Probably  no  single  streptomycin  regimen  is  suitable 
for  all  forms  of  tuberculosis.  Except  in  miliary  tu- 
berculosis and  tuberculous  meningitis,  it  is  advised 
that  streptomycin  be  administered  in  one  half  gram 
doses,  i.e.,  one  gram  daily,  at  twelve-hour  intervals 
in  courses  of  forty-two  days.  Until  further  study,  it 
cannot  be  recommended  that  injections  be  made  less 
frequently  or  for  shorter  periods  of  time  than  here 
indicated. 

Toxic  Manifestations  of  Streptomycin  Therapy. 
Toxic  manifestations  are  relatively  infrequent  on  the 
dose  recommended  above,  i.e.,  one  gram  a day.  Never- 
theless the  following  reactions  do  occur  and  the 
dangers  should  be  weighed  against  the  disease  haz- 
ards: (a)  a disturbance  of  vestibular  function:  (b) 
deafness,  in  very  rare  instances;  (c)  serious  renal 
damage  appears  rarely  without  pre-existing  renal  dis- 
ease: (d)  cutaneous  rashes  occasionally — serious  ex- 
foliative dermatitis  rarely. 

Emergence  to  Predominance  of  Drug-resistant  Tu- 
bercle Bacilli.  The  disappearance  of  drug-sensitive 
strains  of  tubercle  bacilli  and  their  replacement  with 
drug-resistant  strains  handicap  prolonged  effective 
therapy  with  streptomycin.  This  is  usually  avoided  by 
confining  duration  of  therapy  to  forty-two  days. 

Dihydrostreptomycin.  The  committee  has  reviewed 
limited  experimental  and  clinical  evidence  concerning 
dihydrostreptomycin,  a hydrogenated  derivative  of 
streptomycin.  The  pharmacological  and  biological 
properties  of  dihydrostreptomycin  and  streptomycin 
are  quite  similar.  Dihydrostreptomycin  is  less  toxic 
than  streptomycin  in  its  action  on  the  vestibular  ap- 
paratus, although  other  toxic  reactions  sometimes  oc- 
cur. It  appears  to  be  tolerated  by  some  patients  who 
are  hypersensitive  to  streptomycin.  These  advantages 
warrant  extensive  clinical  trials. 

Report  of  Clinical  Subcommittee  of  Committee  on 
Medical  Research  and  Therapy,  Chairman,  John  D. 
Steele,  M.D.,  American  Trudeau  Society,  American 
Review  of  Tuberculosis,  January,  1949. 


406 


Rocky  Mountain  Medical  Journal 


M aid  in  treatment  of  specific  breast  conditions 


UOmCTIVE  BRfflERES 

are  cns tom- fitted  to  prescription... 


Straps  adjusted  for  maximum  com- 
fort with  gentle -yet -firm  support. 

■I  Bi  M m Back  width  designed  to 
encourage  good  posture. 

I mm  H Correct  bust  cup  selected  for 
proper  uplift  and  separation. 


Torso  fitted  to  patient!s 
personal  measurements. 


'Proper  physiological  support  for  the 
breast  is  a medical  problem,  and  patients  are 
grateful  to  the  physician  who  recognizes  this 
fact.  Lov-e’s  extensive  therapeutic  line  of  breast 
supports  provides  remedial  support  for  specific 
breast  conditions.  From  more  than  500  bust-cup- 
torso  size  variations,  the  patient’s  correct  size  is 
selected,  then  fitted  to  her  individual  measure- 
ments by  specially  trained  Lov-e’  technicians, 
according  to  your  exact  instructions. 

Lov-e  Brassieres  are  available  in  a wide  variety 
of  all  fine  fabrics  including  cottons,  rayon  jac- 
quards and  nylons.  Also  available;  sleeping  bras- 
sieres, hospital  binders,  artificial  breasts,  muscle 
pads  and  maternity  garter  supports. 

The  May  Company 

LOV-E  SECTION, 

CORSET  DEPARTMENT, 

THIRD  FLOOR 

DENVER,  COLORADO 


MATERNITY 

— for  pre-natal  and 
post-natal.  Helps 
prevent  leakage. 
Adjusted  without 
charge  during  preg- 
nancy. 


HYPERTROPHIC 

— inner  pocket  for 
pendulous  bust. 
Built  up  back. 
Padded  shoulder 
straps.  Redistributes 
bust  weight. 


MASTECTOMY 

— fitted  with  Lov-e’ 
bust  pads  to  restore 
bust  contour.  Aids 
psychologically. 


for  May,  1949 


407 


Adverlissmeni 


From  where  I sit 
it/  Joe  Marsh 

-^w— 

Duke  Gets  HisTractor 


?!4e  Qo^uuen.  | 

New  Books  Received 

Practical  Aspects  of  Tliyroid  Disease:  By  George 
Crile,  Jr.,  M.D.,  F.A.C.S.,  Department  of  Surgery, 
Cleveland  Clinic.  355  pages,  illustrated.  W.  B. 
Saunders  Company,  Philadelphia  & London,  1949. 


Operating  Room  Technique:  By  Edythe  Louise  Al- 
exander, R.N.,  Supervisor  of  the  Operating  Rooms 
of  the  Roosevelt  Hospital,  New  York  City;  for- 
merly Supervisor  of  Operating  Rooms,  Mountain- 
side Hospital,  Montclair,  New  Jersey;  Supervisor 
of  Private  Pavilion  Operating  Rooms,  New  York 
Hospital,  New  York  City.  Second  Edition  with  668 
illustrations.  The  C.  V.  Mosby  Company,  St.  Louis, 
1949.  flO.OO. 


Duke  Thomas  bought  a farm  with 
the  money  he'd  saved  in  the  Service, 
hut  he  couldn't  get  a tractor.  He  needed 
it  badly,  hut  was  tenth  on  the  local 
dealer's  list. 

“Tell  you  what,”  old  man  Peters 
says.  “If  those  nine  fellows  ahead  of 
you  agree,  you’ll  get  the  next  one  I 
get  in.”  “No,  thanks,”  says  Duke, 
“I’ll  just  take  my  turn.” 

But  old  Peters  mails  out  nine  post- 
cards. And  the  other  day  he  tells  Duke 
his  tractor  will  be  in  next  week.  “/ 
simply  wrote  the  facts  to  the  fellows 
ahead  of  you.  They  decided  it." 

From  where  I sit,  it’s  that  spirit  of 
understanding  that  helps  make  our 
democracy  so  great.  Understanding 
for  the  other  fellow’s  problems  and 
respect  for  the  other  fellow’s  rights — 
whether  it’s  his  right  to  earn  a living, 
his  right  to  cast  his  vote  against  your 
candidate,  or  even  his  right  to  enjoy 
a moderate,  friendly  glass  of  beer  or 
ale — if  and  when  he  chooses.  Let’s 
always  keep  it  that  way! 


Copyright,!  9 U9,  United  States  Brewers  Foundation 


Clinical  Orthoptics  Diagnosis  and  Treatment:  By 

Mary  Everist  Kramer,  Supervisor,  The  Orthoptic 
Department,  The  George  Washington  University 
Hospital,  Washington,  D.  C.  Edited  by  Ernest 
A.  W.  Sheppard,  M.D.,  Professor  of  Ophthalmology, 
Medicine,  Washington,  D.  C.;  and  Louisa  Wells- 
The  George  Washington  University  School  of 
Medicine,  Washington,  D.C. ; and  Louisa  Wells- 
Kramer,  Certified  Orthoptic  Technician,  Washing- 
ton, D,  C.  475  pages  with  147  illustrations.  The 
C.  V.  Mosby  Company,  St.  Louis,  1949.  $8.00. 


British  Surgical  Practice:  Under  the  General  Editor- 
ship of  Sir  Ernest  Rock  Carling,  F.R.C.S.,  F.R,C.P., 
Consulting  Surgeon,  Westminster  Hospital;  and  J. 
Paterson  Ross,  M.S.,  F.R.C.S.,  Surgeon  and  Di- 
rector of  Surgical  Clinical  Unit,  St.  Bartholomew’s 
Hospital;  Professor  of  Surgery,  University  of  Lon- 
don, In  eight  volumes  (with  Index  Volume). 
Volume  4.  486  pages  with  illustrations.  Butter- 

worth  & Co.  (Publishers),  Ltd.,  London,  England. 
The  C.  V.  Mosby  Company,  St.  Louis,  Missouri, 
U.  S A.  1948.  $15.00. 


Campbell’s.  Operative  Orthopedies:  Editor,  J.  S. 

Speed,  M.D, ; Associate  Editor,  Hugh  Smith,  M,D., 
Memphis,  Tenn.  Second  Edition  with  1,141  illus- 
trations including  two  color  plates.  Volume  I,  835 
pages.  The  C.  V.  Mosby  Company,  St.  Louis.  1949. 
$30. 


Campbell’s  Operative  Orthopedies:  Editor,  J S, 

Speed,  M.D. ; Associate  Editor,  Hugh  Smith,  M.D., 
Memphis,  Tenn.  Second  Edition  with  1,141  illus- 
trations including  two  color  plates.  Volume  H, 
801  pages.  The  C.  V.  Mosby  Company,  St.  Louis. 
1949.  $30. 


Handbook  of  Diseases  of  the  Skin;  By  Richard  Li 
Sutton,  M.D.,  Emeritus  Professor  of  Dermatology 
and  Syphiology,  University  of  Kansas  Medical 
School;  and  Richard  L.  Sutton,  Jr.,  M.D.,  Associate 
Professor  of  Dermatology  and  Syphilology,  Uni- 
versity of  Kansas  Medical  School.  719  pages  with 
1,057  illustrations.  The  C.  V.  Mosby  Company,  St. 
Louis.  1949.  $12.50. 

4 

Psyehodynamics  and  the  Allergie  Patient:  By  Harold 
A.  Abramson,  M.D.,  P.A.C.A.,  Associate  Physician 
for  Allergy,  The  Mount  Sinai  Hospital,  New  York, 
N,  Y. : Consulting  Physician  for  Allergy,  Sea  View 
Hospital,  Staten  Island,  N.  Y.;  Assistant  Professor 
of  Physiology,  Columbia  University,  New  York, 
N.  Y.  Panel  Discussion,  Rudolf  L.  Baer,  M.D.; 
Ethan  Allan  Brown,  M.D. ; O.  Spurgeon  English, 
M.D.;  Hal  M.  Davison,  M.D.;  Frank  Fremont- 
Smith,  M.D. ; J.  A.  P.  Miller,  M.D.;  M.  Murray 
Peshkin,  M.D. ; Homer  E.  Prince,  M.D. ; Sandor 
Rado,  M.D.;  Edward  Weiss,  M.D.  An  official  pub- 
lication of  the  American  College  of  Allergists.  81 
pages.  The  Bruce  Publishing  Company,  St.  Paul 
and  Minneapolis.  1948. 


Atlas  of  Peripheral  Nerve  Injuries:  By  William  R. 
Lyons,  Ph.D.,  Associate  Professor  of  Anatomy, 
University  of  California  Medical  School;  and 
Barnes  Woodhall,  M.D.,  Professor  of  Neurosurgery, 
Duke  Medical  School,  Durham,  North  Carolina. 
W.  B.  Saunders  Company,  Philadelphia  and  Lon- 
don. 1949. 


408 


Rocky  Mountain  Medical  Journal 


I^IJRSES 

OFFICIAL 

REGISTRY 

Established  to  Meet  the  Communit3r’s 
Every  Need  for  Nursing  Care 

-K  -X  -K 

GRADUATE  REGISTERED  NURSES 

Hourly  Nursing  Service  Positions 
Filled — Information  on  All 
Nursing  Service 

This  registry  is  endorsed  by  the 
Colorado  State  Graduate  Nurses’ 
Association  and  American  Nurses’ 
Association 

-K  -K  -K 

Undergraduates  and  Practical  Nurses 
Furnished  Upon  Request 

KEystone  0168 

ARGONAUT  HOTEL 


1- 


production  -Se 


ervice 


ELECTROTYPES 

MATRICES 

STEREOTYPES 

PRINTING 

TYPOGRAPHY 


^lAJedtern  %^nion 

Denver  1830  Curtis  St. 

New  York  - - - - 310  East  45th  St. 
Chicago  - - - - 210  So.  Desplaines  St. 

And  33  Other  Cities 


■4- 


If  You  Send  Out  Statements 

ROCKMONT  Statement  Envelopes  save  time  in  your 
office  and  make  it  easy  for  the  patient  to  remit. 

The  statement  is  an  envelope  addressed  back  to  your 
office  and  goes  out  to  the  patient  in  a crystalite  window 
envelope,  thus  saving  one  complete  addressing  opera- 
tion, for  your  secretary.  All  the  patient  has  to  do  is 
simply  insert  check  and  mail. 

For  those  slow-pay  patients,  ROCKMONT 
"COLLECTELOPES”  will  get  results.  Three  colors 
identify  the  message  of  collection.  Proved  copy  brings 
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ROCKMONT  ENVELOPE  COMPANY 

Alameda  and  Cherokee  • PEarl  2484  * Denver,  Colorado 


for  May,  1949 


409 


JVe  Recommend 

KARC’S  PAINT  CO. 

Lowe  Bros.  Paints  Kem-Tone 

Wall  Paper  Painters’  Supplies 

Art  Supplies 

FREE  DELIVERY  

Phone  CHerry  3779 

620  Santa  Fe  Drive  Denver 


Denver's  Fireproof 

COLBURN  HOTEL 

D.  B.  Cerise  is  the  genial  Host  and  Manager 

• CONVENIENT  — Located  only  o ten-minute  walk 
from  the  heart  of  the  city. 

• PLEASANT  — Away  from  — above  the  noise  and 
rush  of  downtown  Denver. 

• EXCELLENT  FOOD  — Dining  that  has  satisfied  the 
demanding  tastes  of  all  patrons. 

• Visit  Our  New  Cocktail  Lounge. 

TENTH  AVE.  at  GRANT  ST. 

Phone  MAin  6261  Denver,  Colo. 


RESTAURANT  240 

MISS  M.  E.  GABRIEL,  Prop. 

SERVING  TRADITIONALLY  GOOD 
F.OOD  AT  MODERATE  PRICES 

HOURS:  11:00  A.M.— 2:00  P.M.  4:30—7:30  P.M. 
SUNDAYS:  12  Noon  to  7:00  P.M. 

Closed  Wednesdays 

240  Broadway  Denver,  Colo. 

SPruce  2182 


We  Cater  to  the  Medical  Profession 

CASCADE  LAUNDRY 

10  Per  Cent  Discount  If  You  Bring  Your 
Laundry  in 

HAND  DRY  CIjEANING 
“Deserving  of  Your  Patronage” 

1621  Tremont  Denver  TAbor  6379 
Charge  Accounts  Invited 


We  Recommend 

ED.  CORBIN’S  DRUG  STORE 

(Evergreen  Drug  Store) 

PRESCRIPTION  SPECIALISTS 
DRUGS  — SUNDRIES 

Evergreen,  Colorado  Altitude 

U.  S.  A.  7,039  Feet 

Phone  Evergreen  22 


Cook  County  Graduate 
School  of  Medicine 

ANNOUNCES  CONTINUOUS  COURSES 

SURGERY — Intensive  course  in  Surgical  Technique, 
two  weeks,  starting  June  20,  July  25,  August  22. 
Surgical  Technique,  Surgical  Anatomy  and  Clinical 
Surgery,  four  weeks,  starting  June  6,  July  11, 
August  8.  Surgical  Anatomy  and  Clinical  Surgery, 
two  weeks,  starting  May  16,  June  20,  July  25. 
Surgery  of  Colon  and  Rectum,  one  week,  starting 
June  13,  September  12.  Esophageal  Surgery,  one 
week,  starting  June  13.  Thoracic  Surgery,  one 
week,  starting  June  20.  Breast  and  Thyroid  Sur- 
gery, one  week,  starting  June  27.  Fractures  and 
Traumatic  Surgery,  two  weeks,  starting  June  13, 
October  3. 

GYNECOLOGY — Intensive  course,  two  weeks,  starting 
June  20,  September  26.  Vaginal  Approach  to  Pelvic 
Surgery,  one  week,  starting  May  16,  June  13,  Sep- 
tember 19. 

OBSTETRICS — Intensive  course,  two  weeks,  starting 
May  1 6,  September  1 2. 

MEDICINE — Intensive  general  course,  two  weeks, 
starting  June  13,  October  3.  Electrocardiography  and 
Heart  Disease,  two  weeks,  starting  July  18.  Gastro- 
enterology, two  weeks,  starting  June  27.  Personal 
course  in  Gastroscopy,  two  weeks,  starting  May 
16,  June  13. 

PEDIATRICS — Diagnosis  and  Treatment  of  Congenital 
Malformations  of  Heart,  two  weeks,  starting  June 
13.  Personal  course  in  Cerebral  Palsy,  two  weeks, 
starting  August  1. 

DERMATOLOGY — Formal  course,  two  weeks,  starting 
June  13.  Informal  clinical  course  every  two  weeks, 

CYSTOSCOPY — Ten-day  practical  course  every  two 
weeks. 

UROLOGY — Intensive  course,  two  weeks,  starting 
September  26. 

GENERAL,  INTENSIVE  AND  SPECIAL  COURSES  IN  ALL 
BRANCHES  OF  MEDICINE,  SURGERY  AND 
THE  SPECIALTIES 

TEACHING  FACULTY — ATTENDING  STAFF  OF  COOK 
COUNTY  HOSPITAL 

Address:  Registrar,  427  South  Honore  Street, 
Chicago  12,  Illinois 


accident  - HOSPITAL  - SICKNESS 

INSURANCE 

For 

Physicians,  Surgeons,  Dentists  Exclusively 


All 

^ PREMIU~MS 

COME  FROM 


$5,000.00  accidental  death  $8.00 

125.00  weekly  Indemnity,  accident  and  siekneas  Quarterly 

$10,000.00  accidental  death  $16.00 

$50.00  weekly  Indemnity,  aeddent  and  sickness  Quarterly 

$15,000.00  accidental  death  $24.00 

$75.00  weekly  Indemnity,  aeddent  and  si^eae  Quarterly 

$20,000.00  accidental  death  $32.00 

$100.00  weekly  Indemnity,  aeddent  and  sickness  Quarterly 


ALSO  HOSPmkl,  ESXPE9NSE}  FOR  IHBOIBraRS. 
WTVRS  AND  CHIDDKESN 


85c  out  of  each  $1.00  gross  income  used  for 
members!’  benefit 

$3,700,000.00  $15,700,000.00 

INVESTED  ASSETS  PAID  FOR  CLAIMS 

$200,000.00  deposited  with  State  of  Nebraska  for  protection  of  oar  memben. 

Disability  need  not  be  incurred  in  line  of  duty — 
benefits  from  the  beginning  day  of  disability 

PHYSICIANS  CASUALTY  ASSOCIATION 
PHYSICIANS  HEALTH  ASSOCIATION 

47  years  under  the  same  management 
400  First  National  Bank  Building,  Omaha  2,  Nebraska 


410 


Rocky  Mountain  Medical  Journal 


Shadel  Sanitarium  has  combined  research*, 
treatment  and  rehabilitation  to  return  thousands 
of  Alcoholics  to  normal  living.  Groundwork 
for  recovery  is  laid  through  intensive, 
individualized  therapy.  Statistical  evaluation  of 
results  since  1935,  have  shown  that  in  over 
3125  cases  reported*,  40%  remained  abstinent 
for  four  years  or  longer.  Our  object  is  . . . 
Cooperation  with  the  family  physician  in 
mapping  the  road  to  recovery. 


RECOGNIZED  BY  THE 

A.  M.  A. 

MEMBER  OF  THE 

A.  H.  A. 


SPECIALISTS  IN  THERAPY  FOR  CHRONIC  ALCOHOLISM 

BY  THE  CONDITIONED  REFLEX  AND  ADJUVANT  METHODS 
7106  35th  AVE.  S.  W.  SEATTLE  6,  WASH.,  WEST  7232,  CABLE  ADDRESS;  "REFLEX" 


for  May,  1949 


411 


DL 

BROWN  SCHOOLS 

For  Exceptional  Children 

Four  distinct  units.  Tiny  Tots  through 
the  Teens.  Ranch  for  older  hoys.  Spe- 
cial attention  given  to  educational  and 
emotional  difficulties.  Speech,  Music, 
Arts  and  Crafts.  Full  time  Psychologist. 
Under  the  daily  supervision  of  a Certi- 
fied Psychiatrist.  Registered  Nurses. 
Private  swimming  pool,  fireproof 
building.  View  Book.  Summer  Camp. 
Approved  by  State  Division  of  Special 
Education. 

BERT  P.  BROWN 

President 

Pau!  L.  White,  M.D.,  F.A.P.A., 
Medical  Director 

P.  0.  Box  4008,  Austin,  Texas 


No  Test  Tubes  • No  Measuring  • No  Boiling 

Diabetics  welcome  “Spot  Tests”  (ready  to  use  dry 
reagents),  because  of  the  ease  and  simplicity  in  using. 

No  test  tubes,  no  boiling,  no  measuring;  just  a little 
powder,  a little  urine — color  reaction  occurs  at  once 
if  sugar  or  acetone  is  present. 

(DENco} 

FOR  DETECTION  OF  FOR  DETECTION  OF 

SU6AR  IN  THE  URINE  ACETONE  IN  THE  URINE 


SAME  SIMPLE 
TECHNIQUE  FOR  BOTH 

1.  A LITTLE  FOWDES 

2.  A LITTLE  URINE 
COLOR  REACTION  IMMEDIATELY 


A carrying  case  containing  cne 
vial  of  Acetone  Test  (Denco) 
and  one  vial  of  Galatest  is  now 
available.  This  is  very  conven- 
ient for  the  medical  bag  or  for 
the  diabetic  patient.  The  case 
also  contains  a medicine  dropper 
and  a Galatest  color  chart.  This 
handy  kit  or  refills  of  Acetone 
Test  (Denco)  and  Galatest  are 
obtainable  at  all  prescription 
harmacies  and  surgical  supply 
ouses.  • 


Accepted  for  advertising  in  the  Journal  of  the  A.M.A. 
WRITE  FOR  DESCRIFTIVE  LITERATURE 


LIVERMORE  SANITARIUM 


• The  Hydropathic  Department 
devoted  to  the  treatment  of  gen- 
eral diseases,  excluding  surgical 
and  acute  infectious  cases.  Special 
attention  given  functional  and  or- 
ganic nervous  diseases.  A well 
equipped  clinical  laboratory  and 
modern  X-ray  Department  are  in 
use  for  diagnosis. 

• The  Cottage  Department  (for 
mental  patients)  has  its  own  fa- 
cilities for  hydropathic  and  other 
treatments.  It  consists  of  small 
cottages  with  homelike  surround- 
ings, permitting  the  segregation  of 
patients  in  accordance  with  the 
type  of  psychosis.  Also  bungalows 
for  individual  patients,  offering 
the  highest  class  of  accommoda- 
tions with  privacy  and  comfort. 


GENERAL  FEATURES 


1.  Climatic  advantages  not  excelled  in  United  States.  Beautiful  grounds  and  attractive  surrounding  country. 

2.  Indoor  and  outdoor  gymnastics  under  the  charge  of  an  athletic  director.  An  excellent  Occupational  Department. 

3.  A resident  medical  staff.  A large  and  well-trained  nursing  staff  so  that  each  patient  is  given  careful  individual  attention. 


Information  and  circulars  upon  request. 

Address:  O.  B.  JENSEN,  M.D. 
Superintendent  and  Medical  Director 
Livermore,  California 
Telephone  313 


CITY  OFFICES: 


San  Francisco 
450  Sutter  Street 
GArfield  1-5040 


Oakland 

1624  Franklin  Street 
GLencourt  1-5988 


412 


Rocky  Mountain  Medical  Journal 


DOCTOR'S  OFFICE  and  HOME 

^acri^ice  (^uicli  Sctie 


Doctor  retiring  and  leaving  Denver.  Three-room  office  and  six-room  brick 
home  designed  for  gracious  living.  Four  beautifully  landscaped  lots  with 
summer  cottage  and  outdoor  living  room.  Handy  to  public  transportation 
and  neighborhood  shopping  centers.  Terms  to  right  party  can  be  arranged. 

% 

Address  inquiries  to  Mrs.  C.  M.  Worth,  4938  W.  Hayward  Place,  Denver  12 

Telephone  CRand  6240 


^JutcmuCUcL  hfjdrochlorlde 


( dihydromorphinone  hydrochloride) 


COUNCIL  ACCEPTED 


Powerful  opiate  analgesic  - dose,  l/32  grain  to  1/20  grain. 
Potent  cough  sedative  - dose,  l/l28  grain  to  l/64  grain. 
Readily  soluble,  quick  acting. 

Side  effects,  such  as  nausea  and  constipation,  seem  less 
likely  to  occur. 

An  opiate,  has  addictive  properties. 

Dependable  for  relief  of  pain  and  cough,  not  administered 
for  hypnosis. 

• Dilaudid  is  subject  to  Federal  narcotic  regulations.  Dilaudid,  Trade  Mark  Bilhuber. 


Bilhuber-Knoll  Corp.  Orange,  N.  J. 


for  May,  1949 


413 


NEWTON  OPTICAL  COMPANY 

GUILD  OPTICIANS 

V.  C.  NORWOOD,  Manager 

309-16th  Street  Denver 

Phone  KEystone  0806 

Catering  to  Medical  Proiession  Patronage 


WANTADS 

FOR  SALE 

Combination  doctor’s  office  and  home.  Doctor  leav- 
ing- city  immediately.  Sacrifice  lovely  6-room  home 
with  3-room  office  for  quick  sale.  Satisfactory- 
terms  to  right  ijarty.  Contact  Mrs.  C.  C.  Worth, 
4935  West  Hayward  Place,  Denver  12;  phone 
GRand  6240. 


FOR  SALE 

One  Allison  Eye  Specialist  Chair,  cheap.  Dr.  Eig- 
ler,  1300  South  Gaylord  Street,  Denver,  Colorado. 


YOUNG,  well-trained  general  practitioner  desires 
position  with  older  physician  in  Colorado.  Will 
be  available  July  1,  1949.  Call  Dr.  G.  W.  Lockwood, 
TAbor  1331. 


YOUNG,  well-trained  general  practitioner  desires 
position  -^vith  older  physician  in  Colorado.  Avail- 
able July  1,  1949.  Call  Dr.  D.  H.  Werner,  TAbor 
1331. 


TELEPHONE  TABOR  5191 
i3TH  & BROADWAY  • DENVER 


COL VIN-Medical  Books 

Medical  PubUcatioiu  of  All  Publi$her$ 

Books  Sent  for  Examination  on  Request 
We  Maintain  This  Book  Store  for  Your  Convenience 
Books  Make  Fine  Christmas  Gifts 
Write  or  Come  to 
705-706  MAJESTIC  BUILDING 

Denver  2,  Colorado  Call  MAin  3866 


414 


Rocky  Mountain  Medical  Journal 


I 


FAIRFAX  SANITARIUM 


Kirkland,  Wash. 


'%  Beautiful  and  restful  surroundings  affording 
recreational  facilities.  Cottage  plan  for  segre- 
gation of  patients.  Insulin  and  Electro-shock 
Therapy  when  indicated. 

Attending  Physicians 
FREDERICK  LEMERE,  M.D. 

NATHAN  K.  RICKLES,  M.D. 

JAMES  H.  LASATER,  M.D. 

MORTON  E.  BASSAN,  M.D. 

JACK  J.  KLEIN,  M.D. 

Manager:  A.  G.  HUGHES 
Route  2,  Box  365,  Kirkland 
Phone:  Kirkland  2391 


Situated  one  mile  north  of  Juanita 


TREATING  NERVOUS  AND 


MENTAL  DISEASES 


SOME  of  the  exclusive  features  of  this 
new  Vacuum  Tube  Hearing  Aid  are: 
Sealed  Crystal  Microphone — gives  same 
dependable  service  under  all  conditions  of 
temperature  and  humidity.  Stabilized  Feed- 
back — amplification  without  distortion. 
No  sudden  blast  from  loud  sounds  when 
volume  is  turned  up. 

For  other  information  write  or  coU 

M.  F.  Taylor  Laboratories 

721  Republic  Building 
MAin  1920  Denver,  Colo. 


SERVICE 

QUALITY 

PAUL  WEISS 

PRESCRIPTION 

OPTICIAN 

1620  ARAPAHOE  ST.  DENVER 

MAin  1722 

WESTERN  ELECTRIC 

HEARING  AIDS 

Engineered  by  Bell  Telephone  Laboratories 


Winning  Health 

in  the 

Pikes  Peak  Region 


COLORADO  SPRINGS 


Inquiries  Solicited 


GLOCKNER  PENROSE  HOSPITAL 

Sisters  of  Charity 

HOME  OF  MODERN  SANATORIA 


for  May,  1949 


415 


RELIABLE  DRUGGISTS 

PATRONIZE  DENVER’S  INDEPENDENT  DRUGGISTS 


WE  RECOMMEND 

COTOTRY  CLUB 
PHARMUICY 

PRESCRIPTION  SPECIALISTS 

1700  E.  6th  Ave.  EAst  7743 

Denver,  Colorado 

We  Recommend 

PFAB  PHARMACY 

JESS  L.  KINCAID,  Prop. 

Prescriptioiis,^  Biologicals 
and  Fine  Cosmetics 

5190  W.  Colfax  at  Sheridan 

Phone  TAbor  9931-0951 

DENVER,  COLORADO 

HATCH  PHARMACY 

PRESCRIPTIONS  OUR  SPECIALTY 
Drugs  — Sundries 

Free  Immediate  Deliveries  on  Prescriptions 

794  Colorado  Blvd.  Denver,  Colo. 

Phone  EAst  7718 

“When  in  Need  Think  of  Us  Indeed” 

We  Recommend 

EAR]\EST  DRUG  COMPAIVY 

T.  H.  BRAYD'EIN,  Prop. 

PRESCRIPTION  SPECIALISTS 
Prompt  Delivery  Service 

1699  Broadway  Phone  KEystone  7237 

Denver,  Colorado 

“Conveniently  Located  for  the  Doctor” 

HYDE’S  PHARMACY 

ACCURATE  PRESCRIPTIONS 

Chas  W.  Hyde,  Prop. 

Rocky  Mountain  Distributor  for  Sherman 
Biologicals  and  Pharmaceuticals 

Free  Deliveries 

62S  16th  St.  (Mack  Bldg.)  KE.  4811 

Doyle's  Pharmacy 

‘^lie  If^articuiar 

East  17th  Ave.  at  Grant  KE.  5987 

21  Years  in  the  Heart  of  North  Denver 

GUIDO  SHUMAKE  DRUGS 

(Formerly  Otto  Drug  Co.) 

PRESCRIPTIONS  ACCURATELY 
COMPOUNDED 

Free  Delivery  Service 

West  38th  Ave.  and  Clay  Denver,  Colo. 

Phone  GRand  9934 

IFe  Recommend 

BONNIE  BRAE 

DRUG  COMPANY 

Alfred  C.  Andersen,  Owner  and  Manager 
Prescriptions  Accurately  Compounded 

Drugs Sundries 

FREE  IMMEDIATE  DELIVERIES 

ON  EMERGENCY  PRESCRIPTIONS 

763  South  University  Boulevard 

Phone  RAce  2874  — Denver,  Colorado 

WE  RECOMMEND 

Whittaker’s  Pharmacy 

“The  Friendly  Store” 

PRESCRIPTION  SPECIALISTS 

West  32nd  and  Perry,  Denver,  Colo. 
Phone  GLendale  2401 

22  Years  in  North  Denver 

OTTO  DRUG  COMPANY 

TRY  US  FIRST 

Prescriptions  Accurately  Compounded 

Free  Delivery  Service 

(New  Location) 

5070  Federal  Boulevard  Denver,  Colorado 

Phone  GRand  9832 

416 


Rocky  Mountain  Medical  Journal 


RELIABLE  DRUGGISTS 

PATRONIZE  DENVER’S  INDEPENDENT  DRUGGISTS 


WALTERS  DRUG  STORE 
801  COLORADO  BLVD. 

Denver,  Colorado 

'A 

Telephone  FRemont  5391 

WE  RECOMMEND 

LAKEWOOD  PHARMACY 

R.  W.  Hoitgren,  Prop. 

PRESCRIPTION  SPECIALISTS 

West  Colfax  at  Wadsworth 

Lakewood  Colorado 

Phone  Lakewood  65 

IdJiig  to  at  lAJeidd 

WEISS  DRUG 

PRESCRIPTION  SPECIALISTS 

A 

Colfax  and  Elm  Denver,  Colorado 

Phone  EAst  1814 

Downing  Street  Pharmacy 

GEORGE  M.  HILL,  Prop. 

PROFESSIONAL  PHARMACIST 

901  Downing  St.  Denver,  Colo. 

Phone  CHerry  2767 

Complete  Merchandise  Line 

Free  Delivery  on  Prescriptions 

We  Recommend 

VAN'S  PHARMACY 

THOS.  A.  VANDERBUR 

Prescriptions,  Drags,  Cosmetics,  Magazines 
Sundries  Excellent  Fountain  Service 

%59  Umatilla  St.,  Cor.  29th  Ave.  at  Umatilla 

GRand  7944  Denver,  Colo. 

East  Denver’s  Prescription  Drug  Store 

m VI  n i i]  N 

Bert  C.  Corgan,  Prop. 

3401  FRANKLEV  STREET 

KEystone  7241 

Dansberry’s  Pharmacy 

“New  Ultra  Modern  Prescription  Service” 

JAMES  F.  DANSBERRY 

Owner  and  Manager 

Champa  at  14th  Street  Denver,  Colorado 

Phone  KEystone  4269 

OVERSTAKE’S  PHARMACY 

Gail  E.  Overstake 

Piescri ption  S pecialists 

DRUGS  — SUNDRIES  — 
COSMETICS  — CANDIES 

We  Deliver 

1000  So.  Gaylord  — RAce  4401 

Harl  Cleveland,  Owner 

CLEVELAND  PHARMACY 

W.  29th  Ave.  at  Speer  Ph.  GL.  9272 

Modem  Prescription  Department 
Registered  Pharmacist 

Drugs  — Sundries  — Soda  Fountain 

HOURS:  Week  Days,  8 a.m.  to  10  p.m. 

Sundays,  10  am.  to  1 p.m..  5 p.m.  le  8 p.m. 

Prescriptions  Delivered  Promptly 

PROFESSIONAL  MEN  RECOMMEND 

D.  MALCOLM  CAREY,  Pharmacist 

Phone  AComa  3711 

224  Sixteenth  Street  Denver,  Colorado 

for  May,  1949 


417 


POSTGRADUATE  COURSE 

In 

Thoracic  Diseases 

And 

Thoracic  Anesthesiology 

Sponsored  by 

AMERICAN  TRUDEAU  SOCIETY 

In  Cooperation  With 

THE  UNIVERSITY  OF  COLORADO 
SCHOOL  OF  MEDICINE 

July  18-30,  1949 

University  of  Colorado 
Medical  Center 
Denver,  Colorado 

Registration  Fee:  $100.00 

Applicants  should  write  to: 

American  Trudeau  Society 

1790  Broadway 
New  York,  N.  Y. 


Dr.  F.  A.  Duncan  Alexander,  Chief  of  Anes- 
thesiology, Veterans  Administration  Hos- 
pital, McKinney,  Texas. 

Dr.  J.  Burns  Amberson,  Jr.,  Professor  of  Medi- 
cine, College  of  Physicians  and  Surgeons, 
Columbia  University;  Visiting  Physician  in 
Charge,  Tuberculosis  Service,  Bellevue  Hos- 
pital, New  York. 

Dr.  Robert  J.  Anderson,  Chief,  Division  of 
Tuberculosis,  United  States  Public  Health 
Service,  Washington,  D.  C. 

Dr.  Robert  G.  Bloch,  Professor  of  Medicine, 
University  of  Chicago,  Chicago,  Illinois. 

Dr.  Emanuel  M.  Papper,  Assistant  Professor 
of  Anesthesia,  New  York  University  College 
of  Medicine. 

Dr.  David  T.  Smith,  Professor  of  Bacteriology 
and  Associate  Professor  of  Medicine,  Duke 
University  School  of  Medicine,  Durham, 
North  Carolina. 

Dr.  Joseph  Weinberg,  Chief  of  Surgery,  Birm- 
ingham Veterans  Administration  Hospital, 
Van  Nuys,  California. 


SICKROOM  SUPPLIES 


a 


OXYGEN  SERVICE 


MASKS  — CATHETERS  — CONE 


AEROSOL  PENICILLIN  EQUIPMENT 

NEW- DRY  ICE  OXYGEN  TENTS 


1739  Welton 


24-Hour  Service 


MAin  5183 


• Preferred  and  Common  Stocks 

* Industrial  Bonds 

* Public  Utility  Bonds 

* Railroad  Bonds 

* Municipal  Bonds 

* Government  Bonds 

Peters,  Writer  & Christensen 

Inc. 

Investment  Bankers 

601-8  U.  S.  National  Bank  Bldg.,  Denver 

MAin  6281  ^ 

418 


Rocky  Mountain  Medical  Journal 


THIS  IS  YOUR  SERVICE- 
WHY  NOT  USE  IT? 


Men  of  science  and  medicine  agree  that  the  functional  efficiency  of  any 
piece  of  technical  apparatus  depends  in  large  measure  upon  the  service 
facilities  maintained  by  the  organization  selling  it. 


When  you  place  your  orders  for  scientific  instruments  with  us,  you  have 
the  assurance  that  experienced  technicians  will  always  be  available  to  pro- 
vide capable  service,  promptly  and  efficiently. 


We  list  below  just  a few  of  the  products  we  sell  and  service: 


Electroca  rdiog  ra  phs 
Photoelectric  Colorimeters 
Warburg  Apporotus 
pH  Meters 
Microscopes 
Laboratory  Ovens 
Laboratory  Furniture 
Metabolators 
Operating  Room  Lights 
Water  Stills 


Electroencephalographs 

Spectrophotometers 

Dubnoff  Metabolic  Shaking  Incubators 
Analytical  Balances 
Photomicrographic  Equipment 
Laboratory  Incubators 
Hospital  Furniture 
Resuscitators 

Autoclaves  and  Sterilizers 
Anesthesia  Apparatus 


Biological  and  Blood  Bank  Refrigerators 
X-Ray  Equipment — Diagnostic  and  Therapy 
X-Ray  Diffraction  Spectrometers 

Films — Dark  Room  Accessories — Protective  Equipment 
Fenwall  System  for  the  Preparation  of  Parenteral  Medications 


When  considering  the  purchase  of  scientific  equipment,  send  us  your  in- 
quiries. Pay  no  more,  but  have  the  assurance  of  professional  maintainance 
facilities. 


TECHNICAL  EQUIPMENT  CORPORATION 

2548  West  29th  Avenue 
Denver  11,  Colo. 

Telephone  GLendale  4768 

FEATURING  INSTRUMENTATION  IN  MODERN  ANALYSIS 


/or  May,  1949 


419 


MEDICAL  CENTER 
PHARMACY 

Located  in  the  New  Medical  Building 

3701  East  Colfax  DExter  5467 

DENVER,  COLO. 

Prescriptions  and  Medical  Supplies 

Wm.  K.  VAN  SANT,  Mgr. 

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Clarence  J.  Daly,  President 

DALY  INSURANCE 

All  Forms  of  Insurance 
Capitol  Life  Insurance  Bldg. 

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KEystone  2211 


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Planning  ahead  so  that  customers  will  have  adequate  electric  capacity  and 
service  at  all  times  is  typical  of  utility  services  founded  on  American  methods  of 
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® Public  Service  Company  of  Colorado® 


420 


Rocky  Mountain  Medical  Journal 


American 

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Company 

THE  FINEST  OF 
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The  Craving  for  Candy  Often  Is 

A CALL  FOR  ENERGY 


Recommend  Brecht’s 

For  Your  Patients  . . . 


SUGAR  PUUMS  . . . tenderest  of  fruit-flav- 
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Packages. 

PANTRTi  SHELF  . . . delicious  hard  candies 
in  many  flavors.  Refreshing  fruit  drops, 
crunchy  filled  wafers  . . . flavor  sealed — 
in  glass  jars. 

DAINTA'  STICKS  ...  so  delicious  and  pure. 
Made  from  sugar,  dextrose,  corn  syrup,  fin- 
est tlavorings,  U.  S.  Certified  Colors,  As- 
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for  May,  1949 


421 


• A BEAUTIFUL  NEW  SUITE  . . . BY  HAMILTON 

The  latest  addition  to  the  Hamilton  line,  this  new  and  beautiful  suite  of  matched  woods  is 
designed  to  create  new  warmth  and  beauty  for  your  examination  room.  Patients  appreciate 
its  modern  distinctive  appearance.  It  is  economically  priced  and  designed  to  help  make  your 
work  more  pleasant. 

Available  in  a choice  of  two  woods  and  four  finishes,  each  designed  to  create  a different 
effect.  Selections  may  be  made  from  red  mahogany  with  tan  upholstery,  blonde  mahogany 
with  tan  upholstery,  regular  walnut  with  brown  upholstery,  or  silver  gray  walnut  with  bur- 
gundy upholstery.  Features  consist  of  a large  examining  chair-table  with  counter  balanced 
top,  adjustable  stirrups,  Hide-A-Roll  attachment,  steel-wood  drawers,  concealed  treatment 
feature  and  generous  storage  space.  The  roomy  instrument  cabinet  is  available  with  either 
solid  or  glass  doors. 

Write  for  your  copy  of  our  RM-549  Nu-Trend  Furniture  Catalog 

Distributed  by 


PHYSICIANS  AND  HOSPITALS  SUPPLY  CO.,  Inc. 

MINNEAPOLIS  MINNESOTA 


422 


Rocky  Mountain  Medical  Jottonal 


lAJooJcro^t  J^oApitai^JPueLioj  doioraJio 

A private  hospital  for  the  scientific  treatment  of  neuro-psychiatric  disorders,  including 
alcoholism  and  drug  addiction.  Beautiful  landscaping  and  home-like  surroundings  afford 
a restful  atmosphere.  Accommodations  vary  from  single  rooms  with  or  without  bath  to 
rooms  en  suite,  allowing  for  segregation  of  guests. 


Detailed  information  furnished  on  request. 


Karl  J.  Waggener,  M.D. 


Wendell  T.  Wingett,  M.D. 


THE  CHILDREN’S  HOSPITAL  ASSOCIATION 

of  DENVER 

NON-SECTARIAN NON-PROFIT 

Providing  medicinal  and  surgical  aid  to  sick  and  crippled  children  of  the  Rocky 
Mountain  Region  from  Birth  to  Maturity 

Every  modern  scientific  aid  available  to  the  physicians  and  surgeons 
of  Colorado  and  Wyoming 

Approved  by  the  American  Medical  Association  and  Full  Three-Year 

the  American  College  of  Surgeons  Nurses’  Training  Course 


for  May,  1949 


423 


YORK 

PHARMACY 

Denver’s  Finest  Prescription  Store 

Free  Delivery 
Phone  FR.  8837 

2300  East  Colfax  Avenue  at  York  Street 

Almay  Cosmetics 


W.O.RocL 

Ambulance 

Service 


Prompt,  Careful  and  Courteous 
Serving  Denver  25  Years 

Approved  by  Phyeiciana  Generally 

18th  Ave.  at  Gilpin  St.,  Phone  EA.  7733 


^Iba  Dairy 

Properly  Pasteurised  Milk 

Ice  Cream — Butter — Buttermilk 


3L 


Phone  1101  Boulder,  Colo 


Surgical  Supports  Expertly  Fitted. 

Miss  Mabel  P.  Cliff,  Authorized  Fitter 


^^ent/er  Sur^lcai C^ompan^ 

“For  better  service  to  the  profession.” 

1438-40  Tremont  Place  CHerry  4458 

Denver  2,  Colorado 


Let’s  exact  the  same  high  standard  of  purity  in  drinking  water  we 
do  in  foods,  medicines,  and  morals. 

“Good  health  deserves  it.  Bad  health  demands  the  hest  water.” 


DEEP  ROCK  WATER  CO. 

Distributors  of 

MOUNTAIN  VALLEY  MINERAL  WATER 

614  27th  Street  From  Hot  Sorings.  Arkansas  TAbor  5121 


424 


Rocky  Mountain  Medical  Journal 


1 


YOU  ARE  INVITED  TO  VISIT  OUR 
NEW  MODERN  STORE 

Conveniently  Located  to  Meet  tbe  Needs 
of  the  Doctor 


DL 


Suapiu  C^o. 


jf^li^iictani  CJT  ^ur^eons  — 'yuppli^ 
Metropolitan  Bldg. 

221  Sixteenth  Street  TAbor  0156 

DENVER 


50  y.ar,  of  €iL  Icai  f^r«6cription 
.Service  to  iLe  a^oclori  of  ^liey-enne 


ROEDEL^S 

PRESCRIPTION  DRUG  STORE 

CHEYENNE,  WYOMING 


Bonita  Pharmacy 


(Established  1921) 


MALONE  DREG  CO. 

New,  Modern,  Drug  Store  Service 


Prescription  Pharmacists 

6th  Avenue  at  St.  Paul  Street 
“RIGHT-A-WAY”  SERVICE 

GERALD  P.  MOORE,  Manager 
Phone  FRemont  2797 


(Colorado  Springs  {Psychopathic  Hospital 

A Private  Hospital  for  Nervous  and  Mental  Diseases 

Situated  in  a beautiful  valley  two  miles  south  of  Colorado  Springs,  which  is  nationally  known  as  a health 
center.  New  building  for  mild  cases  of  Functional  Neurosis,  affording  complete  classification  of  patients. 
Home-like  surroundings,  scientific  medical  treatment  and  nursing  care.  Booklet  and  rates  on  application. 

C.  F.  Rice,  Superintendent,  Colorado  Spring's,  Colorado 


PRESCRIPTIONS  A SPECIALTY 
FREE  DELIVERY 

100  So.  Broadway  SPruce  6226 

Denver,  Colorado 


for  May,  1949 


425 


MEDICAL 

CENTER 

BUILDING 

Colfax  Ave.  and 
Garfield  Stree 


Doctors,  Patients,  Public  A 

oay 


"MOST 


ASTOUNDING 


Only  medical  building  in  Denver  with  direct  telephone  inter- 
communication between  all  tenants  including  prescription  pharmacy. 

Parking  facilities  for  tenants  and  patients 

• Asphalt  Tile  Floors  • Ldboratory  and  X-ray  Service  • Service  Connections  for  Air 
Pressure,  Plumbing,  Gas  and  Electricity  • Humidified  Washed  Air  Conditioning. 


^'<>'1  regarding  the  limited  spate  still  available  for  lease  to  professional  tenants,  tall 

ScKAACK  c Company  Manager 


724  SEVENTEENTH  STREET 


A.  C.  DUERR, 


DENVER  2,  COLORADO 


o o o ergotamine  tartrate 

For  the  Effective  Treatment  of 

MIGRAINE 

Accepted  by  American  Medical  Association 
Council  on  Pharmacy  and  Chemistry 


DOSAGE:  0.5  cc.  intramuscularly  as  early  as  pos- 
sible. In  resistant  cases  the  dosage  may  be  in- 
creased to  1 cc.  In  mild  attacks  2 to  6 tablets 
preferably  sublingually — often  prove  effective. 

LITERATURE  ON  REQUEST 

SANDOZ  PHARMACEUTICALS 

West  Coast  Office — 450  Sutter  Street  San  Francisco  8,  California 


426 


Rocky  Mountain  Medical  Journal 


Index  to  Advertisers 


Page 


Abbey  Rents  418 

Abbott  L.aboratorifes  395 

Alba  Dairy  424 

American  Ambulance  421 

American  Meat  Institute 355 

American  Medical  and  Dental 
Association  352 

Ayerst,  McKenna  & Harrison_393 

Berbert,  George  & Sons 428 

Bib  Corporation 399 

Bilbuber-Knoll  Corp.  413 

Bonita  Pharmacy 425 

Bonnie-Brae  Drug  416 

Borden  Co.  397 

Brecht  Candy  Co 421 

Brown  Schools  412 

Cambridge  Dairy  348 

Camel  Cigarette  349 

Camp  & Co.,  S.  H 391 

Cancer  Conference ^Cover  III 

Capital  Chevrolet  414 

Capitol  Life  Insurance  Co. --_420 

Cascade  Laundry  410 

Children’s  Hospital  Assn 423 

City  Park  Dairy 354 

Cleveland  Pharmacy 417 

Coca-Cola  421 

Colburn  Hotel  410 

Colorado  Springs 

Psychopathic  Hospital  425 

Colvin  Medical  Books 414 

Cook  County  Graduate 

School  of  Medicine 410 

Corbin’s,  Ed  Drug  Store 410 

Country  Club  Pharmacy 416 

Cutter  Laboratories  387 

Dansberry's  Pharmacy  ' 417 

Deep  Rock  Water 424 

Denver  Chemical  Mfg.  Co.,  Inc. 412 
Denver  Oxygen  Co 356 


Denver  Surgical  Supply  Co 424 


Page 

Dorr  Optical  Co 358 

Downing  Street  Pharmacy_.-417 

Doyle’s  Pharmacy  416 

Dryer  & Astler 420 

Earnest  Drug  Co 416 

Ehret  Engraving  Co 356 

Fairfax  Sanitarium  415 

Fairhaven  Maternity 

Hospital  348 

Franklin  Drug  Co. = 417 

Glockner  Penrose  Hospital_-415 

Hatch  Pharmacy  416 

Holland  Rantos  Co 357 

Hyde’s  Pharmacy  416 

Jackson’s  Cut  Rate  Drug 414 

Karg  Paint  Co , 410 

Kendrick-Bellamy  Co.  346 

L.akewood  Pharmacy 417 

Lederle  Laboratories  360 

Lilly,  Eli  & Co. 

Insert  Between 360-361 

Livermore  Sanitarium  412 

LovS  Brassiere  Co 407 

Malone  Drug  Store 425 

M & R Dietetic  Laboratories, 
Inc.  403 

Mead,  Johnson  & Co Cover  IV 

Medical  Center  Pharmacy 420 

Merck  & Co.,  Inc 401 

Newton  Optical  Co 414 

Nurses  Official  Registry 409 

Otto  Drug  Co 416 

Overstake’s  Pharmacy 417 

Park  Floral  Co 356 

Parke,  Davis  & Co. -Cover  11-345 
Peters,  Writer  & Christensen. 418 

Pfab  Pharmacy  416 

Philip  Morris  & Co 405 

Physicians  & Hospitals  Supply 
Co.  422 

Physicians  and  Surgeons 

Supply  425 


Page 

Physicians  and  Surgeons 

Telephone  Service  Exch 414 

Phj-sicians  Casualty  Assn 410 

Professional  Pharmacy 417 

Pubic  Service  Co 420 

Restaurant  240  410 

Roche  Ambulance  Service 424 

Rockmont  Envelope  Co 409 

Roedel’s  Prescription  Drug 425 

Sandoz  Pharmaceuticals  426 

Schering  Corporation  351 

Searle  & Co.,  G.  D 385 

Shadel  Sanitarium  411 

Shadford-Fletcher  Optical  Co. 354 

Shumake  Drug,  Guido 416 

Smith  Dorsey  Co 389 

Smith,  Kline  & French 359 

Stodghill’s  Imperial 

Pharmacy  354 

Technical  Equipment 

Corp.oration  419 

Telephone  Answering  Service  348 

Thoracic  Medicine.  Postgrad- 
uate Course  418 

Thornton,  George  R 346 

United  States  Brew’ing 

Industry  408 

Van’s  Pharmacy  417 

Van  Schaack  & Co 426 

Walters  Drug  Store 417 

Wantads  414 

Weiss  Drug  . 417 

Weiss,  Paul  415 

Western  Electric 

Hearing  Aids  415 

Western  Newspaper  Union 409 

Wheatridge  Farm  Dairy 414 

Whittaker’s  Pharmacy 416 

Winthrop-Stearns,  Inc. 347 

Woodcrott  Hospital  423 

Worth,  Mrs.  C.  M 413 

Wyeth,  Inc.  353 

York  Pharmacy  424 


for  May,  1949 


427 


^s  ALlVis  records 

«ThJs 


IN 


THE  DOCTORS' 
FAVORITE  FILE 

No  other  file  has  ever  approached  the  popu- 
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LASTS  AT  LEAST  FIFTY  YEARS 
COSTS  LESS  THAN  $1.50  A YEAR 


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428 


Rocky  Mountain  Medical  Journal 


nnouncin^ 


The  Third  Annual  Rocky  Mountain 
Cancer  Conference 


JULY  14-15,  1949,  DENVER 

☆ 

An  outstanding  educational  program  presenting  recent 
trends  in  cancer  research,  sponsored  by  the  Colorado 
State  Medical  Society,  Rocky  Mountain  Cancer  Founda- 
tion and  the  Colorado  Division,  American  Cancer  Society. 

☆ 


Eight  Distinguished  Guest  Speakers 


George  F.  Cahill,  M.D.,  Professor 
of  Urology,  Columbia  University 
College  of  Physicians  and  Sur- 
geons. 

Sherwood  Moore,  M.D.,  Professor 
of  Radiology,  Washington  Uni- 
versity. 

C.  S.  O’Brien,  M.D.,  Professor  and 
Head,  Department  of  Ophthal- 
mology, State  University  of  Iowa. 

John  dej.  Pemberton,  M.D.,  Profes- 
sor of  Surgery,  Mayo  Foundation. 


Fred  W.  Stewart,  M.D.,  Patholo- 
gist to  Memorial  Hospital  Cen- 
ter, New  York. 

Fred  D.  Weidman,  M.D.,  Professor 
of  Research  in  Dermatology  and 
Mycology,  University  of  Pennsyl- 
variia. 

Cyrus  C.  Sturgis,  M.D.,  Professor 
of  Medicine,  University  of  Michi- 
gan. 

Idys  Mims  Cage,  M.D.,  Professor  of 
Clinical  Surgery,  Tulane  Univer- 
sity. 


☆ 

Round-Table  Discussion  Recreational  Facilities  Non-Scientific  Banquet 
Hotel  reservations  are  now  available.  Write  Cancer  Conference, 

519  17th,  Denver 

NO  REGISTRATION  FEE 


in  1932  we  brought  out  Pabfum?* 
Embodying  a new  concept  of  cereal  nutrition,  easy  of  pr@p> 
oration,  nonwosteful,  forerunner  of  present  doy  widely 
practised  principles  of  food  fortification — remember? 


3 

a. 

Later,  in  response  to  requests  from 


physicians,  we  went  a step  further  in  Pabena,*  similar  in 
nutritional  and  convenient  features  to  its  father-product, 
Pablum,  different  in  flavor  becouse  of  its  oatmeal  base, 
(f  our  pioneer  work  and  ethical  policy  meet  with  yoqr  appro- 
bation, remember,  pleose,  to  specify  Pablum  and  Pabena. 

*'‘Pabhm’'  and  "Pabena”  are  the  registered  trademarks  of  Mead  Johnson 
& Company  for  these  vifamin'and-mineral-enriched  mixed  cereal  foods. 


PROGRAM  NUMBER,  ROCKY  MOUNTAIN 


Volume  46 


Number  6 


New  Mexico  Looks  to  the  Future — Editorial. 


Observations  on  Recently  Proposed  Legislation 
IN  THE  Congress — J.  W.  Hannett,  Albuquer- 
que. 


o 

/>, 


Extrapleural  Thoracoplasty  in  Caseopneumonic 
Tuberculosis — James  H.  Forsee,  Denver. 


Combined  Vagotomy  and  Partial  Gastric  Resec- 
tion IN  Treatment  of  Peptic  Ulcer — F'.  F. 
Hatch,  Woodrow  Nelson  and  T.  C.  Bauerlein, 
Salt  Lake  City. 


Rocky  Mountain  Medical  Conference — Complete 
Program  and  Program  Notes,  Special  Section. 

(For  Complete  Table  of  Contents,  Turn 
the  First  Page) 


25c  Per  Copy 


$2.50  Per  Year 


DILANTIN  Sodium  ( diphenylhydantoin  sodium,  P.  D.  & Co.)  is  available  in 
0.03  Gm.  (/2  gr.)  and  0.1  Gm.  (I/2  gr. ) Kapseals®,  in  bottles  of  100  and  1000. 

*M5gladery,  J.:  Therapeutic  Conference,  The  Treatment  of  Epilepsy. 
Bull.  Johns  Hopkins  Hosp.,  82:609,  (June)  1948. 


“It  has  the  distinct  advantage  of  being  unassociated  with  mental 
clouding  or  drowsiness.’’*  DILANTIN,  highly  effective  in 
suppressing  grand  mal  seizures,  is  notably  free  from  hypnotic 
side-effects  thus  facilitating  the  educational,  vocational 
and  social  rehabilitation  of  the  epileptic  patient. 


Absence  or  great  diminution  in  frequency  and  severity  of 
attacks  is  achieved  with  individualized  dosage  schedules. 


A N 


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• functional  design 

• durable  metal  construction 

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Sold  exclusively  in  Denver  by 


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1641  California  St.  Denver  2,  Colorado 


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Orthopedic  Brace 
and  Appliance  Co. 

1628  Court  Place  MAin  3026 

Write  for  Measuring  Chart 


Table  of  Contents 

VOLUME  46  NUMBER  6 

JUNE,  1949 


Editorials 

New  Mexico  Looks  to  the  Future 445 

Time  to  Stand  Up  and  Be  Counted 445 

Atomic  Energy 446 

Mismanagement  of  Burns 446 

Disaster  Needs  Educated  Doctors 447 


4- 


Original  Articles 

Some  Observations  Relating  to  Recently 
Proposed  Legislation  in  the  Congress  of 
the  United  States,  J.  W.  Hannett,  M.D 448 

Extrapleural  Thoracoplasty  Early  in  Caseo- 
pneumonic  Tuberculosis,  James  H.  For- 
see,  Colonel,  M.C 452 

The  Combined  Procedure  of  Vagotomy  and 
Partial  Gastric  Resection  in  the  Treat- 
ment of  Peptic  Ulcer,  F.  F.  Hatch,  M.D., 
Woodrow  Nelson,  M.D.,  and  T.  C.  Bauer- 
lein,  M.D 460 


4- 


Rocky  Mountain  Medical  Conference 

History  of  the  Rocky  Mountain  Medical 


Conference  470 

Hotel  Reservations  470 

Entertainment  at  Butte.. 471 

Official  Call  472 

Program 473 

Guest  Speakers  477 

Technical  Exhibits  479 


4- 


Organization 

National 

Free  Tick  Vaccine  No  Longer  Available..  482 


School  Health  Questionnaire 482 

Colorado 

Course  in  Anesthesiology 482 

Cancer  Refresher  Courses  Successful 482 

Obituaries  484 

Auxiliary 484 

Colorado  State  Health  Department 
New  Venereal  Disease  Treatment  Pro- 
gram   486 

Utah 

Obituary  486 

Wyoming 

Official  Call  488 

Book  Corner  463  and  488 

Tuberculosis  Abstract  492 


430 


Rocky  Mountain  Medical  Journal 


ciliary 


activity  in 

COLDS 
SINUSITIS 
HAY  FEVER 


J 


Ciliary  motion  carries  away  exudative  debris  in 
the  upper  respiratory  passages.  This  action 
should  not  be  inhibited  by  therapy  of  the 
common  cold,  sinusitis  or  hay  fever. 

The  isotonic  solutions  of  Neo-Synephrine  hydro- 
chloride permit  ciliary  function  to  continue  in 
an  efficient  manner,  while  congestion  is  reduced 
by  vasoconstriction. 


NEO-SYNEPHRINE 


HYDROCHLORIDE 

BRAND  OF  PHENYLEPHRINE  HYDROCHLORIDE 


Supplied  in  ’>4%  solution  (plain  and  aromatic),  1 oz. 
bottles.  Also,  1 % solution  (when  greater  concentration  is 
required),  1 oz.  bottles,  and  V2%  water  soluble  jelly,  % oz. 


N«o*Synephrme,  trodpmark  r«g.  U.S.  & Conodo. 


INC. 


New  York  13,  N.  Y.  Windsor,  Ont. 


ROCKY  MOUNTAIN  MEDICAL  JOURNAL 

Title  Registered,  U.S.  Patent  Office 
Publication  Office: 

835  Republic  Building  (1612  Tremont  Place),  Denver  2,  Colorado 
Telephone  CHerry  5521. 

EDITORIAL  BOARD 

Colorado:  Douglas  W.  Macomber,  M.D.,  Scientific  Editor,  1820  Gilpin  St.,  Denver;  Lyman  W.  Mason, 
M.D.,  Associate  Editor,  1214  Republic  Bldg.,  Denver,  (Chairman  of  Editorial  Board). 

Montana:  Raymond  F.  Peterson,  M.D.,  Scientific  Editor,  Butte,  Mont.;  Herbert  T.  Caraway,  M.D., 
Associate  Editor,  Billings,  Mont. 

New  Mexico:  Carl  H.  Gellenthein,  M.D.,  Scientific  Editor,  Valmora,  New  Mexico;  Harold  L.  Janu- 
ary, M.D.,  Associate  Editor,  First  National  Bank  Bldg.,  Albuquerque,  New  Mexico. 

Utah:  Richard  P.  Middleton,  M.D.,  Scientific  Editor,  Boston  Bldg.,  Salt  Lake  City;  W.  H.  Tibbals, 
Associate  Editor,  42  South  Fifth  East  St.,  Salt  Lake  City. 

Wyoming:  Earl  Whedon,  M.D.,  Scientific  Editor,  Sheridan;  Arthur  R.  Abbey,  Associate  Editor,  P.O. 
Box  897,  Cheyenne. 


Managing  Editor:  Harvey  T.  Sethman,  835  Republic  Bldg.,  Denver. 
Business  Manager:  Helen  Kearney,  835  Republic  Bldg.,  Denver. 


Ownership  and  Sponsorship  i The  Rocky  Mountain 
Medical  Journal  Is  owned  by  th#  Colorado  State 
Medical  Society  and  Is  published  monthly  as  a non- 
profit enterprise  for  the  mutual  benefit  of  the  or- 
eranizations  which  jointly  sponsor  it.  It  Is  published 
under  the  direction  of  the  Board  of  Trustees  of  the 
Colorado  State  Medical  Society,  assisted  by  an  Edi- 
torial Board  representing'  the  sponsoring  organiza- 
tions. It  is  the  Official  Journal  of  the  Colorado  State 
Medical  Society,  the  Montana  State  Medical  Associa- 
tion, the  New  Mexico  Medical  Society,  the  Utah 
State  Medical  Association,  the  Wyoming  State  Medi- 
cal Society,  the  Rocky  Mountain  Medical  Conference, 
and  the  Colorado  Hospital  Association. 

Manuscripts:  Scientific  Articles,  Case  Reports,  etc., 
from  any  state  for  which  this  is  the  Official  Journal 
should  be  submitted  to  the  Scientific  Editor  for  that 
state  as  named  in  the  Editorial  Board,  above.  Other 
material  from  any  participating  state  should  be  sub- 
mitted to  the  Associate  Editor  for  that  state  as 
named  above.  Manuscripts  from  outside  the  Rocky 
Mountain  area  should  be  sent  direct  to  the  Journal 
office.  Manuscripts  must  be  typewritten,  double  or 
triple  spaced,  using  only  one  side  of  each  sheet.  It 
is  the  policy  of  this  Journal  to  omit  bibliographies. 


Advertising:  National  representatives:  The  Coop- 
erative Medical  Advertising  Bureau,  63  B North  Dear- 
born Street,  Chicago  10,  111.  Local  advertising  from  U 
firms  in  the  Rocky  Mountain  area  should  be  submit-  J 
ted  to  the  Associate  Editor  of  the  appropriate  state 
or  to  the  Journal  office.  Advertising  forms  close  on  •m 
the  20th  of  the  month  preceding  publication;  allow  id 
ten  days  additional  to  insure  submitting  proofs  for  S 
approval.  J 

Subscription:  $2.50  per  year  in  advance,  postpaid  inV 
the  United  States  and  its  possessions;  single  copy,  J 
25  cents  plus  postage.  Subscription  is  included  inf 
medical  society  dues  of  sponsoring  state  medical' 
organizations.  ^ 

Copyright:  This  Journal  is  copyright,  1949,  by  the' 
Colorado  State  Medical  Society.  Requests  for  permis- 
sion to  reproduce  anything  from  the  columns  of  this" 
Journal  should  be  addressed  to  the  Journal  office.  i 
Second  Class  Matter:  Entered  as  second  class  mat- 
ter Jan.  22,  1906,  at  the  Postoffice  at  Denver,  Colo.,' 
under  the  Act  of  Congress  of  March  3,  1879.  Accepted; 
for  mailing  at  special  rates  of  postage  provided  for 
in  Section  1103,  Act  of  Oct.  3,  1917;  autnorized  July 
17,  1918.  .i 


The  Fairhaven  Maternity  Hospital 


Mrs.  H.  E.  Lowther,  Superiatendeat 


Seclusion  for  the  unwed  mother. 
1349  JOSEPHINE 


Write  for  descriptive  booklet. 
EAst  9944  DENVEE 


Don't  miss  important  telephone  calls 

Let  us  act  as  your  secretary  while  you  are  away,  day  or  night: 
our  kindly  voice  conscientiously  tends  your  telephone  business, 
accurately  reports  to  you  when  you  return. 


Telephone  ANSWERING  Service  call  ALpine  i4i4 


Cambridge  Dairy  Grade  ‘*A”  Milk  Is  Produced  and  Processed  at  690  S.  Colo.  Blvd. 

We  do  not  handle  Shipped-in  Milk  produced  Where?  How  and  by  Whom?  Doctors  know  the  difference 
Now  Homogenized  Vitamin  D Milk  is  available  for  baby  feeding  and  family  use. 

We  Invite  Your  Inspection  and  Appreciate  Your  Recommendation. 


Throat  specialists  prove 

CAMEL  MILDNESS  IN 


m 


eO-DAY  SMOKING  TEST 


• In  a recent  coast -to-coast  test, 
hundreds  of  men  and  women 
smoked  Camels — and  only  Camels 
— for  thirty  consecutive  days. 
They  smoked  on  the  average  of 
one  to  two  packages  of  Camels  a 
day.  Each  week  during  the  entire 
test  period,  the  throats  of  these 
Camel  smokers  were  examined  by 
throat  specialists.  A total  of  2,470 
careful  examinations  were  made. 
And  after  correlating  these  case 
histories,  the  throat  specialists 
reported 


“NOT  ONE  SINGLE  CASE  OF  THROAT 


IRRITATION  due  to  smoking  CAMELS.” 


JdONRY-BAfiK  CWARMrtf  ! 


Try  C<am©k  and  teff  tiwm  os 
^ y«5#  smoke,  »hew.  if,  amy 
f»B»,  you  ore  not  «or»wns.©d 
that  Gsmeis  me  fh«  best  dg- 
ar^te  , yoaVe  ■ smoked, 
return  Mt»  {Kjsteg®  with  Ab 
.’unwed  Coffsels.  ond  you  wiM 
. receive,  its- fell  p»rehas»,-p-rkey 
'.plus  i»©stcige*  (Sfgpedl  R.  M 
.rS  e y.a:,©  Ids,-  Tofe^c.^;©  Co* 


According  to  a Nationwide  survey; 

Doctors  Smoke  CAMELS 


than  any  other  cigarette 


When  three  iending  iinlependent  research  organizations 
asked  113,59?^  doctors  what  cigarette  they  smoked, 

the  brand  named  most  was  Camel. 

‘'tix 

: • " 


for  June,  1949 


433 


THE  COLORADO  STATE  MEDICAL  SOCIETY 


Next  Annual  Session:  Shirley-Savoy  Hotel,  Denver;  Sept.  20,  21,  22,  23,  1949 


OFFICERS 

Terms  of  Officers  and  Committees  expire  at  the  Annual  Session 
in  the  year  indicated.  Where  no  year  is  indicated,  the  term 
is  for  one  year  only  and  expires  at  the  1949  Annual  Session. 

President:  Casper  F.  Hegner,  Denver. 

President-elect:  Fred  A.  Humphrey,  Fort  CoUins. 

Vice  President:  Lester  L.  Ward,  Pueblo. 

Constitutional  Secretary  (three  years) : George  B.  Buck,  Denver,  1951. 
Treasurer  (three  years):  George  C.  Shivers,  Colorado  Springs,  1950. 

Additional  Trustees  (three  years):  Ervin  A.  Hinds,  Denver,  1949;  E,  H. 
Munro,  Grand  Jurction,  1949;  S.  P.  Nevman,  Denver,  1950;  Claude  D. 
Bonham,  Boulder,  1951. 

(The  above  nine  officers  compose  the  Board  of  Trustees  of  which  Dr. 
Ervin  A.  Hinds  is  the  1948-1949  Chairman.) 

Board  of  Councilors  (three  years):  District  No.  1:  Clemens  F.  EaUns, 
Brush,  1951;  No.  2:  Ella  A.  Mead,  Greeley,  1951;  No.  3:  L.  0.  Crosby. 
Denver,  1951;  No.  4:  Banning  E.  Likes,  Lamar,  1950;  No.  5:  Guy  H. 
Hopkins,  Pueblo,  1950;  No.  6:  Lester  E.  Thompson,  Salida,  1950;  No.  7: 
A.  L.  Burnett,  Durango,  1949;  No.  8:  Lawrence  L.  Hick,  Delta,  1949; 
No.  9:  W.  W.  Sloan,  Hayden,  1949  (Chairman  of  Board  for  1948-49). 

Board  of  Supervisors  (two  years):  A.  B.  OjeUum,  Del  Norte,  1949;  L.  W. 
Lloyd,  Durango,  1949;  B.  G.  Howlett,  Golden,  1949;  Sratt  A.  Gale. 
Pueblo,  1949;  L.  D.  Dickey,  Fort  Collins,  1949;  N.  A.  Uadler,  Greeley. 
1949  (Chairman  of  Board  for  1948-49);  L.  D.  Buchanan,  Wray,  1950; 
W.  F.  Deal,  Craig,  1950;  G.  C.  Cary,  Grand  Junction,  1950;  W.  A. 
Campbell,  Colorado  Springs,  1950;  Balph  S.  Johnston,  Sr.,  La  Junta, 
1950;  Willi-tm  A.  Liggett,  Denver,  1950,  Secretary. 

Delegates  to  American  Medical  Association  (two  years) : George  A.  Unfug, 
Pueblo,  1949  (Alternate:  Herman  C.  Graves,  Grand  Junction,  1949); 
William  H.  Halley,  Denver,  1960  (Alternate:  Kenneth  C.  Sawyer.  Denver, 
1950). 

Foundation  Advocate:  Walter  ff.  Kin*.  Dobvw. 

Executive  Office  Staff:  Mr.  Harvey  T.  Setbman,  Executive  Secretary; 
Hiss  Helen  Kearney,  Assistant  Executive  Secretary;  Mr.  Evan  A.  Edward, 
Field  Secretary;  Mary  E.  McDonald,  Comi^ttee  Secretary;  835  Be- 

pnbllc  Building,  Denver  2,  Colo.,  Telephone  CHerry  5521. 

General  Counsel:  Mr.  J.  Peter  Nordlund,  Attomey-at-Law,  Denver. 

STANDING  COMMITTEES 

Credentials:  George  K.  Buck,  Denver,  Chairman,  ex-officio;  Harold  E. 
Haymond,  Greeley:  E.  C.  Likes,  Lamar;  Scott  A.  Gale,  Pueblo;  J.  L. 
McDonald,  Colorado  Springs. 

Public  Policy:  Kenneth  C.  Sawyer,  Denver,  Chairman;  McKlnnle  L. 
Phelps,  Denver,  Vice  Chairman;  John  S.  Bouslog,  Denver;  F.  B.  Calhoun, 
Denver;  Fr.ank  B.  McGlone,  Denver;  Lloyd  Anderson,  Sterling;  Sidney  An- 
derson, Alamosa;  Bichard  L.  Davis,  La  Junta;  Herman  C.  Graves,  Grand 
Junction;  John  L.  McDonald,  Colorado  Springs;  George  E.  Bice,  Pueblo; 
Duane  Hartshorn,  Fort  ColUns;  John  D.  Gillaspie,  Boulder.  Ex-Officio 
members:  Casper  F.  Hegner,  President;  Fred  A.  Humphrey,  President-elect; 
George  R.  Buck.  Constitutional  Secretary. 

Sub-Committee  on  Legislation:  H.  I.  Barnard,  Denver,  Chairman. 

Health  Education  (two  years):  A.  C.  Sudan,  Denver,  (Riairman,  1949; 

J.  D.  Bartholomew,  Boulder,  1949;  R.  J.  Savage,  Denver,  1949;  R.  T. 

Porter.  Greeley,  1949;  Bobert  B.  Bradshaw,  Alamosa,  1949;  L.  W.  Bortree, 
Colorado  Springs,  1950;  F.  0.  Bobertson,  Denver,  1950.;  J.  L.  Sadler,  Fort 
Collins,  1950;  Harold  T.  Low,  Pueblo,  1950;  John  H.  Amesse,  Denver, 
1950;  E.  H.  Munro,  Grand  Junction,  1950. 

Scientific  Work:  W.  B.  Condon,  Denver,  Chairman;  Bobert  8.  Liggett, 
Karl  F.  Arndt,  Frank  T.  Joyce,  Marshall  G.  Nims,  Vincent  G.  Cedar- 
blade,  aU  of  Denver. 

Sub-Committee  on  Scientific  Exhibits:  Frank  C.  CampbeU,  (Bialnnaa; 
Nolle  Mumey,  Edgar  W.  Barber,  B.  W.  Vines,  aU  of  Denver. 

Arrangements:  J.  L.  Swigert,  Chairman;  Byron  I.  Dumm,  S.  B.  Childs, 
Jr.,  all  of  Denver. 

Medicolegal  (two  years) : B.  W.  Arndt,  1950,  Chairman;  George  B. 

Packard,  Jr.,  1950;  K.  D.  A.  Allen,  1950.;  C.  S.  Bluemel,  1949;  Lyman 

W.  Mason,  1949;  Harry  C.  Hughes,  1949;  all  of  Denver. 

Medical  Education  and  Hospitals:  George  F.  Wollgaat,  Denver,  (Rialrman; 
W.  W.  Sloan,  Hayden;  F.  R.  Plngrey,  Durango;  E.  B.  Hugrage,  Denver; 
D.  W.  McCarty,  Longmont;  A.  E.  Lubcbenco,  Denver. 

Libhuy  and  Medical  Literature:  A.  J.  Markley,  Denver,  Chairman;  T.  E. 
Beyer,  Denver;  J.  J.  Connor,  Delta;  H.  Dumont  Clark,  Denver. 

Medical  Service  Plans:  F.  H.  Good,  Denver,  Oiairman;  C.  E.  Honsteln, 
Fort  Collins;  James  B.  Blair,  Denver;  Vernon  L.  Bolton,  Colorado  Springs; 
Scott  A.  Gale,  Pueblo;  John  A.  Weaver,  Jr.,  Greeley;  John  E.  Hyland, 
Monte  Vista;  Thomas  K.  Mahan,  Grand  Junction. 

Necrology:  W.  H.  Wilson.  Denver,  Chairman. 

PUBLIC  HEALTH  COMMITTEES 

General  Committee  on  Pnbllc  Health:  Consists  of  the  chairmen  of  the 
following  eleven  public  health  subcommittees,  presided  over  by  Bobert  W. 
Dickson,  Denver,  as  General  Chairman. 

Cancer  Control:  J.  C.  Mendeidiall,  Denver,  Chairman;  John  B.  Grow, 
Denver;  S.  W.  Holley,  Greeley;  T.  Leon  Howard,  Denver;  Jamea  B.  Me- 
Naugbt,  Denver;  Boger  G.  Howlett,  Golden;  James  W.  McMullen,  Colorado 
Springs;  James  E.  DonneUy,  Trinidad;  Lanning  E.  Likes,  Lamar;  Thomas 

K.  Mahan.  Grand  Junction. 


Crippled  Children;  1.  E.  Hendryson,  Denver,  Chairman;  Mary  L.  Moore, 
Grand  Junction;  Richard  H.  MeUen,  Colorado  Springs;  Sidney  E.  Bla^ 
ford,  Jr.,  Denver;  Paul  R.  Hildebrand,  Brush;  Samuel  P.  Newman,  Denver. 

Industrial  Health:  B.  F.  Bell,  Louviers,  Chairman;  A.  B.  Woodbume, 
Denver;  Vincent  E.  Kelly,  LcadviUe:  D.  W.  Boyer,  Pueblo:  H.  0.  Harvey,  Jr., 
Denver;  Robert  Woodruff,  Denver;  Frank  J.  McDonough,  Grand  Junction. 

Local  Health  Units;  Monroe  R.  Tyler,  Denver,  Chairman;  Harold  E. 
Haymond.  Greeley;  R.  6.  Richards,  Fort  Morgan;  Nicholas  S.  Saliba,  Wal- 
senburg;  Marvel  L.  Crawford,  Steamboat  Springs;  B.  Sberwln  Johnston,  Jr., 
La  Junta. 

Maternal  and  Child  Health:  John  R.  Evans,  Denver,  Chairman;  Joseph 
H.  Lyday,  Denver;  John  M.  Nelson,  Denver;  Tracy  D.  Peppers,  Greeley; 
J.  H.  Woodbrldge,  Pueblo;  M.  E.  Snyder,  Colorado  Springs. 

Mental  Hygiene:  Bradford  Murphey,  Denver,  Chairman;  E.  James  Brady. 
Colorado  Springs;  Frank  H.  Zimmerman,  Pueblo;  Paul  A.  Draper,  Colorads 
Springs;  J.  P.  Hilton,  C.  S.  Bluemel,  John  M.  Lyon,  G.  H.  Ashley,  Lewis 
C.  Overholt,  Clarke  H.  Barnacle,  Harold  R.  Carter,  all  of  Denver. 

Milk  Control:  George  W.  Stiles,  Denver,  Chairman;  Max  M.  Ginsbuig, 
Denver;  N.  J.  Miller,  D.V.M.,  Eaton;  Millard  F.  Schafer,  Colorado  Springs; 
Robert  W.  Vines,  Denver:  Mr.  Wendell  Vincent,  Denver. 

New  Hospital  Construction:  D.  B.  Collier,  Wheatridge,  Chairman; 
Henry  M.  Powell,  Colorado  Springs;  Mr.  John  R.  Peterson,  Fort  Collins ; 
Florence  R.  Sabin,  Denver;  Herbert  A.  Black,  Pueblo. 

Public  Water  Supplies:  E.  I.  Dobos,  Denver,  Chairman;  Bobert  Barnard, 
Eagle:  William  C.  Shontz,  San  Luis;  Carl  W.  Maynard,  Pueblo;  W.  B. 
Crouch,  Colorado  Springs:  H.  D.  Palmer.  Denver;  E.  Robert  Orr,  Fmlta. 

Tuberculosis  Control:  John  I.  Zarlt,  Denver.  Chairman;  W.  J.  Hlnrel- 
man,  Greeley;  H.  M.  Van  Der  Schouw,  Wheatridge;  John  P.  McGraw,  Pueblo; 
Arthur  Rest,  Denver;  H.  Calvin  Fisher,  Denver;  T.  D.  Cunningham,  Denver. 

Venereal  Disease  Control;  Sam  W.  Dowidng,  Denver,  Chairman;  Paul  B. 
Stidham,  Grand  Junction;  H.  E.  Coakley,  Pueblo;  D.  E.  Newland,  Denver: 
Joseph  H.  Patterson,  Denver;  James  R.  McDoweU,  Denver. 

SPECIAL  COMMITTEES 

Rocky  Mountain  Medical  Conference  (five  years) : L.  Clark  Hepp,  Denver, 
1953;  G.  P.  Lingenfelter,  Denver,  1952,  Chairman;  Ward  Darley,  Denver, 
1951;  L.  W.  Bortree,  Colorado  Springs,  1960;  George  H.  GHlen,  Denver, 
1949. 

Advisory  to  Auxiliary:  Fred  A.  Humphrey,  Fort  Collins,  Chairman;  Ervin 
A.  Hinds,  George  B.  Buck,  Denver. 

Midwinter  Clinics:  Samuel  B.  Childs,  Jr.,  Chairman;  Raymond  C.  Chat- 
field,  E.  L.  Binkley.  Jr.,  A.  J.  Kauvar,  Terry  J.  Gromer,  aU  of  Denver. 

Rehabilitation:  W.  W.  Haggart,  Denver,  Chairman;  Atha  Tbomaa,  Den- 
ver; Lawrence  T.  Brown,  Denver;  J.  E.  A.  Connell,  Pueblo;  Thad  P.  Sesre, 
Ft  Logan;  Kenneth  C.  Sawyer,  McKlnnle  L.  Phelps,  (leorge  B.  Buck, 
Bradford  Murphey,  aU  of  Denver. 

Advisory  to  the  Goodwill  Industries’  Rehabilitation  Program:  Lewli  C. 
Overholt,  (Rialrman;  William  H.  Halley,  Maurice  Katzman,  Tetty  J. 
Gromer.  Lorenz  W.  Frank,  William  B.  Lipscomb,  Irvin  B.  Hendryson, 
all  of  Denver. 

Rural  Hdalth  Commission:  Leonard  N.  Myers,  Cheyenne  Wells,  (Rialnriaa; 
V.  V.  Anderson,  Del  Norte;  James  S.  Orr,  Frulta;  Keith  P.  Krausnlek, 
Lamar;  Robert  M.  Lee,  Fort  Collins.  Ex-officio  member:  Fred  A.  Hum- 
phrey, Fort  Collins. 

Medical  Disaster  Commission:  Foster  Matcbett,  Denver,  Chairman;  Karl 
Arndt,  Denver,  Secretary;  Mark  S.  Donovan,  Harry  C.  Hughes,  Adolph  J. 
Kafka,  Roderick  J.  McDonald,  William  F.  Stanek,  Henry  Swan,  Karl  F. 
Sunderland,  K.  D.  A.  Allen,  all  of  Denver;  Lawrence  W.  Holden,  Boulder; 
Richard  H.  Mellen.  Colorado  Springs;  Richard  H.  Altmix,  Englewood;  Jacob 
0.  Mall,  Estes  Park;  Thad  P.  Sears,  Fort  Logan;  Donald  E.  Cowen,  Fort 
Morgan;  Kenneth  E.  Prescott,  Grand  Junction;  Walter  A.  Schoen,  Greeley; 
David  W.  McCarty,  Longmont;  David  W.  Boyer,  Pueblo:  J.  G.  Espey,  Craig; 
Leo  W.  Loyd,  Durango;  Keith  F.  Krausnlek,  Lamar;  Bobert  M.  Lee,  Ft.  Col- 
lins; George  H.  Lord,  Aurora;  J.  Gordon  Hedrick,  Wray;  James  P.  Bigg, 
Grand  Junction. 

Lay  Organization  Standards:  George  R.  Buck,  Fredrick  E.  Good,  Ken- 
neth C.  Sawyer,  Frank  B.  McOIone,  T.  D.  Cunningham,  Bradford  Murphey, 
Casper  F.  Hegner,  John  S.  Bouslog,  all  of  Denver. 

Study  of  Child  Welfare  Clinics:  Ralph  H.  Verploeg,  Denver,  Chairman; 
J.  W.  White,  Pueblo;  Jackson  L.  Sadler,  Fort  (kslUns;  L.  K.  Maurer, 
Boulder;  Harvey  M.  Tupper,  Grand  Junction;  Harvey  8.  Busk,  Pueblo. 

Advisory  to  U.M.W.  Welfare  Fund  (Executive  Committee,  three-year 
terms:  others,  one-year):  Executive:  W.  W.  Haggart,  1951,  Chairman; 
F.  H.  Good.  1951;  J.  S.  Bouslog.  1951,  aU  of  Denver;  W.  H.  Halley, 
1950;  C.  F.  Hegner,  1950,  both  of  Denver;  B.  F.  Bell,  1950,  Louviers; 
McKinnie  Phelps.  1949,  Denver;  F.  A.  Humphrey,  1949,  Fort  Collins: 
J.  M.  Lamme,  1949,  Walsenburg.  Other  members:  K.  C.  Sawyer,  A.  C. 
Sudan,  Bradford  Murphey,  all  of  Denver;  C.  D.  Bonham,  Boulder;  J.  W. 
Craighead,  Pueblo;  J.  E.  Donnelly,  Trinidad;  Llgon  Price,  Mt.  Hands;  M.  J. 
McCallum,  Erie. 

Liaison  to  Colorado  State  Nurias  Association:  John  B.  Evans,  Samuel  P. 
Newman,  Denver. 

Liaison  to  Colorado  Bar  Association:  W.  S.  Dennis,  Chairman;  A.  C. 
Sudan,  B.  W.  Arndt,  aU  of  Denver. 

Medical-Dental  Liaison:  Guy  W.  Smith,  Denver,  Chairman;  George  B. 
Warner,  Denver:  Calvin  N.  CaldweU,  Pueblo. 

Ripresentativc  to  Rocky  Mountain  Radio  Council:  William  E.  Hay, 
Denver;  (Alternate:  Cbauneey  A.  Hager,  Denver). 

Rspresentativc  to  Belle  Bonfils  Memorial  Blood  Bank:  0.  S.  Philpott, 
Denver. 

Representatives  to  Liaison  Council  on  Graduate  Education  (two  yoan): 

L.  B.  Safarik,  Denver,  1949;  Harold  I.  Goldman,  Denver,  1950. 

Delegate  to  Colorado  Interprofessional  Connell  (five  years) ; K.  D.  A 
Allen,  Denver,  1949;  (Alternate,  Carl  A.  McLauthlln,  Denver,  1949). 


434 


Rocky  Mountain  Medical  Journal 


’dm  (U^li/u^Kce/ 

i6 

Trimeton 

(brand  of  prophenpyridaniine) 

Trimeton*  differs  from  most  other  antihistaminic 
agents  in  not  being  a derivative  of  ethanolamine  or 
ethylenediamine.  This  difference  is  noteworthy  and  is 
responsible  for  the  gratifying  clinical  results  obtained. 
In  one  study  of  227  patients  with  various  allergic 
conditions^ 

83%  obtained  benefit  from  Trimeton 

Side  effects,  common  to  all  antihistaminics,  occur  with 
Trimeton,  but  only  a few  patients  find  that  they  cannot 
tolerate  the  drug.^ 

Relief  from  allergic  symptoms  is  usually  obtained  with 
one  Trimeton  25  mg.  tablet  three  times  daily;  in  some 
patients  half  this  dosage  is  sufficient.  The  action  of 
Trimeton  lasts  from  four  to  six  hours.^ 

PACKAGING:  Trimeton  (l-phenyl-l-(2-pyridyl)-3-dimethyla- 
niinopropane)  is  available  in  25  mg.  tablets,  scored,  in  bottles  of 
100  and  1000. 

BIBLIOGRAPHY:  1.  Brown,  E.  A.:  Ann.  Allergy  0:393.  1948.  2.  Willich,  E.  W.: 
Ann.  Allergy  6:497,  1948. 

♦Trimeton  trade-mark  of  Scliering  Corporation 

CORPORATION  . BLOOMFIELD,  NEW  JERSEY 

IN  CANADA,  SCHERING  CORPORATION  LIMITED,  MONTREAL 


TRIMETON  « 


MONTANA  STATE  MEDICAL  ASSOCIATION 

Next  Annual  Session:  Finlen  Hotel,  Butte;  Ausr.  1,  2.  3,  4,  1949 


OFTPICERS 

Terms  of  Officers  end  Committees  expire  st  the  Annaal  SesdoB 
in  the  year  indicated.  Where  no  year  is  indicated,  the  term  is 
for  one  year  only  and  expires  at  1949  Annual  Sessioa 

President:  Thomas  L.  Hawkins,  Helens. 

Preildent-eliet:  Thomas  F.  Walker,  Great  Falls. 

Vles-Presldent:  B.  0.  Johnson,  Harlowton. 

Seeretary-Treasorer:  Herbert  T.  Caraway,  Billings. 

Delegate  to  Amerldan  Medical  Association:  Baymond  F.  Peterson,  Butte, 
1950;  Alternate,  Thomas  B.  Moore,  KalispeU,  1950. 


STANDING  COMMITTEES 

Exeentive  Committee:  T.  L.  Hawkins,  Helena,  Chairman;  T.  F.  Walker, 
Great  Falls;  H.  T.  Caraway,  Billings;  L.  W.  AUard,  Billings;  H.  A. 
SblUlngton,  OlendlTe. 

Economics  Committee:  J.  C.  Shields,  Butte,  Chairman;  C.  F.  Brooke,  St. 
Ignatius;  B.  B.  Dumln,  Great  Falls;  Leland  0.  Bussell,  Billings;  S.  D. 
Whetstone,  Cut  Bank. 

Legislative  Committee:  J.  M.  Flinn,  Helena,  Chairman;  F.  D.  Hurd, 
Gn;at  Falls;  P.  E.  Kane,  Butte;  J.  C.  MacGregor,  Great  Falla;  Clauds 
M.  Mears,  Helena. 

Necrology  and  History  of  Medicine  Committee:  L.  W.  Brewer,  Missoula, 
Chairman;  I.  J.  Bridenstine.  Missoula;  J.  H.  Irwin,  Great  Falls;  Claude 
M.  Mears,  Heleru;  J.  P.  Bltchey,  Missoula. 

Public  Relations  Committee:  H.  W.  Gregg,  Butte,  Chairman;  W.  L.  DuBola, 
Cut  Bank;  B.  V.  Morledge,  Billings;  W.  H.  Stephan,  OlUon;  Dora  Walker, 
Great  Falls. 

Legal  Affairs  and  Malpractice  Committee:  J.  C.  MacGregor,  Great  Falla, 
Chairman;  Baymend  Eck,  Lewistown;  W.  E.  Harris,  Livingston;  John  E. 
Hynes,  Billings;  B.  D.  Knapp,  Wolf  Point. 

Program  Committee:  C.  H.  Fredrickson,  Missoula,  Chairman;  H.  T. 
Caraway,  Billings'  H.  W.  Gregg,  Butte;  J.  J.  McCabe,  Helena;  E.  S. 
Murphy,  Missoula. 

Interprofessional  Relationship  Committee:  L.  W.  AUard,  BiUlngs,  Chair- 
man; C.  B.  Canty,  Butte;  S.  A.  Cooney,  Helena;  S.  N.  Preston,  Wssoula; 
F.  I.  Sabo,  Bozeman. 


Nominating  Committee:  H.  B.  James,  Butte,  Chairman;  B.  L.  Andenon, 
Fort  Benton;  B.  D.  Harper,  Sidney;  J.  J.  Malee,  Anaconda;  W.  B.  Me- 
Elwee,  Townsend. 

Auditing  Committee:  E.  H.  Lindsttom,  Helena,  Chairman;  F.  H.  Crago, 
Great  Falls;  B.  D.  Harper,  Sidney;  G.  W.  Setzer,  Malta;  B.  G.  Johnson, 
Harlowton. 

Cancer  Committee:  Mary  E.  Martin,  BiUlngs,  Chairman;  W.  F.  Caah- 
more,  Helena;  C.  H.  Fredrickson,  Missoula;  B.  F.  Peterson,  Butte;  W.  C. 
Robinson,  Shelby. 

Maternal  and  Child  Welfare  Committee;  F.  L.  McPhall,  Great  Falk, 
Chairman;  L.  W.  Brewer,  Missoula;  P.  L.  Eneboe,  Bozeman;  Maude  M. 
Gerdes,  BiUlngs;  D.  L.  GUlespie,  Butte;  A.  L.  Gleason,  Great  Falls;  E.  L. 
Hall,  Great  Falls;  D.  S.  Ma^enzie,  Jr.,  Havre;  B.  IL  MatUson,  BUHngo; 
0.  M.  Moore,  Helena;  F.  W.  Paul,  KalispeU;  C.  W.  Pemberton,  Butte; 
S.  N.  Preston,  Missoula;  A.  E.  Bltt,  Great  FsUs. 

Tuberculosis  Committee:  F.  I.  TerriU,  Galen,  Chairman;  C.  B.  Craft, 
Bozeman;  E.  A.  Dolan,  Anaconda;  A.  B.  Kintner,  Missoula;  J.  A.  Layne, 
Great  Falls. 

Fracture  and  Orthopedic  Committee:  J.  K.  Colman,  Butte,  (%alrman;  L.  C. 
AUard,  BiUlngs;  W.  H.  Hagen,  BilUngs;  S.  L.  Odgers,  Butts;  J.  C.  Wol- 
gamot.  Great  Falls. 

Rural  Health  Committee:  B.  C.  Farrand,  Jordan,  Chairman;  B.  A. 
Benke,  KaUspeU;  W.  A.  Lacey,  Havre;  W.  0.  TangUn,  Poison;  J.  H. 
WilUams,  Culbertson. 

Industrial  Welfare  Committee:  B.  B.  Richardson,  Great  Falls,  Chairman; 
M.  A.  Gold,  Butte;  P.  E.  Logan,  Great  Falls;  D.  S.  MacKenzle,  Jr.,  Havre; 
R.  E.  Walker,  Livingston. 

Rheumatic  Fever  and  Heart  Committee:  F.  R.  Schemm,  Great  Falla, 
Chairman;  D.  T.  Berg,  Helena;  H.  W.  Gregg,  Butte;  A.  B.  Kintner,  Mis- 
soula; P.  E.  Logan,  Great  Falls;  F.  H.  Lowe,  Missoula;  J.  J.  Malee, 
Anaconda;  0.  M.  Moore,  Helena;  H.  W.  Power,  Conrad;  B.  E.  SmaUey, 
BilUngs. 

SPEOIAD  COMMITTEES 

Emergency  Medical  Service  Committee:  B.  F.  Peterson,  Butte,  Chairman; 
Paul  J.  Gans,  Lewistown;  J.  J.  McCabe,  Helena;  S.  A.  Olson,  Glendive; 
L.  G.  BusseU,  BilUngs. 

lAB  Fee  Schedule  Committee:  H.  H.  James.  Butte,  Chairman;  B.  B. 
Llndstrom,  Helena;  J.  J.  Malee,  Anaconda;  D.  S.  McKenzls,  Jr.,  Havre; 
F.  K.  Waniata,  Great  Falls. 


Collection 

Accounts 

All  reports  show  a trend  toward  slower  and  harder  collections  in  the 
months  ahead. 

At  the  first  sign  of  neglect  you  will  save  money  if  they  are  turned  over 
to  us  for  collection. 

Comparison  of  collection  results,  backed  by  35  years  of  experience,  proves 
you  obtain  greater  results  at  less  cost,  when  you  list  your  accounts 

with 

The  American  Medical  and  De 

Suite  524,  810  14th  St.  TAbor  2331 

ntal  Association 

Denver,  Colorado 

436 


Rocky  Mountain  Medical  Journal 


for  June,  1949 


437 


NEW  MEXICO  MEDICAL  SOCIETY 


OFFICERS  — 1948-1949 

PrHidtnt;  P.  L.  TraTere,  Santa  Fe. 

PrMidmt- Elect:  J.  W.  Hannett,  Albuquerque. 

Vice  President:  I.  J.  Marshall,  Boswell. 

Seeretary-Trebsoter:  H.  L.  January,  Albuquerque. 

Cotncllon  (3  years) : W.  D.  Dabbs,  Clovis;  A.  C.  Sbuler,  Carlsbad. 
Ceinellors  (2'  years);  B.  0.  Brown,  Santa  Fe;  C.  H.  Gellentblen,  Valmora. 
Cnncllon  (1  year):  Carl  Mulky,  Albuquerque;  L.  S.  Evans,  Las  Cruces. 

COMMITTEES  — 1948-1949 

Basle  Science:  W.  E.  Nlssen,  Albuquerque,  Cbainnan;  Le  Grand  Ward, 
Sants  Fe;  Vincent  AceariB,  OaUup. 

Rural  Medical  Serica  Service:  Stuart  W.  Adler,  Albuquerque,  Chairman; 
W.  B.  Cantrell,  Hot  Springs;  Samuel  R.  Zeigler,  Espanola;  A.  T.  Gordon, 
Tucumcari;  L.  G.  Foster,  Reserve. 

Cancer:  Minray  M.  Friedman,  Santa  Fe,  Chairman;  Van  A.  Odle,  Roswell; 
J.  B.  Van  Atta,  Albuquerque;  J.  W.  Grossman,  Albuquerque;  B.  W.  Maher, 
Albuquerque. 


Venereal  Disease  Control;  Sam  Jelso,  Albuquerqoe,  Chairman;  V.  E. 
Berchtold,  Santa  Fe;  L.  M.  Miles,  Albuquerque;  L.  S.  Evana,  Las  Ccocea; 
H.  L.  January,  Albuquerque. 

Legislative:  Albert  Latbrop,  Santa  Fe,  Cbainnan;  W.  0.  Connor,  Albu- 
querque; W.  B.  Lovelace,  II,  Albuquerque;  Walter  A.  Stark,  Las  Vegas; 
George  S.  Morrison,  Boswell;  R.  0.  Brown,  Santa  Fe. 

Public  Relations:  D.  A.  McKinnon,  Jr.,  Albuquerque,  Chairman;  Jamee 
L.  McCrory,  Santa  Fe;  H.  M.  Mortimer,  Las  Vegas;  Frank  W.  Parker,  Jr., 
Gallup. 

Tuberculosis:  R.  0.  Brown,  Santa  Fe,  Chairman;  C.  H.  Gellentblen, 
Valmora;  D.  0.  Shields,  Albuquerque;  H.  S.  A.  Alexa^r,  Santa  Fe. 

Advisory  Committee  on  Ins.  Compensation;  Eugene  W.  Flske,  Santa  Fe. 
Chairman;  John  F.  Conway,  Clovis;  A.  C.  Sbuler,  Carlsbad;  B.  E.  Forbla, 
Albuquerque. 

Committee  on  National  Emergency  Medical  Service:  A.  E.  Reymont,  Santa 
Fe,  Chairman;  C.  M.  Thompson,  Albuquerque;  L.  G.  Rice,  Albuquerque; 
Walter  A.  Stark,  Las  Vegas. 


Stodghill's  Imperial  Pharmacy 

Prescriptions  Exclusively 

For  your  prescriptions  we  stock  a complete  line  of  ALMAY — non-allergic — cosmetics. 

Five  Pharmacists 

319  16th  St.  TAbor  4231  Denver,  Colo. 


Oculist  Prescription  Service  Exclusively 

SHADFORD-FLETCHER  OPTICAL 

Dispensing  Opticians 

228  16th  Street,  Denver,  Colo.  AComo  2611 
3705  East  Colfax  (Medical  Center  Building).  FLorida  0202 


These  fine  Dairy  Cattle,  a portion  of  City  Park’s  large  herd  of  Guernsey  and  Holstein 
cows,  are  scientifically  fed  and  cared  for,  continuously  tested  by  competent  veterin- 
arians. Only  through  such  precise  watchfulness  does  City  Park  Milk  receive  Grade 
“A”  designation  which  it  enjoys.  Choose  City  Park’s  regular  Grade  “A”  Pasteurized 
or  Homogenized  milk  today  — notice  the  particularly  clean,  fresh  flavor. 


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Drive — Denver 


438 


Rocky  Mountain  Medical  Journal 


E.  K.  Squibb  & Sons. 


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MANUFACTURING  CHEMISTS  TO  THE  MEDICAL  PROFESSION  SINCE  1858 


for  June,  1949 


439 


THE  UTAH  STATE  MEDICAL  ASSOCIATION 


Next  Annual  Session:  Salt  Lake  City,  Sent.  1,  2,  3,  1949 


OFFICERS  1948-1949 
rrMident:  0.  A.  OglMe,  Salt  Lake  City. 

President-elect:  C.  H.  Jenson,  Ogden. 

Past  President:  J.  C.  Hubbard,  Price. 

Honorary  President:  0.  W.  French,  Coalrille. 

First  Vice  President:  J.  G.  UcQuarrie,  Rlcbfield. 

Second  Vice  President:  Ezra  Cragun,  Levlston. 

Third  Vice  President:  R.  W.  Farnsworth,  Cedar  City. 

Secretary:  Ray  T.  Woolsey,  Salt  Lake  City. 

Exeeotive  Secretary:  Mr.  W.  H.  Tlbbals,  Salt  Lake  City. 

Treasorer:  L.  B.  White,  Salt  Lake  City. 

Coenciior  First  District:  J.  G.  Olson,  Ogden. 

Coenclior  Second  District:  V.  L.  Rees,  Salt  Lake  City. 

Coonciior  Third  District:  L.  W.  Oaks,  Proro. 

Delegate  to  A.M.A.,  1948:  James  P.  Kerby,  Salt  Lake  City. 

Alternate  Delegate  to  A.M.A..  1948:  J.  J.  Weight,  Provo. 

Editor  of  the  Utah  Section  of  the  Rocky  Mounnain  Medical  Journal: 
I.  P.  Middleton,  Salt  Lake  City, 

STANDING  COMMITTEES 
Rocky  Mountain  Medical  Conference  Continuing  Committee:  R.  P.  Mid- 
dleton, Cbairman,  Salt  Lake  City,  1949;  K.  B.  Castleton,  Salt  Lake  City, 
1950;  Clark  Rich,  Ogden,  1951;  Noall  Z,  Tanner,  Layton,  1952;  T.  R. 
Seager,  Vernal,  1953. 

Scientific  Program  Committee:  Ray  T.  Woolsey,  Chairman,  Salt  Lake 
City;  Drew  M.  Peterson,  Ogden;  Stanley  N.  Clark,  Provo;  P.  M.  Howard, 

Salt  Lake  City:  V.  P.  White,  Salt  Lake  City;  L.  V.  Broadbent,  Cedar 

City;  Paul  A.  Pemberton,  Salt  Lake  City. 

Public  Policy  and  Legislation  Committee:  F.  R.  King,  Chairman,  Price, 

1951;  Jesse  J.  Weight,  Provo,  1949;  M.  L.  Crandall,  Salt  Lake  City, 

1949;  V,  L.  Stevenson,  Salt  Lake  CiW.  1949;  N.  F.  Hicken,  Salt  Lake 
City,  1950;  Omar  Budge,  Logan,  1950;  John  Coletti,  Salt  Lake  City,  1950; 
W.  B.  West.  Ogden,  1951;  R.  V.  Larson,  Roosevelt,  1951. 

Medical  Defense  Committee:  W.  J.  Thomson.  Chairman,  Ogden,  1949; 
R.  W.  Owens,  Salt  Lake  City,  1949;  J,  L.  Hansen,  Vernal,  1949;  Homer 
Smith,  Salt  Lake  City,  1950;  L.  N.  (ksman.  Salt  Lake  City,  1950;  Erwin 
D.  Zeman,  Ogden.  1950;  Charles  W.  Woodruff,  Salt  Lake  City,  1951; 
James  Westwood,  Provo,  1951;  L,  H,  Merrill,  Hiawatha,  1951. 

Medical  Education  and  Hospitals  Committee;  I.  Bruce  McQuarrle,  Chair- 
man, Ogden,  1949;  L,  J.  Paul,  Salt  Lake  City,  1949;  0.  A.  Ogilvie, 
Salt  Lake  City,  1949;  G.  G.  Richards,  Salt  Lake  City,  1950.;  Bay  T. 
Woolsey,  Salt  Lake  City,  1950;  T.  E.  Robinson,  Salt  Lake  City,  1950; 
Seth  E.  Smoot,  Provo,  1951;  George  H.  Curtis,  Salt  Lake  City,  1951; 
R.  0.  Porter,  Logan,  1951 : R.  H.  Young,  Ex-Officio,  Salt  Lake  City. 

Medical  Economics  Committee;  Russell  Smith,  Chairman,  Provo,  1949; 
A.  R.  Denman,  Helper.  1949;  W.  T.  Ward,  Salt  Lake  City,  1950;  W.  R. 
Merrill,  Brigham  City,  1951;  Ralph  Pendleton,  Salt  Lake  City,  1951. 


better  ^iowers  at  l^eaionaLie 


ticei 


“Orders  Delivered  to  Any  City  by 
Guaranteed  Service” 


Special  attention  given  to  floral  tributes 
Also  Hospital  Flowers 

Call  KEystone  5106 


Vark  3loral  Co.  Store 


1643  Broadway 


Denver,  Colo. 


Public  Health  Committee:  John  R.  Bourne,  Cbairman,  Roosevelt,  1949; 
F.  D.  Spencer,  Salt  Lake  City,  1950;  Ralph  EIUs,  Ogden,  1951. 

Military  Affairs  and  National  Emergency  Committee;  Cbrles  Woodruff, 
Cbairman,  Salt  Lake  City;  L.  J.  Paul.  Salt  Lake  City;  Mazel  Skolfleld, 
Salt  Lake  City;  W.  M.  Gorishek,  Standardville  L.  R.  CuUlmore,  Orem; 

Ray  H.  Barton,  Magna;  D.  T.  Madson,  Price;  Riley  0.  Clark,  Provo; 

Willis  Hayward,  Logan;  Dean  Tanner,  Ogden. 

Tuberculosis  and  Cardiovascular  Diseases  Committee:  Elmer  M.  Kil- 
patrick, Cbairman,  Salt  Lake  City;  Ray  Rumel,  Salt  Lake  City;  D.  0.  N. 
Lindberg,  Ogden;  W.  C.  Walker,  Salt  Lake  City;  Donald  51.  Moore,  Ogden; 
Don  C,  MerriU,  Provo, 

Cancer  Committee:  0.  A.  Ogilvie,  Chairman,  Salt  Lake  City;  S,  W. 

Fennemore,  Price;  E.  D.  Zeman,  Ogden;  W.  G.  Noble,  Richmond;  Harold 

Austin,  Provo;  Stanley  G.  Rees,  Gunnison;  Paul  K.  Edmunds,  Cedar  City; 
F.  G.  Eskelson,  Vernal;  K.  B.  Castleton,  Salt  Lake  City. 

Fracture  Committee:  A.  M.  Okelberry,  Chairman,  Salt  Lake  City;  Clark 
Rich,  Ogden;  Roy  H.  Robinson,  Kenilworth;  S.  M.  Budge,  Logan;  Norman 
R.  Beck,  Salt  Lake  City;  Louis  Perry,  Ogden;  J.  G.  McQuarrie,  Richfield: 
D.  C.  Evans,  Fillmore. 

Necrology  Committee:  W.  T.  Hasler,  Chairman,  Provo;  L.  A.  Stevenson, 
Salt  Lake  City;  Jos.  A.  Phipps,  Salt  Lake  City. 

Industrial  Health  Committee:  Paul  S.  Richards,  Cbairman,  Bingham 
Canyon;  L.  J.  Taufer,  Salt  Lake  City;  Frank  Gorishek,  Helper;  Byron  Daynm, 
Salt  Lake  City;  E,  B.  Kube,  Salt  Lake  City;  D.  C.  Barker,  Ogden. 

Advisory  Committee  to  the  Woman’s  Auxiirary:  Vernal  Johnson,  Chair- 
man, Ogden;  0.  P.  Heninger,  Provo;  L.  G,  Moencb,  Salt  Lake  City;  James 

K.  Palmer,  Salt  Lake  City. 

Public  Relations  Committee:  R.  P.  Middleton,  Chairman,  Salt  Lake  City: 

Louis  P.  Matthei,  Ogden;  R.  W.  Farnsworth,  Cedar  City;  Quinn  A.  Whit- 
ing, Price;  Clyde  J.  Daines,  Logan;  Ray  E.  Spendlove,  Vernal;  H.  I. 

Goodwin,  Salt  Lake  City;  Gilbert  Wright,  Salt  Lake  City;  Roy  B.  Hammond, 
Provo. 

Inter-Professional  Committee:  J.  Leroy  Kimball,  Chairman,  Salt  Lake 

City;  C.  C.  Hetzel,  Jr.,  Ogden;  T.  E.  Bauman,  Park  City;  Paul  Clayton, 
Salt  Lake  City:  Ralph  G.  Rigby,  Salt  Lake  City, 

Mental  Hygiene  Committee:  Boy  A.  Darke,  Chairman,  Salt  Lake  City: 

L.  G,  Moench,  Salt  Lake  City;  Wm.  D,  Pace,  Salt  Lake  City;  George  Cochran, 
Salt  Lake  City;  E.  L.  Weimers,  Provo. 

Fee  Schedule  Committee:  K.  B.  Castleton,  Cbairman,  Salt  Lake  City; 

Howard  K.  Belnap,  Ogden;  J.  E.  Trowbridge,  Bountiful;  U.  B.  Bryner, 

Salt  Lake  City:  W.  Leroy  Smith,  Salt  Lake  City;  J.  B.  Wherrltt,  Heber 
City;  0.  W.  Budge,  Logan. 

Special  Committee  to  Study  Dues:  H.  R.  Beichman,  Chairman,  Salt 

Lake  City;  Eliot  Snow,  Salt  Lake  City;  Ezra  Cragun,  Lewiston. 

Rural  Health  Committee:  J.  J.  Weight,  Chairman,  Provo;  J.  G,  McQuarrie, 
Richfield:  J.  P.  Burgess,  Hyrum;  Noall  Z,  Tanner,  Layton. 


2^ent/er  Oxuaen 


'x^g.en 

Corner  10th  and  Lawrence  Sts. 
TAbor  5138 


nc. 


Medical  Gas  Division 
MEDICAL  OXYGEN 
CARBON  DIOXIDE-OXYGEN 
MIXTURES 

AVIATORS’  BREATHING  OXYGEN 
WATER  COMPRESSED  NITROGEN 
WATER  COMPRESSED  AIR 
Twenty-Four  Hour  Service 


'CL, 


COLOR  PROCESS. 

LINE  HALFTONE 

BEN  DAY 

ILLU5TRATOR5-DE5IONER5 


PHOTO 

ENGRAVERS 


440 


Rocky  Mountain  Medical  Journal 


...was  developed  to  fill  the 
^‘need  for  an  insulin  with 
activity  intermediate  between 
that  of  regular  insulin  and  that 
of  protamine  zinc  insulin.”^ 


GLOBIN  INSU 


IN  1939,  Reiner,  Searle  and  Lang  described  a new 
“intermediate  acting”  insulin. 

IN  1943,  alter  successful  clinical  testing,  the  new  sub- 
stance was  released  to  the  profession  as  ‘Wellcome’ 
brand  Globin  Insulin  with  Zinc  ‘B.W  & Co.’ 


TODAY,  according  to  Rohr  and  Colwell,  “Fully  80% 
of  all  severe  diabetics  can  be  balanced  satisfactorily”^ 
with  Clobin  Insulin  ‘B.W.  & Co.’— or  with  a 2:1  mixture 
of  regular  insulin:  protamine  zinc  insulin.  Ready-to-use 
Clobin  Insulin  ‘B.W  & Co.’  provides  the  desired  inter- 
mediate action  without  preliminary  mixing  in  vial  or 
syringe. 

In  10  cc.  vials,  U-40  and  U-80. 

1.  Rohr,  J.H.,  and  Colwell,  A.R.:  Arch.  Inf, 
Med.  S2:54,  1948. 

2.  ibid  Proc.  Am.  Diabetic  Assn.  8:37,  1948. 


‘B.W.&CO,’— a mark  to  remember 


BURROUGHS  WELLCOME  & C0.(U.S.A.)  INC.  Tuckahoer.NewVork 


jor  June,  1949 


441 


THE  WYOMING  STATE  MEDICAL  SOCIETY 

Next  Annual  Session:  Elks  Club,  Casper;  Sept.  12,  13,  14,  1949 


OFFICBRS 

President:  George  E.  Baker,  Casper. 

President-Elect:  DeWitt  Dominick,  Cotjy. 

Vice  President:  K.  E.  Krueger,  Rock  Springs. 
Treasurer:  P.  M.  Schunk,  Sheridan. 

Correspondini)  Secretary:  George  H.  Phelps,  Cheyenne. 
Delegate  A M. A.:  R.  H.  Reece,  Casper. 

Alternate  Delegate  A.M.A.:  W.  A.  Bunten.  Cheyenne. 
Executive  Secretary:  Mr.  Arthur  Ahhey,  Cheyenne. 


COMMITTEES 

Rocky  Mountain  Medical  Conference:  Earl  Whedon,  Chairman,  Sheridan; 
George  N.  Phelps,  Cheyenne;  H.  L.  Harvey,  Casper;  C.  W.  Jeffrey,  Rawlins; 
L.  W.  Storey,  Laramie. 

Syphilis  Committee:  N.  E.  Morad,  Chairman,  Caaper;  0.  M.  Oroebart, 
Worland;  L.  H.  Wilmoth,  Lander;  L.  G.  Booth,  Sheridan;  P.  k Halgler, 
Midwest. 

Cancer  Committee:  Earl  Whedon,  Chairman,  Sheridan;  John  Gramllch, 
Cheyenne;  DeWitt  Dominick,  Cody;  J.  R.  Newman,  Kemmerer;  E.  W.  New- 
man, Cheyenne. 

Medical  Economics  Committee;  C.  L.  Rogers,  Chairman,  Sheridan;  Nels 

A.  Vicklund,  ThermopoUs;  R.  A.  Corhett,  Saratoga;  G.  R.  James,  Casper; 
S.  S.  Hellewell,  Evanston. 

Fracture  Committee:  Philip  Teal,  Chairman,  Cheyenne:  Silva  J.  Glovale, 
Cheyenne:  Robert  V.  Batterton,  Rawlins;  LoweU  D.  Kattenbom,  Powell; 
Joseph  E.  Hoadley,  Gillette. 

Medical  Defense  Committee:  George  Baker,  Chairman,  Casper;  Andrew 
Bunten,  Cheyenne;  E.  W.  DeKay,  Laramie. 

Cooncillors:  Earl  Whedon,  Chairman,  Sheridan;  R.  J.  Boesel,  Cheyenne; 

B.  W.  DeKay,  Laramie;  George  Baker,  President,  Casper;  George  Phelps, 
Secretary,  Cheyenne. 

Aduisory  to  Woman’s  Auxiliary:  John  R.  Bunch,  Chairman,  Laramie; 
Virgil  L.  Thorpe,  Newcastle;  H.  J.  Aldrich,  Sheridan;  Q.  B.  Savory,  Chey- 
enne. 

Advisory  to  Workmen’s  Compensation  Department:  J.  D.  Shingle,  Chair- 
man, Cheyenne;  G.  H.  Phelps,  Cheyenne;  W.  A.  Bunten,  Cheyenne;  R.  H. 
Reeve.  Casper;  Albert  T.  Sudman,  Green  River;  P.  M.  Schunk,  Sheridan. 


Industrial  Health  Committee:  K.  E.  Krueger,  Chairman,  Bock  Sprlngi; 
Willard  Pennoyer,  Cheyenne;  Thomas  B.  Croft,  Lorell;  Eugene  Peltoo, 
Laramie. 

Veterans’  Affairs  and  Military  Service  Committee:  A.  J.  Allegrettl,  Oialr- 

man,  Cheyenne;  Jack  Rowlett,  Laramie;  Everett  Ellis,  Cheyenne;  Bernard 
Sullivan,  Laramie;  0.  W.  Koford,  Cheyenne;  Bernard  Stack,  ThermopoUs; 
J.  W.  Sampson,  Sheridan;  DeWitt  Dominick,  Cody;  Paul  B.  Bolts,  Lander; 
George  E.  Baker,  President,  Casper;  George  Phelps,  Secretary,  Cheyenne. 

Blue  Cross  Hospital  Committee:  B.  I.  WilUama,  Chairman,  Cheyenne,  1950; 
W.  A.  Bunten,  Cheyenne,  1949;  E.  W.  DeKay,  Laramie,  1951;  CeiHe 
Jones,  Cody,  1952. 

Pnblle  Policy  and  Legislation:  George  Phelps,  Chairman,  Cheyenne; 
Andrew  Bunten,  Cheyenne;  George  Baker,  President,  Casper;  G.  W.  Kofort, 
Cheyenne;  E.  W.  DeKay,  Laramie;  G.  W.  Henderson,  Casper. 

National  Physicians  Committee:  George  Phelps,  Chairman,  Cheyenne; 
Andrew  Bunten,  Treasurer,  Cheyenne;  E.  W.  DeKay,  Laramie;  George  Baker, 
Casper. 

Poliomyelitis  Committee:  H.  L.  Harvey,  Chairman,  Casper;  N.  A.  Vicklund. 
ThermopoUs;  Leo  Keenan,  Torrlngton;  DeWitt  Dominick,  Cody;  Philip  Teal, 
Cheyenne;  FrankUn  Yoder,  Cheyenne;  P.  A,  Mills,  RawUns. 

State  Institutions  Advisory  Committee:  J.  F.  Whalen,  Chairman,  Evans- 
ton; George  Phelps,  Cheyenne;  C.  W.  Jeffrey,  RawUns;  Earl  Whedon.  Sheri- 
dan; G.  M.  Groshart,  Worland;  R.  H.  Kanahle,  Basin. 

Necrology  Committee;  Earl  Whedon.  Chairman,  Sheridan;  John  B. 
Krahl,  Torrlngton;  FrankUn  Yoder,  Cheyenne. 

Rural  Hdalth  Committee:  Paul  Holtz,  Chairman,  Lander;  Andrew  Bun- 
ten, Cheyenne;  Samuel  Worthen,  Afton;  Wm.  K.  Rosene,  Wheatland;  Claudo 
Raffl,  Basin. 

Public  Health  Department  Liaison  Committee:  E.  C.  Ridgeway,  Chair- 
man, Cody;  B.  P.  Fitzgerald,  Casper;  R.  V.  Batterton.  RawUns:  J.  W. 
Sampson,  Sheridan;  B.  C.  Stratton,  Green  River;  WlUard  Pennoyer, 
Cheyenne. 

Child  Health  Committee:  Paul  W.  Emerson,  Chairman,  Cheyenne;  John 
GramUeh,  Cheyenne;  Thomas  Croft,  LoveU;  Bernard  SulUvaa,  Laramie; 
Paul  R.  Holtz,  Lander;  Geo.  E.  Baker,  Casper;  A.  R.  Abbey,  Cheyenne. 

Council  on  National  Emergency  Medidal  Service:  George  H.  Phelt», 
Chairman.  Cheyenne;  R.  H.  Reeve,  Casper;  DeWitt  Dominick,  Cody;  E.  W. 
DeKay,  Laramie;  K.  S.  Krueger.  Rock  Springs;  P.  M.  Schunk,  Sheridan. 


COLORADO  HOSPITAL  ASSOCIATION 


OFFICERS 

President:  Hubert  VV.  Hughes,  St.  Anthony  Hospital,  Denver. 
President-Elect:  Walter  G.  Christie,  Presbyterian  Hospital,  Denver. 

Vice  President:  Sister  M.  Domnina,  St.  Anthony  Hospital,  Denver. 
Treasurer:  M.  A.  Moritz,  Denver  General  Hospital,  Denver. 

Acting  Executive  Secretary:  Roy  R.  Anderson. 

Trustees:  Roy  R.  Prangley,  St.  Luke’s  Hospital,  Denver  (1949);  James 
P.  Dixon,  M.D. . Denver  General  Hospital,  Denver  (1949);  Louis  Liswood, 
National  Jewish  Hospital,  Denver  (1950);  DeMoss  Taliaferro,  Children's 
Hospital,  Denver  (1950);  Roy  R.  Anderson,  Presbyterian  Hospital,  Den- 
ver (1951);  Rev.  Allen  H.  Erb,  Mennonite  Hospital,  La  Junta,  (Jolo. 
(1951). 

Delegate  to  the  American  Hospital  Association:  Herbert  A.  Black,  M.D., 
Parkview  Hospital,  Pueblo. 

Alternate:  RLsgr.  John  R.  Mulroy,  Catholic  Hospitals,  Denver. 

STAIVDIIVG  COMMITTEES 
Auditing:  R W.  Pontow,  Chairman  (1949),  Colorado  General  Hospital, 
Denver;  Rev.  E.  J.  Friedrich  (1950’),  Lutheran  Sanatorium,  Wheatridge; 
Karl  Mortensen  (1951),  St  Luke’s  Hospital,  Denver. 

Constitution  and  Rules:  Samuel  S.  Golden,  M.D.,  Chairman,  Beth  Israel 
Hospital,  Denver;  Henry  H.  Hill,  Weld  County  Hospital,  Greeley;  Sister 
M.  Johanna,  Surred  Heart  Hospital.  Lamar. 

Legislative:  Msgr.  John  R.  Mulroy,  Chairman,  Catholic  Hospitals.,  Den- 
ver; DeMoss  TaliafeiTo,  Children’s  Hospital,  Denver;  Carl  Ph.  Sehwalb, 
Denver;  Herbert  A.  Black,  M.D.,  Parkview  Hospital,  Pueblo. 

Membership:  Sister  M.  Alphonsus  Chairman,  Mercy  Hospital,  Denver; 
Roy  R.  Prangley,  St.  Luke’s  Hospital,  Denver. 

Resolutions:  Walter  G.  Christie,  Chairman.  Presbyterian  Hospital,  Denver; 
Carl  Ph.  Sehwalb,  Denver. 

Nominating:  Msgr.  John  R.  Mulroy,  Chairman  (1949),  Catholic  Hos- 
pitals, Denver;  Herbert  A.  Black,  M.D.  (1950),  Parkview  Hospital,  Pueblo; 

C.  S.  Bluemel,  M.D.  (1951),  Mount  Airy  Sanatorium,  Denver. 

Program:  George  A.  W.  Currie.  M.D.,  Chairman,  University  of  Colorado 
Medical  Center,-  Denver;  Roy  Anderson,  Presbyterian  Hospital,  Denver. 


Nursing:  DeMoss  Taliaferro,  Chairman,  Children’s  Hospital,  Denver; 
Sister  M.  HugoHna,  St.  Anthony  Hospital,  Denver;  Margaret  E.  Paetznick, 
Director  of  Nurses,  Denver  General  Hospital,  Denver;  Sister  Maria  Gratia* 
R.N.,  Glockner  Sanatorium.  Colorado  Springs;  S.  Buss  Denzler,  M.D., 
Colorado  Hospital,  Canon  City. 

Public  Education;  Dwen  B.  Stubben,  Chairman,  Denver  General  Hospital, 
Denver;  Mr.  Torgersen,  Longmont  Hospital  and  Clinic,  Longmont;  Ward 
Darley,  M.D.,  Director,  University  of  Colorado  Medical  Center,  Denver; 
Chas.  Levine,  J.C.R.S.,  Spivak. 

SPECIAL  COMMITTEES 

Public  Relations:  James  P.  Dixon,  M.D.,  Chairman,  Denver  General 
Hospital,  Denver;  Sister  Mary  Lina,  St.  Francis  Hospital,  Colorado  Springs. 

Rates  and  Charges:  Roy  Anderson,  (Riainnan,  Presbyterian  Hospital, 
Denver;  Msgr.  John  R.  Mulroy,  Catholic  Hospitals,  Denver;  Boy  R. 
Prangley,  St.  Luke’s  Hospital,  Denver;  Walter  G.  Christie,  Presbyterian 
Hospital  Denver;  DeMoss  Taliaferro,  Children’s  Hospital,  Denver;  Ben 
M.  Blumberg,  General  Rose  Memorial  HMpital,  Denver. 

State  Board  of  Health  Advisory:  Msgr.  John  R.  Mulroy,  Chairman, 
Catholic  Hospials,  Denver;  DeMoss  Taliafeiro,  Children's  Hospital,  Denver; 
Herbert  A.  Black.  M.D.,  Parkview  Hospital,  Pueblo. 

Committee  on  Hospital  Licensing  Regulations  and  Standards:  Msgr.  John 
R.  Mulroy,  Chairman.  Catholic  Hospitals,  Denver;  Roy  R.  Prangley,  St 
Luke’s  Hospital,  Denver;  Owen  B.  Stubben,  Denver  General  Hospital,  Denver; 
DeMoss  Taliaferro,  Children’s  Hospital,  Denver;  Roy  Anderson,  Presbyterian 
Hospital,  Denver. 

Premature  Infant  Care;  DeMoss  Taliaferro,  Chairman,  Chidlren’s  Hos- 
pital, Denver;  Roy  Anderson,  Presbyterian  Hospital,  Denver. 

Rehabilitation  Center:  James  P.  Dixon,  M.D.,  Denver  General  Hospital, 
Denver:  Msgr.  John  R.  Mulroy,  Catholic  Hospitals,  Denver;  Loins  M. 
Liswood,  National  Jewish  Hospital,  Denver. 

Inter- Professional  Council:  Hubert  W.  Hughes,  St  Anthony  Hospital, 
Denver. 


id  ^peed  in  Pr 


S. 


eruice 


ccurac^  and  ^peeu  in  rescription 

DORR  OPTICAL  COMPANY 


421  16th  Street 


Denver,  Colorado 


KEystone  5511 


442 


Rocky  Mountain  Medical  Journal 


Further  evidence  of  the  safety 
of  ’Benzedrine’  Sulfate  therapy 


More  data,  showing  that  'Benzedrine’  Sulfate,  in  proper 
dosage,  produced  no  toxic  effects,  have  lately  been  pub- 
lished in  a study  by  Cavenessd 

He  gave  the  drug  for  14  consecutive  weeks  to  23  un- 
selected  hospital  patients  whose  ages  averaged  65  years. 
Daily  dosages  over  the  period  ranged  from  5 to  30  mg. 
The  author  observes: 

. . no  significant  changes  were  noted  in  the  cardiovascular,  urinaiy, 
hematopoietic,  or  respiratory  systems . . 

From  this  study,  it  would  appear  that  'Benzedrine’  Sul- 
fate may  be  safely  used  in  the  treatment  of  depression 
in  the  aged. 

1.  New  York  State  J.  Med.  47il003 


on@  of  the  fundamental  drugs  in  medicine 

Smith,  Kline  & French  Laboratories,  Philadelphia 


for  June,  1949 


443 


The  magic  wall 


j 

4 


I 


Nowhere  in  the  realm  of  biology  exists  so  highly 
specialized  and  so  biologically  efficient  a mem- 
brane as  the  mucosa  of  the  human  intestinal 
tract.  Within  this  mucous  membrane,  about 
five  millimeters  thick,  there  take  place  the  most 
intricate  biochemical  reactions  designed  to 
facilitate  absorption  of  the  products  of  digestion. 

Research  upon  the  fundamental  aspects  of 
hemopoiesis  has  gone  forward  steadily  at 
Lederle  for  more  than  20  years.  Liver  extract, 

♦REQ.  U.  S.  PAT,  OFF. 


FOLVITE*  Folic  Acid,  vitamins,  combina-  ; 
tions  w'ith  ferrous  iron,  and  such  products  of  ) 
nutritional  value  in  tissue  repair  as  amino  acids, 
have  been  made  available  as  rapidly  as  they  ■ < 
could  be  perfected. 

Lederle  research  is  proceeding  actively  in  the  | 
field  of  the  nutritional  anemias,  to  the  end  that  | 
these  almost  completely  preventable  diseases  jj 
may  one  day  essentially  disappear  from  daily  j 
clinical  practice.  ! 


LEDERLE  LABORATORIES  DIVISION 


AMERICAN 


C^anamid 


COMPANY 


3D  ROCKEFELLER  PLAZA  • NEW  YORK  20.  N.  Y. 


- 444 


Rocky  Mountain  Medical  Journal 


I 


AND 

^"’•'•ANAPOLia  u 


. ^ Units  p*f  ^ 


'ROTAMIMB* 
ZINC  A 
^ IIETIN 

Qnsuiim,  ^ 

^AMlSnSciHS*^ 

tllLY  .ft. 

40  Unie 
^^ake  Carefully 

.rf 

^ lit..* ^u9At^ 


I^^ILETIN 

*^sulin,  titt’ 

* ^ Units  oer  cc^ 


Good  News  for  Your  Diabetic  Patients 


The  adequately  treated  diabetic  patient  has  actual  proof  from 
laboratory  reports  to  show  that  his  condition  has  responded  to  treatment. 
If  the  patient  is  in  coma,  then  proper  treatment  will  save  his  life.  If  he 
is  a chronic  invalid  because  his  diabetes  has  been  neglected,  then 
correct  management  will  not  only  prevent  death  from  coma  but  may 
restore  the  patient  to  good  health.  Few  therapeutic  procedures  can  he 
used  by  the  physician  with  such  precision  and  with  such  assurance  of 
benefit  as  the  modern  treatment  of  diabetes. 

For  prompt  effect — 

Iletin  (Insulin,  Lilly),  40  and  80  units 
per  cc. 

For  sustained  effect — 

Protamine,  Zinc  & Iletin  (Insulin,  Lilly), 

40  and  80  units  per  cc. 

Intermediate  effects  may  be  obtained  by  suitable  admixtures  of 
Insulin  and  Protamine  Zinc  Insulin. 


ELI  LILLY  AND  COMPANY,  INDIANAPOLIS  6,  INDIANA,  U.S.A. 

. r 


’ T ■ , 


Keeping  little  ones  well  is  the  job  of  the  pediatrician. 
Nutrition,  infection,  injuries,  and  abnormalities  in  behavior 
are  his  everyday  problems.  This  day-in,  day-out  preoccupation 
with  the  health  of  children  gives  the  pediatrician  a 
profound,  practical  knowledge  of  his  field  and  a keen 
perception  of  the  human  equation. 

Pharmaceutical  and  biological  products  are  playing  an 
increasingly  important  role  in  the  practice  of  pediatrics. 

Several  diseases  of  childhood  are  preventable  with 
routine  immunization  procedures.  Palatable  vitamin 
preparations  assure  infants  and  young  children  of 
prophylaxis  and  cure  of  vitamin  deficiency  syndromes. 
Sulfonamides,  penicillin,  and  streptomycin  have  sharply 
reduced  the  toll  of  many  infectious  diseases.  Lilly  research 
scientists  are  concerned  daily  with  the  yet  unsolved  problems 
facing  the  pediatrician.  Sharper  tools  for  the  physician’s 
competent  hands  are  certain  to  result. 


LILLY  SPECIALISTS  SERVE  THE  MEDICAL  PROFESSION 


IRocky 

Colorado 
Montana 
New  Mexico 
Utah 
Wyoming 


JUNE 

1949 


yUountain 

y^edical  Journal 

Editorial ® 


New  Mexico  Looks 
To  the  Future 

'^HE  New  Mexico  Medical  Society  stepped 
boldly  and  confidently  into  full-time  op- 
erations in  the  public  field  at  its  Annual 
Session  last  month  in  Roswell.  In  spite  of 
its  small  size  numerically — less  than  400 
members — it  let  the  world  know  that  it  looks 
to  a future  in  which  it  will  carry  its  full 
share  of  responsibility  as  a great  state  in 
the  field  of  medical  public  relations  and 
public  service. 

Dr.  J.  W.  Hannett  minced  no  words  in  his 
fighting  presidential  address,  reproduced  in 
this  issue  of  the  Journal.  His  address  set  the 
pattern  and  the  spirit  of  a meeting  that 
made  medical  history  in  New  Mexico.  The 
House  of  Delegates  voted,  among  other 
things,  to  establish  a full-time  office  with 
a full-time  Executive  Secretary  as  soon  as 
the  right  man  for  the  job  can  be  found,  to 
modernize  the  Society’s  Constitution  and 
By-Laws  without  further  delay,  to  under- 
take broad  public  service  and  general  civic 
activities  and  a full-scale  public  relations 
program  similar  to  that  of  the  Colorado  So- 
ciety, to  modernize  self-discipline  of  the 
profession  with  a “grand  jury”  type  of 
Board  of  Supervisors,  again  similar  to  that 
first  started  by  its  neighbor  on  the  north. 

The  New  Mexico  Society  had  already 
called  in  professional  insurance  men  to 
take  over  its  Blue  Shield  plan  and  affili- 
ated hospital  service  plan,  so  that  from  now 
on,  while  the  plan  carries  the  full  support 
and  constant  guidance  of  the  Society  and 
must  maintain  standards  fixed  by  the  med- 
ical profession  through  appropriate  com- 
mittees, the  Medical  Society  as  such  is  out 
of  the  insurance  business  and  has  insurance 
companies  doing  the  job  instead.  In  this 


the  Society  took  a leaf  from  the  experiences 
of  Wisconsin  and  Tennessee. 

These  are  but  a few  of  the  highlights.  Our 
Rocky  Mountain  states  may  be  small,  but 
they  make  up  in  energy  and  determination 
whatever  they  may  lack  in  population.  Con- 
gratulations, New  Mexico! 

V ^ ^ 

Time  to  Stand  Up 
And  Be  Counted! 

'^HERE  have  been  a few  instances  re- 
cently  in  which  medical  organizations, 
particularly  scientific  groups,  have  indi- 
cated reluctance  to  go  on  record  against 
Compulsory  Health  Insurance  on  the  ground 
of  propriety. 

The  question  raised  is  whether  a scien- 
tific group  should  “get  mixed  up  in  poli- 
tics.” 

The  answer  to  that  question  is  that  we 
ARE  “mixed  up  in  politics”  whether  we 
like  it  or  not,  because  medicine  has  been 
brought  under  political  attack. 

The  only  question  which  remains  is 
whether  we  are  going  to  defend  our  pro- 
fession against  that  political  attack  — and 
how  we  can  do  it  most  effectively. 

If  Compulsory  Health  Insurance  is  en- 
acted, every  medical  organization  will  be 
subject  to  political  controls  and  influence — 
and  every  doctor  will  be  restricted  in  the 
practice  of  his  profession.  Then  we  really 
will  be  “mixed  up  in  politics!” 

That  issue,  we  believe,  makes  it  impera- 
tive that  all  medical  organizations — scien- 
tific or  otherwise — take  their  stand,  pub- 
licly and  vigorously,  against  the  emascula- 
tion of  sound  medical  practice. 

American  medicine  needs  to  present  a 
united  front  against  politically-controlled 
medical  practice — and  we  believe  it  is  not 


for  June,  1949 


445 


only  ethical,  but  highly  desirable  for  our 
scientific  groups  to  make  their  position 
known. 

Let’s  stand  up  and  be  counted! 

GEORGE  F.  LULL,  M.D., 
General  Manager,  American 
Association. 

^ <4  V 

Atomic  Energy 

A TOMIC  fission  of  heavy  elements,  as  ura- 
nium  and  plutonium,  is  accompanied  by 
heat  comparable  to  that  of  the  sun  and  the 
violence  of  an  earthquake.  The  present 
bomb  can  produce  100,000  casualties — 40,- 
000  of  which  may  be  fatal.  Statistics  indi- 
cate that  20  per  cent  of  casualties  are  a com- 
bination of  radium  sickness  and  flash  burns, 
60  per  cent  due  to  blast  and  fire,  and  20 
per  cent  varied.  Such  blast  is  several  thou- 
sand times  greater  than  the  largest  “or- 
dinary” explosion  ever  produced. 

Potentialities  of  this  type  call  for  philoso- 
phy, not  resignation.  Otherwise,  panic 
could  be  worse  than  bomb  damage  in  the 
event  of  catastrophe.  Leadership  in  this  in- 
evitable phase  of  future  wars  must  come 
from  the  medical  profession.  Let  us  not 
shelve  this  responsibility  even  in  the  face 
of  governmental  attack  upon  our  profession. 
The  atomic  bomb  is  really  somewhat  the 
greater  evil! 

^ <4  V 

Mismanagement  of  Burns 
'^HE  extent  and  degree  of  a burn  is  de- 
termined  the  moment  it  happens.  Later 
on,  a second  degree  burn  may  be  trans- 
formed into  a third  degree  loss  of  integu- 
ment through  destructive  applications, 
solution  of  remaining  corium  in  decompos- 
ing tissues  and  exudates  in  unchanged 
dressings,  or  by  secondary  infection.  Some 
workers  apparently  retain  the  naive  belief 
that  one  concoction  is  superior  to  another 
in  “healing”  burned  areas.  For  example, 
the  shot-gun  nostrum  called  foille,  which 
contains  fourteen  ingredients,  is  still  being 
used.  In  a recent  Journal  A.M.A.  Cronin 
and  Brauer  report  cases  of  phenol  poison- 
ing, one  of  them  fatal,  proved  to  be  due  to 
this  substance.  It  contains  2.36  per  cent 
phenol.  This  amount  of  carbolic  acid  might 


produce  a certain  amount  of  local  anesthe- 
sia, but  it  is  also  capable  of  tissue  destruc- 
tion and  of  systemic  poisoning  due  to  ab- 
sorption. Its  manufacturers  make  the  usual 
fabulous  claims  for  its  alleged  merit.  The 
A.M.A.  Council  has  voted  that  foille  be 
“not  accepted  for  inclusion  in  New  and 
Nonofficial  Remedies  because  it  is  mar- 
keted under  an  uninformative  proprietary 
name  without  satisfactory  evidence  to  es- 
tablish the  therapeutic  rationale  for  its  com- 
plex formula  and  the  claims  made  for  it.” 
Workers  who  are  aware  of  the  dangerous 
potentialities  of  2 per  cent  phenol  applied 
over  a large  area  for  any  considerable 
length  of  time  believe  that  the  preparation 
should  be  withdrawn  from  the  market. 

The  most  simple  conception  of  a burn — 
that  it  is  an  open  wound  to  be  respected  as 
such  and  kept  clean — seems  to  be  clear  cut. 
If  the  wound  has  not  destroyed  the  true 
skin  and  is  kept  clean,  it  will  heal  spon- 
taneously. If  the  true  skin  has  been  de- 
stroyed and  the  area  is  large  a skin  graft  is 
indicated  as  soon  as  the  extent  of  the  wound 
is  defined,  necrotic  tissue  has  separated, 
and  the  granulation  tissue  is  clean  and  red. 
Awaiting  this  time,  dressings  should  be 
changed  frequently  enough  to  avoid  de- 
composition of  tissues  and  wound  exuda- 
tions which  provide  the  warmth,  moisture, 
and  nutrition  which  abets  multiplication  of 
bacteria  inevitably  present.  When  the 
dressings  are  changed,  the  patient  and  at- 
tendants should  be  gowned  and  masked  be- 
fitting the  respect  which  any  opqn  wound 
deserves.  Areas  involving  mobile  struc- 
tures, as  a hand,  should  be  given  maximum 
range  of  active  and  passive  motion  at  those 
times  to  minimize  “freezing”  of  the  tissues 
from  deep  fibrosis.  A substance  being  suc- 
cessfully used  at  this  time  for  “chemical 
debridement”  is  composed  of  methyl  cellu- 
lose and  pyruvic  acid  on  gauze.*  It  seems 
to  bring  about  rapid  separation  of  necrotic 
tissues  and  rapid  formation  of  healthy  gran- 
ulation tissue.  Many  large  burns  thus 
treated  are  ready  for  grafting  within  two 
and  a half  to  three  weeks,  in  contrast  to 
the  more  usual  time  of  four  or  five  weeks. 

*Annals  of  Surg.  125:418. 


446 


Rocky  Mountain  Medical  Journal 


Why  should  penicillin  be  given  to  the 
burned  patient  prior  to  separation  of  the 
necrotic  tissues  and  the  immediate  prepa- 
ration for  surgery,  when  surgery  is  indi- 
iated?  A number  of  cases  are  seen  where 
penicillin  has  been  started  at  once  and  by 
the  time  that  its  benefits  are  most  needed 
the  bacteria  are  penicillin-fast.  With  this 
antibiotic  available,  we  should  withhold  its 
administration  imtil  it  is  needed  and  will  do 
the  most  good. 

V ««  V 

Disaster  Needs 
Educated  Doctors 

'^HE  recent  release  of  the  Hopley  report 
from  the  Office  of  Civil  Defense  Plan- 
ning entitled,  “Civil  Defense  for  National 
i Security,”  has  laid  down  in  broad  outline 
t the  thinking  at  national  level  as  regards 
civilian  defense.  This  report  emphasizes 
repeatedly  that  in  the  event  of  large  natural 
or  enemy-induced  disasters  the  local  com- 
munity will  be  required  to  draw  upon  its 
own  resources  for  relief.  Regional  and  local 
arrangements  for  mutual  help  must  be 
evolved  because  the  Federal  Government 
will  not  be  able  to  supply  help.  It  will  be 
a complete  reversal  of  the  recent  trend 
toward  “let  Washington  do  it.” 

The  Philadelphia  County  Medical  Society 
has  already  demonstrated  the  type  of  con- 
structive action  in  planning  for  disaster  re- 
lief which  will  be  expected  of  the  medical 
profession  throughout  the  country.  From 
January  to  June  of  1948,  under  the  leader- 
ship of  a Disaster  Preparedness  Committee 
of  the  County  Society,  meetings  were  held 
in  Philadelphia  to  evaluate  the  problems 
which  would  be  presented  by  an  atomic 
explosion  in  that  city.  These  meetings  in- 
cluded many  additional  agencies,  public  and 
voluntary,  concerned  with  the  medical  as- 
pects of  this  problem.  Several  meetings  of 
the  County  Society  were  devoted  to  the 
reports  of  the  work  of  this  committee  which 
can  be  found  in  the  July  and  August  issues 
of  “Philadelphia  Medicine.” 

It  is  obvious  that  in  disaster  preparedness 
the  medical  profession  will  have  a leading 
role  to  play.  Physicians  will  be  responsible 


not  only  for  the  medical  program  but  in  ad- 
dition professional  and  lay  education  and 
coordination  for  the  protection  of  the  cit- 
izens in  the  area.  It  is  also  very  probable 
that  in  the  near  future  in  each  of  our  Rocky 
Mountain  states,  serious  thoughts  will  be 
turned  to  the  development  of  an  organiza- 
tion for  civilian  defense  at  state  and  com- 
munity levels.  The  state  medical  societies 
will,  therefore,  soon  be  called  upon  to  help 
in  this  planning. 

At  the  present  time  the  Disaster  Com- 
mittee of  the  Colorado  State  Medical  So- 
ciety is  in  the  process  of  evaluating  the 
medical  facilities  of  both  personnel  and 
equipment,  actual  and  potential,  through- 
out the  state.  This  committee  stands  ready 
to  serve  in  any  and  all  efforts  by  govern- 
mental and  voluntary  agencies  in  regards 
to  the  plainning  for  disaster  relief. 

However,  the  active  participation  of  every 
member  of  every  state  society  will  be  es- 
sential in  any  proposal  that  is  evolved.  For 
this  reason  every  doctor  should  immediate- 
ly familiarize  himself  with  the  facts  re- 
lating to  the  medical  aspects  of  radiation 
hazards.  Not  only  the  special  therapeutic 
problems  posed  by  severe  irradiation  injury, 
but  also  the  technical  problems  associated 
with  medical  relief  in  the  presence  of  con- 
taminated areas,  clothing,  and  personnel 
must  be  thoroughly  understood  by  the  phy- 
sicians in  each  community,  particularly  by 
those  residing  outside  of  metropolitan  areas. 
Upon  their  shoulders  will  fall  the  major 
portion  of  medical  and  lay  education,  of  the 
prevention  of  hysteria,  and  the  actual  car- 
rying through  of  relief  operations.  In  the 
event  of  an  atomic  explosion  within  the 
state,  every  surviving  doctor  must  know 
how  to  conduct  relief  operations  with  safety 
to  all  personnel  involved. 

At  this  immediate  time  in  American  medi- 
cine, no  better  contribution  to  the  public 
relations  of  our  state  medical  societies 
could  be  possible  than  the  active  demonstra- 
tion that  the  entire  profession  in  this  area 
is  taking  constructive  action  toward  the 
maximum  possible  service  to  the  state  com- 
munity in  the  event  of  a natural  or  enemy- 
induced  disaster. 


for  June,  1949 


447 


riginal  ylrticl 

SOME  OBSERVATIONS  RELATING  TO  RECENTLY  PROPOSED 
LEGISLATION  IN  THE  CONGRESS  OF  THE  UNITED  STATES* 

J.  W.  HANNETT,  M.D.,  F.A.C.S. 

ALBUQUERQUE 


The  fact  that  an  article  of  this  nature  at 
a scientific  meeting  seems  indicated  is  in 
itself  a sad  commentary  on  the  mental 
trends  of  some  of  our  political  leaders.  My 
apologies  to  you  and  to  medical  men  in  gen- 
eral. 

For  the  past  ten  years  the  medical  pro- 
fession of  this  country  has  been  listening  to 
the  sounds  of  an  approaching  tumult  that 
might  easily  affect  the  lives  of  every  man, 
woman,  and  child  of  this  nation  and  all 
succeeding  generations.  Recently  the  noise 
has  become  louder.  It  would  appear  from 
press  reports  and  mail  from  our  parent 
association  that  the  outbreak  of  the  storm 
is  imminent.  Apparently  the  chips  are 
down. 

It  is  not  so  important  that  our  American 
way  of  life  as  physicians  be  disrupted  or 
that  we  become  enmeshed  in  red  tape;  the 
tragedy  would  be  the  ruinous  effect  of  state 
medicine  on  our  rapidly  improving  meth- 
ods of  caring  for  the  sick  and  injured.  Doc- 
tors, after  all,  are  human  beings  and  com- 
petition keeps  us  on  the  alert.  We  do  not 
relish  the  thought  of  a fellow  practitioner 
across  the  street  or  in  some  neighboring 
city  proving  to  our  patients  that  he  is  a 
more  competent  medical  man.  If  private 
enterprise  and  competition  are  destroyed, 
pride  of  accomplishment  will  soon  languish, 
and  our  American  people  will  never  know 
what  they  have  lost.  Why  travel  great  dis- 
tances to  medical  conferences  and  subscribe 
to  journals?  Why  not  just  work  the  re- 
quired eight  hours  per  day,  plus  time  and 
a half  for  overtime,  with  its  all  too  fa- 
miliar ring.  If  Mrs.  Green  goes  into  labor 
after  9:00  p.m.,  she  can  get  Doctor  Brown, 

♦Presidential  Address  given  before  the  Annual 
Meeting  of  the  New  Mexico  Medical  Society,  Roswell, 
May  5,  1949. 


who  is  holding  down  the  swing  shift  that 
week. 

No  attempt  will  be  made  here  to  discover 
the  cause  of  this  tempest,  or  the  impetus  or 
primary  force  that  set  it  in  motion.  It  is 
certainly  not  a grass-roots  uprising  as  none 
of  our  country  editors  “views  us  with 
alarm,”  nor  are  all  the  labor  unions  de- 
nouncing us.  In  fact,  some  of  the  unions 
are  making  overtures  to  organized  medi- 
cine and  have  already  asked  us  to  care  for 
their  members  at  regular  county  society 
fees.  No  doubt  organized  labor  has  learned 
that  the  cost  of  producing  a modern,  well- 
trained  doctor  is  at  least  $25,000  and  twelve 
years’  training  without  pay.  The  rapidly 
diminishing  owners  of  great  wealth  have 
not  crashed  the  headlines  against  us.  In 
fact,  they  are  still  trying  to  aid  our  hard- 
pressed  medical  schools.  The  only  groups 
that  feel  we  are  a sinister  influence  are  the 
political  bureaucrats.  The  American  people 
believe  in  us,  respect  us,  and  apparently 
trust  us. 

It  behooves  us  to  bear  in  mind  that  our 
right  to  practice  medicine  in  an  honorable 
way  as  we  are  under  oath  to  do  is  being 
attacked,  and  we  are  in  danger  of  losing 
that  right.  Our  patients,  the  American  peo- 
ple, are  in  danger  of  being  herded  into 
some  unholy  type  of  medical  concentration 
camps.  The  camps  will  be  our  offices  and 
we  doctors  will  be  so  busy  filling  out  yel- 
low, blue,  white,  green  and  striped  forms 
that  time  for  a history  and  examination 
will  be  out  of  the  question.  Further  than 
that,  we  will  be  doing  home  work  in  the 
evenings  studying  new  directives  out  of 
Washington;  directives — the  brain  children 
of  some  immature  clerk  who  wouldn’t 
know  measles  from  sunburn  but  who  is  a 
master  of  shades  of  colors  in  directives. 


448 


Rocky  Mountain  Medical  Journal 


All  of  us  have  listened  to  speeches  and 
read  articles  on  the  evils  .of  state  medicine 
to  the  point  that  what  might  be  said  here 
would  be  little  more  than  a rehash  of  what 
has  already  been  well  stated  by  better  qual- 
ified men.  Ninety  per  cent  of  us  feel  about 
socialized  medicine  as  Cal  Coolidge’s  preach- 
er felt  about  sin:  “We  are  against  it.”  That 
other  1 per  cent — Pecos  Valley  cowmen 
would  call  them  mavericks — is  always  pres- 
ent in  any  and  all  organizations.  They  are 
to  be  found  in  finance,  industry,  the  clergy, 
and  even  in  splinter  political  parties.  Only 
last  fall,  nearly  1 per  cent  of  our  American 
people  followed  Henry  Wallace  in  his  dan- 
gerous political  philosophy.  Perhaps  it  is 
the  altitude  or  the  sandstorms,  but  to  New 
Mexico  doctors  a medical  maverick  is  par- 
ticularly irksome  and  obnoxious. 

A recent  press  article  stated  that  a cer- 
tain Dr.  Channing  Frothingham,  former 
President  of  the  Massachusetts  Medical  So- 
ciety, had  taken  a walk  from  his  local  chap- 
ter and  joined  a rump  organization.  Of 
course,  that  is  one  of  the  doctor’s  great 
American  privileges.  He  will  find  a few, 
very  few,  kindred  spirits  there:  men  like 
himself  who  are  dreaming  fantastic  dreams, 
their  heads  in  the  clouds  gazing  into  far 
horizons  and  expecting  to  catch  the  first 
faint  glimpse  of  the  millennium — incidently 
living  near  well-stocked  clubs,  frequented 
by  the  Lowells  and  the  Lodges  and  accepted 
by  them  as  slightly  queer  but  proper  back- 
ground, old  family,  and  all  that  sort  of 
thing. 

Shall  we  return  for  a moment  to  that 
name:  Dr.  Channing  Frothingham?  The 
name  alone  is  something  to  conjure  with.  It 
smacks  of  lordly  castles,  clanking  armour, 
and  the  round  table.  “Methinks  I hear  the 
baying  of  the  hounds  and  the  obsequious 
but  restrained  applause  of  the  tenantry.” 
We  wonder  if  the  rank  and  file  of  hard- 
working Massachusetts  practitioners  feel 
that  they  have  been  betrayed  by  a headline 
hunter  with  a high  sounding  name.  I am 
wondering  if  Sir  Channing  ever  delivered 
twins  in  a box  car  along  the  Santa  Fe  right- 
of-way  for  Mrs.  Tony  Perioni  on  a zero 
night  by  the  light  of  a coal  oil  lamp,  some 


distance  from  the  boulevard?  Or  did  the 
necessary  thing  for  Ole  Olson  and  his  frac- 
tured skull  in  a lumber  camp  in  Northern 
Idaho? 

Throughout  the  ages  it  has  been  the  “hew- 
er of  wood  and  drawer  of  water”  in  medi- 
cine who  has  won  us  the  respect  and  affec- 
tion of  our  people.  Perhaps  another  Boston 
Tea  Party  is  in  order.  If  these  words  about 
our  erring  brother  from  Massachusetts 
sound  harsh,  please  bear  in  mind  that  he 
has  joined  the  howling  minority  that  has 
attacked  us.  He  has  become  a partisan  who 
must  agree  with  Senator  Morse  of  Oregon, 
who  was  recently  quoted  in  the  press  as 
stating:  “.  . . the  American  Medical  Asso- 
ciation apparently  believed  in  exterminat- 
ing our  American  babies.” 

Nickolai  Lenin,  prophet  and  god  of  the 
communist,  once  stated  that  socialized  med- 
icine was  the  keystone  to  the  arch  of  gener- 
al socialism,  now  communism. 

We  are  at  the  cross-roads  in  medicine.  It 
is  time  we  stand  up  to  be  counted,  knowing 
as  we  do  that  this  is  a fight  to  the  finish; 
and  knowing  we  are  in  the  right  let  us  try 
to  annihilate  the  monster  with  no  holds 
barred.  We  know  that  socialized  medicine 
would  corrupt  good  medical  practice,  in- 
jure public  health,  weaken  our  hospitals, 
lower  the  standards  of  our  medical  schools, 
damage  the  health  of  our  citizens,  endanger 
our  democratic  form  of  government,  destroy 
traditional  American  initiative  and  self-re- 
liance, and  bend  our  national  financial 
structure  to  the  breaking  point. 

We  are  not  interested  in  the  “ismS”  of 
decadent  Europe;  in  fact,  we  are  having  a 
hard  job  keeping  them  from  starving  to 
death.  We  have  had  one  noble  experiment, 
namely  prohibition,  during  our  lifetime.  It 
made  a mockery  of  our  courts,  filled  our 
penitentiaries,  created  breweries  out  of  our 
American  kitchens.  Our  country  clubs  were 
a disgrace,  and  we  finally  found  our  nation 
well  populated  with  women  alcoholics.  We 
are  still  suffering  from  that  experiment 
and  will  continue  to  suffer  until  that  gen- 
eration has  ceased  to  exist.  .The  Volstead 
Act  was  unfortunate  legislation.  State  med- 
icine would  be  vicious  legislation.  It  would 


for  June,  1949 


449 


be  the  European  system  of  first  crushing 
one  minority  group,  and  then  reaching  out 
for  others  until  socialism  reigned  supreme. 
Even  the  starry-eyed  dreamers  and  do-good- 
ers would  be  caught  in  the  net,  and,  too 
late,  would  begin  to  clamor  about  their 
Constitutional  rights,  even  as  some  of  our 
communists  on  trial  in  New  York  are  now 
doing. 

Mr.  Ewing  and  his  crowd  are  not  dream- 
ers. They  are  hardbitten  politicians  with 
senses  alert  and  eyes  trained  on  a super- 
bureau with  all  of  its  potential  power  and 
glory,  forever  and  ever,  Amen!  It  is  for- 
tunate for  our  American  people  and  our 
profession  that  England’s  experiment  with 
state  medicine  has  been  aired  in  our  press 
and  magazine  articles  at  this  time.  Our 
people  will  perceive  the  tragic  as  well  as 
the  ridiculous  side.  The  British  people  are 
standing  in  line  with  a bundle  of  requisi- 
tions under  one  arm  and  a crying  baby  un- 
der the  other.  Imagine  another  line:  one 
elderly  woman  with  an  abscessed  tooth  and 
a few  others  with  false  teeth  that  fail  to 
mesh,  struggling  to  get  an  audience  with  a 
dentist.  Is  it  not  a reasonable  assumption 
that  all  dentists  and  doctors  who  are  still 
sane  will  be  inquiring  into  the  possibilities 
of  earning  a livelihood  in  the  poultry  busi- 
ness or  leaving  on  a permanent  fishing  trip? 

England,  according  to  authentic  reports, 
is  furnishing  everything  from  toupees  to 
vitamins,  and  prodigal  America  will  en- 
deavor to  break  England’s  record.  We  have 
all  been  devastated  by  the  oriental-shaped, 
many-hued  sun  glasses  of  our  lovelies  on 
the  city  streets.  It  has  been  forty  years  since 
some  of  us  have  been  to  Coney  Island 
Beach  on  a Sunday  afternoon.  It  is  our  un- 
derstanding that  these  same  sun  glasses 
have  been  condemned  as  injurious  by  our 
leading  ophthalmologists.  Nevertheless,  they 
are  becoming  more  and  more  popular  each 
year.  If  we  outdo  England  and  add  the 
cost  of  Coney  Island  sun  glasses  to  rest 
cures  in  Atlantic  City,  Miami  Beach,  and 
the  long  coast  of  California,  the  sum  total 
would  cover  the  expense  of  the  proposed 
radar  encirclement  of  America.  Scalp 
treatments  for  dandruff,  plus  chiropodist 


treatment  for  corns,  should  run  into  a pret- 
ty figure.  With  free  choice  in  the  healing 
arts,  quackery  should  thrive  unabated.  For 
instance,  a Christian  Science  Healer  in  Los 
Angeles  could  render  absent  treatment  to 
a patient  in  -Peoria  and  collect  any  reason- 
able fee  for  the  mental  concentration,  after 
the  universally  accepted  method  of  the  late 
Mary  Baker  Eddy.  With  the  above  sys- 
tem in  vogue,  the  soothsayers,  palmists,  and 
fortune  tellers  should  be  able  somehow  to 
muscle  in. 

Our  1950  census  will  show  that  we  have 
a population  of  about  150,000,000  people  and 
150,000  qualified  physicians.  Before  the  sec- 
ond World  War,  Germany  under  state  med- 
icine found  it  necessary  to  employ  one  of- 
fice worker  per  100  population,  and  we 
must  admit  that  the  Germans  are  a frugal 
and  efficient  people.  Even  if  we  could  get 
along  with  one-half  that  personnel,  it  would 
mean  a bureau  of  750,000  employees.  A 
staggering  expense,  and  not  one  dime  of 
that  money  would  be  spent  on  the  sick  or 
injured.  We  have  been  told  on  good  au- 
thority that  it  would  require  at  least  $1,800,- 
000,000  to  set  up  the  machinery  to  operate 
this  gigantic  bureau.  Incidentally,  it  is  well 
for  us  to  bear  in  mind  that  a bureau  of 
these  tremendous  proportions  could  well  be 
a threat  to  our  two-party  system  of  govern- 
ment. It  is  only  natural  for  every  member 
of  this  bureau  to  be  a zealot  for  its  con- 
tinuance, if  for  no  other  reason  than  to  hold 
his  or  her  forty-hour-per-week  job.  It 
might  become  as  unpopular  as  the  Volstead 
Act,  but  much  harder  to  repeal,  and  no  na- 
tion up  to  the  present  has  been  able  to  re- 
peal it. 

It  is  apparent  that  Mr.  Ewing  is  attempt- 
ing to  jam  something  European  down  the 
throats  of  the  American  people — something 
that  has  no  place  in  our  system  of  free 
enterprise.  Medical  men  of  long  experience 
shudder  to  think  of  an  office  afternoon  de- 
voted to  hypochondriacs  and  panhandlers, 
while  really  sick  people  are  forced  to  wait 
and  get  only  scant  attention.  The  psuedo- 
sick  will  then  report  our  alleged  delin- 
quencies to  some  political  Commissar  with 
the  power  to  reprimand  us. 


450 


Rocky  Moxjutain  Medical  Jouhnal 


The  confidential  relations  of  physician 
and  patient  would  be  gone.  The  govern- 
ment is  paying  the  bills;  hence  the  patient’s 
case  record  would  be  government  property. 
The  British  women  have  already  protested 
bitterly  against  their  case  records  becoming 
government  documents.  It  is  easy  to  con- 
ceive how  the  news  of  these  personal  rec- 
ords would  travel.  To  illustrate:  Gertie 
Smith,  second  cousin  to  Precinct  Chairman 
Bill  Smith  who  controls  thirty  votes  at  the 
round  house,  has  been  advanced  from  the 
ribbon  counter  of  the  Five  and  Ten  Cent 
Store  to  the  position  of  record  clerk  at  the 
Federal  building.  Her  desk  is  next  to  Min- 
nie Jones,  whose  boy  friend  is  a deputy 
sheriff  from  Precinct  18  with  quite  a fol- 
lowing in  the  foundry  district.  Gertie  is 
making  the  usual  nine  copies  of  a case  re- 
port when  lo!  and  behold!  she  notices  that 
the  record  concerns  that  snippy  banker’s 
daughter,  Harriet  Rich.  Gertie  parks  her 
gum  for  a moment  and  calls  Minnie’s  atten- 
tion to  the  scandal.  Harriet  Rich’s  secret 
case  report  is  a secret  that  all  the  town 
knows  before  sunset. 

If  and  when  Mr.  Ewing’s  proposed  ambi- 
tions are  realized,  we  should  sadly  tear  the 
Hippocratic  Oath  from  our  memories  and 
install  a copy  of  Walter  Winchell’s  New 
York  Daily  Mirror  column.  If  the  bureau- 
crats accomplish  their  purpose  in  state  med- 
icine, it  would  be  safe  to  predict  that  10  to 
20  per  cent  of  our  most  capable  physicians 
would  retire  from  practice.  Their  clientele 
would  be  confused  and  scattered.  The  doc- 
tor’s enthusiasm  would  abate.  His  long 
years  of  personal  sacrifice  would  be  wasted 
years. 

Another  phase,  either  not  considered  or 
kept  hidden  by  the  political  bureaucrats,  is 
the  fact  that  our  medical  students,  hence 
doctors,  have  not  been  recruited  from  the 
Rocky-Asterbilts,  but  have  been  and  still 
are  the  sons  of  doctors,  small-town  bankers, 
farmers,  college  professors,  and  small  busi- 
ness men.  In  the  presence  of  state  medi- 
cine, no  wise  doctor  or  sound  business  man 
would  urge  or  even  agree  to  finance  his  son 
or  sons  to  enter  twelve  years  of  arduous 
expensive  medical  training,  and  wind  up  by 


having  his  life  dominated  by  some  ward 
politician.  Some  sound  men  in  our  Congress 
realize  the  dangers  of  compulsory  health 
insurance  and  are  combating  it.  It  will 
require  great  political  courage  and  states- 
manship on  their  parts  to  stem  the  tide. 
They  too  are  human  and  would  like  to 
please  a stampeding  constituency.  It 
seems  that  what  we  have  most  to  fear  at 
the  present  time  is  some  type  of  compro- 
mise between  the  two  major  parties.  Any 
sort  of  compromise  would  prove  fatal.  If 
the  camel  once  gets  his  head  under  the  tent, 
he  will  soon  be  entirely  inside  that  tent.  We 
should  endeavor  in  every  way  to  persuade 
our  friends  in  Congress  to  hold  fast.  It  is 
comforting  to  know  that  the  American  Med- 
ical Association  is  doing  its  utmost  to  com- 
bat the  evil  of  statism. 

We  have  been  accused  of  raising  a “slush 
fund”  of  $3,000,000.  If  it  were  true,  it  is 
indeed  a paltry  sum  compared  with  the  re- 
ported $75,000,000  of  taxpayers’  money  that 
the  bureaus  have  spent  in  promoting  state 
medicine.  Besides,  the  alleged  $3,000,000  is 
our  own  money.  It  is  a pitiful  sum  to  com- 
bat a pathological  philosophy  of  medical 
government  and  to  attempt  to  preserve  the 
best  in  medicine  that  the  world  has  ever 
known. 

We  heartily  endorse  grants  in  aid  to 
states  for  increased  hospital  facilities,  med- 
ical schools,  and  care  of  the  helpless,  aged, 
and  indigent.  These  agencies  are  already 
available  and  would  not  entail  any  appre- 
ciable expense.  But  do  not  disturb  the 
“take  home  pay”  of  the  workers  by  com- 
pulsory health  insurance.  Fifty-two  million 
are  already  insured,  and  the  number  is  in- 
creasing rapidly.  Luxury  taxes  would  cover 
the  above-mentioned  facilities.  The  general 
fund  could  be  increased  by  a tax  on  shaves, 
haircuts,  permanents,  toilet  articles,  gaso- 
line, cocktails,  plain  drinking  whiskey,  beer, 
a national  sales  tax,  even  a tax  on  those 
same  sun  glasses.  The  cost  of  one  package 
of  cigarettes  per  day  and  one  family  movie 
per  week  would  cover  the  expense  of  pri- 
vate insurance  against  catastrophic  illness, 
and  keep  the  clammy  hands  of  the  ward 
politician  out  of  our  affairs. 

LIET.  r.Y  OF 


for  June,  1949 


We  in  New  Mexico  are  not  surprised  that 
our  own  home  boy,  Senator  Dennis  Chavez, 
wants  free  medical  care  for  his  constituency 
from  the  womb  to  the  tomb.  Our  Dennis  in 
this  land  of  manana  would  also  like  to  fur- 
nish them  free  groceries.  The  long  range 
view  of  impending  socialistic  chaos  is  well 
beyond  our  Senator’s  mental  depth.  After 
all,  no  one  yet  has  been  guilty  of  accusing 
either  Harry  Truman  or  Dennis  Chavez  of 
being  profound  students  of  government.  We 
are  quite  sure  that  both  Harry  and  Dennis 
would  concede  that  they  are  not  qualified 
to  play  in  the  same  intellectual  league  with 
Thomas  Jefferson  or  Woodrow  Wilson.  They 


don’t  want  to  crucify  us,  they  just  don’t 
sabe! 

Just  a word  about  our  own  shortcomings. 
We  have  a few,  but  not  serious  ones.  They 
can  all  be  remedied  if  not  cured  by  follow- 
ing the  public  service-public  relations  sys- 
tem adopted  by  the  Colorado  State  Medical 
Society.  Every  doctor  and  layman  in  the 
United  States  should  not  only  read  about  it 
but  study  it  carefully.  It  is  good  medicine. 

In  one  last  comment  on  our  issue-seeking 
bureaucrats  and  our  own  erring  medical 
brethren,  may  we  quote  a line  from  the 
Scripture  that  somehow  seems  to  be  appro- 
priate; “Forgive  them.  Oh  Father,  for  they 
know  not  what  they  do.” 


EXTRAPLEURAL  THORACOPLASTY  EARLY  IN  CASEO- 
PNEUMONIC  TUBERCULOSIS* 

JAMES  H.  FORSEE,  Colonel,  M.C. 

DENVER 


Extrapleural  thoracoplasty  is  the  sheet 
anchor  of  surgical  therapy  in  pulmonary 
tuberculosis.  This  has  been  a fact  for  more 
than  twenty-five  years  and  is  probably  more 
true  today  than  ever  before.  Its  present  ap- 
application  has  been  an  evolution  charac- 
terized by  numerous  changes  in  operative 
technic,  frequent  revision  of  its  indications, 
and  the  clinical  observation  of  an  enormous 
number  of  patients  on  whom  the  procedure 
has  been  performed.  There  have  been 
sporadic  attempts  to  employ  extrapleural 
thoracoplasty  early  in  the  course  of  the 
pulmonary  disease  process.  These  attempts 
have  prior  to  the  era  of  streptomycin  met 
with  disappointment  and  a long  period, 
usually  years,  of  chroncity  has  been  required 
before  thoracoplasty  was  considered  in- 
dicated.^ 

With  the  advent  of  adequate  quantities  of 
streptomycin  there  has  evolved  at  Fitzsim- 
ons  a rather  definite  plan  of  approach  to 
the  utilization  of  surgery  in  pulmonary  tu- 
berculosis, which  is  strikingly  different  in 
certain  respects  to  that  followed  prior  to 
streptomycin.  In  particular,  streptomycin 
is  employed  as  a preparatory  measure  for 

•From  the  Surgical  Service,  Fitzsimons  General 
Hospital,  U.  S.  Army,  Denver  8,  Colorado. 


either  improving  the  operability  of  the  pa- 
tient or  for  aiding  in  the  conversion  of  an 
unsuitable  operative  risk  in  need  of  surgery 
to  a reasonable  surgical  risk.  In  the  former 
instance,  the  drug  is  usually  employed  for 
one  to  three  weeks  pre-operatively  with  a 
view  of  reducing  toxemia,  decreasing  cough 
and  sputum  production,  lowering  the  sedi- 
menation  rate,  and  for  its  almost  specific 
action  of  improving  endobronchial  tuber- 
culosis. In  the  latter  group  are  encountered 
those  patients  with  recent  moderate  to 
extensive  lesions  of  an  exudative  nature.^ 
Streptomycin  undoubtedly  favorably  influ- 
ences the  trend  of  resolution  in  these  exuda- 
tive, soft  lesions.  Usually  this  trend  is  def- 
initely demonstrable  within  a 60-day  pe- 
riod of  therapy  of  one  gram  daily  of  strep- 
tomycin.^ However,  we  have  not  hesitated 
to  employ  two  to  four  month  or  longer  pe- 
riod of  streptomycin  therapy  in  preparing 
patients  for  thoracoplasty  in  whom  the 
exudative  lesions  have  been  very  extensive. 
The  exudative  elements  usually  resolve, 
leaving  cavitary  areas  unchanged.  We 
strongly  believe  such  cavity  processes 
should  be  operated  upon  early  to  avoid  the 
production  of  the  inevitable  hard,  destruc- 


452 


Rocky  Mountain  Medical  Journal 


tive,  fibrous  lesions  in  which  the  anatomic 
and  pathologic  changes  deter  healing,  re- 
sulting in  prolonged  chronicity,  subjecting 
the  patient  to  the  constant  dangers  of  dis- 
ease progression,  hemorrhage,  ipsilateral 
and  contralateral  spread  of  the  disease. 

During  the  year  19.47  and  until  November 
1,  1948,  204  patients  have  been  subjected 
to  extrapleural  thoracoplasty  as  a part  of 
the  treatment  of  their  pulmonary  tubercu- 
losis. It  may  be  of  interest  to  note  that 
during  the  years  1947  and  1948  the  number 
of  patients  undergoing  thoracoplastic  col- 
lapse for  tuberculosis  at  Fitzsimons  will  be 
approximately  the  same  as  that  of  any  pre- 
vious ten-year  period.  This  trend  to  the 
increased  utilization  of  surgery  has  been  a 
combined  project  in  which  the  Medical 
Service  has  been  the  key  to  any  success 
which  has  been  achieved.  Among  this 
series  of  patients,  this  paper  considers  a 
group  who  have  met  the  following  crite- 
rion: 

1.  An  acute  onset. 

2.  Fever,  100  degree  F.  or  more. 

3.  Favorable  response  to  streptomycin. 

4.  Completion  of  thoracoplasty  within 
eighteen  months  or  less  from  onset  of 
symptoms. 

5.  No  other  collapse  procedures  employed 
in  therapy. 

6.  Cavitary  lesions  present  in  all  patients 
at  time  of  thoracoplasty. 

In  this  group  there  are  twelve  patients 
operated  between  January,  1947,  and  July, 
1948,  which  represent,  in  our  opinion,  those 
least  apt  to  obtain  favorable  results  from 
surgical  intervention.  If  satisfactory  re- 
sults are  obtainable,  then  many  other  pa- 
tients with  a similar  type  of  disease  should 
respond  favorably,  thus  widening  the  indi- 
cations for  early  employment  of  surgery  in 
the  treatment  of  pulmonary  tuberculosis. 
Streptomycin  preparation  and  protection 
are  considered  essential  in  this  program. 
This  small  group  represents  in  part  certain 
information  based  on  our  experience  during 
the  past  two  years  in  the  employment  of 
extrapleural  thoracoplasty  early  in  the 
course  of  caseo-pneumonic  tuberculosis.  This 
is  one  of  the  most  frequent  types  of  pul- 


monary tuberculosis.  In  its  acute  phase  it 
is  often  called  tuberculous  pneumonia.  The 
onset  is  sudden,  toxemia  is  marked,  with 
fever  of  100-104  degrees,  and  the  patient  is 
seriously  ill.  The  chronic  phase  ensues  as 
the  isymptims  of  toxemia  decrease,  the 
caseous  material  sloughs  and  is  expecto- 
rated, leaving  areas  of  cavitation.  Exacer- 
bations due  to  bronchogenic  spread  are 
common  as  is  laryngeal  and  intestinal  in- 
volvement. Fibrosis  is  slow;  emphysema, 
atelectasis,  and  bronchial  stenosis  are  com- 
mon. Those  patients  who  survive  become 
the  chronic  fibroid  tuberculous  patients. 
This  healing  tendency  often  requires  many 
months  or  years,  and  these  are  the  patients 
who  have  so  often  been  characterized  as  the 
“good  chronics”  most  suitable  for  thoraco- 
plasty collapse.  Thoracoplasty  early  was 
fraught  with  great  danger  of  spread  of  the 
disease  and  a high  mortality  rate. 

CASE  REPORTS 

Case  No.  1.  This  25-year-old  white  soldier  was 
well  until  April,  1947,  when  he  had  an  acute 
onset  of  fever,  chills,  cough,  night  sweats,  and 
malaise.  A roentgenogram  of  the  chest  re- 
vealed an  exudative  infiltration  throughout  the 
left  lung  with  cavitation  in  the  left  upper  lobe. 
Sputum  was  positive  for  acid  fast  bacilli.  He 
was  admitted  to  FGH  June  22,  1947,  at  which 
time  he  was  toxic  with  daily  temperature  of  100- 
101  degrees  F.  and  expectoration  of  30-40  c.c.  of 


Fig-.  1,  Case  1.  Exten.sive  disease,  left. 


for  June,  1949 


453 


sputum  daily  (Fig.  1).  On  July  7,  1947,  he  was 
started  on  streptomycin  2 grams  daily.  After 
four  months  of  such  therapy  there  had  been 
rather  marked  resolution  of  the  exudative  ele- 
ment as  noted  on  roentgenograms,  temperature 


Pis'.  2,  Case  1.  Considerable  clearing.  Cavitary  le- 
sion unchanged,  left. 


was  normal,  and  sputum  production  had  de- 
creased to  10  c.c.  per  day  (Fig.  2).  On  the  19th 
of  November  he  was  started  on  a second  course 
of  streptomycin  prior  to  thoracoplasty.  Between 
November  24,  1947  and  January  26,  1948,  a four- 
stage,  eight-rib  thoracoplasty  had  been  per- 
formed. Streptomycin  was  discontinued  after 
228  days  of  therapy  and  a total  dosage  of  456 
grams.  Postoperative  course  after  each  operation 
was  uneventful.  From  the  time  of  onset  of  ill- 
ness to  completion  of  thoracoplasty  nine  months 
elapsed.  In  November,  1948,  the  sputum  was 
negative  with  no  evidence  of  cavitation  noted  on 
x-ray  examination  (Fig.  3).  The  patient  left  the 
hospital  against  medical  advice  August  7,  1948, 
and  is  living  in  Denver.  During  this  period  he 
states  that  he  has  suffered  no  noticeable  ill  ef- 
fects, no  fever,  no  loss  of  weight  or  appetite,  and 
that  he  engages . in  light  activities  but  is  not 
working.  He  raises  5 to  10  c.c.  sputum  daily. 

Case  2.  This  patient  is  a 29-year-old  Negro 
soldier  who  was  hospitalized  May  15,  1947,  be- 
cause of  fever  of  102  degrees  F.  and  a mildly 
productive  cough.  He  was  transferred  to  FGH 
May  31,  1947,  at  which  time  his  sputiim  was 
positive  for  tubercle  bacilh  (Fig.  4).  Kahn  re- 
action was  positive.  Chest  roentgenogram  re- 
vealed an  exudative  infiltration  throughout  the 
right  lung  with  large  (6  cm.)  and  smaller  cavi- 
tation in  the  right  upper  lobe  and  evidence  of 
extension  in  the  left  lower  and  right  lower  lung 
fields.  Streptomycin  2 grams  daily  was  given 
from  June  13  to  October  14,  1947.  In  November 
a tuberculous  laryngitis  and  an  ulcerative  endo- 
bronchial tuberculosis  of  the  right  upper  lobe 


Fig.  3,  Case  1.  Ten  months  postoperative.  Cavity 
closed. 


orifice  was  diagnosed.  In  November  he  was 
afebrile,  sedimentation  rate  25/60,  the  exudative 
infiltration  bilaterally  had  cleared  considerably, 
but  the  upper  lobe  cavity  on  the  right  remained. 

On  December  4,  1947,  streptomycin  therapy  1 
gram  daily  was  again  started  (Fig.  5).  A seven 
rib  thoracoplasty,  right,  was  carried  out  between 
December  18,  1947,  and  January  30,  1948.  Strep- 
tomycin was  discontinued.  March  5,  1947,  after 


Fig-.  4,  Case  2.  Extensive  bilateral  disease. 


454 


Rocky  Mountain  Medical  Journal 


he  had  received  332  grains  over  a period  of  209 
days.  Within  eight  months  from  the  time  of 
onset  of  illness,  thoracoplasty  had  been  com- 
pleted. He  was  resistant  to  streptomycin  at  the 
time  of  operation.  In  November,  1948,  there  is 
no  evidence  of  cavitation  beneath  the  thoraco- 
plasty (Fig.  6). 


Fig.  .5,  Case  2.  Marked  clearing  one  day  prior  to 
thoracoplasty. 


Case  3.  A 25-year-old  Negro.  Onset  of  present 
illness  began  in  February,  1947,  characterized  by 
cough  productive  of  blood  streaked  sputum, 
easy  fatigability,  and  profuse  night  sweating.  He 
was  hospitalized  in  Germany  one  month  after 
onset  of  symptoms  and  sputum  was  positive  for 
tubercle  bacilli.  Daily  temperature,  100-101  de- 
grees F.  Patient  was  admitted  to  FGH  May  17, 
1947.  A roentgenogram  of  chest  revealed  ex- 
tensive bilateral  caseo-pneumonic  infiltration 
with  multiple  cavitation  bilaterally.  Largest  area 
of  cavitation,  6 cm.  in  diameter,  in  the  left  upper 
lobe.  Sputum  production  50  c£.  in  twenty-four 
hours.  Streptomycin,  2 grams  daily,  was  started 
August  10,  1947,  and  was  continued  for  four 
months.  Considerable  clearing  of  the  exudative 
lesions  resulted  with  no  alteration  of  the  6 cm. 
cavitation  in  the  left  upper  lobe  and  the  smaller 
cavity  in  the  left  lower  lobe  with  honeycombing 
in  the  right  upper  lung  field.  In  December  his 
temperature  had  been  normal  for  several  weeks, 
sputum  reduced  to  10  c.c.  in  twenty-four  hours, 
and  bronchoscopy  was  negative.  Extrapleural 
thoracoplasty  was  carried  out  in  three  stages 
during  January  and  February,  1948,  eleven 
m.onths  after  onset  of  illness.  Streptomycin  1 
gram  daily  was  given  through  the  period  of 
surgery  and  postoperatively,  i.e.,  December, 
1947,  to  April,  1948;  a total  of  360  grams  being 
given  in  the  treatment  of  this  patient.  He  was 
moderately  resistant  to  streptomycin  prior  to 
thoracoplasty.  In  October,  1948,  the  sputum  was 
positive,  a cavity  was  noted  beneath  thoraco- 


plasty on  x-ray  examination  and  lobectomy  has 
been  recommended.  This  patient  also  had  a 
marked  eosinophilia  and  a clinical  diagnosis  of 
Loeffler’s  syndrome  was  made  in  March,  1948. 

Case  4.  This  patient  is  a colored  male,  aged 
23,  who  was  apparently  well  until  July,  1947, 
when  he  developed  a cold  which  persisted.  By 
September,  1947,  the  additional  symptoms  of 
loss  of  appetite,  fever,  productive  cough,  night 
sweats,  and  weight  loss  of  thirty-five  pounds  in 
two  or  three  months  were  noted.  An  x-ray  of  the 
chest  revealed  extensive  soft  infiltrative  lesions 
in  the  entire  left  lung.  Temperature,  102  degrees 
F.  A clinical  diagnosis  of  pneumonia  was  made 
but  a few  days  later  tubercle  bacilli  were  found 
in  his  sputum.  The  patient  was  admitted  to 
FGH  October  10,  1947  (Fig.  7).  On  October  27, 


Fig.  6,  Case  2.  Six  months  postoperative.  No  cavity. 


1947,  streptomycin  1 gram  daily  was  started  and 
continued  until  March  20,  1948.  Within  approx- 
imately sixty  days  there  was  considerable  clear- 
ing of  the  soft  lesions  noted  on  the  left  with 
multiple  small  areas  of  cavitation  remaining 
(Fig.  8).  Between  January  6,  1948,  and  February 
20,  1948,  a three  stage,  seven  rib  thoracoplasty 
was  performed  without  event.  The  total  dosage 
of  streptomycin  was  145  grams.  Seven  months 
elapsed  between  the  onset  of  symptoms  and  the 
completion  of  thoracoplasty.  In  November,  1948, 
the  patient  was  asymptomatic,  afebrile,  no  cough, 
sputum  negative.  No  cavity  was  detected  beneath 
thoracoplasty  and  he  was  transferred  to  Veter- 
ans Administration  Hospital  for  further  rest 
therapy  (Fig.  9). 

Case  5.  While  on  duty  in  Belgium  in  August, 
1945,  the  patient  developed  sudden  onset  of  fe- 
ver, general  malaise,  and  cough.  Temperature, 
103  to  104  degrees  F.  Roentgenograms  of  the 
chest  revealed  infiltrative  lesions  in  the  right 
upper  one-half  of  the  lung  which  later  became 
a frank  consolidation.  Sputum  was  positive  for 


for  June,  1949 


455 


Fig  7,  Case  4.  Extensive  disease,  left.  Oct.  15.  1947. 


tubercle  bacilli.  On  November  9,  1945,  he  was 
admitted  to  Bruns  General  Hospital,  Santa  Fe, 
New  Mexico.  He  had  lost  thirty  pounds  in 
weight  during  the  first  six  weeks  of  his  illness. 
Sputum  production  was  100  to  150  c.c.  daily. 
X-ray  film  of  the  thorax  in  April,  1946,  re- 
vealed further  progressing  of  the  disease  in  the 
right  lung.  He  suffered  a 500  c.c.  hemorrhage 
in  April  and  was  transferred  to  FGH  with  the 
thought  of  having  a right  pneumonectomy  per- 
formed. He  improved  on  bed  rest  with  con- 
siderable decrease  in  the  quantity  of  expecto- 
rated sputum  and  gained  ten  pounds  in  weight. 
Artificial  pneumothorax,  right,  was  attempted 
but  was  unsuccessful.  On  December  18,  1946,  he 
was  placed  on  2 grams  streptomycin.  His  tem- 
perature became  normal  within  two  weeks  and 
remained  normal.  Between  January  28,  1946, 
and  March  12,  1947,  a three  stage,  ten  rib  tho- 
racoplasty was  performed  without  event.  From 
the  time  of  onset  of  disease  to  completion  of 
thoracoplasty  seventeen  months  elapsed.  Seven- 
teen months  postoperative  the  patient  was  dis- 
charged from  a Veterans  Administration  Hos- 
pital August  31,  1948.  Sputum,  10  c.c.  in  twenty- 
four  hours  was  negative  on  culture  and  guinea 
pig  for  six  months  prior  to  discharge.  This  pa- 
tient made  splendid  improvement  without  strep- 
tomycin. At  present,  streptomycin  would  be 
employed  much  earlier  and  it  is  probable  that 
thoracoplasty  would  have  been  accomplished 
earher. 

Case  6.  This  19-year-old  Negro  was  admitted 
to  FGH  on  September  17,  1947,  as  a transfer 
from  Japan.  He  was  apparently  well  until  June, 
1947,  when  he  developed  an  aching  pain  in  the 
left  chest  and  was  admitted  to  the  hospital 
July  28,  1947.  A diagnosis  of  pneumonia  was 
made  but  when  symptoms  and  findings  failed  to 
subside,  sputums  were  found  to  be  positive  for 
tubercle  bacilli.  On  admission  to  FGH  Septem- 
ber 13,  1947,  an  x-ray  of  the  chest  showed  in- 


filtration throughout  the  left  upper  lobe  with 
areas  of  radiolucency  representing  early  cavi- 
tation. There  was  also  a spread  in  the  right 
lung  field.  Streptomycin  was  started  on  Septem- 
ber 21,  2 grams  every  other  day,  and  his  clinical 
symptoms  rapidly  retrogressed.  Sputum  de- 
creased from  50  to  15  c.c.,  he  began  to  gain 
weight,  and  his  temperature  dropped  from  100 
degrees  F.  to  normal.  In  January,  1948,  a first 
stage  thoracoplasty,  left,  was  performed  with 
removal  of  the  upper  two  and  one-half  ribs. 
Postoperative  course  was  moderately  febrile  and 
an  x-ray  of  the  chest  taken  one  week  following 
his  second  stage  thoracoplasty  showed  what  ap- 
peared to  be  evidence  of  slight  spread  in  the 
lower  lobe  on  the  left.  Streptomycin  was  con- 
tinued, and  after  two  weeks  temperature  re- 
turned to  normal  and  chest  roentgenograms 
showed  a regression  of  the  spread  in  the  left 
lower  lobe.  On  February  17,  1948,  the  third 
stage  was  performed  with  removal  of  postero- 
lateral segments  of  the  sixth,  seventh,  and  eighth 
ribs.  The  patient  was  taken  off  streptomycin 
March  20  after  a total  dosage  of  182  grams  and 
has  been  afebrile  since  his  last  stage  thoraco- 
plasty. From  the  time  of  onset  of  illness  to 
completion  of  thoracoplasty  seven  months 
elapsed.  The  patient  was  a severe  disciplinary 
problem  following  operation,  frequently  going 
AWOL.  In  December,  1948,  sputum  negative 
and  there  is  no  evidence  of  cavity  beneath  the 
thoracoplasty.  He  is  presently  a patient  in  a 
VA  Hospital. 

Case  7.  The  onset  of  the  present  illness  in 
this  21 -year-old  white  premedical  student  dated 
as  of  November  5,  1947,  when  he  had  a moder- 
ate sized  hemoptysis.  For  two  months  previous 
to  this  date,  he  noted  unusual  fatigue,  cough, 
and  weight  loss  of  several  pounds.  He  was  first 
examined  by  a physician  in  February,  1948,  at 
v/hich  time  an  x-ray  of  the  chest  revealed  ex- 


Fig.  S,  Case  4.  Jan.  5,  194S.  One  day  prior  thoraco- 
plasty. Moderate  clearing,  left. 


456 


Rocky  Mountain  Medical  Journal 


tensive  cavitary  disease  in  the  left  upper  lobe, 
and  his  sputum  was  positive  for  acid  fast  bacilli. 
Previous  x-ray  films  of  the  chest  in  March,  1945, 
September,  1947,  and  October  19,  1947,  were 
reported  as  normal.  On  March  8,  he  suffered 
a 500  c.c.  pulmonary  hemorrhage  followed  by  a 
febrile  course  of  100-102  degrees  F.  with  sug- 
gestive evidence  of  spread  in  the  same  and  in 
the  contra-lung  field.  He  was  admitted  to 
FGH  March  19,  1948.  Streptomycin  Vz  gram 
daily  was  started  March  13,  1948,  and  was  con- 


Fig-.  9,  Case  4.  Seven  months  postoperative.  No 
cavity. 


tinned  until  July  27,  1948.  By  May  7 there  was 
appreciable  evidence  of  clearing  of  moderate 
soft  lesions  in  the  left  upper  lobe,  but  the  cavity 
persisted  and  the  lesions  in  the  contralateral 
lung  and  lower  left  lung  field  were  less  distinct. 
A three  stage,  seven  rib  thoracoplasty  was  per- 
formed during  May  and  June,  1948.  Within  six 
months  from  onset  of  symptoms  thoracoplasty 
was  completed.  He  was  sensitive  to  strepto- 
mycin at  the  time  of  thoracoplasty.  Total  dosage 
of  streptomycin  was  64  grams.  In  November 
there  was  no  evidence  of  cavity  on  roentgeno- 
gram, sputum  negative,  and  there  had  been 
rather  marked  general  improvement. 

Case  8.  This  28-year-old  white  female  had 
been  treated  frequently  for  five  months  because 
of  severe  sneezing  and  dry  cough.  No  other 
systemic  symptoms  were  noted  except  that  two 
weeks  prior  to  the  taking  of  an  x-ray  of  the 
chest  her  cough  became  productive.  The  first 
roentgenogram  of  the  chest  was  made  on  No- 
vember 21,  1947,  and  revealed  extensive  soft 
infiltration  in  the  left  upper  lobe  with  multiple 
cavitation.  Sputum  examination  was  positive  for 
tubercle  bacilli.  Temperature,  100  degrees  F. 
Patient  was  admitted  to  FGH  December  4,  1927. 
On  December  23  she  had  pulmonary  hemorrhage 
of  150  to  200  c.c.  On  the  following  day  an  x-ray 
of  chest  revealed  evidence  of  infiltration  in  the 


left  lower  Irmg  field  which  was  not  present  on 
admission.  Temperature  rose  to  102  degrees  F. 
Streptomycin  1 gram  daily  was  given  from  De- 
cember 23,  1947,  to  May  7,  1948.  Considerable 
clearing  of  the  exudative  element  resulted  in  a 
few  weeks  and  a three  stage,  seven  rib  thoroco- 
plasty  was  completed  in  April,  1948.  The  total 
dosage  of  streptomycin  was  137  grams.  In  Oc- 
tober, 1948,  she  had  no  cough  or  sputum  and 
repeated  gastric  examinations  of  tubercle  bacilli 
were  negative. 

Case  9.  This  20-year-old  Negro  soldier  was 
hospitalized  November  10,  1945,  because  of  chest 
pain  and  cough.  X-ray  examination  of  the  chest 
revealed  marked  infiltration  in  the  right  mid- 
lung field  and  sputum  was  positive  for  acid  fast 
bacilli.  On  December  11,  1945,  he  suffered  a 
spontaneous  pneumothorax,  right,  associated 
with  fever  of  104  degrees  F.  He  gradually  im- 
proved and  was  admitted  to  FGH  March  31, 

1946.  At  this  time  he  had  lost  thirty  pounds  in 
weight,  was  dyspneic  to  a severe  degree,  and  his 
daily  temperature  average  was  102  degrees  F. 
The  patient  was  placed  on  streptomycin  2 grams 
daily  from  June  18  until  October  18,  1946.  By 
January,  1947,  there  had  been  considerable 
clearing  of  the  lesions  but  a cavity  remained  in 
the  right  upper  lobe.  The  patient  had  received 
216  grams  of  streptomycin.  On  January  14, 

1947,  he  was  again  placed  on  streptomycin  2 
grams  daily,  and  ten  days  later  a first  stage 


Fig.  10,  Case  12.  Admission  Jan.  21,  1948. 


thoracoplasty  was  carried  out.  A four-stage,  ten 
rib  thoracoplasty  was  completed  March  7,  1947, 
and  streptomycin  was  discontinued  April  1,  1947. 
He  received  152  grams  of  streptomycin  in  his 
second  course  and  a total  dosage  of  378  grams. 
A follow-up  letter  from  the  Veterans  Administra- 
tion Hospital  in  April,  1948,  states  sputum  exam- 
ination and  gastric  washings  for  tubercle  bacilli 
have  been  repeatedly  negative.  His  general 


for  June,  1949 


457 


condition  is  good  and  the  clinical  course  symp- 
tom free.  He  had  been  a severe  disciplinary 
problem  and  was  discharged  from,  the  Veterans 
Administration  Hospital  January  28,  1948.  Six- 
teen months  elapsed  from  the  onset  of  the  dis- 
ease until  the  completion  of  thoracoplasty  and 
he  was  discharged  from  the  hospital  ten  months 
after  thoracoplasty.  In  September,  1948,  patient 
states  he  has  8 c.c.  of  sputum,  has  slight  dizzi- 
ness, but  otherwise  is  asymptomatic. 


Fig.  11,  Case  12.  One  clay  prior  thoracoplasty.  Con- 
siderable clearing.  May  8,  1948. 


Case  10.  In  April,  1946,  while  on  duty  in 
Puerto  Rico,  this  31 -year-old  white  soldier  noted 
onset  of  symptoms  of  moderate  cough,  shortness 
of  breath,  dizziness,  and  lack  of  pep.  Symptoms 
persisted,  and  he  began  to  lose  weight  during 
July.  An  x-ray  of  his  chest  was  not  made  until 
September,  1946.  When  this  was  done  a diffuse 
soft  infiltrative  lesion  was  evident  in  the  entire 
upper  one-half  of  the  right  lung  field.  His 
sputum  examination  was  positive  for  tubercle 
bacilli.  Fever,  101-102  degrees  F.  An  x-ray  film 
made  in  January,  1946,  was  negative.  He  was 
admitted  to  FGH  October  18,  1946.  There  had 
been  further  progression  of  the  disease  and  by 
December,  1946,  there  was  extensive  cavitation, 
right  upper  lobe,  and  daily  fever  of  102  degrees 
F.  Streptomycin  2 grams  daily  was  started  De- 
cember 13,  1946.  There  was  an  immediate  and 
steady  improvement  in  clinical  symptoms,  fever 
progressively  decreased  to  normal  within  two 
and  one-half  months,  sputum  decreased  in 
amount,  and  by  the  middle  of  April  he  was 
considered  for  thoracoplasty.  Between  April  29 
and  June  10,  1947,  a three  stage  thoracoplasty 
was  performed.  Fourteen  months  elapsed  from 
the  time  of  onset  of  disease  to  completion  of 
thoracoplasty.  Total  streptomycin  dosage  was 
358  grams.  The  patient  was  discharged  from 
the  Veterans  Administration  Hospital  on  Feb- 


ruary 4,  1948,  as  apparently  arrested.  Sputiun 
negative  (concentrated  twenty -four  hours)  and 
no  cavity  noted  on  x-ray  film  examination. 

Case  11.  This  29-year-old  Negro  soldier  was 
apparently  well  until  May,  1946,  when  he  de- 
veloped chest  pain,  fever,  and  productive  cough. 
His  sputum  was  positive  for  tubercle  bacilli.  He 
was  admitted  to  FGH  June  10,  1946,  at  which 
time  he  was  emaciated,  febrile  (100-101  degrees 
F.),  and  a roentgenogram  of  the  chest  revealed 
extensive  involvement  of  most  of  the  left  lung 
and  the  mid-portion  of  the  right  lung.  Strepto- 
mycin 2 grams  daily  was  started  June  14  and 
continued  until  November  25.  Moderate  clear- 
ing was  noted,  but  in  two  weeks  after  strepto- 
mycin was  discontinued  he  was  again  febrile 
with  temperature  of  100-103  degrees  F.  daily. 
He  was  again  placed  on  streptomycin  December 

9,  1946.  By  the  second  week  in  March  the  pa- 
tient’s condition  was  such  that  thoracoplasty  on 
the  left  was  recommended.  This  was  accom- 
plished in  three  stages,  being  completed  April 

10,  1947,  without  event.  Streptomycin  was  con- 
tinued one  month  postoperatively.  A total  of 
470  grams  was  given.  He  began  to  gain  weight 
shortly  after  operation.  Sputum  has  been  nega- 
tive since  operation,  and  x-ray  examination  of 
the  chest  does  not  reveal  any  evidence  of  cavi- 
tation. Eleven  months  elapsed  from  onset  of 
disease  until  completion  of  thoracoplasty. 


Fig.  12,  Case  12.  Three  months  postoperative. 


Case  12.  A 20-year-old  Negro  soldier.  Onset 
January,  1948,  with  productive  cough  of  50  c.c. 
sputum  in  twenty-four  hours,  anorexia  and  a 
thirteen-pound  weight  loss  in  about  two  weeks. 
Temperature,  101  degrees  F.  X-ray  of  chest 
revealed  massive  infiltration  of  the  right  upper 
lobe  and  a tentative  diagnosis  of  lobar  pneu- 
monia was  made  and  he  was  hospitalized.  Sedi- 
mentation rate,  24  mm.  (Cutler).  Sputum 
examination  revealed  acid  fast  bacilli.  He 


458 


Rocky  Mountain  Medical  Journal 


was  transferred  to  FGH  January  17,  1948. 

Temperature,  100  degrees  F.  Roentgeno- 
graphic  examination  of  the  chest  revealed  a 
caseo -pneumonic  consolidation  of  the  entire  right 
upper  lobe  with  moderate  spread  in  the  lower 
right  lung  field  and  middle  third  of  the  left 
lung  field  (Fig.  10).  Streptomycin  was  started 
1 gram  daily  January  27,  1948.  By  May  8,  1948, 
there  had  been  rather  marked  clearing  of  the 
exudative  lesion  (Fig.  11).  Temperature  normal 
since  a few  days  after  starting  streptomycin; 
sputum  decreased  to  6 c.c.  in  twenty-four  hours. 
Thoracoplasty  in  three  stages  performed  in  May 
and  June,  1948.  Postoperative  course  was  en- 
tirely uneventful.  From  onset  of  disease  to  com- 
pletion of  thoracoplasty  four  months  elapsed. 
Total  streptomycin  dosage,  175  grams.  In  Sep- 
tember, 1948,  the  patient  was  afebrile  and  asymp- 
tomatic. Present  weight  135  pounds.  Vital 
capacity,  July  29,  1948,  was  2025  c.c.  or  51  per 
cent  of  normal.  Last  positive  sputum  culture 
in  March,  1948  (Fig.  12). 


TABLE  1 

Thoracoplasty  and  Streptomycin  Early  in  Caseo- 
Pneumonic  Tuberculosis 

DOSAGE  OF  STREPTOMYCIN 

Dura- 

Amount  tion 

No.  Daily  Grams  Days 

Patients  1/2  gm.  1 gm.  2 gm.  64-470%  64-235 

12  1 6 5 Av.  278  Av.  182 

(11  patients) 


TABLE  2 

Thoracoplasty  and  Streptomycin  Early  in 
Caseo-Pneumonic  Tuberculosis 

Onset  of  Disease  Period  of  Observation 
No.  to  Thoracoplasty  After  Operation 
Patients  Months  Months 

12  idY  4^d8 

Average-9  Average-9 

8 months  or  less-6 


TABLE  3 


Thoracoplasty  and  Streptomycin  Early  in 
Caseo-Pneumonic  Tuberculosis 
RESULTS  (PRELIMINARY) 


Oper- 

Spread 

Spu-  Resi-  Lobec- 

Lobec- 

No. 

ative 

or 

turn  dual  tomy 

tomy 

Pat- 

Mortal- 

Reacti- 

Nega  Cav-  Per- 

Pend- 

tients 

ity 

vation 

tive  ity  formed 

ing 

12 

0 

1 

10  1 (?)  1 

1 

Discussion 

It  is  desired  to  emphasize  that  thoraco- 
plasty was  employed  relatively  early  in 
caseo-pneumonic  disease  but  only  after 
there  had  been  demonstrable  resolution  of 


exudative  lesions  with  improvement  in 
clinical  signs  and  symptoms.  These  were 
characterized  by  decrease  in  cough  and 
sputum  production,  a change  from  a febrile 
course  to  an  afebrile  one,  usually  a gain  in 
weight,  and  a feeling  of  well  being.  It 
appears  that  streptomycin  has  exerted  a 
favorable  effect  in  bringing  about  these 
changes.  This  has  permitted  the  patient  to 
come  to  thoracoplasty  earlier.  In  this  pre- 
liminary report  sputum  conversion  and  cav- 
ity closure  have  been  very  satisfactory. 
Tables  1 to  3 tabulate  these  data. 

Conclusions 

The  use  of  streptomycin  in  caseo-pneu- 
monic tuberculosis  has  permitted  the  per- 
formance of  extrapleural  thoracoplasty 
early  in  the  course  of  the  disease  with  very 
satisfactory  results.  If  later  follow-up 
study  confirms  the  good  early  results,  the 
practice  of  waiting  several  years  prior  to 
the  performance  of  extrapleural  thoraco- 
plasty may  no  longer  be  necessary. 

RBFEREIVCES 

'Graham,  E.  A.,  Sing-er,  J.  J.,  and  Ballon,  H.  C. : 
Surgical  Diseases  of  the  Chest.  Lea  and  Febiger, 
Philadelphia,  1935,  p.  992. 

^Forsee,  J.  H.,  Neerken,  A.  J.,  andi  Tempel,  C.  W.: 
The  Use  ot  Streptomycin  in  the  Preparation  and 
Protection  of  Patients  With  Pulmonary  Tuberculosis 
Treated  by  Extrapleural  Thoracoplasty.  Journal  of 
Thoracic  Surgery  (in  press). 


AMERICAN  TRUDEAU  SOCIETY 

The  American  Trudeau  Society  and  the  med- 
ical section  of  the  National  Tuberculosis  Asso- 
ciation are  offering  a postgraduate  course  in 
pulmonary  diseases  and  thoracic  anesthesiology 
to  be  heM  at  the  University  of  Colorado  Medical 
Center,  Denver,  Colorado,  July  18  to  30,  1949. 
An  excellent  program  has  been  arranged  with 
a visiting  faculty  consisting  of  Dr.  James  Burns 
Amberson  of  New  York,  Dr.  Robert  Block  of 
Chicago,  Dr.  F.  A.  Duncan  Alexander  of  McKin- 
ney, Texas,  Dr.  Robert  J.  Anderson  of  Washing- 
ton, D.  C.,  and  a local  faculty  of  fifty  members, 
all  experts  in  their  respective  fields.  The  fee 
for  the  course  will  be  $100.  Applicants  should 
write  directly  to  the  American  Trudeau  Society, 
1790  Broadway,  New  York,  requesting  applica- 
tion blanks.  No  applications  will  be  accepted 
after  June  15,  1949.  Any  applicants  wishing 
scholarship  to  this  course  should  apply  to  their 
local  State  Tuberculosis  Association. 


“In  ‘Tribute  to  the  American  Doctor”  is  beau- 
tifully portrayed  in  the  Philip  Morris  spread  on 
pages  502  and  503  of  this  issue.  They  invite  you 
to  send  for  a copy  suitable  for  framing.  Display 
it  in  your  reception  room — your  patients  will 
enjoy  reading  it. 


for  June,  1949 


459 


THE  COMBINED  PROCEDURE  OF  VAGOTOMY  AND  PARTIAL 
GASTRIC  RESECTION  IN  THE  TREATMENT  OF  PEPTIC  ULCER* 

F.  F.  HATCH,  M.D.,  WOODROW  NELSON,  M.D.,  and  T.  C.  BAUERLEIN,  M.D. 

SALT  LAKE  CITY 


Of  the  remote  causes  of  peptic  ulcer,  many 
are  known  and  they  are  varied  in  nature. 
They  may  be  single,  multiple  and  intimate- 
ly interrelated.  The  modus  operand!  of 
these  causal  factors  is  through  either  the 
primary  development  of  erosions  of  the  gas- 
tric mucosa  or  the  enlargement  of  casual 
erosions  by  gastric  secretions.  A summation 
of  contributory  etiologic  factors  of  peptic 
ulcer  is  pertinent  to  consideration  of  any 
new  type  of  ulcer  therapy. 

Etiology 

1.  Acid  factor:  The  frequency  of  associ- 
ated gastric  hyper-acidity,  experimental 
ease  of  production  of  ulcer  by  producing 
hyper-acidity,  and  arrest  of  ulcer  by  reduc- 
ing hyper-acidity,  all  emphasize  the  impor- 
tance of  this  factor.  Accepted  present-day 
procedures  are  based  principally  upon  re- 
duction or  elimination  of  gastric  free  acid. 
That  ulcer  does  occur,  however,  in  the  pres- 
ence of  hyper-acidity  is  well  known  and  it 
may  well  be  that  hyper-acidity  is  a result 
as  well  as  a cause  of  peptic  ulcer  in  man. 

2.  Motility  factor:  Those  areas  which  are 
most  affected  by  gastric  dynamics  are  the 
distal  portions  of  the  stomach  and  the  duo- 
denal cap.  It  is  noteworthy  that  these  are 
the  areas  predominantly  afflicted  by  peptic 
ulceration.  The  vagi  are  the  best  known 
pathways  for  the  production  of  both  hyper- 
peristalsis and  hyper-acidity. 

3.  Neurogenic  factor:  The  production  of 
ulcer  by  central  nervous  system  lesions,  as 
noted  and  investigated  by  Cushing,  and  the 
frequency  of  personality  disorders  in  ulcer 
patients,  suggest  that  the  primary  etiology 
may  often  be  a functional,  or  occasionally 
an  organic,  central  nervous  system  disorder. 
The  complexity  of  humoral  autonomic  cen- 
tral nervous  system  inter-relationships 
make  investigation  of  this  possibility  diffi- 
cult. Vagotomy  may  be  surgery’s  answer 
to  the  neurogenic  hypothesis. 

♦From  the  University  of  Utah  School  of  Medicine, 
The  Inter-Mountain  Ciinic,  and  the  L.D.S.  Hospital, 
Salt  Lake  City,  Utah. 


4.  Vascular  factors:  The  possible  impor- 
tance of  vasospastic  and  organic  ischemic 
anoxia  is  attested  by  (a)  experimental  pro- 
duction of  ulcer  by  vasospastic  drugs,  (b) 
the  apparent  aggravation  of  ulcer  by  nico- 
tine, (c)  the  production  of  ulcer  by  emboli 
from  fat  experimentally  inpected  or  arising 
from  fat  injury  in  fracture  patients,  and 
(d)  the  occasionally  observed  obstructed 
large  artery  in  the  base  of  an  ulcer.  Anoxia 
from  vascular  compression  due  to  the  up- 
right position  of  m-an  has  been  hypothe- 
sized as  a factor  in  ulcer  etiology.  On  the 
other  hand,  the  production  of  ulcer  follow- 
ing dorsal  sympathectomy  and  observed 
hyperemia  of  the  gastric  mucosa  by  emo- 
tional stimuli  may  play  a part  in  causing 
peptic  ulcer. 

5.  Tissue  resistance  factors:  The  occur- 
rence of  a constitutional  predisposition  is 
evidenced  by  increased  incidence  of  ulcer 
in  certain  races  and  families.  Experimental 
ulcer  in  dogs  can  be  healed  with  enter- 
ogastrone.  Some  change  in  tissue  resistance 
seems  to  result  because  healing  persists 
after  enterogastrone  is  withdrawn. 

6.  Nutritional  factors:  An  increased  in- 
cidence of  ulcer  occurs  in  protein-depleted 
animals.  The  importance  of  nutritional  de- 
pletion as  a factor  in  ulcer  etiology  in  man 
has  not  been  well  established. 

7.  Miscellaneous  factors:  It  appears  that 
an  increased  incidence  of  peptic  ulcer  oc- 
curs with  intra-abdominal  and  retroperi- 
toneal inflammatory  processes.  This  may 
correlate  with  the  well  known  changes  in 
gastric  function  resulting  from  such  proc- 
esses rather  than  with  the  infectious  proc- 
ess as  such.  Liberation  of  histamine  may 
explain  the  increased  incidence  of  ulcer  in 
burns.  An  allergic  factor  may  be  present 
in  some  cases  of  peptic  ulcer. 

Evolution  of  Surgical  Treatment 

Gastric  resection  alone  produces  good 
permanent  results  in  the  treatment  of  gas- 
tric ulcer  in  the  great  majority  of  cases. 


460 


Rocky  Mountain  Medical  Journal 


Satisfactory  response  to  medical  manage- 
ment in  most  cases  of  duodenal  ulcer 
indicates  that  surgical  treatment  should  be 
reserved  for  definitely  intractable  or  com- 
plicated cases.  Surgical  treatment  of  duo- 
denal ulcer  has  slowly  evolved  from  the 
stages  of  (a)  local  ulcer  excision,  (b)  gastro- 
enterostomy, and  (c)  antrectomy,  to  ex- 
tensive gastric  resection.  It  was  hoped 
that  gastric  resection  in  the  treatment  of 
duodenal  ulcer  would  eliminate  the  gastric 
phase  of  acid  secretion.  The  extensive  work 
of  Wagensteen’s  group  indicates  that  an  ade- 
quate resection  should  include  removal  of 
75  per  cent  of  the  stomach  including  all  the 
lesser  curvature,  all  of  the  ampullary  mu- 
cosa, and  the  performance  of  a short  loop 
gastro-enterostomy.  They  report  an  ex- 
tremely low  incidence  of  jejunal  ulcer  (1 
per  cent)  following  this  procedure  in  cases 
studied  from  five  to  ten  years  and  an  elec- 
tive mortality  rate  of  3 per  cent.  St.  John, 
et  al.,  recently  also  report  a low  incidence 
(1  per  cent)  of  jejunal  ulcer  following  a 
similar  procedure.  The  average  incidence 
of  jejunal  ulcer  following  partial  gastrec- 
tomy for  duodenal  ulcer  is  about  6 per  cent. 
In  addition,  particularly  in  the  extensive 
resection  groups,  a large  percentage  (35 
per  cent  in  the  Minnesota  group)  lost 
weight  and  digestive  disturbances  of  the 
dumping-syndrome  type  not  infrequently 
occur. 

The  rationale  of  vagotomy  for  duodenal 
ulcer  has  been  based  on  the  decrease  of 
acid  secretion  by  abolition  of  the  cephalic 
phase.  The  results  of  vagotomy,  still  in  an 
experimental  stage,  justify  enthusiasm.  Re- 
lief of  ulcer  pain  is  constant.  The  incidence 
of  stomal  ulcer  or  recurrence  or  persistence 
of  duodenal  ulcer  is  to  date  in  the  region 
of  1 per  cent  and  the  reported  mortality 
rate  is  very  low  (about  1 per  cent) . Marked 
persistent  retention  has  necessitated  the 
addition  of  a concomitant  drainage  opera- 
tion in  about  one-third  of  the  cases.  Even 
with  this  addition,  stasis  and  retention  not 
infrequently  occur.  An  important  objection 
to  the ' procedure  of  vagotomy  is  that  the 
histologic  effect  and  permanence  of  the 
anacidity  or  hypoacidity  produced  is  un- 

for  June,  1949 


determined.  Whether  the  change  in  gastric 
dynamics  or  the  change  in  acid  secretion 
is  the  important  result  of  vagotomy  has  not 
been  determined.  The  final  effect  of  va- 
gotomy on  the  pancreas,  liver  and  intestine 
is  also  unknown.  As  suggested  by  Moore, 
section  of  the  vagi  may  result  in  redistri- 
bution of  neurogenic  impulses  and  the  oc- 
currence of  other  psychosomatic  disease. 

The  uniformly  good  results  of  vagotomy 
for  the  post-gastrectomy  marginal  ulcer 
suggest  that  addition  of  vagotomy  to  gas- 
trectomy may  result  in  an  increased  inci- 
dence of  permanent  cures.  The  50-60  per 
cent  type  of  gastrectomy,  used  in  the  cases 
studied,  should  result  in  maintenance  of  a 
better  nutritional  status  than  that  following 
more  extensive  removal  of  an  organ  having 
a definite  digestive  function.  Absent  per- 
istalsis caused  by  vagotomy  might  be  ex- 
pected to  result  in  less  retention  in  gastrec- 
tomized  patients  because  of  the  gravimetric 
method  of  emptying  which  occurs  following 
gastrectomy. 

For  these  reasons,  it  was  decided  to  per- 
form 50-60  per  cent  gastrectomy  and  vagot- 
omy on  a selected  group  of  patients  with 
intractable  duodenal  ulcer  and  to  attempt 
to  study  these  patients  over  a long  period 
of  time  from  a standpoint  of  1.  permanence 
of  ulcer  cure,  2.  nutritional  status,  and  3. 
gastric  function.  The  patient  follow-up 
included  in  most  cases  careful  personal  in- 
terview and  examination,  x-ray  study,  gas- 
tric analysis,  and  measurement  of  total 
hemoglobin  and  plasma  protein. 

Indications 

Vagotomy  and  gastrectomy  as  indicated 
by  Chart  1 were  performed  concomitantly 
in  twenty-four  cases  of  intractable  duodenal 
ulcer.  All  had  failed  to  heal  or  had  ex- 
perienced multiple  recurrence  over  a pe- 
riod of  four  to  twenty-five  years  or  had  had 
single  or  multiple  complications  of  marked 
organic  obstruction  (nine  cases),  perfora- 
tion (three  cases),  or  repeated  hemorrhage 
(ten  cases).  This  procedure  was  also  per- 
formed in  one  31-year-old  patient  with 
malignant  gastric  ulcer.  This  patient  had 
a high  free  gastric  acidity  and  preoperative 
diagnosis  was  gastric  ulcer,  probably  be- 


nign.  One  patient  had  a benign  gastric 
ulcer  combined  with  a chronic  duodenal 
ulcer.  In  two  patients  the  procedure  was 
done  for  stomal  ulcer  following  gastro- 
enterostomy. Not  included  in  this  report 
are  cases  of  vagotomy  performed  subse- 
quent to  gastric  resection  for  stomal  ulcer 
or  two  cases  of  vagotomy  plus  gastro-enter- 
ostomy. 


TABLE  1.  INDICATIONS 

I.  Duodenal  Ulcer  24  Cases 

A.  Intractable  to  medical  manage- 

ment from  4 to  25  years  with  no 
complications  4 

B.  Intractable  plus  recurrent  hemor- 
rhage   10 

C.  Intractable  plus  fast  perforation..  3 

D.  Intractable  plus  marked  organic 

obstruction  9 

II.  Gastrojejunal  ulcer  following  gas- 

tro-enterostomy  2 Cases 

III.  Malignant  gastric  ulcer  1 Case 


27  Cases 


Procedure 

Preoperatively,  attention  was  paid  pri- 
marily to  restoration  of  measured  or  esti- 
mated deficits  in  total  circulating  hemo- 
globin by  transfusion  of  whole  blood.  Ob- 
structed cases  were  decompressed  and  nor- 
mal electrolyte  and  fluid  balance  restored. 

The  surgical  procedure  consisted  of  a bi- 
lateral infra-diaphragmatic  vagotomy  and 
a 50-60  per  cent  gastrectomy.  Endotracheal 
anesthesia  and  an  adequate  midline  or  L 
incision  were  used.  A semi-Fowler  position 
facilitated  exposure  of  the  esophagus  and 
careful  dissection  of  all  vagal  branches.  We 
feel  pre-operative  blood  volume  restoration 
to  normal  essential  for  prevention  of  cere- 
bral anoxia  that  might  be  caused  by  eleva- 
tion of  the  head.  Two  to  four  centimeter 
sections  of  the  vagal  trunks  were  removed 
and  the  ends  tied.  Vagotomy  was  per- 
formed first  to  minimize  the  possibility  of 
mediastinitis  or  subdiaphragmatic  abscess 
from  contamination  by  gastro-duodenal  con- 
tent. A 50-60  per  cent  gastric  resection  was 
then  performed  removing  about  two-thirds 
of  the  lesser  curvature  and  removing  the 
ulcer  in  most  and  the  ampullary  mucosa 
in  all  cases.  The  duodenal  stump  was 
closed  carefully  with  one  row  of  running 


atraumatic  catgut,  one  row  of  interrupted 
catgut  and  one  of  interrupted  cotton  su- 
tures. It  was  overlaid  with  omentum.  A 
three-layer  posterior  short  loop  gastroje- 
junostomy was  done  and  an  indwelling 
No.  16  Levine  tube  was  passed  through  the 
stoma  ten  inches  into  the  distal  jejunum. 
The  most  inferior  portion  of  the  gastric  rem- 
nant was  used  for  the  anastomosis  and 
tacked  to  the  transverse  mesocolon.  Esti- 
mated operative  blood  loss  was  replaced 
during  the  operation. 

Postoperative  management  consisted  prin- 
cipally of:  1.  Gastric  suction  for  three  or 
four  days.  2.  Maintenance  of  fluid  and 
electrolyte  balance  by  intravenous  glucose 
and  jejunal  and  rectal  saline.  The  enteral 
route  for  sodium  restoration  was  chosen  be- 
cause of  probable  optional  absorption  of 
sodium  administered  by  this  route.  3.  At- 
tempt to  restore  early  positive  nitrogen  bal- 
ance by  jejunal  protein  hydrolysate  and 
intravenous  amino  acids.  4.  Duracillin 
daily  for  four  days  and  parenteral  B com- 
plex and  C.  5.  Relatively  early  ambulation. 

Mortality 

One  patient  died  as  a result  of  diffuse 
operative  and  postoperative  hemorrhage 
and  one  following  duodenal  stump  leakage. 
Their  case  reports  are  as  follows: 

CASE  REPORTS 

K.  S.,  white  female,  aged  45,  admitted  Novem- 
ber 19,  1948.  This  patient  gave  a history  of 
ulcer-type  pain  occurring  intermittently  for  a 
period  of  fifteen  years.  During  this  time  she  had 
eleven  gastro-intestinal  hemorrhages,  severe 
enough  on  several  occasions  to  require  hospital- 
ization and  repeated  transfusions.  Diagnosis  was 
made  on  the  basis  of  history,  localized  epigastric 
tenderness  and  on  repeated  x-ray  findings  of 
duodenal  ulcer.  She  gave  no  history  of  abnor- 
mal bleeding  except  for  the  above  and  her 
bleeding,  clotting  and  prothrombin  times  and 
capillary  fragility  tests  were  normal.  Pre-opera- 
tive platelet  count  was  650,000  and  the  spleen  was 
not  palpable.  Pre-operative  transfusion  of  2,000 
c.c.  of  whole  blood  restored  estimated  total  hemo- 
globin to  near  normal  and  she  had  no  melena 
or  hematemesis  in  the  immediate  pre-operative 
period.  During  incision  of  the  abdominal  wall, 
an  unusually  large  number  of  bleeders  was  en- 
countered but  these  were  controlled  by  ligation. 
Vagotomy  was  performed  and  resection  begun. 
After  ligation  of  the  gastrohepatic  and  gastrocolic 
omentum,  a generalized  increasing  uncontrol- 
lable oozing  from  the  abdominal  wall,  peri- 
esophageal region  and  omental  regions  began 
and  continued  in  spite  of  diligent  attempts  at 
ligation  and  the  liberal  use  of  gelfoam  and  oxi- 
dized cellulose.  Rapid  gastric  resection  was 


462 


Rocky  Mountain  Medical  Journal 


therefore  completed;  leaving  part  of  the  ampul- 
lary  mucosa  and  performing  an  expedient  an- 
terior gastro-enterotomy.  The  abdomen  was 
closed  with  the  hope  that  increased  abdominal 
pressure  would  help  control  the  generalized 
intra-abdominal  bleeding  and  closure  per  se 
would  control  that  in  the  abdominal  wall.  She 
received  3,500  c.c.  of  blood  during  surgery  and 
7,000  c.c.  postoperatively,  in  spite  of  which  she 
expired  with  the  typical  picture  of  shock  six 
hours  postoperatively.  Postmortem  examination 
revealed  engorged  spleen  weighing  900  gm.  and 
an  estimated  7,000  c.c.  of  blood  in  the  peritoneal 
cavity.  Extravasation  of  blood  was  also  present 
in  the  retro-esophageal  region  and  in  the  ab- 
dominal wall.  Complete  postmortem  examina- 
tion, including  examination  of  bone  marrow  and 
small  and  medium  blood  vessels,  revealed  no 
other  pathologic  change.  Final  diagnosis  was 
death  from  operative  and  postopertive  hemor- 
rhage secondary  to  a hemorrhagic  diathesis  of 
undetermined  etiology. 

K.  B.,  white  male,  aged  47,  admitted  December 
19,  1948.  This  patient  had  persistent  ulcer  symp- 
toms in  spite  of  adequate  medical  management 
and  three  moderately  severe  hemorrhages  over 
a period  of  six  years.  Repeated  x-ray  examina- 
tions showed  duodenal  ulcer.  He  had  recently 
lost  eight  pounds.  Complete  physical  examina- 
tion was  negative  except  for  epigastric  tender- 
ness. He  had  a maximum  of  26  degrees  free 
acid  following  alcohol  test  meal.  Blood  volume 
studies  showed  a total  of  red  cell  volume  deficit 
of  1,000  c.c.  Preoperatively  he  was  given  2,000 
c.c.  blood.  No  unusual  difficulty  was  encoun- 
tered during  surgery.  Bilateral  vagotomy  and  a 
60  per  cent  gastric  resection  were  done.  A 500 
c.c.  estimated  operative  blood  loss  was  replaced 
during  surgery.  The  proximal  duodenum  was 
contracted  and  moderately  adherent  to  the  pan- 
creas. It  was  sectioned  just  distal  to  the  pyloric 
junction  and  closed  with  one  layer  of  running 
hemostatic  catgut  sutures,  one  layer  of  inter- 
rupted catgut,  one  layer  of  interrupted  inverting 
cotton  sutures,  and  overlaid  with  a fatty  portion 
of  the  duodeno-colic  ligament.  The  usual  post- 
operative regime  was  carried  out  and  gastric 
suction  maintained  for  four  days.  His  course 
was  uneventful.  Temperature  varied  from  99 
degrees  to  100  degrees  and  pulse  from  80-90  per 
minute.  No  nausea,  vomiting  or  demonstrable 
distention  followed  removal  of  gastric  suction  on 
the  fourth  postoperative  day  and  he  was  taking 
water  and  small  amounts  of  milk  by  mouth.  At 
6 p.m.  on  the  sixth  postoperative  day,  he  de- 
veloped intense  right  lower  quadrant  pain, 
sweating,  pallor  and  increased  pulse  rate  (120). 
Within  one  hour,  abdominal  pain  was  general- 
ized and  marked  abdominal  rigidity  present. 
Pulse  rate  at  this  time  was  130,  temperature  102 
degrees,  and  blood  pressure  160/100.  At  8 p.m. 
his  incision  was  reopened  a distance  of  six 
inches  and  a moderate  amount  of  yellow  turbid 
fluid  found  in  the  periduodenal  area  and  the 
right  gutter.  No  perforation  of  the  stump  was 
seen  but  no  dissection  of  the  stump  or  attempt  at 
reclosure  was  made  because  of  the  marked  sur- 
rounding inflammatory  reaction.  Widespread 
drainage  was  instituted.  Following  this  proce- 
dure, his  pulse  remained  high  (110-130)  and  his 
temperature  varied  from  101  degrees  to  105  de- 
grees. Gastric  suction  was  instituted.  Profuse 
drainage  of  excoriating  pancreatico-biliary  fluid 
occurred,  necessitating  5,000-6,000  c.c.  of  paren- 
teral fluids  and  about  18  gm.  of  salt  daily  to 
maintain  adequate  salt  and  water  balance.  Coarse 
muscular  twitchings  occurred  on  the  fifth  post- 


operative day  and  were  promptly  relieved  by 
intravenous  calcium  gluconate.  Two  blood  trans- 
fusions of  500  c.c.  were  given  in  the  week  fol- 
lowing perforation  and  2 c.c.  of  duracillin  was 
given  daily.  On  the  fifth  day  following  perfor- 
ation, suction  was  discontinued  and  progressive 
liquid  feedings  instituted.  Tenderness  and  rigid- 
ity had  greatly  diminished.  Lower  abdominal 
distention  occurred  intermittently  and  was  re- 
lieved by  rectal  tube  and  saline  enemas.  Pulse 
remained  above  110,  however,  and  the  tempera- 
ture above  101  degrees.  Streptomycin  and  sul- 
fathiozole  were  begun  and  on  the  eighth  day 
after  perforation,  attempt  to  decrease  pancreat- 
ico-biliary drainage  was  made  by  a rubber  bal- 
loon inserted  into  the  abdominal  wound  and 
inflated  with  water.  On  the  sixteenth  day  fol- 
lowing perforation,  he  developed  consolidation 
at  the  right  base,  cough,  and  hemoptysis.  No 
evidence  of  phlebothrombosis  presented  and 
pneumococci  only  were  found  on  sputum  exam- 
ination. Respiration  increased  and  temperature 
rose  to  104  degrees  and  pulse  to  130.  Oxygen  was 
necessary  to  prevent  cyanosis.  On  the  twentieth 
day  tenderness  to  percussion  developed  over 
the  right  tenth  rib  in  the  posterior  axillary  line. 
This  increased  over  a period  of  four  days  and 
on  the  twenty-fourth  day  after  perforation,  the 
posterior  inferior  subdiaphragmatic  space  was 
explored  after  suturing  the  two  layers  of  the 
pleura.  No.  fluid  was  found.  He  was  given  an- 
other 500  c.c.  of  blood.  Twelve  hours  later, 
peripheral  vascular  collapse  occurred  and  the 
patient  died  on  the  twenty-fifth  day  after  per- 
foration. No  pneumothorax  was  present  as  de- 
termined by  examination  and  needle  aspiration. 
Permission  for  autopsy  was  denied.  Cause  of 
death  was  listed  as  peritonitis  and  subsequent 
pneumonia  following  leakage  from  the  duodenal 
stump  following  gastrectomy  and  vagotomy  for 
duodenal  ulcer. 

Morbidity 

Postoperative  complications  occurred  in 
twelve  patients,  an  incidence  of  44  per  cent 
(see  Table  II).  The  three  patients  who  de- 
veloped atelectasis  were  treated  by  intra- 
tracheal aspiration,  etc.  They  recovered 
within  two  to  four  days  and  were  dis- 
charged within  twelve  days  postoperatively. 
Naso-bronchial  drainage  from  irritation  of 
nasal  tubes,  and  diaphragmatic  irritation 
secondary  to  operative  trauma  were  possi- 
ble predisposing  factors.  One  patient  de- 
veloped phlebothrombosis  and  pulmonary 
embolism  one  week  after  discharge.  She 
was  treated  by  bilateral  superficial  femoral 
ligation  and  recovered  uneventfully.  The 
one  patient  with  severe  wound  infection  re- 
covered uneventfully  after  drainage.  Two 
patients  developed  sudden  acute  peritonitis 
secondary  to  duodenal  stump  leakage  and 
were  promptly  drained.  One  died  and  has 
been  reported.  The  other  patient  was  crit- 
ically ill  for  a period  of  fourteen  days.  He 


for  June,  1949 


463 


was  discharged  from  the  hospital  at  the  end 
of  thirty  days  and  is  now  asymptomatic, 
gaining  weight,  and  working  at  his  usual  oc- 
cupation of  flying.  The  postoperative  ileus 
appearing  in  one  patient  was  attributed  to 
intestinal  amotility  secondary  to  vagotomy; 
since  discharge  from  the  hospital  she  has 
been  asymptomatic.  One  patient  had  se- 
vere diarrhea  of  ten  to  twelve  movements 
daily  for  six  hospital  days  and  has  had  no 
diarrhea  since.  The  homologous  serum  jaun- 
dice in  one  case  developed  three  months 
after  discharge.  He  had  received  blood  only 
and  no  plasma. 


TABLE  2.  COMPLICATIONS 


I.  Pulmonary  atelectasis  3 Cases 

II.  Phlebothrombosis  and  pulmonary 

embolism  1 Case 

III.  Duodenal  stump  leakage  2 Cases 

IV.  Abdominal  wound  infection — 

severe  1 Case 

V.  Persistent  ileus  five  days  1 Case 

VI.  Parotitis  1 Case 

VII.  Homologous  serum  jaundice  1 Case 

VIII.  Diarrhea,  severe,  six  days  1 Case 

IX.  Postoperative  hemorrhage  1 Case 


12  Cases 

Morbidity — 44  per  cent. 


Results 

We  have  attempted  to  examine  these  pa- 
tients from  one  to  three  weeks  after  hospi- 
tal discharge  and  then  at  three  and  six 
month  intervals.  With  a few  exceptions, 
follow-up  histories  have  been  by  personal 
interview.  Careful  attempt  has  been  made 
to  elicit  all  symptoms.  Cases  have  been 
classified  into  three  groups  based  upon 
symptoms  present  at  any  time  since  opera- 
tion even  though  these  symptoms  subse- 
quently disappeared. 


TABLE  3.  RESULTS  (27  CASES) 


Group  I.  Excellent  result — asympto- 
matic, normal  activity,  weight  and 
strength,  and  absence  of  objective 

findings  15  Cases 

Group  II.  Good  result — minor  symp- 
toms or  findings  only  7 Cases 

Group  III.  . Fair  result — significant 

symptoms  3 Cases 

Deaths  2 Cases 


Total  27  Cases 


All  patients  experienced  complete  relief 
of  ulcer-type  pain  and  no  patient  gave  ob- 


jective or  subjective  evidence  of  recurrent 
ulceration.  The  patients  have  been  fol- 
lowed for  periods  of  one  to  nineteen  months. 
As  seen  in  Table  III,  very  satisfactory  re- 
sults were  obtained  in  twenty-two  of  the 
twenty-seven  cases.  The  minor  symptoms 
or  findings  of  the  seven  cases  of  Group  II 
included: 

1.  Transient  pain  in  the  shoulder  and 
epigastric  discomfort  after  overeating  in 
two  cases. 

2.  Persistent  sense  of  fullness  for  two  to 
four  hours  after  eating  regular-sized  meals 
in  two  cases. 

3.  Failure  to  regain  optimal  weight  and 
associated  significant  depletion  of  total  cir- 
culating hemoglobin  in  two  cases.  (Seven 
and  four  months  postoperatively) . 

4.  Diarrhea  of  several  (average  three) 
watery  stools  daily  for  four  months  post- 
operatively in  one  case.  Stools  have  been 
normal  for  the  past  three  months. 

Individual  reports  of  the  three  patients  in 
Group  III  follow: 

CASE  REPORTS 

White  male,  aged  60:  This  patient  was  well  for 
nine  months  postoperatively.  He  then  developed 
vomiting  after  almost  every  meal,  loss  of  ten 
poimds,  increasing  nervousness,  pounding  of  the 
heart  and  a heavy  feeling  under  the  breast  bone. 
Examination,  including  complete  G.I.  series, 
gallbladder  series,  gastroscopy,  proctoscopy  and 
E.C.G.,  was  negative.  This  patient  was  pre-op- 
eratively  a chronic  alcoholic  and  had  resumed 
his  habit  prior  to  recurrence  of  symptoms.  He 
is  improving  under  a regime  consisting  pri- 
marily of  attempt  at  alcohol  restriction. 

White  female,  aged  39:  This  patient  had  oc- 
casional diarrhea  and  failed  to  regain  her  op- 
timal weight  eight  months  postoperatively.  She 
was  an  extremely  nervous  individual  both  be- 
fore and  since  her  operation.  She  had  an  asso- 
ciated functional  menorrhagia.  Her  stomach 
emptied  itself  extremely  rapidly  (fifteen  min- 
utes) although  she  had  no  symptoms  suggestive 
of  the  dumping  syndrome,  and  total  circulating 
hemoglobin  was  markedly  diminished.  Complete 
examination  was  otherwise  entirely  negative. 
Treatment  of  the  menorrhagia,  sedation  and  ly- 
ing down  after  meals  has  resulted  in  marked 
improvement. 

White  male,  aged  50:  This  patient  began  to 
vomit  two  months  postoperatively  and  had  con- 
tinued to  vomit  from  one  to  three  times  daily 
up  to  the  time  of  his  last  visit  (six  months  post- 
operative). The  emesis  occurred  principally 
after  meals  and  consisted  of  clear  yellow  fluid. 
It  was  not  associated  with  nausea;  he  had  lost 
no  weight  and  had  no  six-hour  retention  of 
barium.  Examination  was  negative.  He  also  was 
an  unusually  nervous  individual  and  had  been 
involved  in  marital  difficulties  during  the  past 
few  months. 


464 


Rocky  Mountain  Medical  Journal 


Laboratory  Follow-Up  Studies 

X-ray  examination,  including  fluoroscopy 
and  films  for  retention,  was  done  on  all  pa- 
tients soon  after  discharge  from  the  hospi- 
tal and  on  most  at  approximately  six-month 
intervals.  All  patients  showed  persistently 
absent  gastric  peristalsis.  Moderate  dilata- 
tion and  residual  fluid  in  the  gastric  rem- 
nant was  uniformly  present  on  the  first 
postoperative  examination.  In  about  one- 
half  of  the  patients,  some  increase  in  tone 
as  evidenced  by  decreased  size  of  the  rem- 
nant occurred  after  six  months.  Fig.  1 il- 
lustrates persistent  dilatation  that  occurs  in 
some  cases  and  Fig.  2 return  of  tonicity. 
From  50  to  70  per  cent  retention  was  pres- 
ent in  four  cases  at  six  hours  on  their  first 
postoperative  examination.  Seventy  per 
cent  retention  persisted  at  four  months  in 
one  patient  and  25  per  cent  retention  de- 
veloped in  one  patient  at  eight  months. 
Neither  patient  vomited  and  both  were  able 
to  eat  moderate-sized  meals  without  dis- 
tress. 

Gastric  analyses  following  20  units  of 
regular  insulin  under  fasting  conditions 
were  done  in  twenty  patients  from  one  to 


c 


Pig.  1.  Persistent  dilatation  following-  gastrectomy 
and  vagotomy.  A.  Pre-operative.  B.  One  month 
postoperative.  C.  Six  months  postoperative. 


C D 


Fig.  2.  Decrease  in  dilatation  six  months  following 
gastrectomy  and  vagotomy.  A and  B.  Pre-opera- 
tive. C.  One  month  postoperative.  D.  Six  months 
postoperative. 

three  months  postoperatively.  Blood  su- 
gars were  not  measured  but  most  patients 
developed  symptoms  of  hypo-glycemia.  Only 
one  patient  had  any  free  acid.  This  pa- 
tient had  a free  acid  of  6 degrees  on  her 
third  specimen  three  months  postopera- 
tively. Her  pre-operative  free  acidity  with 
test  meal  was  over  40  degrees.  Subsequent 
re-check  insulin  gastric  analyses  on  three 
patients  have  shown  no  free  acid. 

Measurements  of  plasma  volume,  hemat- 
ocrit, hemoglobin  concentration,  and  plas- 
ma protein  concentration  were  made  and 
total  circulating  hemoglobin,  total  circulat- 
ing plasma  protein  and  total  red  cell  vol- 
ume were  calculated  in  sixteen  of  the  cases 
postoperatively.  The  T1824  Evans  blue  dye 
method  was  used  for  calculating  plasma 
volume.  Normal  total  circulating  hemo- 
globin was  present  in  ten  and  significant 
depletion  of  total  hemoglobin  was  present 
in  eight  cases.  Hemoglobin  concentration 
was  normal  in  all  but  two,  illustrating  again 
the  error  frequently  involved  in  assuming 
hemoglobin  concentration  to  be  an  accu- 
rate index  of  total  circulating  hemoglobi’^ 


for  June,  1949 


465 


in  convalescent  or  debilitated  patients.  Sig- 
nificant correlation  between  coincidence  of 
suboptimal  weight  and  total  circulating 
hemoglobin  was  noted.  Incidence  and  ex- 
tent of  hemoglobin  depletion  in  general  was 
highest  in  the  early  postoperative  period. 

Discussion 

It  must  be  re-empasized  that  the  com- 
bined procedure  of  vagatomy  plus  gastrec- 
tomy for  intractable  duodenal  ulcer  is  def- 
initely in  the  earliest  stage  of  evaluation. 
Cope’s  findings  and  our  results  to  date  in- 
dicate that  immediate  relief  of  symptoms 
may  be  anticipated.  Weight  and  strength 
are  usually  restored  and  ulcers  have  not 
formed.  The  function  of  the  stomach  as  a 
storage  and  digestive  organ  appears  to  be 
fairly  well  maintained  and  improves  with 
time.  Cope’s  incidence  of  postoperative 
complications  (50  per  cent)  and  our  inci- 
dence of  44  per  cent  is  relatively  high  but 
not  out  of  line  with  the  morbidity  follow- 
ing extensive  gastric  resection. 

The  occurrence  of  two  duodenal  stump 
perforations  in  this  series  of  twenty-seven 
cases  deserves  consideration.  Both  occurred 
on  the  sixth  postoperative  day,  two  days 
after  removal  of  nasal  suction.  Both  had 
meticulous  closure  of  the  stump  with  double 
inversion.  We  do  not  know  whether  or  not 
the  addition  of  vagotomy  to  the  procedure 
of  gastrectomy  influenced  the  leakage.  It 
might  be  theorized  that  lack  of  gastric  and 
decreased  jejunal  peristalsis  resulted  in  in- 
creased doudenal  pressure  but  no  prelim- 
inary obstructive  signs  appeared.  Certainly 
this  complication  is  dangerous  and  must  be 
blamed,  although  associated  with  subse- 
quent pulmonary  complications,  for  the 
death  of  patient  No.  26.  The  other  post- 
operative death  was  definitely  attributable 
to  a hemorrhagic  diathesis  and  would  un- 
doubtedly have  occurred  from  any  major 
type  of  surgical  procedure.  It  does  empha- 
size two  facts:  1.  That  cases  with  gastro- 
intestinal hemorrhage  should  be  thoroughly 
investigated  preoperatively  for  systemic 
causes  of  hemostatic  dysfunction.  2.  That 
the  tests  currently  employed  to  do  not  al- 
ways accurately  forecast  bleeding  tenden- 
cies. 


We  believe  pre-operative  and  postopera- 
tive blood  volume  studies  to  be  of  marked 
importance.  Ulcer  patients  are  frequently 
in  the  category  of  debilitated  individuals 
with  low  plasma  volumes,  marked  total 
hemoglobin  and  blood  volume  deficits  and 
a resultant  tendency  to  shock  upon  loss  of 
even  small  amounts  of  blood.  Pre-operative 
blood  deficits  can  be  accurately  replaced 
only  by  ascertaining  total  blood  volume 
which  is  simply  done  by  the  T1824  dye 
method.  The  pre-operative  replacement  of 
total  hemoglobin  to  normal  for  the  patient’s 
optimal  weight  enables  him  to  use  subse- 
quently administered  protein  for  the  pur- 
pose of  healing  his  wounds  and  restoring 
his  body  enzymes  and  tissue  proteins.  The 
patient’s  postoperative  maintenance  of  nor- 
mal total  circulating  hemoglobin  also  gives 
a good  estimate  of  his  nutritional  suffi- 
ciency. Lack  of  correlation  between  hemo- 
globin concentration  and  restoration  of  op- 
timal weight  is  exemplified  in  the  report  of 
Gaviser.  Thirty-five  per  cent  in  this  group 
of  416  patients,  followed  up  to  ten  years 
after  extensive  gastric  resection  for  peptic 
ulcer,  failed  to  regain  optimal  weight  yet 
anemia,  as  measured  by  decrease  in  hemo- 
globin concentration,  was  present  in  only 
10  per  cent.  We  suspect  that  measurement 
of  total  circulating  hemoglobin  in  these  pa- 
tients would  reveal  a much  higher  inci- 
dence of  anemia. 

We  intend  to  continue  follow-up  studies 
on  this  group  of  patients.  Studies  of  gas- 
tric secretion  and  motility  and  gastric  mu- 
cosal anatomy  a few  years  postoperatively 
in  this  group  and  in  patients  with  vagot- 
omy alone  certainly  will  result  in  more  ac- 
curate deductions  as  to  the  permanent 
efficiency  of  the  procedures  than  can  now 
be  made.  It  is  usually  stated  that  vagotomy 
should  be  reserved  for  cases  showing  very 
marked  overproduction  of  acid  and  par- 
ticularly those  in  whom  there  is  a high  noc- 
turnal secretion.  However  since  it  is  known 
that  pepsin  is  activated  by  relatively  small 
amounts  of  acid  it  should  be  the  aim  of 
surgery  to  lower  the  acid  to  the  point  of 
inactivating  pepsin.  The  increased  inci- 
dence of  hemorrhage  following  gastric  re- 


466 


Rocky  Mountain  Medical  Journal 


section  in  patients  with  repeated  duodenal 
ulcer  hemorrhage  is  suggested  by  Lahey  as 
an  indication  for  the  combined  procedure 
of  vagotomy  and  gastrectomy.  Increased 
attention  directed  toward  evaluation  of  the 
relative  importance  of  the  various  factors 
involved  in  ulcer  production  in  each  indi- 
vidual case  should  lead  to  better  selection 
of  the  proper  surgical  procedure  for  that 
individual.  The  final  analysis  of  the  results 
of  vagotomy  plus  gastrectomy  must  be 
based  on  comparison  of  series  of  cases  pre- 
senting the  same  indication  for  surgical 
management  as  groups  subjected  to  gastric 
resection  or  vagotomy  alone.  Unfortunately 
the  problem  of  the  choice  of  procedure  for 
duodenal  ulcer  cannot  be  settled  by  experi- 
mental animal  investigation,  although  the 
value  of  such  investigation  is  well  recog- 
nized. Fundamentally,  ulcer  is  a disease  of 
man  and  experimental  production  of  ulcer  in 
animals  is  not  entirely  comparable.  Illus- 
trative of  discrepancies  that  may  occur  in 
applying  results  of  animal  experimentation 
to  man  is  the  failure  of  enterogastrone  to 
prevent  ulcer  in  man  in  spite  of  very  en- 
couraging results  in  dogs.  It  appears  that 
increased  success  in  treating  peptic  ulcer 
will  stem  primarily  from  close  observation 
of  the  results  of  physiologically  sound 
treatment.  We  believe  that  the  rationale  of 
the  combined  attack  on  cephalic  and  gastric 
phases  of  gastric  secretion,  along  with  pres- 
ervation of  a significant  part  of  an  organ 
with  a definite  function,  plus  results  to 
date,  justify  continuance  of  the  perform- 
ance of  vagotomy  with  50  per  cent  gas- 
trectomy on  an  investigative  basis. 

Summary  and  Conclusions 

1.  Vagotomy  plus  50  to  60  per  cent  gas- 
trectomy was  done  on  an  investigative  ba- 
sis on  twenty-four  patients  with  intractable, 
or  complicated  duodenal  ulcer,  one  patient 
with  combined  gastric  and  duodenal  ulcer, 
and  on  two  patients  with  marginal  ulcer 
following  gastro-enterostomy.  These  cases 
have  been  studied  carefully  for  one  to  nine- 
teen months  postoperatively. 

2.  The  rationale  of  this  combined  proce- 
dure was  based  on  (a)  the  hope  that  it 
would,  by  attacking  the  cephalic  and  gastric 


phases  of  gastric  secretion,  increase  the  per- 
centage of  cures,  (b)  that  it  would  produce 
a more  normally  emptying  stomach  and 
leave  a more  functional  digestive  organ 
than  that  produced  by  vagotomy  or  exten- 
sive gastrectomy  alone,  and  (c)  because  of 
the  uniformly  good  results  of  vagotomy  for 
marginal  ulcer  following  gastrectomy. 

3.  Results:  (a)  All  patients  obtained  relief 
of  their  ulcer  type  pain  and  none  has  had 
objective  or  subjective  evidence  of  marginal 
ulcer,  (b)  Most  of  the  patients  are  regaining 
or  have  regained  their  optimal  weight  and 
total  blood  volume  as  determined  by  the 
T1824  blue  dye  method.  We  feel  that  res- 
toration of  optimal  weight  and  normal 
blood  volume  and  total  hemoglobin,  rather 
than  hemoglobin  concentration,  are  a good 
index  of  nutritional  sufficiency,  (c)  Only 
three  patients,  all  with  marked  personality 
disorder,  have  significant  gastro-intestinal 
disturbance,  (d)  X-ray  studies  showed  ab- 
sent peristalsis  in  all  patients,  with  atonic- 
ity  and  dilatation  which  subsides  in  some 
after  six  to  nine  months.  Asymptomatic 
significant  six-hour  retention  after  four 
months  was  present  in  only  four  patients, 
(e)  Anacidity,  following  insulin  stimulation, 
occurred  in  all  cases  except  one  who  had  a 
free  acid  of  6 degrees. 

4.  Two  deaths  occurred  in  this  series.  One 
followed  duodenal  stump  perforation.  The 
other  was  due  to  operative  and  postopera- 
tive hemorrhage  caused  by  a hemorrhagic 
diathesis  of  undetermined  etiology  and, 
therefore,  not  directly  attributable  to  a spe- 
cific type  of  operation.  The  morbidity  in 
this  series  was  44  per  cent. 

5.  Nine  patients  developed  postoperative 
complications  which  promptly  subsided 
with  treatment.  One  other  patient  devel- 
oped duodenal  stump  leakage,  was  critically 
ill  for  two  weeks,  and  subseuently  recov- 
ered completely. 

6.  Conclusions  as  to  permanent  result  of 
vagotomy  plus  gastrectomy  for  intractable 
duodenal  ulcer  cannot  be  made  because  of 
the  short  follow-up  period  (maximum  of 
nineteen  months) . Follow-up  studies  in  this 
group  are  being  continued.  Results  to  date 
are  encouraging. 


for  June,  1949 


467 


BocJz,  Qo^i4^e/i 

II  i I 

Book  Revieivs 

Aeseiilaiiius  Comes  to  the  Colonies.  The  Story  of  the 

Early  Days  of  Medicine  in  the  Thirteen  Original 

Coionies:  By  Maurice  Bear  Gordon,  M.D.  Ventor 

Publishers,  Inc.  Ventor  City,  N.  J.  1949.  560  pages. 

$10. 

Notwithstanding  the  manifest  paucity  of  all 
those  elements  which  we  are  not  accustomed  to 
associate  with  adequate  professional  services,  the 
mythical  God  of  Healing  would  have  found  in 
the  primitive  system  of  our  colonial  era  much 
to  commend. 

The  brilliant  author  of  this  monumental  work 
has,  after  infinite  research,  provided  the  student 
of  medical  history  with  the  clearest  picture  of 
the  scope  of  provincial  practice  afforded  to  this 
time.  As  may  readily  be  imagined,  the  pioneer 
physician  of  the  seventeenth  century,  with  train- 
ing restricted  to  the  narrow  horizon  of  his  pre- 
ceptor, and  sharing  perhaps  unconsciously  the 
bizarre  approach  to  medicine  exhibited  on  every 
side  by  the  neighboring  Indians,  seems  indeed 
a very  remote  progenitor  of  his  modern  kinsman. 
In  spite  of  bigotry,  superstition  and  almost  un- 
believable empiricism,  however,  the  physician 
was  then,  as  he  is  now,  a man  of  importance 
and  even  distinction  in  the  community.  He  must 
have  possessed  uncommon  physical  endurance  to 
meet  the  excessive  demands  made  upon  him,  and 
we  may  be  sure  he  had  the  full  measure  of 
courage  and  flaming  devotion  that  has  adorned 
the  pathway  of  medicine  through  the  ages. 

With  the  dawn  of  the  eighteenth  century  and 
the  arrival  of  well  prepared  professional  leaders 
from  England  and  the  Continent,  the  drab  situa- 
tion was  relieved.  Beacon  lights  such  as  inocu- 
lation and,  later,  vaccination  against  small  pox 
appeared;  cinchona  bark  assumed  a prominent 
place  in  the  chemists’  shops;  the  rudiments  of 
sanitation  were  created  and  health  boards  were 
organized  in  the  larger  centers.  It  is  clear  that 
in  every  respect  the  forward  movement  paral- 
leled closely  the  social  and  political  history  of 
this  era. 

The  story  of  provincial  medicine  has  been  cov- 
ered by  previous  historians  for  such  colonies  as 
Virginia,  Massachusetts,  New  Jersey  and  Penn- 
sylvania, but  the  experience  of  others  — New 
Hampshire,  Rhode  Island  and  the  southern  units 
— appears  to  have  been  somewhat  neglected.  In 
this  comprehensive  study  the  author  presents 
what  he  terms  a balanced  picture  of  all,  and  he 
has  ably  achieved  that  objective. 

The  vast  amount  of  material  offered  is  con- 
fined for  the  most  part  to  the  pre-revolutionary 
period,  but  occasionally  the  narrative  extends  to 
the  nineteenth  century  when  it  seems  necessary 
to  mark  the  completion  of  some  significant  epoch. 
Among  the  innumerable  incidents  here  recorded 
to  demonstrate  the  commanding  position  of  the 
colonial  doctor  are  those  connected  with  the 
Declaration  of  Independence.  Five  of  the  signers 
of  this  immortal  document  were  physicians; 
Josiah  Bartlett  and  Matthew  Thornton  of  New 
Hampshire;  Oliver  Wolcott  of  Connecticut;  Ben- 
jamin Rush  of  Pennsylvania  and  Lyman  Hall  of 
Georgia.  Also  signing  for  Pennsylvania  was 
Benjamin  Franklin,  “America’s  first  great  Amer- 
ican,” who  could  have  qualified  as  a physician. 


Though  not  a graduate  of  any  medical  school, 
Franklin  was  elected  a member  of  several  med- 
ical societies,  and  he  shared  in  their  activities 
throughout  his  entire  life.  It  is  interesting  to 
recall  that  he  was  also  the  inventor,  of  bifocal 
lenses  and  that  his  published  papers  include  es- 
says on  hygiene,  public  health,  botany,  meteor- 
ology, physics,  as  well  as  pioneer  observations  in 
the  field  of  electronics. 

If  Aesculapius,  in  his  periodic  rounds,  could 
have  foregathered  with  such  men  and  their  com- 
patriots in  every  part  of  the  New  World,  he 
would  have  noted  the  intellectual  awakening 
which  was  to  launch  the  young  Republic  on  its 
career  of  leadership.  A feature  which  will  be  of 
special  interest  to  veterans  of  our  recent  wars  is 
the  emphasis  placed  on  the  role  of  colonial  phy- 
sicians in  the  War  of  Independence.  Practically 
all,  from  New  Hampshire  to  Georgia,  volunteered 
for  duty  regardless  of  years  or  physical  disabili- 
ty. Their  services  aided  immensely  in  main- 
taining the  morale  of  our  poorly  equipped  troops, 
and  they  seemed  about  as  proficient  with  a mus- 
ket as  they  were  with  a stethoscope. 

The  arrangement  of  this  volume  provides  ready 
access  for  reference.  Each  of  the  thirteen  orig- 
inal colonies  is  given  a chapter  beginning  with 
a suitable  sketch  of  its  history.  A biographical 
review  follows,  as  exhaustive  as  available  data 
permits,  and  throughout  the  text  are  noted  all 
of  the  outstanding  achievements  in  the  evolution 
of  medicine,  such  as  the  founding  of  medical 
schools  and  hospitals,  the  organization  of  state 
medical  societies,  the  adoption  of  health  or- 
dinances and  advances  in  medical  education. 

J.  W.  AMESSE. 

Briti»ih  Surgical  Practice:  Under  the  General  Editor- 
ship of  Sir  Ernest  Rock  Carling,  P.R.C.P.,  Con- 
sulting Surgeon,  ’Westminster  Hospital:  and  J. 
Paterson  Ross,  M.S.,  P.R.C.S.,  Surgeon  and  Director 
of  Surgical  Clinical  Unit,  St.  Bartholomew’s  Hos- 
pital; Professor  of  Surgery,  University  of  London. 
I.  Butterworth  & Co.  (Publishers),  Ltd.,  London, 
England:  The  C.  “V.  Mosby  Company,  St.  Louis, 
Mo.,  U.S.A.,  1947. 

An  outline  of  surgery  now  being  published  un- 
der the  title  of  “British  Surgical  Practice,”  will 
soon  be  available  in  nine  volumes.  The  first 
volume  has  been  reviewed  and  found  to  be  very 
well  done  from  the  standpoint  for  which  it  was 
intended.  The  work  is  presented  for  the  surgeons 
and  general  practitioners  who  need  an  easy, 
concise  reference  work  on  general  surgery 
which  is  up  to  date  and  authoritive  and  leaves 
out  much  tiresome  detail  and  minutae.  Subjects 
are  listed  alphabetically  throughout  which  sim- 
plifies its  use.  This  volume  begins  with  “Ab- 
dominal Emergencies”  and  concludes  with  “Au- 
tonomic Nervous  System.”  Each  chapter  has 
been  written  by  a recognized  authority  in  his 
particular  field  and  consequently  the  material  is 
concise,  directly  to  the  point,  and  discussion  is 
kept  to  a minimum.  There  are  many  excellent 
illustrations  and  color  plates  which  enhance  the 
value  of  the  book.  Most  all  obsolete  methods  of 
treatment  have  been  deleted  and  sound,  recog- 
nized surgical  practices  are  recommended.  Pen- 
icillin is  not  advocated  as  a “cure-all”  or  in  fa- 
vor of  surgery  in  infections  but  is  used  as  an  ad- 
junct to  good  surgery.  Some  of  the  English  con- 
cepts of  treatment  that  have  not  been  used  to 
any  extent  in  this  country  are  explained.  One 
in  particular  is  the  ambulatory  treatment  of 
thrombophlebitis.  If  the  other  eight  volumes  of 
this  work  are  as  well  done  as  the  first  volume, 
it  will  be  a worthwhile  addition  to  any  library. 

MONROE  R.  TYLER. 


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jlocky  Mountain  Medical  Conference 


lUGUST 

2-3-4 

1949 


BUTTE 

MONTANA 


ON  THE  PREVIOUS  PAGE 

. . . . are  some  scenes  in  and  around  Butte,  Mont., 
that  we  hope  you  like,  and  hope  may  help 
persuade  you  that  this  is  the  summer  meeting 
you  simply  must  attend. 

Upper  left  is  a view  of  the  mountain  range  just 
south  of  Butte,  taken  from  the  city  limits  of 
Butte  proper.  Butte  is  in  a great  bowl,  sur- 
rounded by  scenery  such  as  this.  Upper  right  is 
one  of  Butte’s  attractive  parks. 

In  the  center  is  one  of  the  city’s  main  street 
intersections  (which  will  also  be  the  main  in- 
tersection this  August  during  the  Rocky  Moun- 
tain Medical  Conference,  as  witness  the  Hotel 
Finlen  sign),  showing  the  Christmas  decorations 
last  winter. 

Below  are  typical  scenes  of  Butte’s  principal 
industry,  as  well  as  one  of  its  main  tourist  at- 
tractions— copper  mining.  Those  attending  the 
R.M.M.C.  will  have  opportunities  to  inspect  the 
whole  process  of  copper  mining  and  refining  at 
first  hand. 


THE  R.M.M.C. 

What  It  Is  — What  It  Does 

There  are  many  current  medical  organizations 
which  call  themselves  “conferences.”  Here  we 
have  at  least  one,  the  Rocky  Mountain  Medical 
Conference,  that  is  truly  what  its  name  implies. 
For  it  is  not  an  organization.  It  is  a biennial 
conference,  a self-sustaining  joint  enterprise  of 
five  state  medical  societies. 

The  Rocky  Mountain  Medical  Conference  is, 
we  believe,  unique  in  medical  society  enterprises. 
It  was  first  suggested  in  1935  by  Dr.  George  P. 
Lingenfelter,  Colorado’s  fraternal  delegate  to 
New  Mexico,  Utah  and  Wyoming.  These  three 
societies  decided  to  undertake  such  a conference, 
and  New  Mexico  joined  within  a year.  The  first 
meeting  was  held  in  1937  in  Denver,  with  the 
Colorado  Society  as  host.  At  that  meeting  per- 
manent policies  were  fixed  for  the  future  of  the 
Conference,  and  these  policies  have  been  ad- 
hered to  ever  since.  Montana  joined  the  Con- 
ference in  1939  at  the  time  of  the  second  meeting 
in  Salt  Lake  City. 

Basic  principles  of  the  Conference  include  sev- 
eral “don’ts.”  This  Conference  is  pledged  to 
elect  no  officers,  indulge  in  no  medical  politics, 
adopt  no  resolutions  relating  to  policies  of  or- 
ganized medicine,  undertake  no  activities  that 
would  aggrandize  any  individual  state  or  locality, 
hear  no  scientific  speakers  from  within  its  par- 
ticipating states.  Its  positive  purpose  is  to  meet 
every  two-j^ears  Lur  the  sole  purpose  of  bringing 
Rocky  Mountain  physicians  together  to  discuss 
common  problems  and  to  hear  outstanding  speak- 
ers of  national  stature  from  outside  the  Rocky 
Mountain  region.  Its  meeting  place  is  rotated 
ammng  the  participating  states. 

Management  of  the  Conference  is  vested  in  a 


Continuing  Committee.  Each  participating  State 
Medical  Society  has  organized  a Conference  Com- 
mittee of  five  of  its  members,  serving  over- 
lapping five-year  terms.  These  committees,  to- 
gether, constitute  the  Continuing  Committee  of 
the  Conference  which  meets  at  least  annually  to 
plan  future  programs  and  manage  the  affairs  of 
the  Conference.  The  chairman  of  the  host  state’s 
Conference  Committee  is  Chairman  of  the  Con- 
ference to  be  held  in  that  state.  He  selects  a 
Secretary-Treasurer  for  that  particular  meeting 
and  with  the  help  of  the  Continuing  Committee 
also  selects  the  several  sub-committees  needed 
to  plan  the  meeting  for  which  his  state  is  host. 

The  first  meeting  of  the  Conference,  in  1937, 
established  an  enviable  reputation  among  med- 
ical meetings  for  the  quality  of  its  program,  its 
fraternalism,  and  its  precise  conduct.  The  second 
meeting,  in  1939  with  Utah  as  host,  advanced  the 
ideals  of  the  first.  The  third  was  held  in  1941 
in  Yellowstone  Park  with  Wyoming  as  host  and 
proved  that  this  type  of  meeting  could  be  held 
far  from  centers  of  either  medical  or  general 
population  and  still  attract  the  best  in  the  nation. 
The  fourth  meeting  was  held  in  Albuquerque, 
and  although  it  was  postponed  until  1947  by  the 
exigencies  of  war  the  spirit  of  the  Rocky  Moim- 
tain  Medical  Conference  had  not  lagged  and  the 
New  Mexico  meeting  was  outstanding  in  every 
respect. 

Now  it  is  Montana’s  turn  in  the  rotation  and 
Butte,  rich  in  history,  rich  in  both  medical  and 
general  current  interest,  rich  in  every  respect,  is 
the  host  city.  The  distance  of  Butte  from  such 
cities  as  Denver  and  Salt  Lake  City  is  countered 
by  the  attractions  of  the  trip.  Many  will  plan 
vacation  jaunts  to  include  visits  to  Yellowstone 
National  Park  and  Glacier  National  Park,  Butte 
being  but  a half-day’s  drive  from  either.  Even 
without  these  added  attractions,  the  program  it- 
self on  the  following  pages  will  assure  a record 
attendance. 


HOTEL  RESERVATIONS 

The  New  Finlen  Hotel,  Butte,  Mont.,  will  be 
headquarters  for  the  fifth  Rocky  Mountain  Med- 
ical Conference,  and  most  of  the  activities  of  the 
Conference  will  be  centered  in  that  hotel. 

Naturally,  however,  the  Finlen  Hotel  cannot 
itself  accommodate  everyone  who  attends  the 
Conference.  Butte  has  several  other  good  hotels 
and  many  attractive  motor  courts,  so  the  city 
as  a whole  can  comfortably  house  the  entire 
Conference. 

The  management  of  the  Finlen  Hotel  has 
agreed  to  act  as  a clearing  house  for  reservation 
requests,  whether  they  apply  to  the  Finlen  or  to 
other  hotels  or  motor  courts.  Requests  for  reser- 
vations, therefore,  may  be  addressed  to  the  Man- 
ager, Finlen  Hotel,  Butte,  Mont.,  specifying  the 
type  of  accommodations  desired  and  the  exact 
date  of  arrival  in  Butte. 


470 


Rocky  Mountain  Medical  Journal 


Anyone  who  prefers  may  write  to  Dr.  Charles 
W.  Pemberton,  9 West  Granite  Street,  Butte, 
Mont.,  who  is  Chairman  of  the  Housing  Com- 
mittee for  the  Conference,  and  Dr.  Pemberton 
will  gladly  make  an  appropriate  reservation. 

It  should  be  noted,  however,  that  as  a general 
rule  all  motor  courts  require  a deposit  of  $5  in 
order  to  confirm  an  advance  reservation.  Any- 
one desiring  a motor  court  reservation  should 
enclose  a check  for  $5,  therefore,  to  insure  a 
definite  confirmation. 

Early  reservations  will  naturally  result  in  the 
best  accommodations. 


REGISTRATION  AT  THE  R.M.M.C. 

Registration  at  the  Rocky  Mountain  Medical 
Conference  is  open  to  any  Doctor  of  Medicine 
who  is  a member  in  good  standing  of  his  State 
Medical  Society.  Registration  is  not  limited  to 
physicians  within  the  five  states  which  partici- 
pate in  managing  the  Conference. 

The  registration  fee  for  the  fifth  meeting  of  the 
Conference  at  Butte,  Montana,  is  ten  dollars. 
The  registration  fee  does  not  apply  to  members 
of  the  physician’s  family  who  may  accompany 
him  to  the  meeting.  Each  physician  will  be 
given  an  identification  badge,  and  admission  to 
all  Conference  activities  will  be  by  badge  only. 
Separate  tickets  will  be  on  sale  at  the  Registra- 
tion Desk  for  the  Round-Table  Luncheons  and 
the  Banquet. 

Any  physician  who  is  not  a member  of  his 
State  Medical  Society  may  register  on  payment 
of  the  regular  ten-dollar  registration  fee  plus  a 
penalty  fee  of  five  dollars.  In  such  cases,  the 
additional  five  dollars  will  be  remitted  by  the 
Conference  direct  to  the  appropriate  State  Med- 
ical Society  and  will  become  the  property  of 
that  society.  Should  that  society’s  regulations 
permit  and  should  it  be  mutually  agreeable  to 
the  doctor  and  that  society,  the  five  dollars  may 
be  considered  as  a payment  on  account,  in  case 
of  delinquency,  or  as  an  advance  partial  pay- 
ment of  dues  in  the  event  of  an  application  for 
membership. 

THE  R.M.M.C.  RUNS  BY  THE  CLOCK! 

The  Scientific  Programs  of  the  Rocky  Mountain 
Medical  Conference  are  run  by  the  clock,  to  the 
minute.  This  has  been  true  of  the  four  previous 
meetings,  and  it  will  be  true  at  Butte. 

All  meetings  will  begin  on  time,  all  speakers 
will  be  required  to  begin  their  presentations 
exactly  on  time  and  none  will  be  permitted  to 
speak  longer  than  as  scheduled  in  the  program. 
All  who  attend  the  Conference  are  requested  to 
assist  the  speakers  and  benefit  themselves  by  be- 
ing in  the  meeting  room  a few  minutes  in  ad- 
vance of  the  papers  they  wish  to  hear.  Any 
member  who  arrives  late  to  hear  any  particular 
paper  is  assured  that  he  will  miss  part  of  that 
paper!  Also,  his  late  arrival  would  be  disturb- 
ing to  the  speaker  and  to  the  audience  alike. 


ENTERTAINMENT  AT  BUTTE 

All  work  and  no  play — you  know  the  old  say- 
ing. So,  the  Entertainment  Committees  for  the 
Rocky  Mountain  Medical  Conference  in  Butte 
guarantee  that  there  will  be  plenty  of  play,  and 
plenty  of  time  to  play,  during  the  August  meet- 
ing. 

Sunday  afternoon  and  Monday,  July  31  and 
August  1,  the  Montana  doctors  will  be  busy 
with  their  annual  business  sessions.  House  of 
Delegates,  Council,  etc.  Monday  most  of  the 
doctors  and  their  wives  from  the  other  states 
will  be  arriving.  Monday  night  has  therefore 
been  picked  as  a good  time  for  informal  get-to- 
gethers, tours  of  the  town  and  its  night  spots, 
in  other  words  just  whatever  anyone  wants  to 
do,  singly  or  in  groups. 

Tuesday  evening  there  will  be  planned  enter- 
tainment. A stag  will  be  held  at  the  Butte 
Country  Club.  The  ladies’  party  will  be  at  the 
Finlen  Hotel. 

On  one  of  the  days,  Tuesday,  Wednesday,  or 
Thursday  (August  2,  3,  4),  there  will  be  a special 
tea  for  the  ladies,  the  exact  time  and  place  to  be 
announced  in  the  final  program. 

Wednesday  evening  will  be  largely  given  over 
to  the  banquet,  for  everyone.  This  will  be  held 
at  the  Finlen  Hotel,  and  promises  to  be  out- 
standing in  R.M.M.C,  history.  After  the  banquet 
there  will  be  dancing. 

All  the  above,  of  course,  sounds  fine,  and  just 
like  “old  times.”  In  addition,  Butte  has  the 
famous  “richest  hill  on  earth,”  what  amounts  to 
a solid  mountain  of  rich  copper  ore.  It  has  the 
Anaconda  Copper  Company,  which  has  promised 
our  committees  full  cooperation  so  that  all  at- 
tending the  R.M.M.C.  who  so  desire  may  be 
taken  on  a tour  of  one  of  the  great  copper  mines 
— right  in  the  edge  of  town — and  may  also  make 
a tour  of  the  company’s  huge  copper  smelter  at 
Anaconda,  a few  miles  west  of  Butte. 


POCKET  PROGRAM 

A final  program  for  the  Fifth  Rocky  Mountain 
Medical  Conference  complete  with  additional  de- 
tails not  available  for  the  Program  Number  of 
the  Journal,  will  be  published  in  pocket  size  in 
early  July  and  mailed  to  all  members  of  the 
participating  State  Medical  Societies. 


MONTANA  OBSTETRICAL  AND 
GYNECOLOGICOL  SOCIETY 

The  Montana  Obstetrical  and  Gynecological 
Society  plans  to  hold  a special  meeting  in  Butte 
Monday  evening,  August  1,  in  connection  with 
the  Rocky  Mountain  Medical  Conference.  All 
physicians  attending  the  Conference  who  arrive 
in  Butte  in  time  and  wish  to  attend  the  meeting 
will  be  welcome. 

The  final  pamphlet  program  of  the  Conference 
will  contain  the  details  of  the  special  meeting. 
Watch  for  it. 


for  June,  1949 


471 


YELLOWSTONE  NATIONAL  PARK  — GLACIER  NATIONAL  PARK 


Butte,  Montana,  is  situated  just  about  half  way  between  two  of  the  greatest  na- 
tional parks,  a half-day’s  auto  drive  north  of  Yellowstone,  a half-day’s  drive  south  of 
Glacier.  Physicians  and  their  families  in  the  more  southerly  states  of  the  Rocky  Moun- 
tain Medical  Conference  should  consider  a vacation  trip  to  one  or  both  of  these 
parks  in  their  plans  for  attending  the  Butte  meeting.  Pictured  on  the  left  is  Old  Faith- 
ful geyser  in  Yellowstone,  on  the  right  Going  to  the  Sun  mountain,  in  Glacier. 


Official  Call 

To  the  Officers,  Delegates,  Committeemen,  the  Mem- 
bers of  the  State  Medical  Association  and  Physicians 
of  Montana — Greetings: 

We  are  extremely  fortunate  this  year  that  the 
Scientific  portion  of  our  state  meeting  is  in  col- 
laboration with  the  Rocky  Mountain  Medical 
Conference  and  it  has  been  arranged  that  all  our 
House  of  Delegates  business  be  concluded  prior 
to  this  scientific  session. 

The  Council  will  convene  at  1:00  p.m.,  Sunday, 
July  .31,  1949,  at  the  New  Finlen  Hotel,  Butte, 
Montana. 

The  House  of  Delegates  will  convene  for  its 
First  Session  at  the  New  Finlen  Hotel,  Butte, 
Montana,  at  2:00  p.m.,  Sunday,  July  31,  1949. 
The  Second  Session  will  convene  at  the  same 
place  on  Monday,  August  1,  1949,  at  10:00  a.m. 
The  House  of  Delegates  will  be  subject  to  call  by 
the  President  at  any  other  time  during  the  day 
or  evening  of  Sunday  or  Monday. 

It  is  expected  that  many  problems  of  great 
importance  to  the  profession  in  our  state  will  be 
discussed  at  our  House  of  Delegates.  It  is  ex- 
tremely important  that  all  delegates  make  every 
effort  to  attend. 


The  Scientific  Assembly  of  the  Rocky  Moun- 
tain Medical  Conference  will  convene  at  10  a.m., 
Tuesday,  August  2,  in  the  Silver  Bow  Room  of 
the  New  Finlen  Hotel,  and  subsequently  accord- 
ing to  the  program. 

Thos.  L.  Hawkins,  M.D., 

President. 

Attest: 

H.  T.  Caraway,  M.D., 

Secretary-Treasurer. 


ROUND-TABLE  LUNCHEONS 

During  the  noon  recesses  of  all  three  days  of 
the  Rocky  Mountain  Medical  Conference,  August 
2,  3,  and  4,  Round-Table  Luncheons  will  be  con- 
ducted in  one  or  more  private  dining  rooms  of 
the  Finlen  Hotel,  giving  opportunities  for  ques- 
tions to  be  put  to  the  guest  speakers  regarding 
their  special  fields  of  scientific  work. 

Attendance  at  these  special  luncheons  will  be 
necessarily  limited  by  the  capacity  of  the  dining 
rooms,  and  for  this  reason  tickets  must  be  pur- 
chased in  advance  at  the  Conference  registration 
desk  in  the  hotel  lobby. 

Additional  details  concerning  the  luncheons 
will  be  available  by  the  time  the  final  pocket- 
size  pamphlet  program  is  published. 


472 


Rocky  Mountain  Medical  Journal 


mutant 


Biennial 

ROCKY  MOUNTAIN  MEDICAL  CONFERENCE 

and 

Annual  Session 


MONTANA  STATE  MEDICAL  ASSOCIATION 

BUTTE,  MONTANA 


Note  These  Dates — 

Official  bodies  of  the  Montana  State  Medical  Association  including  its  Council  and  its 
House  of  Delegates,  will  meet  July  31  and  August  1,  1949. 

The  Rocky  Mountain  Medical  Conference  proper  will  meet  August  2,  3,  and  4,  1949. 

Headquarters: 

THE  NEW  FINLEN  HOTEL 


SUNDAY,  JULY  31 

12:00  Noon — Registration  opens  for  both 
meetings. 

1:00  P.M. — Annual  Meeting  of  the  Council 
of  the  Montana  State  Medical  Asso- 
ciation. 

2:00  P.M. — Annual  Session  of  the  House  of 
Delegates,  Montana  State  Medical 
Association,  first  meeting. 

MONDAY,  AUGUST  1 

All  Day — Registration  desk  open  for  all 
meetings. 

All  Day — Installation  of  exhibits. 

10:00  A.M. — Annual  Session  of  the  House 
of  Delegates,  Montana  State  Medical 
Association,  second  meeting. 

Evening — Annual  Meeting,  Montana  Ob- 
stretrical  and  Gynecological  Society; 
details  to  be  announced  later. 

ROCKY  MOUNTAIN  MEDICAL 
CONFERENCE 

General  Program 

TUESDAY,  AUGUST  2 

8:30 — Registration  and  Exhibits  Open. 

Harold  W.  Gregg,  M.D.,  Butte,  Chair- 
man, Rocky  Mountain  Medical 
Conference,  Presiding. 

9:30 — Opening  Exercises. 

9:45 — Cyrus  C.  Sturgis,  M.D.,  Ann  Arbor, 
Professor  of  Medicine,  University  of 

for  June,  1949 


Michigan. — “The  Present  Status  of 
Our  Knowledge  Concerning  the  Eti- 
ology and  Treatment  of  Hyperten- 
sion.” 

Hypertension  will  be  de[ined,  its  frequency  dis- 
cussed, and  the  various  types  classified.  The 
etiology  will  be  considered  with  special  refer- 
ence to  the  role  of  the  kidney  and  the  sympa- 
thetic nervous  system  in  the  production  of  the 
disorder.  The  treatment  of  hypertension  will 
be  evaluated  from  the  standpoint  of  the  im- 
portance of  mental  and  physical  rest,  weight 
reduction,  regulation  of  the  use  of  tobacco  and 
alcohol,  the  effect  of  bacterial  pyrogens,  various 
drugs  as  potasium  sulphocyanate,  nitrites,  tet- 
raethylammonium,  and  the  newer  preparations 
which  inhibit  the  functions  of  the  sympathetic 
nervous  system.  The  indications  for  and  the 
results  obtained,  by  various  operations  on  the 
sympathetic  nervous  system  will  be  presented. 
The  place  of  a low  sodium  diet  in  the  manage- 
ment of  hypertension,  and  the  results  follow- 
ing such  therapy  will  be  discussed.  Finally, 
practical  considerations  dealing  with  the  man- 
agement of  patients  with  hypertension,  and  the 
most  dependable  means  of  form.ulating  a prog- 
nosis in  any  given  patient  will  be  summarized. 

10:30— Harold  G.  Wolff,  M.D.,  New  York 
City,  Associate  Professor  Psychiatry, 
Cornell  University. — “Life  Situations, 
Emotions  and  Bodily  Disease. 

11:15 — Henry  L.  Barnett,  M.D.,  New  York 
City,  Assistant  Professor  of  Pediat- 
rics, Cornell  University. — “Current 
Concepts  Regarding  the  Nature  and 
Treatment  of  Nephritis  and  the 
Nephrotic  Syndrome  in  Children.” 

Our  present  day  care  of  children  with  kidney 
disease  is  based  essentially  on  clinical  experi- 
ence and  is  critically  limited  by  our  lack  of 

473 

libhajry  of  the 

r oy  r r 


basic  understanding  of  the  nature  of  the  disease. 
Associated  with  recent  advancements  in  our 
knowledge  of  kidney  psysiology  the  emphasis 
has  been  shifted  from  earlier  attempts  to  cor- 
relate the  clinical  picture  with  anatomical  find- 
ings to  a more  dynamic  physiologic  approach. 
The  application  of  newer  physiologic  technics 
to  clinical  problems  tvill  be  described:  briefly 
in  regard  to  their  potential  contribution  to  an 
understanding  of  the  nature  of  the  disease;  and 
at  greater  length  in  respect  to  their  role  in 
clinical  evaluation.  The  possible  relationship 
of  the  nephrotic  syndrome  to  some  type  of 
sensitivity  will  also  be  discussed. 

The  influence  of  the  above  factors  on  the 
clinical  management  of  children  with  kidney 
disease  will  be  discussed  in  terms  of  diagnosis, 
treatment  and  prognosis.  This  discussion  will 
include  consideration  of  diet,  activity,  exposure 
to  infection,  chemotherapy,  and  the  wide  variety 
of  agents  recommended  for  the  treatment  of 
edema  (salt-poor  albumin,  measles). 

12:00 — Recess. 

12:30 — Luncheon  and  Round  Table  Discus- 
sion. 

AFTERNOON 

L.  L.  Ward,  M.D.,  Pueblo,  Vice  President, 
Colorado  State  Medical  Society, 
Presiding. 

2:00 — J.  Englebert  Dunphy,  M.D.,  Boston, 
Assistant  Professor  of  Surgery,  Har- 
vard Medical  School. — “The  Treat- 
ment of  Bleeding  Gastric  or  Duo- 
denal Ulcer.” 

The  treatment  of  bleeding  ulcer  is  a joint  re- 
sponsibility which  must  be  .shared  by  both  in- 
ternist and  surgeon.  Since  the  vast  majority  of 
patients  will  recover  with  medical  treatment 
alone,  this  should  be  instituted  initially  in  all 
cases  and  surgery  reserved  for  those  patients 
who  appear  to  be  bleeding  to  death  despite 
medical  measures.  The  details  of  medical  man- 
agement are  of  great  importance  and  if  care- 
fully instituted  reduce  the  number  of  patients 
who  require  surgery  to  a very  small  group. 

The  selection  of  patients  for  operation  is  made 
by  estimating  the  rate  of  bleeding  rather  than 
on  the  basis  of  age,  number  of  previous  hemor- 
rhages or  other  factors  which  have  been  empha- 
sized in  the  past.  Experience  indicates  that  if 
the  rate  of  bleeding  is  such  that  a stable  circu- 
lation cannot  be  maintained  by  transfusions 
roughly  approximating  500  c.c.  per  eight  hours, 
emergency  operation  should  be  undertaken. 

A knowledge  of  the  source  of  bleeding  is  es- 
sential and  if  not  evident  from  the  history  and 
clinical  findings  an  emergency  x-ray  examina- 
tion should  be  done  prior  to  surgery. 

2:45 — Robert  A.  Kehoe,  M.D.,  Cincinnati, 
Director  of  Kettering  Laboratory  of 
Applied  Physiology,  University  of 
Cincinnati. — “The  Medical  Control  of 
Occupational  Lead  Absorption.” 

The  prevention  of  occupational  lead  poisoning 
is  based  upon  a sound  knowledge  of  the  nature 
and  the  degree  of  the  hazards  of  lead  absorption 
associated  with  the  industrial  operations  in 
which  lead  is  handled  or  used.  The  nature  of 
the  hazard  relates  to  the  manner  in  which  in- 


dustrial employees  are  exposed  to  lead,  that  is 
the  means  of  absorption  of  lead,  in  industry 
or  in  a specific  industry  with  which  one  is 
concerned.  The  degree  of  the  hazard  asso- 
ciated with  a specific  occupation  is  concerned 

( 1 ) with  the  rate  at  which  lead  is  absorbed  and 

( 2 ) with  the  duration  of  the  employment.  From 
the  medical  viewpoint,  adequate  knowledge  of 
those  matters  provides  the  only  basis  on  which 
the  safety  of  a group  of  men  under  one’s  super- 
vision can  be  assured.  With  such  knowledge, 
the  physician  can  appraise  the  degree  of  the 
hazard  to  which  individuals  and  groups  of  men 
are  exposed,  and  can  so  limit  the  duration  of 
their  exposure  as  to  prevent  the  occurrence  of 
plumbism.  By  their  removal  from  their  work 
before  they  develop  illness,  and  while  they  are 
on  the  threshold  of  the  danger  of  becoming 
ill,  they  can  be  protected  even  though  their 
work  may  be  hazardous.  Or  by  proper  alter- 
nation of  the  work  schedules  of  men  so  as  to 
make  their  exposure  to  lead  intermittent,  they 
can  be  kept  within  the  limits  of  safe  lead  ab- 
sorption. The  best  means  of  protecting  them 
is  to  see  that  the  working  environment  is  safe. 
The  physician  can  detremine  what  is  safe  but 
only  those  responsible  for  industrial  operations 
can  create  and  maintain  safe  conditions.  The 
best  industrial  practice,  therefore,  calls  for  team- 
work by  physician  and  engineer. 

The  physiogical  facts  and  principles  on  ivhich 
the  means  of  medical  control  can  be  based  in 
some  detail,  and  practical  regimen  will  be  de- 
scribed 

3 :30 — Intermission. 

3:45— Harold  G.  Wolff,  M.D.,  New  York 
City,  Associate  Professor  of  Psychia- 
try, Cornell  University. — “Headache 
Mechanisms.” 

4:30 — Adjourn. 

EVENING 

Stag  party  for  doctors  and  card  party  for 
ladies  to  be  arranged  by  Butte  Committee; 
details  to  be  announcer  later. 

WEDNESDAY,  AUGUST  3 
MORNING 

9:00 — Registration  and  Exhibits  Open. 

Thomas  L.  Hawkins,  M.D.,  Helena, 
President,  Montana  State  Med- 
ical Association,  Presiding. 

9:30 — Henry  L.  Barnett,  M.D.,  New  York 
City,  Assistant  Professor  of  Pediat- 
rics, Cornell  University. — “Common 
Problems  Encountered  in  a Pediatric 
Metabolism  Clinic.” 

Endocrine  diseases  in  children  or  adults  should 
be  considered  a part  of  the  broader  group  of 
general  metabolic  disorders.  In  a general  ped- 
iatric population,  the  number  of  children  found 
to  have  frankly  recognizable  endocrine  disor- 
ders is  very  small  but  the  proper  recognition 
and  treatment  of  this  group  of  children  neces- 
sitates a well-defined  appraisal  of  normal  varia- 
tions in  growth  and  function  which  encompasses 
the  entire  field  of  general  pediatrics  and  par- 
ticularly pediatric  psychiatory. 

The  evaluation  and  treatment  of  children  re- 
ferred to  a special  metabolic  clinic  from  a gen- 


474 


Rocky  Mountain  Medical  Journal 


era/  pediatric  clinic  having  in  excess  of  35.000 
patient  visits  a year  will  be  described.  The 
discussion  will  deal  more  specifically  ivith  chiU 
dred  presenting  the  findings  of  juvenile  obesity, 
diabetes  mellitus,  cryptorchidism  and  hypothy- 
roidism. since  these  represent  the  most  fre- 
quently encountered  problems.  Children  with 
retarded  growth  in  height,  diabetes  insipidus, 
precocious  sexual  development,  hyperthyroidism 
and  adrenal  disorders  will  also  be  considered. 

10:15 — Cyrus  C.  Sturgis,  M.D.,  Ann  Arbor, 
Professor  of  Medicine,  University  of 
Michigan. — “The  Anemias.” 

Anemia  will  be  defined,  the  main  types  classi- 
fied, their  frequency  emphasized,  and  the  rela- 
tion of  the  reduction  of  the  hemoglobin  of  the 
circulating  blood  to  the  production  of  symptoms 
considered.  The  cause  and  treatment  of  the 
anemias  of  infection,  iron  deficiency  anemia, 
and  the  anemias  of  pregnancy  will  be  presented. 
Splenectomy  in  the  treatment  of  some  types  of 
hemolytic  anemia  will  be  evaluated.  Special 
attention  will  be  given  to  the  more  recent  de- 
velopments in  the  treatment  of  the  m.acrocytic 
anemias,  including  Addisonian  pernicious  ane- 
mia and  related  conditions.  The  use  of  folic  acid 
and  vitamin  B-12  in  the  practical  management 
of  the  various  macrocytic  anemias  and  the  re- 
lation of  those  substances  to  the  etiology  of  the 
anemias  will  be  discussed. 

11 :00 — Intermission. 

11:15 — Robert  A.  Kehoe,  M.D.,  Cincinnati, 
Director  of  Kettering  Laboratory  of 
Applied  Physiology,  University  of 
Cincinnati. — “Medical  Practice  in  Re- 
lation to  Industrial  Health.” 

The  practice  of  industrial  medicine,  outside  of 
a few  large  industrial  centers  and  with  the  ex- 
ception of  that  involving  large  industrial  or- 
ganizations in  which  full  time  industrial  physi- 
cians are  engaged,  will  continue  for  some  time 
and  probably  indefinitely  to  be  carried  out  by 
men  whose  primary  training  and  experience  are 
in  the  field  of  private  medical  practice.  The  de- 
mands being  made  on  medical  men  by  a highly 
industrialized  society  such  as  that  of  the  United 
States  are  such  as  to  extend  far  beyond  the 
knowledge  and  professional  competence  of  phy- 
sicians as  they  are  now  generally  trained.  The 
problems  with  which  the  physician  in  industry 
is  presented  are  not  primarily  those  of  curative 
medicine  but  those  of  preventive  medicine.  They 
relate  to  job  appraisal  and  the  fitness  of  the 
employee  for  his  job,  to  detailed  knowledge  of 
the  working  environment,  its  stresses  and  its 
physical,  chemical  and  psychological  hazards. 
They  require,  at  least,  some  familiarity  with 
biometry  and  expidemiology,  considerable 
knowledge  of  industrial  toxicology  in  many 
instances,  and  more  average  chemical  skill. 

The  training  of  specialists  in  the  field  of  in- 
dustrial medicine,  through  postgraduate  train- 
ing of  a comprehensive  type,  has  come  to  be 
our  urgent  professional  need  and  steps  are  being 
taken  to  meet  that  need.  Little  provision  has 
been  made,  as  yet,  in  the  form  of  opportunities 
for  the  training  which  practicing  physicians  re- 
quire to  assume  the  responsibilities  of  part-time 
industrial  medical  practice.  It  may  be  expected 
that  such  opportunities  will  be  provided  by 
various  means  in  the  near  future. 

The  nature  of  the  problems  that  present  them- 
selves will  be  described  briefly,,  and  the  means 


available  to  physicians  who  wish  to  equip  them- 
selves for  satisfactory  practice  in  industrial 
medicine  will  be  discussed. 

12:00 — Recess. 

12:30 — Luncheon  and  Round  Table  Discus- 
sion. 

AFTERNOON 

I.  J.  Marshall,  M.D.,  Roswell,  Presi- 
dent-Elect, New  Mexico  Medical 

Society,  Presiding. 

2:00 — J.  Englebert  Dunphy,  M.D.,  Boston, 
Assistant  Professor  of  Surgery,  Har- 
vard Medical  School. — “Some  Prob- 
lems in  Surgery  of  the  Biliary  Tract.” 

Pathological  lesions  in  the  gall  bladder  and  bile 
ducts  present  problems  of  a controversial  nature 
in  the  daily  life  of  both  internist  and  surgeon. 
This  paper  deals  with  such  questions  as  the 
relationship  between  gallstones  and  heart  dis- 
ease, the  management  of  acute  cholecystitis,  and 
the  indication  for  surgery  in  "silent  gallstones." 
The  mechanism  of  the  "hepatorenal  syndrome" 
following  operation  on  the  biliary  tract  is  dis- 
cussed with  the  report  of  a case  successfully 
treated  by  means  of  the  artificial  kidney. 

2 :45 — Intermission. 

3:00 — John  Royal  Moore,  M.D.,  Philadel- 
phia, Professor  of  Orthopedic  Sur- 
gery, Temple  University. — “Correc- 
tion of  Long  Bone  Deformities  by 
Osteotomy-Osteoclasis.” 

Deformities  of  the  long  bones  including  mal- 
united  fractures,  deformities  secondary  to  rick- 
ets, arthritis,  epiphyseal  injuries,  etc.,  are 
corrected  first  by  an  incomplete  osteotomy  fol- 
lowed by  an  osteoclasis  after  a twenty-one  to 
twenty-eight  day  period.  This  procedure  is 
meritorious  in  that  it  permits  correction  of  many 
of  these  deformities  without  using  external  fixa- 
tion and  without  the  complication  usually  en- 
countered in  handling  such  problems.  Lantern 
slides  will  be  used. 

3:45 — Adjourn. 

4:00 — Meeting  of  R.M.M.C.  Continuing 
Committee. 

EVENING 

7:30 — Banquet  for  the  doctors  and  their 
wives.  Speaker:  L.  Fernald  Foster, 
M.D.,  Bay  City,  Secretary,  Michigan 
State  Medical  Society. — “Public  Re- 
lations Begin  in  the  Doctor’s  Office.” 

9:00 — Dancing. 

THURSDAY,  AUGUST  4 

MORNING 

9:00 — Registration  and  Exhibits  Open. 

C.  H.  Jenson,  M.D.,  Ogden,  President- 
Elect,  Utah  State  Medical 
Association,  Presiding 

9:30 — Harvey  B.  Matthews,  M.D.,  Brook- 
lyn, Professor  of  Obstetrics  and 
Gynecology,  Long  Island  College  of 


for  June,  1949 


475 


Medicine. — “Pelvic  Tumors,  Their 
Influence  on  Pregnancy,  Labor  and 
the  Puerperium.” 

Pelvic  tumors  complicating  pregnancy,  labor 
and  the  puerperium  is  an  important  subject  to 
every  physician  doing  obstetrics.  They  do  not 
always  lead  to  troublesome  situations  but  when 
they  do  such  complications  are  likely  to  be 
major  ones  and  therefore  the  attending  physi- 
cian should  be  fortified  with  sufficient  knowl- 
edge of  the  problem  to  give  the  patient  and 
her  child  the  benefits  of  modern  diagnosis  and 
treatment.  Many  types  of  tumors — solid  and 
cystic — have  been  reported  as  complicating 
pregnancy,  labor  and  the  puerperium — the  most 
frequent  being  fibroids  and  ovarian  cysts,  and 
of  these  fibroids  are  more  common.  Compli- 
cations due  to  the  tumor  per  se  as  well  as  the 
pathological  changes  occurring  within  the  tumor 
are  discussed. 

Labor  in  the  presence  of  tumor  may  be  spon- 
taneous or  complicated.  Malposition  is  more 
frequent,  therefore  the  incidence  of  operative 
delivery  is  higher.  Conservative  treatment  is 
advocated,  both  during  pregnancy  and  labor. 
Fibroids,  unless  large  and  badly  situated,  rarely 
interfere  with  vaginal  delivery.  Uterine  inertia 
of  varying  degree  is  often  present.  Caesarian 
section  rates  somewhat  higher;  including  hyster- 
ectomy, much  higher.  Caesarian  section  and 
myomectomy  not  recommended,  except  under 
special  circumstances.  During  puerperium  de- 
generative changes  within  the  tumor  may  call 
for  laparotomy  or  removal  of  fibroid  via  the 
vagina.  Otherwise  conservative  management 
usually  suffices.  Complications  of  ovarian  cysts 
during  pregnancy,  labor  and  the  puerperium  are 
next  considered.  During  the  child  bearing 
period  ovarian  cysts  are  not  as  common  as 
fibroids  but  treatment  is  more  radical  because 
the  potentialities  for  complications  are  much 
greater.  Conclusions  follow.  {Lantern  slides  il- 
lustrate the  address). 

10:15 — Charles  L.  Martin,  M.D.,  Dallas,  Pro- 
fessor of  Radiology,  Southwestern 
Medical  College.  — “Treatment  of 
Sterility  With  Hysterosalpingogra- 
phy.” 

More  than  half  of  the  women  suffering  from 
sterility  have  occlusion  of  the  fallopian  tubes. 
In  our  experience,  the  Rubin  test  has  been  rela- 
tively unsuccessful  as  a therapeutic  procedure 
in  such  cases,  and  the  best  results  have  been 
obtained  by  maintaining  a slowly  increasing 
pressure  within  the  tubes  applied  with  injected 
lipiodol  over  a considerable  period  of  time.  In 
a series  of  169  cases  subjected  to  this  procedure, 
in  whom  patency  was  established,  pregnancy 
occurred  in  seventy-two  within  a period  of  a 
few  months.  The  filling  of  the  tubes  is  checked 
by  a series  of  radiographs  made  while  the  oil 
pressure  is  applied  and  the  details  of  the  technic 
will  be  illustrated  with  lantern  slides. 

1 1 :00 — Intermission. 

11:15 — L.  Fernald  Foster,  M.D.,  Bay  City, 
Secretary  of  Michigan  State  Medical 
Society. — “Newer  Responsibilities  of 
Organized  Medicine.” 

The  new  present-day  social  and  political  phi- 
losophy under  which  we  are  living  has  brought 
new  responsibilities  to  the  organized  medical 


profession.  It  is  no  longer  possible  for  medical 
men  to  devote  all  their  time  and  energy  to  the 
advancement  of  medicine  as  a science. 

Its  social  and  economic  aspects  have  become 
so  vital  to  our  American  way  of  life  that  medi- 
cal organizations  should  accept  the  responsibil- 
ity of  developing  educational  programs  both  for 
their  individual  members  and  for  the  lay  public. 
Such  programs  must  reflect  the  group  thinking 
of  all  the  members  of  medical  societies  acting 
as  a unit  and  must  make  the  rugged  pronounce- 
ments of  doctors,  as  individuals,  generally  con- 
sistent with  the  group  thinking  of  their  organi- 
zations. The  latter  task  is  a difficult  one  since 
doctors  by  training  and  experience  are  accus- 
tomed to  acting  rigidly  as  individuals. 

There  should  be  no  unsurmonnfable  reason 
why  American  doctors  in  their  organizations 
cannot  agree  upon  certain  basic  philosophies  of 
health  care  and  be  able  to  present  such  philoso- 
phies to  the  American  public. 

12:00 — Recess. 

12:30 — Luncheon  and  Round  Table  Discus- 
sion. 

AFTERNOON 

George  E.  Baker,  M.D.,  Casper,  President, 
Wyoming  State  Medical  Society, 
Presiding. 

2:00 — John  Royal  Moore,  M.D.,  Philadel- 
phia, Professor  of  Orthopedic  Sur- 
gery, Temple  University  Hospital. — 
“Cartilaginous  Cup  Arthroplasty  of 
the  Hip.” 

This  deals  with  nonunited  fractures  of  the  neck 
of  the  femur  and  makes  use  of  the  hyaline 
cartilage  cup.  Literally  it  is  a hyaline 
cartilage  transplantation.  Reference  is  made  to 
similar  transplantations  in  old  club  feet. 

Lantern  slides  and  movies,  16  m.m„  will  be 
used. 

2:45 — Charles  L.  Martin,  M.D.,  Dallas,  Pro- 
fessor of  Radiology,  Southwestern 
Medical  College.  — “Treatment  of 
Cancer  of  the  Skin  With  Irradiation.” 

In  the  Southwestern  states  more  than  30  per 
cent  of  the  patients  entering  a tumor  clinic  have 
skin  cancer  and  many  of  the  lesions  are  far  ad- 
vanced. Technics  have  been  worked  out  where- 
by all  of  the  neoplasms  originating  on  the  face, 
ear,  nose,  eyelids,  lip  and  neck  are  treated  with 
x-rays  or  low  intensity  radium  needles.  In  some 
instances  the  irradiation  is  preceded  by  electro- 
surgery and  occasional  plastic  surgery  is  used 
afterwards.  Many  slides  illustrating  results  will 
be  shown. 


476 


Rocky  Mountain  Medical  Journal 


In  our  clinic,  all  metastatic  cervical  nodes  are 
treated  with  a combination  of  implanted  low 
intensity  radium  needles  and  external  x-ray 
therapy.  The  results  obtained  in  146  such  cases 
treated  five  or  more  years  ago  will  be  reported. 

3 :30 — Intermission. 

3:45 — All  Exhibits  Close. 

3:45 — Harvey  B.  Matthews,  M.D.,  Brook- 
lyn, Professor  Obstetrics  and  Gyne- 
cology, Long  Island  College  of  Medi- 
cine.— “Obstetric  Shock;  Its  Causes, 
Recognition  and  Management.” 

The  condition  of  shock  or  its  equivalent,  in 
one  form  or  another,  has  been  known  since 
primitive  man  came  upon  the  earth.  Even  today 
it  is  very  difficult  to  adequately  define  shock. 
It  is  one  of  the  most  confusing  syndromes  en- 
countered by  the  clinician.  Recognition  before 
degenerative  changes  in  certain  vital  organs  is 
very  necessary  if  successful  treatment  is  to 
follow.  Irreversable  shock  is  sure  death.  The 
means  for  possible  prevention  and  recognition 
of  early  shock  are  at  hand  if  the  physician  is 
cognizant  of  the  early  manifestations. 

Obstetric  shock  is  no  different  from  other  types 
of  shock,  but  the  obstetric  patient  is  more  sus- 
ceptible to  shock,  because  of  the  physiologic 
changes  coincident  with  pregnancy,  labor  and 
the  postpartum  period.  Certain  of  the  physi- 
ological changes  may  predispose-  to  shock  and 
shock-like  conditions  in  the  presence  of  inef- 
ficient function  of  a vital  organ  or  system 
and/or  trauma,  hemmorrhage,  anesthesia  and 
infection.  Early  recognition,  therefore,  is  most 
important.  A thorough  knowledge  of  the  early 
manifestations  is  prerequisite.  The  best  treat- 
ment of  shock  is  prevention.  Active  treatment 
consists  essentially  in  sedation,  maintenance  of 
body  temperature,  and  replacement  of  blood 
volume.  "Pros  and  cons"  of  various  procedures 
recommended  in  treatment  of  shock  are  re- 
viewed. The  importance  of  blood  transfusion  is 
stressed.  {Lantern  slides  illustrate  the  address.) 

4:30 — Final  Adjournment. 


SCIENTIFIC  EXHIBITS 

A noteworthy  group  of  scientific  exhibits  will 
be  displayed  at  the  Butte  meeting  of  the  Rocky 
Mountain  Medical  Conference.  These  exhibits 
will  be  placed  in  large  “sample  rooms”  of  the 
Finlen  Hotel’s  mezzanine  floor,  where  quiet 
study  of  them  is  easy.  The  list  of  scientific  ex- 
hibits will  be  published  in  the  pocket-size  final 
program  of  the  Conference,  to  be  issued  in 
early  July  to  all  physicians  of  the  region. 


HENRY  LEWIS  BARNETT,  M.D. 

New  York  City 

Henry  L.  Barnett, 

M.D.,  Assistant  Pro- 
fessor of  Pediatrics, 

Cornell  University,  re- 
ceived his  pre-medical 
education  at  Dart- 
mouth College  and  his 
medical  degree  from 
the  Washington  Uni- 
versity School  of  Med- 
icine. Dr.  Barnett  was 
head  of  the  Pediatric 
section  of  St.  Louis 
City  Hospital  from 
1941  to  1943  and  as- 
sistant attending  pe- 
diatrician at  New 
York  Hospital.  At  present  he  is  in  charge  of 
research  in  the  Department  of  Pediatrics  at 
Cornell  University  Medical  College.  Dr.  Barnett 
is  a member  of  the  American  Association  for  the 
Advancement  of  Science,  St.  Louis  Pediatric  So- 
ciety, American  Academy  of  Pediatrics,  Society 
for  Pediatric  Research,  Society  of  Experimental 
Biology  and  Medicine,  American  Board  of  Pediat- 
rics. He  has  contributed  widely  to  medical  lit- 
erature. During  World  War  H Dr.  Barnett 
served  as  pediatrician  for  the  community  from 
the  beginning  of  the  atomic  bomb  project  at 
Los  Alamos  where  he  also  participated  in  some 
of  the  experimental  work  on  the  effects  of  ra- 
diation. He  was  part  of  an  investigative  group 
studying  the  effects  of  the  atomic  bombs  in 
Hiroshima  and  Nagasaki  and  later  participated 
in  preparation  of  the  official  report  concerning 
these  effects. 


J.  ENGLEBERT  DUNPHY,  M.D. 

Boston 

J.  Englebert  Dun- 
phy,  M.D.,  Assistant 
Professor  of  Surgery, 
Harvard  School,  grad- 
uated from  Harvard 
Medical  School.  He 
trained  at  Peter  Bent 
Brigham  Hospital  un- 
der the  late  Professor 
Elliot  Cutler  and  has 
been  a member  of  the 
Harvard  faculty  since 
1938.  At  present  he  is 
Assistant  Professor  of 
Surgery  at  Harvard 
and  Surgeon  to  Peter 
Bent  Brigham  Hospi- 
tal. He  served  as  Lt. 
Colonel,  M.C.,  in  England  and  France  during 
World  War  II  and  was  cited  by  the  French  Gov- 
ernment for  contribution  in  Normandy  to  “La 
Cause  Francaise”  during  July  and  August,  1944. 
Contributions  to  the  literature  have  covered  a 
wide  variety  of  topics  but  particularly  shock 
and  surgery  of  the  gastrointestinal  tract. 


for  June,  1949 


477 


CHARLES  L.  MARTIN,  M.D. 
Dallas 


L.  FERNALD  FOSTER,  M.D. 

Bay  City 

L.  Fernald  Foster, 
M.D.,  Secretary  of 
Michigan  State  Med- 
ical Society,  attended 
Lafayette  College 
where  he  was  gradu- 
ated with  a Ph.B.  de- 
gree. He  received  his 
M.D.  at  the  University 
of  Pennsylvania,  with 
an  internship  and  res- 
idency at  the  Presby- 
terian Hospital,  Phila- 
delphia, and  a Resi- 
dency and  Chief  Res- 
idency at  the  Chil- 
dren’s Hospital  of 
Philadelphia. 

Dr.  Foster  has  always  been  active  in  his  pro- 
fessional affiliations,  serving  as  Secretary  of  the 
Bay  County  Medical  Society  for  twenty-five 
years,  and  the  Michigan  State  Medical  Society 
for  thirteen  years.  He  is  also  a Diplomate  of  the 
American  Board  of  Pediatrics  and  of  the  Na- 
tional Board  of  Medical  Examiners,  as  well  as 
a member  of  the  American  Academy  of  Pediat- 
rics. He  served  as  President  of  the  National 
Conference  on  Medical  Service  ten  years  and  is 
now  one  of  the  five  directors  of  the  Co-operative 
Medical  Advertising  Bureau  of  the  AMA  which 
handles  the  business  side  of  thirty-four  state 
medical  journals. 

In  addition  to  private  practice,  his  duties  in- 
clude those  of  Chief  of  the  Department  of  Pediat- 
rics, Mercy  Hospital,  Visiting  Pediatrician,  Bay 
City  General  Hospital,  and  Consulting  Pediatri- 
cian at  the  Midland  and  Mt.  Pleasant  Hospitals. 


ROBERT  ARTHUR  KEHOE,  M.D. 

Cincinnati 

Robert  A.  Kehoe, 

M.D.,  Director  of  Ket- 
tering Laboratory  of 
Applied  Physiology, 

University  of  Cincin- 
nati, received  his  M.D. 
degree  from  the  Uni- 
versity of  Cincinnati 
in  1918  and  has  been 
director  of  Kettering 
Laboratory  since  1930. 

He  is  Professor  of  In- 
dustrial Medicine,  Di- 
rector of  the  Univer- 
sity of  Cincinnati  In- 
stitute of  Industrial 
Health,  Director  of 
Department  of  Pre- 
ventive Medicine  and  Industrial  Health,  Medical 
Director  of  Ethyl  Corporation,  Chief  Medical 
Consultant  Associated  Ethyl  Co.,  Ltd.,  London, 
England,  and  Medical  Consultant  Surgeon  Gen- 
eral’s Office.  In  1920  Dr.  Kehoe  received  the 
Kilgour  prize.  He  is  a member  of  the  Council 
on  Industrial  Health  of  the  American  Medical 
Association.  Dr.  Kehoe  has  contributed  numer- 
ous articles  to  scientific  publications,  also  chap- 
ters in  reference  works  on  industrial  hygiene 
and  toxicology. 


Charles  L.  Martin 
M.D.,  Professor  Radi- 
ology, Southwestern 
Medical  College,  re- 
ceived his  M.D.  de- 
gree at  the  Harvard 
Medical  School.  At  the 
present  time  he  is 
Professor  of  Radiology 
at  the  Southwestern 
Medical  College,  Di- 
rector of  The  Martin 
X-Ray  & Radium 
Clinic  and  radiological 
consultant  to  Baylor, 
Parkland  and  the  Vet- 
e r a n ’ s hospitals  in 
Dallas.  He  is  a past 
President  of  the  American  Radium  Society  and 
has  served  as  Vice  President  of  the  American 
Roetgen  Ray  Society  and  the  American  College 
of  Radiology.  He  has  contributed  some  sixty-five 
scientific  articles  to  the  radiological  literature 
and  has  written  sections  in  two  well  known 
books  dealing  with  the  treatment  of  cancer. 


HARVEY  B.  MATTHEWS,  M.D. 

Brooklyn 

Harvey  B.  Matthews, 

M.D.,  Professor  of  Ob- 
stetrics and  Gynecolo- 
gy, Long  Island  Col- 
lege of  Medicine, 
graduated  from  the 
University  of  Texas 
and  received  his  M.D. 
degree  from  the  Co- 
in m b i a University, 

Physicians  and  Sur- 
geons. He  began  prac- 
tice in  Brooklyn,  New 
York,  in  association 
with  the  late  Dr.  John 
O.  Polak.  Coincident- 
ally  he  became  Lec- 
turer in  Obstetrics  and 
Gynecology  in  the  Long  Island  College  of  Med- 
icine, Brooklyn,  and  for  thirty-five  years  con- 
tinued teaching,  having  successively  been  pro- 
moted to  Associate  Professor,  Clinical  Professor, 
Professor  and  at  the  beginning  of  the  present 
school  year.  Professor  Emeritus.  Dr.  Matthews 
is  Consultant  to  many  hospitals  in  Brooklyn, 
Long  Island,  and  up-state  New  York.  He  was  for 
many  years  Consultant  in  Obstetrics  and  Gyne- 
cology to  the  Will  Rogers  Memorial  Sanitarium 
for  tuberculosis  at  Saranac  Lake,  N.  Y.  His 
writings  include  some  fifty  published  articles. 
His  editorial  activities,  dating  from  1915,  have 
been  varied  and  at  present  he  is  a member  of 
the  Editorial  Board  of  the  American  Journal  of 
Obstetrics  and  Gynecology  and  Associate  Editor 
of  the  Medical  Times.  During  the  New  York 
World’s  Fair  he  was  Chairman  of  a committee 
for  the  New  York  Maternity  Center  Association 
that  put  on  the  exhibit  “How  to  Have  a Baby,” 
which  attracted  1,300,000  visitors. 


478 


Rocky  Mountain  Medical  Journal 


JOHN  ROYAL  MOORE,  M.D. 
Philadelphia 


HAROLD  G.  WOLFF,  M.D. 
New  York  City 


John  Royal  Moore, 
M.D.,  Professor  of  Or- 
th o p e d i c Surgery, 
Temple  University,  re- 
ceived his  M.D.  degree 
in  1925  from  the  Uni- 
versity of  California. 
His  orthopedic  prepa- 
ration was  done  at 
Shriners  Hospital  for 
Crippled  Children  in 
San  Francisco,  1925  to 
1927,  Piedmont  Clinic, 
Atlanta,  Georgia,  un- 
der Dr.  Michael  Hoke, 
1927-1928.  Dr.  Moore 
is  Chief  Surgeon, 
Shriners  Hospital  for 
Crippled  Children,  Philadelphia;  Professor  of 
Orthopedics,  Medical  School  of  Temple  Univer- 
sity, and  Chief  Orthopedic  Surgeon,  Temple  Uni- 
versity Hospital  and  Philadelphia  General  Hos- 
pital; Associate  Professor,  Orthopedics,  Graduate 
School  of  the  University  of  Pennsylvania.  He  is 
a member  of  the  American  Board  of  Orthopedic 
Surgery,  Academy  of  Orthopedic  Surgery,  Fel- 
low of  the  American  Academy  of  Surgery,  mem- 
ber of  the  College  of  Physicians  of  Philadelphia, 
Philadelphia  Orthopedic  Club,  Medical  Club  of 
Philadelphia  and  A.M.A.  Dr.  Moore  is  a Lieu- 
tenant Commander  in  the  Naval  Reserve  and 
Orthopedic  Consultant  for  the  U.  S.  Army. 


CYRUS  C.  STURGIS,  M.D. 

Ann  Arbor 

Cyrus  C.  Sturgis, 

M.D.,  Professor  of 
Medicine,  University 
of  Michigan,  is  a na- 
tive of  Oregon.  He  re- 
ceived his  B.S.  Degree 
from  the  University  of 
Washington,  and  M.D. 
degree  from  Johns 
Hopkins  University  in 
1917.  From  1917  until 
1927,  with  the  excep- 
tion of  one  year  when 
he  served  as  First 
Lieutenant  in  the  U.  S. 

Army,  he  was  con- 
nected with  the  Peter 
Bent  Brigham  Hospi- 
tal in  Boston  and  Harvard  Medical  School.  Since 
1927  he  has  been  Professor  of  Medicine  and  Di- 
rector of  the  Thomas  Simpson  Memorial  Insti- 
tute for  Medical  Research  at  the  University  of 
Michigan.  He  is  a member  of  the  American  So- 
ciety for  Clinical  Investigation,  Central  Society 
for  Clinical  Research,  American  Clinical  and 
Climatological  Association,  American  Goiter  As- 
sociation, American  Association  for  the  Advance- 
ment of  Science  and  is  a Regent  of  the  American 
College  of  Physicians.  His  contributions  to  the 
literature  in  the  field  of  Internal  Medicine  and 
especially  Hematology,  are  well  known. 


Harold  G.  Wolff, 
M.D.,  Associate  Pro- 
fessor Psychiatry,  Cor- 
nell University,  re- 
ceived his  M.D.  and 
A.M.  degrees  from 
Harvard  University. 
He  is  Professor  of 
Medicine  (Neurology) 
and  Associate  Profes- 
sor of  Psychiatry  at 
Cornell  University 
Medical  College.  Dr. 
Wolff  is  also  Attend- 
ing Physician  at  New 
York  Hospital,  Associ- 
ate Attending  Psy- 
chiatrist, Payne  Whit- 
ney Cline,  New  York  Hospital,  and  Consulting 
Neurologist  to  the  Westchester  Division,  New 
York  Hospital,  White  Plains,  New  York.  He  is 
a member  of  the  American  Psychiatric  Associa- 
tion, American  Society  for  Clinical  Investigation, 
New  York  Neurological  Association  and  New 
York  Academy  of  Medicine.  In  1943  and  1949 
he  was  President  for  the  Association  of  Research 
in  Nervous  and  Mental  Disease.  He  has  con- 
tributed widely  to  medical  literature. 


THE  BANQUET  AND  DANCE 

The  evening  of  Wednesday,  August  3,  will  be 
an  especially  bright  spot  for  all  attending  the 
Fifth  Rocky  Mountain  Medical  Conference. 

That  is  the  evening  of  the  banquet  and  dance. 
It  will  be  an  evening  long  to  be  remembered. 
There  will  be  just  one  talk,  by  Dr.  L.  Fernald 
Foster  of  Bay  City,  Michigan,  Secretary  of  the 
Michigan  State  Medical  Society,,  a speaker  of 
national  reputation,  whose  message  is  bound  to 
interest  every  doctor  and  every  doctor’s  wife  and 
family.  There  will  be  other  entertainment,  and, 
finally,  dancing  as  long  as  anyone  wishes. 

Be  sure  to  bring  your  wife,  for'  this  is  not  the 
only  entertainment  designed  with  her  in  mind. 
And  be  sure,  also,  to  get  tickets  for  the  banquet 
and  dance  in  advance.  They  will  be  on  sale  at 
the  Conference  registration  desk. 


TECHNICAL  EXHIBITS 

A S.  Aloe  Laboratories,  St.  Louis,  Missouri, 
Booth  Number  3. 

Ames  Company,  Elkhart,  Indiana,  Booth  Num- 
ber 14. 

Ayerst,  McKenna  & Harrison,  New  York  City, 
Booth  Number  13. 

Baxter,  Inc.,  Don,  Glendale,  California,  Booth 
Number  19. 

Berbert,  George  & Sons,  Denver,  Colorado,  Booth 
Number  D. 

Brown  & Day,  Inc.,  St.  Paul,  Minnesota,  Booth 
Number  2. 

Colvin  Brothers,  Denver,  Colorado,  Booth  Num- 
ber 21. 


for  June,  1949 


479 


Duke  Laboratories,  Inc.,  Stamford,  Connecticut, 
Booth  Number  11. 

Fleet,  C.  B.  Company,  Inc.,  Lynchburg,  Virginia, 
Booth  Number  15. 

General  Electric  X-Ray  Corporation,  Denver, 
Colorado,  Booth  Number  16. 

Harrington’s  Surgical  Supplies,  Butte  and  Bill- 
ings, Montana,  Booth  Number  B. 

Hoffman-LaRoche,  Inc.,  Nutley,  New  Jersey, 
Booth  Number  23. 

Lanteen  Medical  Laboratories,  Incv,  Chicago, 
Illinois,  Booth  Number  8. 

Lederle  Laboratories,  New  York  City,  Booth 
Number  5. 

Lilly,  Eli  and  Company,  Indianapolis,  Indiana, 
Booth  Number  22. 

Lippincott  Company,  J.  B.,  Philadelphia,  Penn- 
sylvania, Booth  Number  9. 

Mead  Johnson  and  Company,  Evansville,  In- 
diana, Booth  Number  4. 

M & R Dietetic  Laboratories,  Inc.,  Columbus, 
Ohio,  Booth  Number  1. 

Philip  Morris  & Company,  Ltd.,  Inc.,  New  York 
City,  Booth  Number  6. 

Physicians  & Hospitals  Supply  Company,  Inc., 
Minneapolis,  Minnesota,  Booth  Number  17. 

Sandoz  Pharmaceuticals,  San  Francisco,  Califor- 
nia, Booth  Number  18. 

Sobering  Corporation,  Bloomfield,  New  Jersey, 
Booth  Number  12. 

Searle,  G.  D.  & Company,  Chicago,  Illinois, 
Booth  Number  25. 

Sego  Milk  Products  Company,  Salt  Lake  City, 
Utah,  Booth  Number  A. 

Sharp  & Dohme,  Philadelphia,  Pennsylvania, 
Booth  Number  10. 

Smith-Dorsey,  Lincoln,  Nebraska,  Booth  Num- 
ber 24. 

Squibb,  E.  R.  & Sons,  New  York,  City  Booth 
Number  7. 

Ulmer  Pharmacal  Company,  Minneapolis,  Min- 
nesota, Booth  Number  20. 

Winthrop-Stearns,  Inc.,  New  York  City,  Booth 
Number  C. 


KEEP  POLITICS  OUT  OF  THIS 
PICTURE! 

Do  you  have  YOUR  copy  of  the  famous  Fildes 
painting,  with  the  “Keep  Politics  Out  of  This 
Picture’’  wording  on  it?  Have  you  hung  it  prom- 
inently in  your  reception  room?  Does  your  fa- 
vorite pharmacist  have  a copy  in  one  of  his  dis- 
play windows?  Is  one  posted  in  your  hospital 
lobby? 

If  you  can  answer  all  these  questions  with  a 
“Yes,”  it  is  time  to  expand  the  displays  to  the 
windows  of  your  banker,  your  grocer,  your 
baker,  your  barber  shop,  your  favorite  depart- 
ment store.  Get  their  agreement  to  use  the  paint- 
ing, then  write  to  A.M.A.  Campaign  Headquar- 
ters, 1 North  La  Salle  Street,  Chicago  2,  Illinois, 
and  ask  for  the  necessary  extra  copies. 

This  painting  and  every  word  in  the  message 
it  carries  should  be  burned  into  the  memory  of 
every  citizen  within  the  next  six  to  nine  months. 


BUTTE— THE  CITY  UNIQUE 

Located  on  the  “Richest  Hill  on  Earth” 

The  “Hill”  is  a spur  of  the  Continental  Divide 
overlooking  a little  valley  locally  called  the 
“Flat.”  This  nook,  tucked  away  in  a hairpin  turn 
of  the  main  range  of  the  Rockies,  is  drained  by 
Silver  Bow  Creek,  a headwater  of  the  Columbia 
River.  The  discovery  of  placer  gold  in  Montana 
in  1862  brought  a stampede  of  prospectors.  Every 
creek  and  bar  were  panned  in  the  eager  search 
for  colors  and,  of  course.  Silver  Bow  Creek  came 
in  for  its  share  of  attention.  Diggings  were 
started  on  the  creek  south  and  west  of  here. 

There  was  not  much  interest  in  so-called 
“quartz”  or  “hard-rock”  mining  because  relative- 
ly few  placer  miners  had  the  technical  knowl- 
edge or  practical  experience  to  mine  ore,  and 
they  didn’t  have  the  capital  to  finance  operations 
requiring  substantial  investments  to  put  them 
on  a paying  basis.  But  as  placer  claims  were 
worked  out  or  the  ground  became  too  lean  for 
“poor-man  mining,”  vein  outcrops  were  located 
and  staked,  samples  sent  away  for  assay  and  ore 
showings  rich  in  gold  and  silver  were  developed 
close  to  the  surface.  Such  discoveries  were  made 
on  the  Hill  and  Butte  City  came  into  existence 
as  a bonanza  silver  camp  in  the  early  1870s. 

The  camp  boomed  for  a number  of  years  with 
all  of  the  excitement,  hopes,  color  and  action  of 
every  new  strike  in  the  golden  west.  Experi- 
enced quartz  miners  came  in  from  the  famous 
Comstock  Lode  of  Virginia  City,  Nevada.  Many 
of  them  were  Irish.  Later,  the  Cousin  Jacks  or 
Cornishmen  were  to  arrive  from  the  mines  in 
Michigan.  Marcus  Daly  was  sent  from  Nevada 
to  manage  the  Alice  Mine  for  Walker  Bros., 
bankers  of  Salt  Lake  City.  When  the  silver  ores 
became  lower  grade  at  comparatively  shallow 
depths  and  refractory  copper  ores  were  encoun- 
tered, the  camp  languished  for  a few  years. 
There  were  no  facilities  for  treating  copper  ores. 
It  was  the  faith  of  young  Marcus  Daly  that  kept 
it  from  becoming  a ghost  town.  His  persistence 
and  optimism  knew  no  limits. 

Other  stalwarts  followed  the  trail  blazed  by 
Daly.  Capital  poured  in  from  east  and  west.  Rol- 
licking Butte  hitched  up  her  metal-studded  gir- 
dle and  swaggered  a bit  more  than  ever  before. 
She  became  a city  of  contrasts  and  caprice  . . . 
generous  and  sordid  . . . sympathetic  and  intol- 
erant . . . convivial  and  bigoted  . . . naive  and 
sophisticated  . . . cultured  and  crass  . . . arty 
and  earthy.  Fortunes  were  made  and  lost  in 
mining  ventures  and  across  the  gaming  tables. 
Conflicting  interests  battled  in  court  for  control 
of  ore  bodies  on  surface  and  underground.  Today 
they  are  consolidated  and  operated  by  the  Ana- 
conda Copper  Mining  Company. 

Butte  is  still  a rugged  individualist  who  served 
the  country  well  during  the  recent  war,  with  her 
enormous  production  of  copper,  zinc,  manganese 
and  other  metals. 

Rocky  Mountain  Medical  Journal 


480 


% Congestive  Heart  F ailure... 


"The  most  striking  effects  were  seen  in 
cases  of  hypertensive  heart  failure.  . . . 
There  is  a rapid  fall  in  the  raised  right 
auricular  pressure  with  a conspicuous  in- 
crease in  the  output  of  the  heart. 


SEARLE 


AMINOPHYLLIN 


❖ 


— improves  eardiac  failure  by  effecting  an  improved  heart 
action  with  increased  blood  flow,  and  eliminating  edema 
fluids  by  the  renal  route. 

Searle  Aminophyllin  is  indicated  in  paroxysmal  dyspnea, 
bronchial  asthma,  Cheyne-Stokes  respiration  and  selected 
cardiac  cases. 


ORAL— PARENTERAL— RECTAL  DOSAGE  FORMS 


*Searle  Aminophyllin  contains  at  least  80%  of  anhydrous 
theophylline.  G.  D.  Searle  & Co.,  Chicago  80,  Illinois. 


SEARLE 


RESEARCH  IN  THE  SERVICE  OF  MEDICINE 


1.  Howarth,  S.;  McMichael,  J.,  and  Sharpey-Schafer,  E.  P.:  The 
Circulatory  Action  of  Theophylline  Ethylene  Diamine,  Clin.  Sc. 
6:125  (July  17)  1947. 


for  June,  1949 


481 


Organization 

National  Affairs  - Proceedings  - Programs  - Society  Notices  - News  - Auxiliary 


NATIONAL  AFFAIRS 


Free  Tick  Vaccine 
No  Longer  Available 

The  United  States  Public  Health  Service  Lab- 
oratory at  Hamilton,  Montana,  has  discontinued 
the  manufacture  of  immunization  materials  for 
protection  against  Rocky  Mountain  Spotted  Fe- 
ver. It  is  therefore  impossible  for  state  health 
departments  to  obtain  the  vaccine  from  the 
U.S.P.H.S.  and  supply  it  free  of  charge  to  phy- 
sicians. The  material  is  now  manufactured  com- 
mercially by  several  of  the  larger  pharmaceu- 
tical houses  and  can  be  purchased  readily 
through  local  and  wholesale  drug  firms.  State 
health  departments  wish  to  caution  Rocky  Moun- 
tain physicians  against  delays  and  disappoint- 
ment which  may  ensue  from  now  on  if  the  vac- 
cine is  requested  from  governmental  sources. 

School  Health 
Questionnaire 

The  secretary  of  each  local  medical  society  will 
soon  receive  in  the  mail  a questionnaire  on  school 
health  services  in  his  community.  The  American 
Medical  Association  in  cooperation  with  the  U.  S. 
Office  of  Education  is  making  a study  of  school 
health  services  through  its  Bureau  of  Health 
Education.  The  survey  is  a preliminary  step  in 
efforts  designed  to  bring  about  improvement  of 
school  health  programs  within  the  framework  of 
the  private  practice  of  medicine.  For  this  rea- 
son, it  is  most  important  that  each  local  med- 
ical society  complete  and  return  the  question- 
naire. 

The  U.  S.  Office  of  Education  in  Washington 
will  concurrently  query  the  schools.  Two  differ- 
ent questionnaires  which  supplement  and  rein- 
force each  other  and  contain  no  duplicate  ques- 
tions are  being  used.  The  information  requested 
is  needed  to  determine  present  strengths  and 
weaknesses  in  school  health  services,  to  indicate 
needs,  and  to  point  up  action  for  the  future.  The 
questionnaire  has  been  tested  prior  to  printing 
and  all  unnecessary  questions  eliminated. 


THE  ROCKY  MOUNTAEV  RADIOLOGICAL 
SOCIETY 

The  Rocky  Mountain  Radiological  Society  will 
meet  in  Denver  at  the  Shirley-Savoy  Hotel  on 
August  18,  19,  20.  The  program  will  appear  in 
the  next  issue  of  this  Journal. 


COLORADO 

State  Medical  Society 

Course  in  Regional 
Anesthesiology 

A postgraduate  course  in  Regional  Anesthesi- 
ology will  be  held  at  the  University  of  Colorado 
Medical  Center  from  June  27  to  July  1,  1949,  in- 
clusive. This  course  is  an  intensive  one-week 
study  in  the  technics,  indications  and  contraindi- 
cations of  regional  anesthesiology,  including  diag- 
nostic and  therapeutic  nerve  blocking.  The  lo- 
calization of  musculoskeletal  pain  and  the  use 
of  saline  and  local  anesthetic  drugs  in  diagnosis 
and  therapy  are  included.  The  subject  will  be 
presented  by  cadaver  dissections,  lectures,  clin- 
ical demonstrations,  and  supervised  practice  in 
the  various  technics  covered  in  the  course. 

The  guest  lecturer  will  be  Emory  A.  Roven- 
stine,  M.D.,  Professor  and  Chairman,  Depart- 
m.ent  of  Anesthesiology,  New  York  University, 
Bellevue  Medical  Center.  Admission  to  this 
course  is  open  to  all  physicians  who  are  mem- 
bers of  their  constituent  medical  societies  or 
the  American  Medical  Association. 

The  registration  fee  is  $5.00  and  tuition  will 
be  $45. 

Further  inquiries  should  be  made  to  the  Di- 
rector of  Graduate  and  Postgraduate  Medical 
Education,  University  of  Colorado  Medical  Cen- 
ter, Denver,  Colorado. 


Cancer  Refresher 
Courses  Successful 

Two  one-day  “schools”  for  Colorado  physicians, 
aimed  at  early  detection  of  cancer  in  doctors’ 
offices,  were  held  during  April.  A refresher 
course  was  held  April  3 in  Fort  Collins  for  all 
doctors  in  the  northeastern  quarter  of  the  state. 
Sixty  physicians  attended  the  Fort  Collins  meet- 
ing, arranged  by  the  medical  societies  of  Lari- 
mer, Weld  and  Boulder  Counties,  under  spon- 
sorship of  the  Cancer  Control  Committee  of  the 
State  Society  and  the  Cancer  Control  Division 
of  the  State  Department  of  Public  Health.  Dr. 
Harold  D.  Palmer,  Denver,  pathologist  and  med- 
ical director  of  Children’s  Hospital,  presided  as 
moderator.  Lecturers  for  the  northeast  meeting 
were  Drs.  Walter  T.  Wilke,  John  A.  Lichty,  Ed- 
ward Mugrage  and  Mason  Morfit,  all  of  the 
University  of  Colorado  Medical  School;  and  Da- 
vid W.  McCarty,  Longmont;  Henry  M.  Russell 
and  Eugene  Wiege,  Greeley;  George  Garrison, 
James  F.  Hoffman,  and  James  Stewart,  Fort 
Collins;  and  Jack  D.  Bartholomew  and  Carl  J. 
Gilman,  Boulder. 

Dr.  Danly  Slaughter,  Associate  Professor  of 


482 


Rocky  Mountain  Medical  Journal 


Alhydrox 

Builds  solid  immunity  step  by  step 

Like  Mr.  McGinty’s  brick  wall  which  stands 
solidly  against  the  ravages  of  time  because  he 
builds  it  carefully,  solidly,  brick  upon  brick,  the 
immunity  you  build  with  CUTTER  "ALHYDROX” 
vaccine  is  solid. 

*Cutter  trade  name  for  aluminum  hydroxide  adsorbed  products. 


"Alhydrox”  is  a CUTTER  excZusioe— developed  and 
used  exclusively  by  CUTTER  for  its  vaccines  and 
toxoids.  It  supplements  the  physician’s  skill  by 
producing  these  immunizing  advantages: 

1.  "Alhydrox”  adsorbed  antigens  are  released  slowly  from  tis- 
sue, giving  the  effect  of  small  repeated  doses. 

2.  "Alhydrox”,  because  of  its  more  favorable  pH,  lessens  pain 
on  injection  and  reduces  side  reactions  to  a minimum. 

3.  "Alhydrox”  selectivity  controls  the  absorption  of  antigens, 
reducing  dosage  volume  while  building  a high  antibody  con- 
centration. Reduced  volume  means  less  tissue  distention  and 
less  pain. 

CUTTER  LABORATORIES  • BERKELEY  10,  CALIF. 


Physicians  nationally  are  specifying  "Alhydrox”  vaccines 

Are  your  storks  adequate? 


CamR 


for  June,  1949 


483 


Surgery  and  Director  of  the  Tumor  Clinic  at  the 
University  of  Illinois  Medical  School,  Chicago, 
was  the  principal  speaker  and  moderator  at  the 
Colorado  Springs  meeting  on  April  24.  The 
southeastern  refresher  course  was  planned  by 
the  El  Paso  County  Medical  Society  and  about 
sixty  doctors  attended  from  that  area.  Taking 
part  in  the  program  there  were  Drs.  E.  F.  Gee- 
ver,  R.  R.  Anderson,  Robert  H.  Smith,  W.  S. 
Williams,  William  F.  Stone,  John  B.  Hartwell, 
Louis  J.  Kennedy,  Harry  H.  Lamberson,  Vernon 
L.  Bolton  and  J.  A.  del  Regato  from  Colorado 
Springs;  Wilbert  O.  Brown,  John  P.  McGraw  and 
Harold  T.  Low  of  Pueblo;  Frank  B.  McGlone 
and  Robert  K.  Brown  of  Denver;  J.  Alan  Shand, 
La  Junta,  and  Leonard  N.  Myers  of  Cheyenne 
Wells. 

These  reginal  courses  are  designed  to  supple- 
ment the  Society’s  annual  Rocky  Mountain  Can- 
cer Conference  held  each  July  in  Denver,  and 
offer  the  local  physicians  opportunity  of  par- 
ticipating in  the  smaller  meetings.  The  refresh- 
ers have  met  with  very  favorable  response  and 
subsequent  meetings  are  planned  for  the  other 
areas  of  the  state. 

Materials  for 
Public  Campaign 

Space  in  this  issue  of  the  Journal  does  not  per- 
mit a detailed  discussion  or  even  an  outline  of 
the  general  A.M.A.  Educational  Program  mate- 
rials now  available  for  the  nation-wide  campaign 
under  way  in  each  state  and  locality.  Our  next 
issue  will  contain  such  an  outline.  In  the  mean- 
time, each  reader  is  urged  to  get  in  touch  with 
the  officers  or  campaign  chairman  of  his  County 
Medical  Society  and  avail  himself  of  the  wealth 
of  material  now  on  hand. 


Obituaries 

WILLARD  K.  HILLS 

Dr.  Willard  K.  Hills  of  Colorado  Springs  died 
April  13,  1949,  at  the  age  of  62.  He  had  been 
ill  for  several  years. 

Born  in  Aspen,  Colorado,  on  February  11,  1887, 
Dr.  Hills  moved,  in  1899,  to  Colorado  Springs 
with  his  family,  where  he  completed  his  prepara- 
tory education.  He  attended  the  University  of 
Colorado  School  of  Medicine.  Following  his 
graduation  in  1911  he  served  his  internship  at 
St.  Joseph’s  Hospital  in  Denver. 

In  1913  Dr.  Hills  went  to  Tampico,  Mexico, 
where  he  served  as  physician  and  surgeon  for 
the  Doheny  Oil  Company  for  three  years.  On 
his‘  return  to  the  States  he  re-establised  his 
residency  in  Colorado  Springs  and  began  the 
private  practice  of  medicine.  During  World  War 
I he  served  in  the  Medical  Corps  as  a First 
Lieutenant. 

Dr.  Hills  was  a member  of  the  El  Paso  County 
and  Colorado  State  Medical  Societies  and  the 
Rocky  Mountain  Pediatrics  Society.  From  1939 
to  1947  Dr.  Hills  served  as  a member  of  the 
Board  of  Councilors  of  the  State  Society.  Two 


of  these  years  he  served  as  Chairman  of  that 
Board. 

Long  active  in  local  and  state  medical  circles. 
Dr.  Hills’  passing  will  be  keenly  felt  by  all  who 
knew  him. 


WILLIAM  J.  BINGHAM 

Dr.  William  J.  Bingham  of  Denver  died  on 
April  25,  1949,  at  the  age  of  77. 

Born  in  Coventry,  England,  on  October  20, 
1872,  Dr.  Bingham  moved  to  Toronto,  Canada, 
when  he  was  17.  After  attending  college  in 
Louisville,  Kentucky,  and  the  Moody  Bible  In- 
stitute in  Chicago,  Dr.  Bingham  came  to  Colo- 
rado and  enrolled  in  the  Colorado  University 
Medical  School.  He  graduated  in  1904. 

In  1906  Dr.  Bingham  went  to  Guatemala’  as  a 
medical  missionary,  but  because  of  ill  health  was 
forced  to  return  to  Colorado  two  years  later. 
He  also  spent  several  years  in  Puebla,  Mexico, 
and  Managua,  Nicaragua,  in  the  same  capacity. 

Following  his  missionary  work.  Dr.  Bingham 
spent  some  time  in  Denver  in  private  practice 
and  also  as  superintendent  of  the  Denver  City 
Mission.  For  six  years  prior  to  his  retirement 
in  1939  he  was  pastor  of  the  Bethany  Baptist 
Church  in  Denver. 

A true  humanitarian  in  every  sense  of  the 
word.  Dr.  Bingham  dedicated  his  life  to  the  re- 
lief of  suffering  both  at  home  and  abroad. 


Auxiliary 

LARIMER  COUNTY 

The  Larimer  County  Medical  Auxiliary  has 
just  completed  a pleasant  year  of  fellowship. 

Besides  the  four  regular  business  and  social 
meetings  they  elected  to  do  plain  sewing  for 
the  Larimer  County  Hospital  one  day  each  month 
at  the  hospital.  Those  having  portable  sewing 
machines  took  them  and  many  plain  garments 
were  made;  besides,  members  participating  had 
the  pleasure  of  working  together  and  becoming 
better  acquainted. 

A joint  meeting  was  held  with  our  husbands 
in  Loveland  in  March  where  we  learned  much 
regarding  socialized  medicine  and  our  part  in  the 
A.M.A.’s  educational  campaign.  Mrs.  F.  A. 
Humphrey  has  prepared  herself  to  speak  upon 
the  subject  and  has  spoken  to  eight  different 
organizations.  The  Auxiliary  acted  collectively 
and  as  individuals  to  send  statements  against 
socialized  medicine  to  our  Congressmen. 

Members  of  the  Auxiliary  served  light  refresh- 
ments to  the  visitors  calling  at  Larimer  Cormty 
Hospital  on  May  12,  1949,  Annual  Hospital  Day. 
We  were  honored  to  have  our  State  President, 
Mrs.  Arthur  A.  Wearner,  and  State  Publicity 
Chairman,  Mrs.  Russell  John  Evans,  as  guests  at 
our  annual  May  luncheon. 

MRS.  PAUL  E.  TRAMP,  President. 


THE  PHI  DELTA  EPSILON  GRADUATE  CLUB 

The  Phi  Delta  Epsilon  Graduate  Club  of  Den- 
ver is  sponsoring  the  first  Phi  Delta  Epsilon 
Lecture,  to  be  held  at  Denison  Auditorium,  Uni- 
versity of  Colorado  Medical  Center,  at  8:00  p.m., 
June  27,  1949.  Dr.  Emory  A.  Rovenstine,  Pro- 
fessor and  Chairman  of  the  Department  of  An- 
esthesiology, New  York  University-Bellevue 
Medical  Center,  will  be  the  first  Phi  Delta 
Epsilon  lecturer.  He  will  speak  on  “The  Abuse 
of  Hypnotics  and  Analgesics.” 


484 


Rocky  Mountain  Medical  Journal 


i The  ^eSCRfFnfOU\wi^Wk’k  Food 

I 

I For  the  intire  Bottle-feeding  Period 


Year  after  year,  more  and  more 
doctors  are  prescribing  Baker’s 
Modified  Milk  because  of  its  effectiveness 
and  simplicity . . , because  it  reduces  tbe 
possibility  of  error  (requires  only  one 
simple  operation:  dilute  with  water,  pre- 
viously boiled)  . . . because  it  contains 
the  essentials  any  physician  would  want 
to  include  in  a complete  formula  for 


infant  feeding  . . . because  it  closely  con- 
forms to  human  milk  . . . because  it  is 
well  tolerated  by  both  premature  and 
full-term  infants  . . . and  because  for 
the  normal  healthy  baby  it  requires  no 
changing  of  formula  (except  an  increase 
in  quantity)  as  the  baby  grows  older. 
Complete  information  and  samples  will 
be  mailed  on  request. 


BAKER’S  MODIFIED  MILK 


THE  BAKER  LABORATORIES  INC.,  Clmland,  Ohio 


for  June,  1949 


485 


COLORADO 

State  Health  Department 

NEW  VENEREAL  DISEASE  TREATMENT 
PROGRAM 

The  public  health  picture,  as  far  as  the  control 
of  veneral  disease  is  concerned,  is  improving 
with  the  increasing  availability  of  procaine  peni- 
cillin. 

It  is  not  necessary  to  transport  patients  over 
long  distances  in  order  that  they  may  receive 
a course  of  rapid  treatment  in  a rapid  treatment 
center.  He  can  now  receive  such  a course  of 
treatment  in  his  own  community  by  his  family 
physician  or  any  private  practitioner. 

The  Venereal  Disease  Section  of  the  Colorado 
State  Department  of  Public  Health  for  the  past 
few  months  has  been  working  toward  the  de- 
centralization of  venereal  disease  treatment  by 
informing  physicians  that  procaine  penicillin  is 
available  for  the  treatment  of  early  syphilis  in 
the  indigent  and  that  a request  for  the  drug  made 
on  the  reverse  side  of  the  morbidity  card,  upon 
which  the  case  is  reported,  will  result  in  prompt 
action. 

Inasmuch  as  appropriations  are  somewhat  cur- 
tailed for  the  ensuing  year,  physicians  are  re- 
quested to  endeavor  to  have  patients  pay  for  the 
administration  of  the  drug.  However,  if  the  pa- 
tient is  unable  to  pay,  the  state  will  pay  $15  to 
the  physician  for  administering  each  course  of 
treatment  required  as  long  as  funds  are  available 
for  this  purpose. 

The  dosage  recommended  for  primary,  second- 
ary and  early  latent  syphilis  is  6,000,000  units 
intramuscularly  given  over  a period  of  ten  days. 
This  time  has  been  reduced  to  five  days  under 
unusual  circumstances.  This  course  of  treatment 
is  followed  by  monthly  Kahn  tests.  As  long  as 
the  number  of  Kahn  units  decrease  and  continue 
to  do  so,  the  case  is  making  satisfactory  progress. 
Sometimes  a period  of  a year  is  required  for  the 
blood  to  become  normal.  In  some  cases  the  Kahn 
may  persist  in  titers  of  ten  units  or  less.  This, 
provided  it  does  not  assume  a gradual  rise  but 
fluctuates  between  ten  units  and  negative,  could 
be  ignored  except  where  some  clinical  manifes- 
tations modify  the  picture. 

If  at  any  time  during  the  post  treatment  ob- 
servation period  the  Kahn  titer  should  level  off 
at  a fairly  high  titer  or  should  start  to  rise  and 
continue  to  rise,  treatment  would  be  indicated. 

Late  cases  of  syphilis  are  more  of  a welfare 
problem  than  a public  health  problem.  Procaine 
penicillin  is  indicated  in  this  type  of  case  in- 
cluding neuro-syphilis  and  cardio-vascular  syphi- 
lis. A minimum  of  10,000,000  units  is  given.  Some 
clinicians  urge  that  caution  be  used,  as  they  feel 
that  in  paresis,  an  acute  psychosis  may  be  pre- 
cipitated. In  cardio-vascular  syphilis,  they  be- 
lieve that  death  may  sometimes  follow  its  use. 

The  use  of  a preparatory  course  of  bismuth  in 
late  syphilis  is  believed  to  be  effective  in  pre- 
venting a serious  result.  Other  clinicians  hold 
the  opposite  view. 

Gonorrhea  is  treated  with  300,000  units  of 
procaine  penicillin.  Results  are  prompt.  In  so- 
called  penicillin  resistant  cases,  it  is  necessary  to 
repeat  the  treatment  until  urethral  smear  and 
culture  are  negative.  However,  in  the  presence 
of  a persistent  discharge,  it  is  good  practice  to 
investigate  the  possibility  of  other  organisms; 
one  of  the  most  common  being  trichomona  vagin- 
alis. 


Venereal  disease  treatment  has  been  in  the 
hands  of  the  specialist  for  the  past  few  years  but 
is  now  going  back  to  the  general  practitioner. 
This  brief  summary  of  the  Colorado  pubhc  health 
prograrn  has  been  given  with  a view  to  the 
orientation  of  those  of  the  medical  profession 
who  have  been  out  of  touch  with  veneral  dis- 
ease, but  who  will  no  doubt  be  called  upon  in  the 
future  to  treat  cases  of  this  type. 

UTAH 

State  Medical  Association 


Obituary 

HOWARD  PENDLETON  KIRTLEY 

Dr.  Howard  Pendleton  Kirtley,  widely  known 
Salt  Lake  physician  and  surgeon,  died  suddenly 
on  May  4,  1949,  in  the  mountains  of  Wasatch 
County  where  he  and  Dr.  John  F.  Sharp  had 
gone  for  an  outing. 

Dr.  Kirtley  was  born  October  9,  1877,  in  Wood- 
bay,  New  Jersey.  His  parents  were  Ophelia  and 
Lycurgues  Kirtley.  He  spent  his  boyhood  in 
Peoria,  Illinois.  In  1900  he  was  graduated  from 
the  University  of  Chicago  with  an  A.B.  degree 
and  in  1904  he  received  his  M.D.  degree  from 
the  Rush  Medical  College  at  Chicago.  He  served 
his  internship  at  Cook  County  Hospital  from 
1905  to  1906.  In  1907  he  located  in  Salt  Lake 
City,  Utah,  where  he  practiced  medicine  and 
surgery  until  the  time  of  his  death. 

On  November  11,  1908,  he  was  married  to 
Adelaide  Eugenia  Odell.  Dr.  Kirtley  was  a.  Ma- 
jor in  the  United  States  Army  during  World 
War  I where  he  served  in  France.  Later  he  was 
commissioned  a Lt.  Colonel  in  the  Medical  Re- 
serve Corps  of  the  Army.  He  served  as  Presi- 
dent of  the  Salt  Lake  County  Medical  Society 
and  later  was  President  of  the  Utah  State  Med- 
ical Association.  At  the  time  of  his  death  he 
was  a member  of  the  St.  Mark’s  Hospital  Staff. 
He  was  active  in  the  construction  of  the  Medical 
Arts  Building  and  had  been  a member  of  its 
Board  of  Directors  from  the  beginning. 

Dr.  Kirtley  devoted  much  time  to  Masonry.  A 
member  of  Mt.  Moriah  Lodge  No.  2,  F.  and  A.  M., 
since  1911,  he  was  Grand  Master  of  the  Utah 
Grand  Lodge  from  January  20,  1932,  to  January 
17,  1933.  All  honors  of  the  York  Rite  and  Scot- 
tish Rite  bodies  were  conferred  upon  Dr.  Kirtley. 
He  headed  the  Utah  Grand  Chapter,  R.  A.  M., 
Utah  Grand  Council,  R.  and  S.  M.,  and  the  Utah 
Commandery,  K.  T.  A member  of  El  Kalah 
Temple,  Mystic  Shrine,  since  April  15,  1914,  Dr. 
Kirtley  served  as  Illustrious  Potentate  in  1926. 


CERTIFICATES  READY  FOR  FORMER 
FLIGHT  SURGEONS 

Certificates  are  now  ready  for  mailing  to  for- 
mer medical  officers  who  served  during  the  war 
with  the  designation  as  Flight  Surgeons. 

The  certificates,  which  are  suitable  for  fram- 
ing, indicate  that  the  officers  concerned  were 
graduated  from  the  Aviation  Medical  Examiner’s 
Course  given  at  the  U.  S.  Air  Force  School  of 
Aviation  Medicine,  Randolph  Air  Force  Base, 
Texas.  Those  who  are  eligible  to  receive  the 
certificates  may  secure  them  by  writing  direct 
to  The  Air  Surgeon,  Headquarters,  U.  S.  Air 
Force,  Washington  25,  D.  C.  Officers  now  on 
active  duty  are  not  eligible  to  receive  the  cer- 
tificates. 


486 


Rocky  Mountain  Medical  Journal 


WHEI\I  OBESITY  IS  A PROBLEli 


S.  H.  CAMP  and  COMPANY 

JACKSON,  MICHIGAN 

World's  Largest  Manufacturers 
of  Scientific  Supports 

0£Sces  in  New  York  • Chicago 
Windsor,  Ontario  • London,  England 


Clinicians  have  long  noted 
that  the  forward  bulk  of  the 
heavy  abdomen  with  its  fat- 
laden wall  moves  the  center 
of  gravity  forward.  As  the 
patient  tries  to  balance  the 
load,  the  lumbar  and  cervical 
curves  of  the  spine  are  in- 
creased, the  head  is  carried 
forward  and  the  shoulders 
become  rounded.  Often  there 
is  associated  visceroptosis. 
Camp  Supports  have  a long 
history  among  clinicians  for 
their  efficacy  in  supporting 
the  pendulous  abdomen.  The 
highly  specialized  designs  and 
the  unique  Camp  system  of 
controlled  adjustment  help 
steady  the  pelvis  and  hold  the 
viscera  upward  and  backward . 
There  is  no  constriction  of 
the  abdomen,  and  effective 
support  is  given  to  the  spine. 
Physicians  may  rely  on 
the  Camp- trained  fitter  for 
precise  execution  of  all  in- 
structions. 

If  you  do  not  have  a copy  of 
the  Camp  “Reference  Book 
for  Physicians  and  Surgeons’  ’ , 
it  will  be  sent  on  request. 


THIS  EMBLEM  is  displayed  only  by  reliable  merchants 
in  your  community.  Camp  Scientific  Supports  are  never 
sold  by  door-to-door  canvassers.  Prices  are  based  on 
intrinsic  value.  Regular  technical  and  ethical  trOining  of 
Camp  fitters  insures  precise  and  conscientious  attention 
to  your  recommendations. 


for  June,  1949 


487 


WYOMING 

State  Medical  Society 


Official  Call 

For-  Annual  Meeting 

In  accordance  with  my  office  as  President  of 
the  Wyoming  State  Medical  Society,  I hereby 
serve  notice  of  the  Annual  Meeting  of  the  Wyo- 
ming State  Medical  Society  to  be  held  in  the  city 
of  Casper  on  September  12,  13,  and  14,  1949,  dur- 
ing which  time  the  meetings  of  the  House  of 
Delegates  of  the  Society  will  be  held  and  a Sci- 
entific Program  presented. 

GEORGE  E.  BAKER,  M.D.,  President, 
Wyoming  State  Medical  Society. 


THE  BOOK  CORNER,  Continued 
New  Books  Received 

The  T.se.s  of  1‘enieilliii  and  Streptomycin:  By  Ches- 
ter Scott  Keefer,  il.D.,  Wade  Professor  of  Medi- 
cine, Boston  University  School  of  Medicine,  Di- 
rector of  Evans  Memorial  and  Physician-in-Chief 
of  the  Jlassachusetts  Memorial  Hospitals;  Porter 
Lectures,  Series  15;  University  of  Kansas  Press, 
Lawr-ence,  Kansas,  1949.  Price  $2.00. 


Coronarj'  Artery  Disease;  By  Ernst  P.  Boas,  M.D., 
Associate  Physician,  Mount  Sinai  Hospital,  New 
York  City;  and  Norman  F.  Boas,  M.D.  The  Year 
Book  Publishers,  Inc.,  304  South  Dearborn  Street, 
Chicago,  $6,00, 


Fain  Syndromes,  Treatment  by  Paravertebral  Nerve 
Block:  By  Bernard  Judovich,  B.S.,  M.D.,  Instructor 
in  Neurology,  Graduate  School  of  Medicine,  Uni- 
versity of  Pennsylvania;  Consulting  Surgeon, 
Babies’  Hospital  and  Philadelphia  Home  for  In- 
curables; Consulting  General  Surgeon,  Wills  Hos- 
pital, Philadelphia,  Pa.  Foreword  by  Joseph  C. 
Yaskin,  M.D.,  Professor  of  Neurology,  Graduate 
School  of  Medicine,  University  of  Pennsylvania, 
Philadelphia,  Pa,  181  Illustrations.  Third  Edition. 
F.  A.  Days  Company,  Publishers,  Philadelphia, 
1949,  $6.00. 


Aesculapius  Comes  to  the  Colonies,  The  Story  of  the 
Early  Days  of  Medicine  in  the  Thirteen  Original 
Colonies:  By  Maurice  Bear  Gordon,  M.D.  Ventnor 
Publishers,  Inc.,  Ventnor,  N.  J.  $10.00. 


Booh  Reviews 

Handbook  of  Orothopaedic  Surgery:  By  Alfred  Rives 
Shands,  Jr.,  B.A.,  M.D.,  Medical  Director  of  the 
Alfred  I.  duPont  Institute  of  the  Nemours  Foun- 
dation, Wilmington,  Delaware;  Visiting  Professor 
of  Orthopaedic  Surgery,  University  of  Pennsyl- 
vania School  of  Medicine,  Philadelphia,  Pennsyl- 
vania. In  Collaboration  with  Richard  Beverly 
Raney,  B.A.,  M.D.,  Associate  in  Orthopaedic  Sur- 
gery, Duke  University  School  of  Medicine,  Dur- 
ham, North  Carolina;  Lecturer  in  Orthopaedic 
Surgery,  University  of  North  Carolina  School  of 
Medicine,  Chapel  Hill,  North  Carolina,  Illustr.ated 
by  Jack  Bonacker  Wilson.  Third  Edition.  574  pages. 
The  C.  V.  Mosby  Company.  $6.00. 

This  is  a fine,  well-bound  C.  V.  Mosby  Com- 
pany 1948  publication  of  a 775 -page,  3rd  edition, 
1948  Handbook  of  Orthopaedic  Surgery.  In  1937 
the  above  authors  published  a very  complete 
textbook  which  could  be  readily  understood  and 
studied  and  serve  as  an  excellent  textbook  for 
junior  and  senior  medical  students.  The  illus- 
trations and  reading  were  of  such  character  that 


they  would  serve  very  nicely  as  a reference  and  i 
even  a textbook  for  the  training  of  nurses.  The 
original  book  numbered  about  600  pages  and  was 
on  heavier  paper.  At  the  time  of  publication  of 
the  1st  edition,  the  author  was  professor  of 
Orthopaedic  Surgery  at  Duke  University  and  the  I 
co-author  was  his  associate.  During  the  war  the 
author  became  director  of  orthopaedic  surgery 
for  the  air  corps.  This  3rd  edition  sells  for  $6.00 
and  is  complete  in  every  detail.  It  is  about  one 
inch  thick  and  measures  six  inches  wide  by  eight 
and  three-quarter  inches  high. 

It  is  a ready  reference  for  general  practition- 
ers, medical  students  and  specialists.  The  topics 
are  black  printed  and  stand  out.  The  one  thing 
which  appeals  to  me  more  than  anything  else  is 
that  instead  of  saying  that  the  photograph  above 
shows  roughly  what  we  have  in  mind,  each  con- 
dition described  is  illustrated  by  typical  pencil 
drawings  which  incorporate  all  the  typical  or 
usual  findings.  These  illustrations  leave  little 
doubt  as  to  what  the  average  picture  should  be. 
They  leave  nothing  to  be  hoped  for  or  imagned. 

In  addition  to  a very  complete  25-page  double- 
columned  index  in  the  back  of  the  book  there  is 
a 75-page  complete  bibliography  for  excellent 
reference  on  all  of  the  various  topics  covered  in 
this  book.  All  the  great  writers’  names  in  or- 
thopaedic surgery  can  be  found  in  these  biblio- 
graphical pages  at  the  back  of  this  book. 

The  1st  edition  came  out  in  1937,  the  2nd  in  ' 
July,  1939,  and  the  3rd  was  revised  to  February, 
1948.  The  chapter  headings  are: 

Chapter  I.  Introduction. 

Chapter  II.  Congenital  Deformities. 

Chapter  III.  Congenital  Deformities  (Con- 
tinued). 

Chapter  IV.  Affections  of  Growing  Bone. 

Chapter  V.  Affections  of  Adult  Bone. 

Chapter  VI.  Infections  of  Bone  (Exclusive  of 
Tuberculosis). 

Chapter  VII.  Infections  of  Joints  (Exclusive 
of  Tuberculosis). 

Chapter  VIII.  Tuberculosis  of  Bones  and 
Joints;  The  Spine  and  Pelvis. 

Chapter  IX.  Tuberculosis  of  Bones  and  Joints; 
The  Extremities. 

Chapter  X.  Chronic  Arthritis. 

Chapter  XI.  Chronic  Arthritis:  Special  Joints. 

Chapter  XII.  Neuromuscular  Disabilities:  In- 
fantile Paralysis. 

Chapter  XIII.  Neuromuscular  Disabilities 
(Exclusive  of  Infantile  Paralysis):  Involvement 
of  the  Brain  and  Spinal  Cord. 

Chapter  XIV.  Neuromuscidar  Disabilities  (Ex- 
clusive of  Infantile  Paralysis):  Involvement  of 
Peripheral  Nerves  and  of  Muscles. 

Chapter  XV.  Tumors. 

Chapter  XVI.  Fracture  Deformities. 

Chapter  XVII.  Body  Mechanics  and  Physical 
Therapy. 

Chapter  XVHI.  Affections  of  the  Spine  and  i 
Thorax. 

Chapter  XIX.  Affections  of  the  Low  Back. 

Chapter  XX.  Affections  of  the  Hip. 

Chapter  XXI.  Affections  of  the  Knee. 

Chapter  XXII.  Affections  of  the  Ankle  and 
Foot. 

Chapter  XXHI.  Affections  of  the  Neck  and  , 
Shoulder. 

Chapter  XXIV.  Affections  of  the  Elbow,  ' 
Wrist,  Hand  and  Jaw. 

FOSTER  MATCHETT. 
Rocky  Mountain  Medical  Journal  ' 


488 


of  your  patients..  • The  form  housewife  whose  work  is  trufy  never  done  may 

find  that  the  distressing  symptoms  of  the  cfimacteric  moke 
the  smallest  chore  an  arduous  project.  She  depends  on 
your  help  to  resume  normal  efficiency  in  the  performance  of 
her  daily  tasks  os  well  as  to  maintain  a positive  outlook  during 
this  trying  period. 


'"'"Premarin'^  offers  a solution.  Many  thousand  physicians  prescribe 
this  naturally-occurring,  oral  estrogen  because... 

7.  Prompt  symptomatic  improvement  usually  follows  therapy. 


2.  Untoward  side-effects  ore  seldom  noted. 


3.  The  sense  of  well-being  so  frequently  imparted  tends  to  quickly  restore 
the  patient's  confidence  and  normal  efficiency. 

4.  This  "Plus"  (the  sense  of  well-being  enjoyed  by  the  patient)  is  conducive  to 
a highly  satisfactory  patient-doctor  relationship. 

5.  Four  potencies  permit  flexibility  of  dosage:  2.5  mg.,  1 .25  mg.,  0.625  mg.,  and  0.3 
mg.  tablets;  also  in  liquid  form,  0.625  mg.  in  each  4 cc.  (1  teaspoonful). 


While  sodium  estrone  sulfate  is  the  principal  estrogen 
in  "Premarin,"  other  equine  estrogens ...  estradiol, 
equilin,  equilenin,  hippulin  . . .are  probably  also  pres- 
ent in  varying  amounts  as  water-soluble  conjugates. 


ESTROGENIC  SUBSTANCES  (WATER-SOLUBLE) 
also  known  os  CONJUGATED  ESTROGENS  (equine) 


Ayerst,  McKenna  & Harrison  Limited  22  East  40th  Street,  New  York  1 6,  New  York 

4917 


for  June,  1949 


489 

LIBRAP.Y  OF  THE 

COLLEGE  CF  rCYSICIANS 


Haiidbook  of  Diseases  of  the  Skin;  Sy  Richard  L. 
Sutton,  M.D.,  Emeritus  Professor  of  Dermatology 
and  Syphilology,  University  of  Kansas  Medical 
School;  and  Richard  L.  Sutton,  Jr.,  M,D.,  Associate 
Professor  of  Dermatology  and  Syphilology,  Uni- 
versity of  Kansas  Medical  School.  719  pages  tvith 
1,057  illustrations.  The  C.  V.  Mosby  Company,  St. 
Louis.  1949.  ?12.50. 

The  Drs.  Sutton  have  given  us  a new  and  very 
practical  addition  to  their  group  of  dermatologic 
texts.  This  new  book  has  for  the  student  many 
points  of  superiority.  Their  “Synopsis  of  Dis- 
eases of  the  Skin”  is  in  general  too  brief  to  fur- 
nish proper  material  for  study  and  their  “Dis- 
eases of  the  Skin”  is  so  large  that  the  student  is 
often  frightened  by  it. 

In  general,  a medical  student  may  learn  a 
great  deal  of  dermatology  by  the  study  of  the 
bold  faced  type  only.  If  he  should  come  across 
some  point  in  which  he  wanted  to  go  more  deep- 
ly the  finer  type  gives  more  detailed  discussion, 
and  the  placing  of  very  numerous  references  di- 
rectly in  the  text  offers  a quick  and  convenient 
access  to  the  hterature.  Besides  the  above  fea- 
tures which  are  original  and  I believe  make  the 
“Handbook”  extremely  convenient  and  useful, 
Dr.  Sutton  has  covered  practically  every  known 
dermatologic  entity,  at  least  by  a short  descrip- 
tive paragraph  and  one  or  two  references  to  the 
literature. 

The  reorganization  and  grouping  of  skin  dis- 
eases according  to  etiology  has  a big  advantage 
and  conforms  more  closely  to  non-dermatologic 
medical  literature.  However,  it  has  one  disad- 
vantage from  the  standpoint  of  the  student  and 
practitioner.  Namely,  when  a case  is  seen  and 
a text  referred  to,  the  older  grouping  on  a mor- 
phological basis  brought  similar  looking  entities 


into  the  same  part  of  the  book,  thus  allowing 
comparison  of  all  members  in  this  group  with 
the  case  at  point  and  helping  the  student  in  dif- 
ferential diagnosis.  There  are  plenty  of  texts 
with  the  older  classification  so  that  the  new  ap- 
proach will  ably  complement  them. 

In  the  groups  under  the  etiologic  classification 
the  Schizomycetes  are  divided  into  two  groups, 
those  diseases  produced  by  bacteria  and  those 
due  to  fungi.  Since  these  have  been  separated, 
I think  it  would  have  helped  the  clarity  to  also 
make  a separate  group  of  those  diseases  due  to 
spirochetes  and  other  spiral  organisms. 

Dr.  Sutton  has  put  Seborrheic  Dermatitis  in 
the  group  of  ‘ diseases  produced  by  fungi  and 
writes  supporting  the  etiologic  importance  of 
the  Pityrosporum  Ovale  in  this  disease.  This 
point  has  been  debated  pro  and  con  since  the 
time  of  Unna  and  the  great  majority  of  Amer- 
ican dermatologists  are  not  yet  ready  to  accept 
this  organism  as  etiologic.  However,  apparently 
Dr.  Sutton  accepts  its  importance. 

The  great  importance  of  the  interplay  between 
the  psyche  and  the  soma  has  received  increasing 
study  in  its  relation  to  many  dermatoses.  We 
feel  that  more  space  should  be  devoted  to  the 
understanding  of  this  important  problem  in  the 
book,  especially  its  importance  in  therapy  of 
many  dermatoses  having  important  neurogenic 
components.  Dr.  Sutton  minimizes  the  im- 
portance of  nervous  and  mental  factors. 

The  “Handbook”  is  profusely  illustrated  with 
excellent  and  typical  photographs.  The  text  is 
concise  and  clear  and  we  feel  that  this  is  one  of 
the  finest  volumes  available  in  dermatology  for 
student  and  practitioner. 

A.  R.  WOODBURNE. 


y\dercy  JKospital 

Conducted  by  the  Sisters  of  Mercy 

School  of  Nursing  in  Connection 

A General  Hospital  Scientifically  Equipped 

1619  Milwaukee  St.,  Denver  FRemont  2771 


H.  C.  Stapleton  Drug  Company 

Service  Wholesalers  for  the  Prescription  Department 
RAPID— INTELLIGENT— SERVICE 

1252-54  Arapahoe  St.,  Denver,  Colo.  Phone  MAin  4152 


St.  Anthony  Hospital 

Write  or  Phone  Registrar  for  Information 

West  16th  Ave.  and  Perry  AComa  1761 

Denver,  Colorado 


490 


Rocky  Mountain  Medical  Journal 


home 


run 


A T 


VITAMIN 


TIME 


Important  to  every  youngster,  oldster  and 
in-hetweener  is  this  fact:  the  oral  forms  of  Abbott  Vitamin  Products  are  made 
as  attractive  as  possible  in  appearance,  flavor  and  odor~for  good  reason. 

This  plays  an  important  role  in  influencing  patients  to  adhere  to  prescribed 
dosage  schedules.  But  even  more  important  to  you  is  the  eflEcacy  of 
the  vitamin  content.  You  may  be  sure  that  every  Abbott  Vitamin  Product  is 

pure,  potent  and  stable,  rigidly  adheres  to  label  claims  for  the  contained  vitamins. 
In  the  complete  Abbott  line  are  single  and  multivitamin  products  . . . 
in  liquid,  capsule  and  tablet  form  . . . for  oral  and  parenteral  use  . . . 
for  supplemental  and  therapeutic  dosage.  Your 
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for  June,  1949 


491 


Advertisement 


From  where  I sit 
j&u  Joe  Marsh 


Remember  How 
We  Talked? 

It  went  like  this  at  the  Hooper’s  last 
night.  Map’s  eighteen-year-old  daugh- 
ter is  talking  about  “a  real  gone  guy 
— solid — out  of  this  world,  hut  def.” 

“Now  what  kind  of  language  is  that 
supposed  to  be?”  Hap  barks.  “Can’t 
she  speak  English?” 

“I’ll  translate  it  for  you,”Ma 
Hooper  says,  “in  the  language  of  the 
twenties,  when  you  were  about  twenty 
years  old.  She  simply  means  this  fel- 
low is  the  ‘cat’s  whiskers.’  Remember 
how  we  used  to  talk  sometimes?”  Hap 
went  back  to  reading  his  newspaper. 

From  where  I sit,  it’s  easy  to  criti- 
cize the  other  person  when  we  don’t 
take  a good  long  look  at  ourselves. 
Sure,  there’ll  always  be  some  differ- 
ences. I’m  fond  of  a temperate  glass  of 
beer  and  maybe  you  would  prefer  gin- 
ger ale — but  let’s  just  live  and  let  live. 
Because  when  we  go  out  of  our  way  to 
find  things  to  find  fault  with  in  others, 
chances  are  they  can  find  a few  in  us. 


Copyright,  19U9,  United  States  Brewers  Foundation 


Juberculosis  Abstracts 

Issued  Monthly  by  the  National  Tuberculosis 
ssociation 

Vol.  XXII  JUNE,  1949  Xo.  0 

Every  argument  tised  to  encourage  the  examination 
of  apparently  healthy  persons  for  the  purpose  of  find^ 
ing  unsuspected  tuberculosis  gains  added  force  when 
applied  to  college  students.  If  tuberculosis  is  found 
among  them  in  the  early  stage  when  it  is  more  easily 
cured,  future  and  potentially  valuable  citizens  are 
saved  for  productive  lives. 


TUBERCULOSIS  AMONG  COLLEGE 
STUDENTS 

Modern  tuberculosis  case-finding  technics  applied  to 
groups  of  apparently  healthy  people  are  productive  of 
irnportant,  instructive  and  often  startling  results.  Active 
and  communicable  cases  of  tuberculosis  are  not  infre- 
quently found  where  there  is  no  other  evidence  that 
anything  is  amiss.  Fortunately,  the  majority  of  cases 
so  discovered  are  in  an  early  or  a minimal  stage  of  the 
disease,  when  the  chances  for  rapid,  complete  recovery 
are  best. 

To  no  other  population  group  are  the  above  state- 
ments of  more  importance  than  to  college  students. 
These  young  men  and  women  are  at  the  highest  level 
of  health,  strength  and  vigor  and  from  their  ranks  are 
recruited  leaders  for  the  various  fields  of  human  en- 
deavor. From  their  ranks  are  also  recruited  many 
cases  of  tuberculosis. 

For  seventeen  years  the  Tuberculosis  Committee  of 
the  American  Student  Health  Association  has  been  pro- 
moting interest  in  tuberculosis  among  the  institutions 
of  learning  in  the  United  States.  For  more  than  ten 
of  these  years,  all  colleges  have  repeatedly  been  urged 
to  develop  a tuberculosis  control  program,  and  many 
have,  although  in  some  colleges  tuberculosis  still  is 
not  recognized  as  a serious  threat  to  students. 

The  curve  of  college  participation  has  shown  an 
almost  constant  upward  trend.  For  reasons  that  are 
not  entirely  clear,  the  1947  returns  show  fewer  pro- 
grams reported.  Each  of  the  885  institutions  to  which 
a questionnaire  was  sent  was  asked  to  return  the 
questionnaire  but  only  311  replies  were  received,  of 
which  259  reported  a program. 

In  spite  of  lessened  returns  many  cases  of  tuber- 
culosis were  discovered  among  college  students.  The 
total  number  of  cases,  presumably  of  the  "reinfection" 
type,  reported  for  1946-47  was  630,  and  all  but  nine 
were  foimd  at  colleges  having  anti-tuberculosis  pro- 
grams. In  1946-47,  590  arrested  cases  of  tuberculosis 
Vvere  again  permitted  to  resume  their  college  work.  They 
emphasize  the  fact  that  “they  do  come  back.” 
Programs  Employing  the  Tuberculin  Test  and  X-ray 
of  Reactors 

Colleges  depending  primarily  upon  the  tuberculin 
test  as  their  initial  screening  method  numbered  105. 
Based  on  adequacy  of  data  submitted,  apparent  pro- 
portion of  student  body  tested  and  number  of  reactors 
x-rayed,  twenty-four  programs  were  roughly  classified 
as  "excellent,”  thirty-four  as  "good,”  thirty-three  as 
"fair”  and  fourteen  as  "poor."  A college  has  an  "ex- 
cellent” program  when  entering  students  are  tuberculin 
tested  and  reactors  among  them  x-rayed,  and  when, 
each  year,  upper  classmen  non-reactors  are  retested  and 
reactors  re-x-ayed. 

In  recent  years  an  increasing  number  of  colleges  have 
reported  the  use  of  both  the  tuberculin  test  and  the 
chest  x-ray  for  all  entering  students.  It  is  recom- 
mended that  this  combined  procedure  be  employed 
wherever  facilities  permit. 


492 


Rocky  Mountain  Medical  Journal 


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Association  and  American  Nurses’ 
Association 

Undergraduates  and  Practical  Nurses 
Furnished  Upon  Request 

KEystone  0168 

ARGONAUT  HOTEL 


For  better  results,  and  to  insure  greater  uniformity, 
tuberculin  testing  should  be  done  intradermally  (Man- 
toux),  using  Purified  Protein  Derivative  of  tuberculin 
(P.P.D.)  in  two  strengths.  The  first  dose,  prepared 
according  to  directions,  is  0.00002  milligrams.  If  no 
reaction  occurs  after  seventy-two  hours  a second  dose 
of  0.005  milligrams  is  given.  Equally  dependable  re- 
sults may  be  obtained  if  Old  Tuberculin  (O.T.)  is  used. 
The  first  dose,  injected  intradermally,  is  0.1  milligram. 
When  no  reaction  occurs  after  seventy-two  hours  a 
second  dose  of  1.0  milligram  is  given.  Failure  to 
react  to  the  second  dose  of  either  P.P.D.  or  O.T.  may 
be  taken  as  evidence  of  freedom  from  tuberculosis  in- 
fection. 

Programs  Using  X-ray  Alone  as  a Screen 

The  main  criterion  for  an  excellent  program  was  that 
all  students  were  x-rayed  annually.  When  this  is 
done,  most  of  the  significant  cases  of  tuberculosis  will 
be  found  in  a relatively  short  time. 

Forty-seven  colleges,  distributed  over  twenty-three 
states,  indicated  that  part  or  all  of  their  x-ray  program 
had  been  conducted  by  either  the  local  tuberculosis  as- 
sociation or  one  of  the  official  health  departments. 
One  of  the  limitations  of  the  x-ray  is  that  it  gives  no 
certain  proof  either  of  tuberculin  infection  or  tuber- 
culous disease.  Diagnosis  may  be  made  only  after 
careful  clinical  study  of  a suspected  case.  Calcifica- 
tions noted  on  chest  films  are  not  proof  of  previous 
tuberculous  infection.  Diagnoses  have  undoubtedly 
been  ascribed  to  "healed  childhood  tuberculosis"  when 
the  true  cause  was  Hisfoplasma  capsulatum.  One  who 
reacts  to  tuberculin  should  have  regular  examination, 
including  chest  x-ray,  for  evidence  of  active  tuber- 
culosis. Conversely,  except  in  a few  well-recognized 
instances,  the  non-reactor  does  not  have  tuberculosis. 
Program  Participation  by  Non-Students 

Students  come  in  daily  contact  with  other  members 
of  the  college  community  which  includes  all  of  the 
college  staff,  the  administration,  the  faculty  and  other 
employees.  Any  one  of  these  may  have  tuberculosis. 
Students  would  have  added  protection  if  all  college 
employees  were  examined. 

Student  health  services  are  in  the  best  possible  posi- 
tion to  inform  vast  numbers  of  young  people  about 
tuberculosis,  and  must  be  prepared  to  meet  this  chal- 
lenge. 

Tuberculosis  Among  College  Students,  Seventeenth 
Annual  Report  o}  the  Tuberculosis  Committee,  Chair- 
man, Max  L.  DurleCt,  M.D.,  American  Student  Health 
Association,  for  the  Academic  Year,  1946-1947 , The 
Journal-Lancet,  November,  1948. 


There  are  many  features  in  a good  tuberculosis 
control  program,  but  all  of  them  are  based  on 
the  fundamental  principle  that  tuberculosis  is 
contagious,  and  that  the  patient  who  has  the 
germs  in  his  sputum,  or  who  shows  x-ray  evi- 
dence of  progressive  disease  of  the  lungs  such 
that  the  sputum  is  likely  to  become  positive, 
must  be  isolated  from  his  family  and  from  the 
community  in  a tuberculosis  hospital  or  sana- 
torium where  strict  bed-rest,  good  diet,  and  spe- 
cial surgical  procedures  in  selected  cases,  can  be 
provided  to  stop  the  advance  of  the  disease  and 
render  him  non-inf ective. — Miriam  E.  Brailey, 
M.D.,  Baltimore  Health  News,  Nov.,  1948. 


Fear  plays  a considerable  part  in  the  delay 
that  many  patients  allow  before  consulting  a 
physician.  Certainly  it  is  the  next  important 
factor  after  ignorance  in  causing  delay. — C.  D. 
Haagensen,  M.D.,  Bull.  New  York  Acad.  Med., 
Oct,  1948. 


494 


Rocky  Mountain  Medical  Journal 


PHOSPHO-SOOA 


(FIEET) 

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CHECK  LIST  for  choice  of  a lax 


''"lor-  TYPf  OF 

(FLEET)  action 
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Flexible  Dosage 
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Mucosal  irritation  V'  Nonhabituating  u„,e48Gm 

Phospho-Soda  (Fleet)  is  a solution  containing  in  each  too  ce.  so  lom  ip  osp 

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MEDICAL  ASSOCIATION 


Of  the  rnany  features  which  have  won  for  Phospho-Soda 
(Fleet)*  an  impressive  record  of  clinical  acceptance, 
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'PHOSPHO-SODA'  ond  'FLEET' 

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496 


Rocky  Mountain  Medical  Journal 


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g Parenteral  therapy  with  estrogenic  substances  derived  from  natural 
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g Permits  gradual  adjustment  to  postmenopausal  estrogen  levels  . 
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A General  Hospital  for  Surgical,  Medical  or  Maternity  Cases 

One  hundred  sixty  beds  and  twenty-five  bassinets.  Fireproof.  Telephone  service  to  every 
bed.  Hot  and  cold  running  water  and  toilet  service  in  every  room.  Complete  laboratory 
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DAVIS  BROS.  DRUG  CO. 

WHOLESALE  DRUGS 

1628  15th  Street,  Denver,  Colorado  Phone  KEystone  5131 


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A Postgraduate  Course 

for  Anesthesiologists,  Surgeons  and  Physicians 
June  27  to  July  1,  1949 

An  intensive  one-week  course  is  offered  in  the  techniques,  indications  and 
contraindications  of  regional  anesthesiology,  including  diagnostic  and  ther- 
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use  of  saline  and  local  anesthetic  drugs  in  diagnosis  and  therapy  are  in- 
cluded. The  subject  will  be  presented  by  cadaver  dissections,  lectures, 
clinical  demonstrations,  and  supervised  practice  in  the  various  techniques 
covered  in  the  course.  Guest  Lecturer,  Emory  A.  Rovenstine,  M.D., 
Professor  and  Chairman,  Department  of  Anesthesiology  New  York  Univer- 
sity— Bellevue  Medical  Center. 

Registration  is  $5.00,  payable  before  June  21.  Tuition  is  $45.00,  payable 
at  time  of  registration. 

Division  of  Anesthesiology 
University  of  Colorado  Medical  Center 
4200  East  Ninth  Avenue 
Denver  7,  Colorado 

Applications  by  request  from  Director  of  Graduate  and  Postgraduate  Medical 

Education. 


498 


Rocky  Mountain  Medical  Journal 


OPTIMUM  PROTECTION 
IN  ONE  PACKAGE... 


The  experience  of  competent  clinicians  clearly  establishes  that 
optimum  protection  is  afforded  the  patient  by  the  combined  use 
of  an  occlusive  diaphragm  and  a spermatocidal  jelly. 

By  specifying  the 


PRESCRIPTION  PACKET  NO.  501 

the  physician  provides  optimum  protection  in  one  convenient 
package. 

COMPLETE  LITERATURE  ON  REQUEST 
"RAMSES”*  Prescription  Packet  No.  501  . . . Contains  a 
"RAMSES”  Flexible  Cushioned  Diaphragm  of  the  prescribed 
size,  a "RAMSES”  Diaphragm  Introducer  of  corresponding  size, 
and  a tube  of  "RAMSES”  Vaginal  Jelly. 

"RAMSES”  Vaginal  Jelly  is  accepted  by  the  Council  on  Phar- 
macy and  Chemistry  of  the  American  Medical  Association.  The 
"RAMSES”  Diaphragm  and  Diaphragm  Introducer  are  accepted 
by  the  Council  on  Physical  Medicine  of  the  American  Medical 
Association. 

gynecological  division 

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fied Psychiatrist.  Registered  Nurses. 
Private  swimming  pool,  fireproof 
building.  View  Book.  Summer  Camp, 
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BERT  P.  BROWN 

President 

Paul  L.  White,  M.D.,  F.A.P.A., 
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P.  0.  Box  4008,  Austin,  Texas 


SHIRLEY- SAVOY 
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Rocky  Mountain  Medical  Journal 


SHOW  HOW  = KNOW  HOW 

Knowing  that  the  success  of  her  business  career  depends  to  a major  extent 
on  the  satisfaction  her  patrons  derive  from  their  Luzier  preparations,  your 
Cosmetic  Consultant  is  vitally  concerned  not  only  that  the  preparations  are 
suited  in  every  respect  to  your  requirements  and  preferences,  hut,  just  as  im- 
portant, that  you  thoroughly  understand  the  sequence  and  manner  of  applying 
them  to  obtain  the  best  results. 

The  Luzier  Application  Chart  is  designed  for  her  to  use  in  showing  you  how 
we  recommend  that  our  preparations  be  applied.  This  chart  provides  space 
for  an  outline  of  your  service  with  suggestions  based  on  your  particular  re- 
quirements. 


LUZIER’S  FINE  COSMETICS  AND  PERFUMES 
Are  Distributed  in  Colorado  and  Wyoming  by: 

BURBRIDGE  & BURBRIDGE,  Divisional  Distributors 
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Elizabeth  Haskin 
649  Adams 
Denver,  Colo. 


District  Distributors 
Baker  & Baker 
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Cecile  Armstrong 

1352  Jasmine  St. 
Denver,  Colo. 


Catherine  Phelps 
Sterling  Hotel 
Greeley,  Colo. 


Nellye  Knight 

P.  O.  Box  156 
Casper,  Wyo. 


Irene  K.  Reece 
1337  Madison 
Denver,  Colo. 

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324  So.  7th  St. 
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Local  Distributors 

Joyce  Kilgore 
250  Collins 
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1426  Grand  Ave. 
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911  San  Pedro 
Trinidad,  Colo. 


Sylvia  Rath 

1254  Cook  St. 
Denver,  Colo. 

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P.  O.  Box  902 
Laramie,  Wyo. 


for  June,  1949 


501 


. . .rjorsmtcesi 

Q sfmlfmcasm  (fmtwn,  or^t  } 

onsaa^?  I 

Wfio  shalfasscss  Qr^  war  (gainst 

tfic 

Or  set  a sum  u^m  tfu 

irt  IS  a,  service  beyon6  the  measure  £f  a^. 

A cause  above  remuneration. 

An  i6ealJor  xoKlcK  there  is  no  price. 

This  is  the  service...the  cause. ..the  i4eal...£|^ die  American  doctor 
I-JOTO  shall  r»e  reckon  it,  an6  by  eohatjormulae? 

Hoxo  muchjor  the  lai^hter  p|-  a little  chil6  rescued  out  ^crisis? 
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Wlio  can  pa^  Jor  a sleepless  n^ht? 

Name  the  price  pj^a  cure! 


AMERICAN  DOCTOR^ 


qpWe  IS  no  al^ebrajor  it, no  scnbUe  £(■  ji^ures,  no  paper  value. 
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Jt  is  all  this,  an^  the  ^ykt  thejob  6onc, 

De6icate6  to  service — in  the  name  Merc^ 

An6  the  common  brotherhooi  man. 


PHILIP  MORRIS  & COMPANY 


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'j^^tribute,  suitable  for  framing.  Please  make  your  request  on  your  professional  stationery. 
" Address  Research  Dept.,  PHILIP  MORRIS  & CO.,  LTD.,  INC.  I J 9 Fifth  A'ue.,  New  York  3,  N.  Y. 


POSTGRADUATE  COURSE 

In 

^uedt  ^peaLerd 

Thoracic  Diseases 

And 

Dr.  F.  A.  Duncan  Alexander,  Chief  of  Anes- 
thesiology, Veterans  Administration  Hos- 
pital, McKinney,  Texas. 

Thoracic  Anesthesiology 

Sponsored  by 

AMERICAN  TRUDEAU  SOCIETY 

Dr.  J.  Burns  Amberson,  Jr.,  Professor  of  Medi- 
cine, College  of  Physicians  and  Surgeons, 
Columbia  University;  Visiting  Physician  in 
Charge,  Tuberculosis  Service,  Bellevue  Hos- 
pital, New  York. 

In  Cooperation  With 

THE  UNIVERSITY  OF  COLORADO 
SCHOOL  OF  MEDICINE 

Dr.  Robert  J.  Anderson,  Chief,  Division  of 
Tuberculosis,  United  States  Public  Health 
Service,  Washington,  D.  C. 

July  18.30,  1949 

Dr.  Robert  G.  Bloch,  Professor  of  Medicine, 
University  of  Chicago,  Chicago,  Illinois. 

University  of  Colorado 

Medical  Center 

Denver,  Colorado 

Dr.  Emanuel  M.  Papper,  Assistant  Professor 
of  Anesthesia,  New  York  University  College 
of  Medicine. 

Registration  Fee:  $100.00 

Applicants  should  write  to: 

American  Trudeau  Society 

1 790  Broadway 

New  York,  N.  Y. 

Dr.  David  T.  Smith,  Professor  of  Bacteriology 
and  Associate  Professor  of  Medicine,  Duke 
University  School  of  Medicine,  Durham,  , 
North  Carolina. 

Dr.  Joseph  Weinberg,  Chief  of  Surgery,  Birm- 
ingham Veterans  Administration  Hospital, 

Van  Nuys,  California. 

LIVERMORE  SANITARIUM 


• The  Hydropathic  Department 
devoted  to  the  treatment  of  gen- 
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attention  given  funaional  and  or- 
ganic nervous  diseases.  A well 
equipped  clinical  laboratory  and 
modern  X-ray  Department  are  in 
use  for  diagnosis. 


• The  Cottage  Department  (for 
mental  patients)  has  its  own  fa- 
cilities for  hydropathic  and  other 
treatments.  It  consists  of  small 
cottages  with  homelike  surround- 
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patients  in  accordance  with  the 
type  of  psychosis.  Also  bungalows 
for  individual  patients,  offering 
the  highest  class  of  accommoda- 
tions with  privacy  and  comfort. 


GENERAL  FEATURES 

1.  Climatic  advantages  not  excelled  in  United  States.  Beautiful  grounds  and  attractive  surrounding  country. 

2.  Indoor  and  outdoor  gymnastics  under  the  charge  of  an  athletic  director.  An  excellent  Occupational  Department. 

3.  A resident  medical  staff.  A large  and  well-trained  nursing  staff  so  that  each  patient  is  given  careful  individual  attention. 


Information  and  circulars  upon  request. 

Address:  O.  B.  JENSEN,  M.D. 
Superintendent  and  Medical  Direaor 
Livermore,  California 
Telephone  313 


CITY  OFFICES: 

San  Francisco  Oakland 

450  Sutter  Street  1624  Franklin  Street 

GArfield  1-5040  GLencourt  1-5988 


504 


Rocky  Mountain  Medical  Journal 


so  VITAL  FOR  OPTIMAL  HEALTH 


In  the  achievement  and  maintenance  of 
optimal  health,  no  other  single  influ- 
ence looms  so  vital  as  sound  nutrition. 
In  fact,  so  important  is  this  principle  to 
preventive  medicine  that  optmal  nutri- 
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When  nutritional  health  is  threat- 
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is  insufflcient  because  of  other  reasons, 
the  multiple  dietary  supplement  Ovaltine 


in  milk  is  especially  useful  for  over- 
coming nutrient  deficiencies  of  the  diet. 

Three  glassfuls  daily  may  readily 
supplement  even  poor  diets  to  ade- 
quacy. Easy  digestibility  makes  its 
many  valuable  nutrients  — vitamins, 
minerals,  biologically  complete  protein, 
and  food  energy — quickly  available. 
The  pleasing  flavor  adds  to  its  wide 
applicability  and  usefulness. 

The  table  below  gives  the  amounts 
of  nutrients  in  three  glassfuls  of  Oval- 
tine  in  milk. 


THE  WANDER  COMPANY,  360  N.  MICHIGAN  AVE.,  CHICAGO  1,  ILL. 


Three  servings  daily  of  Ovaltine,  each  made  of 
V2  oz.  of  Ovaltine  and  8 oz.  of  whole  milk,*  provide: 


CALORIES 676  VITAMIN  A 3000  1.U. 

PROTEIN 32  Gm.  VITAMIN  Bi 1.16  mg. 

FAT 32  Gm.  RIBOFLAVIN 2.0  mg. 

CARBOHYDRATE  ....  65  Gm.  NIACIN 6.8  mg. 

CALCIUM  1.12  Gm.  VITAMIN  C 30.0  mg. 

PHOSPHORUS  0.94  Gm.  VITAMIN  D 417  I.U. 

IRON  12  mg.  COPPER 0.5  mg. 


•Based  on  average  reported  values  for  milk. 

Two  kinds.  Plain  and  Chocolate  Flavored.  Serving  for 
serving,  they  are  virtually  identical  in  nutritional  content. 


for  June,  1949 


505 


RELIABLE  DRUGGISTS 

PATRONIZE  DENVER’S  INDEPENDENT  DRUGGISTS 


WE  RECOMMEND 

We  Recommend 

COUNTRY  CLUB 

PFAB  PHARIMACY 

PHARIHACY 

JESS  L.  KINCAID,  Prop. 

PRESCRIPTION  SPECIALISTS 

Prescri pti oits,  Bi ologi cals 

'k 

and  Fine  Cosmetics 

5190  W.  Colfax  at  Sheridan 

1700  E.  6th  Ave.  EAst  7743 

Phone  TAbor  9931-0951 

Denver,  Colorado 

DENVER,  COLORADO 

HATCH  PHARMACY 

PRESCRIPTIONS  OUR  SPECIALTY 
Drugs  — Sundries 

Free  Immediate  Deliveries  on  Prescriptions 

794  Colorado  Blvd.  Denver,  Colo. 

We  Recommend 

EARNEST  DRUG  COMPANY 

T.  H.  BRAYDfEIN,  Prop. 

PRESCRIPTION  SPECIALISTS 
Prompt  Delivery  Service 

Phone  EAst  7718 

1699  Broadway  Phone  KEystone  7237 

Denver,  Colorado 

“When  in  Need  Think  of  Us  Indeed” 

"Conveniently  Located  for  the  Doctor” 

HYDE’S  PHARMACY 

DnarniDfif 

ACCURATE  PRESCRIPTIONS 

j rilHilllciliy 

Chas  W.  Hyde,  Prop. 

Rocky  Mountain  Distributor  for  Sherman 

*^lie  Particuiar 

Biologicals  and  Pharmaceuticals 

Free  Deliveries 

629  16th  St.  (Mack  Bldg.)  KE.  4811 

East  17th  Ave.  at  Grant  KE.  5987 

21  Years  in  the  Heart  of  North  Denver 

We  Recommend 

GUIDO  SHUMAKE  DRUGS 

BONNIE  BRAE 

(Formerly  Otto  Drug  Co.) 

DRUG  COMPANY 

PRESCRIPTIONS  ACCURATELY 

Alfred  C.  Andersen,  Owner  and  Manager 

COMPOUNDED 

Prescriptions  Accurately  Compounded 

Free  Delivery  Service 

Drugs Sundries 

FREE  IMMEDIATE  DELIVERIES 

West  38th  Ave.  and  Clay  Denver,  Colo. 

ON  EMERGENCY  PRESCRIPTIONS 

763  South  University  Boulevard 

Phone  GRand  9934 

Phone  RAce  2874  — Denver,  Colorado 

WE  RECOMMEND 

22  Years  in  North  Denver 

Whittaker’s  Pharmacy 

OTTO  DRUG  COMPANY 

TRY  US  FIRST 

“The  Friendly  Store” 

Prescriptions  Accurately  Compounded 

Free  Delivery  Service 

PRESCRIPTION  SPECIALISTS 

West  32nd  and  Perry,  Denver,  Colo. 

(New  Location) 

5070  Federal  Boulevard  Denver,  Colorodo 

Phone  GLendale  2401 

Phone  GRand  9832 

506 


Rocky  Mountain  Medical  Journal 


RELIABLE  DRUGGISTS 

PATRONIZE  DENVER’S  INDEPENDENT  DRUGGISTS 


WALTERS  DRUG  STORE 
801  COLORADO  BLVD. 
Denver,  Colorado 

'A 

Telephone  FRemont  5391 


lAJht  to  at 

WEISS  DRUG 

PRESCRIPTION  SPECIALISTS 

'k 

Colfax  and  Elm  Denver,  Colorado 

Phone  EAst  1814 


We  BLecomiaeiidl 

VAN'S  PHARMACY 

THOS.  A.  VANDERBUR 

Prescriptions,  Dmgrs,  Cosmetics,  Masazlnes 
Sundries  Excellent  Fountain  Service 

2859  Umatilla  St.,  Cor.  29th  Ave.  at  Umatilla 
GRand  7044  Denver,  Colo. 


Dansberry’s  Pharmacy 

“New  Ultra  Modern  Prescription  Service" 

JAMES  F.  DANSBERRY 
Owner  and  Manager 

Champa  at  14th  Street  Denver,  Colorado 
Phone  KEystone  4269 


Harl  Cleveland,  Owner 

CLEVELAND  PHARMACY 

W.  29th  Ave.  at  Speer  Ph.  GL.  9272 

Modem  Prescription  Department 
Registered  Pharmacist 

Dmgs  — Sundries  — Soda  Fountain 
HOURS:  Week  Days,  S a.m.  to  10  p.m. 

Sundays.  10  om.  to  1 p.m.,  5 p.m.  to  8 p.m. 

Prescriptions  Delivered  Promptly 


WE  RECOMMEND 

LAKEWOOD  PHARMACY 

R.  W.  Holtgren,  Prop. 
PRESCRIPTION  SPECIALISTS 


West  Colfax  at  Wadsworth 
Lakewood  Colorado 

Phone  Lakewood  65 


Downing  Street  Pharmacy 

GEORGE  M.  HILL,  Prop. 

PROFESSIONAL  PHARMACIST 

901  Downing  St.  Denver,  Colo. 

Phone  CHerry  2767 

Complete  Merchandise  Line 
Free  Delivery  on  Prescriptions 


East  Denver’s  Prescription  Drug  Store 


Bert  C.  Corgan,  Prop. 

3401  FRANKLIN  STREET 
KEystone  7241 


OVERSTAKE’S  PHARMACY 

Gail  E.  Overstake 
Prescription  Specialists 

DRUGS  — SUNDRIES  — 
COSMETICS  — CANDIES 

We  Deliver 

1000  So.  Gaylord  — RAce  4401 


PROFESSIONAL  MEN  RECOMMEND 


D.  MALCOLM  CAREY,  Pharmacist 

Phone  AComa  3711 

224  Sixteenth  Street  Denver,  Colorado 


for  June,  1949 


507 


W.D.I^ocL 

Ambulance 
Service 

Prompt,  Careful  and  Courteous 
Serving  Denver  25  Years 

Approved!  by  Physiciaiui  0«nerally 

18th  Ave.  at  Gilpin  St.,  Phone  EA.  7733 


Surgical  Supports  Expertly  Fitted. 

Miss  Mabel  P.  Cliff,  Authorized  Fitter 


2>  enver  ^uratcai ,Suopiu  C^o 


tur^ical  y^ompan^ 

’“For  better  service  to  the  profession” 

1438-40  Tremont  Place  CHerry  4458 

Denver  2,  Colorado 


OXYGEN  SERVICE 

MASKS  — CATHETERS  — CONE 


AEROSOL  PENICILLIN  EQUIPMENT 


NEW-DRY  ICE  OXYGEN  TENTS 

1739  Welton  24-Hour  Service  MAin  5183 


The  Complete 

RENTAL  SERVICE 


Cooler  — Water  — Cups 
Modernize  Your  Office  With 

PURE  DEEP  ROCK 

Artesian  Water 


COLD  STORAGE  SPACE 

For  Biological  Supplies 


ICE  CUBES 

A Generous  Supply 


ELEC.  WATER  COOLERS 

All  Types  and  Makes 


FOR  RENT  OR  FOR  SALE 


DEEP  ROCK  WATER  CO. 

614  27th  St.  TAbor  5121 


508 


Rocky  Mountain  Medical  Journal 


Shadel  Sanitarium  has  combined  research*, 
treatment  and  rehabilitation  to  return  thousands 
of  Alcoholics  to  normal  living.  Groundwork 
for  recovery  is  laid  through  intensive, 
individualized  therapy.  Statistical  evaluation  of 
results  since  1935,  have  shown  that  in  over 
3125  cases  reported*,  40%  remained  abstinent 
for  four  years  or  longer.  Our  object  is  . . , 
Cooperation  with  the  family  physician  in 
mapping  the  road  to  recovery. 


ECIALISTS 


RECOGNIZED  BY  THE 

A.  M.  A. 

MEMBER  OF  THE 

A.  H.  A. 


N THERAPY  FOR  CHRONIC  ALCOHOLISM 


BY  THE  CONDITIONED  REFLEX  AND  ADJUVANT  METHODS 
7106  35th  AVE.  S.  W.  SEATTLE  6,  WASH.,  WEST  7232,  CABLE  ADDRESS:  "REFLEX" 


for  June,  1949 


509 


We  Recommend 

KARC’S  PAINT  CO. 

Lowfc  Bros.  Paints  Kem-Tone 

Wall  Paper  Painters’  Supplies 

Art  Supplies 

FREE  DELIVERY  

Phone  CHerry  3779 

620  Santa  Fe  Drive  Denver 

NEWTON  OPTICAL  COMPANY 

GUILD  OPTICIANS 

V.  C.  NORWOOD.  Manager 

309-16th  Street  Denver 

Phone  KEystone  0806 

Catering  to  Medieol  Profession  Patronage 

Denver’s  Fireproof 

COLBURN  HOTEL 

D.  B.  Cerise  is  the  genial  Host  and  Manager 

• CONVENIENT  — Located  only  a ten-minute  walk 
from  the  heart  of  the  city. 

• PLEASANT  — Away  from  — above  the  noise  and 
rush  of  downtown  Denver. 

• EXCELLENT  FOOD  — Dining  that  has  satisfied  the 
demanding  tastes  of  all  patrons. 

• Visit  Our  New  Cocktail  Lounge. 

TENTH  AVE.  at  GRANT  ST. 

Phone  MAin  6261  Denver,  Colo. 

A TELEPHONE  SERVICE 
THAT’S  INVALUABLE 

TO  PROFESSIONAL  MEN 

The  Physicians  & Surgeons  Exchange 

965  Gas  & Electric  Bldg.  K£.  8173 

We  take  your  phone  calls — get  them 
to  you.  On  the  job  24  hours  every  day. 

RESTAURANT  240 

MISS  M.  E.  GABRIEL,  Prop. 

SERVING  TRADITIONALLY  GOOD 
FOOD  AT  MODERATE  PRICES 

HOURS:  11:00  A.M.— 2d)0  P.M.  4:30—7:30  P.M. 
SUNDAYS:  12  Noon  to  7:00  P.M. 

Closed  Wednesdays 

240  Broadway  Denver,  Colo. 

SPruce  2182 

WHEATRIDCE  FARM  DAIRY 

COMPLETE  LINE  OF  GRADE  A 

DAIRY  PRODUCTS 

Special  Milk  for  Babies 
DELIVERED  TO  YOUR  DOOR 

We  Have  Our  Own  Cows 

8000  West  44th  Ave. 

GL.  1719  ARVADA  220 

We  Cater  to  the  Medical  Profession 

CASCADE  LAUNDRY 

10  Per  Cent  Discount  If  You  Bring  Your 
Laundry  in 

HAND  DRY  CLEANING 
“Deserving  of  Your  Patronage” 

1621  Tremont  Denver  TAbor  6379 

Charge  Accounts  Invited 

We  Recommend 

Jackson’s  Cut  Rate  Drugs 

LIQUORS— SUNDRIES 
PRESCRIPTIONS 

% 

Call  SP.  3445 

DOWNING  and  ALAMEDA 

UNITED  STATES  FIDELITY  AND  GUARANTY  COMPANY 

(U.  S.  F.  & G.) 

Assets — Over  $149,000,000  David  Jacobs,  Manager 

922  University  B!dg.,  P.O.  Box  1437  Denver  1,  Colorado 

Carries  professional  liability  insurance  under  group  policies  for  many  of  the  indi- 
vidual members  of  the  Colorado,  New  Mexico  and  Wyoming  State  Medical  Societies. 

Please  write  for  rates  and  other  details.  Also  will  take  care  of  your  needs  for  the 

following: 

OFFICE— Burglary  and  Robbery,  Public  Liability  and  Property  Damage,  Fidelity 

Bond. 

PERSONAL — Automobile  Insurance — all  types  Comprehensive  Personal  Residence 

Burglary  and  Hold-up. 

Any  business  written  will  be  for  the  account  of  our  agent  in  your  territory. 

510 


Rocky  Mountain  Medical  Journal 


ONE  EASY  COMPUTATION: 

^ SET  THE  CALCULATOR 
✓ READ  THE  ANSWER 

Pride  in  possession  of  a McKesson  Water- 
less Metabolor  increases  with  your  growing 
awareness  of  its  matchless  accuracy,  unsur- 
passed convenience  and  harmonious  de- 
sign. It  adds  heauty  to  your  office,  pleas- 
ure to  your  work,  satisfaction  through  the 
years. 

This  improved  basal  metabolism  unit  is 
easy  to  prepare,  calculate  and  clean.  The 
technique  of  operation  is  simple,  direct 
and  positive.  Automatic  calculator  pre- 
pares data,  insures  accuracy.  Only  one 
mathematical  procedure  required.  The 
McKesson  Waterless  Metabolor  incorpo- 
rates all  the  desirable  features  of  modern, 
scientific  diagnostic  equipment. 


COMPLETELY  MODERN  IN  DESIGN.  THE  McKESSON  WATERLESS 
METABOLOR  IS  BEAUTIFULLY  FINISHED  IN  PORCELAIN  AND 
CHROME  TO  BLEND  WITFI  MODERN  OFFICE  APPOINTMENTS 
AND  HOSPITAL  INTERIORS. 

*Write  today  for  descriptive  booklet  No.  RM-649  in  which  the  ad- 
vantages of  the  McKesson  Waterless  Metabolor  are  fully  de- 
scribed. Available  in  stock  . . . for  immediate  delivery. 

DISTRIBUTED  BY 


PHYSICIANS  AND  HOSPITALS  SUPPLY  CO.,  Inc. 

MINNEAPOLIS  MINNESOTA 


jor  June,  1949 


511 


Winning  Health 

in  the 

Pikes  Peak  Region 


COLORADO  SPRINGS 


Inquiries  Solicited 


GLOCKIVER  PETVROSE  HOSPITAL 

Sisters  of  Charity 

HOME  OF  MODERN  SANATORIA 


SOME  of  the  exclusive  features  of  this 
new  Vacuum  Tube  Hearing  Aid  are: 
Sealed  Crystal  Microphone— gives  same 
dependable  service  under  all  conditions  of 
temperature  and  humidity.  Stabilized  Feed- 
back — amplification  without  distortion. 
No  sudden  blast  from  loud  sounds  when 
volume  is  turned  up. 

For  othsr  iniormation  write  or  coll 

M.  F.  Taylor  Laboratories 

721  Republic  Building 
MAin  1920  Denver,  Colo. 


SERVICE 

QUALITY 

PAUL  WEISS 

PRESCRIPTION 

OPTICIAN 

1620  ARAPAHOE  ST.  DENVER 

MAin  1722 

FAIRFAX  SANITARIUM 

Kirkland,  Wash. 

Situated  one  mile  north  of  Juanita 

TREATING  NERVOUS  AND 
MENTAL  DISEASES 

Beautiful  and  restful  surroundings  affording 
recreational  facilities.  Cottage  plan  for  segre- 
gation of  patients.  Insulin  and  Electro-shock 
Therapy  when  indicated. 

Attending  Physicians 
FREDERICK  LEMERE,  M.D. 

NATHAN  K.  RICKLES,  M.D. 

JAMES  H.  LASATER,  M.D. 

MORTON  E.  BASSAN,  M.D. 

JACK  J.  KLEIN,  M.D. 

Manager:  A.  G.  HUGHES 
Route  2,  Box  365,  Kirkland 
Phone:  Kirkland  2391 


WESTERN  ELECTRIC 

HEARING  AIDS 

Engineered  by  Bell  Telephone  Laboratories 


512 


Rocky  Mountain  Medical  Journal 


a summation  of  activity" 


CeynGit  on  Phofmocy  and  Chemistry,  AM.  A, 

J.A.M.A,  137:769  fJune  26}  1943. 


In  Tincture  Mercresin,*  secondary  amyltricresols  and 
orthohydroxyphenylmercuric  chloride  "supplement  each  other 

so  that  the  mixture  is  approximately  twice  as  germicidal 

for  Staphylococcus  aureus  os  the  component  cresol  derivatives 
alone  and  seven  to  ten  times  as  germicidal  as 

the  mercury  compound  alone." 


Mercresin  combines  this  germicidal  potency  with 
bacterhstaik  and  fungicidal  properties  for 

1.  antisepsis  of  superficial  wounds  or  infections, 

2.  irrigation  of  certain  body  cavities  and  deep 
infected  wounds, 

3.  topical  application  to  mucous  membranes,  and 

4.  prophylactic  surgical  preparation  of  intact  skin. 


Seeendery-ctmyftricreseU  1/10%  - 
Orthehydroxypheitylmereurtc 

Chloride,.... 1/10% 

A>€eton@ 10% 

Alcohol  50% 

/Ttnfedj:  2 oz.,  4 oz.,  pint,  ond 
gallon  bottles 

(Stainless):  4 oz.,  pint,  and 
gallon  bottles 

riNE  PHARMACEUTICALS  SINCE  1886 


j 


i 


Upjohn 

KALAMAZOO  99,  M!CH!GAN 


^TRADEMARK,  REG.  U.8.  PAT.  OFF. 


for  June,  1949 


513 


Cook  County  Graduate 
School  of  Medicine 

ANNOUNCES  CONTINUOUS  COURSES 

SURGERY — Intensive  Course  in  Surgical  Technique,  Two 
Weeks,  starting  June  20,  July  25,  August  22.  Surgi- 
cal Technique,  Surgical  Anatomy  and  Clinical  Sur- 
gery, Four  Weeks,  starting  July  11,  August  8,  Sep- 
tember 12.  Surgical  Anatomy  and  Clinical  Surgery, 
Two  Weeks,  starting  June  20,  July  25,  August  22. 
Surgery  of  Colon  and  Rectum,  One  Week,  starting 
June  13,  September  12.  Esophageal  Surgery,  One 
Week,  starting  October  10.  Thoracic  Surgery,  One 
Week,  starting  June  20.  Breast  and  Thyroid  Surgery, 
One  Week,  starting  June  27.  Fractures  and  Trau- 
.matic  Surgery,  Two  Weeks,  starting  June  13. 

GYNECOLOGY — Intensiye  Course,  Two  Weeks,  starting 
June  20,  September  26.  Vaginal  Approach  to  Pelvic 
Surgery,  One  Week,  starting  June  13,  September  19. 

OBSTETRICS — Intensive  Course,  Two  Weeks,  starting 
September  1 2. 

MEDICINE — Intensive  General  Course,  Two  Weeks, 
starting  June  13.  Gastroenterology,  Two  Weeks, 
starting  June  27.  Gastroscopy,  Two  Weeks,  starting 
June  13,  July  18.  Electrocardiography  and  Heart 
Disease,  Two  Weeks,  starting  July  18. 

PEDIATRICS — Diagnosis  and  Treatment  of  Congenital 
Malformations  of  the  Heart,  Two  Weeks,  starting 
June  13.  Personal  Course  in  Cerebral  Palsy,  Two 
Weeks,  starting  August  1 . 

DERMATOLOGY — Formal  Course,  Two  Weeks,  starting 
June  13.  Informal  Clinical  Course  every  two  weeks. 

UROLOGY — Intensive  Course,  Two  Weeks,  starting 
September  26.  Ten  Day  Practical  Course  in  Cysto- 
scopy every  two  weeks. 

GENERAL,  INTENSIVE  AND  SPECIAL  COURSES  IN  ALL 
BRANCHES  OF  MEDICINE,  SURGERY  AND 
THE  SPECIALTIES 

TEACHING  FACULTY,  ATTENDING  STAFF  OF 
COOK  COUNTY  HOSPITAL 
Address:  REGISTRAR,  427  South  Honors  Street, 
Chicago  12,  Illinois 


FOR 

AUTOMOTIVE 
SERVICE 


Visit  Denver’s 
LEADING 

SERVICE  CENTER 

Where  You  Get 
Quality  at  a 
Fair  Price! 


CO. 


TiLEPHONE  TABOR  5191 
& BROADWAY  • DENVER 


If  You  Send  Out  Statements 

ROCKMONT  Statement  Envelopes  save  time  in  your 
office  and  make  it  easy  for  the  patient  to  remit. 

The  statement  is  an  envelope  addressed  back  to  your 
office  and  goes  out  to  the  patient  in  a crystalite  window 
envelope,  thus  saving  one  complete  addressing  opera- 
tion, for  your  secretary.  All  the  patient  has  to  do  is 
simply  insert  check  and  mail. 

For  those  slow-pay  patients,  ROCKMONT 
"COLLECTELOPES”  will  get  results.  Three  colors 
identify  the  message  of  collection.  Proved  copy  brings 
payment  in  fast,  without  offending. 


Sacked 

and 

SPEEDS  UP 
COLLECTIONS! 


SPECIAL  OFFER  . . . ask  for  Assortment  "X"  . . . 500  Statement  envelopes/  plus 
500  "Collectelopes"  plus  1,000  window  envelopes  ALL  FOR  ONLY  $20.26  postpaid! 

Price  includes  imprinting 


ROCKMONT  ENVELOPE  COMPANY 

Alameda  and  Cherokee  » PEari  2484  • Denver,  Colorado 


514 


Rocky  Mountain  Medical  Journal 


A private  hospital  for  the  scientific  treatment  of  neuro-psychiatric  disorders,  including 
alcoholism  and  drug  addiction.  Beautiful  landscaping  and  home-like  surroundings  afford 
a restful  atmosphere.  Accommodations  vary  from  single  rooms  with  or  without  bath  to 
rooms  en  suite,  allowing  for  segregation  of  guests. 


Detailed  information  furnished  on  request. 


Karl  J.  Waggener,  M.D. 


Wendell  T.  Wingett,  M.D. 


THE  CHILDREN’S  HOSPITAL  ASSOCIATION 

of  DENVER 

NON-SECTARIAN- — NON-PROFIT 

Providing  medicinal  and  surgical  aid  to  sick  and  crippled  children  of  the  Rocky 
Mountain  Region  from  Birth  to  Maturity 

Every  modern  scientific  aid  available  to  the  physicians  and  surgeons 
of  Colorado  and  Wyoming 

Approved  by  the  American  Medical  Association  and  Full  Three- Year 

the  American  College  of  Surgeons  Nurses’  Training  Course 


for  June,  1949 


515 


w* 


Natural  Fortification 


• special  Morning  Milk  is  fortified  (from  natural  sources) 
with  400  U.S.P.  units  vitamin  D and  2000  U.S.P.  units 
vitamin  A per  reconstituted  quart. 


Morning 


516 


Rocky  Mountain  Medical  Journal 


MALONE  DREG  CO. 

New,  Modern,  Drug  Store  Service 

PRESCRtPTIONS  A SPECIALTY 
FREE  DELIVERY 

100  So.  Broadway  SPruce  6226 

Denver,  Colorado 


YOU  ARE  INVITED  TO  VISIT  OUR 
NEW  MODERN  STORE 

Conveniently  Located  to  Meet  the  Needs 
of  the  Doctor 


DL 


Su.pt}iu  C^o. 


f^li^diciunS  CT"  ^ur^eonS  ^uppl^ 
Metropolitan  Bldg. 

221  Sixteenth  Street  TAbor  0156 

DENVER 


Bonita  Pharmacy 

(Established  1921) 

Prescription  Pharmacists 

6th  Avenue  at  St.  Paul  Street 
“RICHT-A-WAY”  SERVICE 

GERALD  P.  MOORE.  Manager 

Phone  FRemont  2797 


ton 


50  y.ars  of  Clk  icai  PraAcriplii 

Service  to  the  ^^octori  of  d-lia^anna 


ROEDEL^S 

PRESCRIPTION  DRUG  STORE 

CHEYENNE,  WYOMING 


Qotorado  Springs  !Psychopathic  Hospital 

A Private  Hospital  for  Nervous  and  Mental  Diseases 

Situated  in  a beautiful  valley  two  miles  south  of  Colorado  Springs,  which  is  nationally  known  as  a health 
center.  New  building  for  mild  cases  of  Functional  Neurosis,  affording  complete  classification  of  patients. 
Home-like  surroundings,  scientific  medical  treatment  and  nursing  care.  Booklet  and  rates  on  application. 

C.  F.  Rice,  Superintendent,  Colorado  Springs,  Colorado 


for  June,  1949 


517 


MEDICAL 

CENTER 

BUILDING 

Colfax  Ave.  and 
Garfield  Stree 


Doctors,  Patients,  Public 


MOST  ASTOUNDING 


19 


Only  medical  building  in  Denver  with  direct  telephone  inter- 
communication between  all  tenants  including  prescription  pharmacy. 

Parking  facilities  for  tenants  and  patients 

• Asphalt  Tile  Floors  • Laboratory  and  X-ray  Service  • Service  Connections  for  Air 
Pressure,  Plumbing,  Gas  and  Electricity  • Humidified  Washed  Air  Conditioning. 


^€^1  regarding  the  limited  space  still  available  tor  lease  to  professiona 

\^AN  ScKAACK  e Company  Manager 

:cT  il  nilCDD 


724  SEVENTEENTH  STREET 


A.  C.  DUERR, 


DENVER  2,  COLORADO 


MEDICAL  CENTER 
PHARMACY 

Located  in  the  New  Medical  Building 

3701  East  Colfax  DExter  5467 

DENVER,  COLO. 

Prescriptions  and  Medical  Supplies 

Wm.  K.  VAN  SANT,  Mgr. 

Free  Delivery 


YORK 

PHARMACY 

Denver’s  Finest  Prescription  Store 

Free  Delivery 

Phone  FR.  8837 

2300  East  Colfax  Avenue  at  York  Street 
Almay  Cosmetics 


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Ot‘niii — Butler Biillermilk 

Phone  1101  Boulder,  Colo 


Silver  State  Laundry 

Highest  Quality  Laundry  Service 

Everything  washed  with  Ivory  Soap  and 
artesian  water  at  no  additional  cost  to  you 

Zoric  Garment  Cleaning  System 

Broadway  at  25th  Phone  TAbor  5181 

Denver 


518 


Rocky  Mouotain  Medical  Journal 


Index  to  Advertisers 


Page 


Abbey  Rents 508 

Abbott  Laboratories  491 

Alba  Dairy  518 

American  Medical  and  Dental 
Association 436 

Ayerst,  McKenna  & Harrison_489 

Baker  Laboratories,  Inc 485 

Bonita  Pharmacy 517 

Bonnie-Brae  Drug  506 

Brown  Schools  500 

Burroughs  Wellcome  & Co 441 

Cambridge  Dairy  432 

Camel  Cigarette 433 

Camp  & Co.,  S.  H 487 

Cancer  Conference Cover  III 

Capital  Chevrolet  514 

Cascade  Laundry 510 

Children’s  Hospital  Assn 515 

City  Park  Dairy 438 

Cleveland  Pharmacy  507 

Colburn  Hotel  510 

Colorado  Springs 

Psychopathic  Hospital 517 

Columbian  Bifocal  Company_496 

Colvin  Medical  Books 498 

Continental  Casualty  Co 493 

Cook  County  Graduate 
School  of  Medicine 514 

Country  Club  Pharmacy 506 

Cutter  Laboratories 483 

Dansberry’s  Pharmacy  507 

Davis  Bros.  Drug  Company 498 

Deep  Rock  Water 508 

Dellinger,  Lee  W.  496 

Denver  Fire  Clay  Co.,  The 496 

Denver  Oxygen  Co 440 

Denver  Surgical  Supply  Co. 508 

Denver  Towel  Supply  Co 500 

Dorr  Optical  Co 442 

Downing  Street  Pharmacy 507 

Doyle’s  Pharmacy  506 

Durbin  Surgical  Supply  Co.__520 


Page 


Earnest  Drug  Co 506 

Ehret  Engraving  Co 440 

Fairfax  Sanitarium  512 

Fairhaven  Maternity 

Hospital  432 

Fleet,  C.  B.,  Company,  Inc 495 

Franklin  Drug  Co 507 

Glockner  Penrose  Hospital 512 

Hatch  Pharmacy 506 

Hyde’s  Pharmacy  506 

Jackson’s  Cut  Rate  Drug 510 

Karg  Paint  Co 510 

Kendrick-Bellamy  Co. 430 

Kremers  Urban  Company 497 

Lakewood  Pharmacy 507 

Lederle  Laboratories 444 

Lilly,  Eli  & Co. 

Insert  Between  444-445 

Livermore  Sanitarium  504 

Luzler’s,  Inc.  501 

Malone  Drug  Store 517 

Mead,  Johnson  & Co Cover  IV 

Medical  Center  Pharmacy 518 

Mercy  Hospital  490 

Morning  Milk  516 

Newton  Optical  Co 510 

Nurses  Official  Registry 494 

Otto  Drug  Co 506 

Overstake’s  Pharmacy  507 

Park  Floral  Co 440 

Parke,  Davis  & Co._Cover  11-429 

Pfab  Pharmacy  506 

Philip  Morris  & Co 502-503 

Physicians  & Hospitals  Supply 
Co.  511 

Physicians  and  Surgeons 

Supply  517 

Physicians  and  Surgeons 

Telephone  Service  Exch 510 

Physicians  Casualty  Assn 500 

Presbyterian  Hospital  498 

Professional  Pharmacy 507 

Restaurant  240  510 


Page 


Roche  Ambulance  Service 508 

Rockmont  Envelope  Co 514 

Roedel’s  Prescription  Drug 517 

Schering  Corporation  435 

Schmid,  Julius,  Inc 499 

Searle,  G.  D.  & Co 481 

Shadel  Sanitarium  509 

Shadford-Fletcher  Optical  Co.  438 

Shirley-Savoy  Hotel 500 

Shumake  Drug,  Guido 506 

Silver  State  Laundry 518 

Smith,  Kline  & French 443 

Squibb  Insulin  Products 439 

St.  Anthony  Hospital 490 

Stapleton,  H.  C.,  Drug  Co 490 

Starco  Products  Company 500 

Stodgill’s  Imperial 

Pharmacy  438 

Telephone  Answering  Service  432 

Thoracic  Medicine,  Postgrad- 
uate Course  504 

Thornton,  George  R 430 

United  States  Brewing 

Industry  492 

United  States  Fidelity  and 

Guaranty  Company 510 

Upjohn 513 

Univ.  of  Colo.  Medical  School_498 

Van’s  Pharmacy 507 

Van  Schaack  & Co 518 

Walters  Drug  Store 507 

Wander  Company 505 

Weiss  Drug  507 

Weiss,  Paul  512 

Western  Electric 

Hearing  Aids  512 

Western  Newspaper  Union 494 

Wheatrldge  Farm  Dairy 510 

Whittaker’s  Pharmacy  506 

Winthrop-Stearns,  Inc 431 

Woodcroft  Hospital  515 

Wyeth,  Inc.  437 

York  Pharmacy  518 


jor  June,  1949 


519 


1625  COURT  PLACE,  DENVER  2,  COLORADO 


-y^nnouncina  . . . 

The  Third  Annual  Rocky  Mountain 
Cancer  Conference 

JULY  14-15,  1949,  DENVER 

☆ 

An  outstanding  educational  program  presenting  recent 
trends  in  cancer  research,  sponsored  by  the  Colorado 
State  Medical  Society,  Rocky  Mountain  Cancer  Founda- 
tion and  the  Colorado  Division,  American  Cancer  Society. 

☆ 

Eight  Distinguished  Guest  Speakers 


George  F.  Cahill,  M.D.,  Professor 
of  Urology,  Columbia  University 
College  of  Physicians  and  Sur- 
geons. 

Sherwood  Moore,  M.D.,  Professor 
of  Radiology,  V/ashington  Uni- 
versity. 

C.  S.  O’Brien,  M.D.,  Professor  and 
Head,  Department  of  Ophthal- 
mology, State  University  of  Iowa. 

John  dej.  Pemberton,  M.D.,  Profes- 
sor of  Surgery,  Mayo  Foundation. 


Fred  W.  Stewart,  M.D.,  Patholo- 
gist to  Memorial  Hospital  Cen- 
ter, New  York. 

Fred  D.  Weidman,  M.D.,  Professor 
of  Research  in  Dermatology  and 
Mycology,  University  of  Pennsyl- 
vania. 

Cyrus  C.  Sturgis,  M.D.,  Professor 
of  Medicine,  University  of  Michi- 
gan. 

Idys  Mims  Cage,  M.D.,  Professor  of 
Clinical  Surgery,  Tulane  Univer- 
sity. 


☆ 


Round-TabEe  Discussion  RecreationaE  Facilities  Non-Scientific  Banquet 
Hotel  reservations  are  now  available.  Write  Cancer  Conference, 

519  17th,  Denver 

NO  REGISTRATION  FEE 


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Boil  water. 


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Dextri-Maltose 
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Bladder  Neck  Obstruction  in  Women  and 
Children — John  F.  Patton,  M.D.,  St.  Louis. 

A Simple  Bedside  Method  for  the  Determination 
OF  Plasma  Salicylate — Joseph  H.  Miller, 
M.D.,  and  Richard  W.  Whitehead,  M.D.,  Den- 
ver. 

Severe  Bleeding  of  an  Esophageal  Varix  Con- 
trolled BY  OxYCEL — David  A.  Dolowitz,  M.D., 
William  C.  Walker,  M.D.,  and  Grant  Lee  Ben- 
son, Jr.,  M.D.,  Salt  Lake  City. 


The  Treatment  of  Status  Asthmaticus  With 
Intravenous  Ethyl  Alcohol — John  D.  Gil- 
laspie,  M.D.,  Boulder. 


Extradural  Hemorrhage — M.  W.  Van  Allen, 
M.D.,  Denver. 


Fatal  Chronic  Peptic  Ulcer  in  the  Aged — Erving 
F.  Geever,  M.D.,  Colorado  Springs. 


Perspective  in  Cancer  Research — H.  Mason 
Morjit,  M.D.,  Denver. 

Protective  Sterilization  in  the  Rocky  Moun- 
tain States — Clarence  J.  Gamble,  M.D.,  Mil- 
ton,  Mass. 


{For  Complete  Table  of  Contents,  Turn 
the  First  Page) 


25c  ■ Copy 


1 

i 


surgical  technic 

OXYCEL 


In  general  surgery  and  in  the  specialized  branches 
of  surgery  OXYCEL  ( oxidized  cellulose,  Parke,  Davis 
& Company ) aids  the  operator  by  stopping  bleeding 
not  readily  controllable  by  clamp  or  ligature.  This 
refinement  in  surgical  technic  is  made  possible  by  the 
the  distinctive  features  of  OXYCEL. 


PACKAGE  INFORMATION 

OXYCEL  is  supplied  in  individual  screw-capped  bottles. 

OXYCEL  PADS  (Gauze  Type)  Sterile  3"  x 3"  eight-ply  pads. 

OXYCEL  STRIPS  (Gauze  Type)  Sterile  18"  X 2"  four-ply  strips, 
pleated  in  accordion  fashion. 

OXYCEL  fLEDGETS  (Cotion  Type)  Sterile  2/4"  x 1"  x 1"  portions. 

OXYCEL  FOLEY  CONES  Sterile  four-ply  gauze-type  discs  of  5"  Or  7" 
diameter  folded  in  radially  fluted  form,  used  in  prostatectomy 


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Table  of  Contents 

VOLUME  46  NUMBER  7 

JULY,  1949 


Editorials 

The  Fishbein  Era  Draws  to  a Close 537 

Silhouettes  From  the  A.M.A.  House  of 

Delegates  538 

Medicine  Through  a Knot  Hole 538 

Talc  Granuloma 539 

Correspondence  539 


4- 

Original  Articles 


Bladder  Neck  Obstruction  in  Women  and 

Children,  John  F.  Patton,  M.D 540 

A Simple  Bedside  Method  for  the  Deter- 
mination of  Plasma  Salicylate,  Joseph 
H.  Miller,  M.D.,  and  Richard  W.  White- 

head,  M.D 544 

Severe  Bleeding  of  an  Esophageal  Varix 
Controlled  by  Oxycel,  David  A.  Dolowitz, 
M.D.,  William  C.  Walker,  M.D.,  and 

Grant  Lee  Benson,  Jr.,  M.D 546 

The  Treatment  of  Status  Asthmaticus  With 
Intravenous  Ethyl  Alcohol,  John  D.  Gil- 

laspie,  M.D 547 

Extradural  Hemorrhage,  A Report  of 

Three  Cases,  M.  W.  Van  Allen,  M.D 549 

Fatal  Chronic  Peptic  Ulcer  in  the  Aged, 

Erving  F.  Geever,  M.D 553 

Perspective  in  Cancer  Research,  H.  Mason 

Morfit,  M.D , 559 

Protective  Sterilization  in  the  Rocky  Moun- 
tain States,  Clarence  J.  Gamble,  M.D 564 


> 


Case  Report 

Primary  Lymphosarcoma  of  the  Appendix 
Vermiformis,  David  J.  Almas,  M.D 567 

4- 


Organization 

Colorado 

Rocky  Mountain  Radiological  Society 


Program  568 

Campaign  Materials  Are  Available 570 

Obituaries  570 

Auxiliary  570 

College  of  American  Pathologists 572 

Colorado  State  Health  Department 
Policies  and  Technics  for  Immuniza- 
tion of  Children 572 

Utah 

Auxiliary  574 

Obituary 576 

Tuberculosis  Abstract  578 

Book  Corner  558 


522 


Rocky  Mountain  Medical  Journal 


The  famous  English  poet,  Algernon  Charles  Swinburne,  who  began  to  show 
signs  of  epilepsy  at  the  age  of  25,  is  a prominent  example  that  despite  epilepsy 
a man  may  develop  to  true  greatness. 

Comparative  studies  have  shown  that  in  some  cases  better  control  of  grand 
ma!  as  well  as  petit  mal  seizures  can  be  obtained  with  Mebaral  than  with 
corresponding  doses  of  other  antiepileptic  drugs.Mebaral  produces  tranquillity 
with  little  or  no  drowsiness.  It  is  particularly  desirable  not  only  in  epilepsy 
but  also  in  the  management  of  anxiety  states  and  other  neuroses.  The  fact 
that  Mebaral  is  almost  tasteless  simplifies  its  administration  to  children. 
Average  dose  for  children  to  3 grains,  adults  3 to  6 grains  daily.  Tablets 
Y%,  1 Vz  and  3 grains. 


''irci  r*oil' (I  *.  Afnnu'fo 


INC.  • NEW  YORK  J3,  N.  Y.  WINDSOR,  ONT. 


ROCKY  MOUNTAIN  MEDICAL  JOURNAL 

Title  Registered,  U.S.  Patent  Office 
Publication  Office: 

835  Republic  Building  (1612  Tremont  Place),  Denver  2,  Colorado 
Telephone  C Kerry  5521. 

EDITORIAL  BOARD 

Colorado:  Douglas  W.  Macomber,  M.D.,  Scientific  Editor,  1820  Gilpin  St.,  Denver;  Lyman  W.  Mason, 
M.D.,  Associate  Editor,  1214  Republic  Bldg.,  Denver,  (Chairman  of  Editorial  Board). 

Montana:  Raymond  F.  Peterson,  M.D.,  Scientific  Editor,  Butte,  Mont.;  Herbert  T.  Caraway,  M.D., 
Associate  Editor,  Billings,  Mont. 

New  Mexico:  Carl  H.  Gellenthein,  M.D.,  Scientific  Editor,  Valmora,  New  Mexico;  Harold  L.  Janu- 
ary, M.D.,  Associate  Editor,  First  National  Bank  Bldg.,  Albuquerque,  New  Mexico. 

Utah:  Richard  P.  Middleton,  M.D.,  Scientific  Editor,  Boston  Bldg..  Salt  Lake  City;  W.  H.  Tibbals, 
Associate  Editor,  42  South  Fifth  East  St.,  Salt  Lake  City. 

Wyoming:  Earl  Whedon,  M.D.,  Scientific  Editor,  Sheridan;  Arthur  R.  Abbey,  Associate  Editor,  P.O. 
Box  897,  Cheyenne. 


Managing  Editor:  Harvey  T.  Sethman,  835  Republic  Bldg.,  Denver. 
Business  Manager:  Helen  Kearney,  835  Republic  Bldg.,  Denver. 


Ownership  and  Sponsorship:  The  Rocky  Mountain 
Medical  Journal  Is  owned  by  the  Colorado  State 
Medical  Society  and  Is  published  monthly  as  a non- 
profit enterprise  for  the  mutual  benefit  of  the  or- 
ganizations which  jointly  sponsor  it.  It  is  published 
under  the  direction  of  the  Board  of  Trustees  of  the 
Colorado  State  Medical  Society,  assisted  by  an  Edi- 
torial Board  representing  the  sponsoring  organiza- 
tions. It  is  the  Official  Journal  of  the  Colorado  State 
Medical  Society,  the  Montana  State  Medical  Associa- 
tion, the  New  Mexico  Medical  Society,  the  Utah 
State  Medical  Association,  the  Wyoming  State  Medi- 
cal Society,  the  Rocky  Mountain  Medical  Conference, 
and  the  Colorado  Hospital  Association. 

IlfanuseriptN:  Scientific  Articles,  Case  Reports,  etc., 
from  any  state  for  which  this  is  the  Official  Journal 
should  be  submitted  to  the  Scientific  Editor  for  that 
state  as  named  in  the  Editorial  Board,  above.  Other 
material  from  any  participating  state  should  be  sub- 
mitted to  the  Associate  Editor  for  that  state  as 
named  above.  Manuscripts  from  outside  the  Rocky 
Mountain  area  should  be  sent  direct  to  the  Journal 
office.  Manuscripts  must  be  typewritten,  double  or 
triple  spaced,  using  only  one  side  of  each  sheet.  It 
is  the  policy  of  this  Journal  to  omit  bibliographies. 


Advertising:  National  representatives;  The  Coop- 
erative Medical  Advertising  Bureau,  535  North  Dear- 
born Street,  Chicago  10,  111.  Local  advertising  from 
firms  in  the  Rocky  Mountain  area  should  be  submit- 
ted to  the  Associate  Editor  of  the  appropriate  state 
or  to  the  Journal  office.  Advertising  forms  close  on 
the  20th  of  the  month  preceding  publication;  allow 
ten  days  additional  to  insure  submitting  proofs  for 
approval. 

Subscription:  J2.50  per  year  in  advance,  postpaid  in 
the  United  States  and  its  possessions;  single  copy, 
25  cents  plus  postage.  Subscription  is  included  in 
medical  society  dues  of  sponsoring  state  medical 
organizations. 

Copyright:  This  Journal  is  copyright,  1949,  by  the 
Colorado  State  Medical  Society.  Requests  for  permis- 
sion to  reproduce  anything  from  the  columns  of  this 
Journal  should  be  addressed  to  the  Journal  office. 

Scooiul  ri:iss  Matter:  Entered  as  second  class  mat- 
ter Jan.  22,  1906,  at  the  Postoffioe  at  Denver,  Colo., 
under  the  Act  of  Congress  of  March  3.  1879.  Accepted 
for  mailing  at  special  rates  of  postage  provided  for 
in  Section  1103,  Act  of  Oct.  3.  1917;  authorized  July 
17.  1918. 


The  Fairhaven  Maternity  Hospital 


Mrs.  H.  E.  Lowther,  Superintendent 


Seclusion  for  the  unwed  mother. 
1349  JOSEPHINE 


Write  for  descriptive  booklet. 
EA»t  9944  DENVER 


Don't  miss  important  telephone  calls 

Let  us  act  as  your  secretary  while  you  are  away,  day  or  night: 
ovr  kindly  voice  conscientiously  tends  your  telephone  business, 
■_  accurately  reports  to  you  when  you  return. 

Telephone  ANSWERING  Servke  call  ALpine  mm 


Cambridge  Dairy  Grade  “A”  Milk  Is  Produced  and  Processed  at  690  S.  Colo.  Blvd. 

We  do  not  handle  Sbipped-in  Milk  produced  Where?  How  and  by  Whom?  Doctors  know  the  difference 
Now  Homogenized  Vitamin  D Milk  is  available  for  baby  feeding  and  family  use. 

We  Invite  Your  Inspection  and  Appreciate  Your  Recommendation. 


I 

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In  « recent  ®*j’n„|y  Cnmels 

“ ‘‘s.r  ""I 

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PtRSOHM 

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secretary 


R.  J.  Reynolds  Tobacco  Company,  Winston-Salem,  N.  C. 


According  to  a Nationwide  survey: 


than  any  other  cigarette 


Doctors  smoke  for  pleasure,  too!  And  when  three  leading  independent  research  organiza- 
tions asked  113,597  doctors  what  cigarette  they  smoked,  the  brand  named  most  was  Camel 


for  July,  1949 


525 


THE  COLORADO  STATE  MEDICAL  SOCIETY 


Next  Annual  Session:  Shirley-Savoy  Hotel,  Denver;  Sept.  20,  21,  22,  23,  1949 


OFFICERS 

Terms  of  Officers  and  Committees  expire  at  the  Annual  Session 
in  the  year  indicated.  Where  no  year  is  Indicated,  the  term 
is  for  one  year  only  and  expires  at  the  1949  Annual  Session. 

President;  Casper  F.  Hegner.  Denver. 

President-elect:  Fred  A.  Humphrey,  Fort  Collins. 

Vice  President:  Lester  L.  Ward,  Puehlo. 

Constitutional  Secretary  (three  years);  George  B.  Buck,  Denver,  1931. 
Treasurer  (three  years):  George  C.  Shivers,  Colorado  Springs,  1950. 

Additional  Trustees  (three  years):  Ervin  A.  Hinds,  Denver,  1949;  E.  H. 
Munro,  Grand  Jurction,  1949;  S.  P.  Newman,  Denver,  1950;  Claude  D. 
Bonham,  Boulder.  1951. 

(The  above  nine  officers  compose  the  Board  of  Trustees  of  which  Dr. 
Ervin  A.  Hinds  is  the  1948-1949  Chairman.) 

Board  of  Councilors  (three  years):  District  No.  1;  Clemens  F.  EaMns, 
Brush,  1951;  No.  2;  Ella  A.  Mead,  Greeley,  1951;  No.  3:  L.  G.  Crosby, 
Denver,  1951;  No.  4;  Canning  E.  Likes,  Lamar,  1950;  No.  5:  Guy  H. 
Hopkins.  Pueblo,  1950;  No.  6:  Lester  E.  Thompson,  Sallda,  1950;  No.  7: 
A.  L.  Burnett,  Durango,  1949;  No.  8:  Lawrence  L.  Hick,  Delta,  1949; 
No.  9:  W.  W.  Sloan,  Hayden.  1949  (Chairman  of  Board  for  1948-49). 

Board  of  Supervisors  (two  years) : A.  B.  Gjellum,  Del  Norte,  1949;  L.  W. 
Lloyd,  Durango,  1949;  R.  G.  Howlett,  (iolden,  1949;  Scott  A.  Gale, 
Pueblo,  1949;  L.  D.  Dickey,  Fort  Collins,  1949;  N.  A.  Madler,  Greeley, 
1949  (Chairman  of  Board  for  1948-49);  L.  D.  Buchanan,  Wray,  1950; 
W.  F.  Deal,  Craig,  1950;  G.  C.  Cary,  Grand  Junction,  1950;  W.  A. 
Campbell,  Colorado  Springs,  1950;  Ralph  S.  Johnston,  Sr.,  La  Junta, 
1950;  Willi.im  A.  Liggett,  Denver,  1950,  Secretary. 

Delegates  to  American  Medical  Association  (two  years) : George  A.  Unfug, 
Pueblo,  1949  (Alternate:  Herman  C.  Graves,  Grand  Junction,  1949): 
WlUlam  H.  Halley.  Denver,  1950  (Alternate:  Kenneth  C.  Sawyer,  Denver, 
1950). 

Foundation  Advocate:  Waller  W.  Kins,  Denvor. 

executive  Office  Staff:  Mr.  Harvey  T.  Sethman,  Executive  Secretary; 

Miss  Helen  Kearney,  Assistant  Executive  Secretary;  Mr.  Evan  A.  Ed-”ards, 
Field  Secretary:  Miss  Mary  E.  McDonald,  Committee  Secretary;  835  Re- 
public Building,  Denver  2.  Colo.,  Telephone  CHerry  5521. 

General  Counsel:  Mr.  J.  Peter  Nordlund,  Attorney-at-Law,  Denver. 

STANDING  COMMITTEES 

Credentials:  George  R.  Buck.  Denver,  Chairman,  ex-officio;  Harold  E. 
Haymond,  Greeley;  E.  C.  Likes,  Lamar;  Scott  A.  Gale,  Pueblo;  J.  L. 
McDonald.  Colorado  Springs. 

Public  Policy:  Kenneth  C.  Sawyer,  Denver,  Chairman:  McKlnnle  L. 
Phelps,  Denver,  Vice  Chairman;  John  S.  Bouslog,  Denver;  F.  B.  Calhoun, 
Denver;  Frank  B.  McGlone,  Denver;  Lloyd  Anderson,  Sterling;  Sidney  An- 
derson, Alamosa;  Richard  L.  Davis,  La  Junta;  Herman  C.  Graves,  Grand 
Junction:  .John  L.  McDonald,  Colorado  Springs:  George  E.  Rice,  Pueblo; 
Duane  Hartshorn,  Fort  Collins;  John  D.  Gillaspie,  Boulder.  Ex-Officio 

members:  Casper  F,  Hegner,  President;  Fred  A.  Humphrey,  President-elect: 
George  R.  Buck,  Constitutional  Secretary. 

Sub-Committee  on  Legisiation;  H.  I.  Barnard,  Denver,  Chairman. 

Health  Education  (two  years);  A.  C.  Sudan,  Denver,  Chairman,  1949; 
J.  D.  Bartholomew,  Boulder,  1949;  R.  J.  Savage,  Denver,  1949;  B.  T. 
Porter,  Greeley,  1949;  Robert  B.  Bradshaw,  Alamosa.  1949;  L.  W.  Bortree, 
Colorado  Springs,  1950;  F.  0.  Robertson,  Denver,  1950.:  J.  L.  Sadler,  Fort 
Collins,  1950;  Harold  T.  Low,  Pueblo,  1950;  John  H.  Amesse,  Denver, 
1950;  E.  H.  Munro,  Grand  Junction,  1950. 

Scientific  Work:  W.  B.  Condon,  Denver,  Chairman;  Robert  S.  Liggett, 

Karl  F.  Arndt,  Frank  T.  Joyce,  Marshall  G.  Nims,  Vincent  G.  Cedar- 

blade,  all  of  Denver. 

Sub-Committee  on  Scientific  Exhibits:  Frank  C.  CampbeU,  Chairman; 

NoUe  Mumey,  Edgar  W.  Barber,  R.  W.  Vines,  all  of  Denver. 

Arrangements:  J.  L.  Swigert,  Chairman;  Byron  I.  Diimm,  S.  B.  Childs, 

Jr.,  all  of  Denver. 

Medicolegal  (two  years) : R.  W.  Arndt,  1960,  Chairman;  George  B. 

Packard,  Jr.,  1950;  K.  D.  A.  Alien,  1950.;  C.  S.  Bluemel,  1949;  Lyman 
W.  Mason,  1949;  Harry  C.  Hughes,  1949;  all  of  Denver. 

Medical  Education  and  Hospitals:  George  F.  WoUgast,  Denver,  Chairman: 
W.  W.  Sloan,  Hayden;  F.  R.  Plngrey,  Durango;  E.  B.  Mugrage,  Denver: 
D.  W.  McCarty,  Longmont;  A.  E.  Lubchenco,  Denver. 

Library  and  Medical  Literature:  A.  J.  Markley,  Denver,  Chairman;  T.  E. 
Beyer,  Denver;  J.  J.  Connor,  Delta;  H.  Dumont  Clark,  Denver. 

Medical  Service  Plans:  F.  H.  Good,  Denver,  Chairman;  C.  E.  Honstein, 
Fort  CoUins;  James  B.  Blair,  Denver;  Vernon  L.  Bolton,  Colorado  Springs; 
Scott  A.  Gale.  Pueblo;  John  A.  Weaver,  Jr.,  Greeley;  John  B.  ^land, 
Monte  Vista;  Thomas  K.  Mahan,  Grand  Junction. 

Necrology:  W.  H.  Wilson.  Denver.  Chairman. 

PUBLIC  HEALTH  COMMITTEES 

General  Committee  on  Public  Health:  Consists  of  the  chairmen  of  the 
foUowing  eleven  public  health  subcommittees,  presided  over  by  Robert  W. 
Dickson,  Denver,  as  General  Chairman. 

Cancer  Control:  J.  C.  Mendenhall,  Denver,  Chairman;  John  B.  Grow, 
Denver;  S.  W.  HoUey,  Greeley:  T.  Leon  Howard,  Denver:  James  B.  Mc- 
Naught,  Denver:  Roger  G.  Hewlett,  Golden:  James  W.  McMullen,  Colorado 
Springs;  James  E.  DonneUy,  Trinidad:  Lanning  E.  Likes,  Lamar;  Thomas 
K yiahau  Grand  Junction 


Crippled  Children:  I.  E.  Hendryson,  Denver,  Chairman;  Mary  L.  Moore, 
Grand  Junction:  Richard  H.  Mellen,  Colorado  Springs;  Sidney  E.  BUnd- 
ford.  Jr..  Denver:  Paul  R.  Hildebrand.  Brush;  Samuel  P.  Newman,  Denver. 

Industrial  Health;  R.  F.  Bell,  Louviers.  Chairman;  A.  R.  Woodbume, 
Denver:  Vincent  E.  Kelly,  Leadville;  D.  W.  Boyer,  Pueblo:  H.  G.  Harvey,  Jr.,- 
Denver:  Robert  Woodruff.  Denver;  Frank  J.  McDonough,  Grand  Junction. 

Local  Health  Units;  Monroe  R.  Tyler,  Denver,  Chairman;  Harold  E. 
Haymond.  Greeley:  R.  B.  Richards.  Fort  Morgan;  Nicholas  S.  Sallba,  Wal- 
senburg;  Marvel  L.  Crawford,  Steamboat  Springs:  R.  Sherwln  Johnston,  Jr., 
La  Junta. 

Maternal  and  Child  Health:  John  R.  Evans,  Denver,  Chairman;  Joseph 
H.  Lyday,  Denver:  John  M.  Nelson,  Denver;  Tracy  D.  Peppers,  Greeley: 
J.  H.  Woodbridge,  Pueblo:  M.  E.  Snyder,  Colorado  Springs. 

Mental  Hygiene:  Bradford  Murphey,  Denver,  Chairman;  E.  James  Brady, 
Colorado  Springs;  Frank  H.  Zimmerman,  Pueblo;  Paul  A.  Draper,  Colors^ 
Springs;  J.  P.  Hilton,  C.  S.  Bluemel,  John  M.  Lyon,  G.  H.  Ashley,  Lewis 
C.  Overholt,  Clarke  H.  Barnacle,  Harold  R.  Carter,  all  of  Denver. 

Milk  Control;  George  W.  Stiles,  Denver,  Chairman;  Max  M.  Olnsburg, 
Denver;  N.  J.  Miller,  D.V.M.,  Baton;  Millard  F.  Schafer,  Colorado  Springs; 
Robert  W.  Vines.  Denver;  Mr.  Wendell  Vincent,  Denver. 

New  Hospital  Construction:  D.  R.  ColUer,  Wheatridge,  Chairman: 
Henry  M.  Powell,  Colorado  Springs;  Mr.  John  R.  Peterson,  Fort  OiUlns; 
Florence  R.  Sabin,  Denver;  Herbert  A.  Black,  Pueblo. 

Public  Water  Supplies;  E.  I.  Dobos,  Denver.  Chairman;  Robert  Barnard, 
Eagle;  WilUam  C.  Shontz,  San  Luis;  Carl  W.  Maynard,  Pueblo;  W.  B. 
Crouch.  Colorado  Springs:  H.  D.  Palmer,  Denver,  E.  Robert  Orr.  Fnilta. 

Tuberculosis  Control:  John  I.  Zarit,  Denver,  Chairman;  W.  J.  Hinzel- 
man,  Greeley;  H.  M.  Van  Der  Schouw,  Wheatridge:  John  P.  McGraw,  Pueblo; 
Arthur  Rest,  Denver;  H.  Calvin  Fisher,  Denver;  T.  D.  Cunningham,  Denver. 

Venereal  Disease  Control:  Sam  W.  Downing,  Denver,  Chairman;  Paul  B. 
Stidham,  Grand  Junction;  H.  E.  Coakley,  Pueblo;  D.  E.  Newland,  Denver; 
Joseph  H.  Patterson.  Denver.  James  R.  McDowell,  Denver. 

SPECIAL  COMMITTEES 

Rocky  Mountain  Medical  Conference  (five  years) : L.  Clark  Hepp,  Denver, 
1953;  G.  P.  Llngenfelter,  Denver,  1952,  Chairman;  Ward  Darley,  Denver, 
1951;  L.  W.  Bortree,  Colorado  Springs,  1950;  George  H.  Gillen,  Denver, 
1949, 

Advisory  to  Auxiliary:  Fred  A.  Humphrey,  Fort  Collins,  Chairman;  Ekvln 
A.  Hinds,  George  R.  Buck.  Denver. 

Midwinter  Clinics;  Samuel  B.  Childs,  Jr.,  Chairman;  Raymond  C.  Chat- 
field,  E.  L.  Binkley,  Jr.,  A.  J.  Kauvar,  Terry  J.  Gromer,  aU  of  Denver. 

Rehabilitation:  W.  W.  Haggart,  Denver,  Chairman;  Atha  Thomas,  Den- 
ver; Lawrence  T.  Brown,  Denver;  J.  E.  A.  ConneU,  ^cblo;  Thad  P.  Sean, 
Ft.  Logan;  Kenneth  C.  Sawyer,  McKlnnle  L.  Phelps,  George  R.  Buck, 
Bradford  Murphey,  all  of  Denver. 

Advisory  to  the  Goodwill  Industries’  Rehabilitation  Program:  Lewis  C. 
Overholt,  Chairman;  William  H.  Halley,  Maurice  Katzman,  Terry  J. 
Gromer.  Lorenz  W.  Frank,  William  R.  Lipscomb,  Irvin  B.  Hendryson, 
all  of  Denver. 

Rural  Hdalth  Commission:  Leonard  N.  Myers,  Cheyenne  Wells,  Chairman; 
V.  V.  Anderson,  Del  Norte;  James  S.  Orr,  Frulta;  Keith  F.  Krausnlek, 
Lamar;  Robert  M.  Lee,  Fort  Collins.  Ex-offlclo  member:  Fred  A.  Hum- 
phrey, Fort  CoUins. 

Medical  Disaster  Commission:  Foster  Matchett,  Denver,  Chairman;  Karl 
Arndt,  Denver,  Secretary;  Mark  S.  Donovan,  Harry  C.  Hughes.  Adolph  J. 
Kafka,  Roderick  J.  McDonald,  WlUlam  F.  Stanek,  Henry  Swan,  Karl  F. 
Sunderland,  K D.  A.  Allen,  aU  of  Denver;  Lawrence  W.  Holden,  Boulder: 
Richard  H.  Mellen.  Colorado  Springs;  Richard  H.  Altmix.  Englewood:  Jacob 
0.  Mall,  Estes  Park;  Thad  P.  Sears,  Fort  Logau:  Donald  E.  Cowen,  Fort 
Morgan;  Kenneth  E.  Prescott,  Grand  Junction;  Walter  A.  Schoen,  Greeley; 
David  W.  McCarty,  Longmont;  David  W.  Boyer,  Pueblo;  J.  G.  Espey,  Craig; 
Leo  W.  Loyd,  Durango;  Keith  F.  Krausnlek,  Lamar;  Robert  M.  Lee,  Ft  Col- 
lins; George  H.  Lord,  Aurora;  J.  Gordon  Hedrick,  Wray;  James  P.  Bigg, 
Grand  Junction. 

Lay  Organization  Standards;  George  R.  Buck,  Fredrick  H.  Good,  Ken- 
neth C.  Sawyer,  Frank  B.  McGlone,  T.  D.  Cunningham,  Bradford  Murphey. 
Casper  F.  Hegner,  John  S.  Bouslog,  ail  of  Denver. 

Study  of  Child  Welfare  Clinics:  Ralph  H.  Verploeg,  Denver,  Chairman; 
J.  W.  White,  Pueblo-  Jackson  L.  Sadler,  Fort  CoUins;  L.  E.  Maurer, 
Boulder;  Harvey  M.  Tupper,  Grand  Junction;  Harvey  S.  Rusk,  Pueblo. 

Advisury  to  U.IM.W.  Welfare  Fund  (Executive  Committee,  three-year 
terms;  others,  one-year):  Executive:  W.  W.  Haggart,  1951,  Chairman; 
F.  H.  Good,  1951;  J.  S.  Bouslog,  1951,  all  of  Denver:  W.  H.  HaUey, 
1950;  C.  P.  Hegner,  1950,  both  of  Denver;  R.  P.  Bell,  1950,  Louviers; 
McKinnie  Phelp.s  1949,  Denver;  F.  A.  Humphrey,  1949,  Fort  Collins; 
J.  M.  Lamme,  1949,  Walsenburg.  Other  members:  K.  C.  Sawyer,  A.  C. 
Sudan,  Bradford  Murphey,  all  of  Denver;  C.  D.  Bonham,  Boulder;  J.  W. 
Craighead,  Pueblo;  J.  E.  Donnelly,  Trinidad:  Llgon  Price,  Mt.  Harris;  M.  J. 
McCallum,  Erie. 

Liaison  to  Colorado  State  Nurses  Association:  John  R.  Evans,  Samuel  P. 
Newman,  Denver. 

Liaison  to  Colorado  Bar  Association:  W.  S.  Dennis,  Chairman;  A.  C. 
Sudan,  R.  W.  Arndt,  aU  of  Denver. 

Medical-Dental  Liaison:  Guy  W.  Smith,  Denver,  Chairman;  George  R. 
Warner,  Denver;  Calvin  N.  CaldweU,  Pueblo. 

Representative  to  Rocky  Mountain  Radio  Council:  WilUam  E.  Hay, 
Denver;  (Alternate:  Chauncey  A.  Hager,  Denver). 

Representative  to  Belle  Bonfils  Memorial  Blood  Bank;  0.  S.  Pbilpott, 
Denver. 

Representatives  to  Liaison  Council  on  Graduate  Education  (two  years) : 
L.  R.  Safarik,  Denver,  1949;  Harold  I.  Goldman,  Denver,  1950. 

Delegate  to  Colorado  Interprofessional  Council  (five  years):  K.  D.  A. 
Allen,  Denver,  1949;  (Alternate,  Carl  A.  McLauthUn,  Denver,  1949). 


526 


Rocky  Mountain  Medical  Journal 


many  things 

to  consider 


The  choice  of  an  oral  estrogen 
depends  on  many  factors  — 
potency,  dosage,  safety  and  cost. 
3n  the  basis  of  cost  alone,  a sound  choice 
is  difficult.  An  oral  estrogen  that  appears 
to  “cost  less”  may  be  wanting  in  potency;  another 
may  provoke  troublesome  side  actions.  On 
the  basis  o.f  potency,  however,  the  differences 
among  oral  estrogens  are  enlightening. 


ESTINYL 

• (brand  of  ethinyl  estradiol) 

is  by  far  the  most  potent  oral  estrogen 

in  clinical  use  today.  Estinyl*  is  from  7 to  87  times  as  potent  as  the  most 
active  stilbenes  in  use.  Estinyl  is  given  in  almost  incredibly  small  dosage 
—as  little  as  0.02  mg.  (1/3200  gr.)  which  is  sufficient  to  control  meno- 
pausal symptoms  in  many  cases. 

This  extraordinary  clinical  activity  has  practical  importance.  It  is  char- 
acterized. by  virtual  freedom  from  untoward  reactions.  Such  low  dosage 
obviously  results  in  lower  cost. 

There  are  many  things  to  consider  in  choosing  an  oral  estrogen.  Duly 
considered,  Estinyl  is  an  oral  estrogen  of  choice. 

ESTINYL  Tablets,  0-02  or  0.05  mg.,  in  bottles  of  100, 
250  and  1000. 

ESTINYL  Liquid,- 0.03  mg.  per  4 cc.  (teaspoonful),  in 
bottles  of  4 and  16  oz. 

CORPORATION  • BLOOMFIELD,  NEW  JERSEY 

IN  CANADA,  SCHERINC  CORPORATION  LIMITED.  MONTREAL 


MONTANA  STATE  MEDICAL  ASSOCIATION 

Next  Annual  Session:  Finlen  Hotel,  Butte;  Auff.  1,  2,  3,  4,  1949 


OFFICERS 

Terms  of  Officers  and  Committees  expire  at  tbe  Annual  Session 
In  tbe  year  Indicated.  Where  no  year  Is  Indicated,  the  term  Is 
for  one  year  only  and  expires  at  1949  Annual  Sesdon. 

President:  Thomas  L.  Bawhlns,  Helena. 

President-elect;  Thomas  F.  Walker,  Great  Falls. 

Vice-President:  R.  G.  Johnson,  Harlowton. 

Secretary-Treasurer:  Herbert  T.  Caraway,  BllUngs. 

Delegate  to  American  Medical  Association:  Raymond  F.  Peterson,  Butte, 
1950:  Alternate,  Thomas  B.  Moore,  KaUspell,  1950. 


STANDING  COMMITTEES 

Execntive  Committee:  T.  L.  Hawkins,  Helena,  Chairman;  T.  F.  Walker, 
Great  Falls;  H.  T.  Caraway,  Billings;  L.  W.  Allard,  BllUngs;  M.  A. 

Shlllington,  Glendire. 

Economics  Committee:  J.  C.  Shields,  Butte,  Chairman;  C.  P.  Brooke,  St 
Ignatius:  R.  B.  Durnin,  Great  Falls:  Leland  G.  Russell,  BlUngs;  S.  D. 

Whetstone,  Cut  Bank. 

Legislative  Committee;  J.  M.  Flinn,  Helena,  Chairman;  F.  D.  Hurd, 

Gnat  Falls;  P.  E.  Kane,  Butte;  J.  C.  MacGregor,  Great  Falls;  Claude 

M Mears,  Helena. 

Necrology  and  History  of  Medicine  Committee:  L.  W.  Brewer,  Missoula. 
Chairman:  I.  J.  Bridenstine.  Missoula;  J.  H.  Irwin,  Great  Falls;  Claude 
M.  Mears,  Helena-  J.  P,  Bitcbey,  Missoula. 

Public  Relations  Committee:  H.  W.  Gregg,  Butte,  Chairman;  W.  L.  DuBois, 
Cut  Bank;  R.  V.  Morledge,  Billings;  W.  H.  Stephan,  Dillon;  Dora  Walker, 
Great  Falls. 

Legal  Affairs  and  Malpractice  Commltteoi  J.  C.  MacGregor,  Great  Falls, 
Chairman;  Raymand  Eck,  Lewistown;  W.  E.  Harris,  UvlngstoD;  John  E. 
Hynes,  BllUngs;  R.  D.  Knapp,  Wolf  Point. 

Program  Committee:  C.  H.  Fredrickson,  Missoula,  Chairman;  B.  T. 
Caraway,  BllUngs-  H.  W.  Gregg,  Butte;  J.  J.  McCabe,  Helena;  E.  S. 
Murphy,  Missoula 

Interprofessional  Relationship  Committee;  L.  W.  AUard,  BllUngs,  Chair- 
man: C.  R.  Canty,  Butte;  S.  A.  Cooney,  Helena:  S.  N.  Preston,  Missoula; 
F.  1.  Sabo,  Bozeman. 


Nominating  Committee:  H.  B.  James,  Butte,  Chairman;  E.  L.  Andenon, 
Fort  Benton;  R.  D,  Harper,  Sidney;  J.  J.  Malee,  Anaconda;  W,  B.  Hc- 
Elwee,  Townsend. 

Auditing  Committee:  E.  H.  Llndstrom,  Helena,  Chairman;  F.  H.  Crago, 
Great  Falls;  R.  D.  Harper,  Sidney;  G.  W.  Setzer,  Malta;  R,  0.  Johnson, 
Harlowton. 

Cancer  Committee;  Mary  E.  Martin,  BllUngs,  Chairman;  W,  F.  Cash- 
more,  Helena;  C.  H.  Fredrickson,  Missoula;  R.  F.  Peterson,  Butte;  W.  C. 
Robinson,  Shelby. 

Maternal  and  Child  Welfare  Committee;  F.  L.  McPhall,  Great  Falls, 
Chairman;  L.  W.  Brewer,  Missoula;  P.  L.  Eneboe,  Bozeman;  Maude  H. 
Gerdes,  BllUngs;  D.  L.  Gillespie,  Butte;  A.  L.  Gleason,  Great  Falls;  & L. 
Hall,  Great  Falls;  D.  S.  MacKenzle,  Jr.,  Havre;  B.  E.  Mattlson,  BllUngs; 
0.  M.  Moore,  Helena;  F.  W.  Paul,  KallspeU;  C.  W.  Pemberton,  Butte; 
S.  N.  Preston,  Missoula;  A.  E.  Bitt,  Great  Falls. 

Tuberculosis  Committee:  F.  I.  TerriU,  Galen,  Chairman;  C,  B.  Craft, 
Bozeman:  E.  A.  Dolan,  Anaconda;  A.  R.  Klntner,  Missoula;  1.  A.  Layne, 
Great  Falls. 

Fracture  and  Orthopedic  Committee:  J.  K.  Colman,  Butte,  Chairman;  !>.  C. 
Allard,  BllUngs;  W.  H.  Hagen,  BllUngs;  S.  L.  Odgers,  Butts;  J.  C.  Wol- 
gamot.  Great  Falls. 

Rural  Health  Committee:  B.  C.  Farrand,  Jordan,  Chairman;  B.  A. 
Benke,  KaUspell;  W.  A,  Lacey,  Havre;  W.  G,  TangUn,  Poison;  J.  H. 
Williams,  Culbertson. 

Industrial  Welfare  Committee:  B.  B.  Richardson,  Great  Falls,  Cbalnnaa; 
M.  A.  Gold,  Butte;  P.  E.  Logan,  Great  Falls;  D.  S.  MacKenzle,  Jr.,  Havre; 
R.  E.  Walker.  Livingston. 

Rheumatic  Fever  and  Heart  Committee:  F.  B.  Sebemm,  Great  FaUs, 
Chairman;  D.  T.  Berg,  Helena;  H.  W.  Gregg,  Butte;  A.  B.  Klntner,  Mis- 
soula; P.  E.  Logan,  Great  Falls;  F.  H.  Lowe,  Missoula;  J.  J.  Malee, 
Anaconda;  0.  M.  Moore,  Helena;  H.  W.  Power,  Conrad;  B.  E.  SmaUey, 
BllUngs. 

SPECIAL.  COMMITTEES 

Emergency  Medical  Service  Committee:  R.  F.  Peterson,  Butte,  Chairman; 
Paul  J.  Gans,  Lewistown;  J.  J.  McCabe,  Helena;  S.  A.  Olson,  Glendive: 
L.  G.  RusseU,  BllUngs. 

lAB  Fee  Schedule  Committee:  H.  H.  James.  Butte,  Chairman;  E.  H. 
Llndstrom,  Helena;  J.  J.  Malee,  Anaconda;  D.  S.  McKenzie,  Jr.,  Havre; 
F.  K.  Wanlata,  Great  Falls. 


Collection 


of 


Accounts 


All  reports  show  a trend  toward  slower  and  harder  collections  in  the 
months  ahead. 

At  the  first  sign  of  neglect  you  will  save  money  if  they  are  turned  over 
to  us  for  collection. 

Comparison  of  collection  results,  backed  by  35  years  of  experienee,  proves 
you  obtain  greater  results  at  less  cost,  when  you  list  your  accounts 

with 

The  American  Medical  and  Dental  Association 

Suite  524,  810  14th  St.  TAbor  2331  Denver,  Colorado 


528 


Rocky  Mountain  Medical  Journal 


The  tensions  of  modem  living  demand  a price  that 
is  frequently  gastrointestinal  injury,  occasionally 
peptic  ulcer.  The  prevention  and  cure  of  peptic 
ulcer  embrace  the  application  of  hygienic, 
psychiatric,  dietary,  and  therapeutic  techniques 
to  this  problem. 

Logically,  therapy  should  include  the  administra- 
tion of  materials  which  will  tend  to  reduce  the  acidity 


of  the  gastric  content  without  producing  alkalosis  or 
other  undesirable  effects.  Coincidentally,  a demulcent 
effect  should  be  sought  to  coat  the  ulcerated  sur- 
faces and  protect  them  from  erosion.  Lederle 
research  has  found  that  a casein,  low  in  sodium, 
high  in  calcium,  in  appropriate  form,  when  given 
by  mouth  will  accomplish  these  ends  and  pro- 
vide the  patient  with  prompt  symptomatic  relief. 


LEDERLE  LABORATORIES 


DIVISION 


AMERICAN 


G^anamid 


COMPANY 


39  ROCKEFELLER  PLAZA  • NEW  YORK  20,  N.  K 


for  July,  1949 


529 


NEW  MEXICO  MEDICAL  SOCIETY 


OFFICERS— 1949-1950 

President:  .1.  W.  Hannett,  Albuquerque. 

President-Elect:  I.  J.  Marshall,  Roswell. 

Vice  President:  Leland  S.  Evans,  Las  Cruces. 

Secretary-Treasurer:  H.  L.  January,  Albuquerque. 

Councilors  (o  years):  Carl  Mulky,  Albuquerque;  J.  C.  Sedgwick.  Las 
Cruces.  (2  years):  W.  D.  Dabbs,  Clovis;  A.  C.  Shuler,  Carlsbad.  (1  year): 
A.  S^'Lathrop,  Santa  Fe;  C.  H.  Gellenthien,  Valmora. 

COMMITTEES— 1949-1950 

Basic  Science:  Raymond  L.  Young,  Santa  Fe,  Chairman;  W,  E,  Nissen, 
Albuquerque;  Walter  A,  Stark,  Las  Vegas. 

Rural  Medicai  Service:  Stuart  Adler,  Albuquerque,  Chairman;  Samuel  R. 
Zeigler,  Espanola;  A,  T,  Gordon,  Tucmucari;  L.  G,  Foster,  Reserve;  J,  P. 
Turner,  Caridzozo. 

Cancer:  Murray  Friedman,  Santa  Fe,  Chairman;  Van  A,  Odle,  Roswell; 
J.  R,  Van  Atta,  Albuquerque;  J,  W,  Grossman,  Albuquerque;  R,  C.  Derby- 
shire, Artesia, 

Venereai  Disease  Controi;  Sam  Jelso,  Albuquerque,  Chairman;  V,  E.  Berch- 
told,  Santa  Fe:  L.  M.  Miles.  Albuquerque;  Vincent  Accardi,  Gallup;  F.  C. 
Bohannon,  Carlsl'ad. 


Legislative  and  Public  Policy:  A.  S.  Lathrop,  Santa  Fe,  Chairman;  H.  T. 
Watson,  Gallup;  C.  B.  Elliott,  Raton;  John  F.  Conway,  Clovis;  H.  M.  Mor- 
timer, Las  Vegas:  G.  S.  Morrison,  Roswell;  D.  B.  Marsh,  Deming;  K.  A. 
Watts,  Silver  City;  Ashley  Pond,  Taos:  W.  L.  Minear,  Hot  Springs;  L.  S. 
Evans.  Las  Cruras;  W.  M.  Tha.vton,  Tucumcari;  William  C.  White,  Los 
Alamos;  W.  0.  Connor,  Albuquerque;  C.  S.  Stone,  Hobbs;  A.  C.  Shuler, 
Carlsbad. 

Public  Relations:  C.  P.  Bunch,  Artesia,  Chairman;  Earl  L.  Malone,  Ros- 
well; 0.  S.  Cramer,  Albuquerque;  Eric  P.  Hausner,  Santa  Fe. 

Tuberculosis:  C.  H.  Gellenthien,  Valmora,  Chairman;  William  H,  Thearle, 
Albuquerque;  P.  0.  Shields,  Albuquerque;  Carl  Mulky,  Albuquerque;  H.  S. 
A.  Alexander,  Santa  Fe. 

Advisory  Conmittee  on  Insurance  Compensation:  L.  M.  Overton,  Albuquer- 
que, Chairman;  R.  E.  Forbis,  Albuquerque;  Edward  Pamall,  Albuquerque;  H. 
D.  Corbusier,  Santa  Fe. 

National  Emergency  Medical  Service:  A.  E.  Reymont,  Santa  Fe,  Chair- 
man: L.  G.  Rice,  Albuquerque;  C.  M.  Thompson,  Albuquerque. 

Board  of  Supervisors:  L.  G.  Rice,  Bernalillo  County;  Van  A.  Odle,  Chaves 
County:  Milton  Floersheim,  Colfax  jCounty;  John  F.  Conway,  Curry  County; 
C.  P.  Bunch.  Eddy  County;  Frank  W.  Parker,  Jr.,  McKinley  County;  V.  E. 
Berchtold.  Santa  Fe  County;  W’,  A.  Stark,  San  Miguel  County. 


Oculist  Prescription  Service  Exclusively 

SHADFORD-FLETCH  ER  OPTICAL  CO 

Dispensing  Opticians 

228  16th  Street,  Denver,  Colo.  AComa  2611 
3705  East  Colfax  (Medical  Center  Building).  FLorido  0202 


These  fine  Dairy  Cattle,  a portion  of  City  Park’s  large  herd  of  Guernsey  and  Holstein 
cows,  are  scientifically  fed  and  cared  for,  continuously  tested  by  competent  veterin- 
arians. Only  through  such  precise  watchfulness  does  City  Park  Milk  receive  Grade 
“A"  designation  which  it  enjoys.  Choose  City  Park’s  regular  Grade  “A”  Pasteurized 
or  Homogenized  milk  today  — ■ notice  the  particularly  clean,  fresh  flavor. 


’Phone 
EAst  7707 


Cherry  Creek 
Drive — Denver 


530 


Rocky  Mountain  Medical  Journal 


ESSENTIALLY  THE  SAME  AS  HUMAN  MILK 
IN  ALL  VITAL  NUTRIENTS 


In  S-M-A  the  amino  acid  content—the  growth-promoting  factors,  methionine 
and  tryptophane  included— is  as  high  as  the  peak  values  for  these 
amino  acids  in  human  milk  ... 

vitamin  content  (including  vitamin  C)  equals  or  exceeds  mini- 
mum daily  requirements . . . 

minerais  compare  favorably  with  those  of  human  milk  . . . 
fat — the>iodine  number  (index  of  unsaturated  fatty  acids)for 
S-M-A  fat  is  standardized  at  the  top  of  the  range  found  in  human  milk. 


for  July,  1949 


531 


THE  UTAH  STATE  MEDICAL  ASSOCIATION 

Next  Annual  Session:  Salt  Lake  City,  Sept.  1,  2,  3,  1949 


OFl)'ICE}iRS  1»4S-1»40 
Freiident:  0.  A.  OgilTle,  Salt  Lake  Citf. 

President-elect:  C.  H.  Jenson,  Ogden. 

Past  President:  J.  C.  Hubbard,  Price. 

Honorary  President:  0.  W.  French,  CoalrlUe. 

First  Vice  President:  J.  0.  McQuarrle,  Richfield. 

Second  Vice  President:  Ezra  Cragun,  Lewiston. 

Third  Vice  President:  R.  W.  Farnsworth,  Cedar  City. 

Secretary:  Ray  T.  Woolsey,  Salt  Lake  City. 

Exeentlve  Secretary:  Mr.  W.  H.  Tlbbals,  Salt  Lake  City. 

Treasurer:  L.  B.  White,  Salt  Lake  City. 

Connellor  First  District:  J.  0.  Olson,  Ogden. 

Coancllor  Second  District:  V.  L.  Rees,  Salt  Lake  City. 

Connellor  Third  District;  L.  W.  Oaks,  Provo. 

Delegate  to  A.M.A.,  1948:  James  P.  Kerby,  Salt  Lake  City. 

Alternate  Delegate  to  A.M.A.,  1948:  J.  J.  Weight,  Provo. 

Editor  of  the  Utah  Section  of  the  Rocky  Mounnain  Medical  Joornal: 
1.  P.  Middleton,  Salt  Lake  City. 

STANDING  COMMITTEJES 
Rocky  Mountain  Medical  Conference  Continuing  Committee:  R.  P.  Mid- 
dleton, Chairman,  Salt  Lake  City,  1949;  K.  B.  Castletoa,  Salt  Lake  City, 
1950;  Clark  Rich,  Ogden,  1951;  Noall  Z.  Tanner,  Layton,  1952;  T.  B. 
Beager,  Vernal,  1953. 

Scientific  Program  Committee:  Ray  T.  Woolsey,  Chairman,  Salt  Lake 
City;  Drew  M.  Peterson,  Ogden;  Stanley  N.  Clark,  Provo;  P.  M.  Howard, 
Salt  Lake  City;  V.  P.  White,  Salt  Lake  City;  L.  V.  Broadbent.  Cedar 
City;  Paul  A.  Pemberton,  Salt  Lake  City. 

Public  Policjl  and  Legislation  Committee:  F.  R.  King,  Chairman,  Price, 
1951;  Jesse  J.  Weight,  Provo,  1949;  M.  L.  CrandaU,  Salt  Lake  City, 
1949;  V.  L.  Stevenson,  Salt  Lake  City,  1949;  N.  P.  Hicken,  Salt  Lake 
Oty,  1950;  Omar  Budge,  Logan,  1950;  John  Colettl,  Salt  Lake  City,  1950; 
W.  B.  West,  Ogden,  1951;  B.  V.  Larson.  Roosevelt,  1951. 

Medical  Defense  Committee:  W.  J.  Thomson,  Chairman,  Ogden,  1949; 
«.  W.  Owens,  Salt  Lake  City,  1949;  J.  L.  Hansen,  Vernal,  1949;  Homer 
Smith,  Salt  Lake  City,  1950;  L.  N.  Ossman,  Salt  Lake  City,  1950;  Bkwln 

D.  Zeman,  Ogden.  1950;  Charles  W.  Woodruff,  Salt  Lake  City,  1961; 

James  Westwood,  Provo,  1951;  L.  H.  Merrill,  Hiawatha,  1951. 

Medical  Education  and  Hospitals  Committee:  I.  Bruce  McQuarrle,  Chair- 
man, Ogden,  1949;  L.  J.  Paul,  Salt  Lake  City,  1949;  0.  A.  OgUvie, 
Balt  Lake  City,  1949;  0.  G.  Richards,  Salt  Lake  City,  1950.;  Bay  T. 
Woolsey,  Salt  Lake  City,  1950;  T.  B.  Robinson,  Salt  Lake  City,  1950; 

Seth  E.  Smoot,  Provo,  1951;  George  H.  Curtis,  Salt  Lake  City,  1961; 

B.  0.  Porter,  Logan,  1951;  R.  H.  Young,  Ex-Officio,  Salt  Lake  City. 

Medical  Economics  Committee:  Russell  Smith,  Chairman,  Provo,  1949; 
A.  R.  Denman,  Helper,  1949;  W.  T.  Ward,  Salt  Lake  City,  1950;  W.  R. 
Merrill,  Brigham  City,  1951;  Ralph  Pendleton,  Salt  Lake  City,  1951. 


(f^etter  JiowetA  at  l^eadonaLie 


need 


“Orders  Delivered  to  Any  City  by 
Guaranteed  Service” 

Special  attention  given  to  floral  tributes 
Also  Hospital  Flowers 

Call  KEystone  5106 

Vark  3lora[  Co.  Store 


1643  Broadway 


Denver,  Colo. 


Public  Health  Committee:  John  R.  Bourne,  Chairman,  Roosevelt,  194B: 
F.  D.  Spencer,  Salt  Lake  City,  1950;  Ralph  Ellis,  Ogden,  1951. 

Military  Affairs  and  National  Emergency  Committee:  Chrlec  Woodtuff, 
Chairman,  Salt  Lake  City;  L.  J.  Paul,  Salt  Lake  City;  Mazel  SkolfloIB, 
Salt  Lake  City;  W.  M.  Goiishek,  StandardvlUe  L.  R.  Culllmore,  Or«; 
Ray  H.  Barton,  Magna;  D.  T.  Madson,  Price;  Riley  G.  Clark,  Prwro; 
Willis  Hayward,  Logan;  Dean  Tanner,  Ogden. 

Tuberculosis  and  Cardiovascular  Diseases  Committee:  Elmer  M.  KU- 
patrick.  Chairman,  Salt  Lake  City;  Ray  Rumel,  Salt  Lake  City;  D.  0.  N. 
Lindberg,  Ogden;  W.  C.  Walker,  Salt  Lake  City;  Donald  M.  Moore,  Ogden; 
Don  C.  Merrill,  Provo. 

Cancer  Committee:  0.  A.  Ogllvie,  Chairman,  Salt  Lake  City;  S.  W. 
Fennemore,  Price;  E.  D.  Zeman,  Ogden;  W.  G.  Noble,  Richmond;  HaroM 
Austin,  Provo;  Stanley  G.  Rees,  Gunnison;  Paul  K.  Edmunds,  Cedar  City; 
F.  G.  Eskelson,  Vernal;  K.  B.  Castleton,  Salt  Lake  City. 

Fracture  Committee:  A.  M.  Okelberry,  Chairman,  Salt  Lake  City;  Clark 
Rich,  Ogden;  Roy  H.  Robinson,  Kenilworth;  S.  M.  Budge,  Logan;  Norman 
R.  Beck,  Salt  Lake  City;  Louis  Perry,  Ogden;  J.  G.  McQuarrle,  Richfield; 
D.  C.  Evans,  Fillmore. 

Necrology  Committee:  W.  T.  Hosier,  Chairman,  Provo;  L.  A.  Stevenson, 
Salt  Lake  City;  Jos.  A.  Phipps,  Salt  Lake  City. 

Industrial  Health  Committee:  Paul  S.  Richards,  Chairman,  Bingham 
Canyon;  L.  J.  Taufer,  Salt  Lake  City;  Frank  Gorishek,  Helper;  Byron  Dayneo, 
Salt  Lake  City;  B.  B.  Kuhe,  Salt  Lake  City;  D.  C.  Barker,  Ogden. 

Advisory  Committee  to  the  Woman’s  AuxilFary:  Vernal  Johnson,  Chair- 
man, Ogden;  0.  P.  Heninger,  Provo;  L.  G.  Moench,  Salt  Lake  City;  Janma 

K.  Palmer,  Salt  Lake  City. 

Public  Relations  Committee:  R.  P.  Middleton,  Chairman,  Salt  Lake  City; 
Louis  P.  Matthei,  Ogden;  R.  W.  Farnsworth,  Cedar  City;  Quinn  A.  Whit- 
ing, Price;  Clyde  J.  Dalnes,  Logan;  Ray  E.  Spcndlove,  Vernal;  H.  L 
Goodwin,  Salt  Lake  City;  Gilbert  Wright,  Salt  Lake  City;  ^y  B.  Hammond, 
Provo. 

Inter-Professional  Committee:  J.  Leroy  Kimball,  Chairman,  Salt  Lake 
City;  C.  C.  Hetzel,  Jr.,  Ogden;  T.  E.  Bauman,  Park  City;  Paul  Clayton, 
Salt  Lake  City;  Ralph  G.  Rigby,  Salt  Lake  City. 

Mental  Hygiene  Committee:  Roy  A.  Darke,  Chairmaa,  Salt  Lake  City; 

L.  G.  Moench,  Salt  Lake  City;  Wm.  D.  Pace,  Salt  Lake  City;  George  Cochran, 
Salt  Lake  City;  E.  L.  Weimers,  Provo. 

Fee  Schedule  Committee:  K.  B.  Castleton,  Chairman,  Salt  Lake  City; 
Howard  K.  Belnap,  Ogden;  J.  E.  Trowbridge,  Bountiful;  D.  B.  Brynar, 
Salt  Lake  City;  W.  Leroy  Smith,  Salt  Lake  City;  J.  B.  Whwritt,  Hober 
City;  0.  W.  Budge,  Logan. 

Special  Committee  to  Study  Dues:  H.  B.  Reicbman,  Chairman,  Salt 
Lake  City;  Eliot  Snow,  Salt  Lake  City;  Ezra  Cragun,  Lewiston. 

Rural  Health  Committee:  J.  J.  Weight,  Chairman,  Provo;  J.  Q.  McQuairio, 
Richfield:  J.  P.  Burgess,  Hyrum;  Noall  Z.  Tanner,  Laytw. 


'em/et 


Comer  10th  and  Lawrence  Sts. 
TAbor  5138 


Medical  Gas  Division 
MEDICAL  OXYGEN 
CARBON  DIOXIDE-OXYGEN 
MIXTURES 

AVIATORS’  BREATHING  OXYGEN 
WATER  COMPRESSED  NITROGEN 
WATER  COMPRESSED  AIR 
Twenty-Four  Hour  Service 


COLOR  PROCESS.  M ITf/ 
LINE  & HALFTONE  J A H-X 

BEN  DAY rLHIL/ 

ILLUSTRATORS -DESIGNERS 


PHOTO 

ENGRAVERS 


532 


Rocky  Mountain  Medical  Journal 


30  day  wonder 


The  new-born  infant  is  truly  a "30-day  wonder"  taking  in  his 
stride  the  sudden  changes  birth  imposes  and  adjusting  accord- 
ingly. The  rapid  increase  in  weight  is,  alone,  a feat  no  adult  could 
duplicate.  The  right  start  on  the  right  feeding  is  of  vital  import- 
ance—particularly  during  the  first  30  days  when  infant  mortality 
is  at  its  highest  and  when  he  not  only  must  regain  his  birthweight 
but  keep  on  gaining  if  he  is  to  survive. 

'Dexin'  has  proved  an  excellent  "first  carbohydrate"  because  of 
its  high  dextrin  content.  It  (l)  resists  fermentation  by  the  usual 
intestinal  organisms,-  (2)  tends  to  hold  gas  formation,  distention 
and  diarrhea  to  a minimum,  and  (3)  promotes  the  formation  of 
soft,  flocculent,  easily  digested  curds. 

Simply  prepared  in  hot  or  cold  milk,  'Dexin'  brand  High  Dextrin 
Carbohydrate  provides  well-taken  and  well-retained  nourishment. 

'Dexin'  does  make  a difference.  Literature  on  request 

HIGH  DEXTRIN  CARBOHYDRATE 

BRAND 

Composition — Dextrins  75%  • Maltose  24%  • Mineral  Ash  0.25%  • Moisture 
0.75%  • Available  carbohydrate  99%  • 115  calories  per  ounce  • 6 level  packed 
tablespoonfuls  equal  1 ounce  • Containers  of  twelve  ounces  and  three  pounds  • 
Accepted  by  the  Council  on  Foods  and  Nutrition,  American  Medical  Association. 

‘Dexin’  Reg.  Trademark 


BURROUGHS  WELLCOME  & CO.  (U.S.A.)  INC,  9 & 11  East  41st  St.,  New  York  17,  N.Y. 


ior  July,  1949 


533 


THE  WYOMING  STATE  MEDICAL  SOCIETY 

Next  Annual  Session:  Elks  Club,  Casper;  Sept.  12,  13,  14,  1949 


OFFICERS 

President:  George  E.  Baker,  Casper. 

President-Elect:  DeWitt  Dominick,  Cody. 

Vice  President:  K.  E,  Krueger,  Rock  Springs. 
Treasurer:  P.  M.  Schunk,  Sheridan. 

Correspond) no  Secretary:  George  H.  Phelps,  Cheyenne. 
Delegate  A M. A.:  R.  H.  Reeve,  Casper. 

Alternate  Delegate  A.M.A.:  W.  A.  Bunten,  Cheyenne. 
Executive  Secretary:  Mr.  Arthur  Abbey,  Cheyenne. 


COMMITTEES 

Rocky  Mountain  Medical  Conference:  Earl  Whedon,  Chairman,  Sheridan; 
George  N.  Phelps,  Cheyenne;  H.  L.  Harvey,  Casper;  C.  W.  Jeffrey,  Rawlins; 
L.  W.  Storey,  Laramie. 

Syphilis  Committee;  N.  E.  Morad,  Chairman,  Casper;  G.  M.  Grosbart, 
Worland;  L.  H.  Wilmoth,  Lander;  L.  G.  Booth,  Sheridan;  F.  H.  Halgler, 
Midwest. 

Cancer  Committee:  Earl  Whedon,  Chairman,  Sheridan;  John  Gramllch, 
Cheyenne;  DeWitt  Dominick,  Cody;  J.  R.  Newman,  Kemmerer;  E.  W.  New- 
man, Cheyenne. 

Medical  Economics  Committee:  C.  L.  Rogers,  Chairman,  Sheridan;  Nets 
A.  Vicklund,  ThermopoUs;  R.  A.  Corbett,  Saratoga;  G.  R.  James,  Casper; 
S.  S.  Hellewell,  Evanston. 

Fracture  Committee:  Philip  Teal,  Chairman,  Cheyenne;  Silva  J.  Giovale, 
Cheyenne;  Robert  V.  Batterton,  Rawlins;  Lowell  D.  Kattenhorn,  Powell; 
Joseph  E.  Hoadley,  Gillette. 

Medical  Defense  Committee:  George  Baker,  Chairman,  Casper;  Andrew 
Bunten,  Cheyenne;  E.  W.  DeKay,  Laramie. 

Counciliors:  Earl  Whedon,  Chairman,  Sheridan;  R.  J.  Boesel,  Cheyenne: 
E.  W.  DeKay,  Laramie;  George  Baker,  President,  Casper;  George  Phelps, 
Secretary,  Cheyenne. 

Ad«isory  to  Woman’s  Auxiliary:  John  R.  Bunch,  Chairman,  Laramie; 
Virgil  L.  Thorpe,  Newcastle;  H.  J.  Aldrich,  Sheridan;  G.  B.  Savory,  Chey- 
enne. 

Advisory  to  Workmen’s  Compensation  Department:  J.  D.  Shingle,  Chair- 
man, Cheyenne;  G.  H.  Phelps,  Cheyenne;  W.  A.  Bunten,  Cheyenne;  R.  H. 
Reeve,  Casper;  Albert  T.  Sudman,  Green  River;  P.  M.  Schunk,  Sheridan. 


Industrial  Health  Committee:  K.  E.  Krueger,  Chairman,  Bock  Springs; 

Willard  Pennoyer,  Cheyenne;  Thomas  B.  Croft,  Lovell;  Eugene  Felton, 
Laramie. 

Veterans’  Affairs  and  Military  Service  Committee:  A.  J.  AUegrettl,  Chair- 
man, Cheyenne;  Jack  Rowlett,  Laramie;  Everett  Ellis,  Cheyenne;  Bernard 
Sullivan,  Laramie;  G.  W.  Koford,  Cheyenne;  Bernard  Stack,  ThermopoUs; 
J.  W.  Sampson,  Sheridan;  DeWitt  Dominick,  Co^;  Paul  B.  Holtz,  Lander; 
George  E.  Baker,  President,  Casper;  George  Phelps,  Secretary,  Cheyenne. 

Blue  Cross  Hospital  Committee:  B.  I.  WllUams,  Chairman,  Cheyenne,  1950; 
W.  A.  Bunten,  Cheyenne,  1949;  E.  W.  DeKay,  Laramie,  1951;  Cedric 
Jones,  Cody,  1952. 

Public  Policy  and  Legislation;  George  Phelps,  Chairman,  Cheyenne; 
Andrew  Bunten,  Cheyenne;  George  Baker.  President,  Casper;  G.  W.  Koford, 
Cheyenne;  E.  W.  DeKay,  Laramie;  G.  W.  Henderson,  Casper. 

National  Physicians  Committee:  George  Phelps,  Chairman,  Cheyenne; 
Andrew  Bunten,  Treasurer,  Cheyenne;  E.  W.  DeKay,  Laramie;  George  Baker, 
Casper. 

Poliomyelitis  Committee:  H.  L.  Haney,  Chairman,  Casper;  N.  A.  Vicklund, 
ThermopoUs;  Leo  Keenan,  Torrington;  DeWitt  Dominick,  Cody;  PhlUp  Teal, 
Cheyenne:  FrankUn  Yoder,  Cheyenne;  F.  A.  Mills,  RawUns. 

State  Institutions  Advisory  Committee;  J.  F.  Whalen,  Chairman,  Evans- 
ton; George  Phelps,  Cheyenne;  C.  W.  Jeffrey,  RawUns;  Earl  Whedon,  Sheri- 
dan; G.  M.  Groshart,  Worland;  R.  H.  Kanable,  Basin. 

Necrology  Committee:  Earl  Whedon.  Chairman,  Sheridan;  John  B. 
Krahl,  Torrington;  FrankUn  Yoder.  Cheyenne. 

Rural  Hdalth  Committee:  Paul  Holtz,  Chairman,  Lander;  Andrew  Bun- 
ten,  Cheyenne;  Samuel  Worthen,  Afton;  Wm.  K.  Eosene,  Wheatland;  Claude 
Raffl,  Basin. 

Public  Health  Department  Liaison  Committee:  E.  C.  Bidgeway,  Chair- 
man, Cody;  R.  P.  Fitzgerald,  Casper;  R.  V.  Batterton.  RawUns;  J.  W. 
Sampson,  Sheridan;  R.  C.  Stratton,  Green  River;  WlUard  Pennoyer, 
Cheyenne. 

Child  Health  Committee:  Paul  W.  Emerson,  Chairman,  Cheyenne;  John 
GramUch,  Cheyenne;  Thomas  Croft,  LoveU;  Bernard  SulUvan,  Laramie; 
Paul  B.  Holtz,  Lander;  Geo.  E.  Baker,  Casper;  A.  R.  Abbey,  Cheyenne. 

Council  on  National  Emergency  Medidal  Service:  George  H.  Pbel^, 
Chairman,  Cheyenne;  R.  H.  Reeve,  Casper;  DeWitt  Dominick,  Cody;  E.  W. 
DeKay,  Laramie;  K.  S.  Krueger,  Bock  Springs;  P.  M.  Schunk,  Sheridan. 


COLORADO  HOSPITAL  ASSOCIATION 


OFFICERS 

President:  Hubert  W.  Hughes.  St.  Anthony  Hospital,  Denver. 
President-Elect:  Walter  G.  Christie,  Presbyterian  Hospital,  Denver. 

Vice  President:  Sister  M.  Domnina,  St.  Anthony  Hospital,  Denver. 
Treasurer;  M.  A.  Moritz,  Denver  General  Hospital,  Denver. 

Acting  Executive  Secretary:  Roy  R.  Anderson. 

Trustees;  Roy  E.  Prangley,  St.  Luke’s  Hospital,  Denver  (1949);  James 
P.  Dixon,  M.D.  Denver  General  Hospital,  Denver  (1949);  Louis  Liswood, 
National  Jewish  Hospital,  Denver  (1950);  DeMoss  TaUaferro,  Children’s 
Hospital,  Denver  (1950);  Roy  R.  Anderson,  Presbyterian  Hospital,  Den- 
ver (1951);  Rev.  Allen  H.  Brb,  Mennonite  Hospital,  La  Junta,  Colo. 
(1951). 

Delegate  to  the  American  Hospital  Association:  Herbert  A.  Black,  M.D., 
Parkview  Hospital,  Pueblo. 

Alternate:  Msgr.  John  R.  Mulroy,  CathoUc  Hospitals,  Denver. 

STANDING  COMMITTEES 
Auditing;  R W.  Pontow,  Chairman  (1949),  Colorado  General  Hospital, 
Denver;  Rev.  E.  J.  Friedrich  (1950),  Lutheran  Sanatorium,  Wheatridge; 
Karl  Mortensen  (1951),  St  Luke’s  Hospital,  Denver. 

Constitution  and  Rules:  Samuel  S.  Golden,  M.D.,  Chairman,  Beth  Israel 
Hospital,  Denver;  Henry  H.  HiU,  Weld  County  Hospital,  Greeley;  Sister 
M.  Johanna,  Sacred  Heart  Hospital,  Lamar. 

Legislative:  Msgr.  John  E.  Mulroy,  Chairman,  Catholic  Hospitals,  Den- 
ver; DeMoss  TaUaferro,  ChUdren’s  Hospital,  Denver;  Carl  Ph.  Schwalb, 
Denver;  Herbert  A.  Black,  M.D.,  Parkview  Hospital,  Pueblo. 

Membership:  Sister  M.  Alphonsus  Chairman,  Mercy  Hospital,  Denver; 
Roy  E.  Prangley,  St.  Luke’s  Hospital,  Denver. 

Resolutions:  Walter  G.  Christie,  Chairman,  Presbyterian  Hospital,  Denver; 
Carl  Ph.  Schwalb,  Denver. 

Nominating:  Msgr.  John  R.  Mulroy,  Chairman  (1949),  CathoUc  Hos- 
pitals, Denver;  Herbert  A.  Black,  M.D.  (1950),  Parkview  Hospital,  Pueblo; 
C.  S.  Bluemei,  M.D.  (1951),  Mount  Airy  Sanatorium,  Denver. 

Program:  George  A.  W.  Currie,  M.D.,  Chairman,  University  of  Colorado 
Medical  Center,  Denver;  Roy  Anderson,  Presbyterian  Hospital,  Denver. 


Nursing;  DeMoss  Taliaferro,  Chairman,  Children’s  Hospital,  Denver; 
Sister  M.  Hugolina,  St.  Anthony  Hospital,  Denver;  Margaret  E.  Paetzulck, 
Director  of  Nurses,  Denver  General  Hospital,  Denver;  Sister  Maria  Gratia, 
R.N.,  Glocluier  Sanatorium,  Colorado  Springs;  S.  Russ  Denzler,  M.D., 
Colorado  Hospital,  Canon  City. 

Public  Education:  Owen  B.  Stubben,  Chairman,  Denver  General  Hospital, 
Denver;  Mr.  Torgensen,  Longmont  Hospital  and  Clinic,  Longmont;  Ward 
Darley,  M.D.,  Director,  University  of  Colorado  Medical  Center,  Denver; 
Chas.  Levine,  J.C.E.S.,  Spivak. 

SPECIAL,  COMMITTEES 

Public  Relations;  James  P.  Dixon,  M.D.,  Chairman,  Denver  General 
Hospital,  Denver;  Sister  Mary  Lina,  St.  Francis  HospitaJ,  Colorado  Springs. 

Rates  and  Charges:  Roy  Anderson,  Chairman,  Presbyterian  Hospital, 
Denver;  Msgr.  John  R.  Mulroy,  Catholic  Hospitals,  Denver;  Roy  B. 
Prangley,  St.  Luke's  Hospital,  Denver;  Walter  G.  Christie,  Presbyterian 
Hospital  Denver,  DeMoss  Taliaferro,  Children’s  Hospital,  Denver;  Ben 
M.  Blumberg,  General  Rose  Memorial  Hospital,  Denver. 

State  Board  of  Health  Advisory:  Msgr.  John  R.  Mulroy,  Chairman, 
CathoUc  Hospials,  Denver;  DeMoss  TaUaferro,  Children’s  Hospital,  Denver; 
Herbert  A.  Black.  M.D.,  Parkview  Hospital,  Pueblo. 

Committee  on  Hospital  Licensing  Regulations  and  Standards:  Msgr.  John 
R.  Mulroy,  Chairman,  Catholic  Hospitals,  Denver;  Roy  E.  Prangley,  SL 
Luke’s  Hospital,  Denver;  Owen  B.  Stubben,  Denver  General  Hospital,  Denver; 
DeMoss  Taliaferro,  Children’s  Hospital,  Denver;  Roy  Anderson,  Presbyterian 
Hospital,  Denver. 

Premature  Infant  Care:  DeMoss  Taliaferro,  Chairman,  Chidlren’s  Hos- 
pital, Denver;  Roy  Anderson,  Presbyterian  Hospital,  Denver. 

Rehabilitation  Center;  James  P.  Dixon,  M.D.,  Denver  General  Hospital, 
Denver:  Msgr.  John  R.  Mulroy,  CathoUc  Hospitals,  Denver;  Louis  M. 
Liswood,  National  Jewish  Hospital,  Denver. 

Inter-Professional  Council:  Hubert  W.  Hughes,  St.  Anthony  Hospital. 
Denver. 


*tion 


eruice 


,^ccutac^  and  ^peed  in  f^reicripi 

DORR  OPTICAL  COMPANY 

421  16th  Street  Denver,  Colorado  KEystone  5511 


534 


Rocky  Mountain  Medical  Journal 


M EAT. . . 

And  This  Protein  Era 


0 


“Today  we  are  in  the  protein  era.”*  This  terse  but  meaningful  state-? 
ment,  made  by  an  outstanding  authority  in  a recent  review  on  the 
progress  of  nutrition,  reflects  an  accomplishment  of  utmost  significance. 

This  resume  of  modern  nutrition  concepts  shows  convincingly  that 
the  recognition  of  the  vital  role  of  protein  in  health  and  disease  ranks 
among  the  great  advances  of  medicine. 

The  therapeutic  use  of  a high  protein  dietary  has  revolutionized 
the  prognostic  outlook  in  many  hepatic  diseases  formerly  considered 
resistant  to  treatment. 

The  use  of  high  protein  dietaries  has  resulted  in  a gratifying  re- 
duction of  surgical  morbidity  and  mortality,  made  possible  by  sys- 
tematic presurgical  nutritional  build-up  of  the  patient.  Through  this 
same  approach,  wound  healing  and  general  recovery  are  greatly 
promoted. 

In  nephritis  and  nephrosis,  at  one  time  considered  absolute  contra-- 
indications  for  animal  protein  in  the  dietary,  the  use  of  protein  in 
liberal  amounts  can  significantly  reduce  mortality  and  decidedly  im-: 
prove  the  clinical  condition. 

The  benefits  derived  from  high-protein  nutrition  in  pregnancy  and 
lactation  are  diversified  and  far-reaching,  embracing  both  mother 
and  offspring.  For  this  reason,  a generous  extra  serving  of  meat, 
given  daily  as  a routine  measure,  has  been  strongly  recommended 
as  a means  of  improving  the  health  of  mother  and  child. 

Meat  is  rightfully  regarded  as  an  outstanding  protein  source.  It  is 
notably  rich  in  protein.  The  protein  of  meat  is  biologically  complete, 
capable  of  satisfying  all  protein  needs  of  the  body  from  childhood 
to  old  age.  And,  particularly  important  in  disease,  the  excellent 
digestibility  of  meat  gives  virtual  assurance  that  its  protein  and  other 
valuable  nutrients  become  available  for  utilization. 

•McLester,  J.  S.:  Protein  Comes  Into  Its  Own,  J.A.M.A.  139-897  (April  2)  1949. 

The  Seal  of  Acceptance  denotes  that  the  nutri- 
tional statements  made  in  this  advertisement 
are  acceptable  to  the  Council  on  Foods  and 
Nutrition  of  the  American  Medical  Association. 

American  Meat  Institute 

Main  Office,  Chicago. ..Members  Throughout  the  United  States 


for  July,  1949 


535 


CHOICE  oc  “ 


, * ^>50  ftm.  • '••  c 

'^'''•- '"c..  ,„  “"'’“’‘■“ssr.-- 

A 


'n  ind;  . ® ^•'<»es  a/J  "''®'''*9.  I 

'^‘"Phra  eon,  *^®''®»nejr  , 

'^'“nger  n '•“"doK-  ‘y  ^o, 
" roe®  ^PP'-'^for  ,fc  J®'”®'"®*  A, 

‘^'•®-Preo 

'”®ni#  fL  ®''«ney  ,• 

'“'"•‘eoffna  . " P««e, 

’‘’-”■"9  »»„  ° "”"'«r  <.L7"'-9  >P.,„ 

^ '*  ®'sO  ova-. 


536 


Rocky  Mountain  Medical  Journal 


Ku  ULLY 
•f'niANAI 


'“MYANV 


faHUh^Yr  wiu4; 


^*PavceKl^ 

!»»oc«iWH 


R«lu.re.N„cx>..cOrd„  Bi 
POISON 


100 


Tablets  No.  1733 

papaverine 

hydrochloride 


’ «"•  (0.2  Gm.) 


Adult  n~ , . , 

..  '***  * tubist  as 

air«:ted  by  the 
physician. 


nireaiic  Orde 

POISON 


100 

Tablets  No.  1671 

papaverine 

hvdrochloride 


1 l/2grs.(0.i  Gm.) 
•<1  by  the  phyRietan. 


ooo 

^ 


Quiets  Smooth-Muscle  Spasm 


The  chief  effect  of  papaverine  is  relaxation  of  all  smooth 
muscle  without  interference  with  normal  contractions. 

Many  conditions  associated  with  smooth-muscle  spasm  have 
been  benefited  by  papaverine  therapy.  Prescribe  Papaverine 
Hydrochloride,  Lilly,  for  relief  of  vascular  spasm 
associated  with  coronary  occlusion,  angina  pectoris,  and 
peripheral  and  pulmonary  embolism;  for  bronchial  spasm 
and  accompanying  allergic  conditions,  such  as  asthma; 
and  for  visceral  spasm,  as  in  ureteral,  biliary,  and 
gastro-intestinal  colic.  Tablets  and  ampoules  are 
available  on  prescription  at  all  retail  and  hospital 
pharmacies. 


ELI  LILLY  AND  COMPANY,  INDIANAPOLIS  6,  INDIANA,  U.S.A. 


The  incidence  of  heart  disease  continues  to  increase  as  the 
average  span  of  life  is  lengthened.  The  problem  is  being 
attacked  on  several  fronts.  Delicate  instruments  of  diagnosis, 
better  preventive  measures,  and  improved  surgical 
techniques  have  been  devised.  Knowledge  of  the  physiology 
of  the  heart  and  vascular  system  is  increasing.  Useful  new 
drugs  have  been  introduced,  and  more  are  being  developed. 

Specialists  in  this  field  at  the  Lilly  Research  Laboratories 
are  placing  major  stress  upon  the  medical  approach  to  this 
problem.  With  crystalline  digitoxin  and  newer  diuretic  drugs, 
many  victims  of  advanced  heart  failure,  who  formerly  would 
have  been  considered  beyond  treatment,  are  now  relieved  of 
symptoms.  Papaverine  hydrochloride  makes  possible  the 
symptomatic  relief  of  coronary  occlusion,  angina  pectoris,  and 
certain  types  of  vasospastic  disease.  Even  though  the 
fundamental  disease  condition  remains,  life  may  be  prolonged 
and  made  more  useful  and  pleasant. 


LILLY  SPECIALISTS  SERVE  THE  MEDICAL  PROFESSION 


SRocky 

Colorado 
Montana 
New  Mexico 
Utah 
Wyoming 


/ 


JULY 

1949 


y\/lountaLn 

J\Aedical  Journal 

Editorial ^ 


The  Fishbein  Era 
Draws  to  a Close 

Toothing  in  years  has  given  such  a lift 

^ to  the  morale  of  Rocky  Mountain  phy- 
sicians as  the  news  from  Atlantic  City  last 
month  that  at  long  last  the  dominance  of 
one  man  over  the  public  utterances  and 
internal  policies  of  the  American  Medical 
Association  had  been  ended.  The  Board  of 
Trustees,  backed  solidly  by  the  Associa- 
tion’s House  of  Delegates,  finally  put  the 
house  of  our  profession’s  national  headquar- 
ters in  order. 

There  is  no  denying  the  brilliance  of  Dr. 
Morris  Fishbein’s  career.  Though  the  term 
genius  is  often  loosely  used,  we  believe  it 
rightfully  applies  to  him.  He  has  been  one 
of  modern  history’s  greatest  editors  and 
most  prolific  writers,  one  of  the  nation’s 
outstanding  public  speakers  both  on  the 
lecture  platform  and  as  an  after-dinner  wit. 
His  lightning-like  reading  and  photographic 
memory  have  been  psychological  marvels. 
It  has  been  said,  perhaps  truthfully,  that 
he  knows  everyone  worth  knowing  in  the 
United  States.  He  has  been  an  efficient 
organizer  of  persons  and  projects,  an  adept 
medical  politician,  and  his  mental  and  phy- 
sical energy  and  capacity  for  work  have 
been  almost  beyond  belief. 

But  with  all  that,  the  fact  has  always 
remained  that  the  American  Medical  Asso- 
ciation is  much,  much  bigger  than  any  one 
genius,  that  the  A.M.A.  is  far  more  impor- 
tant to  the  future  of  medicine  in  this  coun- 
try than  is  the  personal  ambition  of  any  one 
of  its  employees.  The  crack  in  his  mental 
armor  was  his  inability  to  see  himself  as 
the  servant  of  his  profession  rather  than 
its  master. 

It  required  fifteen  years  for  medical  lead- 


ers in  the  heavily  populated  eastern  states 
to  appreciate  the  problem  first  recognized 
by  the  Rocky  Mountain  and  Pacific  Coast 
states.  The  problem  was  really  simple. 
One  man,  great  editor  though  he  was,  was 
being  more  and  more  carried  away  by  his 
own  brilliance  and  his  easy  ability  to  in- 
fluence many  men  of  lesser  accomplish- 
ments. Increasingly,  his  activities  impressed 
doctor  and  layman  alike  that  here  was  a 
man  above  the  Board  of  Trustees,  above  the 
officers  and  the  House  of  Delegates  of  the 
Association,  above  the  Principles  of  Ethics 
themselves.  Too  much  was  finally  enough. 

For  the  record,  therefore,  we  reprint  in 
full  the  statement  read  before  the  opening 
meeting  of  the  House  of  Delegates  June  6 
by  Dr.  Elmer  Henderson  of  Louisville,  Ken- 
tucky, retiring  Chairman  of  the  Board  of 
Trustees  (and  three  days  later  unanimously 
chosen  President-elect  of  the  Association) : 

The  Board  of  Trustees  is  aware  of  the  criticism 
of  the  Editor  coming  from  within  and  from  with- 
out the  profession.  The  Board  recognizes  that 
the  public  has  come  to  believe  that  the  Editor 
is  the  spokesman  of  the  Association.  The  mem- 
bership undoubtedly  wishes  the  elected  officials 
to  speak  authoritatively  on  all  matters  of  medi- 
cal policy. 

Against  the  time  when  the  Editor  retires.  Dr. 
Austin  Smith  has  for  some  months  been  in 
training  as  the  Assistant  Editor  and  the  talent 
of  the  Editor  will  be  retained  for  the  present 
under  the  control  of  the  Board  of  Trustees. 

In  view  of  the  increasing  responsibility  of  the 
Editor  and  reorganization  of  the  department,  the 
Board  of  Trustees  has  decided  on  the  following 
points: 

1.  The  Editor  will  completely  ehminate  speak- 
ing on  all  controversial  subjects  both  by  plat- 
form and  by  radio.  Approval  of  all  speaking 
engagements  will  be  made  by  the  Executive 
Committee. 

2.  Elimination  of  all  interviews,  including 
press  conferences,  and  statements  by  Doctor 
Fishbein  except  on  scientific  subjects. 


/or  July,  1949 


537 


3.  Editorials  on  controversial  subjects  will  be 
supervised  by  the  Executive  Committee. 

4.  Complete  information  as  to  these  activities 
will  be  reported  to  the  members  of  the  House  of 
Delegates. 

5.  There  will  be  permanent  elimination  of  the 
diary  in  “Tonics  and  Sedatives.” 

6.  Plans  for  the  training  of  a new  Editor  in 
an  orderly  manner,  including  the  retirement  of 
the  present  Editor,  will  be  formulated. 

The  Board  of  Trustees  of  the  American  Medi- 
cal Association  announces  that  plans  have  been 
formulated  for  the  retirement  of  Dr.  Morris 
Fishbein  as  Editor  of  the  Journal  of  the  Ameri- 
can Medical  Association  at  an  appropriate  time. 
For  thirty-seven  years.  Dr.  Fishbein  has  served 
the  A.M.A.  well  and  faithfully.  The  Journal 
of  the  A.M.A.  is  an  endxiring  monument  to  his 
genius  and  devotion.  His  activities  have  ex- 
tended far  beyond  his  immediate  duties  as  an 
editor  and  the  Board  desires  to  pay  tribute  to 
his  many  accomplishments  in  other  fields. 

The  Board  finds  that  serious  dislocation  would 
result  from  any  sudden  replacement.  With  this 
in  mind,  a reorganization  of  the  editorial  staff 
is  under  way  so  that  his  retirement,  when  con- 
summated, will  not  result  unfavorably  for  ven- 
tures of  the  Association. 


SILHOUETTES 

from  the  A.M.A.  House  of  Delegates 


The  statement’  of  the  Board  of  Trustees  to  the 
House  of  Delegates,  quoted  in  full  by  one  of  this 
Journal’s  editorial  writers  above,  tells  the  story 
of  the  most  important  achievement  of  the  recent 
A.M.A.  convention  in  Atlantic  City.  The  medical 
profession  of  Colorado  and  all  the  Rocky  Moun- 
tain states  can  feel  that  our  “voices  crying  in  the 
wilderness”  have  finally  been  heard. 

Dear  old  A.M.A.,  God  bless  her,  has  had  her 
face  lifted  and  her  figure  streamlined.  She  will 
need  it — to  weather  the  storms  and  vicissitudes 
still  ahead  of  her.  She  has  come  through  a few 
preliminary  squalls,  money  for  public  enlighten- 
ment, H.R.  782,  etc.  Now,  with  Morris  gone.  Dr. 
Ernest  Irons  at  the  wheel.  Dr.  Elmer  Henderson 
backing  him  up  as  President-elect,  and  an  al- 
ready good  Board  of  Trustees  strengthened  by 
Dr.  F.  J.  L.  Blasingame  of  Texas,  we  are  in  a po- 
sition to  really  fight  through  this  storm. 

Our  Bill  Halley  (Senior  Delegate  from  Colo- 
rado and  usual  author  of  this  column)  flew  to 
England  for  a well-earned  rest,  right  after  our 
Atlantic  City  adjournment.  We  can  be  sure  that 
he  will  return  with  interesting  news  from  that 
country,  which  is  also  cursed  with  so’  many 
politicians  inoculated  with  the  Messiah  complex. 
HERMAN  C.  GRAVES,  M.D., 

Acting  Junior  Delegate  from  Colorado. 


Medicine  Through  a Knot  Hole 
\ JUSTIFIED  criticism  directed  toward 
our  profession  from  various  sources 
concerns  our  over-specialization.  Doctors 
who  specialize  too  early  are  rarely  “the 
best”  in  their  respective  fields.  Recognition 
of  this  fact  is  a primary  reason  why  the 
general  practitioner  is  now  enjoying  a new 
dignity  and  is  receiving  the  recognition  he 
well  deserves.  Undergraduate  and  post- 
graduate education  are  directed  to  him, 
programs  of  local  and  national  scope  are 
built  for  and  around  him.  He  is  the  man 
of  the  hour! 

Most  of  our  colleagues  believe  that  one 
of  the  answers  to  maldistribution  of  doctors 
and  medical  service  lies  in  requiring  every 
medical  graduate  to  practice  in  a small 
community  three  to  five  years  before  his 
acceptance  for  postgraduate  study  toward 
ceritfic^tion  as  a specialist.  In  other  words, 
before  being  a specialist  he  should  be  an 
all-around  doctor.  Upon  such  foundation, 
better  specialists  would  be  built.  People 
would  receive  the  consideration  and  under- 
standing that  they  expect  from  their  doc- 
tors, rather  than  seemingly  indifferent 
consideration  of  one  who  looks  upon 
their  problems  through  a knot  hole.  Many 
of  their  problems  would  be  answered  by 
one  doctor  and  there  would  be  fewer  un- 
necessary referrals  from  one  specialist  to 
another.  Thus  through  one  important  de- 
cision many  of  our  objectors  would  be  an- 
swered and  some  of  the  mud  thrown  our 
way  would  stay  among  the  grass  roots. 

Our  literature  occasionally  presents  un- 
fortunate and  at  times  amusing  examples 
of  knot  hole  medicine.  For  example,  a re- 
cent article  discusses  “removal”  of  angio- 
mata by  physical  means  of  destruction,  such 
as  freezing,  chemical  cauterization,  and  ir- 
radiation, as  though  such  attack  is  the  only 
treatment  available.  Processes  of  destruc- 
tion in  situ  may  substitute  one  disability 
for  another  and  residual  scar  or  deformity 
is  often  far  from  minimum.  Surgical  ex- 
cision is  ignored  by  the  author,  apparently 
because  he  is  not  a surgeon.  One  author 
states  that  “surgery  is  preferred  by  sur- 
geons.” This  seems  to  be  a generous  con- 


538 


Rocky  Mountain  Medical  Journal 


cession,  and  it  is  probably  true.  Many  of 
the  surgeons  have  seen  some  of  the  end- 
results,  and  it  is  quite  understandable  that 
they  would  prefer  surgery.  Impartially,  let 
us  say  that  all  of  the  specialists — derma- 
tologists, radiologists,  surgeons — should  un- 
derstand the  methods,  potentialities  and  an- 
ticipated results  of  each  method  and  should 
recommend  to  the  patient  that  which  is  best 
for  him  individually,  and  which  will  net 
him  the  superior  end  result.  The  same 
reasoning  applies  to  the  treatment  of  ma- 
lignancies. No  specialty  has  all  the  answers. 

Another  amusing  example  of  knot  hole 
medicine  appeared  in  summary  in  a recent 
throw-away  journal.  It  recommended  the 
old  tannic  acid-silver  nitrate  method  of  de- 
stroying tattoos.  Such  treatment  is  merely 
another  means  of  destruction  in  situ;  an 
eschar  of  silver  tannate  is  precipitated  in 
the  skin  which  contains  the  pigment.  When 
it  separates,  it  is  supposed  to  take  the  pig- 
ment with  it.  If  the  pigment  is  in  the 
corium,  as  it  frequently  is,  the  true  skin 
must  separate  if  the  tattoo  is  to  be  removed. 
Otherwise  the  tattoo  is  only  botched  up, 
not  removed.  Furthermore,  if  the  treat- 
ment is  thorough  and  the  mark  completely 
removed,  third  degree  loss  of  skin  results. 
Healing  is  then  impossible  without  scar,  and 
healing  is  necessarily  uncomfortable,  un- 
clean, and  prolonged.  An  erroneous  state- 
ment is  made  in  the  article — that  scar  does 
not  result.  Thus  the  unsuspecting  doctor 
who  reads  the  article  will  believe  that  here 
we  have  an  office  procedure  which  will  re- 
move tattoo  completely  and  without  resid- 
ual disfigurement.  He  will  convey  this 
impression  to  his  patient,  and  he  and  his 
patient  will  discover  the  hard  way  that 
they  have  been  misled.  The  patient  will 
be  disappointed  because  he  has  been  made 
to  expect  more  than  can  be  delivered  to 
him.  It  is  quite  clear  that  the  author  of 
the  article  is  not  familiar  with  excision 
and  skin  grafting.  His  experience  must 
have  been  narrow  and  his  enthusiasm  un- 
bounded by  the  knowledge  which  experi- 
ence gives.  He  has  looked  at  this  problem 
through  a knot  hole  and  he  has  promulgated 
a dangerously  small  amount  of  information. 


Among  our  answers  to  the  nationalization 
of  our  profession  and  governmental  control 
of  doctors,  let  us  oppose  over-specialization. 
May  the  pendulum  swing  back  part  way 
and  may  the  following  generation  of  doc- 
tors not  study,  look,  and  practice  through 
knot  holes. 

V <4 

Talc  Granuloma 

URGEONS  have  been  suspicious  for 
years  that  talc  is  an  irritant.  Its  insol- 
uble granules  are  unquestionably  irritating 
to  wounds  and  unhealed  surfaces.  Despite 
this  fact,  rinsing  of  gloves  prior  to  making 
an  incision  or  doing  a dressing  is  a tech- 
nical refinement  often  neglected.  A seem- 
ingly small  maneuver  is  easily  overlooked 
among  the  more  gross  requirements  of  mak- 
ing ready  the  scene  for  operative  procedure. 

Ample  evidence  is  available  to  demon- 
strate foreign  body  reaction  and  formation 
of  granulomata  where  tissues  have  reacted 
to  minute  injury  from  talc  contamination. 

Work  has  been  done  to  produce  a soluble 
and  non-irritating  substitute.  One  firm  has 
produced  a powder  composed  of  a soluble 
amylose  which  possesses  the  advantages  of 
talc,  but  is  free  of  its  irritant  properties  and 
insolubility. 

More  publicity  in  this  element  of  surgical 
technic  is  indicated.  Meanwhile  let  us  rinse 
our  gloves  before  we  make  the  incision! 


Correspondence 


FAVORS  UNIONIZATION 

To  the  Editor; 

I was  interested  in  your  latest  “Silhouettes” 
column  (May,  1949),  and  keep  asking  myself  the 
question  you  pose:  “Why  not?’” 

Since  courts  have  ruled  that  the  medical  pro- 
fession is  a trade  organization,  wouldn’t  it  be 
well  to  “unionize”?  A beginning  might  be  made 
by  doing  this  in  the  states  served  by  the  Rocky 
Mountain  Medical  Journal.  Since  such  an  organ- 
ization would  be  effected  for  the  sole  purpose  of 
self-preservation — of  offering  a imited  front — 
to  stay  the  tide  of  opposition  toward  the  Ameri- 
can way  of  life  and  medical  practice — again. 
Why  not? 

Fraternally, 

P.  K.  EDMUNDS,  M.D., 
Cedar  City,  Utah. 

P.  S.:  I wish  it  made  clear  that  this  is  my  per- 
sonal opinion  and  does  not  necessarily  reflect  the 
attitude  of  the  Southern  Utah  Medical  Associa- 
tion, of  which  I have  been  an  officer. — P.  K.  E. 


jor  July,  1949 


539 


Original  Articles 

BLADDER  NECK  OBSTRUCTION  IN  WOMEN  AND  CHILDREN* 

JOHN  F.  PATTON,  M.D. 

ST.  LOUIS,  MO. 


The  female  urethra  is  a frequent  site  of 
pathology.  The  explanation  for  the  major- 
ity of  bladder  symptoms  in  women  may  be 
found  in  this  short  and  comparatively  sim- 
ple channel.  It  is  similar  in  histological 
structure  to  the  male  urethra  and  glandular 
elements  have  been  demonstrated  in  both 
the  posterior  and  anterior  segments.  It  is 
likewise  subject  to  similar  types  of  lesions, 
such  as  inflammation,  stricture,  granulo- 
mata,  polyps  and  hyperplasia.  Such  lesions 
are  common  and  may  in  some  instances 
cause  interference  with  urinary  flow,  with 
a resulting  inability  of  the  patient  to  com- 
pletely empty  the  bladder.  The  majority 
are  amenable  to  local  therapy  and  the  pa- 
tient can  be  given  rather  prompt  relief  by 
instillations  of  a silver  preparation,  by  dila- 
tations or  fulguration  of  the  hyperplastic 
tabs.  I would  also  mention,  at  this  point, 
the  role  of  cystocele  as  a cause  for  vesical 
disorders.  While  ptosis  of  the  pelvic  organs 
is  unquestionably  responsible  for  vesical 
dysfunction,  I am  of  the  opinion  that  all  too 
frequently  they  are  incriminated  when  not 
at  fault.  Attention  to  co-existing  pathology 
in  the  urethra  and  at  the  bladder  neck  will 
often  afford  relief,  and  certainly  these  cases 
deserve  careful  cystoscopic  study  before 
surgical  correction  of  the  relaxed  pelvic 
floor  is  decided  upon. 

We  are  concerned  here  with  a less  fre-  ’ 
quent  but  more  profound  lesion,  involving 
the  bladder  neck,  and  causing  obstructive 
changes.  The  adult  male  has  long  been 
known  to  be  subject  to  bladder  neck  ob- 
struction. Discovery  of  the  prostate  as  a 
cause  of  obstruction  goes  back  to  the  mid- 
dle of  the  sixteenth  century  and  is  at- 

*Read before  the  Utah  State  Medical  Association 
Annual  Meeting,  September  3,  1948.  The  author  is 
Assistant  Professor  of  Clinical  Genito-Urinary  Sur- 
gery, Washington  University  School  of  Medicine, 
St.  Louis,  Missouri. 


tributed  to  Nicolo  Ulassa,  a Venetian  phy- 
sician. The  female,  however,  escaped  sus- 
picion and  it  was  not  until  1921  that  Caulk 
called  attention  to  a similar  lesion  in  wom- 
en, in  a paper  entitled  “Contracture  of  the 
Vesical  Neck  in  the  Female.”  In  1934  Caulk 
and  I reported  a total  of  twelve  such  cases. 
Nesbit,  Fite,  Thompson  and  others  have  con- 
tributed to  this  interesting  subject. 

This  present  report  is  based  on  a series  of 
twenty-one  cases.  For  sake  of  brevity,  only 
the  salient  features  will  be  discussed.  The 
ages  of  these  women  ranged  from  29  to  74 
and  averaged  48.  Urinary  symptoms  were 
present  in  varying  degrees  of  severity,  from 
frequency  and  nocturia  to  complete  reten- 
tion. - Four  had  incontinence,  eight  had  dif- 
ficulty in  voiding,  and  six  had  renal  pain 
resulting  from  regurgitation  of  bladder  con- 
tents up  the  ureter,  the  so-called  “regur- 
gitant colic.”  Residual  urine  was  present  in 
seventeen  cases  and  ranged  from  30  c.c.  to 
1,000  c.c.  Ten  had  a residual  of  over  200 
c.c.  Infection  was  present  in  all  and  the 
majority  of  the  patients  had  experienced 
acute  episodes  of  pyelonephyritis.  Uremia, 
evidenced  by  elevation  of  the  blood  nitro- 
gen, was  present  in  four  cases.  Obstructive 
changes  typical  of  prostatic  obstruction  in 
the  male  are  demonstrated,  such  as  trabecu- 
lation  of  the  bladder  wall,  diverticula  and 
hydronephrosis.  The  great  majority  of  the 
obstructions  are  in  the  form  of  a contrac- 
ture of  the  vesical  neck;  however,  three 
cases  showed  a definite  median  enlarge- 
ment. The  cystoscopic  appearance  of  these 
obstructions  is  often  deceptive  and  the  in- 
experienced cystoscopist  may  tend  to  dis- 
count what  he  sees.  The  diagnosis  is  made 
only  after  careful  study.  The  patient’s  his- 
tory will  usually  give  the  first  clue,  and  the 
simple  test  for  residual  urine  will  tend  to 


540 


Rocky  Mountain  Medical  Journal 


substantiate  the  evidence.  Careful  cysto- 
scopic  study,  cystography,  and  pyelography 
will  furnish  the  final  data  necessary.  One 
must  be  careful  to  exclude  the  possibility 
of  a neurogenic  element.  One  of  these 
cases,  however,  is  that  of  a contracture  of 
the  bladder  neck  in  a woman  37  years  old 
associated  with  a neurogenic  bladder  due  to 
multiple  sclerosis.  She  had  extreme  dif- 
ficulty in  voiding  and  a residual  of  600  c.c. 
Transurethral  resection  of  the  bladder  neck 
gave  excellent  results.  She  is  still  living 
and  although  confined  to  a wheel  chair  be- 
cause of  her  multiple  sclerosis,  she  empties 
her  bladder  completely  and  has  a clear  urine 
nine  years  after  operation. 

The  operation  for  relief  of  these  obstruc- 
tions is  by  transurethral  methods.  The 
cautery  punch  was  employed  in  these  cases, 
except  in  one  instance  when  the  McCarthy 
resectoscope  was  used  because  the  punch  in- 
strument was  not  available.  The  punch 
type  instrument  with  fenestrated  sheath  is 
a much  safer  instrument  than  that  employ- 
ing high  frequency  cutting  current.  The 
cutting  current  where  heat  penetration 
is  pronounced  makes  one  careful  to  apply 
it  to  this  delicate  tissue.  Although  vesico- 
vaginal fistulae  have  been  reported  with  the 
use  of  high  frequency  current,  I know  of  no 
such  complication  from  the  use  of  a punch 
type  instrument.  There  were  no  complica- 
tions resulting  from  operation  in  any  of 
these  cases  and  no  deaths.  A urethral  cath- 
eter is  left  in  place  for  one  to  three  days  aft- 
er operation.  In  some  cases  it  is  necessary 
to  repeat  the  procedure.  It  is  better  to 
take  out  too  little  tissue  at  one  sitting  than 
too  much.  Pathological  examination  of  the 
tissue  removed  shows  in  most  cases  fibro- 
sis and  in  some  connective  tissue,  smooth 
muscle  and  epithelial  hyperplasia.  It  is 
interesting  to  note  that  in  one  case  the  re- 
port was  returned  as  “prostate,  chronic  in- 
flammation.” The  results  in  the  great  ma- 
jority of  cases  are  extremely  gratifying.  It 
is  advisable  to  follow  these  patients  at 
periodic  intervals  and  in  some  instances  oc- 
casional dilatation  is  necessary. 

The  problem  of  urinary  infection  in  in- 
fants and  children  deserves  serious  consid- 

for  JuLY,vil949 


eration,  particularly  when  the  disease  does 
not  disappear  spontaneously,  respond  read- 
ily to  treatment  or  recurs  a second  time. 
There  is  little  doubt  that  acute  urinary 
infection  in  adult  life  may  sometimes  be 
merely  an  exacerbation  of  a tenacious  low 
grade  infection  which  has  persisted  since 
infancy.  In  a series  of  girls  with  acute  pyel- 
onephritis and  later  discharged  from  the 
hospital  as  cured,  Cabot,  on  re-examination 
several  months  later,  found  pathogenic  bac- 
teria in  the  urine  in  half  of  them.  Acute 
urinary  tract  infections  may  and  often  do 
clear  up  spontaneously  or  will  respond  to 
our  present  formidable  array  of  chemothera- 
peutic agents.  The  responsibility  of  the 
physician  does  not  end,  however,  when  the 
acute  symptoms  subside  and  the  tempera- 
ture returns  to  normal.  At  least  two  nega- 
tive cultures  or  four  negative  smears  of  the 
centrifuged  urine,  made  at  weekly  intervals, 
should  be  obtained  after  all  medication  has 
been  discontinued,  before  a cure  is  pro- 
nounced. If  we  are  to  prevent  the  destruc- 
tive effects  of  chronic  infection  in  later 
life,  such  as  hydronephrosis,  renal  atrophy, 
possible  stone  formation  and  other  serious 
sequelae,  this  first  episode  of  urinary  tract 
infection  must  be  given  close  attention  and 
followed  carefully.  One  must  be  all  the 
more  alert  for  recurrence  or  persistence  of 
a low-grade  symptomless  infection  with  the 
present  day  use  of  the  sulfonamides,  peni- 
cillin and  streptomycin.  These  drugs  may 
be  so  effective  as  to  produce  a sterile  urine 
even  in  the  presence  of  stasis.  Where  sta- 
sis is  present  or  remains  unrelieved,  recur- 
rence of  infection  is  inevitable.  Therefore, 
recognition  and  adequate  treatment  of  the 
accessory  causes  of  persistent  or  recurrent 
urinary  tract  infection  are  the  essentials  of 
proper  management. 

Urinary  infections  in  children  are  strik- 
ingly frequent.  Most  of  them  are  acute, 
and  usually  secondary  to  some  focal  infec- 
tion elsewhere  such  as  the  middle  ear,  upper 
respiratory  passages,  the  intestinal  tract  or 
vagina.  Many  of  these  acute  conditions  are 
cured  following  relief  of  the  primary  focus. 
We  are  concerned  here  with  those  infec- 
tions* which  resist  the  usual  treatment,  or 


541 


tend  to  recur.  Infants  and  children  are 
known  to  be  subject  to  practically  every 
urological  disease  common  to  the  adult.  The 
development  of  instruments  of  small  cali- 
ber makes  it  possible  to  investigate  the 
urinary  tract  in  infants  equally  as  well  as 
in  the  adult.  In  fact,  they  tolerate  instru- 
mentation much  better  and  reactions  seldom 
if  ever  occur.  In  chronic  or  recurrent 
urinary  tract  infections  one  may  expect  the 
presence  of  some  complicating  factor  in  at 
least  80  per  cent  of  the  cases.  Obstructive 
conditions  along  the  urinary  pathway  are 
exceedingly  frequent.  The  sites  of  pre- 
dilection for  obstruction  are  the  normal 
physiological  points  of  constriction,  that  is, 
the  uretero-pelvic  juncture,  the  intramural 
or  vesical  end  of  the  ureter  and  the  internal 
vesical  orifice  or  bladder  neck.  The  latter 
is  the  most  frequent.  We  have  to  the  pres- 
ent time  a total  of  forty-six  such  cases. 
Seven  of  these  patients  were  seen  before 
the  age  of  2,  sixteen  were  between  2 and  5, 
fifteen  between  5 and  10,  and  eight  were 
over  10  years  of  age.  The  incidence  of 
bladder  neck  obstruction  in  regards  to  sex 
is  about  equal;  twenty-five  were  boys  and 
twenty-one  were  girls.  All  had  urinary 
symptoms. 

It  should  be  pointed  out  here  that  the 
symptom-complex  is  not  necessarily  directed 
primarily  to  the  bladder.  The  predominant 
signs  and  symptoms  may  revolve  around  a 
swollen  tender  kidney  and  yet  the  under- 
lying cause  may  be  an  obstruction  in  the 
lower  urinary  tract  with  both  kidneys  in- 
volved and  only  one  manifesting  the  dis- 
ease. Thirteen  of  these  patients  had  fre- 
quency of  urination  and  eleven  difficulty  in 
voiding;  twenty-six  had  definite  signs  of 
pyelonephritis;  five  suffered  renal  colic,  the 
result  of  ureteral  regurgitation.  Inconti- 
nence, diurnal  or  nocturnal,  or  both,  was 
present  in  thirty-one  instances.  It  is  inter- 
esting to  note  that  in  nine  cases,  bed-wet- 
ting was  the  predominant  symptom  and  in 
six  the  sole  complaint.  Uremia  was  present 
in  twelve  cases,  as  determined  by  nitrogen 
retention  in  the  blood.  The  majority  of  these 
patients  had  a residual  urine  of  over  100  c.c. 
Four  had  a residual  of  over  500  c.c.  In  eight 


cases  no  residual  was  found,  although  the 
symptoms  and  signs  were  significant.  Re- 
gurgitation of  bladder  contents  up  the  ure- 
ters was  present  in  nineteen  cases  as  dem- 
onstrated by  the  cystogram.  In  eleven  it 
was  bilateral  and  in  eight  cases  unilateral. 
Hydronephrosis  was  present  in  twenty-two 
instances.  Other  associated  conditions  sec- 
ondary to  the  obstruction  at  the  vesical  neck 
were  trabeculation  of  the  bladder  wall  in 
nine  cases,  diverticula  in  four  cases,  and  the 
presence  of  a vesical  calculus  in  two  cases. 

From  the  standpoint  of  practical  meas- 
ures of  value  to  the  practitioner,  there  are 
several  simple  diagnostic  procedures  which 
may  be  carried  out  that  will  give  valuable 
information  regards  the  status  of  the  uri- 
nary tract  and  which  will  often,  establish  the 
diagnosis  even  before  the  necessity  for  cys- 
toscopic  study: 

1.  Test  for  residual  urine.  The  presence  of 
residual  urine  is  highly  indicative  of  some 
type  of  obstructive  pathology  distal  to  the 
bladder,  most  likely  at  the  bladder  neck. 

2.  Determination  of  total  renal  function 
by  PSP  or  by  blood  urea  nitrogen  or  NPN. 
If  the  total  function  is  low,  as  indicated  by 
these  tests,  one  may  be  assured  that  both 
kidneys  are  involved  regardless  of  the  pal- 
pable evidence. 

3.  Cystogram.  The  simple  procedure  of 
filling  the  bladder  with  a solution  opaque  to 
the  x-ray,  such  as  5 or  10  per  cent  sodium 
iodide,  will  afford  valuable  information  as 
to  the  topographical  outline  of  the  urinary 
system.  If  there  is  regurgitation  up  the 
ureters,  one  may  be  certain  the  fundamental 
lesion  is  at  the  bladder  neck. 

4.  Intravenous  urography  is  also  highly  in- 
formative in  determining  the  status  of  the 
urinary  system  and  acts  as  a test  of  func- 
tion as  well  as  delineating  its  outline.  If 
renal  function  is  low,  however,  it  may  give 
unsatisfactory  results,  and  will  not  in  any 
case  determine  the  presence  or  absence  of 
ureteral  regurgitation. 

The  above  procedures  may  rule  out  the 
presence  of  obstructive  uropathy,  but  if  evi- 
dence of  obstruction  is  suggested  by  them, 
cystoscopic  study  is  necessary  before  any 
corrective  therapy  may  be  considered.  The 


542 


Rocky  Mountain  Medical  Journal 


great  majority  of  these  bladder  neck  ob- 
structions, as  revealed  by  the  cystoscope, 
are  of  two  types,  contractures  of  the  vesical 
neck  and  congenital  valves. 

Their  operative  relief  is  by  instrumental 
or  trans-urethral  methods.  To  attack  the  ob- 
struction through  a suprapubic  cystotomy 
is  both  unnecessary  and  unsatisfactory. 
These  little  patients  are  prepared  for  opera- 
tion much  in  the  same  manner  as  the  pros- 
tatic. In  children  with  high  residual  urines, 
particularly  when  associated  with  regurgi- 
tation into  the  ureters  and  severe  renal 
infection,  preliminary  drainage  is  employed 
by  use  of  the  urethral  catheter.  In  rare 
instances,  where  there  is  marked  tortuosity 
of  the  ureters  with  extensive  hydronephro- 
sis, drainage  by  nephrostomy  or  ureteros- 
tomy may  be  indicated.  General  supportive 
measures  as  well  as  therapy  directed  to  the 
control  of  infection  and  improvement  of 
renal  function  are  likewise  employed,  and 
operation  is  never  performed  until  the  blood 
nitrogen  is  normal  or  has  become  stabilized, 
the  febrile  reaction  has  subsided  and  the 
general  appearance  of  the  child  is  good. 

I shall  not  go  into  a detailed  discussion 
of  the  technic  of  operation.  In  some  cases, 
valves  may  be  destroyed  satisfactorily  by 
fulguration.  In  the  great  majority  of  cases, 
however,  particularly  in  the  vesical  neck 
contractures,  tissue  must  be  removed,  and 
this  is  accomplished  by  the  child’s  cautery 
punch  or  the  McCarthy  infant  panendoscope 
employing  a high  frequency  loop.  I have 
used  the  latter  in  four  instances  but  prefer 
the  punch  type  instrument.  The  same  vis- 
ual lens  is  employed  and  one  has  the  ad- 
vantage of  seeing  the  tissue  to  be  removed 
engaged  in  the  slot  before  cutting  occurs.  A 
urethral  catheter  is  left  in  place  and  re- 
moved after  one  to  three  days.  If  sufficient 
tissue  has  not  been  resected  to  provide  a 
good  stream  and  allow  the  patient  to  empty 
the  bladder  completely,  the  procedure  may 
be  repeated,  as  is  necessary  in  approximate- 
ly 10  per  cent  of  the  cases.  The  overall 
results  are  exceedingly  satisfactory.  Follow- 
ing operation,  measures  taken  to  eradicate 
infection  are  intensified.  It  is  imperative 
that  these  children  be  followed  carefully 


and  over  a long  period,  particularly  those 
with  marked  hydronephrosis  and  gross  in- 
fection. 

As  was  pointed  out  earlier,  bedwetting  is 
prominent  in  the  list  of  symptoms  of  blad- 
der neck  obstruction  and  in  nine  of  these 
cases  was  the  principal  complaint.  Early 
recognition  and  correction  of  the  underlying 
cause  of  eneuresis  may  frequently  prevent 
serious  damage  to  the  urinary  tract  as  well 
as  cure  the  incontinence.  Bedwetting  is  a 
common  condition  and  is  too  often  accepted 
by  parents  as  a part  of  the  natural  course 
of  events  in  a child’s  life.  As  a result,  med- 
ical advice  is  often  sought  at  a rather  late 
date.  Likewise,  the  condition  is  far  too 
often  considered  a psychologic  disturbance. 
If  a child  with  enuresis  is  permitted  to  en- 
ter the  school  age  and  is  not  already  a psy- 
chiatric problem,  there  is  little  doubt  but 
that  he  will  soon  become  one.  Every  effort 
should  be  made  to  correct  this  condition  by 
the  time  the  child  is  five  and  certainly  be- 
fore his  sixth  birthday.  Medical  and  psy- 
chotherapy are  permissible  for  a reasonable 
period  but  if  enuresis  persists  after  three 
months  of  such  a regime,  urological  inves- 
tigation is  indicated.  Congenital  anomalies 
and  diseases  of  the  urogenital  system  are 
far  more  often  the  underlying  cause  of  bed- 
wetting than  is  generally  believed.  In  a 
study  of  532  cases  of  enuresis,  Campbell 
found  uropathology  in  60  per  cent.  If,  after 
thorough  urological  investigation  no  disease 
is  found,  one  may  be  assured  that  control 
will  eventually  be  established. 

Summary  and  Conclusions 

A discussion  of  bladder  neck  obstructions 
in  women  and  children  is  presented,  as  a 
cause  of  persistent  or  recurrent  urinary 
tract  infection.  A clear  urine,  however,  does 
not  rule  out  the  possibility  of  bladder  neck 
or  urethral  pathology  and  persistent  bladder 
symptoms  demand  investigation. 

The  importance  of  early  recognition  by 
judicious  urologic  study  and  application  of 
appropriate  corrective  measures  is  stressed, 
in  order  to  prevent  late  obstructive  changes 
and  irreparable  renal  damage,  as  well  as  to 
relieve  the  distressing  symptoms. 


for  July,  1949 


543 


Urinary  tract  infections  in  infants  and 
children  are  common  and  the  first  attack 
deserves  our  most  careful  attention.  A close 
follow-up  is  essential  after  the  acute  symp- 
toms subside  and  if  infection  in  the  urine 
persists  or  if  it  recurs,  complete  urologic 
study  is  mandatory. 


Enuresis  is  a problem  which  is  all  too 
frequently  neglected.  If  the  application  of 
medical  and  psychotherapy  does  not  pro- 
duce results  within  a reasonable  period, 
further  delay  in  urologic  investigation  is 
unwarranted.  Certainly,  every  effort  should 
be  made  to  correct  this  condition  before  the 
child  enters  the  school  age. 


A SIMPLE  BEDSIDE  METHOD  FOR  THE  DETERMINATION  OF 

PLASMA  SALICYLATE* 

JOSEPH  H.  MILLER,  M.D.,  and  RICHARD  W.  WHITEHEAD,  M.D. 

DENVER 


The  report  of  Coburn  gave  new  impetus 
to  the  use  of  large  doses  of  salicylates  in  the 
treatment  of  acute  rheumatic  fever.  He  and 
others  have  indicated  that  if  the  desired 
results  are  to  be  obtained  from  this  therapy 
the  plasma  salicylate  concentration  must  be 
maintained  above  a certain  level.  Because 
of  the  marked  variations  in  the  plasma  sali- 
cylate level  from  time  to  time  in  the  same 
individual  and  from  individual  to  individual 
on  the  same  dosage,  and  because  of  the  low 
level  at  which  toxic  symptoms  may  occur, 
a method  by  which  this  level  could  be  read- 
ily determined  would  be  of  great  value.  The 
method  of  Brodie  et  ah,  and  that  of  Weich- 
selbaum  and  Shapiro  work  well  for  this  pur- 
pose. They  have  the  disadvantages,  how- 
ever, of  requiring  venesection,  a trained 
technician,  considerable  equipment  and  tox- 
ic reagents.  For  these  reasons  the  methods 
cited  are  impractical  for  use  outside  of  large 
hospitals  or  for  frequent  determinations  on 
children.  It  appears,  therefore,  that  a meth- 
od which  could  be  quickly  and  easily  per- 
formed by  any  physician  at  the  bedside, 
requiring  only  the  blood  from  a finger 
puncture  and  simple,  inexpensive  equip- 
ment, would  be  of  value. 

Equipment 

1.  A lancet  such  as  a Bard-Parker  No.  11 
scalpel  blade. 

2.  A small  glass  or  plastic  cup  about  5 mm. 
in  diameter  and  3 mm.  deep  with  vertical 
walls  for  collecting  the  blood. 

♦From  the  Department  of  Physiology  and  Pharma- 
cology, University  of  Colorado  Medical  Center,  Den- 
ver, Colorado. 


3.  Prepared  capillary  tubes:  Capillary 
tubes  about  7 cm.  in  length  and  with  an  in- 
ternal diameter  of  0.8  mm.  to  1.1  mm.,  such 
as  those  supplied  by  the  Kimble  Glass  Co.,* 
were  used.  The  inside  surface  for  two- 
thirds  the  length  of  the  tube  was  wetted 
with  a solution  consisting  of  three  parts  by 
weight  of  powdered  gum  acacia  mixed  in 
a mortar  with  ten  parts  of  water  and  then 
with  seven  parts  by  weight  of  magnesium 
sulfate.  The  tube  was  then  dried  at  about 
95  degrees  C.  To  prevent  coagulation  of  the 
blood  a small  amount  of  heparin  powder 
was  placed  in  one  end  of  the  tube  and  al- 
lowed to  fall  out  the  other  end.  The  neces- 
sary amount  of  heparin — about  5 gamma — 
remains  in  the  tube. 

4.  A small  rubber  bulb,  one  end  of  which 
is  pierced  with  a hole  into  which  the  end 
of  a capillary  tube  may  be  snugly  fitted  and 
the  opposite  end  of  which  is  pierced  by  a 
larger  hole  that  may  be  occluded  with  a 
finger  tip  so  that  the  bulb  works  like  a 
medicine-dropper  bulb. 

5.  A small  block  of  rubber  partially 
pierced  by  a small  hole  so  that  it  may  be 
used  to  cap  the  capillary  tube  and  support 
it  in  an  upright  position. 

6.  A piece  of  glass  about  the  size  of  a mi- 
croscope slide.  The  glass  cup  described  in 
2 above  may  be  fastened  to  one  end  of  it. 

7.  A saturated  solution  of  ferric  nitrate  in 
distilled  water.  About  1 c.c.  should  suffice 
for  100  tests. 

8.  A color  scale  made  by  matching  with 

•Kimble  Glass  Co.,  Vineland,  New  Jersey,  capillary 
tubing  No.  46486. 


544 


Rocky  Mountain  Medical  Journal 


water  colors  or  oils  the  colors  produced  by 
plasmas  of  known  salicylate  content.  Pre- 
pared tubes  should  be  used  in  making  the 
standard  color  scale  in  order  to  compensate 
for  such  changes  as  may  be  introduced  by 
the  acacia-magnesium  sulfate  reagent.  The 
scale  should  be  mounted  on  a yellow-green 
background  for  best  contrast. 

Procedure 

A finger  tip  of  the  patient  is  wiped,  with 
alcohol,  punctured  by  the  lancet  and  wiped 
dry.  About  0.1  c.c.  of  the  blood  which  then 
collects  is  gathered  in  the  glass  cup.  By 
using  the  rubber  bulb  attached  to  the  un- 
treated end  of  the  capillary  tube,  the  blood 
is  drawn  into  the  tube  for  a little  more 
than  two-thirds  its  length  and  then  nearly, 
but  not  completely,  extruded  back  into  the 
cup.  This  is  repeated  several  times  until 
the  coating  in  the  capillary  tube  is  dis- 
solved. The  tube  is  then  filled  to  within 
a few  millimeters  of  the  top.  Care  must  be 
taken  to  be  sure  the  column  of  blood  is  un- 
broken by  air  bubbles. 

Holding  the  tube  horizontally,  the  filling 
end  is  occluded  with  a finger  while  the  rub- 
ber bulb  is  removed.  The  filling  end  is  then 
capped  with  the  rubber  block  and  the  tube 
set  as  nearly  vertical  as  possible,  using  the 
rubber  block  as  the  base.  In  a few  minutes 
the  erythrocytes  will  clump  and  begin  to 
settle  rapidly.  After  the  tube  has  stood  for 
fifteen  minutes  the  column  of  plasma  will 
have  reached  a length  of  about  2 to  3 cm. 
If  greater  speed  is  desired  the  tube  and  rub- 
ber block  may  be  centrifuged.  This  will 
also  give  an  estimation  of  the  hematocrit. 
The  tube  is  then  broken  at  the  line  of  de- 
markation  while  holding  it  horizontally.  By 
using  the  rubber  bulb  the  plasma  is  ex- 
truded upon  the  glass  slide.  The  end  of  the 
tube  is  wiped  dry  and  a quantity  of  the  fer- 
ric nitrate  reagent  equal  to  about  one- 
third  the  quantity  of  plasma  is  drawn  up 
into  it  and  expressed  on  top  of  the  drop  of 
plasma  with  which  it  is  gently  stirred  to 
form  a coagulum.  The  density  of  the  pur- 
ple coloration  of  this  coagulum  is  then  com- 
pared with  the  standard  color  chart  and  the 
salicylate  concentration  estimated.  Oxalated 
plasma  is  unsatisfactory  since  oxalates  in- 
terfere with  the  color  reaction. 


Results  obtained  with  this  method  in  sev- 
en clinical  cases  are  given  in  the  table  be- 
low; 


Plasma  Salicylate  Plasma  Salicylate 
Concentrations  Concentrations 

Determined  by  Determined  by 

Bedside  Method  Brodie’s  Method 

Msr.  % Mg.  % 


Case  A 9.0  8.1 

Case  B 12.5  11.0 

Case  C 20.5  22.6 

Case  D 8.0  7.8 

Case  E 9.0  11.2 

Case  F 25.0  26.7 

Case  G 21.0  23.8 

Case  H 27.0  28.0 


Discussion 

With  the  exception  of  the  cotton  and  the 
alcohol,  all  the  equipment  necessary  to  per- 
form fifty  tests  can  be  easily  contained  in 
a box  2%"xr'xl4"  in  size — truly  vest-pocket 
dimensions. 

In  addition  to  using  equipment  which  can 
be  easily  carried,  the  test  can  be  quickly 
performed,  requiring  only  about  three  min- 
utes and  a fifteen-minute  period  of  waiting. 

Of  greater  importance,  however,  is  the 
accuracy  of  the  test.  The  colors  range  from 
white  at  10  mg.  per  cent  to  dark  purple  at 
50  mg.  per  cent.  The  5 mg.  per  cent  grada- 
tions are  easily  distinguishable  from  one 
another  and  interpolation  to  the  nearest  2 
mg.  per  cent  is  not  difficult.  In  repeated 
tests  with  plasma  prepared  by  adding  sali- 
cylates to  it  in  vitro,  the  test  was  accurate 
to  within  2 mg.  per  cent.  Tests  on  blood 
drawn  from  patients  on  salicylate  therapy 
gave  results  that  were  usually  1 to  3 mg. 
per  cent  lower  than  values  obtained  by 
Brodie’s  method. 

The  test  appeared  to  be  equally  accurate 
whether  sodium  salicylate  or  acetyl  salicy- 
lic acid  was  used  for  oral  therapy. 

Conclusion 

1.  The  need  for  a simple,  bedside  method 
of  blood  salicylate  determination  is  noted. 

2.  The  necessary  equipment  and  the  pro- 
cedure for  performing  such  a test  are  de- 
scribed. 

3.  It  is  believed  that  the  method  described 
is  sufficiently  accurate  and  practical  to  be 
used  as  a guide  in  salicylate  therapy. 


for  July,  1949 


545 


SEVERE  BLEEDING  OF  AN  ESOPHAGEAL  VARIX  CONTROLLED 

BY  OXYCEL* 

DAVID  A.  DOLOWITZ,  M.D.,  WILLIAM  C.  WALKER,  M.D.,  and  GRANT  LEE  BENSON,  JR.,  M.D. 

SALT  LAKE  CITY 


In  a recent  paper  it  was  suggested  that 
local  coagulants  might  be  used  to  control 
the  hemorrhage  of  a bleeding  esophageal 
varix.  Such  an  attempt  is  here  reported, 
where  a bleeding  varix  was  observed 
through  an  esophagoscope  and  the  hemor- 
rhage controlled  by  the  local  application  of 
oxycel. 

Various  operations  have  been  devised  to 
re-route  a portion  of  the  blood  flow  and 
thus  relieve  the  pressure  on  the  portal 
anastomoses.  However,  the  patient  with  a 
bleeding  varix  is  freqnently  so  exsanguin- 
ated as  to  be  an  impossible  surgical  risk. 
Few  successful  methods  have  been  devised 
to  arrest  this  bleeding  so  that  the  patient 
can  be  built  up  to  tolerate  operation.  Per- 
haps the  most  successful  method  has  been 
the  cauterization  of  the  vessel  through  an 
esophagoscope.  This  is  usually  done  by 
wrapping  the  tip  of  the  cautery  in  cotton, 
moistened  with  saline  to  insure  a super- 
ficial burn  which  will  not  penetrate  the 
vessel  wall.  While  it  is  usually  possible  to 
decrease  the  bleeding,  the  method  is  un- 
satisfactory as  frequently  one  is  unable  to 
cauterize  the  bleeding  paint  adequately 
without  damaging  the  vein.  The  use  of  a 
topical  coagulant  obviates  that  difficulty. 

CASE  REPORT 

The  patient,  a 49-year-old  white  woman  of 
Italian  extraction,  was  admitted  to  the  Holy 
Cross  Hospital  in  January,  1948.  Her  symptoms 
had  begun  early  in  November,  1947,  with  an 
upper  respiratory  infection  associated  with  nau- 
sea and  vomiting.  Although  the  upper  respira- 
tory infection  cleared,  the  anoxeria,  weakness 
and  nausea  continued,  and  the  patient  stated 
that  she  had  had  a weight  loss  of  thirty  pounds. 
In  January,  1948,  her  physician  noted  enlarge- 
ment of  the  liver  and  thereupon  admitted  her 
to  the  Holy  Cross  Hospital  for  further  study. 

There  were  no  complaints  at  the  time  of  ad- 
mission. The  outstanding  fact  in  her  history 
was  a daily  consumption  of  approximately  500 
c.c.  of  wine  with  consequent  neglect  of  ordinary 
food  intake.  She  was  moderately  obese  and  ap- 
peared much  older  than  her  stated  age.  There 

*Prom  the  Holy  Cross  Hospital,  and  the  Depart- 
ment of  l&urgery,  University  of  Utah  School  of  Med- 
icine, Salt  Lake  City,  Utah. 

was  a suggestion  of  icterus.  The  liver  was  en- 
larged and  extended  5 centimeters  below  the 
costal  margin  in  the  right  nipple  line.  There 


was  mild  pitting  edema  of  the  ankles.  The 
heart  was  moderately  enlarged;  a faint  systolic 
aortic  murmur  was  audible  and  there  were  oc- 
casional premature  auricular  extrasystoles.  Dur- 
ing the  hospital  course,  the  liver  did  not  regress; 
on  the  contrary  it  enlarged  rapidly  so  that  by 
the  eleventh  hospital  day  its  edge  was  palpable 
at  the  level  of  the  umbilicus.  Laboratory  tests 
indicated  a hemoglobin  of  14  grams  per  cent, 
hematocrit  of  42,  and  a white  blood  cell  count  of 
6,800  per  cubic  mm.  The  thymol  turbidity  test 
showed  40  units. 

Bed  rest,  parenteral  vitamins,  and  a diet  high 
in  carbohydrate,  proteins,  and  calories  were  in- 
stituted. Meperidine  hydrochloride  was  given  as 
needed  for  intermittent  gastric  pain.  She  was 
discharged  from  the  hospital  on  the  fourteenth 
day,  with  a diagnosis  of  cirrhosis  of  the  liver. 

Two  months  later  the  patient  had  a sudden 
onset  of  vomiting  of  bright  red  blood.  She 
passed  loose  stools  containing  dark  blood  and 
felt  extremely  dizzy  and  weak.  She  lapsed  into 
a semi-stuporous  state  and  was  re-admitted  to 
the  hospital.  Physical  examination  at  this  time 
showed  marked  signs  of  emaciation,  as  compared 
to  her  condition  at  the  time  of  her  previous  ad- 
mission. Her  color  was  leaden,  the  face  was 
puffy,  and  the  tongue  was  dry.  The  blood  pres- 
sure was  unexpectedly  found  to  be  120/60  and 
the  pulse  rate  was  only  85.  Cardiac  examination 
revealed  nothing  new.  A few  moist  rales  were 
heard  at  the  right  lung  base.  The  liver  edge 
was  still  palpable  at  the  umbilicus.  There  was 
no  change  in  the  pitting  edema  of  the  legs.  The 
deep  reflexes  were  depressed.  There  was  com- 
plaint of  pain  on  movement  of  the  arms. 

The  stuporous  state  continued  and  the  patient 
continued  to  vomit  blood  and  to  pass  copious 
quantities  of  blood  in  the  stool.  Despite  mor- 
phine, intravenous  fluids,  a transfusion  of  500 
c.c.  whole  blood  and  parenteral  vitamin  K,  the 
passing  of  fresh  blood  continued.  The  pulse  rate 
rose  to  90.  The  blood  pressure  fell  to  110/50. 
Bleeding  continued  for  the  three  days  following 
admission  and  her  condition  was  regarded  as 
critical.  There  was  a low  grade  fever.  The 
hemoglobin  dropped  to  10.4  grams  per  cent  and 
the  hematocrit  to  29.  On  the  fourth  hospital 
day,  after  a second  transfusion  of  500  c.c.  of 
whole  blood,  it  was  felt  that  since  all  other  treat- 
ment was  failing  esophagoscopy  should  be  at- 
tempted as  a heroic  measure. 

When  the  esophagoscope  was  inserted  blood 
was  seen  to  be  welling  from  a mass  of  varices 
in  the  lower  third  of  the  esophagus  but  the 
precise  bleeding  point  could  not  be  located  im- 
mediately. When  the  clot  had  been  lifted  off 
and  the  underlying  tangle  of  veins  had  been 
separated  the  source  of  hemorrhage  was  located 
and  a piece  of  oxycel  one  square  centimeter  in 
area  was  placed  in  contact  with  it.  The  oxycel 
rapidly  turned  black  and  the  bleeding  stopped. 
Three  additional  pieces  were  placed  over  the 
first  one.  These  also  slowly  turned  black.  The 
adjacent  veins  were  permitted  to  return  to  their 
original  positions  and  thus  to  exert  pressure  on 
the  oxycel  covering  the  rent  in  the  varix.  Fi- 
nally, a roll  of  oxycel  of  appropriate  size  was 
placed  over  the  entire  area  and  the . esophago- 
scope was  removed. 


546 


Rocky  Mountain  Medical  Journal 


No  further  vomiting  of  blood  occurred.  The 
patient  was  given  a final  blood  transfusion 
(1,000  c.c.)  and  intravenous  glucose  solution  (4,- 
000  c.c.)  She  soon  became  responsive  for  the 
first  time  since  her  hospital  admission.  Nothing 
was  given  by  mouth  for  seventy-two  hours,  after 
which  a milk  diet  was  instituted.  Convalescence 
was  uneventful. 

Summary 

1.  A case  of  severe  bleeding  from  an 
esophageal  varix  is  reported.  The  hemor- 
rhage was  arrested  by  the  local  apphcation 
of  oxycel  through  an  esophagoscope. 


2.  In  such  cases  care  should  be  taken  to 
unravel  the  varices  so  that  the  actual  bleed- 
ing point  can  be  seen  and  the  oxycel  applied 
directly  to  it. 

3.  Some  of  the  cases  encountered  will  be 
moribund  so  that  even  esophagoscopy  is  a 
severe  surgical  risk.  Nevertheless  endo- 
scopy and  local  application  of  a coagulant 
may  be  a life  saving  procedure  and  should 
be  tried  despite  the  risk. 


THE  TREATMENT  OF  STATUS  ASTHMATICUS  WITH 
INTRAVENOUS  ETHYL  ALCOHOL* 

JOHN  D.  GILLASPIE,  M.D. 

BOULDER,  COLORADO 


The  asthmatic  patient  in  status  presents 
a medical  emergency  requiring  immediate 
treatment.  The  continuous  severe  respira- 
tory difficulty  and  wheezing  with  the  re- 
sultant fatigue,  dehydration,  and  nervous 
tension  increase  the  seriousness  of  the  pa- 
tient’s condition.  Status  asthmaticus  is  a 
period  of  intense  dyspnea  which  may  last 
for  several  days.  Edema  of  the  bronchial 
mucous  membrane  and  spasm  of  the  bron- 
chial musculature  decrease  the  lumen  of  the 
bronchi  to  produce  the  dyspnea  and  wheez- 
ing. The  outpouring  of  extremely  tenacious 
mucus  plugs  the  bronchi  to  add  to  the  dif- 
ficulty of  respiration.  As  the  condition  per- 
sists, secondary  factors  of  dehydration,  fall 
in  blood  sugar,  and  increased  nervous  ten- 
sion become  more  and  more  severe. 

According  to  Vaughn\  “Status  asthmat- 
icus terminates  in  one  of  four  ways:  1, 
death,  usually  from  exhaustion;-  2,  rapid 
termination  -with  abundant  expectoration 
after  twenty-four  hours  or  longer;  3,  fever 
without  localizing  pulmonary  signs,  devel- 
oping about  the  third  day  and  lasting  for 
three  or  four  days,  with  disappearance  of 
the  dyspnea  prior  to  the  disappearance  of 
fever;  4,  pulmonary  consolidation  with  phy- 
sical findings  of  pneumonia.”  Death  may 
occur  at  any  age  during  a severe  asthmatic 
attack,  but  the  majority  of  reported  deaths 

"Presented  before  the  Seventy-Eig-hth  Annual  Ses- 
sion Colorado  State  Medical  Society.  September,  1948, 
Glenwood  Springs,  Colorado. 

for  July,  1949 


occur  in  individuals  over  40  and  who  have 
had  asthma  less  than  five  years. 

Differential  diagnosis  must  rule  out  ma- 
lignancy, foreign  body  in  the  bronchus,  me- 
chanical pressure,  mediastinal  growths,  sub- 
sternal  thyroid,  etc. 

The  treatment  of  status  asthmaticus  must 
attempt  to  relieve  bronchial  edema  and 
spasm,  liquify  secretions,  correct  dehydra- 
tion, and  produce  rest  and  relaxation.  Many 
drugs  have  been  used  alone  or  in  combina- 
tion to  accomplish  these  ends.  Since  these 
patients  are  so-called  “adrenalin  fast,” 
epinephrine  is  of  little  value.  Efron^  in  1937 
first  suggested  the  use  of  aminophyllin  in- 
travenously to  relieve  status.  Since  then 
this  drug  has  been  widely  used  both  by 
intravenous  administration  and  in  rectal 
suppositories.^  Unger^  reported  excellent 
results  in  treatment  of  status  with  amin- 
ophyllin in  5 per  cent  glucose-saline  solu- 
tion given  continuously  over  a period  of 
several  days.  Sedation  has  been  accom- 
plished with  various  barbital  preparations, 
chloral  hydrate,  and  by  the  use  of  rectal 
administration  of  ether  and  oil,  avertin,  etc. 
Demerol  is  useful  and  apparently  without 
the  dangerous  effects  of  morphine,  which 
should  never  be  used  in  the  treatment  of 
status. 

My  first  use  of  intravenous  alcohol  in 
status  was  accidental.  A patient  was  ad- 
mitted to  the  hospital  in  severe  status  pre- 

547 


cipitated  by  an  acute  upper  respiratory  in- 
fection. He  had  been  hospitalized  several 
times  before  in  status  and  had  responded 
poorly  to  the  usual  form  of  treatment.  Upon 
admission  he  was  given  aminophyllin  in- 
travenously and  was  placed  in  an  oxygen 
tent.  Penicillin,  30,000  units  every  three 
hours,  was  ordered  because  of  fever  and 
infection.  Symptoms  continued  with  in- 
creasing severity  and  0.5  grams  of  amin- 
ophyllin in  1,000  c.c.  of  5 per  cent  glucose- 
saline  solution  was  ordered  to  be  given  in- 
travenously. About  one  hour  later  the  nurse 
reported  the  patient  was  breathing  easily, 
but  was  unconscious  and  could  not  be 
roused.  When  examined,  he  was  sleeping; 
his  face  was  flushed;  pulse  was  regular, 
slow,  and  good  quality;  respirations  were 
full,  regular,  and  without  wheezing.  The 
intravenous  set-up  was  examined  and  it  was 
found  that  5 per  cent  alcohol  in  5 per  cent 
glucose  had  been  given  in  place  of  the  5 
per  cent  glucose  solution.  The  patient  slept 
well  for  about  five  hours.  The  following 
day  intravenous  alcohol  5 per  cent  in  glu- 
cose with  0.5  grams  aminophyllin  was  re- 
peated because  of  increasing  respiratory 
distress.  There  was  rapid  relief  of  symp- 
toms and  the  patient  slept  well  throughout 
the  night.  The  third  hospital  day  he  re- 
mained symptom-free  and  all  medication 
was  discontinued.  He  was  discharged  from 
the  hospital  the  fourth  day  after  admission. 

Following  this  experience  a review  of  the 
literature  gave  no  record  of  intravenous 
alcohol  being  used  in  the  treatment  of 
status.  Behan®  reported  the  use  of  intra- 
venous alcohol  as  a postoperative  sedative 
to  relieve  pain  and  produce  relaxing  sleep. 
In  thirty  reported  cases  two  did  not  sleep, 
eight  had  interrupted  sleep,  and  twenty 
slept  well.  No  complications  were  noted.  In 
1945  Verkovskyaya®  reported  the  use  of  in- 
travenous alcohol  as  a general  anesthetic 
in  thirty  cases  of  bone  surgery. 

In  conversation  with  Dr.  Ethan  Allen 
Brown,  I found  he  had  used  intravenous  al- 
cohol in  status  and  was  publishing  his  re- 
sults in  treating  five  cases.  Brown’^  first 
reported  the  use  of  intravenous  alcohol  in 
the  treatment  of  status  asthmaticus  as  fol- 


lows: “For  intravenous  treatment  the  ideal 
drug,  allowing  for  the  glucose-saline  in 
which  it  is  administered,  should  be  non- 
toxic, nonallergenic,  and  evenly  and  rapid- 
ly metabolized,  so  that  its  administration 
may  be  controlled.  There  should  be  a wide 
margin  of  safety  between  the  pharmacolo- 
gic and  toxic  doses.  The  drug  should  be 
sedative,  vasodilating,  and,  if  possible,  stim- 
ulating to  respiration.  Ethyl  alcohol,  given 
intravenously,  fulfills  these  and  other  es- 
sential criteria.” 

Ethyl  alcohol  given  intravenously  has  a 
wide  margin  of  safety.  The  toxic  dose  is 
7.7  c.c.  per  kilogram  of  body  weight,  while 
the  dose  for  analgesia  and  sleep  varies  from 
1.5  to  3 c.c.  per  kilogram  of  body  weight. 
Forty  to  60  c.c.  of  alcohol  will  produce  sleep 
in  the  majority  of  patients  and  will  last 
from  two  to  five  hours.®  ® 

Solutions  of  5 per  cent  ethyl  alcohol  in 
5 per  cent  glucose-saline  solution  are  avail- 
able commercially.  The  solution  should  be 
given  at  a rate  of  100  to  120  drops  per  min- 
ute so  that  100  c.c.  of  the  solution  is  given 
during  the  first  ten  minutes.  The  rate  can 
then  be  reduced  to  80  to  100  drops  per  min- 
ute, depending  on  the  reaction.  Epinephrine, 
1 c.c.  of  1-1000  solution,  or  aminophyllin 
may  be  added  to  the  solution. 

We  have  had  occasion  to  use  intravenous 
alcohol  twenty  times  in  seven  patients  dur- 
ing the  past  eighteen  months.  Excellent 
relief  of  symptoms  occurred  in  six  patients. 
One  patient  became  restless,  complained  of 
headache,  had  nausea  and  vomiting,  and 
only  slight  relief  of  asthma.  No  other  com- 
plications were  experienced.  Detailed  case 
reports  and  results  are  to  be  published  in  a 
subsequent  report. 

It  is  realized  that  this  series  of  cases  is 
too  small  to  draw  definite  conclusions,  but 
from  personal  experience  and  the  experi- 
ence of  others  who  have  used  intravenous 
alcohol,  it  seems  that  this  drug  alone  or  in 
combination  with  aminophyllin  or  epineph- 
rine, is  the  procedure  of  choice  in  the  treat- 
ment of  status  asthmaticus. 

Conclusions 

1.  Ethyl  alcohol  given  intravenously  in 
5 per  cent  solution  produces  rest,  relaxation. 


548 


Rocky  Mountain  Medical  Journal 


and  relief  of  severe  dyspnea  in  the  major- 
ity of  patients  in  status  asthmaticus. 

2.  There  is  a wide ' margin  of  safety  be- 
tween the  therapeutic  and  toxic  dose. 

RElPEiRENCES 

Waughn:  Practice  of  Allergy,  p.  951. 

^Eifron,  in  discussion  on  article  by  Tuft,  L.,  and 
Brodsky,  M.  L..:  The  Influence  of  Various  Drugs 
Upon  Allergic  Reactions.  J.  Allergy,  7:238,  1936. 


^Dees,  Susan:  The  Use  of  Amlnophyllin  Rectal 
Suppositones  in  the  Treatment  of  Bronchial  Asthma. 
J.  Allergy,  14:469,  1943. 

^Goodall  and  Unger;  Continuous  Intravenous 
Aminophyllin  Therapy  in  Status  Asthamaticus.  Ann. 
Allergy,  51:196,  1947. 

“Behan,  R.  J. ; Ethyl  Alcohol  Intravenously  as  a 
Postoperative  Sedative.  Am.  J.  Surg.,  69:227,  1945. 

“Verkovskyaya,  E.  V.:  Intravenous  Alcohol  Anes- 
thesia. Am.  Rev.  Soviet  Med.,  2:1944-1945. 

’Brown,  E.  A.;  The  Use  of  Intravenous  Ethyl  Al- 
cohol in  the  Treatment  of  Status  Asthmaticus.  Ann. 
Allergy,  5:193,  1947. 


EXTRADURAL  HEMORRHAGE* 

A REPORT  OF  THREE  CASES 
M.  W.  VAN  ALLEN,  M.D. 

DENVER 


At  a time  when  head  trauma  is  common- 
place in  civil  practice  it  seems  appropriate 
to  review  one  of  its  important  complications. 
Extradural  hemorrhage  occurs  in  2 to  3 per 
cent  of  patients  who  have  suffered  trauma 
to  the  head.  Early  diagnosis  and  emergency 
surgery  are  mandatory  if  the  patient  is  to 
survive.  Munro  reported  a case  mortality 
rate  of  about  50  per  cent.  Gurdjian  re- 
ported an  operative  mortality  of  approxi- 
mately 25  per  cent  in  a recent  article.  This 
high  mortality  is  essentially  due  to  two  fac- 
tors— associated  brain  damage  and  failure 
to  make  the  diagnosis  in  time  for  surgery  to 
be  beneficial. 

Pathology 

Extradural  hemorrhage,  as  the  term  im- 
plies, is  hemorrhage  between  the  dura  and 
the  skull.  The  blood  acts  as  an  expanding 
intracranial  ipass.  As  such,  it  produces  un- 
consciousness and  other  abnormal  neuro- 
logic signs.  As  the  hematoma  increases  in 
size,  death  is  the  inevitable  result  in  the 
untreated  patient.  Extradural  hemorrhage 
is  almost  always  associated  with  a fracture 
of  the  skull  which  crosses  the  middle  men- 
ingeal artery  or  one  of  its  branches.  This 
artery  is  closely  applied  to  the  inner  surface 
of  the  skull  so  that  a fracture  line  which 
extends  across  its  course  may  very  easily 
result  in  a tear  of  the  arterial  wall.  The 
veins  which  accompany  this  artery  may 
Likewise  be  torn.  Lacerations  in  the  larger 
venous  sinuses  of  the  dura  may  also  result 
in  extradural  hematoma. 

The  clot  usually  collects  in  the  temporo- 

*From the  Section  of  Neurosurgery,  Division  of 
Surgery,  Denver  General  Hospital,  Denver,  Colorado. 


parietal  region  where  tears  of  the  middle 
meningeal  artery  occur.  The  volume  of  the 
clot  has  been  reported  to  be  as  large  as  300 
cubic  centimeters.  Extradural  bleeding  is  to 
some  extent  self -propagating  because  as  the 
dura  is  stripped  from  the  bone,  new  bleed- 
ing points  are  initiated.  The  operative  find- 
ings in  Case  2 illustrate  this  fact. 

The  hematoma  resulting  from  extradural 
hemorrhage  clots  quickly.  Organization  of 
the  clot  begins  early  so  that  it  may  be  nec- 
essary to  scrape  the  clot  from  dura  if  it  has 
been  present  for  a few  days.  The  extra- 
dural hematomas  do  not  form  neo-mem- 
branes  nor  undergo  liquefaction  as  is 
characteristic  of  the  subdural  hematomas. 

Diagnosis 

The  symptoms  and  signs  of  extradural 
hemorrhage  are  essentially  those  of  an 
acutely  expanding  intracranial  mass.  When 
such  symptoms  and  signs  are  present  and 
there  is  a history  of  recent  head  trauma, 
intracranial  hemorrhage  is  suggested.  If 
there  is  roentgenographic  evidence  of  a 
fracture  crossing  a dural  artery  or  sinus, 
the  possibility  that  the  hemorrhage  is  ex- 
tradural is  likely. 

It  is  commonly  taught  that  the  clinical 
course  of  this  lesion  is  as  follows:  Transient 
unconsciousness  occurs  at  the  time  of  head 
injury  followed  by  a period  of  consciousness 
or  “lucid  interval”  of  several  hours  to  sev- 
eral days,  during  which  headache  and  vom- 
iting are  prominent  symptoms.  The  patient 
lapses  into  stupor  and  unconsciousness 
again.  The  usually  accepted  diagnostic 
signs  are  a dilated  pupil  on  the  side  of  the 
hematoma,  a slow  pulse  and  elevated  blood 


for  July,  1949 


549 


pressure.  The  spinal  fluid  is  clear  and  under 
increased  pressure  However,  this  sequence 
of  events  and  group  of  signs  and  symptoms 
are  not  frequently  seen.  The  “lucid  in- 
terval” occurred  in  less  than  half  of  the  re- 
ported cases.  If  the  blow  to  the  head  is 
severe,  then  associated  brain  injury  alone 
may  result  in  a pe’'iod  of  unconsciousness 
that  is  maintaineu  so  that  a “lucid  interval” 
does  not  occur.  As  the  hematoma  increases 
in  size,  return  to  consciousness  is  precluded. 
Alcohol  or  drugs  taken  prior  to  the  injury 
may  prevent  an  early  return  to  conscious- 
ness. Hence,  especially  if  a history  is  un- 
available, the  physican  may  be  confronted 
with  only  the  objective  evidence  of  trauma 
as  a basis  for  diagnosis  of  the  cause  of  the 
patient’s  unconsciousness.  However,  if  the 
physican  can  obtain  a history  of  a secondary 
lapse  into  unconsciousness  or  can  observe 
it  as  in  Case  1,  he  has  sufficient  cause  to 
suspect  a hematoma.  That  an  intracranial 
hematoma  is  not  always  found  in  such  cases 
does  not  lessen  the  value  of  this  observation 
as  an  indication  for  surgery.  In  Case  3 the 
mental  status  of  the  patient  could  hardly 
have  been  described  as  “lucid,”  yet  in  a few 
hours  it  progressed  from  confusion  and  ir- 
rationality to  coma.  The  length  of  the  “lucid 
interval,”  when  present,  is  usually  in  terms 
of  hours.  It  is  rarely  more  than  a few  days. 
Variations  in  the  rate  of  bleeding  largely 
determine  the  period  of  time  necessary  for 
the  hematoma  to  cause  unconsciousness  and 
ether  abnormal  signs. 

It  is  often  possible  to  observe  the  develop- 
ment of  abnormal  neurologic  signs  produced 
by  the  enlarging  mass  of  extradural  clot. 
The  localizing  value  of  positive  signs  re- 
lated to  this  lesion  are  more  reliable  than 
those  due  to  subdural  hematoma.  In  a re- 
cent series  of  thirty-five  operated  cases  of 
extradural  hemorrhage  reported  by  Gurd- 
jian,  the  pupil  on  the  side  of  the  lesion  was 
larger  in  twenty-five  cases.  The  pupils  were 
equal  in  nine  cases  and  in  only  one  case 
was  the  pupil  larger  on  the  opposite  side. 
Some  focal  sign  was  present  in  thirty  of 
the  thirty-five  cases. 

Signs  of  cortical  impairment  which  may 
indicate  an  expanding  mass  and  aid  in  its 
clinical  localization  are:  The  development  of 


weakness  of  the  face,  arm  and  leg  on  one 
side,  difference  in  activity  of  the  deep  re- 
flexes on  the  two  sides,  and  the  appearance 
of  the  Babinski  sign.  When  a hematoma  is 
suspected,  repeated  examinations  of  the  pa- 
tient should  be  made  since  the  observed  de- 
velopment of  these  various  signs  is  of  con- 
siderably greater  diagnostic  importance 
than  is  their  presence  on  admission.  If 
these  signs  are  present  when  the  patient  is 
first  seen,  the  possibility  that  they  are  due 
to  cerebral  contusion  must  be  strongly  con- 
sidered. 

Convulsive  movements,  local  or  general, 
occasionally  occur.  In  Case  2 they  began  on 
the  side  opposite  the  hematoma.  The  pulse 
is  ordinarily  slow  in  patients  with  extra- 
dural hemorrhage  but  may  become  rapid 
late  in  the  course.  The  blood  pressure  find- 
ings are  of  little  value  in  diagnosis.  The 
evidence  of  a linear  or  depressed  fracture 
overlying  a dural  artery  occurs  in  a high 
percentage  of  cases.  Munro  states  that  all 
of  his  cases  have  presented  fractures.  Cases 
without  fracture,  however,  have  been  re- 
ported. A well  defined  fracture  crossing  the 
torn  dural  artery  was  present  in  all 
three  of  the  cases  reported  here.  The  loca- 
tion of  the  fracture  is  of  considerable  value 
in  localizing  the  hematoma  and  in  planning 
the  operative  attack.  Moreover,  if  stupor 
deepens,  the  evidence  of  a fracture  line 
crossing  the  middle  meningeal  artery  or  one 
of  its  branches  becomes  strong  indication 
for  immediate  exploration.  Hence,  roent- 
genograms of  the  skull  are  of  considerable 
importance  when  extradural  hemorrhage  is 
suspected.  In  this  particular  instance  the 
value  of  the  roentgenographic  evidence 
justifies  the  disturbance  of  the  patient.  Spi- 
nal fluid  pressures  were  elevated  and  the 
fluid  contained  gross  blood  in  all  of  the 
cases  reported  in  this  paper.  This  is  the 
usual  finding. 

The  final  diagnosis  of  the  presence  or  ab- 
sence of  an  intracranial  hematoma  is  often 
made  only  by  exploration.  Bilateral  burr 
holes  in  the  skull  or  other  exploratory  ap- 
proach must  be  considered  the  single  most 
important  procedure  in  diagnosis.  Burr 
openings  in  the  skull  are  made  with  a mini- 
mum of  trauma  and  shock  to  the  patient. 


550 


Rocst  Mot'ntain  Medical  Journal 


The  procedure  can  often  be  done  under  lo- 
cal anesthesia.  Earl,y  and  more  frequent 
explorations  in  doubtful  cases  should  be  en- 
couraged. 

Differential  Diagnosis 

Other  pathologic  entities  may  simulate 
acute  extradural  hemorrhage.  Among  these 
are  acute  subdural  hematoma,  acute  sub- 
dural hygroma,  subcortical  hematoma,  and 
cerebral  edema.  Since  all  but  the  last  con- 
dition warrant  exploration,  differential  di- 
agnosis need  not  assume  major  importance 
and  certainly  should  not  be  cause  for  de- 
laying exploration. 

Treatment 

Removal  of  the  clot  is  the  only  treatment. 
The  usual  approach  is  through  an  opening 
in  the  skull  under  the  temporal  muscle, 
commonly  referred  to  as  subtemporal  de- 
compression. This  may  be  accomplished 
through  a vertical  linear  incision  anterior 
to  the  ear  or  by  turning  down  a scalp  and 
bone  flap. 

The  general  care  of  these  patients  both 
before  and  after  operation  is  of  great  im- 
portance. The  comatose  patient  must  have 
an  adequate  airway  at  all  times.  He  should 
be  turned  frequently.  The  upper  respiratory 
passages  can  be  cleared  of  mucus  and  blood 
by  suction,  using  a soft  rubber  catheter 
passed  through  the  nose.  A pharyngeal  air- 
way will  hold  the  tongue  forward  and  pre- 
vent obstruction  from  this  source.  Oxygen 
should  be  administered  to  every  patient  in 
coma  due  to  head  injury.  Bronchoscopy 
should  be  seriously  considered  if  rapid  pulse 
and  respiratory  rate,  with  rising  tempera- 
ture and  chest  signs  indicate  atelectasis.  The 
comatose  patient  with  an  obstructed  airway 
will  profit  sufficiently  from  removal  of  as- 
pirated material  to  justify  the  disturbing 
nature  of  the  procedure.  Unless  every  ef- 
fort is  made  to  keep  the  air  passages  clear 
and  respiratory  exchange  adequate,  the  pa- 
tient may  die  of  anoxia  regardless  of  how 
adequate  all  other  treatment  may  have 
been. 

Over  a period  of  approximately  eighteen 
months  on  the  Neurosurgical  Service  of  the 
Denver  General  Hospital  the  author  oper- 
ated upon  three  patients  with  extradural 


hematoma  and  insofar  as  he  knows,  no 
other  instance  of  significant  extradural 
hemorrhage  has  been  found  either  at  oper- 
ation or  autopsy  during  this  time.  The  case 
reports  of  three  patients  follow; 

CASE  1 

C.  S.,  a white  male,  aged  5%  years,  was  ad- 
mitted to  Denver  General  Hospital,  Denver,  Colo- 
rado, on  October  13,  1947,  at  6:30  p.m.  He  had 
been  struck  by  a street  car.  He  was  consciouss 
on  admission.  There  was  a contusion  of  the  scalp 
in  the  left  occipitoparietal  region.  Soon  after 
admission  to  the  hospital  he  became  irritable 
and  restless  and  vomited  repeatedly.  He  became 
stuporous  in  a short  time  and  two  and  one-half 
hours  after  the  accident  responded  only  to  pain- 
ful stimuli.  The  blood  pressure  was  92/48  and 
the  pulse  rate  68  per  minute.  The  pupils  were 
equal  in  size  but  the  light  reflex  on  the  left 
was  sluggish.  There  was  lateral  deviation  of 
the  left  eye.  The  Babinski  sign  was  present  on 
both  sides.  The  spinal  fluid  was  tinged  with 
blood  and  its  pressure  was  340  mm.  of  water  in 
the  prone  position.  Roentgenograms  of  the  skull 
showed  a diagonal  fracture  line  in  the  left  tem- 
poral bone.  A presumptive  diagnosis  of  extra- 
dural hemorrhage,  left,  was  made. 

Operation:  Operation  was  begun  approximately 
four  and  one-half  hours  after  the  accident.  The 
scalp  was  infiltrated  with  2 per  cent  novocaine 
solution.  The  operative  approach  was  that  of  a 
subtemporal  decompression  on  the  left.  Imme- 
diately after  the  bone  was  penetrated,  fresh  clots 
extruded.  The  dura  had  been  stripped  from 
skull  over  most  of  the  temporoparietal  cortex. 
The  greatest  thickness  of  the  hematoma  was  es- 
timated to  be  about  1.5  cm.  As  the  clots  were 
sucked  away  the  posterior  branch  of  the  middle 
meningeal  artery  was  found  to  be  torn  at  a point 
underlying  the  fracture  line.  Bleeding  was  con- 
trolled with  a suture  ligature.  The  cavity  re- 
maining after  removal  of  the  hematoma  was 
partially  obliterated  by  suturing  the  dura  to  the 
temporal  muscle  around  the  inner  margin  of 
the  bony  defect.  Two  Penrose  drains  were  left 
in  the  epidural  space.  At  the  end  of  the  proce- 
dure the  child  responded  and  answered  simple 
questions. 

Convalescence  was  rapid  and  the  patient  be- 
came alert  and  free  of  abnormal  neurologic 
signs  on  the  fourth  day  after  operation.  He  was 
discharged  on  the  fifteenth  hospital  day. 

Comment:  This  case  illustrates  a typical  “lu- 
cid interval”  with  rapid  progress  to  unconscious- 
ness. Had  not  an  alert  intern  recognized  the 
possibility  of  an  extradural  hemorrhage,  a fa- 
tality might  well  have  resulted.  The  clinical 
localization  of  the  hematoma  to  the  left  side  was 
based  on  the  left  third  nerve  palsy  and  the  frac- 
ture of  the  left  temporal  bone. 

CASE  2 

F.  C.,  a white  male,  aged  42  years,  was  ad- 
mitted to  Denver  General  Hospital  on  December 
19,  1947,  at  7:22  p.m.  He  had  been  placed  in  the 
county  jail  that  morning  for  intoxication.  There 
was  no  evidence  that  he  had  suffered  any  injury 
to  the  head  before  that  time.  The  jailer  re- 
ported that  the  patient  had  been  walking  about 
his  cell  in  the  afternoon  and  had  eaten  with  the 
other  prisoners  at  5:00  p.m.  Later  in  the  day  he 
had  a convulsion  while  lying  in  his  bunk  and 
fell  a distance  of  two  and  one-half  feet  to  the 
floor.  He  was  admitted  to  the  hospital  in  coma 
and  presented  a large  contusion  over  the  left 
temple.  Three  more  convulsions  were  witnessed, 
all  of  which  started  on  the  right  side  and  became 


for  July,  1949 


551 


generalized.  (Because  of  a previous  admission 
of  this  patient  on  August  18,  1947,  for  epilepsy, 
the  seriousness  of  his  present  convulsions  was  at 
first  minimized  by  the  house  staff  h However, 
during  the  next  few  hours  he  developed  a right 
hemiplegia  and  a dilated  pupil  on  the  left. 

About  six  hours  after  his  fall  in  jail,  he  was 
still  comatose,  and  responded  only  to  painful 
stimuli.  The  left  pupil  was  now  dilated  and 
fixed  and  the  left  eye  deviated  outward.  The 
pulse  rate  was  120  per  minute.  The  spinal  fluid 
was  tinged  with  blood  and  showed  a pressure  of 
200  mm.  of  water  in  the  prone  position.  Roent- 
genograms of  the  skull  showed  an  oblique  linear 
fracture  in  the  left  temporoparietal  region  which 
extended  across  the  middle  meningeal  groove. 

A diagnosis  of  extradural  hemorrhage,  left, 
was  made  and  the  patient  was  operated  on  at 
once. 

Operation:  After  infiltration  of  the  scalp  with 
2 per  cent  novocaine  solution,  the  usual  incision 
for  subtemporal  decompression  was  made  on  the 
left.  A large  amount  of  extradural  clot  extruded 
as  soon  as  the  bone  was  penetrated.  This  hema- 
toma was  found  to  cover  the  dura  over  most  of 
the  frontal  and  temporoparietal  cortex  extending 
from  the  base  to  within  3 to  4 cm.  of  the  sagittal 
suture  and  posteriorly  to  a point  somewhat  be- 
hind the  external  auditory  meatus.  The  greatest 
depth  was  1.5  cm.  The  anterior  branch  of  the 
middle  meningeal  artery  was  found  to  be  torn  at 
the  site  of  the  fracture.  Its  bleeding  was  con- 
trolled with  the  electrocautery.  Troublesome 
bleeding  occurred  at  many  other  points  where  the 
dura  was  stripped  from  the  skull,  so  that  it  was 
necessary  to  extend  the  removal  of  bone  in  order 
to  affect  hemostasis.  Profuse  bleeding  near  the 
sagittal  sinus  was  controlled  by  suturing  dura  to 
galea  through  a separate  burr  opening  in  this 
region.  The  dura  was  likewise  tacked  to  the  galea 
and  temporal  muscle  in  the  region  of  the  de- 
compression. The  dura  was  opened  and  a small 
amoimt  of  subdural  clot  was  evacuated.  Penrose 
drains  were  placed  in  the  extradural  space.  The 
patient  stopped  breathing  during  the  operative 
procedure  but  recovered  after  a minute  of  forced 
respiration  and  stimulants  and  remained  in  fair 
condition  thereafter.  Transfusions  of  whole  blood 
were  given  to  replace  the  loss  of  blood.  For  a few 
days  following  operation  the  patient  was  irra- 
tional, restless,  and  incontinent.  However,  by  the 
seventh  day  he  was  rational  and  ambulatory.  He 
was  discharged  on  the  thirteenth  hospital  day  in 
full  possession  of  his  faculties.  The  left  pupil 
was  still  slightly  dilated. 

Comment:  There  was  no  known  “lucid  inter- 
val” in  this  case.  Diagnosis  was  delayed  because 
of  the  previous  history  of  epilepsy.  However,  the 
progression  of  neurologic  signs  in  the  presence 
of  a fracture  line  crossing  the  middle  meningeal 
artery  was  sufficient  indication  for  immediate 
surgery.  The  ipislateral  dilated  pupil  and  con- 
tralateral hemiplegia  proved  to  be  accurate  lo- 
calizing signs.  The  difficulty  in  controlling  bleed- 
ing from  other  points  in  the  dura  than  that  of  the 
torn  artery  was  well  illustrated. 

CASE  3 

R.  T.,  a white  male,  aged  61,  was  admitted  to 
Denver  General  Hospital  at  noon  on  January  9, 
1948.  He  had  apparently  fallen,  striking  his  head 
on  the  sidewalk  and  was  found  in  a semicon- 
scious state.  Two  small  scalp  lacerations  were 
present  in  the  occipital  region.  The  admission 
note  indicates  that  he  was  responsive  but  con- 
fused. Roentgenograms  were  not  taken  because 
of  lack  of  cooperation  by  the  patient.  He  was  sent 
to  the  ward  but  was  not  called  to  the  attention 
of  the  resident  physician  until  about  7:00  p.m., 
at  which  time  he  was  in  coma  and  responded 


only  slightly  to  painful  stimuli.  The  entire  body 
was  rigid  and  the  neck  quite  stiff.  The  arms 
were  rigidly  flexed  across  the  chest.  The  legs 
were  extended  and  crossed  one  over  the  other 
in  strong  adduction.  The  feet  were  in  plantar 
extension.  The  deep  tendon  reflexes  were  more 
active  on  the  left  than  on  the  right,  but  were 
hyperactive  throughout.  The  Babinski  sign  was 
present  on  both  sides.  There  were  frequent 
twitching  movements  of  the  extremities.  Both 
pupils  were  dilated  and  fixed  and  the  eyes 
were  immobile  in  forward  gaze.  The  lids  of  the 
right  eye  were  swollen  and  ecchymotic.  The 
pulse  rate  was  60  per  minute,  blood  pressure 
98/62.  The  spinal  fluid  was  blood  tinged  and 
under  a pressure  of  260  mm.  of  water.  Roent- 
genograms of  the  skull  showed  a transverse  frac- 
ture in  the  right  frontoparietal  region  crossing 
the  middle  meningeal  groove. 

A diagnosis  of  extradural  hemorrhage,  right 
frontoparietal,  was  made  and  the  patient  was 
operated  on  approximately  eleven  hours  after 
the  accident. 

Operation  The  scalp  was  infiltrated  with  2 
per  cent  novocaine  solution  and  a vertical  in- 
cision was  made  over  the  point  where  the  frac- 
ture line  crossed  the  middle  meningeal  groove. 
A large  amount  of  extradural  clot  was  imme- 
diately encountered  and  when  this  was  sucked 
away  the  torn  posterior  branch  of  the  middle 
meningeal  artery  was  found  to  be  bleeding 
furiously.  It  had  been  stripped  from  the  dura 
for  a short  distance  so  that  it  could  be  easily 
grasped  with  a hemostat  and  ligated.  A generous 
opening  was  made  in  the  skull  and  further  trou- 
blesome bleeding  was  encountered  at  the  junc- 
tion of  the  orbit  and  the  greater  wing  of  the 
sphenoid  bone.  The  fracture  involved  the  roof 
of  the  right  orbit  at  this  point.  Bleeding  was  fi- 
nally stopped  with  a small  pack  of  absorbable 
‘cellulose  which  was  left  in  the  wound.  No  sub- 
dural clots  were  found.  The  dura  was  sutured 
to  the  temporal  muscle  through  the  bony  defect. 
Four  Penrose  drains  were  left  in  the  wound,  one 
of  them  beneath  the  dura. 

The  patient  responded  within  a half  hour  after 
completion  of  the  operation  and  was  able  to 
answer  simple  questions.  Convalescence  was 
surprisingly  uneventful;  and  all  neurologic  signs 
including  the  hemiplegia  and  excepting  the  lat- 
eral deviation  of  the  right  eye  cleared  in  a few 
days.  At  the  time  of  his  discharge  on  the  nine- 
teenth hospital  day  he  was  alert  and  oriented. 

Comment:  This  patient  did  not  present  an  im- 
pressive “lucid  interval”  but  the  progress  from 
stupor  to  coma  was  valuable  in  the  diagnosis. 
Roentgenographic  evidence  of  the  fracture  line 
on  the  right  was  the  only  substantial  guide  to 
localization.  The  presence  of  dilated  fixed  pupils 
and  generalized  rigidity  in  a patient  who  has  suf- 
fered head  trauma  is  a very  grave  sign.  That 
this  patient  returned  to  consciousness  so  rapidly 
following  removal  of  the  clot  was  surprising. 

All  three  of  these  patients  were  in  serious  or 
desperate  condition  at  the  time  surgery  was  done, 
yet  all  of  them  were  operated  on  within  less  than 
twelve  hours  of  their  injury.  The  necessity  for 
early  surgery  is  the  rule  in  extradural  hemor- 
rhage. Operation  after  a prolonged  period  of 
coma  is  usually  unsuccessful.  The  favorable  out- 
come with  little  or  no  permanent  brain  damage 
encourages  early  exploration  as  soon  as  the  diag- 
nosis is  suggested.  The  benefit  of  exploration 
should  not  be  withheld  because  the  patient  ap- 
pears to  be  in  poor  condition. 

Summary 

Extradural  hemorrhage  is  a relatively  in- 
frequent complication  of  head  injury.  It 


552 


Rocky  Mountain  Medical  Journal 


deserves  special  attention,  however,  because 
although  the  patient’s  condition  becomes 
desperate  in  a matter  of  hours,  early  de- 
compression and  removal  of  the  clot  may  be 
rewarded  by  a dramatic  recovery.  It  is  es- 
sential that  all  patients  who  have  suffered 
a head  injury  be  closely  observed  for  signs 
of  an  expanding  intracranial  mass.  The 
most  important  of  these  signs  is  a deteriora- 
tion in  the  state  of  consciousness.  “Lucid 
interval”  is  not  a common  feature  in  the  his- 
tory. 

Three  cases  of  extradural  hemorhage  with 
recovery  are  presented.  A young  boy  ex- 
perienced a “lucid  interval”  followed  by  a 
rapid  onset  of  unconsciousness.  Complete 


recovery  followed  removal  of  the  clot.  A 
man  in  middle  age  remained  comatose  after 
he  suffered  a head  injury  during  a convul- 
sion. Several  more  convulsions  followed 
and  he  was  at  first  thought  to  be  in  post- 
convulsive  coma  because  of  a previous  his- 
tory of  epilepsy.  The  appearance  of  localiz- 
ing neurologic  signs  and  the  presence  of  a 
fracture  line  crossing  the  middle  meningeal 
groove  led  to  the  proper  diagnosis  and  im- 
mediate surgery.  The  third  patient  was  an 
elderly  man  who  entered  in  a confused  state 
following  a fall.  Later  he  became  deeply 
comatose  and  presented  dilated  fixed  pupils 
and  a state  of  generalized  rigidity.  He  re- 
sponded within  a half  hour  after  removal  of 
the  clot  and  made  a good  recovery. 


FATAL  CHRONIC  PEPTIC  ULCER  IN  THE  AGED* 

ERVING  F.  GEEVER.  M.D. 

COLORADO  SPRINGS,  COLO. 


The  modern  clinical  description  of  chronic 
peptic  ulcer  often  portrays  a slender,  tense, 
middle-aged  business  man  with  character- 
istic digestive  complaints  and  symptoms. 
When  a patient  over  60  years  of  age  pre- 
sents himself  with  a gastric  disturbance,  the 
first  diagnosis  logically  entertained  by  most 
physicians  is  carcinoma.  However,  various 
workers  have  pointed  out  that  the  possi- 
bility of  chronic  peptic  ulcer  should  not  be 
excluded  on  the  basis  of  age  alone.  Further- 
more, prompt  diagnosis  and  early  treatment 
of  such  complications  as  perforation  or 
hemorrhage  are  of  major  importance,  since 
the  prognosis  is  much  poorer  in  the  aged 
patient.  Mulson  mentioned  that  the  true 
nature  of  the  condition  was  often  revealed 
only  at  necropsy.  Tanner  also  stated  that 
the  possibility  of  peptic  ulcer  did  not  suggest 
itself  so  readily  to  the  'practitioner  in  an 
aged  patient  with  intercurrent  ailments  and 
a long  history  of  pain.  Tanner  stressed  the 
great  importance  of  time  in  the  treatment 
of  complications.  He  was  able  to  save  eight 
out  of  ten  patients  on  whom  he  performed 

•From  the  Pathology  Service  of  Glockner-Penrose 
and  St.  Francis  Hospitals,  Colorado  Springs,  Colo. 
The  author  expresses  appreciation;  to  Doctors  R.  O. 
Beadles,  W.  A.  Campbell,  J.  Mihalick,  W.  P..  Mc- 
Crossln,  A.  M.  Mullett,  H.  W.  Maly  and  Col.  Hugh 
Mahon  for  the  clinical  histories  and'  other  informa- 
tion on  these  patients. 


simple  closure  within  twelve  hours  after 
perforation.  Finally,  Boles  and  Dunbar,  in 
an  analysis  of  ninety-seven  cases  between 
60  and  93  years,  found  that  old  people  with 
acute  and  chronic  peptic  ulcer  were  subject 
to  hemorrhage  and  perforation,  the  cause 
of  which  was  often  unsuspected.  The  pur- 
pose of  this  report  is  to  present  seven  cases 
of  chronic  peptic  ulcer  with  death  due  to 
complicating  hemorrhage  or  perforaj;ion. 
An  attempt  will  be  made  to  analyze  the 
clinical  symptoms  and  physical  findings  and 
correlate  them  with  the  fundamental  path- 
ology at  necropsy.  Complete  postmortem 
examinations  were  performed  in  each  case. 

CASE  REPORTS 

Case  I.  A.  H.,  white  male,  68  years  old;  sudden 
onset  of  acute  abdominal  pain,  board-like  ab- 
dominal rigidity,  shock,  death  fifty-two  hours 
later.  This  man  was  admitted  to  the  hospital 
at  3:15  p.m.,  November  17,  1947,  with  the  com- 
plaint of  severe  abdominal  pain  of  four  and  one- 
half  hours’  duration.  The  past  history  was  non- 
contributory  and  the  patient  stated  at  first  that 
he  had  always  been  in  good  health..  He  had  lost 
fifteen  pounds  in  weight,  however,  during  the 
past  few  months. 

Physical  examination  revealed  a slender,  eld- 
erly male  in  acute  writhing  pain.  Temperature 
was  97.6  degrees  F.,  pulse  16  per  minute  and 
respirations  16  per  minute.  The  abdomen  was 
rigid  and  acutely  tender  to  palpation,  particular- 
ly around  the  umbilicus.  Blood  pressure  was 
140/60.  As  preparation  was  being  made  for  im- 


jor  July,  1949 


553 


mediate  operation,  the  patient  went  into  pro- 
found shock  with  weak  rapid  pulse,  mental  con- 
fusion and  a fall  in  blood  pressure  to  80/70. 
Laboratory  studies;  X-ray  of  the  abdomen 
showed  no  evidence  of  free  peritonial  gas;  urin- 
alysis: S.  G.  1.022,  -|-  Albumin,  -b  + + casts; 
serum  amylase  380  units  (normal  80  to  150 
units);  and  blood:  RBC,  4,510,000,  hemoglobin 
12.5  gms.,  WBC,  5,500  with  87  per  cent  polym- 
orphs. 

Treatment  consisted  of  intravenous  5 per  cent 
glucose,  blood  transfusions  and  oxygen  by  mask. 
There  was  no  response,  and  the  patient  re- 
mained in  deep  shock  with  the  systolic  pressure 
varying  between  60  and  80  mms.  of  mercury. 
Death  occurred  at  2:40  p.m.  on  November  19, 
1947. 

The  important  findings  at  necropsy  were  in 
the  duodenum  and  peritoneal  cavity.  The  duo- 
denum revealed  two  chronic  ulcers,  one  ante- 
riorly with  a wide  perforation  (Fig.  1).  The 
other  ulcer  was  located  on  the  posterior  wall  of 
the  duodenum.  There  was  widespread  fibrino- 
purulent  peritonitis  and  the  peritoneal  cavity 
contained  about  a quart  of  fluid. 


Fig’.  1.  Case  1.  Liver,  gallbladder,  stomach  and  duo- 
denum. Arro-w  indicates  anterior  perforating  ulcer 
in  the  first  part  of  the  duodenum  -with  secondary 
generalized  fibrino-purulent  peritonitis. 

Comment:  In  this  case,  the  patient  presented 
a picture  of  abdominal  pain  and  marked  ab- 
dominal muscular  rigidity.  The  diagnosis  of 
perforated  viscus  was  made  and  preparation  for 
operation  was  under  way.  However,  profound 
shock  intervened  and  the  systohc  blood  pressure 
could  not  be  brought  above  80  mms.  Hg  with 
blood  transfusions  and  supportive  treatment.  At 
this  time,  the  patient  when  roused  denied  having 
pain.  The  absence  of  air  imder  the  diaphragm 
in  the  abdominal  roentgenograph  and  the  ele- 
vated serum  amylase  led  to  the  impression  that 
the  ulcer  was  posterior  in  the  wall  of  the  duo- 
denum and  eroding  into  the’  pancreas.  Under  the 
above  conditions,  it  was  felt  that  surgical  ex- 
ploration would  have  been  inevitably  fatal  and 
supportive  measures  appeared  to  be  the  treat- 
ment of  choice,  with  the  hope  that  the  lesion 
would  be  sealed  off  by  the  pancreas.  Two  duo- 
denal ulcers  were  foimd,  one  perforated.  The 
lesions  were  of  one  or  more  months’  duration 
and  had  considerable  fibrous  tissue  in  their  mar- 
gins. 

Case  2.  S.  W.,  white  male,  65  years  old;  sudden 
onset'  of  tarry  and  bloody  stools,  weakness, 
shock,  dea:th  forty-eight  hours  later.  This  man 


entered  the  hospital*  on  November  23,  1943,  in 
a state  of  shock.  The  history,  as  obtained  from 
others  on  entry,  was  that  the  patient  had  been 
fairly  well  up  until  the  day  of  admission.  At 
9:00  a.m.  on  that  day,  he  passed  a large  amount 
of  tarry  and  bloody  stools.  Frequent  black  and 
bloody  bowel  movements  occurred  during  the 
day  and  were  accompanied  by  progressive  weak- 
ness. His  neighbors  summoned  medical  assist- 
ance and  the  patient  was  brought  to  thei  hos- 
pital about  7:00  p.m.  on  the  same  day.  Blood 
pressure  on  admission  was  38/20.  The  patient’s 
mental  state  was  confused,  but  cleared  tempo- 
rarily. Questioning  about  the  gastro -intestinal 
tract  revealed  only  that  he  had  suffered  in  the 
past  from  occasional  attacks  of  diarrhea.  No 
positive  abdominal  findings  were  elicited  in  the 
physical  examination.  Treatment  consisted  of 
blood  transfusions,  plasma  and  intravenous 
fluids.  However,  bleeding  from  the  rectum  con- 
tinued in  gushes  periodically  during  the  night  and 
the  next  day.  Death  occurred  at  7:05  a.m.  on 
November  25,  1947,  approximately  forty-eight 
hours  following  the  onset  of  melena. 

The  significant  findings  at  necropsy  were  in 
the  gastro-intestinal  tract:  A chronic  peptic  ulcer 
was  found  along  the  lesser  curvature  of  the 
stomach  (Fig.  2)  with  an  open  blood  vessel  and 
recent  blood  clot  in  the  base.  The  stomach  and 
intestinal  tract  contained  much  free  blood.  The 
brain  showed  some  senile  atrophic  changes  with 
moderate  cerebral  arteriosclerosis. 


Pig.  2.  Case  2.  Inner  surface  of  stomach.  Arrow 
indicates  ulcer  which  was  the  source  of  fatal  hemor- 
rhage. 


Comment:  In  this  case,  the  patient  presented 
a picture  of  shock,  with  tarry  and  bloody  stools 
and  nothing  else  in  the  history  or  physical  find- 
ings to  direct  attention  to  the  source  of  hemor- 
rhage in  the  stomach.  The  history  of  occasional 
attacks  of  diarrhea  was  of  Httle  or  no  assistance. 
The  author  examined  this  patient  on  admission 
and  did  the  necrospy  forty-eight  hours  later 
with  the  expectation  of  finding  a mahgnancy 
somewhere  in  the  gastro-intestinal  tract.  The 
bleeding,  benign  peptic  ulcer  in  the  stomach  was 
a complete  surprise.  The  lesion  as  of  one  or 
more  months’  duration  and  had  eroded  deep  into 
the  muscular  layer.  The  latter  had  been  par- 
tially replaced  by  fibrous  tissue. 

Case  3.  A.  S.,  white  female,  75  years  old; 

*Prom  the  Pathology  Department  of  Pitzsimons 
General  Hospital,  Denver,  Colo. 


'554 


Rocky  Mountain  Misjical  Journal 


nausea  and  vomiting  of  fortyi-eight  hours’  dura- 
tion, exhaustion,  pain  in  the  side,  drowsiness, 
mental  confusion  and  death  after  ninety-nine 
hours.  This  woman  entered  the  hospital  at  9:00 
a.m.  on  November  18,  1947,  in  a state  of  ex- 
haustion, following  a period  of  prolonged  vom- 
itmg.  Hoarseness  and  weakness  from  vomiting 
and  a pronoimced  Swedish  accent  prevented  ade- 
quate understanding  and  a satisfactory  history. 
Indefinite  information  was  obtained  concerning 
a gastric  hemorrhage  during  the  previous  spring. 
The  patient  had  been  imder  a physician’s  care 
at  that  time  in  another  city.  Her  present  com- 
plaints were  nausea,  vomiting  and  throat  soreness 
of  about  forty-eight  hours’  duration. 

Physical  examination  revealed  an  exhausted 
and  dehydrated,  elderly  white  female  with  a 
temperature  of  98.4  degrees  F.,  pulse  94  per  min- 
ute, respirations  20  per  minute.  The  tongue 
was  dry  and  coated.  The  lungs  were  clear.  The 
heart  rate  was  increased  to  110  per  minute  and 
the  sounds  were  indistinct.  There  were  no 
murmurs.  Blood  pressure  was  104/70.  The  ab- 
domen was  tender  in  the  midline  epigastrium, 
but  there  was  no  rigidity  and  there  were  no 
palpable  masses.  Laboratory  studies:  urinalysis: 
trace  of  acetone  and  -f  4-  -f  + sugar;  repeat  urin- 
alysis showed  -f  acetone  and  a trace  of  sugar; 
blood:  RBC.,  4,320„000;  hemoglobin,  12.5  gms.; 
WBC.,  13,750;  with  85  per  cent  polymorphs. 

The  former  physician  in  another  city  was  re- 
quested to  submit  previous  medical  findings.  In 
the  meantime,  treatment  was  rmdertaken  with 
intravenous  fluid,  chipped  ice  by  mouth  and 
codeine  for  pain.  The  patient  complained  of 
pain  in  the  back,  right  side  and  right  chest.  She 
became  drowsy,  confused  mentally  and  lost  con- 
sciousness within  twenty-four  hoirrs  of  admis- 
sion. Death  occurred  during  the  morning  of 
November  21,  1947,  forty-one  hours  after  entry. 

Necropsy  revealed  a chronic  anterior  duodenal 
ulcer  with  a large  perforation  (Fig.  3).  The  peri- 
toneal cavity  contained  about  1000  c.c.  of  dark 
brown  fluid  and  the  serous  surfaces  of  the  ab- 
dominal organs  were  coated  with  fibrinous  exu- 
date. The  ulcer  had  also  caused  narrowing  of 
the  lumen  of  the  pylorus  and  proximal  duo- 
denum and  partial  obstruction.  The  stomach  was 
markedly  dilated. 


Fig-.  3.  Case  3.  Liver,  gallbladder,  stomach  and 
duodenum.  Anterior  perforating  nicer  is  visible  in 
the  first  part  of  duodenum  -v'ith  early  fibrinous  ex- 
udate on  adjacent  serous  surfaces. 

Comment:  This  patient  presented  no  evidence 
of  a perforated  viscus.  The  abdomen  was  soft 
at  all  times,  although  some  tenderness  was 
elicited  in  the  midline  epigastrium.  The  hema- 


temesis  at  this  age  also  suggested  carcinoma. 
Forty-eight  hours  after  death,  a letter  was  re- 
ceived from  the  doctor  who  had  treated  the  par 
tient  on  February  23,  1946,  for  a gastric  hemor- 
rhage. Roentgen  ray  study  at  the  time  revealed 
an  active  duodenal  ulcer.  Following  blood  trans- 
fusions and  ulcer  therapy,  the  patient  left  the 
hospital  greatly  improved  on  March  12,  1946. 
She  spat  up  blood  again  in  November,  ^946,  but 
up  until  March,  1947,  when  he  last  saw  her, 
no  further  gastro -intestinal  hemorrhages  were 
experienced. 

Case  4.  J.  B.,  white  male,  83  years  old,  short- 
ness of  breath,  loss  of  appetite,  nausea,  three 
days  previously;  sudden  collapse  at  home,  ad- 
mitted to  hospital  in  shock;  death  three  hours 
later. 

This  83-year-old  white  male  was  admitted  to 
the  hospital  on  January  22,  1948,  in  a state  of 
shock  and  died  less  than  three  hours  later.  He 
had  been  examined  by  a physician  at  home  three 
days  previously.  At  that  time,  he  complained 
of  shortness  of  breath,  swelhng  of  the  ankles  and 
legs,  loss  of  appetite  and  an  undetermined  loss 
of  weight  of  three  months’  duration.  The  past 
history  was  significant  only  for  a “heart  attack” 
three  or  four  years  before,  which  was  character- 
ized by  pain  in  the  chest.  Although  the  loss  of 
appetite  was  sometimes  accompanied  by  nausea, 
the  patient  denied  associated  pain,  vomiting, 
diarrhea  or  change  in  the  color  of  the  stools.  He 
stated  that  his  bowel  movements  had  always 
been  normal. 


Fig.  4.  Case  4.  Bleeding,  chronic  duodenal  ulcer, 
posterior  wall  (magnification  x 20).  The  section 
shows  the  eroded  superior  pancreatico-duodenal  ar- 
tery in  the  ulcer  base. 

Physical  examination  at  home  revealed  a pale, 
elderly,  white  male  with  normal  temperature, 
pulse  100  per  minute,  and  normal  respirations. 
Blood  pressure  was  140/70.  The  chest  was  of 
emphysematous  type.  The  heart  examination  was 
negative;  there  were  no  murmurs  and  there  was 
no  evidence  of  enlargement.  The  abdomen  was 
moderately  distended  and  revealed  generalized 
tenderness,  which  was  most  marked  to  the  right 
of  the  umbilicus.  The  liver  edge  was  not  pal- 
pable and  no  fluid  wave  could  be  elicited.  The 


for  July,  1949 


555 


clinical  impression  was  msilignancy  of  the  colon, 
and  the  patient  was  advised  to  enter  the  hospital 
for  further  observation  and  treatment.  He  re- 
fused and  stated  that  all  he  needed  was  a little 
something  for  my  heart.”  The  patient  showed  no 
change  in  his  condition  until  the  morning  of  ad- 
mission. At  that  time,  he  collapsed  in  his  bath- 
room. He  was  admitted  to  the  hospital  shortly 
thereafter  in  a state  of  shock. 

Physical  examination  on  entry  revealed  a 
thready,  fast,  pulse.  Blood  pressure  was  unob- 
tainable. Coramine  was  administered  on  entry. 
Emergency  blood  count  revealed:  BBC  1,600,000, 
hemoglobin  20  per  cent.  The  patient  was  typed 
and  cross  matched  for  blood  transfusion.  Death 
occurred  before  transfusion  could  be  instituted. 

At  autopsy,  the  most  important  pathology  was 
found  in  the  stomach  and  duodenum.  The 
proximal  third  of  the  duodenum  was  greatly 
thickened  and  distorted  by  dense  fibrous  ad- 
hesions which  bound  the  structure  to  the  ad- 
jacent gallbladder.  The  duodenum  showed  two 
crater-like  lilcers,  one  on  the  posterior  surface 
v/ith  a vessel  in  the  center,  covered  with  a fairly 
fresh  thrombiis  (Fig.  4).  There  was  another  deep 
ulcer  on  the  anterior  surface  with  prominent, 
firm  and  fibrous  margins.  Both  ulcers  were  lo- 
cated within  1.0  cm.  of  the  pyloric  ring.  The 
orifice  of  the  latter  was  greatly  narrowed  and 
the  stomach  was  markedly  enlarged.  The  stom- 
ach measured  55  cms.  in  length  along  the  greater 
curvature.  The  lumen  of  the  small  intestine  and 
part  of  the  large  intestine  was  filled  with  fresh 
and  partly  digested  blood.  The  heart  showed 
moderate  coronary  arteriosclerosis  with  small 
foci  of  fibrosis  visible  microscopically. 

Comment:  This  octogenarian  complained  of 
“heart  trouble”  and  had  only  vague  symptoms 
which  could  be  referred  to  the  gastro -intestinal 
tract.  The  duodenal  ulcers  found  at  necropsy 
had  eroded  deep  and  v>^ere  of  at  least  one  month’s 
duration  with  abundant  fibrous  tissue  in  their 
walls.  Pyloric  obstruction  had  caused  marked 
chronic  dilatation  of  the  stomach.  Death  had 
resulted  from  massive  hemorrhage. 

Case  5.  S.  M.,  white  male,  72  years  of  age, 
bloody  urine,  carcinoma  of  urinary  bladder,  sud- 
den epigastric  pain  with  muscle  spasm  and  ab- 
dominal tenderness  one  day  after  admission, 
death  twelve  days  after  entry.  This  72-year-old 
white  male  entered  the  hospital  December  8, 
1948,  with  a history  of  bleeding  on  urination  for 
the  past  two  years,  more  severe  in  the  past  two 
v/eeks.  The  patient  also  complained  of  frequent 
scanty  urination  and  difficult  and  painful  urin- 
ation with  the  passage  of  tissue  fragments.  Phys- 
ical examination  on  admission  revealed  an 
emaciated,  dehydrated,  elderly  white  male.  Tem- 
perature was  99.8  degrees,  piilse  80,  and  respira- 
tions 18  per  minute.  Blood  pressure  was  115/80. 
The  head  and  neck  examinations  were  negative. 
Examination  of  the  chest  revealed  lungs  clear 
to  percussion  and  auscultation.  The  heart 
sounds  were  distant  but  otherwise  net  remark- 
able. Examination  of  the  abdomen  revealed 
warm  dry  skin  with  evidence  of  marked  weight 
loss.  The  liver  was  not  enlarged  and  no  masses 
could  be  palpated.  The  genitalia  and  extremities 
were  normal.  The  reflexes  were  normal.  Rectal 
examination  revealed  -f-4-  enlargement  of  the 
prostate  but  the  enlargement  was  smooth.  Cysto- 
scopic  examination  showed  many  blood  clots  in 


the  bladder  but  visibility  was  poor  due  to 
marked  bleeding.  However,  a sloughing,  necrotic 
and  bleeding  lesion  was  visible  on  the  base  and 
lateral  walls  of  the  urinary  bladder.  Laboratory 
studies:  blood  on  admission — RBC  4,080,000; 
WBC  8,750  with  75  per  cent  polymorphs;  later, 
with  intravenous  fluids,  the  RBC  dropped  to 
3,620,000  but  the  WBC  rose  to  11,600  with  91 
per  cent  polymorphs.  On  December  9,  1948,  the 
patient  suddenly  developed  severe  epigastric 
pain  with  marked  tenderness  and  spasm  of  the 
abdominal  muscles.  There  was  no  rebound  or 
referred  tenderness.  The  patient  was  indefinite 
as  to  whether  the  pain  was  intermittent  or  con- 
stant. Closer  questioning  at  this  time  revealed 
a past  history  of  duodenal  ulcers.  The  patient 
did  not  complain  of  nausea,  did  not  vomit,  and 
there  was  no  temperature  elevation.  At  times  he 
passed  a limited-  amount  of  flatus.  X-ray  exam- 
ination of  the  abdomen  at  this  time  showed  no 
air  under  the  diaphragm.  The  clinical  impres- 
sion was  ureteral  obstruction  due  to  blood  clots 
with  reflex  pylorospasm.  The  possibility  was 
considered  of  intra-abdominal  metastases,  sec- 
ondary to  carcinoma  of  the  urinary  bladder. 
Finally,  perforated  ulcer  or  carcinoma  of  the 
stomach  were  considered.  The  patient  was 
treated  with  intravenous  fluids,  blood  and  plas- 
ma transfusions,  oxygen,  Levine  suction  and 
penicillin.  There  seemed  to  be  some  temporary 
beneficial  response  but  the  patient  relapsed 
shortly  thereafter  and  death  occurred  on  De- 
cember, 1948. 

At  autopsy  multiple  duodenal  ulcers  were 
found,  one  perforated  through  the  anterior  waU. 
The  peritoneal  cavity  contained  about  1,000  c.c. 
of  bile  stained  flxiid  with  early  fibrino-purulent 
exudate  coating  the  serosal  surfaces  of  the  va- 
rious organs.  A large  carcinoma  of  the  urinary 
bladder  was  encoimtered  involving  the  anterior 
and  right  lateral  wall.  No  metastases  were 
found.  The  limgs  showed  marked  hypostatic 
congestion  and  pneumonia.  Death  had  resulted 
from  cachexia  and  toxemia. 

Comment:  The  case  was  confusing  in  several 
respects.  There  was  no  air  under  the  dia- 
phragm, no  nausea  or  vomiting,  no  rebound 
tenderness  and  no  temperature  elevation  to  in- 
dicate perforation  of  a duodenal  ulcer  and  gen- 
eralized peritonitis.  Since  a definite  urinary 
bladder  malignancy  was  visualized  by  cysto- 
scopy, the  rational  deduction  was  to  assume  that 
the  epigastric  symptoms  were  in  some  way  sec- 
ondary to  it,  that  is,  either  due  to  metastatic 
carcinoma  or  to  referred  upper  ureteral  or  renal 
obstruction. 

Case  6.  O.  E.,  white  male,  69  years,  severe  ab- 
dominal pain,  tenderness,  muscular  rigidity  and 
vomiting  of  three  hours  duration,  death  six  days 
after  entry. 

This  69-year-old  white  farmer  entered  the 
hospital  on  November  8,  1948,  with  complaints 
of  severe  abdominal  pain  and  vomiting  of  three 
hours  duration.  The  pain  was  so  severe  that  it 
made  him  short  of  breath  and  unable  to  lie  flat 
in  bed.  The  past  history  revealed  that  the  pa- 
tient had  had  a diagnosis  of  “ulcers”  for  the  past 
five  or  six  years  during  which  time  he  suffered 
from  periodic  attacks  of  stomach  distress  with 
nausea  and  vomiting.  His  last  attack  of  that 
character  was  on  November  5,  1948,  and  he  at- 
tributed it  to  the  fact  that  he  had  quit  taking 
his  powders.  Physical  examination  on  admis- 


556 


RocKry  Mountain  Medical  Journal 


sion  revealed  a thin,  fairly  well  developed,  de- 
hydrated, elderly  white  male  in  acute  pain.  The 
patient  had  a fecal  odor  to  his  breath  and  was 
sitting  up  in  bed.  The  temperature  was  100  de- 
grees, pulse  104,  and  respirations  24  per  minute. 
The  blood  pressure  was  100/58.  The  mucous 
membranes  were  dry.  The  heart  and  lungs  were 
normal  to  palpation,  inspection,  percussion  and 
ausculation.  The  abdomen  was  rigid,  board-like 
and  exquisitely  tender  to  the  right  and  above  the 
umbilicus.  The  extremities  were  normal.  Lab- 
oratory studies  showed:  urinalysis — -H-f  dextrose, 
two  to  three  pus  cells  per  Mgh-powered  field 
and  + granular  casts;  blood — RBC,  5,150,000, 
WBC  20,900  with  72  per  cent  polymorphs,  repeat 
examination  the  next  day  following  intravenous 
fluid  revealed  a drop  of  the  WBC  to  12,700  with 
71  per  cent  polymorphs.  X-ray  examination  of 
the  abdomen  was  reported  as  negative  for  free 
air  under  the  diaphragm..  The  large  bowel  was 
distended  with  gas  and  the  small  bowel  also 
showed  a gaseous  distention  suggestive  of  ob- 
struction. Treatment  was  imdertaken  with  ene- 
mas, Wangensteen  suction  and  intravenous 
fluids  including  amigen  and  glucose.  There 
seemed  to  be  some  temporary  beneficial  response 
but  the  patient  relapsed  thereafter,  developed 
abdominal  distention,  pain,  restlessness  and  died 
on  November  14,  1948. 

At  autopsy  a chronic  peptic  ulcer  was  found 
on  the  anterior  wall  of  the  duodenum  with  per- 
foration. The  peritoneal  cavity  contained  1,000 
to  1,500  c.c.  of  foul-smelling,  bile-stained  fluid 
mixed  with  fibrino-purulent  exudate.  Death  had 
resulted  from  toxemia. 

Comment:  The  reported  absence  of  air  under 
the  diaphragm  in  the  flat  abdominal  roentgeno- 
gram was  misleading  in  this  case  as  in  several 
others  described  above.  The  distention  of  loops 
of  small  intestine  also  favored  the  diagnosis  of 
intestinal  obstruction.  The  clinical  diagnosis  was 
considered  to  be  either  intestinal  obstruction  or 
gallbladder  disease. 

Case  7.  J.  P.,  colored  male,  76  years,  pain  in 
the  stomach,  vomiting  of  dark  brown  fluid  of 
one  week’s  duration;  history  of  digestive  disease 
for  two  years;  G-I  x-ray  series  with  deformity 
on  greater  curvature;  death  four  days  after 
entry. 

This  76-year-old  colored  male  entered  the  hos- 
pital on  December  20,  1948,  with  the  complaint 
of  pain  in  the  stomach.  The  history  was  diffi- 
ciilt  to  obtain  as  the  patient  seemed  to  ramble 
mentally.  With  the  help  of  the  family  and  re- 
peated questioning,  it  was  learned  that  the  pain 
was  intermittent,  sometimes  sharp  and  piercing 
and,  at  other  times,  aching  in  character.  It  was 
associated  with  the  vomiting  of  dark  brown 
liquid  material.  The  patient  stated  that  the 
symptoms  were  of  only  one  week’s  duration  but 
the  family  maintained  that  he  had  suffered  from 
digestive  upsets  with  loss  of  strength  and  weight 
for  the  past  two  years. 

Physical  examination  on  admission  revealed 
a well  developed,  somewhat  undernourished, 
elderly,  colored  male.  The  patient  seemed  weak 
and  unsteady  during  the  course  of  the  examina- 
tion. The  skin  was  dry.  Head  and  neck  exam- 
inations were  negative.  Chest  examination  re- 
vealed no  pulmonary  pathology  detectable  by 
inspection,  percussion  or  ausciiltation.  The 
heart  sounds  were  distant  but  normal  otherwise. 


The  abdomen  revealed  slight  left  costo-vertebral 
tenderness.  No  masses  were  felt.  The  extremi- 
ties were  negative.  Laboratory  studies  showed: 
urinalysis — specific  gravity  1.012,  2 to  4 plus 
cells  per  high-powered  field,  1 to  4 red  blood 
cells;  blood  examination — RBC  2,340,000;  WBC 
11,650  with  65  per  cent  polymorphs;  x-ray  of  the 
G-I  tract  showed  constant  deformity  of  the  great- 
er curature  of  the  stomach  near  the  pylorus. 
The  radiologic  impression  was  stomach  neoplasm. 
The  clinical  course  was  rapidly  downhill.  The 
patient  was  typed  and  given  500  c.c.  of  blood. 
Death  occurred  on  December  24,  1948. 

At  autopsy  a large  peptic  ulcer,  approximately 
3. 0x2. 5 cm.  in  surface  dimensions,  was  found  on 
the  greater  curvature.  A partly  thrombosed  ves- 
sel was  foimd  in  its  base.  The  small  intestine 
was  filled  with  partly  digested  blood.  The  right 
kidney  showed  marked  hydronephrosis  second- 
ary to  an  old  ureteral  stricture.  The  lungs  were 
edematous  and  congested.  Death  had  resulted 
from  anemia  and  toxemia. 

Comment:  In  this  case  there  were  conflicting 
histories  as  furnished  by  the  patient  and  his 
family.  He  insisted  that  he  had  no  digestive 
symptoms  previous  to  one  week  before  entry. 
The  family  stated  that  he  had  suffered  from  di- 
gestive upsets  with  slow  loss  of  weight  and 
strength  for  two  years.  The  presence  of  a le- 
sion along  the  greater  curvature,  as  seen  in  the 
roentgenographic  examination,  pointed  to  a 
neoplasm  rather  than  a benign  inflammatory 
condition. 

Discussion 

The  increased  alertness  of  physicians  to 
cancer  of  the  stomach  is  commendable. 
However,  there  is  danger  that  the  great  in- 
crease in  cancer  publicity  may  divert  med- 
ical consciousness  from  peptic  ulcer  in  the 
older  age  group.  When  complications  de- 
velop, such  as  severe  hemorrhage  or  per- 
foration and  are  unrecognized,  the  mortality 
figures  for  peptic  ulcer  are  not  much  less 
than  in  carcinoma  of  the  stomach.  An  el- 
derly patient  brought  to  a physician  for 
the  first  time  in  such  a condition  presents 
a difficult  problem  requiring  the  utmost 
diagnostic  skill.  The  history  may  be  vague 
due  to  a combination  of  shock,  mental  con- 
fusion, and  senile  mental  changes.  A 
phlegmatic  and  uncomplaining  personality 
may  minimize  symptoms.  Physical  find- 
ings are  often  atypical.  The  abdomen  in 
perforation  may  be  soft,  may  show  no  re- 
bound tenderness  and  be  associated  with  lit- 
tle or  no  temperature  elevation.  The  re- 
sults of  laboratory  studies  may  be  mislead- 
ing: there  may  be  absence  of  air  under  the 
diaphragm  despite  perforation;  multiple 
duodenal  ulcers  may  be  present  with  the 


for  July,  1949 


557 


posterior  one  causing  pancreatic  irritation 
and  elevated  serum  amylase  and  an  an- 
terior lesion  perforating  into  the  peritoneal 
cavity.  The  white  blood  counts  may  be  nor- 
mal or  only  slightly  elevated  during  the 
acute  peritonitis  due  to  perforation.  The 
reluctance  of  the  attending  physician  to 
operate  or  recommend  operation  under  such 
circumstance  of  meagre  findings  and  poor 
general  condition  is  easily  understandable. 
In  two  of  the  four  cases  with  perforation 
reported  here,  the  diagnosis  of  peptic  ulcer 
was  considered  and  then  rejected  in  favor 
of  malignancy.  In  all  three  cases  with 
hemorrhage,  the  diagnosis  of  gastric  or  in- 
testinal malignancy  was  made. 

With  the  progressive  increase  in  aging  of 
the  population,  a greater  percentage  of  pep- 
tic ulcer  patients  will  be  found  in  the  group 
over  60  years  of  age.  Thus,  the  diagnosis 
and  control  of  the  peptic  ulcer  before  com- 
plications occur  would  seem  to  be  the  most 
effective  approach  to  treatment.  Elderly 
patients  with  vague  or  ill-defined  alimen- 
tary tract  symptoms  should  have  thorough 
clinical,  roentgenographic,  and  laboratory 
examinations.  Such  examinations  would 
serve  the  dual  purpose  of  detecting  peptic 
ulcers  and  alimentary  tract  malignancies. 
When  the  diagnosis  of  peptic  ulcer  is  made, 
the  patient  and  close  relatives  should  be 
informed  clearly  of  the  condition.  They 
should  be  forewarned  about  the  danger  of 
recurrence  and  of  complications  and  the 
vital  importance  of  their  early  recognition 
and  treatment. 

Conclusions 

1.  The  great  increase  in  cancer  publicity 
creates  a danger  of  diverting  medical  con- 
sciousness from  peptic  ulcer  in  the  older  age 
group.  When  complications  such  as  perfor- 
ation and  hemorrhage  occur  and  are  un- 
recognized, the  mortality  rate  is  not  much 
less  than  in  gastric  carcinoma. 

2.  Seven  cases  are  presented  of  chronic 
peptic  ulcer  in  patients  65  years  of  age  or 
over  with  death  due  to  complicating  per- 
foration or  hemorrhage. 

3.  The  histories,  clinical  symptoms  and 
physical  and  laboratory  findings  at  the  time 
medical  attention  was  sought  were  often 


vague,  atypical  or  misleading,  probably  due 
to  a combination  of  senile  mental  changes 
with  shock. 

4.  When  the  diagnosis  of  chronic  peptic 
ulcer  is  made  in  an  aged  person,  the  patient 
and  close  relatives  should  be  informed 
clearly  of  the  condition.  They  should  be 
forewarned  about  the  dangers  of  recurrence 
and  of  complications  and  the  vital  impor- 
tance of  their  early  recognition  and  treat- 
ment. 


'7<4e  Booh  Cofute^ 

New  Books  Received 

Current  Therapy,  1948,  Latest  Approve^  Methods  ot 
Treatment  for  the  Practicing  Physicians  Howard 
F.  Conn,  M.D.,  Editor.  Consulting  Editors,  M.  Ed- 
ward Davis,  Vincent  J.  Derbes,  Garfield  G.  Dun- 
can, Hugh  J.  Jewett,  William  J.  Kerr,  Perrin  H. 
Long,  H.  Houston  Merritt,  Paul  A.  O’Leary,  Wal- 
ter L.  Palmer,  Hobart  A.  Reimann,  Cyrus  C. 
Sturgis,  Robert  H.  Williams.  637  pages.  W.  B. 
Saunders  Company,  Philadelphia  and  London. 


Physicians’  Desk  Reference  Fharmacentlcal  Special- 
ties and  Blttlngicals— Pour  Sectinnss  Section  I 
(Pink)  Alphabetical  Index;  Section  II  (Yellow) 
Drug  and  Pharmacological  Index:  Section  HI 
(Blue)  Therapeutic  Indications  Index;  Section  IV 
(White)  Div.  “A”  Professional  Products  Informa- 
tion, Div.  “B”  General  Professional  Information. 
Compilation  and  printing  mechanics  require  our 
using  an  arbitrary  page  numbering  plan.  Section 
One  starts  on  101,  Section  Two  on  201,  Section 
Three  on  301  and  Section  Pour  on  401.  Richard  R. 
Maehler,  Editor  of  Compilation  and  Arrangement; 
R.  J.  Jaeggi,  Assistant  tO'  Editor  and  Publisher; 
E.  C.  L.  Miller,  M.D.,  Medical  College  of  Virginia, 
Richmond,  Virginia,  Editor  of  Nomenclature;  J. 
Morgan  Jones,  Editor  and  Publisher.  Published  by 
Medical  Economics,  Inc.,  Rutherford,  N.  J.  Copy- 
right 1948  by  Medical  Economics,  Inc.  All  rights 
Reserved.  Printed  in  United  States  of  America. 


Operative  Surgery:  By  Frederick  C.  Hill,  B.A.,  M.S. 
(Surg.),  M.D.,  Associate  Professor  of  (Surgery,  The 
Creighton  University  School  of  Medicine,  Omaha, 
Nebraska,  Foreword  by  Charles  W.  Mayo,  B.A., 
M.S.  (Surg.),  M.D.,  Section  on  Surgery,  Mayo 
Clinic,  Rochester,  Minnesota.  New  York,  Oxford 
University  Press,  1949.  Oxford  Medical  Publica- 
tions. 


British  Surpdcal  Practice:  Under  the  General  Editor- 
ship of  Sii'  Ernest  Rock  Carling,  P.R.C.S.,  F.R.C.P., 
■Consulting-  Surgeon,  Westminster  Hospital;  and 
J.  Paterson  Ross,  M.S.,  F.R.C.S.,  Surgeon  and  Di- 
rector of  Surgical  Clinical  Unit,  St.  Bartholomew’s 
Hospital:  Professor  of  Surgery,  University  of  Lon- 
don. In  Eight  Volumes  (With  Index  Volume);  Vol- 
ume 5,  Butterworth  & Co.  (Publishers),  Ltd.,  Lon- 
don, England;  the  C.  V.  Mosby  Company,  St.  Louis, 
Mo.,  U.  S.  A..  1948. 


Nutrition  and  Diet  in  Health  and  Disease:  By  James 
S.  McLester,  M.D.,  Professor  of  Medicine,  Univer- 
sity of  Alabama,  Birmingham.  Fifth  Edition.  W. 
B.  Saunders  Company,  Philadelphia  and  London, 
1949. 


Ocular  Signs  iu  Slit-Lamp  Microscopy:  By  James 
Hamilton  Doggart,  M.A.,  M.D.  (Cantab.),  F.R.C.S. 
(Eng.);  Surgeon  and  Late  Research  Scholar,  Moor- 
fields,  Westminster  and  Central  Eye  Hospital; 
Ophthalmic  Surgeon,  St.  George’s  Hospital;  Lec- 
turer in  Ophthalmology  at  St.  George’s  Hospital 
Medical  School;  Ophthalmic  Surgeon,  Hospital  for 
Sick  Children,  Great  Ormond  Street;  Late  Senior 
Open  Foundation  Scholar,  King’s  College,  Cam- 
bridge. With  93  Illustrations,  of  which  85  are  in 
color.  St.  Louis,  The  C.  V.  Mosby  Company,  1949. 
$6.75. 


558 


Rocky  Mountain  Medical  Journal 


PERSPECTIVE  IN  CANCER  RESEARCH* 

H.  MASON  MORFIT,  M.D. 

DENVER 


No  one  questions  the  fact  that  our  pres- 
ent day  treatment  of  cancer  with  x-ray  and 
surgery  produces  clinical  “cures”  in  a cer- 
tain proportion  of  patients.  It  is  well  to 
realize,  however,  that  such  cures  seem  to 
result  from  removing  the  effect,  without 
even  remotely  unravelling  the  cause,  of  this 
disease.  Indeed,  in  this  respect  the  surgeon 
who  performs  a radical  mastectomy  for  can- 
cer of  the  breast  may  be  likened  to  a doctor 
who  excises  “rose  spots”  in  typhoid  fever. 
The  as  yet  still  obscure  (hormonal?)  fac- 
tors acting  on  the  substrata  of  breast  tissue 
to  produce  a cancer  persist  unchanged  by 
such  an  operation  and  if  the  patient  is 
young  and  lives  long  enough,  a second  can- 
cer in  the  remaining  breast  may  develop, 
presumably  due  to  continued  urging  by 
these  carcinogenic  factors. 

The  evidence  suggests  at  this  date  that  the 
potentialities  of  x-ray  therapy  may  have 
been  largely  exploited.  Our  experience 
over  the  last  thirty  to  thirty-five  years  has 
now  placed  us  in  a position  to  pretty  well 
anticipate  success  or  failure  with  this  agent 
in  a given  patient.  We  are  now  at  the  point 
where  a critical  analysis  of  “cure  rates”  by 
radiation,  despite  the  great  variation  and 
ingenuity  in  schemes  of  application,  reveals 
closely  similar  results.  This  in  itself  sug- 
gests that  an  end  point  may  have  been 
reached. 

With  the  advances  that  have  “made  sur- 
gery safe  for  the  patient  and  the  patient 
safe  for  surgery,”  a rejuvenation  of  radical 
surgical  procedures  is  now  coming  to  the 
fore.  Adequate  time  will  permit  us  to  tell 
whether  such  an  approach  will  improve  our 
results.  It  is  quite  possible  that  except  in 
occasional  instances,  no  dramatic  change  in 
the  picture  will  come  from  this.  For  the 
moment  it  is  perhaps  wise  to  consider  these 
operations  as  a method  of  attack  on  the 
problem  only  justified  by  the  fact  that  our 

*From  the  Bonfils  Tumor  Clinic  and  the  Depart- 
ment of  Surgery,  University  of  Colorado  Medical 
Center.  The  author  is  Assistant  Professor  of  Sur- 
gery at  the  University  of  Colorado  School  of  Medi- 
cine. 


results  by  radiation  did  not  live  up  to  our 
expectations  and  hopes. 

Appreciation  of  such  facts  as  these  has 
spurred  the  search  for  more  efficacious 
modes  of  therapy  other  than  x-ray  and 
surgery.  When  such  agents  are  discovered 
their  value  will  be  reflected  in  an  improve- 
ment in  cure  rates  of  20,  30,  or  50  per  cent 
above  our  present  best  results  and  not  in 
lesser  differential  percentages  that  now 
abound  in  comparing  most  published  re- 
ports' and  in  which  the  vagaries  of  statistical 
comparisons  may  be  accepted  as  playing  a 
rather  questionable  role. 

To  younger  men  now  engaged  in  the 
study  of  medicine  the  present  status  of  our 
efforts  at  research  into  the  cancer  problem 
can  be  most  confusing.  Coming  on  the 
scene  somewhat  like  arriving  in  the  middle 
of  a theatre  performance,  it  is  difficult  to 
develop  perspective.  Such  a lack  of  per- 
spective may  be  the  basis  for  pessimistic 
statements  regarding  accomplishment  of  ac- 
tual solution  of  the  problem  and  to  the  con- 
trary may  prompt  unnecessarily  sanguine 
ideas.  Recapitulation  encourages  orienta- 
tion. Let  us  review  some  of  the  past  efforts 
in  this  field. 

The  Period  of  Humoral  Doctrines 

The  earliest  medical  writings  contain  ref- 
erences to  tumors  so  we  know  that  the 
earlier  physicians  were  aware  of  the  ex- 
istence and,  to  some  degree,  the  nature  of 
this  disease.  Before  medical  writings,  how- 
ever, we  have  evidence  of  skeletons  show- 
ing metastatic  lesions  of  the  bones  of  pre- 
historic and  primitive  man.  So  it  seems 
that  the  disease  has  been  present  through- 
out the  development  of  man  to  his  present 
state. 

The  earlier  theories  of  the  etiology  of  this 
disease  were  entirely  in  keeping  with  the 
lines  of  medical  reasoning  then  commonly 
circulated.  I quote  from  Paul  of  Aegius 
who  in  the  seventh  century  A.D.  wrote, 
“Cancer  i^  particularly  frequent  in  the 
breasts  of  women;  because  owing  to  their 


for  July,  -.IQiQ 


559 


laxity,  they  readily  admit  the  thick  hu- 
mours which  occasion  it.  For  cancers  are 
formed  by  black  bile  overheated;  and  if 
particularly  acrid,  it  is  attended  with  ulcer- 
ation.” 

The  Period  of  Macroscopic  Pathology 

More  objective  speculation  concerning  the 
nature  of  tumors  awaited  the  efforts  of  the 
18th  century  physicians.  In  1761  Morgagni 
published  a three  volume  atlas  of  pathology 
in  which  he  described  some  forms  of  cancer. 
His  work  was  based  on  the  study  of  700 
autopsy  specimens.  Matthew  Baillie,  the 
Englishman,  wrote  the  first  systematic  text- 
book of  pathology  in  any  language  in  1793 
and  it  contained  further  statements  on  can- 
cer based  on  gross  inspection  of  diseased 
organs  at  autopsy. 

In  an  effort  to  correlate  the  clinical  with 
the  pathological,  the  healthy  practice  of  the 
physician  who  cared  for  a patient  during 
life,  also  performing  the  autopsy  on  the 
same  patient,  seems  to  have  been  rather 
common.  Hodgkin’s  disease,  Bright’s  dis- 
ease, Graves’  disease,  Addison’s  disease  and 
Laennac’s  cirrhosis  are  all  entities  whose 
inception  had  their  origins  on  such  a basis. 
All  of  these  earlier  descriptions  were  based 
entirely  on  gross  inspection  of  diseased  or- 
gans. 

The  Period  of  Microscopic  Pathology 

In  retrospect,  it  may  appear  curious  to 
us  at  this  date,  that  although  the  micro- 
scopic was  invented  during  the  17th  century, 
it  was  not  utilized  in  the  study  of  diseased 
organs.  About  200  years  passed  before 
Rudolph  Virchow  seized  upon  this  instru- 
ment and  began  to  develop  its  potentialities. 
At  the  University  of  Berlin  about  1850, 
Virchow  developed  the  system  of  staining 
tissues  and  studying  their  cellular  structure 
under  the  scope.  Johannes  Muller  about 
1830  had  done  some  limited  work  in  this 
field  but  it  was  Virchow  who  really  ex- 
panded this  approach  in  the  study  of  dis- 
ease. “The  Father  of  Cellular  Pathology” 
soon  attracted  many  exponents.  Through 
their  efforts  the  tedious  but  stimulating  at- 
tempt to  catalog  and  classify  tumors  ac- 
cording to  morphologic  and  histologic  cri- 


teria began  to  get  under  way.  The  gaps  in 
the  more  obscure  forms  of  tumors  are  still 
being  filled  in  today  and  there  continues  to 
be  a minor  reshuffling  here  and  there.  For 
practical  purposes,  nevertheless,  a fairly 
stable  picture  has  been  worked  out  and  has 
aided  clinicians  materially  in  recognizing 
certain  patterns  of  behavior  in  the  natural 
history  of  specific  tumor  types.  For  ex- 
ample, if  the  pathologist  reports  a biopsy 
as  some  form  of  sarcoma  we  know  we  can 
expect  blood  borne  metastases  to  the  lung; 
if  the  report  is  carcinoma,  we  would  first 
expect  regional  lymph  node  metastases  as 
the  next  step  in  the  natural  history  of  its 
continued  growth.  If  a skin  cancer  is  of 
basal  cell  origin,  the  problem  is  a local  one 
and  no  metastases  would  be  anticipated  as 
in  squamous,  epidermoid  cancer,  or  melan- 
oma, etc. 

Earlier  workers  had  noted  the  presence 
of  distant  deposits  of  disease  away  from 
the  primary  site.  It  remained  for  the  Vir- 
chow school  truly  to  visualize  these  metas- 
tatic deposits  in  lymph  nodes,  lungs,  etc., 
and  to  demonstrate  that  the  histologic  pic- 
ture of  the  metastatic  deposit  mirrored  the 
structure  of  the  parent  primary  growth. 
Speculation  as  to  method  of  spread  to  secon- 
dary sites  from  the  primary  tumor  next  en- 
siled with  resultant  appreciation  of  the  im- 
portance of  lymphatics.  With  this  knowl- 
edge the  stage  was  set  for  a rational  mode 
of  surgical  excision.  The  principle  of  “block 
dissection”  or  “dissection  in  continuity” — 
meaning  the  excision  of  the  primary  tumor, 
regional  lymph  nodes  and  if  possible  all 
intervening  tissue  (e.g.,  radical  mastec- 
tomy)— stands  tested  today  as  the  desired 
objective  in  any  attempt  to  eradicate  a can- 
cer. 

Dr.  William  Welch  was  largely  respon- 
sible for  bringing  the  Virchow  doctrines  to 
America  and  there  are  few  of  our  older 
pathologists  who  did  not  have  contact,  di- 
rect or  indirect,  with  this  man. 

The  Beginnings  of  Animal  Experimentation 

The  fact  that  animals  as  well  as  humans 
suffer  from  cancer  had  been  recognized  for 
some  years.  Transplantibility  of  tumors 
spontaneously  occurring  in  lower  animals 


560 


Rocky  Mountain  Medical  Journal 


from  one  animal  to  another  was  the  goal  of 
many  workers  in  the  19th  century.  Despite 
the  multitude  of  efforts  along  this  line,  no 
success  was  achieved.  The  announcement, 
therefore,  about  1880  by  Morau  of  France, 
claiming  success  in  transplanting  rat  tu- 
mors, was  received  with  mixed  feelings. 
Few  believed  it.  In  1902  Jensen  of  Copen- 
hagen and  Leo  Loeb  in  America  simultane- 
ously announced  their  successes  along  this 
line.  Loeb’s  results  were  demonstrated  at 
a meeting  of  the  American  Society  of  Path- 
ologists and  in  the  words  of  Ewing,  “Our 
indignation  changed  to  admiration.”  Loeb 
was  also  the  first  to  culture  tumor  tissues 
in  vitro. 

It  will  be  recalled  that  about  this  time 
bacteriology  was  in  its  most  active  and 
fruitful  discovery  period.  It  was  quite 
natural  then  that  the  theories  of  immunity 
and  vaccination  which  had  proved  so  valu- 
able in  many  of  the  infectious  diseases 
should  be  tried  out  in  cancer.  It  was  dis- 
appointing to  learn  that  nothing  could  be 
procured  from  tumor  cells  in  the  form  of 
extracts,  filtrates,  etc.,  which  would  pro- 
duce tumors  in  the  recipient  animal. 

It  soon  became  evident  after  injecting 
every  conceivable  form  of  extract  of  tumors 
into  humans  that  no  immunity  such  as  we 
conceive  of  in  infectious  diseases  could  be 
stimulated  by  this  means.  As  the  work  on 
tumor  transplants  was  reported  and  evi- 
dence accumulated,  the  discouraging  con- 
clusion was  reached  that  despite  success  in 
transplantibility,  the  transplanted  tumor 
carried  its  ultimate  secret  with  it  in  host 
after  host.  It  should  be  said  here  that  even 
at  this  time,  there  is  no  incontrovertible 
evidence  that  any  form  of  human  cancer 
can  be  disseminated  by  any  infectious  mode. 

The  First  Artificial  Production  of  Cancer 

It  has  become  a sine  qua  non  for  any  suc- 
cessful laboratory  study  of  a disease  proc- 
ess that  the  disease  be  reproduced  for  study 
in  some  experimental  animal.  Until  1914 
no  easily  produced  “laboratory  currency” 
was  available  and  the  experimental  study 
of  cancer  suffered  from  such  a lack.  In  that 
year  Yamigiwa  and  Ichikawa  produced 


what  has  since  become  broadly  known  as 
“tar  cancer.”  This  consisted  of  simply  rub- 
bing the  skin  of  the  ears  of  rabbits  with  tar 
compounds  over  a prolonged  period  of  time 
with  the  eventual  development  of  growths 
at  these  sites.  The  tumors  thus  produced 
were  found  after  thorough  study  to  fulfill 
every  criteria  to  justify  the  term  cancer. 
In  the  light  of  reproduction  of  skin  cancer 
by  tar  inoculations  the  earlier  clinical  re- 
port of  Percival  Pott  in  1775  regarding 
“Chimney-sweep  cancer”  of  the  scrotum 
took  on  a new  significance.  The  soot  accu- 
mulating in  the  groin  of  such  individuals 
and  persisting  over  long  periods  of  time 
supplied  the  clinical  counterpart  in  the  hu- 
man being  of  Yamigiwa’s  tar  inoculations 
on  animals. 

Kennaway  in  1930  succeeded  in  identify- 
ing and  isolating  the  specific  anthracene  de- 
rivatives in  tars  responsible  for  the  induc- 
tion of  Yamigiwa’s  skin  cancers  and  these 
substances  have  become  generally  known  as 
the  carcinogenic  hydrocarbons.  Following 
this  initial  artificial  reproduction  of  cancer, 
other  workers  subsequently  succeeded  in 
producing  genuine  malignant  tumors  by 
other  agents.  X-rays,  discovered  in  1895, 
and  whose  potentiality  for  producing  cancer 
was  initially  unknown,  began  to  give  rise  to 
the  now  well  recognized  late  effects  of  the 
same  in  the  form  of  radiation  cancers  de- 
veloping in  workers  exposed  to  this  agent. 
Similarly,  radiation  cancers  were  produced 
in  laboratory  animals. 

Dr.  C.  C.  Little  at  Bar  Harbor  was  among 
the  first  to  appreciate  the  possible  impor- 
tance of  the  genetics  factor  in  the  cause  of 
cancer  and  by  successive  periods  of  inbreed- 
ing of  mice  ultimately  developed  strains  sus- 
ceptible to  specific  tumors,  resistant  to  spe- 
cific tumors,  etc.  A precise  similarity  be- 
tween Little’s  high  tumor  strain  mice  and  a 
naturally  occurring  human  clinical  counter- 
part could  hardly  be  said  to  exist  since  Lit- 
tle’s mice  reached  the  high  tumor  strain 
stages  after  as  many  as  fifty  generations  of 
inbreeding.  The  human  race  at  large  is  a 
mixed  group  and  a practical  clfnical  corre- 
lation between  the  two  settings  would 
hardly  ever  occur  in  the  natural  course  of 


;for  July,  1949 


561 


human  breeding.  Chromosomal  transmis- 
sion of  tumors  may  be  a factor  in  human 
cancer  but  it  can  hardly  be  proved  to  be  a 
major  one  on  the  basis  of  evidence  at  this 
time.  (Rous) . 

With  the  discovery  of  the  so-called  “milk 
factor”  simultaneously  announced  in  Hol- 
land and  at  Bar  Harbor  by  Bittner  the 
extra-chromosomal  factor  in  tumors  was 
demonstrated.  Briefly,  these  experiments 
showed  that  the  mammary  tumors  occur- 
ring in  high  tumor  strain  female  mice  were 
transmitted  by  way  of  the  mother.  By 
removing  the  young  mice  from  their  mother 
before  nursing,  these  baby  mice  escaped  the 
later  development  of  mammary  cancer.  A 
single  nursing  was  found  to  be  enough  not 
only  to  establish  the  factor  in  the  young 
high  tumor  strain  female  itself  but  in  all 
of  its  descendants.  Probably  most  impor- 
tant was  the  corollary  experiment  showing 
that  by  removing  these  baby  mice  of  a high 
tumor  strain  from  exposure  to  the  milk  fac- 
tor by  means  of  preventing  nursing,  no 
breast  cancers  developed;  in  short,  one  mode 
of  cancer  prevention  had  been  demon- 
strated. 

Females  of  low  tumor  strain  mice  do  not 
show  a high  breast  tumor  ratio  if  nursed  by 
high  tumor  strain  foster  mothers.  How- 
ever, when  these  mice  receive  the  milk  fac- 
tor the  latter  still  maintains  its  potency. 
This  is  demonstrated  when  it  is  shown  that 
these  low  tumor  strain  females  acting  as 
host  vector  for  the  milk  factor  subsequently, 
at  considerably  later  period  in  their  life,  in 
turn  act  as  foster  mothers  for  baby  mice  of 
a high  tumor  strain,  these  baby  mice  will 
develop  mammary  cancer  just  as  though 
they  had  been  nursed  by  their  own  high 
tumor  strain  mother. 

Within  the  first  days  of  animal  experi- 
mentation one  of  the  most  persistent  theo- 
ries as  to  the  nature  of  tumors  became  in- 
valid. It  had  been  held  by  many  (Ribbert 
was  the  chief  exponent)  that  cells  grew  be- 
yond normal  physiological  expectations  and 
formed  tumors  through  the  relaxation  of 
some  obscure  growth  restraint  exercised  by 
the  surrounding  stroma  and  body  at  large. 


Assuming  that  this  “growth  restraint”  had 
once  been  relaxed  and  superseded,  it  should 
be  possible  in  experimental  animals  in 
whom  tumors  had  been  artificially  created 
to  produce  subsequent  tumors  with  less  ef- 
fort and  weaker  stimuli  than  was  necessary 
when  the  initial  tumor  was  produced.  How- 
ever, it  was  just  as  hard  to  develop  a sec- 
ond, third,  and  fourth  “tar  cancer”  of  the 
skin  of  experimental  animals  as  it  was  to 
produce  the  first  tumor.  The  idea  that  can- 
cer cells  are  special  sui  generis  cells  that 
behave  as  cancer  as  a secondary  result  of 
some  primary  relaxation  of  growth  re- 
restraint is  no  longer  popular.  The  concept 
of  normal  organs  subsequently  producing 
abnormal  cells  as  a result  of  (in  most  in- 
stances) as  yet  still  obscure  carcinogenic 
urgings  is  becoming  more  tenable  and  is  a 
basic  concept  underlying  all  present  day 
cancer  research. 

The  period  of  cancer  research  inaugu- 
rated with  the  first  production  of  cancer  in 
experimental  animals  can  only  be  consid- 
ered as  being  an  extremely  fruitful  one. 
Perhaps  the  most  important  concept  which 
was  placed  upon  a firm  scientific  footing 
involves  the  importance  of  so-called  car- 
cinogenic agents  in  the  production  of  can- 
cer. From  clinical  observations  and  ex- 
perimental corroboration  of  such  observa- 
tions in  the  laboratory  it  has  become  ap- 
parent that  carcinogenic  agents  are  not  rare, 
unusual,  isolated  factors  in  the  production 
of  cancer.  The  analine  dye  cancers  of  the 
bladder,  the  osteogenic  sarcomas  of  the  jaw 
in  the  radium  dial  workers,  the  skin  cancers 
from  x-rays,  the  cancers  resulting  from  pro- 
longed actinic  exposure,  etc.,  are  only  the 
most  familiar  examples.  Biochemists  are 
now  synthesizing,  isolating,  and  describing 
in  a bewildering  number  new  agents  which 
may  subsequently  be  shown  to  have  prac- 
tical carcinogenic  properties.  That  any  hu- 
man individual  escapes  clinical  cancer  may 
well  be  shown  to  be  due  not  to  the  fact  that 
they  have  not  been  exposed  to  carcinogenic 
agents  but  that  the  intensity  and  frequency 
of  exposure  has  not  been  adequate  enough 
to  promote  an  overt  cancer. 


562 


Rocky  Mountain  Medical  Journal 


Metabolic  Phase  of  Cancer  Research 

It  has  been  said  by  some  that  the  most 
beneficial  results  from  our  current  atomic 
investigations  will  consist  of  the  use  of  ra- 
dioactive agents  in  the  treatment  of  cancer. 
There  is  little  evidence  at  this  time  to  en- 
courage the  belief  that  by  direct  applica- 
tion of  a radioactive  compound  to  a cancer 
any  startling  results  will  be  obtained.  It  is 
true  that  with  radioactive  phosphorus  some 
striking  palliative  results  have  been  at- 
tained in  lymphatic  leukemias  and  poly- 
cythemia. Much  also  has  been  written  con- 
cerning the  effects  of  radioactive  iodine  in 
thyroid  cancer.  To  the  best  of  my  knowl- 
edge no  true  cure  of  thyroid  cancer  has 
ever  been  accomplished  despite  the  fact  that 
studies  have  shown  an  amazing  concentra- 
tion of  radioactive  energy  in  some  of  the 
thyroid  metastases. 

It  would  appear  more  likely  that  the  ben- 
efits from  radioactive  compounds  will  re- 
sult largely  from  their  use  in  tracer  studies 
of  cellular  metabolism.  Just  as  in  1846  with 
the  inauguration  of  Virchow’s  use  of  the  mi- 
croscope in  the  study  of  malignant  disease, 
these  agents  constitute  a new  tool  for  study 
of  obscure  changes  within  cells.  With  their 
aid  and  with  the  aid  of  such  instruments  as 
the  electronic  microscope  it  may  be  said 
that  for  the  first  time  we  are  beginning  to 
study  the  metabolism  of  cancer  in  its  most 
specific  sense. 

Cohnheim’s  hypothesis  that  tumor  cells 
are  autonomous  isolated  tissue  groups  com- 
prising a sui  generis  which  are  unrelated 
to  body  metabolism  as  a whole  has  had 
strong  adherence  for  many  years.  In  1923 
Mallory  stated,  “Tumor  cells  grow  entirely 
by  multiplication  not  by  transmission  of 
normal  cells  into  tumor  cells.  Attempts 
to  trace  gradations  between  normal  and 
neoplastic  cells  are  founded  on  incorrect 
observations,  interpretations  and  deduc- 
tions.” As  recently  as  1940  Ewing  stated, 
“Yet  these  instances  of  lateral  extensions 
of  tumor  processes,  if  they  eventually  stand 
the  test  of  criticism,  are  rare  and  it  should 
be  emphasized  that  the  great  majority  of 
tumor  cells  are  isolated  in  origin  and 
throughout  their  history.” 


It  may  be  said  that  now  enough  experi- 
mental work  has  been  accomplished  to  state 
with  certainty  that  the  border  line  between 
normal  cells,  benign  tumors  and  malignant 
tumors  is  an  ill-defined  one.  This  is  seen  on 
observations  of  microscopic  slides  where 
the  pathologist  is  many  times  unable  to  de- 
cide from  the  histologic  picture  alone 
whether  to  classify  the  abnormality  as  be- 
nign or  malignant.  The  reflection  of  similar 
confusion  on  the  part  of  clinicians  is  seen  in 
the  use  of  such  terms  as  “benign  metasta- 
sizing struma”  and  anyone  who  delves  into 
the  subject  of  endometriosis  and  bladder 
papillomata  may  well  emerge  with  con- 
siderable doubt  in  his  mind  as  how  to  clas- 
sify such  clinical  entities. 

The  importance  of  Huggins’  discovery  in 
1941  concerning  the  effects  of  castration  in 
prostatic  cancer  cannot  be  over  empha- 
sized. It  provides  clinical  proof  for  the 
claim  that  cancer  and  tumors  in  general  are 
not  autonomous  entities  but  are  closely  as- 
sociated with  body  metabolism  as  a whole 
and  that  cancers  attempt  with  varying  de- 
grees of  success  to  respond  to  physiological 
stimuli.  Although  it  is  a rule  of  most  ma- 
lignant tumors  that  once  initiated  the  dis- 
ease process  will  roll  along  under  its  own 
steam  and  ultimately  result  in  death,  such 
observations  as  Huggins’  prove  that  this  is 
not  invariably  the  case.  It  simply  means 
that  for  the  majority  of  the  neoplasms,  at 
the  present  time  we  have  not  found  the 
agent  which  will  rob  these  tumors  of  their 
sustaining  growth  influence. 

The  efforts  at  control  of  thyroid  cancer 
treated  with  radioactive  iodine,  prostatic 
cancer  treated  with  estrogens  or  castration 
and  breast  cancer  treated  with  testosterone 
are  all  based  on  an  appreciation  of  the  in- 
terrelationship of  these  tumors  to  the  body 
metabolism  as  a whole.  There  is  nothing 
new  in  this  chemotherapeutic  approach  to 
cancer  control.  The  history  of  therapy  is 
voluminous  in  its  mention  of  extracts,  tox- 
ins, antitoxins  and  filtrates  of  every  con- 
ceivable type.  The  contribution  lies  in  the 
fact  that  for  the  first  time  these  efforts  are 
not  applied  entirely  on  a hit  and  miss  basis 
but  are  founded  on  a proved  interrelation- 


for  July,  1949 


563 


ship  between  cancer  cells  and  extraneous 
factors.  As  may  be  anticipated,  the  more 
differentiated  the  tumor  the  more  favorable 
its  response  to  the  above  chemotherapeutic 
agents.  Unfortunately,  in  the  extremely 
anaplastic  tumors  the  inability  to  respond 
to  these  particular  agents  as  a result  of  their 
lack  of  differentiation  is  discouragingly  ob- 
bious. 

If  effective  agents  of  this  type  were 
known  for  each  individual  tumor  in  the 
body,  it  might  well  be  that  results  similar 
to  the  checking  of  prostatic  cancer  by  de- 
privation of  male  hormone  or  the  use  of 
stilbesterol  might  be  obtainable  in  other 
forms  of  cancer.  Conversely,  if  it  were 
known  precisely  which  agents  in  our  every 
day  environment  and  habits  further  the  neo- 
plastic process,  the  avoidance  of  such  agents 
would  ultimately  lead  to  cancer  prevention. 
It  is  perhaps  wiser  to  expect  that  no  one 
agent  applicable  to  all  tumors  will  ever  be 
found  in  preventing  neoplasia  any  more 
than  one  agent  was  found  to  be  effective  in 
preventing  “inflammation.”  The  current 


biochemical  and  metabolic  studies  of  cancer 
should  result  in  more  data  on  this  subject. 
At  the  present  time  it  is  our  most  fruitful 
line  of  research. 

The  “golden  manure”  is  now  abundantly 
available  to  sustain  our  efforts  at  solution 
of  this  problem.  A review  of  our  past  ac- 
complishments in  this  field  must  force  one 
to  admit  that  much  has  been  learned.  It  is 
also  apparent  that  the  most  stimulating  ad- 
vances have  all  been  made  within  the  past 
seventy-five  to  100  years.  In  the  face  of 
these  facts  a balanced  optimism  in  our  fu- 
ture efforts  is  justified. 


REFERENCES 

1.  Ewing,  James:  “Neoplastic  Disease.”  2nd  Edi- 
tion, 1940.  Philadelphia. 

2.  Mallory,  F.  B. : “Principles  of  Pathologic  His- 
tology,” 1923.  Philadelphia. 

3.  Willis,  R.  A.:  “Pathology  of  Tumors,”  1948. 

4.  Sutton,  Bland:  “Tumors  Benign  and  Innocent,” 
1906. 

5.  Bittner,  J.  J. : “The  Milk  Influence  on  Tumor 
Formation  Biology  of  the  Laboratory  Mouse,”  1941. 

6.  Rous,  Peyton:  “Recent  Advances  in  Cancer  Re- 
search,” Bulletin  of  New  York  Academy  of  Medicine, 
February,  1947. 

7.  Huggins,  Charles,  and  Hodges,  C.  V.:  “Studies  in 
Prostatlc  Cancer.”  Cancer  Research,  1,  pp.  293,  April, 
1941. 

8.  Paul  of  Aegius:  7th  Century  A.D.,  translated  by 
F.  Adams.  Proc.  of  Sydenham  Society,  1844. 

9.  Moore,  Robert:  “A  Textbook  of  Pathology,  1944. 


PROTECTIVE  STERILIZATION  IN  THE  ROCKY  MOUNTAIN  STATES 

CLARENCE  J.  GAMBLE,  M.D. 

MILTON,  MASS. 


Surgical  sterilization  is  an  important  in- 
strument of  long-range  preventive  medi- 
cine. While  not  all  of  the  children  of  psy- 
chotic or  mentally  deficient  patients  inherit 
the  parental  handicap,  each  is  apt  to  act  as 
a carrier  of  unfavorable  heredity.  Even 
though  such  a child  may  appear  normal,  its 
surroundings  and  its  upbringing  by  a men- 
tally abnormal  parent  cannot  be  satisfac- 
tory. Thus,  acting  through  both  heredity 
and  environment,  sterilization  of  the  in- 
sane and  the  feebleminded  accomplishes 
much  in  protecting  the  next  generation. 

When  compared  with  the  prevention 
which  it  furnishes,  the  cost  of  sterilization 
is  slight.  The  financial  cost  to  the  state  is 
little  more  than  that  of  the  first  delivery 
which  the  operation  makes  unnecessary.  As 
several  surveys  have  shown  that  there  is 


no  change  in  sexual  characteristics  or  de- 
sires^ ^ the  cost  to  the  patient  is  minimal, 
and  is  far  outweighed  by  the  advantages  to 
society  and  the  potential  children. 

Recognizing  the  value  of  this  procedure 
to  the  next  generation,  states  have  passed 
eugenic  sterilization  laws  until  twenty- 
seven  of  these  are  now  in  effect.  The  ex- 
tent to  which  they  have  been  employed  has 
varied.  California,  according  to  data  col- 
lected by  the  Human  Betterment  Founda- 
tion of  California  and  by  Birthright,  Inc.,’ 
has  reported  the  largest  number,  18,716  at 
the  end  of  1947.  To  make  the  reports  com- 
parable, the  sterilizations  per  100,000  popu- 
lation (using  the  1947  estimate  of  the  Cen- 
sus Bureau)  have  been  calculated  and  are 
given  in  the  table.  The  cumulative  totals 
compared  with  the  population  are  also  given 
in  the  figure.  For  clarity  it  has  been  nec- 


564 


Rocky  Mountain  Medical  Journal 


essary  to  omit  the  curves  for  some  of  the 
states. 


STERILIZATIONS  RETORTED  BY  STATE  INSTI- 
TUTIONS PER  100,000  POPULATION 

Compiled  from  the  reports  of  the  Human  Better- 
ment Foundation  and  of  Birthright,  Inc. 


Total  Sterilizations  Sterilizations  per  Year 


to  Jan.  1,  1948 

1943 

-1947 

1947 

Del. 

.256 

Del. 

7.6 

Utah 

9 1* 

r!al. 

.189 

TTtflh 

6 9 

.<4  D 

8 2* 

Va. 

.173 

Vfl 

5 9. 

5 1 

Kan. 

.156 

Cal. 

4.8 

Cal. 

.4.1 

N.  D. 

.136 

N D 

4.3 

Va 

4 0 

S.  D. 

130 

N.  C. 

3.4 

N.  C. 

.3.7* 

Ore. 

.117 

S.  D. 

3.1 

N.  D. 

.3.1 

N.  H. 

.100 

Ind.  _ _ 

3.0 

Iowa 

.2.7 

Utah 

. 85 

Kan. 

2.9 

Ind. 

.2.3 

Minn. 

. 76 

N.  H.  _ 

._  _ 2.9 

Ore. 

.1.9 

Vt. 

. 69 

Orp. 

2.6 

1.9* 

N.  C. 

. 53 

Ga. 

2.2 

Kan. 

.1.5 

Neb. 

. 51 

Neb. 

2.1 

Mont. 

.1.2* 

Wis. 

. 49 

Iowa 

2.1 

TSJ  H 

1 1 

Mont. 

. 48 

Mich. 

1.6 

Wis. 

1.1 

Ind. 

. 46 

vt. 

1.4 

Ga. 

.0.7 

Mich. 

. 46 

Wis. 

1.3 

Neb. 

0.5 

Iowa 

. 29 

Mont. 

1.1 

Miss. 

.0.5 

Miss. 

. 28 

Minn. 

0.7 

Me. 

.0.3 

Me. 

25 

Miss.  _ _ 

0.5 

.0.3 

.0.03 

Conn. 

. 25 

Conn. 

.0.4 

Minn. 

Okla. 

. 24 

Me. 

0 3 

Ga. 

. 17 

S.  C. 

0.2 

S.  C. 

. 4 

W.  Va.  - 

0.01 

Ariz. 

. 3 

Ida. 

3 

W.  Va. 

. 3 

27  states  hav 

ing  steriliza- 
zation  laws  . 

. 79 

2.3 

2.1 

*Population  interpolated  from 

U.  S.  Census 

for 

1940  and  estimate  for  1947:  1947 
1943-1947. 

rate  greater  than 

The  first  available 

report  shows  that 

at 

the  end  of  1927  Montana  had  applied  the 
eugenic  sterilization  law  to  thirty-five  pa- 
tients. This  increased  to  236  at  the  end  of 


1947,  or  forty-eight  per  100,000,  which  was 
exceeded  in  fourteen  other  states.  The  to- 
tal is  somewhat  more  than  half  of  the  aver- 
age for  the  twenty-seven  states  having 
sterilization  laws.  The  six  cases  protected 
during  1947  were  1.2  per  100,000,  giving 
Montana  thirteenth  place  among  the  states. 

Utah’s  total  of  539  sterilizations  give  the 
state  ninth  position  when  compared  with 
population.  The  protection  rate  has  in- 
creased during  recent  years,  however,  so 
that  the  nine  per  100,000  sterilized  in  1947 
were  exceeded  by  no  other  state.  When  the 
average  for  the  last  five  years  is  considered, 
Utah’s  seven  per  100,000  was  second  only  to 
Delaware. 


Montana’s  Sterilization  Law 

The  law  for  eugenic  sterilization  in  Mon- 
tana was  passed  in  1923.*  To  better  the 
physical,  mental,  neural  or  psychic  condi- 
tion of  the  inmate  of  any  custodial  institu- 
tion or  to  protect  society  from  the  menace 
of  his  or  her  procreation,  the  chief  physi- 
cian of  the  institution  may  present  a cer- 
tificate of  sterilization  to  the  State  Board 
of  Eugenics. 

This  Board  consists  of  the  Secretary  of 
the  State  Board  of  Health  who  acts  as 
chairman,  and  of  the  chief  physician  of 
each  custodial  institution,  the  President  of 
the  State  Medical  Association  and  of  a fe- 
male member  named  by  the  Association.  If 
consent  of  the  guardian  or  next  of  kin  is 
not  secured,  they  are  to  be  notified  and  a 
hearing  held.  An  appeal  from  the  order  of 
the  Board  may  be  taken  to  the  District 
Court. 

The  Sterilization  Law  in  Utah 

Utah’s  law  for  eugenic  sterilization  was 
passed  in  1925  and  received  minor  amend- 
ments in  1929.®  It  provides  that  whenever 
the  superintendent  of  the  state  hospital  or 
the  training  school  considers  it  for  the  best 
interest  of  an  inmate  or  of  society  that  a 
patient  with  insanity,  feeblemindedness  or 
epilepsy  shall  be  sterilized,  he  shall  address 
a petition  to  the  Board  of  his  institution.  If 
the  Board  finds  that  the  patient,  by  the 
laws  of  heredity,  is  the  probable  potential 
parent  of  socially  inadequate  offspring 
likewise  afflicted,  and  that  the  welfare  of 
the  inmate  and  of  society  shall  be  promoted 
by  an  operation  for  sterilization,  the  Board 
may  order  it  performed.  An  appeal  from 
their  decision  may  be  taken  to  the  District 
and  to  the  Supreme  Courts. 

The  Adequacy  of  the  Use  of  the 
Sterilization  Law 

The  236  patients  sterilized  in  Montana 
and  the  539  in  Utah  represent  important 
achievements  in  public  health.  They  also 
mean  freedom  from  institutional  life  to 
many  who  could  not  otherwise  be  released. 
To  estimate  the  adequacy  of  the  program, 
they  can  be  compared  with  the  number  of 
the  mentally  deficient. 


for  July,  1949 


565 


Various  surveys  have  indicated  that  the 
feebleminded  constitute  1.2  to  3 or  more 
per  cent  of  the  population.  Thus  Lemkau, 
Tietze  and  Cooper®  found  1.2  per  cent  in 
Baltimore,  as  did  the  South  Dakota  Com- 
mission for  the  Control  of  the  Feebleminded 
in  a survey  of  that  state. Haines®  in  com- 
bining twelve  surveys  found  3.2  per  cent  of 
52,514  schoolchildren  were  reported  as 
mentally  deficient.  Taking  1 per  cent  as  a 
conservatively  low  value,  indicates  that 
there  are  at  least  4,940  feebleminded  in 
Montana.  These  are  twenty  times  the  236 
which  have  been  protected  by  sterilization. 

The  assumption  that  the  mentally  defi- 
cient have  an  average  life  span  of  fifty 
years  indicates  that  in  Montana  there  are 
ninety-nine  new  feebleminded  in  the  state 
each  year.  These  are  sixteen  times  the  six 
individuals  sterilized  for  this  cause  in  1947. 

Similar  calculations  for  Utah  indicate  that 
there  are  more  than  6,370  feebleminded 
persons  in  the  state,  or  twelve  times  the 
539  which  have  been  sterilized.  The  an- 
nual accession  of  127  new  feebleminded  is 
twice  the  sixty-six  such  patients  sterilized 
in  1947. 

The  indications  for  sterilization  of  the 
insane  are  not  as  compelling  as  for  the 
feebleminded.  The  disease  is  inherited  in 
a smaller  proportion  of  the  children,  and 
there  is  hope  for  recovery.  A rough  esti- 
mate of  the  adequacy  of  the  use  of  the  law 
may  be  secured  by  comparing  the  number 
sterilized  with  those  discharged  with  psy- 
chosis for  the  first  time  from  institutions 
for  the  insane.  While  the  number  of  these 
is  not  published,  it  must,  in  the  long  run, 
equal  the  difference  between  the  first  ad- 
missions with  psychosis  and  the  deaths.  In 
1944,  the  most  recent  year  for  which  these 
figures  are  available,  this  difference  in 
Utah  amounted  to  214®.  This  is  107  times 
the  two  cases  sterilized  because  of  insanity 
in  1947.  It  would  seem  that  protection  of 
the  patient  and  of  the  potential  children 
might  be  indicated  in  a larger  proportion 
of  the  cases. 

Tubectomy  and  the  Practitioner 

While  few  cases  of  mental  disease  or  de- 
ficiency may  be  found  in  the  practice  of  the 


average  physician,  he  can  and  should  play 
an  important  part  in  this  form  of  preven- 
tive medicine.  Because  of  the  administra- 
tive difficulties  involved,  tubectomy  is 
rarely  performed  without  the  consent  of  the 
patient  or  of  his  or  her  family.  Since  the 
laity  so  often  confuses  sterilization  with 
castration,  this  consent  is  often  difficult  to 
secure,  making  protection  of  the  next  gen- 
eration incomplete.  If  each  doctor  will  let 
his  practice  understand  that  the  operation 
makes  no  change  which  the  patient  can  de- 
tect other  than  the  desired  one  that  children 
are  not  produced,  much  future  unhappiness 
and  mental  ill  health  will  be  avoided. 


7 0 5 O 5 T 

Fig.  1.  Sterilizations  reported  by  state  institutions 
since  the  passage  of  the  sterilization  laws.  (Cumu- 
lative figures. 

The  broad  line  indicates  the  average  values  for  the 
twenty-seven  states  having  sterilization  laws.  The' 
decrease  in  some  of  the  curves  results  from  a growth 
of  the  population  which  is  more  rapid  than  the  in- 
crease in  the  total  liumber  of  sterilizations. 


566 


Rocky  Mountain  Medical  Journal 


references 

'Vruwink,  John,  and  Pau'l  Popenoe:  “Postoperative 
Changes  in  the  Libido  Following  Sterilizat^^^ 
Amer.  Jl.  of  Obstetrics  and  Gynecology,  Vol.  XIX, 
No.  1,  Pg.  72.  Jan.,  1930.  . , „ 

“Craft,  J.  H.:  “The  Effects  of  Sterilization.’  Jl.  ot 
Heredity,  Vol.  27,  Pg.  379.  Oct.,  1936. 

“Publication  No.  5.  Birthright,  Inc.,  134  Nassau  St., 
Princeton,  N.  J, 

^Montana  Gen.  Law,  1923,  Ch.  164;  Montana  Code, 
Secs.  1444.1  to  1444.8. 

“Utah  Gen.  Law,  1925,  Ch.  82,  and  Utah  Gen.  Law, 
1929,  Ch.  59  and  75;  Utah  Code,  Sec.  89-0-1  to  12. 

“Lemkau,  Paul;  Tietze,  Christopher;  and  Cooper, 
Marcia:  “Mental-Hygiene  Problems  in  an  Urban  Dis- 
trict.’’ Mental  Hygiene,  26,  274.  April,  1942. 

“Report  of  the  State  of  South  Dakota  Commission 
for  the  Control  of  the  Feeble-minded,  1944. 

“Haines,  Thomas  H. : “Mental  Deficiency  Among 
Public  School  Children  in  the  United  States.  ’ Pro- 
ceedings of  the  American  Association  for  the  Study 
of  the  Feeble-minded,  31.  1931. 

““Patients  in  Mental  Institutions,  1943.”  U.  S.  De- 
partment of  Commerce,  Bureau  of  the  Census.  U.  S. 
Government  Printing  Office.  1946. 


PRIMARY  LYMPHOSARCOMA  OF  THE 
APPENDIX  VERMIFORMIS* 

DAVID  J.  ALMAS,  M.D. 

HAVRE,  MONTANA 


Primary  lymphosarcoma  is  a rare  condi- 
tion affecting  the  cecal  appendix.  Ewing^ 
stated  that  the  appendix  is  seldom  a pri- 
mary source  of  extranodal  lymphosarcoma. 
Although  considerable  interest  has  been 
shown  of  late  in  the  sarcoma  group  of  tu- 
mors, large  reviews,  such  as  that  by  War- 
ren and  Lulenski^,  make  no  reference  to 
sarcoma  of  the  appendix.  Knox-  collected 
the  reported  cases  from  the  literature  in 
1945  and  found  twenty-three  cases,  of  which 
sixteen  seemed  to  be  true  primary  lympho- 
sarcoma in  the  appendix.  Since  Knox’s  col- 
lective review,  the  only  report  I find  is  that 
of  Wilson^,  recording  a single  case. 

CASE  REPORT 

Mrs.  E.  M.,  a 19-year-old  white  married  fe- 
male, came  to  the  office  on  July  21,  1942,  com- 
plaining of  a large  lump  in  her  lower  abdomen 
on  the  right  side,  which  she  had  noticed  for  one 
month,  and  mild  constant  right  lower  quadrant 
pain  which  occasionally  radiated  to  her  pelvic 
cavity.  She  had  experienced  a normal  preg- 
nancy and  delivery  eight  months  previously.  An 
examination  by  her  family  physician  six  weeks 
postpartum  revealed  no  abnormal  condition. 
There  were  no  other  signs  or  symptoms  refer- 
able to  the  gastro-intestinal  and  genito-urinary 
systems.  There  had  been  a weight  loss  of  fifteen 
pounds  in  the  last  three  months,  for  which  no 
cause  was  apparent.  Her  family  and  past  history 
were  otherwise  non-contributory. 

•Dr.  James  R.  Gay  aided  in  the  preparation  of  the 
manuscript.  L.  Marguerite  Prime,  American  College 
of  Surgeons,  aided  in  searching  the  literature. 


Physical  Examination:  Temperature,  98  F; 
pulse,  76  per  minute;  respirations,  24  per  minute; 
weight,  115  pounds.  The  complexion  was  sallow 
with  slight  pallor.  Blood  pressure,  106/62.  The 
abdomen  was  flat  and  thin-walled.  A firm,  free- 
ly movable  mass  was  present  in  the  right  lower 
quadrant,  about  the  size  of  a fist.  This  mass 
could  be  manipulated  up  to  the  right  costal  mar- 
gin and  do’wn  into  the  pelvis,  but  not  much  past 
the  mid-line  medially.  It  was  slightly  tender  to 
pressure.  Liver  and  spleen  were  not  palpable. 
There  was  no  evidence  of  fluid  in  the  abdomen. 
There  were  no  palpable  lymph  nodes.  On  pelvic 
examination  a mass  was  found  in  the  right 
adnexa  about  the  size  of  a large  orange,  slightly 
cyctis,  slightly  tender  and  only  slightly  movable. 
The  uterus  was  pushed  to  the  left  by  this  mass. 

Laboratory  report:  Hemoglobin,  11.5  grams  per 
cent;  white  blood  count,  11,000  per  cubic  mm.; 
blood  smear,  negative  save  for  slight  anemia; 
urine,  negative;  blood,  Kolmer-Wasserman  and 
Kahn,  negative.  Intravenous  pyelograms  showed 
normal  size,  shape,  position,  prompt  appearance 
and  good  concentration  of  dye. 

Pre-operative  diagnoses:  Intraligamentous  and 
ovarian  cysts. 

Operation:  August  3,  1942,  at  Sacred  Heart 
Hospital.  Under  spinal  anesthesia,  a midline 
sub-umbilical  incision  was  made  and  a right 
intraligamentous  cyst  about  ten  centimeters  in 
diameter  was  found.  It  appeared  to  be  a smooth 
serous  cystadenoma.  The  tumor  mass  was  the 
appendix,  free  of  adhesions  in  the  peritoneal 
cavity.  The  tip  for  about  two  centimeters  ap- 
peared normal,  the  remainder  was  replaced  by 
a firm,  meaty,  uniform,  gray-brown  tumor  mass 
approximately  four  by  six  centimeters  in  size. 
The  cecum  at  the  base  of  the  appendix  contained 
a firm  mass  about  two  and  one-half  centimeters 
in  diameter.  There  was  a moderate  constriction 
at  the  union  of  the  appendix  and  cecum.  The 
lymph  nodes  were  not  enlarged  except  in  the 
peri-cecal  area  where  a number  of  small  soft 
nodes  were  present  in  the  ileo-cecal  angle.  The 
liver  was  normal  to  palpation.  The  cecum  and 
ascending  colon  had  a fully  developed  messen- 
tery.  The  appendix  was  amputated  and  sec- 
tioned. Because  of  the  gross  appearance  of  ma- 
lignancy, the  terminal  ileum  was  sutured  to  the 
transverse  colon;  the  protruding  mass  was  re- 
moved under  clamps  to  form  a Lahey-Mikulicz 
type  of  colostomy. 

Her  postoperative  course  for  the  first  four 
days  was  uneventful.  The  evening  of  the  fourth 
day  she  became  very  restless  and  began  to  com- 
plain of  severe  epigastric  pain.  There  were  no 
signs  or  symptoms  of  obstruction  or  peritonitis. 
Urinary  output  was  good.  Signs  of  broncho- 
pneumonia developed  and  she  died  on  the  sixth 
postoperative  day  despite  the  use  of  sulfona- 
mides and  oxygen.  Permission  for  autopsy  was 
not  obtained. 

Pathological  report  (Dr.  Thomas  F.  Walker, 
Great  Falls,  Montana): 

“Rather  firm  grayish  tumor  mass  approximate- 
ly 5 cm.  in  diameter,  from  one  portion  of  which 
there  protrudes  the  terminal  portion  of  the  ap- 
pendix roughly  2 cm.  in  length. 

“On  section,  the  mass  is  found  to  be  composed 
of  a fish-flesh-like  material  of  uniform  texture. 
Sections  from  the  outer  portion  of  the  mass  show 
that  it  is  covered  by  a peritoneal  layer,  just  be- 
neath which  are  found  occasional  thin  strands  of 
muscle  tissue,  probably  representing  the  greatly 
thinned  and  stretched  out  muscular  coat  of  the 
appendix. 


for  JutY^,1949 


567 


“No  other  appendiceal  tissues  can  be  identified 
in  the  tumor  mass,  which  is  composed  of  rather 
well  developed  lymphocytes.  Occasional  mitotic 
figures  can  be  demonstrated. 

“The  reticulum  is  rather  scanty  and  does  not 
come  into  intimate  contact  with  the  cells. 

“The  growth  is  a lymphosarcoma  of  the  ap- 
pendix.” 

RUFE.REWCElS 

iEwing,  J. : Neoplatic  Diseases.  Philadelphia,  W.  B. 
Saunders  Company,  1928. 

^Knox,  Graham:  Lymphosarcoma  Primary  in  the 
Appendix:  A Study  of  Twenty-three  Cases.  Arch. 
Surg-.,  50:288-292  (June),  1945. 

^Warren,  Shields,  and  Lulenskl,  C.  R.:  Primary 
Solitary  Lymphoid  Tumors  of  the  Gastro-Intestinal 
Tract.  Ann.  Surg.,  115-1-12  (Jan.),  1942. 

^Wilson,  W.  E. : Lymphosarcoma  of  the  Appendix. 
J.M.A.  Alabama,  15-98-100  (Sept.),  1945. 


PROGRAM 

The  Rocky  Mountain  Radiological  Society 

THURSDAY  MORNING,  AUGUST  18 
9:30  A.M. 
to 

11:00  A.M.  Registration. 

11:00  A.M.  Symposiums  “Ethics  and  Economies  in 
Radiological  Practice.” — James  P.  Kerby,  M.D., 
Salt  Lake  City,  Presiding. 

“Responsibilities  to  Radiological  Societies  and 
Organized  Medicine.” — John  S.  Bouslog,  M.D., 
Denver,  Colorado. 

“Radiology  in  Great  Britain  and  Scandinavia.” — ' 
H.  Milton  Berg,  M.D.,  Bismarck,  North  Da- 
kota. 

“Public  Health,  Cancer  and  Tuberculosis  Pro- 
grams.”— Alfred  M.  Popma,  M.D.,  Boise,  Idaho. 
“Voluntary  and  Compensation  Insurance  Plans, 
Veterans’  Program.” — Thomas  B.  Bond,  Fort 
Worth,  Texas. 

“Hospital  Practice  and  Institutional  Problems.” 

— Howard  B.  Hunt,  M.D.,  Omaha,  Nebraska. 
“Inter-Relationship  Between  Radiologists,  Other 
Doctors  and  Patients.” — James  P.  Kerby,  M.D., 
Salt  Lake  City,  Utah. 

12:30  M Round  Table  Luncheon..— Discussion  of 
Ethics  and  Economics  in  Radiological  Practice. 
— Kenneth  D.  A.  Allen,  M.D.,  Denver,  President- 
Elect,  Presiding. 

C.  Edgar  Virden,  M.D.,  Kansas  City,  Mo. 

Charles  L.  Martin,  M.D.,  Dallas,  Texas. 

THURSDAY  AFTERNOON,  AUGUST  18 
2:00  P.M.  Howard  B.  Hunt,  M.D.,  Presiding;  Presi- 
dent of  the  Rocky  Mountain  Radiological  Society. 
Addres.s  of  Welcome. — Greetings  from  Colorado 
State  Medical  Society. 

Scientific  Session. — ^Paul  R.  Weeks,  M.D.,  Denver, 
Colorado,  Presiding. 

2:10  P.M.  “Pathologic  Anatomy  of  Congenital 
Heart  Disease.” — Harold  D.  Palmer,  M.D.,  Den- 
ver, Colorado. 

2:45  P.M.  “Angiocardiography.” — J.  E.  Miller,  M.D., 
Dallas,  Texas. 

3:30  P.M.  “Hypertension  of  the  Pulmonary  Circu- 
lation.”— C.  Allen  Good,  M.D.,  Rochester,  Minne- 
sota. 

4:00  P.M.  “The  Auxiliary  Heart.” — W.  Walter 
Wasson,  M.D.,  Denver,  (Colorado. 

4:45  P.M.  Discussion. — John  B.  Grow,  M.D.,  Den- 
ver, Colorado:  T.  D.  Cunningham,  M.D.,  Denver, 
Colorado;  William  B.  Condon,  M.D.,  Denver, 
Colorado. 

5:00  P.M.  Executive  Session. 

THURSDAY  EiVENING,  AUGUST  18 
8:00  P.M.  Joint  Meeting  With  the  Medical  Society 
of  the  City  and  County  of  Denver. — Frederick  H. 
Good,  M.D.,  President  of  the  Medical  Society  of 
the  City  and  County  of  Denver;  and  Howard  B. 
Hunt,  M.D.,  President  of  the  Rocky  Mountain 
Radiological  Society,  presiding  as  Co-Chairmen. 
Guest  Speakers.— Paul  C.  Swenson,  M.D.,  Phila- 
delphia, Pa. — “Problems  in  the  Roentgen  Ex- 
amination of  the  Gastrointestinal  Tract”; 
Charles  L.  Martin,  M.D.,  Dallas,  Texas.^ — “The 
Treatment  of  Intra-Oral  Cancer.” 

Movies  of  previous  meetings. 

FRIDAY  MORNING,  AUGUST  19 
9:00  A.M.  Thomas  B.  Bond,  M.D.,  Vice  President, 
Rocky  Mountain  Radiological  Society,  Fort 
Worth,  Texas,  Presiding. 


“Double  Contrast  Study  of  the  Colon.” — Robert 
C.  Moreton,  M.D.,  Temple,  Texas. 

9:20  A.M.  “Tumors  of  the  Small  Intestine.” — C. 
Allen  Good,  M.D.,  Rochester,  Minnesota. 

9:50  AM.  '“Bronchography  in  Carcinoma  of  the 

Lung.” — John  W.  Walker,  M.D.,  Kansas  City,  Mo. 

10:10  AM.  Discussion.- — ^Leo  G.  Rigler,  M.D.,  Minne- 
apolis, Minnesota:  John  T.  McGreer,  M.D.,  Lin- 
coln, Nebraska. 

10:25  A.M.  “Diagnostic  X-Ray  Procedures  at  the 

Time  of  Labor.” — Paul  C.  Swenson,  M.D.,  Phila- 
delphia, Pa. 

11:10  A.M.  “Uterosalpingography  in  the  Diagnosis 
and  Treatment  of  Sterility.” — Charles  L.  Martin, 
M.D.,  Dallas,  Texas. 

11:45  A.M.  Dlscussiun. — E.  Stewart  Taylor,  M.D., 
Denver,  Colorado;  Nathan  B.  Newcomer,  M.D., 
Denver,  Colorado. 

12:00  M.  Adjournment. 

12:30  P.M.  Round  Table  Lunclieon. 

Discussion  of  Diagnostic  Problems. — William  M. 
McCaw,  M.D.,  Greeley,  Colorado,  President  of 
Colorado  Radiological  Society,  Presiding. 

FRIDAY  AFTERNOON,  AUGUST  19 

Edward  J.  Weister,  M.D.,  Denver,  Colorado, 
Presiding. 

2:00  P.M.  “Characteristics,  Instrumentation  and 
Safe  Handling  of  Radioisotopes  in  Medical  Prac- 
tice.”— Paul  G.  Aebersold,  Ph.D.,  Oak  Ridge, 
Tenn. 

2:45  P.M.  “Application  of  Radiophosphorus  in  Ra- 
diological Practice.” — Capres  S.  Hatchett,  M.D., 
Amarillo,  Texas. 

3:15  P.M.  “Studies  on  the  Genesis  and  Function  of 
Neoplasms  of  the  Thyroid  With  Modern  Tools.” — 
Rulon  W.  Rawson,  M.D.,  New  York  City. 

4:00  P.M.  “The  Evaluation  and  Treatment  of  Hy- 
perthyroidism by  Radioiodine.” — Earl  R.  Miller, 
M.D.,  San  Francisco,  Calif. 

4:45  P.M.  Diseussion, — Thad  P.  Sears,  M.D.,  Fort 
Logan,  Colorado:  Charles  F.  Ingersoll,  M.D.,  Fort 
Logan,  Colorado. 

,5:00  P.M.  Executive  Sessions 

The  Rocky  Mountain  Radiological  Society. 
Election  of  Officers. 

FRIDAY  EVENING,  AUGUST  19 

7:00  P.M.  Social  Hour. 

7:30  P.M.  Informal  Banquet.— Toastmaster:  Maur- 
ice D.  Frazer,  M.D.,  Lincoln,  Nebraska. 

8:45  P.M.  Address:  “Illustrated  Travelogue  Through 
Scandinavia  and  Great  Britain.” — H.  Milton, 
Berg,  M.D.,  Bismarck,  North  Dakota. 

.SATURDAY  MORNING,  AUGUST  20 

9:00  A.M.  Installation  of  Officers. — Howard  B. 
Hunt,  M.D.,  Presiding. 

Scientific  Session — M.  Lowry  Allen,  M.D.,  Salt 
Lake  City,  First  Vice  President,  Rocky  Moun- 
tain Radiological  Society,  Presiding. 

9:10  A.M.  “Epidermoid  Carcinodma  of  Bu'lbar  Con- 
junctiva.” Edward  J.  Meister,  M.D.,  Denver, 
Colorado. 

9:30  A.M.  “Radiotherapy  in  Brain  Tumors.” — Ga- 
len M.  Tice,  M.D.,  Kansas  City,  Kansas. 

10:00  A.M.  “Cerebral  Angiography.” — Earl  R.  Mil- 
ler, M.D.,  San  Francisco,  California. 

10:30  A.M.  Discussion.— E,  Edgar  Virden,  M.D.,  Kan- 
sas City,  Mo.;  Charles  G.  Freed,  M.D.,  Denver, 
Colo.;  Ralph  M.  Stuck,  Denver,  Colo. 

10:45  A-M.  “High  Voltage  Radiography.” — E.  Dale 
Trout,  Ph.D.,  Milwaukee,  Wisconsin. 

11:00  A.M.  “Short  Distance  Radiography.” — James 
W.  Lewis,  M.D.,  Colorado  Springs,  Colorado. 

11:15  AM.  “Relation  of  the  Atomic  Ehergy  Pro- 
gram to  Medical  Practice  and  Research.” — Paul 
G.  Aebersold,  Ph.D.,  Oak  Ridge,  Tenn. 

11:35  A.M.  “Some  Newer  Aspects  of  Cancer  Re- 
search.”— Rulon  W.  Rawson,  M.D.,  New  York 
City,  New  York. 

11:15  A.M.  Discussion. — Kenneth  D.  A.  Allen,  M.D., 
Denver,  Colorado. 

12:00  M.  AJjaurnment. 

12:30  P.M.  Round  Table  Discussion. — Discussion  of 
of  Therapy. — ^Alfred  M.  Popma,  M.D.,  Boise, 
Idaho,  Presiding. 

SATURDAY  AFTERNOON,  AUGUST  20 

4:00  P.M.  Annual  Picnic.— Pine  Gables  Ranch. 


568 


Eocky  Mountain  Medical  Journal 


“A  high  index  of  suspicion” 

The  difficulties  and  pitfalls  in  diagnosing  amebiasis 
are  stressed  frequently  in  medical  literature. 

. . despite  the  absence  of  a history  of  dysentery, 
amebiasis  must  be  considered  in  the  differential  diag- 
nosis of  many  bizarre  clinical  syndromes.  ...  A high 
index  of  suspicion  is  the  keynote  of  early  diagnosis.”^ 

In  acute  or  latent  forms  of  amebiasis,  Diodoquin 
may  be  employed  over  prolonged  periods.  This  high- 
iodine-containing  amebacide  “is  well  tolerated.  . . . 

The  great  advantage  of  this  simple  treatment  is  that 
in  the  vast  majority,  it  destroys  the  cysts  of  E.  his- 
tolytica and  is,  therefore,  especially  valuable  in  ster- 
ilizing ‘cyst-carriers.’  It  can  readily  be  taken  by  am- 
bulant patients  and,  therefore,  eliminates  the  neces- 
sity of  hospitalization. ”2 

Diodoquin* 

{Sy7-diiodo-8-hydroxy  quinoline) 


SEARLE 

RESEARCH  IN  THE  SERVICE  OF  MEDICINE 

G.  D.  Searle  & Co.,  Chicago  80,  Illinois 


1.  Warshawsky,  H.;  Nolan,  D.  E., 
and  Abramson,  W. : Hepatic  Com- 
plications of  Amebiasis,  New  Eng- 
land J.  Med.  255:678  (Nov.  7)  1946. 

2.  Manson-Bahr,  P. ; Some  Trop- 
ical Diseases  in  General  Practice: 
“A  Post-War  Legacy,”  Glasgow 
M.  J.  27:123  (May)  1946. 


for  July,  1949 


569 


Organization 

National  Affairs  - Proceedings  - Programs  - Society  Notices  - News  - Auxiliary 


COLORADO 

State  Medical  Society 

CAMPAIGN  MATERIALS  ARE  AVAILABLE 

Some  excellent  campaign  materials  have  been 
developed  by  Whitaker  and  Baxter,  who*  are 
handhng  the  socialized  medicine  campaign  for 
the  American  Medical  Association.  Most  physi- 
cians are  familiar  with  the  pamphlets  and  other 
information  pieces  and  have  been  putting  them 
to  good  use. 

While  some  mailings  are  being  handled  from 
Chicago  to  county  societies  or  individual  physi- 
cians, the  bulk  of  the  campaign  materials  are 
being  routed  through  State  Society  offices  and 
are  being  distributed  by  County  Society  cam- 
paign chairmen  or  officers.  They  should  be  con- 
tacted when  additional  materials  are  needed. 

A direct  mailing  of  fifty  each  of  the  two 
latest  pamphlets  was  recently  authorized  by  the 
Board  of  Trustees  of  the  A.M.A.  and  attractive 
cartons  of  literature  will  be  sent  to  every  U.  S. 
physician  to  supplement  state  and  county  society 
distribution. 

Since  Congress  will  undoubtedly  be  in  session 
this  fall,  physicians  will  have  further  need  for 
campaign  materials  and  will  be  interested  in  this 
listing  of  items  now  available; 

“The  Voluntary  Way  Is  the  American  Way,” 
a question  and  answer  pamphlet. 

“Your  Medical  Program  . . . Compulsory? — or — 
Voluntary?”  illustrated  reception  room  and  mail 
enclosure  piece. 

“Compulsory  Health  Insurance — A Threat  to 
Health — A Threat  to  Freedom.”  Basic  speech 
in  pamphlet  form. 

Blueprint  of  the  campaign,  a pamphlet. 

Gummed  stickers  for  letters  or  envelopes.  An 
adaptation  of  the  Colorado  sticker. 

“American  Medicine  Replies  to  President  Tru- 
man,” a fine  statement  by  A.M.A.’s  Board  of 
Trustees  Chairman. 

The  A.M.A.  12-point  program. 

“The  Doctor,”  19x20  inches,  color  reproduction 
of  Fildes  painting  for  physicians’  offices. 

“The  Doctor,”  35x35  inches,  large  reproduction 
of  Fildes  painting,  for  use  in  hospital  lobbies, 
medical  buildings,  etc. 


Obituaries 

MARTIN  D.  CURRIGAN 

Dr.  Martin  D.  Currigan  of  Denver  died  on 
May  12,  1949,  of  a cardiac  accident.  He  was  61. 

He  was  born  in  Denver  on  July  10,  1887.  A 
graduate  of  Regis  College,  he  received  his  medi- 
cal degree  from  the  University  of  Colorado 
School  of  Medicine  in  1912.  Dr.  Currigan  was 
licensed  to  practice  in  Colorado  the  following 
year. 

A member  of  the  Denver  County  and  Colorado 
State  Medical  Societies,  Dr.  Currigan  was  also 
a Fellow  of  the  American  College  of  Surgeons. 


In  1932  he  was  elected  to  the  University  of 
Colorado  Board  of  Regents,  serving  until  1938. 
In  1940  he  was  re-elected  for  another  six-year 
term. 

Dr.  Currigan  was  prominent  in  civic  and  medi- 
cal fields  alike.  His  passing  is  a great  loss  to 
his  community  and  to  his  state. 


EDWARD  H.  KRUEGER 

Dr.  Edward  H.  Krueger  of  Denver  died  on 
May  19,  1949,  of  a cerebral  accident.  He  was 
60  years  of  age. 

Bom  in  Tomah,  Wisconsin,  on  October  13,  1888, 
Dr.  Krueger  received  his  professional  training  at 
Loyola  University  Medical  School  in  Chicago, 
graduating  in  1910.  Following  his  internship  at 
Jefferson  Park  Hospital  in  Chicago  he  served  as 
a resident  at  Chicago  Lying-In  Hospital. 

Dr.  Krueger  practiced  in  Chicago  until  1918,  at 
which  time  he  came  to  Colorado  for  his  health. 
Ten  years  later  he  resumed  practice,  this  time 
in  Denver. 

Dr.  Krueger  was  a member  of  the  Denver 
County  and  Colorado  State  Medical  Societies. 
For  many  years  he  served  as  examining , physi- 
cian for  the  Colorado  State  Boxing  Commission. 
He  remained  in  active  practice  until  he  retired 
one  year  ago. 

His  twenty  years  of  practice  in  Colorado 
brought  him  many  friends  among  the  profession 
and  laity  alike.  His  sudden  death  represents  a 
great  loss  to  us  all. 


ROBERT  G.  MORRISON 

Dr.  Robert  G.  Morrison,  a retired  Denver 
physician  and  surgeon,  died  May  17,  1949,  at 
the  age  of  72. 

Born  in  Denver  in  1877,.  Dr.  Morrison  attended 
Denver  public  schools.  He  graduated  from 
Denver  and  Gross  College  of  Medicine  in  1903. 
He  became  a member  of  the  Colorado  State 
Medical  Society  in  1917  and  remained  in  good 
standing  until  1937,  at  which  time  he  discon- 
tinued his  membership. 

Dr.  Morrison  will  be  remembered  by  many 
as  a prominent  figure  in  Denver  ihedicine  in  the 
early  part  of  the  century. 


Auxiliary 

ANNUAL  MEETING,  COLORADO 
MEDICAL  AUXILIARY 

All  of  the  members  of  the  Colorado  Medical 
Auxiliary  will  be  interested  in  the  plans  for  the 
annual  meeting  in  September,  in  Denver. 

On  the  afternoon  of  Wednesday,  September  21, 
the  Denver  County  Auxiliary  has  invited,  all 
state'  members  to  join  them  in  their  annual  fall 
tea.  It  will  be  held  at  the  home  of  Mrs.  Kenneth 
Sawyer,  the  new  President  of  Denver  County 
Auxiliary. 

The  annual  meeting  and  luncheon,  open  to 
all  State  Auxiliary  members,  will  be  held  at 
the  Brown  Palace  Hotel,  Friday,  September  23. 
The  meeting  will  be  at  10:00  a.m.  in  the  Onyx 


570 


Rocky  Mountain  Medical  Journal 


H: 

Alhydrex 

Builds  solid  immunity  step  by  step 

Like  Mr.  McGinty’s  brick  wall  which  stands 
solidly  against  the  ravages  of  time  because  he 
builds  it  carefully,  solidly,  brick  upon  brick,  the 
immunity  you  build  with  CUTTER  "ALHYDROX” 
vaccine  is  solid. 


*'Alhyilrox''  is  a CUTTER  cArcfusioe— developed  and 
used  exclusively  by  CUTTER  for  its  vaccines  and 
toxoids.  It  supplements  the  physician’s  skill  by 
producing  these  immunizing  advantages: 

T.  "Alhydrox”  adsorbed  antigens  are  released  slowly  from  tis* 
sue,  giving  the  effect  of  small  repeated  doses. 

2.  "Alhydrox”,  because  of  its  more  favorable  pH,  lessens  pain 
on  injection  and  reduces  side  reactions  to  a minimum. 

3.  "Alhydrox”  selectivity  controls  the  absorption  of  antigens, 
reducing  dosage  volume  while  building  a high  antibody  con- 
centration. Reduced  volume  means  less  tissue  distention  and 
less  pain. 


*Cutter  trade  name  for  aluminum  hydroxide  adsorbed  products.  CUTTER  LABORATORIES  • BERKELEY  10,  CALIF. 


Specify  "Alhydrox”  when  you  order  vaccines 

AN  EXCLUSIVE  WITH... 


CumR 


for  July,  1949 


571 


Room  and  the  luncheon  will  be  at  12:30  in  the 
Ma5rfair  Room. 

There  will  also  be  two  Board  meetings,  re- 
stricted to  Board  members  only.  The  pre-con- 
vention Board  meeting  will  be  held  on  Thursday, 
September  22,  at  2:00;  the  post-convention  Board 
meeting  will  follow  the  annual  meeting  and 
luncheon  on  Friday,  September  23. 

Double  reply  post  cards  will  be  sent  out  later 
to  each  state  member  so  we  will  know  the  exact 
number  to  expect  for  the  tea  and  luncheon.  We 
hope  all  the  frmctions  will  be  well  attended. 

MRS.  A.  A.  WEARNER. 


COLLEGE  OF  AMERICAN  PATHOLOGISTS, 
SOUTH  CENTRAL  REGION 

Saturday,  July  16,  1949 

University  of  Colorado  Medical  Center 
Denision  Auditorium 

9:00  to  10:00  A.M.  Registration.  $2.00  attend- 
ance fee,  includes  luncheon. 

MORNING  SESSION 
Moderator — James  B.  McNaught,  M.D., 
Professor  and  Head  of  Department  of  Pathology, 
University  of  Colorado  Medical  Center 
10:00  to  10:30  A.M.  Comparative  Pathology  of 
Testicular  Tumors  in  Man  and  the  Dog. — 
Richard  M.  Mulligan,  M.D.,  Professor  of 
Pathology,  University  of  Colorado  Medical 
Center. 

10:30  to  11:00  A.M.  Fatal  Asphyxia  Following 
Lucite  Plombage. — Irving  F.  Geever,  M.D., 
Assistant  Professor  of  Pathology,  University 
of  Colorado  Medical  Center;  Pathologist, 
Glockner-Pensose  and  St.  Francis  Hospitals, 
Colorado  Springs. 

11:00  to  11:30  A.M.  Bronchogenic  Adenomas. — 
Sion  W.  Holley,  M.D.,  Pathologist,  Weld  and 
Larimer  County  Hospitals,  Greeley,  Colorado. 
11:30  to  12:15  P.M.  Common  Pathological  Errors 
in  Cancer  Diagnosis. — Fred  W.  Stewart,  M.D., 
Associate  Professor  of  Surgical  Pathology, 
Cornell  Medical  College. 

12:15  to  12:30  P.M.  Questions. 

12:30  to  2:00  P.M.  Luncheon. 

AFTERNOON  SESSION 
Moderator — Carl  W.  Maynard,  M.D.,  Pathologist, 
Pueblo  Clinic,  Pueblo,  Colorado. 

2:00  to  2:30  P.M.  The  Lymphomas. — James  D. 
Thomas,  M.D.,  Instructor  in  Medicine,  Uni- 
versity of  Colordao  Medical  Center. 

2:30  to  3:00  P.M.  The  Leucomoid  States. — 
Eleanor  H.  Valentine,  M.D,,  Associate  Pro- 
fessor of  Clinical  Pathology,  University  of 
Colorado  Medical  Center;  Director  of  Labora- 
tories, Denver  General  Hospital. 

3:00  to  3:30  P.M.  Rh  Problems  in  a Blood  Bank. 
— Marion  R.  Rymer,  Ph.D.,  Director  of  BeUe 
Bonfils  Memorial  Blood  Bank;  Instructor  in 
Clinical  Pathology,  University  of  Colorado 
Medical  Center. 

3:30  to  4:00  P.M.  Exfoliative  Cytological  Diag- 
nosis of  Cancer. — Walter  T.  Wikle,  M.D.,  In- 
structor in  Pathology,  University  of  Colo- 
rado Medical  Center. 

400  to  4:30  P.M.  The  Brucellosis  Problem. — 
George  W.  Stiles,  M.D.,  Director  of  Labora- 
tory Section,  Colorado  State  Division  of 
Public  Health,  Denver. 


COLORADO 

State  Health  Department 

POLICIES  AND  TECHNICS  FOR  IMMUNIZA- 
TION OF  CHILDREN 

Policies 

To  promote  widespread  protection  of  children 
against  communicable  diseases,  the  Colorado 
State  Department  of  Public  Health  and  the  Colo- 
rado State  Medical  Society  have  formulated  the 
following  basic  policy  regarding  the  distribution 
of  biological  preparations  for  immunizations.  The 
Colorado  State  Department  of  Public  Health  will 
furnish  biological  materials  for  use  in  infant 
and  child  health  conferences,  school  health  pro- 
grams and  general  immunization  programs, 
staffed  by  local  qualified  physicians  when  the 
technics  and  the  policies  of  such  programs?  have 
the  approval  of  the  local  medical  society  and 
meet  the  standards  of  the  Colorado  State  Depart- 
ment of  Public  Health. 

The  State  Department  of  Health  will  pay 
travel  expenses  of  7 cents  per  mile  and  an  hon- 
orarium of  $5.00  per  hour  to  local  physicians 
assisting  in  these  programs  where  no^  charge  is 
made  for  the  services.  If  a charge  is  made  for 
the  service,  the  State  Health  Department  cannot 
fiunish  biolo^cal  materials,  but  public  health 
nurses  will  still  cooperate  with  the  physician  in 
every  way  possible  in  order  to  get  all  the 
children  in  the  community  immunized,  especially 
the  infants  and  the  pre-school  group. 

Every  effort  will  be  made  through  public  edu- 
cation to  induce  parents  to  have  their  children 
immunized  during  the  first  year  of  life,  pref- 
erably as  part  of  their  general  supervision  by 
a family  physician.  The  tendency  on  the  part 
of  many  parents  to  postpone  immunization  of 
their  children  urftil  they  enter  school  will  be 
discouraged,  as  it  leaves  the  infants  and  pre- 
school group  unprotected  during  their  most  sus- 
ceptible years. 

Reporting 

It  is  necessary  that  plans  for  any  immuniza- 
tion program  be  cleared  in  advance  with  the 
Colorado  State  Department  of  Public  Health. 
Blanks  will  be  furnished  for  reporting  each 
individual  immunized  by  name  and  age.  This 
will  be  the  responsibiltiy  of  the  public  health 
nurse  where  she  participates  in  the  program; 
where  there  is  no  nurse,  it  can  be  carried  out 
by  others.  Such  reports  are  essential,  as  they 
are  a means  of  determining  the  extent  and  dis- 
tribution of  immunized  procedures  in  Colorado 
children. 

Dptional  Schedule  for  Infants 

In  general  the  procedures  in  “Recommenda- 
tions for  Active  Immunization,”  by  the  Colorado 
State  Department  of  Public  Health  and  the  Colo- 
rado State  Medical  Society  (July  1,  1947),  are 
still  valid.  An  optional  method  of  immunizing 
infants  is  recommended  by  the  State  Depart- 
m.ent  of  Public  Health,  with  the  approval  of 
the  Colorado  State  Medical  Society.  This  in- 
volves three  monthly  injections  of  an  alum  pre- 
cipated,  triple  antigen,  beginning  at  age  3 
months.  A booster  dose  is  recommended  at  15 
to  18  months  of  age  and  another  before  entering 
school.  This  avoids  the  necessity  of  using  per- 
tussis vaccine  alone  and  reduces  the  total  num- 
ber of  injections  per  infant. 


572 


Rocky  Mountain  Medical  Journal 


In  dietary  planning,  the  physician  may  prescribe  with 
complete  confidence  any  of  Borden's  nutritional 
preparations.  They  conform  at  all  times  to  the  most 
modern  concepts  of  nutritional  science,  and  are 
formulated  and  produced  with  meticulous  concern 
for  quality,  purity,  and  clinical  serviceability. 


BIOLAC,  approximating  human  milk  in  its  nutritional  content 
and  digestibility,  is  an  ideal  replacement  for  mothers’  milk. 

With  the  addition  only  of  ascorbic  acid,  it  becomes  a complete 
food  — “baby  talk  for  a good  square  meal”. 

MULL-SOY  is  a hypoallergenic  soy  concentrate  — for  those 
allergic  to  milk  — closely  resembling  cow’s  milk  in  all  its 
nutritional  values,  but  without  the  offending  animal  proteins. 
When  milk  becomes  “forbidden  food”,  Mull-Soy  offers 
a nutritionally  efficient  replacement. 

DRYCO  provides  a “master  key”  to  infant  nutrition  with  its 
wide  range  of  formula  flexibility  for  individual  needs. 

Its  high  protein,  low  fat,  intermediate  carbohydrate  ratio 
— for  use  with  or  without  added  carbohydrate  — makes  it  the 
“custom-formula”  food  for  all  infant  requirements. 

BETA  LACTOSE  is  a highly  palatable  and  readily  soluble 
formula  modifier  in  the  form  of  an  improved  milk  sugar, 
five  times  more  soluble  than  alpha  lactose.  Milk’s  natural 
carbohydrate  for  infants  and  adults  alike. 

KLIM  solves  the  problem  whenever  fluid  milk  is  indicated  in 
the  diet,  but  lack  of  availability  or  of  refrigeration  make 
its  use  impracticable.  This  superior  quality,  spray-dried, 
whole  milk,  with  soft  curd  properties  is  invaluable 
for  use  in  infant  feeding,  or  for  dietotherapy  in 
peptic  ulcer  and  other  special  adult  diets. 

The  nutritional  statements  of  this  advertisement  are  acceptable 
to  the  Council  on  Foods  and  Nutrition  of  the  A.  M.  A. 

These  Borden  Prescription  Products  ore  available  at  all 
pharmacies.  Full  detailed  professional  information 
gladly  supplied  on  request. 


BORDEN’S  PRESCRIPTION  PRODUCTS  DIVISION 

350  MADISON  AVENUE  • NEW  YORK  17,  N.  Y. 


for  July,  1949 


573 


Precautions 

To  avoid  serious  local  reactions  in  infants  from 
alum  precipitated  antigens,  the  following  tech- 
nical precautions  should  be  observed:  1.  Deep 
intramuscular  injections.  2.  Use  of  a clean  needle 
(having  none  of  the  material  in  the  lumen)  for 
each  injection.  3.  Introduction  of  a . small  air 
bubble  before  the  needle  is  withdrawn. 

UTAH 

State  Medical  Association 


Auxiliary 

ANNUAL  REPORT,  WOMAN’S  AUXILIARY 

Report  of  the  annual  meeting  of  the  House  of 
Delegates  of  the  Woman’s  Auxiliary  to  the  Utah 
State  Medical  Association,  held  at  the  Ben  Lo- 
mond Hotel  at  Ogden,  Utah,  May  12,  1949.  The 
following  persons  were  elected  as  incoming  of- 
ficers: 

President — Mrs.  John  Z.  Brown,  Salt  Lake 
City,  Utah. 

President-Elect — Mrs.  Orin  A.  Ogilvie,  Salt 
Lake  City,  Utah. 

First  Vice  President — Mrs.  Eugene  L.  Weimers, 
Provo,  Utah. 

Second  Vice  President — Mrs.  Warren  B.  West, 
Ogden,  Utah. 

Recording  Secretary — Mrs.  Juel  E.  Trowbridge, 
Boimtiful,  Utah. 

Corresponding  Secretary — Mrs.  Raymond  B. 
Maw,  Salt  Lake  City,  Utah. 

Treasurer — Mrs.  Vernon  L.  Stevenson,  Salt 
Lake  City,  Utah. 

Auditor — Mrs.  Leroy  V.  Broadbent,  Cedar  City, 
Utah. 

Historian — Mrs.  M.  J.  Seidner,  Ogden,  Utah. 

Mrs.  Luther  H.  Kice,  National  President  of 
the  Woman’s  Auxihary  to  the  American  Medical 
Association,  visited  Utah  on  May  25,  26,  and  27. 
She  met  with  officers  of  the  State  Medical  As- 
sociation as  v/ell  as  Auxiliary  officers. 

Mrs.  John  Z.  Brown,  Utah  Auxiliary  President, 
and  Mrs.  Silas  S.  Smith  entertained  Mrs.  Kice 
in  Salt  Lake  City.  As  the  guest  of  Mrs.  Brown, 
Mrs.  Kice  participated  in  the  women’s  activities 
held  in  connection  with  the  Ogden  Surgical  So- 
ciety meetings. 

MRS.  DAVID  B.  GOTTFREDSON, 
Press  and  Publicity  Chairman. 


PRESIDENT’S  REPORT  FOR  THE  YEAR 
1948-1949 

This  year  stands  out  in  retrospect  as  a friendly 
and  profitable  one  indeed.  It  was  off  to  a good 
start  at  the  State  Convention  last  September  2, 
3,  and  4 at  Cedar  City.  Amid  the  splendor  of 
the  Utah  Parks  and  under  the  capable  chair- 
manship of  Second  Vice  President  Mrs.  L.  V. 
Broadbent,  the  convention  broke  all  records  for 
attendance;  and  through  excellent  standards  of 
hospitality,  business  content  of  meetings,  and 
well-planned  activities  it  was  pronoimced  an  out- 
standing success.  It  was  here  the  projects  that 
were  to  be  carried  on  throughout  the  year  were 
presented  and  discussed.  Months  prior  to  the 
convention,  the  decision  had  been  reached  that 
the  bulk  of  our  time  and  energy  should  be  con- 
centrated on  two  main  issues  of  the  day,  namely, 
nurse  recruitment  and  legislation. 


In  preparation  for  an  extensive  nurse  recruit- 
ment program,  the  film,  “This  Way  to  Nursing,” 
was  purchased  by  the  Coronet  Club  of  Ogden 
and  presented  to  the  State  Medical  Auxiliary  to 
be  used  as  it  saw  fit  imder  the  capable  gmdance 
of  Mrs.  M.  J.  Seidner,  state  chairman.  The 
groundwork  was  laid  during  the  fall  and  winter 
months,  then  in  February  the  program  was 
launched  in  Cache  County  to  run  a state-wide 
course.  Mrs.  S.  M.  Budge  and  Mrs.  Hansen, 
two  Auxiliary  members,  worked  with  a public 
health  nurse  and  graduate  nurses  in  Logan 
to  conduct  a successful  campaign  in  the  three 
liigh  schools  in  that  district. 

During  March,  the  program  came  into  full 
swing  in  Weber  County  with  Mrs.  Douglas  C. 
Barker  at  the  helm.  The  newspaper  publicity 
was  informative  and  effective,  of  which  a com- 
plete coverage  has  been  filed  with  the  State 
Historian.  Fifteen  minute  radio  programs  dur- 
ing the  active  campaign  received  wide  public 
response.  The  Thomas  D.  Dee  Memorial  and  the 
St.  Benedict  Hospitals  prepared  a student  pro- 
gram which  was  presented  at  Morgan,  Davis, 
Box  Elder,  Bear  River,  Weber,  and  Ogden  High 
Schools.  The  material  used  in  skits,  speeches, 
and  original  songs  gave  a clear  picture  of  re- 
quirements necessary  ot  enter  training  schools, 
educational  advantages  offered  by  the  schools, 
and  positions  available  at  the  present  time  in 
the  various  fields  of  nursing.  The  entire  pro- 
gram struck  a responsive  chord,  for  256  senior 
girls  have  asked  for  further  information  to 
date  from  Weber  County  alone,  and  of  this 
number,  many  have  filled  in  applications  and 
asked  for  interviews. 

Ogden’s  student  program  was  taken  to  Utah 
County  by  request  during  April  and  presented 
to  junior  and  senior  high  school  students  within 
the  area.  Nirrsing  school  information  and  ap- 
plications were  placed  conveniently  at  the  reg- 
istrar’s office. 

In  May  the  program  will  be  completed  in  the 
southern  part  of  the  state.  Carbon  County  Aux- 
iliary is  planning  a tea  for  all  seniors  at  Price, 
North  and  South  Emery  High  Schools,  and  wiU 
display  bulletins  from  the  hospitals,  posters,  and 
information  questionnaires  for  all  those  inter- 
ested. Also  one  nursing  scholarship  is  available. 
In  Cedar  City  and  St.  George  the  Auxiliary  is 
working  with  the  public  health  nurses  to  arouse 
interest.  Training  school  bulletins  will  be  dis- 
tributed after  each  showing  of  the  film,  “This 
Way  to  Nursing.”  It  is  significant  to  note  that 
some  three  thousand  girls  will  have  seen  the 
film  by  the  completion  of  the  program. 

Mrs.  Seidner  sums  up  the  excellent  work  that 
has  been  done  this  year  in  the  following  way: 
“There  is  no  doubt  this  project  is  one  to  benefit 
the  general  public,  the  hospitals,  and  the  doctors. 
The  knowledge  that  the  Medical  Auxiliary  is 
willing  to  help  relieve  the  present  burden  is  a 
good  morale  builder  for  the  nursing  profession.” 
Also  she  leaves  the  following  recommendations 
for  next  year: 

1.  The  program  to  be  carried  out  in  the  schools 
on  the  basis  of  vocational  guidance  instead  of 
recruitment. 

2.  Each  county  nominate  a chairman  for  re- 
cruitment immediately  following  election  of  of- 
ficers so  she  may  familiarize  herself  with  the 
program. 

3.  Carefully  organize  for  a uniform  program 
throughout  the  state  and  be  ready  to  complete 
arrangements  by  the  end  of  March,  1950. 

The  State  Auxiliary  warmly  congratulates  her 
for  the  far-reaching  effects  of  her  work.  And 


574 


Rocky  Mountain  Medical  Journal 


Designs  developed  over  many 
years,  in  full  consultation  with 
obstetricians,  insure  ample 
support  for  the  abdominal 
musculature,  pelvic  girdle  and 
lumbar  spjne  without  con- 
strictionat  any  point.  All  Camp 
Supports  are  accurately  fitted 
about  the  pelvis.  Thus  theuter- 
us  is  maintained  in  better  po- 
sition, the  abdominal  muscles 
and  fasciae  are  conserved  and 
there  is  support  for  the  re- 
laxed pelvic  joints.  The  patient 
is  assisted  in  maintaining  bet- 
ter balance  in  the  course  of 
the  postural  changes  of  preg- 
nancy. Physicians  may  rely  on 
the  Camp-trained  fitter  for 
precise  execution  of  all 
instructions. 

If  you  do  not  have  a copy  of 
the  Camp  “Reference  Book  for 
Physicians  and  Surgeons”,  it 
will  be  sent  on  request. 


P 

SCIENTIFIC 

PRENATAL 

SUPPORTS 


THIS  EMBLEM  is  displayed  only  by  reliable  mferchants  in  your  community.  Camp  Scientific  Supports 
are  never  sold  by  door-to-door  canvassers.  Prices  are  based  on  intrinsic  value.  Regular  technical 
and  ethical  training  of  Camp  fitters  insures  precise  and  conscientious  attention  to  your  recommendations. 


S.  H.  CAMP  & COMPANY,  JACKSON,  MICHIGAN 

World’s  Largest  Manufacturers  of  Scientific  Supports 
Offices  in  New  York  • Chicago  • Windsor,  Ontario  • London,  England 


for  JuLYj  1949 


575 


as  the  Editor  of  the  Standard  Examiner  ob- 
served, “If  the  doctors’  wives  are  going  to  stand* 
behind  the  medical  profession  in  an  attempt  to| 
improve  health  standards,  socialized  medicine’ 
will  be  a long  time  in  coming.” 

In  the  field  of  legislation,  our  chairman,  Mrs. 
R.  F.  Hicken,  Mrs.  V.  L.  Stevenson,  and  Mrs. 
W.  R.  Middlemiss  had  an  exceptionally  active 
year.  They  attended  meetings  at  the  state  Cap- 
itol weekly  while  the  legislature  was  in  session, 
and  monthly  otherwise.  The  Utah  State  Medical 
Society  requested  cooperation  in  the  campaign 
for  the  enactment  of  a Basic  Science  Law.  This 
was  done  in  the  following  manner: 

1.  Active  support  was  enlisted  fromi  each  Aux- 
iliary in  the  state  in  contacting  legislators  and 
distributing  information. 

2.  Copies  of  the  proposed  Basic  Science  bill 
and  2,500  Basic  Science  pamphlets  were  mailed 
to  the  counties;.  Each  Auxiliary  member  placed 
five  of  these  in  key  positions  in  her  area. 

3.  The  State  and  the  Salt  Lake  County  Legis- 
lative Committees  worked  at'  the  capital  con- 
tacting legislators  personally,  and  were  present 
at  each  session  when  the  bill  was  being  dis- 
cussed. 

4.  Several  of  the  counties  conducted  round 
table  discussions  on  the  bill  and  invited  civic 
organizations  to  participate. 

The  Basic  Science  Bill  passed  the  Senate  but 
was  defeated  in  the  House.  In  spite  of  this, 
it  was  a triumph  for  our  committee  because  it 
was  the  first  time  the  bill  had  ever  been  called 
out  of  committee. 

In  addition,  500  pamphlets  on  national  legisla- 
tion were  mailed  to  each  Auxiliary  for  distribu- 
tion. Our  national  legislators  were  contacted 
by  letters  and  telegrams  in  opposition  to  S.B.  5, 
the  old  Wagner-Murray-Dingell  bill.  Most  sig- 
nificant of  all  is  the  fact  that  the  Utah  State 
Senate  was  the  fourth  in  the  Nation  to  go  on 
record  as  opposing  Socialized  Medicine.  Our 
legislative  committee,  together  with  that  of  the 
State  Medical  Society,  was  largely  responsible 
for  such  excellent  results.  We  extend  them  our 
deepest  gratitude. 

Archives  and  Biography  were  again  under  the 
chairmanship  of  Mrs.  Walter  Stookey.  The 
biographies  of  two  Weber  County  doctors,  Jo- 
seph R.  Morrell  and  Edward  I.  Rich,  have  been 
placed  in  the  files.  Also,  a book,  “History  of 
Midwifery  in  Utah,”  by  Claire  Wilcox  Noall,  is 
near  completion  to  be  entered  in  our  archives. 

The  Benevolent  Memorial  Loan  Fund  has  been 
steadily  growing.  Mrs.  S.  M.  Budge  reports  a 
net  receipt  of  $339.72  from  private  contributions 
plus  state  and  county  projects,  which  brings  the 
total  well  over  $6,000. 

Although  more  Hygeia  subscriptions  were  sold 
this  year  than  last,  Mrs.  Vernal  H.  Johnson, 
Hygeia  chairman,  announced  that  our  percentage 
quota  fell  from  194  per  cent  to  99  per  cent 
because  of  the  sudden  increase  in  Auxiliary 
membership  on  which  the  contest  is  based.  The 
tabulations  are  as  follows: 


Credits 

Quota  Received 


Carbon  18  43 

Central 16  16  4/12 

Salt  Lake  246  155  2/12 

Utah  55  85 

Weber 55  86  9/12 


Mrs.  W.  H.  Anderson,  Bulletin,  announced 
that  State  Board  personnel  and  many  coimty 
officers  had  sent  in  subscriptions. 

To  the  Public  Relations  Chairman,  Mrs.  Frank 
Spencer,  went  the  responsibility  not  only  of 
working  with  the  Legislative  Committee  but  also 
conducting  the  Essay  Contest,  “Why  the  Private 
Practice  of  Medicine  Provides  This  Country 
With  the  Finest  Medical  Care.”  By  the  first  of 
February,  your  State  President  had  written  let- 
ters to  the  principals  of  the  seventy-five  high 
schools  in  Utah  informing  them  of  the  contest 
and  inviting  the  participation  of  their  students. 
Asi  a follow-up,  Mrs.  Spencer  instructed  Presi- 
dents of  each  county  as  to  the  rules  of  the  con- 
test and  prizes  to  be  awarded.  They,  in  turn, 
carried  it  on  to  the  various  high  schools  in  their 
districts.  The  project  has  now  run  its  course. 
The  winning  essays  from  each  county  are  now 
gathered  together  to  be  judged  by  a state  com- 
mittee composed  of  a doctor,  a faculty  member, 
and  a newspaper  man.  These  winners  will  be 
awarded  prizes  and  sent  on  to  national  com- 
petition. Mrs.  Spencer  has  dealt  skillfully  with 
many  problems  and  deserves  our  highest  com- 
mendation. 

Last,  but  by  no  means  least,  Mrs.  John  Z. 
Brown  has  been  hard  at  work  as  State  Organiza- 
tion Chairman.  Through  her  diligence  one  more 
county.  Southern  Basin,  has  been  organized. 
This  brings  the  total  to  seven,  with  only  one  re- 
maining unorganized.  It  gives  us  great  satisfac- 
tion to  note  a paid-up  membership  of  517  doc- 
tors’ wives. 

With  pride  and  gratitude,  I thank  my  officers, 
my  chairmen  of  standing  committees,  and  the 
presidents  and  component  parts  of  the  various 
counties  for  their  loyal  support  and  imtiring 
efforts.  I feel  that  through  them  entirely  we 
can  mark  the  end  of  an  exceptionally  brilliant 
and  well  integrated  year. 

Respectfully  submitted, 

HELEN  A.  HARDING  (MRS.  GLEN  F.), 
President,  Auxiliary  to  the  Utah  State 
Medical  Association. 


Obituary 

WILLIAM  T.  CANNON 

Dr.  William  Tenney  Cannon,  78,  2043  E.  27th 
South,  Salt  Lake  City,  Utah,  retired  physician 
and  former  Bishop  for  the  Church  of  Jesus  Christ 
of  Latter-Day  Saints,  died  at  his  residence  Sat- 
urday, May  21,  1949,  after  a lingering  illness. 

He  attended  medical  college  in  Philadelphia, 
graduating  in  1898  and  returned  to  Utah  where 
he  practiced  in  Brigham  City  a short  time  be- 
fore coming  to  Salt  Lake  City. 

Dr.  Cannon  was  a member  of  the  Salt  Lake 
County  Medical  Society  and  the  Utah  State 
Medical  Association.  Dr.  Cannon  served  as  an 
L.  D.  S.  Missionary  to  Belgium  from  1899  to 
1901  and  to  Hawaii  in  1945  to  1946,  after  which 
he  retired  from  medical  practice. 


Dr.  T.  E.  Beyer  of  Denver  attended  a meeting 
of  the  Postgraduate  Club  at  the  University  of 
Argentine,  Buenos  Aires,  on  March  30,  1949.  He 
presented  a paper  entitled  Sialography,  which 
had  appeared  in  this  Journal  during  1946. 


WANTADS 

FOR  SALE 

Three  stand  model  gas  machines  less  than  one  year 
old  for  sale.  Contact  Dr.  E.  T.  Arnn,  Ward  12, 
V.A.  Hospital,  Fort  Logan,  Colo. 


576 


Rocky  Mountain  Medical  Journal 


even  after^Q  , a woman's  work  is  never  done... 

Dishes,  dustpans,  a thousand  details . . . the  three  "d's"  of 
household  drudgery. ..  ore  challenge  enough  at  any  age, 
but  a stack  of  dinner  dishes  can  look  mountain  high  to  the 
woman  in  the  menopause.  This  is  a disquieting  aspect  of  the 
daily  life  of  such  patients  that  physicians  can  bring  into  proper 
perspective  with  '"^Premarin." 

^^Premarin"  therapy,  it  has  been  found,  has  in  it  a certain  "plus" 
that  produces  a sense  of  well-being  in  most  women.  ^'"Premarin"  quickly 
relieves  the  symptoms  of  the  menopause.  It  is  orally  active,  and  is  rapidly 
absorbed  from  the  intestine. 


ft 


While  sodium  estrone  sulfate  is  the  principal  estrogen 
in  "Prerttarin,"  other  equine  estrogens ...  estradiol, 
equilin,  equilenin,  hippulin  . . .are  probably  also  pres- 
ent in  varying  amounts  as  water  soluble  conjugates. 


ESTROGENIC  SUBSTANCES  (WATER  SOLUBLE) 
also  known  as  CONJUGATED  ESTROGENS  (aquine) 


Ayerst,  McKenna  & Harrison  Limited  22  East  40th  Street,  New  York  16,  New  York 

4901 


for  July,  1949 


577 


Advertisement 


From  where  I sit 
ly  Joe  Marsh 


How’s  Your 
Listening  Time? 

Buck  Howell  and  I were  in  Baleville 
last  week.  Dropped  in  at  Bob’s  diner 
where  some  friends  were  sitting  around 
talking  about  whether  to  sell  their  hogs 
now  or  wait. 

Right  away,  Buck  plunges  right  into 
the  discussion.  He’s  lecturing  away 
when  suddenly  they  all  stand  up  and 
start  stomping  their  feet  like  it  w’as 
an  Indian  war  dance. 

I’m  flabbergasted.  But  Buck  only 
looked  sheepish:  “Guess  I was  talking 
again,  when  I should-of  been  listen- 
ing. When  a person’s  talking  time  gets 
out  of  line  with  his  listening  time 
around  here,  the  gang  reminds  him 
by  standing  up  and  stomping.” 

From  where  I sit,  that’s  a good  sys- 
tem. Everyone  has  a right  to  his  opin- 
ions— but  others  have  a right  to  theirs 
— whether  it’s  deciding  between  to  sell 
or  not  to  sell,  apple  or  cherry  pie,  or  a 
glass  of  beer  or  cider.  Life’s  more  in- 
teresting that  way,  and  hang  it  if  you 
don’t  sometimes  learn  something! 


Copyright,  19 UQ,  United  States  Brewers  Foundation 


Juberculosis  Abstracts 

Issued  Monthly  by  the  National  Tuberculosis 
ssociation 

Vol.  XXII  JULY,  1»49  Xo.  7 

The  screening  of  large  numbers  of  people  tor  tuber- 
culosis by  the  use  ot  chest  x-rays  has  resulted  in  an 
appreciable  number  of  cases  ot  primary  carcinoma  ot 
the  lung  being  tound  at  a stage  in  which  surgical  in- 
tervention may  be  ettective.  As  with  tuberculosis, 
prompt  detection  and  treatment  before  symptoms  ap- 
pear give  the  greatest  hope  tor  complete  recovery. 


CANCER  OF  THE  LUNG 

Cancer  of  the  lung,  its  detection  and  treatment,  is 
so  closely  linked  to  the  modem  attack  upon  tubercu- 
losis that  every  physician  and  surgeon,  every  social 
worker  and  educator^,  interested  in  the  latter  disease 
should  likewise  be  well  informed  about  primary  cancer 
of  the  lung.  Many  skilled  observers  believe  that  this 
disease  actually  is  increasing  in  incidence:  others  argue 
that  it  is  merely  being  identified  more  accurately  in 
recent  decades.  All  agree  that  it  is  one  of  the  most  fre- 
quently encountered  and  one  of  the  most  important 
types  of  malignant  disease  encountered  in  the  male  sex, 
probably  second  only  to  cancer  of  the  stomach. 

There  is  no  explanation  for  the  remarkable  fact  that 
primary  cancer  of  the  lung  is  six  to  eight  times  as 
common  in  men  as  it  is  in  women.  Its  amazing  fre- 
quency among  miners  working  with  radioactive  mate- 
rials in  certain  German  mines  may  be  significant  to  the 
coming  age  of  atomic  warfare  and  atomic  power.  Its 
possible  relationship  to  potentially  carcinogenic  agents 
in  road  building  materials  and  exhaust  products  of  in- 
ternal combustion  motors  has  been  questioned  and  de- 
nied. The  actual  causes  of  cancer  of  the  lung  are  as 
obscure  as  are  the  causes  of  other  types  of  malignant 
growth. 

The  effective  surgical  treatment  of  primary  cancer 
of  the  lung  has  developed  largely  within  the  past  ten 
years,  aided  by  new  technics  and  by  the  protective 
value  of  modern  antibiotics.  Many  surgeons  received 
special  training  and  experience  in  thoracic  surgery  dur- 
ing the  recent  war  and  hence  the  availability  of  such 
treatment  has  been  greatly  increased  within  the  past 
five  years.  Surgical  mortality  rates  are  still  declining 
steadily,  so  that  exploration  of  the  chest  can  be  per- 
formed almost  as  freely  and  almost  as  safely  as  surgi- 
cal exploration  of  the  abdomen. 

Chemotherapy  of  cancer  has  not  yet  come  of  age 
but  steady  progress  has  been  recorded  in  recent  years 
and  never  before  have  so  many  diligent  and  skilled 
scientists  devoted  so  much  energy  to  a medical  prob- 
lem. Indeed,  no  previous  medical  problem  could  be 
more  significant  to  the  human  race. 

As  with  other  cancers,  early  diagnosis  is  of  para- 
mount importance:  and,  as  with  other  pulmonary  dis- 
eases, x-ray  examination  of  healthy  persons  and  of 
those  with  ecirly  respiratory  symptoms  is  the  most  use- 
ful screening  procedure.  However,  early  cancers  of 
the  lung  often  cast  indefinite  or  confusing  shadows 
upon  x-ray  films,  simulating  tuberculosis,  pneumonia, 
lung  abscess  or  almost  any  other  type  of  localized 
pulmonary  infiltration.  Bronchoscopy  will  reveal  the 
early  cancers  which  originate  in  larger  bronchi,  espe- 
cially those  of  the  lower  lobes  of  the  lungs.  Recently 
the  microscopic  examination  of  sputum'  for  cancer  cells 
has  gained  in  accuracy  and  in  popularity,  but  few 
trained  diagnosticians  in  this  difficult  technic  of  exam- 
ination are  available  today. 

Every  large  chest  x-ray  survey  project  brings  to 
light  cases  of  primary  cancer  of  the  lung,  and  these 
may  prove  to  be  the  most  readily  curable  if  detected 
and  treated  before  symptoms  have  developed  and  be- 


578 


Rocky  Mountain  Medical  Journal 


Send  for 
Your  FREE 
Copy 
TQclay 


• How  are  repository  penicillin 
preparations  best  used? 


• Which  kinds  of  infections  will 
respond  to  low  levels  of  penicillin? 


These  questions  and  many  others  are  answered  in  “Repository  Penicillin 
Therapy,"  a new  36-page  book  prepared  by  the  Medical  Staff  of  Abbott 
Laboratories  to  help  clarify  the  penicillin  picture.  This  book  covers  recent 
and  significant  work  by  leading  investigators  in  the  field  of  penicillin 
research  and  therapy.  Numerous  charts  illustrate  the  text.  The  bibliography 
contains  67  references. 

For  your  FREE  COPY  of  this  up-to-date,  informative  manual,  simply  fill 
out,  clip  and  return  the  coupon  below.  Do  it  now  before  it  slips  your  mind. 


ABBOTT 

! Professional  Service  Deporlment  W 

i ABBOTT  LABORATORIES  ' 

LABORATORIES 

1 North  Chicago,  Illinois 

1 

North  Chicigo,  Illinois 

1 Penicillin  Therapy”: 

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; STMJ  27-749 

• Why  should  a busy  practicing 
physician  bother  about  understand- 
ing the  factors  that  influence  peni- 
cillin blood  curves? 


• Are  blood  levels  after  penicillin 
procaine  in  aqueous  suspension 
similar  to  those  after  penicillin  pro- 
caine in  oil? 


* Can  penicillin  G potassium  in  aque- 
ous solution  be  used  for  repository 
therapy? 


for  July,  1949 


579 


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fore  the  disease  has  proceeded  to  an  inoperable  stage. 
Some  of  these  cases  have  been  referred  to  tuberculosis 
sanatoriums  under  erroneous  diagnosis  or  for  observa- 
tional purposes.  Seinatoriuni  physicians  are  learning 
to  view  with  suspicion  any  localized  pulmonary  lesion, 
especially  if  somewhat  circumscribed  and  progressive 
and  if  tubercle  bacilli  cannot  be  demonstrated. 

Modem  cultural  technics  for  isolating  tubercle  bacilli 
are  sufficiently  accurate  that  negative  examinations  of 
secretions  have  real  value  in  excluding  tuberculosis 
and  in  increasing  the  suspicion  of  cancer.  But  occa- 
sionally the  shadow  cast  by  xt-ray  is  sufficiently  sug- 
gestive of  cancen  even  when  the  lesion  is  small,  to 
justify  exploratory  surgery  without  awaiting  the  pro- 
longed incubation  of  cultures.  As  with  all  other  medi- 
cal decisions  which  affect  the  life  of  the  patient,  the 
physician  must  have  the  skill  and  experience  to  bal- 
ance the  risk  of  early  radical  action  against  the  some- 
times greater  risk  of  delay  and  observation.  Wliether 
or  not  a curative  operation  can  be  performed  may  de- 
pend upon  whether  it  is  done  within  the  first  few  weeks 
after  detection  of  a lesion. 

Physicians  in  general  practice  and  specialists  in  in- 
ternal medicine  are  learning  that  repeated  attacks  of 
pneumonia  may  actually  be  obstructive  pneumonitis 
caused  by  the  blocking  effect  of  a bronchial  cancer, 
and  that  symptoms  may  be  relieved  promptly  but  only 
temporarily  by  penicillin  treatment.  They  have  learned 
that  every  case  of  pneumonia  should  be  studied  by 
x-ray  and  followed  by  repeated  films  until  the  pos- 
sibility of  an  obstructing  cancer  is  excluded.  The  ex- 
pectoration of  blood  is  more  typical  of  cancer  than  it 
is  of  tuberculosis.  Wheezing  respiration  caused  by  an 
obstructing  bronchial  cancer  may  simulate  asthma  for 
a few  weeks  or  months.  Pleurisy  caused  by  cancer  ex- 
tending to  the  pleural  surface  of  the  lung  may  at  first 
simulate  the  pleurisy  of  tuberculosis  or  of  pneumonia. 

The  campaign  against  cancer,  like  the  campaign 
against  tuberculosis,  must  depend  upon  an  enlightened 
pilblic,  a skillful  and  alert  medical  profession,  and  an 
inspired  corps  of  scientific  investigators.  The  universal 
use  of  xi-ray,  almost  to  the  point  of  apparent  extrava- 
gance, would  seem  to  be  required  if  any  large  propor- 
tion of  cases  of  cancer  of  the  lung  are  to  be  detected 
in  time  to  permit  curative  treatment  by  present-day 
methods. 

Cancer  oi  the  Lung,  H.  Corwin  Hinshaw,  M.D.,  The 
NT  A Bulletin,  February,  1949. 


FOR.  SAJLE 

1 MAICO  STEiTHBTRON  in  good  condition,  $150. 
Contact  Dr.  Wm.  H.  Lamberson,  Colorado  Springs, 
Colorado. 


FOR  RENT — 3-room  office  for  rent.  Fully  equipped; 
x-ray;  excellent  location  on  two  bus  lines.  BAst 
5525. 


FOR  SADE — Eye,  Ear,  Nose  and  Throat  Equipment 
and  Good  Will.  Retiring.  3425  South  Broadway, 
Englewood.  Phone  SlTnset  l-6886‘. 


580 


Rocky  Mountain  Medical  Journal 


How  much  longer  do  you  expect 
to  practice? 

Might  it  be  10,  15  or  20  years? 

Will  you  average  $750  a month — 
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These  are  Incomes  worth  Insuring! 
CAN  YOU  insure  your  Income  for 
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YES!  You  can  insure  against  loss  of  Income  up  to  75% 

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Total  Permanent  Disability  Benefits  of  $300  a month  thereafter  for  Life 
Loss  of  Hands,  Feet  or  Eyes  $5,000  and  $300  a month  for  Life 
Accidental  Death  Benefits  of  $7,500 — ^Travel  Acc’d  $12,500 
(Adjusted  benefits  for  disabilities  occuring  after  age  60) 


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Unusually  Complete  Protection 

Provides  Monthly  Benefits  from  1st  Day  to  Life. 
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for  July,  1949 


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GRADUATE  REGISTERED  NURSES 

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Filled“In£ormation  on  All 
Nursing  Service 

This  registry  is  endorsed  by  the 
Colorado  State  Graduate  Nurses’ 
Association  and  American  Nurses’ 
Association 

^ 

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Furnished  U pan  Request 

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SOUND  PLATFORM  PLANKS 


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Your  utility  services  are  th”* 
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® Public  Service  Company  of  Colorado  ® 


582 


Rocky  Mountain  Medical  Journal 


PATIENT  COMFORT 

in  gastro-intestinal  intubation 


with 


K AS  LO  W Tu  BES 


^atin-smooth  Kaslow  plastic  Tubes  make 
gastro-intestinal  intubation  easier  for  both  you  and 
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to  nasal  and  pharyngeal  tissues. 

Extensive  clinical  experience  has  already 
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opportunity  for  effective  therapy . . . 
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Cat.  No.  single  lumen  stomach  tube 

Cat.  No.  m single  lumen  gastro-intestinal  tube 

Cat.  No.  OK  double  lumen  stomach  irrigation  tube  ^ 

All  Kaslow  Tubes  are  mode  of  satin-smoolh,  transparent,  odorless 
plastic.  They  resist  kinking  or  twisting  and  have  perforations  orranged 
spirally  to  maintain  flow  no  matter  what  position  the  tube  assumes 
ofter  insertion. 

Kaslow  Tubes  are  now  avoilable  from  your  regular  Baxter  supplier. 

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No  Test  Tubes  • No  Measuring  • No  Boiling 

Diabetics  welcome  “Spot  Tests”  (ready  to  use  dry 
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No  test  tubes,  no  boiling,  no  measuring;  just  a little 
powder,  a little  urine — color  reaction  occurs  at  once 
if  sugar  or  acetone  is  present. 

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FOR  DETECTION  OF  FOR  DETECTION  OF 

SUGAR  IN  THE  URINE  ACETONE  IN  THE  URINE 


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COLOR  REACTION  IMMEDIATELY 


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WRITE  FOR  DESCRIPTIVE  LITERATURE 


A carrying  case  containing  cne 
vial  of  Acetone  Test  (Denco) 
and  one  vial  of  Galatest  is  now 
available.  This  is  very  conven- 
ient for  the  medical  bag  or  for 
the  diabetic  patient.  The  case 
also  contains  a medicine  dropper 
and  a Galatest  color  chart.  This 
handy  kit  or  refills  of  Acetone 
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obtainable  at  all  prescription 
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tjdee^D’ne  {denco).  , 

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prescribe  Bromural  for  daytime  sedation^ 
one  tablet  every  three  to  five  hours.  For 
sleep,  2 or  3 tablets  upon  retiring  or 
when  wakeful  during  the  night. 

BROMURAL,  brand  of  Bromisovalum,  mono- 
bromisovalerylurea,  is  available  as  5-grain  tab- 
lets and  in  powder  form. 


ORANGE,  NEW  JERSEY 


584 


Rocky  Mountain  Medical  Journal 


curd  of  Similac— 
0 grams 
truly  a fluid  food 


curd  of  breast  milk  — 
0 grams 

truly  a fluid  food 


SIMILAC  DIVISION  ‘MAR  DIETETIC  LABORATORIES,  INC. 


SIMIKAC 

SO  similar  to  human  breast  milk 
that  1 

mere  is  no 
closer 

equivalent* 

* Similac  protein  has  been  so  modified 

* Similac  fat  has  been  so  altered 

* Similac  minerals  have  been  so  adjusted 

that 

* There  is  no  closer  approximation  to 
mother’s  milk. 

curd  of 
powdered  milk 
especially  prepared 
for  infant  feeding  — 

12  grams 

COLUMBUS  16.  OHIO 


for  Jtjly,  1949 


585 


MALONE  DRUG  CO. 

Bonita  Pharmacy 

New,  Modern,  Drug  Store  Service 

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PRESCRIPTIONS  A SPECIALTY 

Prescription  Pharmacists 

FREE  DELIVERY 

6th  Avenue  at  St.  Paul  Street 

100  So.  Broadway  SPruce  6226 

“RIGHT-A-WAY”  SERVICE 

Denver,  Colorado 

GERALD  P,  MOORE,  Manager 

Phone  FRemont  2797 

YOU  ARE  INVITED  TO  VISIT  OUR 

50  ^eard  of  ^tLicai  Prescription 

NEW  MODERN  STORE 

Conveniently  Located  to  Meet  the  Needs 

Service  to  the  2)octorS  of  Pke^enne 

of  the  Doctor 

OL 

☆ 

f^L^ilciand  &' ^ur^eond  C^o. 

ROEDEL’S 

Metropolitan  Bldg. 

PRESCRIPTION  DRUG  STORE 

221  Sixteenth  Street  TAbor  01S6 

DENVER 

CHEYENNE,  WYOMING 

w 

Qolorado  Springs  {Psychopathic  Hospital 

A Private  Hospital  tor  Nervous  and  Mental  Diseases 

Situated  in  a beautiful  valley  two  miles  south  of  Colorado  Springs,  which  is  nationolly  known  as  « health 
center.  New  building  lor  mild  cases  of  Functional  Neurosis,  affording  complete  classification  of  plants. 
Home-like  surroundings,  scientific  medical  treatment  and  nursing  care.  Booklet  and  rates  on  application. 

C.  I*.  Rice,  Smperinteiideiit,  Colorado  SparingB,  Colorado 


586 


Rocky  Mountain  Medical  Journal 


A Significant  Advance 
in  ANTIBIOTIC  THERAPY 


Note  these  five  favorable  attributes 
of  Dihydrostreptomycin  Merck 

(1)  Low  incidence  of  vestibular  disturbances 

(2)  Significantly  less  toxic 

(3)  Less  frequent  allergic  manifestations 

(4)  Highly  purified 

(5)  Undiminished  antibacterial  activity  against  Mycobacterium  tuberculosis 


Anew,  highly  purified  antibiotic, 
chemically  distinct  from  strepto- 
mycin, with  greatly  reduced  neu- 
rotoxicity, Dihydrostreptomycin 
Merck  is  especially  useful  in  cases  re- 
quiring relatively  high  dosage,  such  as 
miliary  tuberculosis  and  tuberculous 
meningitis. 

It  can  be  used  interchangeably  for 
intramuscular  therapy  with  Strepto- 
mycin Calcium  Chloride  Complex 
Merck  or  other  forms  of  streptomycin. 

Descriptive  literature  is  yours  for  the  asking. 


LOW  INCIDENCE 
OF  EIGHTH  CRANIAL 
NERVE  DAMAGE 


MERCK  & CO.,  Inc.  RAHWAY,  N.  J. 


for  July,  1949 


587 


ACCIDENT  - HOSPITAL  - SICKNESS 


INSURANCE 

For 


Physicians,  Surgeons,  Dentists  Exclusively 

AIL 

PREMIUMS 

COME  FROM 


$5,000.00  accidental  death  $8.00 

$25.00  weekly  ladenmlty,  aeddent  and  elcknesa  Quarterly 

$10,000.00  accidental  death  $16.00 

$50.00  weekly  indeamlty,  aeddent  and  deknees  Quarterly 

$15,000.00  accidental  death  $24.00 

$T5.00  weekly  Indemnity,  aeddent  and  deknees  Quarterly 

$20,000.00  accidental  death  $32.00 

$100.00  weekly  Indemnity,  aeddent  and  sickne.ss  Quarterly 


Cost  has  never  exceeded  amounts  shown. 

ALSO  HOSPITAL  EXPENSE  FOR  MEMBERS,  WIVES  & CHILDREN 


85c  out  of  each  $1.00  gross  income  used  for 
members^  benefit 


$3,700,000.00  $15,700,000.00 

INVESTED  ASSETS  PAID  FOR  CLAIMS 

$200,000.00  deposited  with  State  of  Nebraska  for  protection  of  our  members. 

Disability  need  not  be  incurred  in  line  of  duty — 
benefits  from  the  beginning  day  of  disability 

PHYSICIANS  CASUALTY  ASSOCIATION 
PHYSICIANS  HEALTH  ASSOCIATION 


47  ycors  under  the  same  management 
400  XAtlonnl  flsrT^k  RiiilHinSo  Oni»hfl  *2,  !VehraniEa 


American 

Ambulance 

Company 

THE  FINEST  OF 
CARE  AND  SERVICE 

Oxygen  Equipped 
Cadillacs 

Now  Radio  Telephone  Controlled 


2045  DOWNING  TAbor  2261 

DENVER 


DL 

BROWN  SCHOOLS 

For  Exceptional  Children 

Four  distinct  units.  Tiny  Tots  through 
the  Teens.  Ranch  for  older  boys.  Spe- 
cial attention  given  to  educational  and 
emotional  difficulties.  Speech,  Music, 
Arts  and  Crafts.  Full  time  Psychologist. 
Under  the  daily  supervision  of  a Certi- 
fied Psychiatrist.  Registered  Nurses. 
Private  swimming  pool,  fireproof 
building.  View  Book.  Summer  Camp. 
Approved  by  State  Division  of  Special 
Education. 

BERT  P.  BROWN 

President 

Paul  L.  White,  M.D.,  F.A.P.A., 
Medical  Director 

P.  0.  Box  4008,  Austin,  Texas 


The  Craving  for  Candy  Often  Is 

A CALL  FOR  ENERGY 


Recommend  Brecht’s 

For  Your  Patients  . . . 


SUGAR  PliUMS  . . . tenderest  of  fruit-flav- 
ored Jelly  Candles,  made  with  sugar,  corn  * 
syrup,  dextrose,  citrus  fruit  pectin,  U,  S. 
Certified  Colors.  Cellophane-topped  Party 
Packages. 

PANTRV  SHEILF  . . . delicious  hard  candies 
in  many  flavors.  Refreshing  fruit  drops, 
crunchy  filled  wafers  . . . flavor  sealed — 
in  glass  jars. 

DAINTY  STICKS  ...  SO  delicious  and  pure. 
Made  from  sugar,  dextrose,  corn  syrup,  fin- 
est flavorings,  U.  S.  Certified  Colors,  As- 
sorted flavors. 


588 


Rocky  Mountain  Medical  Journal 


FROM  SECRETARY  OF  DEFENSE  LOUIS  JOHNSON 


Your  personal  help  is  needed  to  avert  a serious 
threat  to  our  national  security! 

By  the  end  of  July  of  this  year  we  will  have 
lost  almost  one-third  of  the  physicians  and 
dentists  now  serving  with  our  Armed  Forces. 
Without  an  increased  inflow  of  such  per- 
sonnel, the  shortage  will  assume  even  more 
dangerous  proportions  by  December  of  this 
year. 

These  losses  are  due  to  normal  expiration  of 
terms  of  service.  The  professional  men  who 
are  leaving  the  Armed  Forces  during  this 
critical  period  are  doing  so  because  they 
liave  fulfllled  their  duty-obligations  and  have 
earned  the  right  to  return  to  civihan  practice. 

Without  suflacient  replacements  for  these 
losses,  we  cannot  continue  to  provide  ade- 
quate medical  and  dental  care  for  the  almost 
1,700,000  service  men  and  women  who  are 
the  backbone  of  our  nation’s  defense. 

normal  procuroment  rhannels  will  not  provide 
sufficient  replacements! 

To  alleviate  this  critical,  impending  shortage 
of  professional  manpower  in  the  three  serv- 
ices, I am  urging  aU  physicians  and  dentists 
who  were  trained  under  wartime  A.  S.  T.  P. 
and  V-12  programs  under  government 
auspices  or  who  were  deferred  in  order  to 
complete  their  training  at  personal  expense, 
and  who  saw  no  active  service,  to  volunteer 
for  a two-year  tour  of  active  duty,  at  once! 


We  have  written  personally  to  more  than 
10,000  of  you  in  the  past  weeks  urging  such 
action.  The  response  to  this  appeal  has  not 
been  encouraging,  and  our  Armed  Forces 
move  rapidly  toward  a professional  man- 
power crisis! 

Many  responses  have  been  negative,  but 
worse — a great  number  of  doctors  have  not 
replied.  It  is  urgent  that  we  hear  from  you 
immediately! 

We  feel  certain  that  you  recognize  an  obligation 
to  your  fellow  men  as  well  as  to  your  profession 
in  this  matter.  We  are  confident  that  you  will 
fulfill  that  obligation  in  the  spirit  of  public 
service  that  is  a tradition  with  the  physician 
and  dentist. 

There  is  much  to  be  said  for  a tour  of  duty 
with  any  of  the  Armed  Forces.  You  will 
work  and  train  with  leading  men  of  your 
professions.  You  will  have  access  to  abun- 
dant clinical  material;  have  the  best  medical 
and  dental  facilities  in  which  to  practice. 
You  will  expand  your  whole  concept  of  hfe 
through  travel  and  practice  in  foreign  lands. 
In  many  ways,  a tom:  of  service  will  be 
invaluable  to  you  in  later  professional  hfe! 

Volunteer  now  for  active  duty.  You  are  urged 
to  contact  the  Office  of  Secretary  of  Defense  by 
collect  wire  immediately,  signifying  your  ac- 
ceptance and  date  of  availability.  Your  services 
are  badly  needed.  Will  you  offer  them? 


for  July,  1949 


589 


LIVERMORE  SANITARIUM 


• The  Hydropathic  Department 
devoted  to  the  treatment  of  gen- 
eral diseases,  excluding  surgical 
and  acute  infectious  cases.  Special 
attention  given  functional  and  or- 
ganic nervous  diseases.  A well 
equipped  clinical  laboratory  and 
modern  X-ray  Department  are  in 
use  for  diagnosis. 


• The  Cottage  Department  (for 
mental  patients)  has  its  own  fa- 
cilities for  hydropathic  and  other 
treatments.  It  consists  of  small 
cottages  with  homelike  surround- 
ings, permitting  the  segregation  of 
patients  in  accordance  with  the 
type  of  psychosis.  Also  bungalows 
for  individual  patients,  offering 
the  highest  class  of  accommoda- 
tions with  privacy  and  comfort. 


GENERAL  FEATURES 

Climatic  advantages  not  excelled  in  United  States.  Beautiful  grounds  and  attractive  surrounding  country. 

Indoor  and  outdoor  gymnastics  under  the  charge  of  an  athletic  director.  An  excellent  Occupational  Department. 

A resident  medical  staff,  A large  and  well-trained  nursing  staff  so  that  each  patient  is  given  careful  individual  attention. 


Information  and  circulars  upon  request. 

Address:  O.  B.  JENSEN,  M.D. 
Superintendent  and  Medical  Dirertor 
Livermose,  California 
Telephone  313 


CITY  OFFICES: 


San  Francisco 
450  Sutter  Street 
GArfieid  1-5040 


Oakland 

1624  Franklin  Street 
GLencourt  1-5988 


590 


Rocky  Mountain  Medical  Journal 


rRESH  AIR  for  FIFTY  ROOMS 


OZlUM  r-ljfeshener 

!?c"  Setely  eliminates.^  ^ 

obiectionable.  that 

?alt%cting  air  ba  S 
'SS‘^3  appreciate. 


mcr 


BS?t^glgysaESSiigi^g8«5?>^^ 


GEO.  BERBER!  & SONS,  Inc. 

1524  Court  Place 
Denver  2,  Colo. 

AL.  0408 


for  July,  1949 


591 


RELIABLE  DRUGGISTS 

PATRONIZE  DENVER’S  INDEPENDENT  DRUGGISTS 


WE  RECOMMEND 

COVWWRY  CLUB 
PHARMACY 

PRESCRIPTION  SPECIALISTS 

1700  E.  6th  Ave.  EAst  7743 

Denver,  Colorado 

We  Recommend 

Kineaid’s  Pharmacy 

JESS  L.  KINCAID,  Prop. 

Prescriptions,  Biologicals 
and  Fine  Cosmetics 

7024  W.  Colfax  Ave. 

Phone  Lakewood  436 

LAKEWOOD,  COLORADO 

ROBERTS  PHARMACY 

East  23  rd  Ave.  at  Onedio  St. 

Phone  DExter  9411 

D.  Lyall  Roberts,  Prop. 

East  Denver's  Newest  Neighborhood  Drug  Store 
Takes  Pleasure  to  Fill  the  Needs  of  Your  Pa- 
tients. 

Prompt  Free  Delivery  Service 

Our  Prescription  Stock  Is  Complete 

We  Recommend 

EARIVEST  DRUG  COMPANY 

T.  H.  BRAYUKIN,  Prop. 

PRESCRIPTION  SPECIALISTS 
Prompt  Delivery  Service 

1699  Broadway  Phone  KEystone  7237 

Denver,  Colorado 

“Conveniently  Located  for  the  Doctor’" 

HYDE’S  PHARMACY 

ACCURATE  PRESCRIPTIONS 

Chas  W.  Hyde,  Prop. 

Rocky  Mountain  Distributor  for  Sherman 
Biologpcals  and  Pharmaceuticals 

Free  Deliveries 

629  16th  St.  (Mack  Bldg.)  KE.  4811 

Doyle's  Pharmacy 

particular  ^hruffUt** 

East  17th  Ave.  at  Grant  KE.  5987 

21  Years  in  the  Heart  of  North  Denver 

GUIDO  SHUMAKE  DRUGS 

(Formerly  Otto  Drug  Co.) 

PRESCRIPTIONS  ACCURATELY 
COMPOUNDED 

Free  Delivery  Service 

West  38th  Ave.  and  Clay  Denver,  Colo. 

Phone  GRand  9934 

We  Recommend 

BONNIE  BRAE 

DRUG  COMPANY 

Alfred  C.  Andersen,  Owner  and  Manager 
Prescriptions  Accurately  Compounded 
Drugs  - - - Sundries 

FREE  IMMEDIATE  DELIVERIES 

ON  EMERGENCY  PRESCRIPTIONS 

763  South  University  Boulevard 

Phone  RAce  2874  — Denver,  Colorado 

WE  RECOMMEND 

Wliittaker’s  Pkarmacy 

“The  Friendly  Store” 

PRESCRIPTION  SPECIALISTS 

West  32nd  and  Perry,  Denver,  Colo. 
Phone  GLendale  2401 

22  Years  in  North  Denver 

OTTO  DRUG  COMPANY 

TRY  US  FIRST 

Prescriptions  Accurately  Compounded 

Free  Delivery  Service 

(New  Location) 

5070  Federal  Boulevard  Denver,  Colorado 

Phone  GRand  9832 

592 


Rocky  Mountain  Medical  Journal 


RELIABLE  DRUGGISTS 

PATRONIZE  DENVER’S  INDEPENDENT  DRUGGISTS 


WALTERS  DRUG  STORE 
801  COLORADO  BLVD. 
Denver,  Colorado 

☆ 

Telephone  FRemont  5391 


lAJhg  to  at  ^yUeiiS 

WEISS  DRUG 

PRESCRIPTION  SPECIALISTS 

Colfax  and  Elm  Denver,  Colorado 

Phone  EAst  1814 


We  Recommend 

VAN'S  PHARMACY 

THOS.  A.  VANDERBUR 

Prescriptions,  Rrngs,  Cosmetics,  Magazines 
Sundries  Excellent  Fonntain  Service 

28!W  Umatilla  St.,  Cor.  20th  Ave.  at  Umatilla 
GRand  7044  Denver,  Colo. 


Dansberry’s  Pharmacy 

“New  Ultra  Modern  Prescription  Service’’ 
JAMES  F.  DANSBERRY 
Owner  and  Manager 

Champa  at  14th  Street  Denver,  Colorado 
Phone  KEystone  469 


Harl  Cleveland,  Owner 

CLEVELAND  PHARMACY 

W.  29th  Ave.  at  Speer  Ph.  GL.  9272 

Modem  Prescription  Department 
Registered  Pharmacist 

Drugs  — • Sundries  — Soda  Fountain 

HOURS:  Week  Days.  8 a.m.  to  10  p.m. 

Sundays,  10  am.  to  1 p.m..  5 p.m.  to  9 p.m. 

Prescriptions  Delivered  Promptly 


WE  RECOMMEND 

LAKEWOOD  PHARMACY 

R.  W.  Holtgren,  Prop. 
PRESCRIPTION  SPECIALISTS 

West  Colfax  at  Wadsworth 
Lakewood  Colorado 

Phone  Lakewood  65 


Downing  Street  Pharmacy 

GEORGE  M.  HILL,  Prop. 

PROFESSIONAL  PHARMACIST 

901  Downing  St.  Denver,  Colo. 

Phone  CHerry  2767 

Complete  Merchandise  Line 
Free  Delivery  on  Prescriptions 


East  Denver’s  Prescription  Drug  Store 


Bert  C.  Corgan,  Prop. 
3401  FRANKLIN  STREET 
KEystone  7241 


OVERSTAKE’S  PHARMACY 

Gail  E.  Overstake 
Prescription  Specialists 

DRUGS  — SUNDRIES  — 
COSMETICS — CANDIES 

We  Deliver 

1000  So.  Gaylord  — RAce  4401 


PROFESSIONAL  MEN  RECOMMEND 


D.  MALCOLM  CAREY,  Pharmacist 

Phone  AComa  3711 

224  Sixteenth  Street  Denver,  Colorado 


for  July,  1949 


593 


W.D.RocL 

Ambulance 

Service 


Prompt,  Careful  and  Courteous 
Serving  Denver  25  Years 

Approved  by  Pbysiciana  0«n*rally 

18th  Ave.  at  Gilpin  St.,  Phone  EA.  7733 


Surgical  Supports  Expertly  Fitted. 

Miss  Mabel  P.  Cliff,  Authorized  Fitter 

^^enver  ^ur^icai dompan^ 

“For  better  service  to  the  profession.” 

1438-40  Tremont  Place  CHerry  4458 

Denver  2,  Colorado 


Stodghiirs  Imperial  Pharmacy 

Prescriptions  Exclusively 

For  your  prescriptions  we  stock  a complete  line  of  ALMAY — non-allergic — cosmetics. 

Five  Pharmacists 

319  16th  St.  TAbor  4231  Denver,  Colo. 


COLVITV-Medical  Books 

Medical  Publications  of  All  Publishers 

Books  Sent  for  Examination  on  Request 
We  Maintain  This  Book  Store  for  Your  Convenience 
Books  Make  Fine  Christmas  Gifts 
Write  or  Come  to 
705-706  MAJESTIC  BUILDING 


Denver  2,  Colorado 


Call  MAin  3866 


The  Complete 

RENTAL  SERVICE 

Cooler  — Water  — Cups 
Modernize  Your  Office  With 

PURE  DEEP  ROCK 

Artesian  Water 

COLD  STORAGE  SPACE 

For  Biological  Supplies 

ICE  CUBES 

4 Generous  Supply 

ELEC.  WATER  COOLERS 

All  Types  and  Makes 

FOR  RENT  OR  FOR  SALE 
DEEP  ROCK  WATER  CO. 

614  27th  St.  TAbor  5121 


594 


Rocky  Mountain  Medical  Journal 


^lAJoodci’oft  JdoApitai—jfdueLioj  (Colorado 

A private  hospital  for  the  scientific  treatment  of  neuro-psychiatric  disorders,  including 
alcoholism  and  drug  addiction.  Beautiful  landscaping  and  home-like  surroundings  afford 
a restful  atmosphere.  Accommodations  vary  from  single  rooms  with  or  without  bath  to 
rooms  en  suite,  allowing  for  segregation  of  guests. 


Detailed  information  furnished  on  request. 


Karl  J.  Waggener,  M.D. 


Wendell  T.  Wingett,  M.D. 


THE  CHILDREN’S  HOSPITAL  ASSOCIATION 

of  DENVER 

NON-SECTARIAN NON-PROFIT 

Providing  medicinal  and  surgical  aid  to  sick  and  crippled  children  o£  the  Rocky 
Mountain  Region  from  Birth  to  Maturity 

Every  modern  scientific  aid  available  to  the  physicians  and  surgeons 
of  Colorado  and  Wyoming 

Approved  by  the  American  Medical  Association  and  Full  Three-Year 

the  American  College  of  Surgeons  Nurses’  Training  Course 


for  July,  1949 


595 


Winning  Health 

in  the 

Pikes  Peak  Region 


COLORADO  SPRINGS 


Inquiries  Solicited 


OLOCKIVER  PEIVROSE  HOSPITAL 

Sisters  of  Charity 

HOME  OF  MODERN  SANATORIA 


SOME  of  the  exclusive  features  of  this 
new  Vacuum  Tube  Hearing  Aid  are: 
Sealed  Crystal  Microphone — gives  same 
dependable  service  under  all  conditions  of 
temperature  and  humidity.  Stabilized  Feed- 
back — ■ amplification  without  distortion. 
No  sudden  blast  from  loud  soimds  when 
volume  is  turned  up. 

For  other  information  write  or  coll 

M.  F.  Taylor  Laboratories 

721  Republic  Building 
MAin  1920  Denver,  Colo. 


SERVICE 

QUALITY 

PAUL  WEISS 

PRESCRIPTION 

OPTICIAN 

1620  ARAPAHOE  ST.  DENVER 

MAin  1722 

WESTERN  ELECTRIC 

HEARING  AIDS 

Engineered  by  Bell  Telephone  Laboratories 


FAIRFAX  SANITARIUM 

Kirkland,  Wash. 

Situated  one  mile  north  of  Juanita 

TREATING  NERVOUS  AND 
MENTAL  DISEASES 

Beautiful  and  restful  surroundings  affording 
recreational  facilities.  Cottage  plan  for  segre- 
gation of  patients.  Insulin  and  Electro-shock 
Therapy  when  indicated. 

Attending  Physicians 
FREDERICK  LEMERE,  M.D. 

NATHAN  K.  RICKLES,  M.D. 

JAMES  H.  LASATER,  M.D. 

MORTON  E.  BASSAN,  M.D. 

JACK  J.  KUIN,  M.D. 

Manager:  A.  G.  HUGHES 
Route  2,  Box  365,  Kirkland 
Phone:  Kirkland  2391 


596 


Rocky  Mountain  Medical  Journal 


s 


i 


i 


I 


Shadel  Sanitarium  has  combined  research*, 
treatment  and  rehabilitation  to  return  thousands 
of  Alcoholics  to  normal  living.  Groundwork 
for  recovery  is  laid  through  intensive, 
individualized  therapy.  Statistical  evaluation  of 
results  since  1935,  have  shown  that  in  over 
3125  cases  reported*,  40%  remained  abstinent 
for  four  years  or  longer.  Our  object  is  . . . 
Cooperation  with  the  family  physician  in 
mapping  the  road  to  recovery. 


RECOGNIZED  BY  THE 

A.  M.  A. 

MEMBER  OF  THE 

A.  H.  A. 


SPECIALISTS 


I N 


THERAPY  FOR 


1935  TO  1949 

CHRONIC  ALCOHOLISM 


BY  THE  CONDITIONED  REFLEX  AND  ADJUVANT  METHODS 
7106  35th  AVE.  S.  W.  SEATTLE  6,  WASH.,  WEST  7232,  CABLE  ADDRESS:  “REFLEX” 


for  July,  1949 


597 


Cook  County  Graduate 
School  of  Medicine 

ANNOUNCES  CONTINUOUS  COURSES 

SURGERY — Intensive  course  in  Surgical  Technique, 
two  weeks,  starting  July  25,  August  22,  Septem- 
ber 26.  Surgical  Technique,  Surgical  Anatomy 
and  Clinical  Surgery,  four  weeks,  starting  July 
11,  August  8,  September  12.  Surgical  Anatomy 
and  Clinical  Surgery,  two  weeks,  starting  July 
25,  August  22,  September  26.  Surgery  of  Colon 
and  Rectum,  one  week,  starting  September  12, 
October  10.  Esophageal  Surgery,  one  week,  start- 
ing Ocober  10.  Thoracic  Surgery,  one  week,  start- 
ing October  3.  Breast  and  Thyroid  Surgery  one 
week,  starting  October  10.  Fractures  and  Trau- 
matic Surgery,  two  weeks,  starting  October  3. 

GYNECOLOGY — Intensive  Course,  two  weeks,  start- 
ing September  26,  October  24.  Vaginal  Approach 
to  Pelvic  Surgery,  one  week,  starting  September 
19,  November  7. 

OBSTETRICS — -Intensive  course,  two  weeks,  starting 
September  12,  November  7. 

MEDICINE — -Intensive  general  course,  two  weeks, 
starting  October  3.  Gastroenterology,  two  weeks, 
starting  October  24.  Gastroscopy,  two  weeks,  start- 
ing July  18,  September  26.  Electrocardiography 
and  Heart  Disease,  two  weeks,  starting  July  18. 
Electrocardiography  and  Heart  Disease,  four  weeks, 
starting  September  7. 

PEDIATRICS— Personal  course  in  Cerebral  Palsy, 
two  weeks,  starting  August  1. 

DERMATOLOGY — Formal  course,  two  weeks,  start- 
ing October  24.  Informal  Clinical  course  every 
two  weeks. 

UROLOGY — Intensive  Course,  two  weeks,  starting 
September  26.  Ten  day  practical  course  in  Cystos- 
copy every  two  weeks. 

GENERAL,  INTENSIVE  AND  SPECIAL  COURSES 
IN  ALL  BRANCHES  OF  MEDICINE,  SURGERY 
AND  THE  SPECIALTIES 

TEACHING  FACULTY— ATTENDING  STAFF  OF 
COOK  COUNTY  HOSPITAL 
Address;  Registrar,  427  South  Honore  Street, 
Chicago  12,  Illinois 


If  You  Send  Out  Statements 

IT  A 

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Alameda  and  Cherokee  * PEarl  2484  * Denver/  Colorado 


598 


Rocky  Mountain  Medical  Journal 


Index  to  Advertisers 


Page 


Abbott  Laboratories 579 

Alba  Dairy  600 

American  Ambulance  Co 588 

American  Meat  Institute 535 

American  Medical  and  Dental 
Association  528 

Ayerst,  McKenna  & Harrison_577 

Baxter,  Don,  Inc 583 

Berber!,  George  & Sons 591 

Bilhuber-Knoll  Corp.  584 

Bonita  Pharmacy  586 

Bonnie-Brae  Drug 592 

Borden  Company  573 

Brecht  Candy  Co 588 

Brown  Schools 588 

Burroughs  Wellcome  & Co. 533 

Cambridge  Dairy 524 

Camel  Cigarette 525 

Camp  & Co.,  S.  H 575 

Capital  Chevrolet  598 

Cascade  Laundry 580 

Children’s  Hospital  Assn 595 

City  Park  Dairy 53  0 

Cleveland  Pharmacy 593 

Coca-Cola 590 

Colburn  Hotel  580 

Coleman  & Bell 600 

Colorado  Springs 

Psychopathic  Hospital 586 

Colvin  Medical  Books 594 

Continental  Casualty  Co 581 

Cook  County  Graduate 

School  of  Medicine 598 

Country  Club  Pharmacy 592 

Cutter  Laboratories 571 

Dansberry’s  Pharmacy 593 

Deep  Bock  Water 594 

Dellinger,  Lee  W 584 


Page 


Denver  Chemical  Manufactur- 
ing Company 584 

Denver  Fire  Clay  Co.,  The 583 

Denver  Oxygen  Co 532 

Denver  Surgical  Supply  Co 594 

Dorr  Optical  Co 534 

Downing  Street  Pharmacy 593 

Doyle's  Pharmacy  592 

Dryer-Astler  Printing  Co 580 

Earnest  Drug  Co 592 

Ehret  Engraving  Co 532 

Fairfax  Sanitarium  596 

Fairhaven  Maternity 

Hospital  524 

Fifth  Rocky  Mountain 

Medical  Conference Cover  III 

Franklin  Drug  Co 593 

Glockner  Penrose  Hospital 596 

Holland  Rantos  Company 536 

Hyde’s  Pharmacy 592 

Jackson’s  Cut  Rate  Drug 580 

Karg  Paint  Co 580 

Kendrick-Bellamy  Co 522 

Kincaid’s  Pharmacy 592 

Lakewood  Pharmacy 593 

Lederle  Laboratories 529 

Lilly,  Eli  & Co. 

Insert  Between 536-537 

Livermore  Sanitarium 590 

M & R Dietetic  Laboratories_585 

Malone  Drug  Store 586 

Mead,  Johnson  & Co Cover  IV 

Medical  Center  Pharmacy 600 

Merck  & Company,  Inc 587 

Newton  Optical  Company 600 

Nurses  Official  Registry 582 

Otto  Drug  Co 592 

Overstake’s  Pharmacy 593 

Park  Floral  Co ! 532 

Parke,  Davis  & Co. -Cover  11-521 


Page 


Peters,  Writer  & Christensen-600 

Physicians  and  Surgeons 

Supply  586 

Physicians  and  Surgeons 

Telephone  Service  Exch 600 

Physicians  Casualty  Assn 588 

Professional  Pharmacy 593 

Public  Service  Co.  of  Colo 582 

Restaurant  240  580 

Roberts  Pharmacy 592 

Roche  Ambulance  Service 594 

Rockmont  Envelope  Co 598 

Roedel’s  Prescription  Drug — 586 

Schering  Corporation  527 

Searle,  G.  D.  & Co 569 

Shadel  Sanitarium  597 

Shadford-Fletcher  Optical  Co.  530 

Shumake  Drug,  Guido 592 

Stodgill’s  Imperial 

Pharmacy  594 

Telephone  Answering-  Service  524 

Thornton,  George  R 522 

LTnited  States  Army 589 

United  States  Brewing 

Industry  578 

Van’s  Pharmacy  593 

Walters  Drug  Store 593 

Wantads 576  & 580 

Weiss  Drug  593 

Weiss,  Paul 696 

Western  Electric 

Hearing  Aids  596 

Western  Newspaper  Union 582 

Whittaker’s  Pharmacy 592 

Winthrop-Stearns,  Inc. 523 

Woodcroft  Hospital 595 

Wyeth,  Inc.  531 

York  Pharmacy 600 


for  July,  1949 


599 


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Rocky  Mountain  Medical  Journal  > 


FIFTH 

ROCKY  MOUNTAIN 
MEDICAL  CONFERENCE 

Butte,  Montana 
August  2,  3,  4,  1949 

Headquarters:  Finlen  Hotel 


^lie  .SpeaLerd  Witt  3„JuM 


Henry  Lewis  Barnett,  M.D.,  New  York  City. 

J.  Englebert,  Dunphy,  M.D.,  Boston. 

L.  Fernald  Foster,  M.D.,  Bay  City,  Michigan. 

Robert  Arthur  Kehoe,  M.D.,  Cincinnati. 

Charles  L.  Martin,  M.D.,  Dallas. 

Harvey  B.  Matthews,  M.D.,  Brooklyn. 

John  Royal  Moore,  M.D.,  Philadelphia. 

Cyrus  C.  Sturgis,  M.D.,  Ann  Arbor. 

Harold  G.  Wolf,  M.D.,  New  York  City. 


vr , 


PABLUM 


I f'llw  ‘"‘*'^^f’^'’>‘AamM.a*u^’'‘i>’^'^*'‘''  I 

^ 1^*'*'*^' 

>.  '"'ttc  S P®*'<*«fe<l  bee(  bone  LI 

I !?***n(j  chloride,  powdered  *'**'?  Lied  I 

5 s~^  resultani  rupture  of  •”  ’ |)>i| 

'*«>ttrtni!ation.  Psbium  f?^^|!iitipj 
5?*  **'00  c!r  sources,  atrd  ''‘'*”]^,Vjt^| 

S*''  “Wum  and  0)1*1 

I fow  in  crude  fiber.  p«fat*b».  ano  \ 

and  economical  to  prepare. 


PABENA 


There  is  only  one  Pablum.  It, 
was  originated  in, 1932  by  and 
is  made  by  Mead  Johnson  & 
Company.  “Pablum”  is  the 
registered  trademark  of  Mead 
Johnson  & Company  for  this 
pioneer  vitamin-and-mineral- 
eqriched  precooked  mixed  ce- 
real food. 


cooked 

I 2!^%  oatmeal,  malt  syrup.  P®****^  poed**' 

use.  sodium  chlor^-  Trd* 

faon  fA  ffi’amirie.  and  nutritionally  ' I’L  g 

calcium,  and  pf>«f^*Lh  JiS*^ 

■'  '^laL^"’K  »"'*  'frying. 

, convenient  io  Lepare.  .. 

NO  COOK.-,  i-Add 


">! 


Pabena  was  introduced  by 
Mead  Johnson  & Company  in 
response  to  numerous  requests 
by  the  medical  profession. 
“Pabena”  is  Mead  Johnson’s 
registered  trademark  for  this 
vitamin  - and-  mineral  - enriched 
precooked  oatmeal  food. 


MANY  PHYSICIANS  RECOGNIZE  MEAD  JOHNSON'  AND 
COMPANY'S  PIONEER  EFFORTS  IN  THE  FIELD  OF  INFANT 
CEREALS  BY  SPECIFYING  ”PA.BLUM”~ AND  ALSO  THE  NEW 
PABLUM-LIKE  OATMEAL  CEREAL  KNOWN  AS  "PABENA” 


it 


Differential  Diagnosis  of  Poliomyelitis — Henry 
W.  Woltman,  M.D.,  Rochester. 

Intestinal  Obstruction — Philip  Thorek,  M.D., 
Chicago. 

Low  Back  Pain — Earl  D.  McBride,  M.D.,  Okla- 
homa City. 

The  Rural  Health  Program — Fred  A.  Humph- 
rey, M.D.,  Fort  Collins. 

Psychosomatic  Aspects  of  Gastro-Intestinal 
Disorders — Clarke  H.  Barnacle,  M.D.,  Denver. 

Treatment  of  Superficial  Carcinoma — Wendell 
P.  Stampfli,  M.D.,  Denver. 

Improvement  in  Patients’  General  Condition 

After  Brucellosis  Skin  Test Max  L. 

Weiker,  M.D.,  Boulder. 

Colorado  Premature  Infant  Care  Program — 
Harry  H.  Gordon,  M.D.,  and  John  A.  Lichty, 
M.D.,  Denver. 

Programs  of  State  Societies — Organization. 

(For  Complete  Table  of  Contents,  Turn  the 
First  Page) 


25c  Per  Copy 


$2.50  Pet  Year 


of  a sensitized  body  ct 


t 

! 


Contact  of  a sensitized  body  cell  with  an  allergen  and 
subsequent  release  of  histamine  is  considered  to  be  the 

mechanism  of  allergic  disorders. 


Blocking  the  action  of  histamine,  BENADRYL  prevents  reaction 
in  cells  that  have  been  sensitized.  Relief  of  symptoms  is 
gratifyingly  rapid,  usually  occurring  within  an  hour  or 
two  after  the  first  dose.  And  treatment  with  BENADRYL 
is  simple,  convenient,  and  inexpensive. 


BENADRYL 


BENADRYL  has  been  found  highly  effective  in  a wide  variety  of 
allergic  states,  ranging  from  seasonal,  such  as  hay  fever,  to 
the  non-seasonal,  such  as  acute  and  chronic  urticaria,  angioneurotic 
edema,  vasomotor  rhinitis,  contact  dermatitis,  erythema  multiforme, 
pruritic  dermatoses,  dermographism,  serum  sickness,  food  allergy, 
and  sensitization  to  drugs,  such  as  penicillin  and  the  sulfonamides. 


BENADRYL  hydrochloride  (diphenhydramine  hydrochloride,  Parke-Davis)  is  available 
in  a variety  of  forms  to  facilitate  individualized  dosage  and  flexibility  of 
administration,  including  Kapseals®,  Capsules  and  a palatable  Elixir. 

The  usual  dosage  of  BENADRYL  is  25  to  50  mg.  repeated  as  requir  ed.  Children  up 
to  12  years  of  age  may  be  given  1 to  2 teaspoonsful  of  Elixir  Benadryl. 


Q Q 


Kendrick-Bellamy  prescribe  o g 

Comfort  for  Yourself,  Your  9:  ^ 

Office  Staff  and  Patients!  o i 

A 


HOT  WEATHER  REMEDY:  S'  ^ 

These  New  Window  Fans — Y>  S' 

VORNADO  "TURNABOUT 


< 

o 


o 

Q. 

O 


This  entirely  new,  reversible  fan  forces  stale 
air  out,  or  you  simply  turn  it  about  to  fill  your 
offices  and  waiting  room  with  fresh  air  from 
outside. 


Air  where  you  want  it  with  Vornado's 
feathet-touch  tilting  and  turn-about  fea- 
ture. Come  in  for  demonstration. 


KEystone  0241 

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Write  for  Measuring  Chart 


Table  of  Contents 

VOLUME  46  NUMBER  8 

AUGUST,  1949 


Editorials 

Firsthand  Information 617 

A New  Style  for  Medical  Publications 618 

Report  From  London 618 

Incidence  of  Poliomyelitis. 619 

Silhouettes  From  the  A.M.A.  House  of 
Delegates  619 


-f 


Original  Articles 


The  Differential  Diagnosis  of  Poliomyelitis, 
Henry  W.  Woltman,  M.D 620 

Intestinal  Obstruction,  Philip  Thorek,  M.D.  627 

Low  Back  Pain,  Earl  D.  McBride,  M.D 631 

The  Rural  Health  Program,  Fred  A. 

Humphrey,  M.D 638 

Psychosomatic  Aspects  of  Gastro-Intestinal 
Disorders,  Clarke  H.  Barnacle,  M.D 642 

General  Principles  in  the  Treatment  of 
Superficial  Carcinoma, 

Wendell  P.  Stampfli,  M.D 647 

Improvement  in  Patients’  General  Condi- 
tion After  Application  of  Skin  Test  for 
Brucellosis,  Max  L.  Weiker,  M.D 649 

Colorado  Premature  Infant  Care  Program, 
Harry  H.  Gordon,  M.D.,  and  John  A. 
Lichty,  M.D 650 


Organization 

Colorado 

Preliminary  Program,  79th  Annual  Ses- 
sion of  the  Colorado  State  Medical 


Society  656 

Preliminary  Program,  Rocky  Mountain 
Chapter,  American  College  of  Chest 
Physicians  664 

Utah 

Program,  Fifty-fourth  Annual  Meeting, 
Utah  State  Medical  Association 668 

Wyoming 

Program,  Forty-sixth  Annual  Meeting, 
Wyoming  State  Medical  Society 670 

Colorado  State  Health  Department 674 

Tuberculosis  Abstract  676 


602 


Rocky  Mountain  Medical  Journal 


...Nasal  Engorgement  Reduced 
...Soreness,  Congestion  Relieved 
...Aeration  Promoted 
...Drainage  Encouraged 


HYDROCHLORIDE 

Brand  of  ; ^ ■ 

Phenylephrine  Hydrochloride 


w hen  Neo-Synephrine  comes  in  contact  with  the 
swollen,  irritated  mucous  membrane  of  the  nose,  the  patient 
soon  experiences  relief. 

This  powerful  vasoconstrictor  acts  quickly  to  shrink  engorged  mucous 
membranes,  restoring  easy  breathing,  and  promoting  free  drainage. 


The  prolonged  effect  of  Neo-Synephrine  makes  fewer  applications 
necessary  for  the  relief  of  nasal  congestion  — permitting  longer 
periods  of  comfort  and  rest. 


INC. 


New  York  J3,  N.  r.  Windsor,  Ont. 


Neo-SynepKrine,  trademark  reg.  U.  S.  & Canada 


Neo-Synephrine  does  not  lose  its  effectiveness  on  repeated 
application  ...  It  may  be  employed  with  good  results 
throughout  the  hay  fever  season  ...  It  is  notable  for 
relative  freedom  from  sting  and  absence  of 
compensatory  congestion  . . . Virtually  no 
systemic  side  effects  are  produced. 


Supplied  as: 

¥4%  and  1%  in  isotonic  saline  solution 
— 1 oz.  bottles. 


%%  in  aromatic  isotonic  solution  of 
three  chlorides—l  oz.  bottles. 

¥2%  water  soluble  jelly— Ys  oz.  tubes. 


ROCKY  MOUNTAIN  MEDICAL  JOURNAL 

Title  Registered,  U.S.  Patent  Office 
Publication  Office: 

835  Republic  Building  (1612  Tremont  Place),  Denver  2,  Colorado  ' 

Telephone  CHerry  5521. 

EDITORIAL  BOARD 

Colorado:  Douglas  W.  Macomber,  M.D.,  Scientific  Editor,  1820  Gilpin  St.,  Denver;  Lyman  W.  Mason, 
M.D.,  Associate  Editor,  1214  Republic  Bldg.,  Denver,  (Chairman  of  Editorial  Board). 

Montana:  Raymond  F.  Peterson,  M.D.,  Scientific  Editor,  Butte,  Mont.;  Herbert  T.  Caraway,  M.D., 
Associate  Editor,  Billings,  Mont. 

New  Mexico:  Carl  H.  Gellenthein,  M.D.,  Scientific  Editor,  Vahnora,  New  Mexico;  Harold  L.  Janu- 
ary, M.D.,  Associate  Editor,  First  National  Bank  Bldg.,  Albuquerque,  New  Mexico. 

Utah:  Richard  P.  Middleton,  M.D.,  Scientific  Editor,  Boston  Bldg.,  Salt  Lake  City;  W.  H.  Tibbals, 
Associate  Editor,  42  South  Fifth  East  St.,  Salt  Lake  City. 

Wyoming:  Earl  Whedon,  M.D.,  Scientific  Editor,  Sheridan;  Arthur  R.  Abbey,  Associate  Editor,  P.O. 
Box  897,  Cheyenne. 


Managing  Editor:  Harvey  T.  Sethman,  835  Republic  Bldg.,  Denver. 
Business  Manager:  Helen  Kearney,  835  Republic  Bldg.,  Denver. 


Ownership  and  Sponsorship  i The  Hocky  Mountain 
Medical  Journal  is  owned  by  the  Colorado  State 
Medical  Society  and  Is  published  monthly  as  a non- 
profit enterprise  for  the  mutual  benefit  of  the  or- 
ganizations which  Jointly  sponsor  it.  It  Is  published 
under  the  direction  of  the  Board  of  Trustees  of  the 
Colorado  State  Medical  Society,  assisted  by  an  Bdi- 
torlal  Board  representing-  the  sponsoring  organiza- 
tions. It  is  the  Official  Journal  of  the  Colorado  State 
Medical  Society,  the  Montana  State  Medical  Associa- 
tion, the  New  Mexico  Medical  Society,  the  Utah 
State  Medical  Association,  the  Wyoming  State  Medi- 
cal Society,  the  Rocky  Mountain  Medical  Conference, 
and  the  Colorado  Hospital  Association. 

Manuscripts:  Scientific  Articles,  Case  Reports,  etc., 
from  any  state  for  which  this  is  the  Official  Journal 
should  be  submitted  to  the  Scientific  Sditor  for  that 
state  as  named  in  the  Bditorial  Board,  above.  Other 
material  from  any  participating  state  should  be  sqb- 
mitted  to  the  Associate  Editor  for  that  state  as 
named  above.  Manuscripts  from  outside  the  Rocky 
Mountain  area  should  be  sent  direct  to  the  Journal 
office.  Manuscripts  must  be  typewritten,  double  or 
triple  spaced,  using  only  one  side  of  each  sheet.  It 
is  the  policy  of  this  Journal  to  omit  bibliographies. 


Advertising:  National  representatives:  The  Coop- 
erative Medical  Advertising  Bureau,  S35  North  Dear- 
born Street,  Chicago  10,  111.  Local  advertising  from 
firms  in  the  Rocky  Mountain  area  should  be  submit- 
ted to  the  Associate  Editor  of  the  appropriate  state 
or  to  the  Journal  office.  Advertising  forms  close  on 
the  20th  of  the  month  preceding  publication;  allow 
ten  days  additional  to  insure  submitting  proofs  for 
approval. 


Snbscrlption:  |2.50  per  year  in  advance,  postpaid  in 
the  United  States  and  its  possessions;  single  copy, 
25  cents  plus  postage.  Subscription  is  included  in 
medical  society  dues  of  sponsoring  state  medical 
organizations. 

Copyright:  This  Journal  is  copyright,  1949,  by  the 
Colorado  State  Medical  Society.  Requests  for  permis- 
sion to  reproduce  anything  from  the  columns  of  this 
Journal  should  be  addressed  to  the  Journal  office. 


Second  Class  Matter:  Entered  as  second  class  mat- 
ter Jan.  22,  1906,  at  the  Postoffice  at  Denver,  Colo., 
under  the  Act  of  Congress  of  March  3,  1879.  Accepted 
for  mailing  at  special  rates  of  postage  pro-vlded  for 
in  Section  110-3,  Act  of  Oct.  3,  1917;  authorized  July 
17.  1918. 


The  Fairhaven  Maternity  Hospital 

Mrs.  H.  E.  Lowther,  Superintendent 

Seclusion  for  the  unwed  mother.  Write  for  descriptive  booklet 

1349  JOSEPHINE  DExter  1411  DENVER 


Don't  miss  important  telephone  calls 

Let  us  act  as  your  secretary  while  you  are  away,  day  or  night: 
our  kindly  voice  conscientiously  tends  your  telephone  business, 
accurately  reports  to  you  when  you  return. 

Telephone  ANSWERING  Service  call  Alpine  mm 


Cambridge  Dairy  Grade  ‘*A”  Milk  Is  Produced  and  Processed  at  690  S.  Colo.  Blvd. 

We  do  not  handle  Shipped-in  Milk  produced  Where?  How  and  by  Whom?  Doctors  know  the  difference 
Now  Homogenized  Vitamin  D Milk  is  available  for  baby  feeding  and  family  use. 

We  Invite  Your  Inspection  and  Appreciate  Your  Recommendation. 


How  mild  can  a cigarette  be? 


in  a rec«." 
nf  people  who 
for  30  days.  "‘ 
..kina  weekly 


telephone  operator 


IjjOkERS  REpJ" 


R.  J.  Reynolds  Tobacco  Company.  \\  inston-balem.  N.  C. 


According  to  a NatMonwude  survey: 


More  Doctors  Smoke  Camels 

than  any  other  cigarette 

Doctors  smoke  for  pleasure,  too!  And  when  three  leading  independent  research  organiza- 
tions asked  1 13,597  doctors  what  cigarette  they  smoked,  the  brand  named  most  was  Camel! 


for  August,  1949 


605 


THE  COLORADO  STATE  MEDICAL  SOCIETY 


Next  Annual  Session:  Shirley-Savoy  Hotel,  Denver;  Sept.  20,  21,  22,  23,  1949 


OFFICERS 

Terms  of  Officers  and  Committees  expire  at  the  Annual  Session 
In  the  year  Indicated.  Where  no  year  Is  Indicated,  the  term 
Is  for  one  year  only  and  expires  at  the  1949  Annual  Session. 

President:  Casper  F.  Hegner,  Denver. 

President-elect:  Fred  A.  Humphrey,  Fort  CoUlns. 

Vice  President:  Lester  L.  Ward,  Pueblo. 

Constitutional  Secretary  (three  years) : George  B.  Buck,  Denver.  1951. 
Treasurer  (three  years):  George  C.  Shivers,  Colorado  Springs,  1950. 

Additional  Trustees  (three  years):  Ervin  A.  Hinds,  Denver,  1949;  E.  H. 
Munro,  Grand  Jurctlon,  1949;  S.  P.  Newman,  Denver,  1950;  Claude  D. 
Bonham,  Boulder,  1951. 

(The  above  nine  officers  compose  the  Board  of  Trustees  of  which  Dr. 
Ervin  A.  Hinds  Is  the  1948-1949  Chairman.) 

Board  of  Councilors  (three  years):  District  No.  1:  Clemens  F.  EaMns, 
Brush,  1951;  No.  2:  Ella  A.  Mead,  Greeley,  1951;  No.  3:  L.  G.  Crosby, 
Denver,  1951;  No.  4:  Banning  E.  Likes,  Lamar,  1950;  No.  5;  Guy  H. 
Hopkins,  Pueblo,  1950;  No.  6:  Lester  E.  Thompson,  Salida,  1950;  No.  7: 
A.  L.  Burnett,  Durango,  1949;  No.  8:  Lawrence  L.  Hick,  Delta,  1949; 
No.  9;  W.  W.  Sloan,  Hayden,  1949  (Chairman  of  Board  for  1948-49). 

Board  of  Supervisors  (two  years):  A,  B.  Gjellum,  Del  Norte,  1949;  L.  W. 
Lloyd.  Durango,  1949;  E.  G.  Howlett,  Golden,  1949;  Scott  A.  Gale, 
Pueblo,  1949;  L.  D.  Dickey,  Fort  Collins,  1949;  N.  A.  Madler,  Greeley, 
1949  (Chairman  of  Board  for  1948-49);  L.  D.  Buchanan,  Wray,  1960; 
W.  F.  Deal,  Craig,  1950;  G.  C.  Cary,  Grand  Junction,  1950;  W.  A. 
Campbell.  Colorado  Springs,  1950;  Balph  S.  Johnston,  Sr.,  La  Junta, 
1950;  William  A.  Liggett,  Denver,  1950,  Secretary. 

Delegates  to  American  Medical  Association  (two  years):  George  A.  Unfug, 
Pueblo,  1949  (Alternate:  Herman  C.  Graves,  Grand  Junction,  1949); 
William  H.  Halley.  Denver,  1950  (Alternate:  Kenneth  C.  Sawyer.  Denver. 
1950). 

Feundation  Advocate:  Walter  W.  King,  Denver. 

executive  Office  Staff:  Mr.  Harvey  T.  Sethman,  Executive  Secretary; 
Miss  Helen  Kearney,  Assistant  Executive  Secretary;  Mr.  Evan  A.  Edr-ards, 
Field  Secretary;  Miss  Mary  E.  McDonald,  Committee  Secretary;  835  Be- 
public  Building,  Denver  2,  Colo..  Telephone  CHerry  5521. 

General  Counsel:  Mr.  J.  Peter  Nordlund,  Attorney-at-Law,  Denver. 

STANDING  COBIMITTEES 

Credentials:  George  B.  Buck.  Denver,  Chairman,  ex-officio;  Harold  E. 
Haymond,  Greeley;  E.  C.  Likes,  Lamar;  Scott  A.  Gale,  Pueblo;  J.  L. 

McDonald,  Colorado  Springs. 

Public  Policy:  Kenneth  C.  Sawyer,  Denver,  Chairman;  McKlnnle  L. 

Phelps,  Denver,  Vice  Chairman;  John  S.  Bouslog,  Denver;  F.  B.  Calhoun, 
Denver;  Fr.ank  B.  McGlone,  Denver;  Lloyd  Anderson,  Sterling;  Sidney  An- 
derson, Alamosa;  Bichard  L.  Davis,  La  Junta;  Herman  C.  Graves,  Grand 
Junction;  John  L.  McDonald,  Colorado  Springs;  George  E.  Rice,  Pueblo; 
Duane  Hartshorn,  Fort  Collins;  John  D.  Gillaspie,  Boulder.  Ex-Officio 
members:  Casper  F.  Hegner,  President;  Fred  A.  Humphrey,  President-elect; 
George  R.  Buck,  Constitutional  Secretary. 

Sub-Committee  on  Legislation:  H.  I.  Barnard,  Denver,  Chairman. 

Health  Education  (two  years);  A.  C.  Sudan.  Denver,  Chairman,  1949; 

J.  D.  Bartholomew,  Boulder,  1949;  R.  J.  Savage,  Denver,  1949;  R.  T. 

Porter,  Greeley,  1949;  Robert  B.  Bradshaw,  Alamosa,  1949;  L.  W.  Bortree, 
Colorado  Springs,  1950;  F.  0.  Robertson,  Denver,  1950;  J.  L.  Sadler,  Fort 

Collins,  1950;  Harold  T.  Low,  Pueblo,  1950;  John  H.  Amesse,  Denver, 

1950;  E.  H.  Munro,  Grand  Junction,  1950. 

Scientific  Work:  W.  B.  Condon,  Denver,  Chairman;  Robert  S.  Liggett, 
Karl  F.  Arndt.  Frank  T.  Joyce,  Marshall  G.  Nims,  Vincent  G.  Cedar- 
blade,  all  of  Denver. 

Sub-Committee  on  Scientific  Exhibits:  Frank  C.  CampbeU,  Chairman; 
Nolle  Mumey,  Edgar  W.  Barber,  B.  W.  Vines,  all  of  Denver. 

Arrangements:  J.  L.  Swigert,  Chairman;  Byron  I.  Dumm,  S.  B.  Childs, 
Jr.,  all  of  Denver. 

Medicolegal  (two  years):  B.  W.  Arndt,  1950,  Chairman;  George  B. 
Packard,  Jr..  1950;  K.  D.  A.  AUen,  1950.;  C.  S.  Bluemel,  1949;  Lyman 
W.  Mason,  1949;  Harry  C.  Hughes,  1949;  all  of  Denver. 

Medical  Education  and  Hospitals;  George  F.  WoUgast,  Denver,  Chairman; 
W.  W.  Sloan,  Hayden;  F.  B.  Pingrey,  Durango:  E.  R.  Mugrage,  Denver; 
D.  W.  McCarty,  Longmont:  A.  E.  Lubchenco,  Denver. 

Library  and  Medical  Literature:  A.  J.  Markley,  Denver,  Chairman;  T.  E. 
Beyer,  Denver;  J.  J.  Connor,  Delta;  H.  Dumont  Clark,  Denver. 

Medical  Service  Plans;  F.  H.  Good,  Denver,  Chairman;  C.  E.  Honsteln, 
Fort  Collins;  James  B.  Blair,  Denver;  Vernon  L.  Bolton,  Colorado  Springs: 
Scott  A.  Gale,  Pueblo;  John  A.  Weaver,  Jr.,  Greeley;  John  E.  ^land, 
Monte  Vista;  Thomas  K.  Mahan,  Grand  Junction. 

Necrology:  W.  H.  Wilson.  Denver,  (Bialrman. 

PUBLIC  HEALTH  COMMITTEES 

General  Committee  on  Public  Health:  Consists  of  the  chairmen  of  the 
following  eleven  public  health  subcommittees,  presided  over  by  Bobert  W. 
Dickson,  Denver,  as  General  Chairman. 

Cancer  Control:  J.  C.  Mendenhall,  Denver,  Chairman;  John  B.  Grow, 
Denver:  S.  W.  HoUey,  Greeley;  T.  Leon  Howard,  Denver;  James  B.  Me- 
Naught,  Denver;  Roger  G.  Howlett,  Golden;  James  W.  McMullen,  Colorado 
Springs;  James  E.  Donnelly,  Trinidad;  Lanning  E.  Likes,  Lamar;  Thomas 

K.  Mahan.  Grand  Junction. 


Crippled  Children:  I.  E.  Hendryson,  Denver,  Chairman;  Mary  L.  Moore, 
Grand  Junction;  Richard  H.  Mellen,  Colorado  Springs;  Sidney  E.  Bland- 

ford,  Jr.,  Denver;  Paul  B.  Hildebrand,  Brush;  Samuel  P.  Newman,  Denver. 

Industrial  Health:  R.  F.  Bell,  Louviers.  Chairman;  A.  R.  Woodbume, 
Denver;  Vincent  E.  Kelly,  LeadvHle;  D.  W.  Boyer,  Pueblo;  H.  G.  Harvey,  Jr., 
Denver:  Robert  Woodruff,  Denver;  Frank  J.  McDonough.  Grand  Junction. 

Local  Health  Units:  Monroe  R.  Tyler,  Denver,  Chairman;  Harold  E. 
Haymond.  Greeley;  R.  B.  Richards,  Fort  Morgan;  Nicholas  S.  SaUba,  Wal- 
senburg;  Marvel  L.  Crawford,  Steamboat  Springs;  R.  Sberwin  Johnston,  Jr., 
La  Junta. 

Maternal  and  Child  Health:  John  B.  Evans,  Denver.  Chairman;  Joseph 

H.  Lyday,  Denver;  John  M.  Nelson,  Denver;  Tracy  D.  Peppers,  Greeley; 
J.  H.  Woodbridge,  Pueblo:  M.  E.  Snyder,  Colorado  Springs. 

Mental  Hygiene:  Bradford  Murphey,  Denver,  Chairman;  E.  James  Brady, 
Colorado  Springs;  Frank  H.  Zimmerman,  Pueblo;  Paul  A.  Draper,  Colors^ 
Springs;  J.  P.  Hilton,  C.  S.  Bluemel,  John  M.  Lyon,  G.  H.  Ashley,  Lewis 
C.  Overholt,  Clarke  H.  Barnacle,  Harold  R.  Carter,  all  of  Denver. 

Milk  Control:  George  W.  Stiles.  Denver,  Chairman;  Max  M.  Oinsburg, 
Denver;  N.  J.  Miller,  D.V.M.,  Eaton;  Millard  F.  Schafer.  Colorado  Springs; 
Bobert  W.  Vines,  Denver;  Mr.  Wendell  Vincent,  Denver. 

New  Hospital  Construction:  D.  R.  Collier,  Wheatridge,  Chairman; 

Henry  M.  Powell,  Colorado  Springs;  Mr.  John  R.  Peterson,  Fort  Collins; 

Florence  R.  Sabin,  Denver:  Herbert  A.  Black,  Pueblo. 

Public  Water  Supplies:  E.  I.  Dobos,  Denver,  Chairman;  Robert  Barnard, 
Eagle;  William  C.  Shontz,  San  Luis;  Carl  W.  Maynard,  Pueblo;  W.  B. 
Crouch,  Colorado  Springs;  H.  D.  Palmer,  Denver,  E.  Robert  Orr,  Frulta. 

Tuberculosis  Control;  John  I.  Zarit,  Denver,  Chairman;  W.  J.  Hlnzel- 
man,  Greeley;  H.  M.  Van  Der  Schouw,  Wheatridge;  John  P.  McGraw,  Pueblo; 
Arthur  Rest,  Denver;  H.  Calvin  Fisher,  Denver;  T.  D.  Cunningham,  Denver. 

Venereal  Disease  Control:  Sam  W.  Downing.  Denver,  Chairman;  Paul  B. 
Stidham,  Grand  Junction;  H.  E.  Coakley,  Pueblo;  D.  E.  Newland,  Denver; 
Joseph  H.  Patterson,  Denver,  James  R.  McDowell,  Denver. 

SPECIAL  COMMITTEES 

Rocky  Mountain  Medical  Conference  (five  years) : L.  Clark  Hepp,  Denver, 
1953;  G.  P.  Lingenfelter,  Denver.  1952,  Chairman;  Ward  Darley,  Denver, 
1951;  L.  W.  Bortree,  Colorado  Springs.  1950;  George  H.  Gillen,  Denver, 
1949. 

Advisory  to  Auxiliary:  Fred  A.  Humphrey,  Fort  Collins,  Chairman;  Ervin 
A.  Hinds,  George  R.  Buck,  Denver. 

Midwinter  Clinies:  Samuel  B.  Childs,  Jr..  Chairman;  Raymond  C.  Chat- 
field,  E.  L.  Binkley,  Jr.,  A.  J.  Kauvar,  Terry  J.  Gromer,  all  of  Denver. 

Rehabilitation;  W.  W.  Haggart,  Denver,  Chairman;  Atha  Thomas,  Den- 
ver; Lawrence  T.  Brown,  Denver;  J.  E.  A.  Connell,  ^eblo;  Thad  P.  Sears, 
Ft.  Logan:  Keimeth  C.  Sawyer,  McKlnnle  L.  Phelps,  George  R.  Buck. 
Bradford  Murphey,  ail  of  Denver. 

Advisory  to  the  Goodwill  Industries’  Rehabilitation  Program:  Lewis  C. 
Overholt,  Chairman;  William  H.  Halley,  Maurice  Katzman,  Terry  J. 
Gromer.  Lorenz  W.  Frank,  William  R.  Llpscomh,  Irvin  E.  Hendryson, 
all  of  Denver.’ 

Rorai  Hdalth  Commission:  Leonard  N.  Myers,  Cheyenne  Wells,  Chairman; 
V.  V.  Anderson,  Del  Norte;  James  S.  Orr,  Fruita;  Keith  F.  Krausnlek, 
Lamar:  Robert  M.  Lee,  Fort  Collins.  Ex-officio  member:  Fred  A.  Hum- 
phrey, Fort  Collins. 

Medical  Disaster  Commission:  Foster  Matchett,  Denver,  Chairman;  Karl 
Arndt,  Denver,  Secretary;  Mark  S.  Donovan,  Harry  C.  Hughes,  Adolph  J. 
Kafka,  Roderick  J.  McDonald,  William  F.  Stanck,  Henry  Swan,  Karl  F. 
Sunderland,  K.  D.  A.  Allen,  all  of  Denver;  Lawrence  W.  Holden,  Boulder; 
Richard  H.  Mellen.  Colorado  Springs:  Richard  H.  Altmix,  Englewood;  Jacob 
0.  Mall,  Estes  Park;  Thad  P.  Sears,  Fort  Logan;  Donald  E.  Cowen,  Fort 
Morgan;  Kenneth  E.  Prescott,  Grand  Junction;  Walter  A.  Schoen,  Greeley; 
David  W.  McCarty,  Longmont;  David  W.  Boyer,  Pueblo;  J.  G.  Espey,  Craig; 
Leo  W.  Loyd,  Durango;  Keith  F.  Krausnlek,  Lamar;  Bobert  M.  Lee,  FL  Col- 
lins; George  H.  Lord,  Aurora;  J.  Gordon  Hedrick,  Wray;  James  P.  BIk. 
Grand  Junction. 

Lay  Organization  Standards;  George  R.  Buck,  Fredrick  H.  Good,  Ken- 
neth C.  Sawyer,  Frank  B.  McGlone,  T.  D.  Cunningham,  Bradford  Murphey, 
(lasper  F.  Hegner,  John  S.  Bouslog,  aU  of  Denver. 

Study  of  Child  Welfare  Clinics:  Balph  H.  Verploeg,  Denver,  Chairman; 
J.  W.  White,  Pueblo;  Jadtson  L.  Sadler,  Fort  Collins;  L.  B.  Maurer, 
Boulder;  Harvey  M.  Tupper,  Grand  Junction;  Harvey  S.  Busk,  Pueblo. 

Advisory  to  U.M.W.  Welfare  Fund  (Executive  Committee,  three-year 
terms;  others,  one-year);  Executive;  W.  W.  Haggart,  1951,  Chairman; 
F.  H.  Good,  1951;  J.  S.  Bouslog,  1951,  aH  of  Denver;  W.  H.  Halley, 
1950;  C.  F.  Hegner,  1950,  both  of  Denver;  R.  F.  Bell,  1950,  Louviers; 
McKinnie  Phelps.  1949,  Denver;  F.  A.  Humphrey.  1949,  Fort  Collins: 
J.  M.  Lamme,  1949,  Walsenburg.  Other  members:  K.  C.  Sawyer,  A.  C. 
Sudan,  Bradford  Murphey,  all  of  Denver;  C.  D.  Bonham,  Boulder;  J.  W. 
Craighead,  Pueblo;  J.  E.  Donnelly,  Trinidad;  Ligon  Price,  Mt.  Harris;  M.  J. 
McCallum,  Erie. 

Liaison  to  Colorado  State  Norses  Association:  John  R.  Evans,  Samuel  P. 
Newman,  Denver. 

Liaison  to  Colorado  Bar  Association:  W.  S.  Dennis,  Chairman;  A.  C. 
Sudan,  R.  W.  Arndt,  all  of  Denver. 

Medical-Dental  Liaison:  Guy  W.  Smith,  Denver,  Chairman;  George  B. 
Warner.  Denver;  Calvin  N.  CaldweU,  Puehlo. 

Representative  to  Rocky  Mountain  Radio  Council:  William  E.  Bay, 
Denver;  (Alternate:  Chaunoey  A.  Hager,  Denver). 

Representative  to  Belle  Bonfils  Memorial  Blood  Bank:  0.  S.  Pbilpott, 
Denver. 

Representatives  to  Liaison  Council  on  Graduate  Education  (two  years) : 

L.  R.  Safarlk,  Denver,  1949;  Harold  I.  Goldman,  Denver,  1950. 

Delegate  to  Colorado  Interprofessional  Council  (five  years) ; K.  D.  A 
Allen,  Denver.  1949;  (Alternate,  Carl  A.  McLauthlin.  Denver,  1949). 


606 


Rocky  Mountain  Medical  Journal 


Wherever  your  pollen-sensitive  patient 
spends  his  vacation,  Trimeton*  may  add  to  his  enjoyment 
and  rest  by  alleviating  his  symptoms  of  pollinosis.  Trimeton  is  an 
unusual  antihistaminic.  Essentially  different  in  chemical  composition,  it  is  so 
potent  that  only  one  25  milligram  tablet  is  usually  required  to  attain  the  desired  relief 
in  fifteen  to  thirty  minutes.  Best  of  all,  your  patient  isn’t  likely  to  sleep  away  his 
vacation  because  the  small  milligram  dosage  lessens  side  effects. 

T Ifeur  patient  will  also  appreciate  that  the  high  potency  of 

^ Trimeton  also  means  lower  cost  of  therapy. 

rimeton 


Dosage ; One  25  mg.  tablet  one  to  three  times  daily. 

Trimeton,  brand  of  prophenpyridamine,  25  mg.  tablets,  scored,  are  available  in  bottles  of  100  and  1000. 

♦Trimeton  trade-mark  of  Schering  Corporation 


CORPORATION  • BLOOMFIELD,  NEW  JERSEY 

IN  CANADA,  SCHERING  CORPORATION  LIMITED,  MONTREAL 
Serving  the  WEST  COAST.  Schering  Corporation 
149  New  Montgomery  St.,  San  Francisco  5,  Calif.  • Douglas  2-1544 


“A” 

4b 


TRIMETON^ 


MONTANA  STATE  MEDICAL  ASSOCIATION 


Next  Annual  Session:  Finlen  Hotel,  Butte;  Au^.  1,  2,  3,  4,  1949 


OFFICBRS 

Tenns  of  Officers  and  Committees  expire  at  the  Annnal  Session 
In  the  year  indicated.  Where  no  year  is  Indicated,  the  term  Is 
for  one  year  only  and  expires  at  1949  Annual  Session. 

President:  Thomas  L.  Hawtdns,  Helena. 

President-elect:  Thomas  V.  Walher,  Great  Falls. 

Vlea-Presldent:  R.  0.  Johnson,  Harlowton. 

Secretary-Treasurer:  Herbert  T.  Caraway,  Billings. 

Delegate  to  American  Medical  Association:  Raymond  F.  Peterson,  Butte, 
1950;  Alternate,  Thomas  B.  Moore,  Kallspell,  1950. 


STANDING  COMMITTEES 

Execetlva  Committee:  T.  L.  Hawkins,  Helens,  Chairman;  T.  F.  Walker, 
Great  Falls;  H.  T.  Caraway,  Billings;  L.  W.  Allard,  BiUinga;  M.  A. 
Shllllngton,  Olendlre. 

Economics  Committee:  J.  C.  Shields,  Butte,  Chairman;  C.  F.  Brooke,  St 
Ignatius;  R.  B.  Dumln,  Great  Falls;  Lelsnd  G.  Russell,  Billings;  S.  D. 
Hhetstone,  Cut  Bank. 

Legislative  Committee:  J.  M.  Flinn,  Helena,  Chairman;  F.  D.  Hurd, 
Gnat  Falls;  P.  E.  Kane,  Butte;  J.  C.  MacGregor,  Great  Falls;  Claude 
M.  Mears,  Helena. 

Necrology  and  History  of  Medicine  Committee:  L.  W.  Brewer,  Missoula, 
Chairman:  I.  J.  Brldenstlne.  Missoula;  J.  H.  Irwin,  Great  Falls;  Claude 
M.  Mears,  Helena'  J.  P.  Ritchey,  Missoula. 

Public  Relations  Committee:  H.  W.  Gregg,  Butte,  Chairman;  W.  L.  DuBols, 
Cut  Bank;  B.  V.  Morledge,  Billings;  W.  H.  Stephan,  Dillon;  Dora  Walker, 
Great  Falls. 

Legal  Affairs  and  Malpractice  Committee:  J.  C.  MacGregor,  Great  Falls, 
Chairman;  Raymond  Eck,  Lewlstown;  W.  E.  Harris,  Livingston;  John  E. 
Hynes,  Billings;  R.  D.  Knapp,  Wolf  Point. 

Program  Committee:  C.  H.  Fredrickson,  Missoula,  Chairman;  H.  T. 
Caraway,  BlUlngs:  H.  W.  Gregg,  Butte;  J.  J.  McCabe,  Helena;  E.  S. 
Murphy,  Missoula. 

Interprofessional  Relationship  Committee:  L.  W.  AUard,  Billings,  Chair- 
man; C.  R.  Canty,  Butte;  S.  A.  Cooney,  Helena;  S.  N.  Preston,  Missoula; 
F.  I.  Sabo,  Bozeman. 


Nominating  Committee:  H.  H.  James,  Butte,  Chairman;  R.  L.  Aadenoa, 
Fort  Benton;  R.  D.  Harper,  Sidney;  J.  J.  Malee,  Anaconda;  W.  B.  Mt- 
Elwee,  Townsend. 

Aoditing  Committee;  E.  H.  Llndstrom,  Helena,  Chairman;  F.  H.  Cnga, 
Great  Falls;  R.  D.  Harper,  Sidney;  G.  W.  Setzer,  Malta;  B.  0.  Joboson, 
Harlowton. 

Cancer  Committee;  Mary  E.  Martin,  BlUlngs,  Chairman;  W.  F.  Caah- 
more,  Helena;  C.  H.  Fredrickson,  Missoula;  B.  F.  Peterson,  Butte;  W.  C. 

Robinson,  Shelby. 

Maternal  and  Child  Welfare  Committee;  F.  L.  MePbaU,  Great  Falb, 
Chairman;  L.  W.  Brewer,  Missoula;  P.  L.  Eneboe,  Bozeman;  Maude  H. 
Gerdes,  BlUlngs;  D.  L.  GiUesple,  Butte;  A.  L.  Gleason,  Great  Falla;  lb  L. 
Hall,  Great  Falls;  D.  S.  Ma^enzie,  Jr.,  Havre;  B.  E.  Mattlson,  BiUinga; 
0.  M.  Moore,  Helena;  F.  W.  Paul,  KalispeU;  C.  W.  Pembert^  Butte; 
S.  N.  Preston,  Missoula;  A.  E.  Bltt,  Great  Falls. 

Tuhereolosls  Commltree:  F.  I.  TerrlU,  Galen,  Chairman;  C.  B.  Craft, 
Bozeman;  E.  A.  Dolan,  Anaconda;  A.  R.  Klntner,  Missoula;  J,  A.  Layne, 
Great  Falls. 

Fracture  and  Orthopedic  Committee:  J.  K.  Colman,  Butte,  Cbalnnan;  L.  C. 
AUard,  BilUngs;  W.  H.  Hagen,  BilUngs;  S.  L.  Odgers,  Butte;  J.  C.  Wol- 
gamot.  Great  Falls. 

Rural  Health  Committee:  B.  C.  Farrand,  Jordan,  Chairman;  B.  A. 
Benke,  KalispeU;  W.  A.  Lacey,  Havre;  W.  G.  TangUn,  Poison;  J.  H. 
Williams,  Culbertson. 

Industrial  Welfare  Committee;  B.  B.  Richardson,  Great  Falls,  Chairman; 
M.  A.  Gold,  Butte;  P.  E.  Logan,  Great  Falls;  D.  S.  MacKenzle,  Jr.,  Havre; 
R.  E.  Walker,  Livingston. 

Rheumatic  Fever  and  Heart  Committee:  F.  B.  Schemm,  Great  FaUs. 
Chairman;  D.  T.  Berg,  Helena;  H.  W.  Gregg,  Butte;  A.  B.  Kintner,  Mis- 
soula; P.  E.  Logan,  Great  Falls;  F.  H.  Lowe,  Missoula;  J.  J.  Malee, 
Anaconda;  0.  M.  Moore,  Helena;  H.  W.  Power,  Conrad;  R.  E.  SmaUey, 
Billings. 

SPEOIAI.  COMMITTEES 

Emergency  Medical  Service  Committee:  B.  F.  Peterson,  Butte,  Cbalnnan; 
Paul  J.  Gans,  Lewlstown;  J.  J.  McCabe,  Helena;  S.  A.  Olson,  Glendlve; 
L.  G.  RusseU,  BilUngs. 

lAB  Fee  Schedule  Committee:  H.  H.  James.  Butte,  Chairman;  E.  B. 
Llndstrom,  Helena;  J.  J.  Malee,  Anaconda;  D.  S.  McKemUe,  Jr.,  Havre; 
F.  K.  Wanlata,  Great  Falls. 


Collection 


of 


Accounts 


All  reports  show  a trend  toward  slower  and  harder  collections  in  the 
months  ahead. 

At  the  first  sign  of  neglect  you  will  save  money  if  they  are  turned  over 
to  us  for  collection. 

Comparison  of  collection  results,  backed  by  35  years  of  experience,  proves 
you  obtain  greater  results  at  less  cost,  when  you  list  your  accounts 

^ ' with 

The  American  Medical  and  Dental  Association 

Suite  524,  810  14th  St.  TAbor  2331  Denver,  Colorado 


608 


Rocky  Mountain  Medical  Journal 


For  infant  feeding  in  hot  weather . • . 


Hot  weather  presents  no  problem  when  Lactogen*  is  used  for  infant  feeding 
I ...because  when  refrigeration  is  not  available,  each  feeding  may  be  prepared 
I separately.  The  doctor  can  always  advise  the  mother  to  prepare  individual 
i Lactogen  feedings  whenever  the  baby  is  ready  for  his  bottle. 

I Preparing  each  Lactogen  feeding  just  before  feeding  time  safeguards 
I the  baby  against  the  danger  of  nutritional  upsets  caused  by  bacteriological 
j changes  in  the  formula. 


LACTOGEN 


HOMOGENIZED  SPRAY  DRIED  WHOLE  COW’S  MILK 
Modified  with  MILK  FAT  & LACTOSE  • Reinforced  with  IRON 

No  advertising  or  feeding  directions  except  to  physicians. 


‘"LACTOGEN"  is  the  exclusive  registered  trade  mark  of  The  Nestle  Company,  Inc. 


NEW  MEXICO  MEDICAL  SOCIETY 


OFFICERS— 1949-1950 

President:  J.  Hannett,  Albuquerque. 

President-Elect:  I.  J.  Marshall,  Roswell. 

Vice  President!  Leland  S.  Evans,  Las  Cruces. 

Secretary-Treasurer:  H.  L.  January,  Albuquerque. 

Councilors  (o  years):  Carl  Mulky,  Albuquerque;  J.  C.  Sedgwick,  Las 
Cruces.  (2  years):  VV.  D.  Dabbs,  Clovis;  A.  C.  Shuler,  Carlsbad.  (1  year): 
A.  S.  Lathrop,  Santa  Fe;  C.  H.  Gellenthien,  Valmora. 

COMMITTEES— 1949-1950 

Basic  Science:  Raymond  L.  Young.  Santa  Fe,  Chairman;  VV.  E.  Nissen, 
Albuquerque;  Walter  A.  Stark.  Las  Vegas. 

Rural  Medical  Service:  Stuart  Adler,  Albuquerque,  Chairman;  Samuel  R. 
Zeigler,  Espanola,  A.  T.  Gordon,  Tucumcari;  L.  G.  Foster,  Reserve;  J.  P. 
Turner,  Canizozo. 

Cancer:  Murray  Friedman,  Santa  Fe,  Chairman;  Van  A.  Odle,  Roswell; 
J.  R.  Van  Atta.  Albuquerque;  J.  W.  Grossman,  Albuquerque;  R.  C.  Derby- 
shire, Artesia. 

Venereal  Disease  Control:  Sajn  Jelso,  Albuquerque,  Chairman;  V.  E.  Berch- 
told,  Santa  Fe;  L.  M.  Miles,  Albuquerque;  Vincent  Accardi,  Gallup;  F.  C. 
Bohannon,  Carlsbad. 


Legislative  and  Public  Policy:  A.  S.  Lathrop,  Santa  Fe,  Chairman;  H.  T. 
Watson,  Gallup;  C.  B.  Elliott,  Raton;  John  F.  Conway,  Clovis;  H.  M.  Mor- 
timer, Las  Vegas:  G.  S.  Morrison,  Roswell;  D.  B.  Marsh,  Deming;  R.  A. 
Watts,  Silver  City;  Ashley  Pond,  Taos;  W.  L.  Minear,  Hot  Springs;  L.  S. 
Evans,  Las  Cruces;  W.  M.  Thaxton,  Tucumcari;  William  C.  White,  Los 
Alamos;  W.  0.  Connor,  Albuquerque;  C.  S.  Stone,  Hobbs;  A.  C.  Shuler, 
Carlsbad. 

Public  Relations:  C.  P.  Bunch,  Artesia,  Chairman;  Earl  L.  Malone,  Ros- 
well; 0.  S.  Cramer,  Albuquerque;  Eric  P.  Hausner,  Santa  Fe. 

Tuberculosis:  C.  H.  Gellenthien,  Valmora,  Chairman;  William  H.  Thearle, 
Albuquerque;  P.  0.  Shields,  Albuquerque;  Carl  Mulky,  Albuquerque;  H.  S. 
A.  Alexander,  Santa  Fe, 

Advisory  Conmittee  on  Insurance  Compensation:  L.  M.  Overton,  Albuquer- 
que, Chairman;  R.  E.  Forbis,  Albuquerque;  Edward  Pamall,  Albuquerque;  H. 
D.  Corbusier,  Santa  Fe. 

National  Emergency  Medical  Service;  A.  E.  Beymont,  Santa  Fe,  Chair- 
man; L.  G.  Rice,  Albuquerque;  C.  M.  Thompson,  Albuquerque. 

Board  of  Supervisors:  U G.  Rice,  Bernalillo  County;  Van  A.  Odle,  Chaves 
County;  Milton  Floersheim,  Colfax  County;  John  F.  Conway,  Curry  County; 
C.  P.  Bunch,  Eddy  County;  Frank  W.  Parker,  Jr.,  McKinley  County;  V.  E. 
Berchtold,  Santa  Fe  County;  W.  A.  Stark,  San  Miguel  County. 


Oculist  Prescription  Service  Exclusively 

SHADFORD-FLETCHER  OPTICAL 

Dispensing  Opticians 

228  16th  Street,  Denver,  Colo.  AComa  2611 
3705  East  Colfax  (Medical  Center  Building).  FLorido  0202 


CO 


These  fine  Dairy  Cattle,  a portion  of  City  Park’s  large  herd  of  Guernsey  and  Holstein 
cows,  are  scientifically  fed  and  cared  for,  continuously  tested  by  competent  veterin- 
arians. Only  through  such  precise  watchfu'ness  does  City  Park  Milk  receive  Grade 
“A”  designation  which  it  enjoys.  Choose  City  Park’s  regular  Grade  “A”  Pasteurized 
or  Homogenized  milk  today  — notice  the  particularly  clean,  fresh  flavor. 


’Phone 
EAst  7707 


Cherry  Creek 
Drive — Denver 


610 


Rocky  Mountain  Medical  Journal 


LEDERLE  LABORATORIES  DIVISION 


AMERICAN 


G^anamid 


COMPANY 


30  ROCKEFELLER  PLAZA  • NEW  YORK  20,  N.  Y. 


recovery  process  has  been  shown 
empirically  to  speed  the  patient  upon 
the  road  to  normal  health.  Amino  acid 
preparations  should  be  supplemented 
by  moderate  amounts  of  vitamins. 

Lederle  research  has  for  some  time  been 
concerned  with  such  mixtures  of  amino 
acids  and  vitamins  and  their  application 
in  the  field  of  nutrition. 


73 


Tissue  repair  is  the  keystone  of  the 
recovery  process.  It  makes  little  difference 
if  the  infection  is  halted,  the  fracture 
reduced,  or  the  metabolic  imbalance  ad- 
justed— it  is  the  patient’s  own  cells  that 
must  complete  the  cure. 

While  true  hypoproteinemia  is  compara- 
tively rare,  nevertheless  hypernutrition 
with  essential  amino  acids  during  the 


for  August,  1949 


611 


THE  UTAH  STATE  MEDICAL  ASSOCIATION 

Next  Annual  Session:  Salt  Lake  City,  Sept.  1,  2,  S, ' 1949 


OimCEiRS 

Preildent:  0.  A.  OgllTle,  Salt  Lake  dtp. 

Prnldent'tleet:  C.  H.  Jensim,  Ogden. 

Past  Pruident:  J.  C.  Hubbard,  Price. 

Honorary  President:  0.  W.  French,  CoaWlle. 

First  Vice  President:  J.  0.  McQuarrie,  Bicbfleld. 

Second  Vice  President:  Hzra  Cragun,  Lewiston. 

Third  Vice  President:  K.  W.  Farnsworth,  Cedar  City. 

Secretary:  Ray  T.  Woolsey,  Salt  Lake  City. 

Execotlve  Secretary:  Ur.  W.  H.  Tibbals,  Salt  Lake  City. 

Treasorer:  L.  B.  White,  Salt  Lake  City. 

Conncllor  First  District:  J.  G.  Olson,  Ogden. 

Coancllor  Second  District:  V.  L.  Rees,  Salt  Lake  dty. 

Councilor  Third  District;  L.  W.  Oaks,  Proro. 

Delegate  to  A.M.A.,  1948:  James  P.  Kerby,  Salt  Lake  City. 

Alternate  Delegate  to  A.M.A.,  1948:  J.  J.  Weight,  Ftoto. 

Editor  of  tho  Utah  Section  of  the  Rocky  Monnnain  Medical  Journal; 
I.  P.  Middleton,  Salt  Lake  City. 

STANDING  COMMITTEES 
Rocky  Mountain  Medical  Conference  Continuing  Committee:  R.  P.  Mid- 
dleton, Chairman,  Salt  Lake  City,  1949;  K.  B.  Castleton,  Salt  Lake  City, 
1950;  Clark  Rich,  Ogden,  1951;  NoaU  Z.  Tanner,  Layton,  1952;  T.  R. 
Seager,  Vernal,  1953. 

Seientifle  Program  Committee:  Ray  T.  Woolsey,  Chairman,  Salt  Lake 
City;  Drew  M.  Peterson,  Ogden;  Stanley  N.  Clark,  ProTo;  P.  M.  Howard, 
Salt  Lake  City;  V.  P.  White,  Salt  Lake  City;  L.  V.  Broadbent,  Cedar 
City;  Paul  A.  Pemberton,  Salt  Lake  City. 

Public  Pulley  and  Legislation  Committee:  F.  R.  King,  Chairman,  Price, 
1951;  Jesse  J.  Weight,  Proro,  1949;  M.  L.  CrandaU,  Salt  Lake  City, 
1949;  V.  L.  Sterenson,  Salt  Lake  City,  1949;  N.  F.  Hicken,  Salt  Lake 
ety,  1950;  Omar  Budge,  Logan,  1950;  John  Colettl,  Salt  Lake  City,  I960: 
W.  B.  Wrat,  Ogden,  1951;  R.  V.  Larson.  Rooserelt,  1951. 

Medical  Defense  Committee:  W.  J.  Thomson,  Chairman,  Ogden,  1949; 
R.  W.  Owens,  Salt  Lake  City,  1949;  J.  L.  Hansen,  Vernal,  1949;  Homer 
Smith,  Sait  Lake  City,  1950;  L.  N.  Ossman,  Salt  Lake  City,  1950;  Erwin 

D.  Zeman,  Ogden.  1950;  Charles  W.  Woodruff,  Salt  Lake  City,  1951; 

James  Weitwood,  Proro,  1951;  L.  H.  Merrill,  Hiawatha.  1951. 

Medical  Education  and  Hospitals  Committee:  I.  Bruce  McQuarde,  Chair- 
man. Ogden,  1949;  L.  J.  Paul,  Salt  Lake  City,  1949.;  0.  A.  Ogllrte. 
Bait  Lake  City,  1949;  G.  G.  Richards,  Salt  Lake  (Sty.  1950.;  Bay  T. 
Woolsey,  Salt  Lake  City,  1950;  T.  E.  Robinson,  Salt  Lake  City,  1950: 

Seth  B.  Smoot,  Provo,  1951;  George  H.  Curtis,  Salt  Lake  City,  1951: 

R.  0.  Porter,  Logan.  1951;  R.  H.  Young,  Ex-Officio,  Salt  Lake  City. 

Medical  Econenles  Committee:  RiBsell  Smith,  Chalnnan,  Provo,  1949; 
A.  E.  Denman,  Helper,  1949;  W.  T.  Ward,  Salt  Lake  City,  1950;  W.  B. 
Merrill,  Brigham  City,  1951;  Ralph  Pendleton,  Salt  Lake  City,  1951. 


Public  Health  Committee;  John  R.  Bourne,  Chairman,  Boasevelt,  lS4t: 
F.  D.  Spencer,  Salt  Lake  City,  1950;  Ralph  BHia,  Ogden,  1951. 

Military  Affairs  and  National  Emergency  Conmlttec:  Chrlea  WoodrtST, 
Chairman,  Salt  Lake  City;  L.  J.  Paul,  Salt  Lake  City;  Maxel  StolflelC 
Salt  Lake  City;  W.  M.  Gorishek,  SUndardrlUc  L.  B.  CuUlBore,  Otm; 

Ray  H.  Barton,  Magna;  D.  T.  Madaon,  Prict;  Elley  G.  Clark,  Prwt; 

Wllllu  Hayward,  Logan;  Dean  Tanner,  Ogden. 

Tuberculosis  and  Cardiwaseuiar  Dlseasei  OoBmittee:  Elmer  M.  EU- 
Patrick,  Chairaan,  Salt  Lake  Qty;  Kay  Ruiael,  Salt  Lake  City;  D.  0.  N. 
Lindbe:^,  Ogden;  W.  C.  Walker,  Salt  Lake  City;  Donald  M.  Moore.  Ogdea; 
Don  C.  Merrill,  Provo. 

Cancer  Committee:  0.  A.  Wlvle,  Chairman,  Salt  Lake  City;  S.  W. 

Fennemore,  Price;  E.  D.  Zeman,  Ogden;  W.  0.  Noble,  Richasoiil:  Har®M 

Austin,  Provo;  Stanley  G.  lera,  Gunnlsoa;  Paul  K.  Edmunefe,  Cedar  (Sty; 
F.  G.  Eskekon,  Vernal;  K.  B.  C^tletan,  Salt  Lake  City. 

Fracture  Committee;  A.  M.  Okelbeny,  Chalrnian,  Salt  Lake  City;  Chuk 
Rich,  Ogden;  Roy  H.  Robinson,  Kenilworth;  S.  M.  Budge,  Logan;  Norman 
R.  Beck,  Salt  Lake  City;  Loms  Perry,  Ogden;  J.  Q.  McQuarrie.  BieMleM; 
D.  C.  Evans,  Fillmore. 

Nenloty  Oommittee;  W.  T.  Hasler,  Chalman,  Provo;  L.  A.  Stsveason, 
Salt  Lake  City;  Jos.  A.  Phipps,  Salt  Lake  City. 

Industrial  Health  Committee:  Paul  S.  Blcbards,  Chairman,  Binghaa 
Canyon;  L.  J.  Tauter,  Salt  Lake  City;  Frank  Gorishd:,  Helper;  Byron  Dayset, 
Salt  Lake  City;  E.  B.  Kuhe,  Salt  Lake  City;  D.  C.  Barker,  Ogden. 

• Advisory  Committee  to  the  Woman’s  Aoxllfary:  Vernal  Johnson,  Chair- 
man, Ogden;  0.  P.  Heninger,  Prow;  L.  G.  Moench,  Salt  Late  Oty;  Janii 

K.  Palmer,  Salt  Lake  City. 

Public  Relations  Cmnmittee:  R.  P.  Middleton,  Chairman,  Salt  Lake  City: 
Louis  P.  Matthei,  Ogden;  R.  W.  Farnsworth,  Cedar  City;  Quinn  A.  Whit- 
ing, Price;  Clyde  J.  Dalnes,  Logan;  Bay  B.  Spendlove,  Vernal;  H.  L 
Goodwin,  Salt  Lake  City;  Gilbert  Wright,  Salt  Lake  Oty;  Boy  B.  Hammond, 
Provo. 

iRter-Professjonal  Csmmittei:  J.  Leroy  KlmbaU,  Chairman,  Salt  Lake 
City;  C.  C.  Hetzel,  Jr.,  Ogden;  T.  B.  Bauman,  Park  City;  Paul  (^ytm. 
Salt  Lak,e  City;  Ralph  G.  Blgby,  Salt  Lake  aty. 

Mental  Hygiene  ComraIttM:  Roy  A.  Darke,  ChalrmaD,  Salt  Lake  0ly; 

L.  G.  Moench,  Salt  Lake  City;  Wm.  D.  Pace,  Salt  Lake  City;  Georg*  Coehras, 
Salt  Lake  City;  E.  L.  Weimeis,  Prevo. 

Fee  Sehedole  Commltt**:  K.  B.  Castleton,  Chairman,  Salt  Lake  0tr; 
Howard  K.  Belnap,  Ogden;  J.  1.  Trowbridge,  BountlM;  U.  B.  Mtfmt, 
Salt  Lake  City;  W.  Leroy  Smith,  Salt  Lake  aty;  J.  1.  Whetrltt,  H»b« 
(Sty;  0.  W.  Budge,  Logan. 

Special  Cummlttet  to  Study  Dues;  H.  E.  Belehman,  Chalimail,  Salt 
Lake  City;  Eilot  Snow.  Salt  Lake  City;  Kura  Oagun,  Lewiston. 

Rural  Htalth  Conmittee;  J.  J.  Weight,  Chairman,  Provo;  J.  0.  HeQuanl*. 
Richfield;  J.  P.  Burgess,  Hyrum;  NoaU  Z.  Tanner,  Layton, 


PHOTO 


COLOR.  PROCESS,  h iTT/ 
LINE  & HALFTONE  / A A 
BEN  DAY. ..  ...rLH  U 
ILLUSTRATORS-DESIGNERS 


612 


Eocey  Mountain  Medical  Journal 


Modern  therapy  with  Digoxin  helps  eliminate  the 
hazards  of  digitalization  through  more  precise  and  more 
predictable  action.  A pure  crystalline  drug  of  constant 
potency,  Digoxin  allows  greater  accuracy  of  dosage  and 
greater  ease  of  adjustment  than  do  the  crude  digitalis, 
preparations  assayed  in  biological  units. 

Rapid  digitalization  follows  oral  as  well  as  parenteral 
administration  because  the  drug  is  promptly  and  uni- 
formly absorbed.  Rapid  elimination  assures  short  dura- 
tion of  possible  toxic  side  effects. 

The  average  digitalized  patient  on  a maintenance  dose 
of  one  and  one-half  to  three  grains  of  whole  leaf  digitalis 
per  day  may  be  simply  switched  to  maintenance  with 
Digoxin  with  an  initial  trial  daily  dose  of  0.25  mg.  (1 
‘Tabloid’  Digoxin)  and  adjusted  subsequently  in  accord 
with  his  needs. 


ORAL  PREPARATIONS: 

'Tabloid'  brand  Digoxin,  0.25  mgm. 
(gr.  1/260  approx.) 

Bottles  of  25,  100  and  500. 

Solution  of  Digoxin 
(B.  W.  & Co.)  0.5  mgm. 

(gr.  1/130  approx.)  in  I cc. 
(supplied  with  pipette). 

FOR  INTRAVENOUS  USE; 
'Wellcome'*  brand  Digoxin 
Injection  0.5  mgm.  (gr.  1/130 
approx.)  in  I cc.  Boxes  of  10 
and  100  ampuls. 

*Formerly  known  as  'Hypoloid' 


BURROUGHS  WELLCOME  & CO.  (U.S.A.)  INC. 
9 & II  EAST  41st  STREET.  NEW  YORK 


DIGOXIN 


a crystalline  glycoside  of  digitalis  lanata 


for  August,  1949 


613 


THE  WYOMING  STATE  MEDICAL  SOCIETY 

Next  Annual  Session:  Elks  Club,  Casper;  Sept.  12,  13,  14,  1949 


OFFICERS 

President:  George  E.  Baker,  Casper. 

President-Elect:  DeWitt  Dominick,  Cody. 

Vice  President:  K.  E.  Krueger,  Rock  Springs. 
Treasurer:  V.  M.  Schunk,  Sheridan. 

Correspondino  Secretary:  George  H.  Phelps,  Cheyenne. 
Delegate  A M. A.:  R.  H.  Eeeye,  Casper. 

Alternate  Delegate  A.M.A. : W.  A.  Buntcn,  Cheyenne. 
Executive  Secretary:  Mr.  Arthur  Abbey,  Cheyenne. 


COMMITTEES 

Rocky  Mountain  Medical  Conference:  Earl  Wbedon,  Chairman,  Sheridan; 
George  N.  Phelps,  Cheyenne;  H.  L.  Harvey,  Casper;  C.  W.  Jeffrey,  Rawlins; 
L.  W.  Storey,  Laramie. 

Syphilis  Committee:  N.  E.  Morad,  Chairman,  Casper;  G.  M.  Oroehsrt, 
Worland;  L.  B.  Wilmoth,  Lander;  L.  0.  Booth,  Sheridan;  F.  H.  Halgler, 
Midwest.  , 

Caneer  Committee:  Earl  Whedon,  Chairman,  Sheridan;  John  Gramlleh, 
Cheyenne:  DeWitt  Dominick,  Cody;  J.  R.  Newman,  Kemmerer;  E.  W.  New- 
man, Cheyenne. 

Medical  Economics  Committee:  C.  L.  Rogem,  Chairman,  Sheridan;  Nels 

A.  Vlcklund,  Thermopolls;  R.  A.  Corbett,  Saratoga;  G.  R.  James,  Casper; 
S.  S.  Hellewell,  Evanston. 

Fracture  Committee:  Philip  Teal,  Chairman,  Cheyenne;  Silva  J.  Giovale, 
Cheyenne;  Robert  V.  Batterton,  Rawlins;  Lowell  D.  Kattenbom,  Powell; 
Joeeph  E.  Hoadley,  Gillette. 

Medical  Defense  Committee:  George  Baker,  Chairman,  Casper;  Andrew 
Bonten,  Cheyenne;  E.  W.  DeKay.  Laramie. 

Councillors:  Earl  Whedon,  Chairman,  Sheridan;  B.  J.  Boesel,  Cheyenne; 

B.  W.  DeKay,  Laramie;  George  Baker,  President,  Casper;  George  Phelps. 
Secretary,  Cheyenne. 

Advisory  to  Woman’s  Auxiliary:  John  R.  Bunch,  Chairman,  Laramie; 
Virgil  L.  Thorpe,  Newcastle;  H.  J.  Aldrich,  Sheridan;  G.  B.  Savory,  Chey- 
usne. 

Advisory  to  Workmen’s  Compensation  Department:  J.  D.  Shingle,  Chair- 
man, Cheyenne;  G.  H.  Phelps,  Cheyenne;  W.  A.  Bunten,  Cheyenne;  R.  B. 
Reeve,  Casper;  Albert  T.  Sudman,  Green  River;  P.  M.  Schunk,  Sheridan. 


Industrial  Health  Committee;  R.  E.  Krueger,  Chairman,  Rock  Springs; 
Willard  Pennoyer,  Cheyenne;  Thomas  B.  Croft,  Lovell;  Eogene  Felton, 
Laramie. 

Veterans’  Affairs  and  Military  Service  Committee:  A.  J.  AUegretU,  Chair- 
man, Cheyenne;  Jack  Rowlett,  Laramie;  Everett  Ellis,  Cheyenne;  Bernard 
SulUvan,  Laramie;  G.  W.  Koford,  Cheyenne;  Bernard  Stack,  Tbermopolis; 
J.  W.  Sampson,  ^erldan;  DeWitt  Dominick,  Cody;  Paul  B.  Beltz,  Lander; 
George  E.  Baker,  President,  Casper;  George  Phelps,  Secretary,  Cheyenne. 

Blue  Cross  Hospital  Committee:  B.  I.  Williams,  Chairman,  Cheyenne,  1950; 
W.  A.  Bunten,  Cheyenne,  1949;  E.  W.  DeKay,  Laramie,  1951;  Cedric 
Jones,  Cody,  1952. 

Public  Policy  and  Legislation:  George  Phelps,  Chairman,  Cheyenne; 
Andrew  Bunten,  Cheyenne;  George  Baker,  President,  Casper;  G.  W.  Koford, 
Cheyenne;  E.  W.  DeKay,  Laramie;  G.  W.  Henderson,  Casper. 

National  Physicians  Committee;  George  Phelps,  Chairman,  Cheyenne; 
Andrew  Bunten,  Treasurer,  Cheyenne;  E.  W.  DeKay,  Laramie;  George  Baker, 
Casper. 

Poliomyelitis  Committee:  H.  L.  Harvey,  Chairman,  Casper;  N.  A.  Vlcklund, 
Thermopolls;  Leo  Keenan,  Torrlngton;  DeWitt  Dominick,  Cody;  Philip  Teal, 
Cheyenne;  Franklin  Yoder,  Cheyenne;  F.  A.  Mills,  Rawlins. 

State  Institutions  Advisory  Committee:  J.  F.  Whalen,  Chairman,  Evaoi- 
ton;  George  Phelps,  Cheyenne;  C.  W.  Jeffrey,  Rawlins;  Earl  Whedon,  Sheri- 
dan; G.  M.  Groshart,  Worland;  R.  H.  Kanable,  Basin. 

Necrology  Committoe:  Earl  Whedon.  Chairman,  Sheridan;  John  B. 
Krahl,  Torrlngton;  Franklin  Yoder,  Cheyenne. 

Rural  Hdalth  Committee;  Paul  Holtz,  Chairman,  Lander;  Andrew  Bun- 
ten, Cheyenne;  Samuel  Worthen,  Alton;  Wm.  K.  Bosene,  Wheatland;  Claude 
Raffl,  Basin. 

Public  Health  Department  Liaison  Committee:  E.  C.  Bldgeway,  Chair- 
man, Cody;  B.  P.  Fitzgerald,  Casper;  B.  V.  Batterton,  BawUns;  J.  W. 
Sampson,  Sheridan;  R.  C.  Stratton,  Green  River;  WiUard  Pennoyer, 

Cheyenne. 

Child  Health  Committee:  Paul  W.  Emerson,  Chairman,  Cheyenne;  John 
GramUch,  Cheyenne;  Thomas  Croft,  LoveU;  Bernard  Sullivan,  Laramie; 

Paul  R.  Holtz,  Lander:  Geo.  £.  Baker,  Casper;  A.  B.  Abbey,  Cheyenne. 

Council  on  National  Emergency  Medidal  Service:  George  H.  Fhetm, 
Chairman,  Cheyenne;  R.  H.  Reeve,  Casper;  DeWitt  Dominick,  Co^;  E.  W. 
DeKay,  Laramie;  K.  S.  Krueger,  Rock  Springs;  P.  M.  Schunk,  Sheridan. 


COLORADO  HOSPITAL  ASSOCIATION 


OETPICEJaS 

President:  Hubert  W.  Hughes,  St.  Anthony  Hospital,  Denver. 
President-Elect:  Walter  G.  Christie.  Presb^erian  Hospital,  Denver. 

Vice  President:  Sister  M.  Domnina,  St.  Anthony  Hospital,  Denver. 
Treasurer:  M.  A.  Moritz,  Denver  General  Hospital,  Denver. 

Acting  Executive  Secretary:  Roy  R.  Anderson. 

Trustees:  Roy  R.  Prangley,  St.  Luke’s  Hospital,  Denver  (1949);  James 
P.  Dixon,  M.D.,  Denver  General  Hospital,  Denven  (1949);  Louis  Liswood, 
National  Jewish  Hospital,  Denver  (1950);  DeMoss  Taliaferro,  Children’s 
Hospital,  Denver  (1950);  Roy  R.  Anderson,  Presbyterian  Hospital,  Den- 
ver (1951);  Rev.  AUeu  H.  Brb,  Mennonite  Hospital,  La  Junta,  Colo. 
(1951). 

Delegate  to  the  American  Hospital  Association:  Herbert  A.  Black,  M.D., 
Parkview  Hospital,  Pueblo. 

Aiternate:  ALsgr.  John  R.  Mulroy,  CathoUc  Hospitals,  Denver. 

STANDING  COMMITTEEJS 
Auditing:  R W.  Pontow,  Chairman  (1949),  Colorado  General  Hospital, 
Denver;  Rev.  E.  J.  Friedrich  (1950),  Lutheran  Sanatorium,  Wheatridge; 
Karl  Mortensen  (1951),  St.  Luke’s  Hospital,  Denver. 

Constitution  and  Rules:  Samuel  S.  Golden,  M.D.,  Chairman,  Beth  Israel 
Hospital,  Denver;  Henry  H.  Hill,  Weld  County  Hospital,  Greeley;  Sister 
M.  Johanna,  Sacred  Heart  Hospital.  Lamar. 

Legislative:  Msgr.  John  R.  Mulroy,  Chairman,  Catholic  Hospitals;,  Den- 
ver; DeMoss  Taliaferro,  Children’s  Hospital,  Denver;  Carl  Ph.  Schwalb, 
Denver;  Herbert  A.  Black,  M.D.,  Parkview  Hospital,  Pueblo. 

Membership:  Sister  M.  Alphonsus  Chairman,  Mercy  Hospital,  Denver; 
Roy  R.  Prangley,  St.  Luke’s  Hospital,  Denver. 

Resolutions:  Walter  G.  Christie,  Chairman.  Presbyterian  Hospital,  Denver: 
Carl  Ph.  Schwalb,  Denver. 

Nominating:  Msgr.  John  R.  Mulroy,  (Bialrman  (1949),  Catholic  Hos- 
pitals, Denver;  Herbert  A.  Black,  M.D.  (1950),  Parkview  Hospital,  Pueblo; 

C.  S.  Bluemel,  M.D.  (1951),  Mount  Airy  Sanatorium,  Denver. 

Program:  George  A.  W.  Currie,  M.D.,  Chairman,  University  of  Colorado 
Medical  Center,  Denver;  Roy  Anderson,  Presbyterian  Hospital,  Denver. 


Nursing:  DeMoss  Taliaferro,  Chairman,  Children’s  Hospital,  Denver; 
Sister  M.  HugoHna,  St.  Anthony  Hospital,  Denver:  Margaret  E.  Paetzniek, 
Director  of  Nurses,  Denver  General  Hospital,  Denver;  Sister  Maria  Gratia, 
BN.,  Glockner  Sanatorium,  Colorado  Springs;  S.  Buss  Denzler,  M.D., 
Colorado  Hospital,  Canon  City. 

Public  Education:  Owen  B.  Stubben,  Chairman,  Denver  General  Hospital, 
Denver;  Mr.  Torgeisen,  Longmont  Hospital  and  Clinic,  Longmont;  Ward 
Darley,  M.D.,  Director,  University  of  Colorado  Medical  Center,  Denver; 
Chas.  Levine,  J.C.R.S.,  Spivak. 

SPElCIAI,  COMMITTEHES 

Public  Relations:  James  P.  Dixon,  M.D.,  Chairman,  Denver  General 
Hospital,  Denver;  Sister  Mary  Lina,  St.  Francis  Hospital,  Colorado  Spring. 

Rates  and  Charges:  Boy  Anderson,  Chairman,  Presbyterian  Hospital, 
Denver;  Msgr.  John  B.  Mulroy,  Catholic  Hospitals,  Denver:  Boy  B. 
Prangley,  St  Luke’s  Hospital,  Denver;  Walter  G.  Christie,  Presbyterian 
Hospital  Denver;  DeMoss  Taliaferro,  Children’s  Hospital,  Denver;  Ben 
M.  Blumberg,  General  Rose  Memorial  Hospital,  Denver. 

State  Board  of  Health  Advisory:  Msgr.  John  R.  Mulroy,  Chairman, 
Catholic  Hospials,  Denver:  DeMoss  Taliaferro,  Children’s  Hospital,  Denver; 
Herbert  A.  Black.  M.D.,  Parkview  Hospital,  Pueblo. 

Committeo  on  Hospital  Licensing  Regulations  and  Standards:  Msgr.  John 
R.  Mulroy,  Chairman,  Catholic  Hospitals,  Denver;  Boy  B.  Prangley,  St 
Luke’s  Hospital,  Denver;  Owen  B.  Stubben,  Denver  General  Hospital,  Denver; 
DeMoss  Taliaferro,  Children’s  Hospital,  Denver;  Boy  Anderson,  Presbyterian 
Hospital,  Denver. 

Premature  Infant  Care:  DeMoss  Taliaferro,  Chairman,  Chldlren’s  Hos- 
pital, Denver;  Roy  Anderson.  Presbyterian  Hospital,  Denver. 

Rehabilitation  Center:  James  P.  Dixon,  M.D.,  Denver  General  Hospital. 
Denver;  Msgr.  John  B.  Mulroy,  Catholic  Hospitals,  Denver;  Louis  U. 
Liswood,  National  Jewish  Hospital,  Denver. 

Inter-Professional  Council:  Hubert  W.  Hughes,  St.  Anthony  Hospital, 
Denver. 


jeruice 


f-ccuracu  and  ^peed  in  PreAcription 

DORR  OPTICAL  COMPANY 

421  16th  Street  Denver,  Colorado  KEystone  5511 


614 


Rocky  Mountain  Medical  Journal 


. . . and  nothing  but  the  whole  gland 

can  achieve  the  effects  of  the  full 
array  of  cortical  hormones  in  correcting 
such  typical  symptoms  of  adrenal  cortical 
insufficiency  as  loss  of  weight,  impaired 

resistance  to  infections,  lowered  muscle 
tone,  lassitude  and  mental  apathy. 


Because  ADRENAL  CORTEX  EXTRACT  (UPJOHN)  is  a specially 
extracted  preparation  from  the  whole  gland,  it 

provides  all  the  active  principles  of  the 
cortex  for  full  therapeutic  replacement 

of  multiple  cortical  on  carbohydrate, 
fat  and  protein  metabolism,  vascular 
permeability,  plasma 
body  fluids  and  electrolytes. 


Sfarife  Sofufion 
in  TO  ce.  rubber* 
capped  vials  for 
subcufaneouSf 
inframuseular,  and 
infravenous  therapy 


ADRENAL  CORTEX  EXTRACT  (UPJOHN) 


WWlWSff® 


UBiohn 


nR6F8il»liACEIiTICALS  SINCE  laSfi 


BmZOO  99, 

::: 


MICHI 


for  August,  1949 


615 


WHEN  THE  DIET 


Comparison  of  the  accompanying  two 
columns  of  nutritional  values  clearly  shows 
why  Ovaltine  in  milk  has  been  so  widely 
accepted  as  a highly  effective  multiple 
dietary  food  supplement. 

Column  A lists  the  National  Research 
Council’s  Recommended  Daily  Dietary 
Allowances  for  each  100  calorie  portion  in 
the  diet  of  a 154-pound  man  of  sedentary 
occupation.  Column  B lists  the  amounts 

•Based  on  average  reported  values  for  milk.  Three  servings 
of  Ovaltine,  each  made  of  Vi  oz.  of  Ovaltine  and  8 fl.  oz.  of 
whole  milk,  the  daily  dosage  recommended  for  diet  sup- 
plementation, provide  676  calories. 


of  the  same  nutrients  provided  by  a 100 
calorie  portion  of  Ovaltine  in  milk. 

A B 

N.R.C.  Diet  Ovoltine  in  Milk* 


CALORIES 

...  100 

...,100 

CALCIUM 

...  40 

mg 

...166 

mg. 

IRON 

. . . 0.5 

mg 

, ...  1.8 

mg. 

PHOSPHORUS. .. .. 

.. . 60 

mg 

...  139 

mg. 

VITAMIN  A 

...  208 

I.U 

. . . 444 

I.U. 

THIAMINE.  ..  

. . . 0.05 

mg 

...0.17 

mg. 

RIBOFLAVIN 

...  0.00 

mg 

. . . 0.30 

mg. 

NIACIN 

...  0.5 

mg,, . . 

. ...  1.0 

mg. 

ASCORBIC  ACID  . . . 

...  3.1 

mg..  . . 

. ...  4.4 

mg. 

VITAMIN  D 

. ...  62 

I.U. 

PROTEIN 

. . . 2.9 

Gm.. . . 

. ...  4.7 

Gm. 

The  easy  digestibility  and  appealing  flavor 
of  Ovaltine  in  milk  enhance  its  value  as 
a dietary  supplement.  Chocolate  Flavored 
Ovaltine  is  especially  liked  by  children. 


THE  WANDER  COMPANY,  360  N.  MICHIGAN  AVE.,  CHICAGO  1,  ILL. 


616 


Rocky  Mountain  Medical  Journal 


5 : SECONAL  SpD^ 

is  , ‘'""A'”' 


warning- 

habit  fo» 


drtpentbtl 


caOTION- 

„|y  by  «t  O" 

hi  , pbytit'"- 


Pulvulc* 

SECONAL 

sodium 

3/4  g^(o^o5CmO 

^um 

/Uj  BbtbieuraK,  UUy) 
•wr^’MfNG— May  ^ 


Sleep  That  Makes  the  Darkness  Brief 


Physicians  are  well  aware  of  the  importance  of  a good 
night’s  rest.  When  tired  limbs  and  overbusy  minds  cause 
restlessness  and  insomnia,  a bedtime  dose  of  ‘Seconal  Sodium’ 
(Sodium  Propyl-methyl-carbinyl  Allyl  Barbiturate,  Lilly) 
is  indicated. 

‘Seconal  Sodium’  exerts  its  hypnotic  effect  quickly, 
inviting  forgetfulness  and  sleep.  Because  of  its  brief  duration 
of  action,  the  patient  awakes  refreshed,  well  rested. 

Specify  ‘Seconal  Sodium’  on  orders  and  prescriptions. 
Druggists  have  it  in  ^-grain  and  lL2-grain  pulvules,  in 
ampoules,  and  in  suppositories. 


ELI  LILLY  AND  COMPANY,  INDIANAPOLIS  6.  INDIANA,  U.S.A. 


Co-operative  teamwork  is  part  and  parcel  of  the  American 
way.  In  order  to  diagnose  correctly  obscure  bone  and  joint 
disorders,  the  orthopedic  surgeon  needs  the  roentgenologist 
and  often  the  pathologist  and  the  bacteriologist.  The  combined 
knowledge  and  experience  of  all  these  specialists  result  in 
better  service  for  the  patient. 

Co-operative  effort  is  also  the  rule  at  the  Lilly  Research 
Laboratories.  Scores  of  qualified  workers,  representing  all 
of  the  allied  medical  sciences,  pool  their  skills  to  assist  in 
the  solution  of  medical  problems.  Their  findings,  in  turn,  are 
made  available  to  physicians  in  the  form  of  improved 
techniques  and  better  pharmaceutical  and  biological  products. 
Their  aim  is  to  contribute  to  the  welfare  of  the  patient  by 
placing  safer,  more  effective  medicinal  agents  in  the 
physician’s  competent  hands. 


AN  ORTHOPEDIST 
COUNTS  HIS  ALLIES 


LILLY  SPECIALISTS  SERVE  THE  MEDICAL  PROFESSION 


SRocky 

Colorado 
Montana 
New  Mexico 
Utah 
Wyoming 


AUGUST 

1949 


JM-ountain 

JVledical  Journal 

editorial * 


First-hand  Information 

INSTRUCTIVE  letter  has  been  re- 
ceived  from  a colleague  in  England.  He 
is  a surgeon  of  note,  a professor  in  one  of 
the  medical  schools.  Because  of  the  breadth 
of  his  education,  including  a degree  in  den- 
tistry, and  his  proved  worth  as  an  adminis- 
trator, his  responsibilities  have  been  great- 
ly increased  since  the  war.  The  doctor’s 
intimate  association  with  a university  staff, 
entailing  total  cooperation  with  govern- 
mental control  of  our  profession,  gives  him 
acute  insight  into  its  workings  and  short- 
comings. Excerpts  from  the  letter  follow: 

I don’t  know  if  you  hear  very  much  of  the 
ordinary  news  from  Britain  in  your  papers  or 
news  broadcasts.  There  is  at  last  a realization 
of  the  very  straitened  circumstances  of  the 
country’s  finances  and  this  is  largely  due  to  the 
Indian  summer  we  had  at  the  expense  of  the 
American  loan.  It  was  squandered  absolutely 
and  gave  people  a very  false  sense  of  a return 
to  the  pre-war  prosperity.  The  country  has 
lacked  leadership  and  the  workers,  especially 
the  miners,  are  taking  their  pound  of  flesh  from 
the  government.  I think  that  the  leaders  are 
too  frightened  to  say  that  their  calculations  and 
theories  don’t  work  out  as  planned.  All  na- 
tionalized industries  have  failed  to  pay  and  all 
the  commodities  they  supply  have  gone  up  in 
price.  The  cost  of  living  continues  to  rise.  The 
Health  Service  is  proving  to  be  a very  costly 
item  and  unless  we  are  careful  the  whole  stand- 
ard of  medicine  will  decline.  The  majority  of 
teaching  hospitals  have  had  their  estimates  cut 
and  yet  the  Minister  of  Health  states  that  the 
comfort  of  the  patient  must  not  suffer  as  the 
result  of  the  cuts.  The  Budget  has  increased  the 
cost  of  food  and  even  telephone  calls  are  up  50 
per  cent.  All  this  has  to  come  out  of  the  Annual 
Grant  and  the  Chancellor  states  no  supplemen- 
tary estimates  will  be  considered.  So,  with  the 
food  and  administration  costs  rising,  the  equip- 
ment costs  must  correspondingly  decrease.  I 
wonder  if  you  saw  the  specialists’  rate  of  pay? 
It  is  suggested  that  a full-time  specialist  should 
ultimately  at  about  the  age  of  40  get  2,750  pounds 
and  unless  he  qualify  for  a distinction  award  of 


500,  1,500,  or  2,500  pounds  he  has  reached  the 
maximum  salary  obtainable.  While  it  is  very 
hard  on  two-thirds  of  the  specialists,  it  is  hardest 
on  those  who  have  just  reached  the  stage  where 
they  are  making  their  name,  as  they  learned 
their  specialty  at  little  or  no  salary,  expecting 
to  have  a good  income  over  about  twenty  years. 
But  now  the  Health  Service  has  cramped  their 
style  and  their  economy.  Under  the  new  scheme, 
specialists  in  training  get  750  to  1,500  pounds 
during  their  training  period,  so  that  their  pre- 
liminary period  is  not,  as  before,  one  of  the 
“seven  lean  years.” 

Dentistry  is  well  paid  in  general  practice.  Most 
dentists  are  better  off  than  ever  before  and  all 
are  hard  worked,  but  their  money  is  sure;  no 
bad  debts  in  the  state  service!  It  is  almost  im- 
possible to  get  an  aching  tooth  extracted  by  a 
general  practitioner  unless  one  waits  for  four 
to  six  weeks.  This  has  led  to  opportunities  for 
some  extortionate  private  fees  by  the  unscrupu- 
lous. The  Dental  Hospital  has  almost  doubled 
the  attendances  of  patients  compared  with  the 
pre-scheme  days.  The  whole  business  has  been 
rushed  through  too  soon  and  not  enough  prepara- 
tion for  it  was  made.  However,  now  that  we 
have  it  we  will  have  to  pay  for  it  and  there 
is  no  doubt  about  it.  . . . 

The  communication  is  interesting  and  in- 
structive in  several  ways.  The  Old  World’s 
straitened  financial  circumstances,  the  ul- 
timate failure  of  the  American  loan,  lack 
of  dynamic  leadership  following  replace- 
ment of  Churchill,  nationalization  of  indus- 
try, rising  cost  of  living,  unprecedented  cost 
of  health  service,  sacrifice  of  funds  for 
equipment  to  meet  price  of  food  and  ad- 
ministration, the  ceiling  upon  earnings  of 
medical  men,  the  dental- profession  swamped 
with  work,  the  waiting  period  of  patients 
for  service — all  are  elements  of  a complex 
and  unwieldly  picture.  They  are  the  evils 
which  we  in  America  predict  if  the  govern- 
ment takes  over.  Our  campaign  against 
the  Truman  program  is  to  defend  our  peo- 
ple against  this  fate,  not  to  glorify  our- 
selves or  pad  our  pocketbooks. 


for  August,  1949 


617 


A New  Style  for 
Medical  Publications 

'^HE  life  of  a busy  doctor  limits  the  time 
he  can  spend  on  current  medical  liter- 
ature. Journals  are  stacked  high  on  his 
table  and  material  which  passes  from  his 
desk  to  the  wastebasket  reaches  incalcu- 
lable proportions.  Scientific  material  gath- 
ering dust  in  the  library  is  not  serving  to 
remove  cobwebs  from  doctors’  brains.  Thus, 
permit  your  Editor  to  make  a plea  on  be- 
half of  a new  style  for  writing  medical 
papers.  They  should  be  streamlined  so 
that  facts  may  be  quickly  digested  and 
readers  need  not  wade  through  historical 
reviews  and  involved  discussions  of  theory. 
Our  editorial  office  receives  occasional 
comments,  especially  when  we  make  a mis- 
take. The  most  favorable  comments  are 
upon  the  articles  which  are  brief  and  to  the 
point.  They  are  more  widely  read  and  ef- 
fectively assimilated,  thus  serving  a more 
useful  purpose  than  those  which  are  studied 
by  relatively  few  readers. 

Consider  the  popularity  of  lay  publica- 
tions which  abridge  current  literature. 
Readers  can  easily  find  what  they  want  and 
quickly  gain  the  knowledge  they  seek.  Sure- 
ly it  is  possible  for  us  to  increase  the  popu- 
larity of  this  style  of  writing  in  medical 
literature.  One  of  our  colleagues  is  credited 
with  the  slogan  “Tradition  Is  the  Enemy  of 
Progress.”  He  urges  that  the  first  paragraph 
of  a medical  paper  devote  approximately 
three  minutes  to  a conclusion  and  the  re- 
maining seven  minutes  to  diagnosis,  path- 
ology, and  treatment.  The  reader  would 
thereby  know  at  once  whether  he  wishes  to 
read  the  whole  article,  and  if  he  does  it 
takes  only  a few  more  minutes.  The  ma- 
jority of  readers  turn  to  the  summary  and 
conclusion  first,  anyway.  Why  not  make 
this  as  easy  as  possible  for  them  and  also 
save  their  time  and  energy? 

From  an  editor’s  standpoint  short  articles 
are  easier  to  prepare,  more  economical  to 
print,  and  progress  more  rapidly  through 
the  process  of  publication.  Our  Journal 
should  be  known  for  its  quality,  its  quantity 
being  incidental.  When  you  prepare  a talk. 


an  article,  or  write  up  a case  that  our  col- 
leagues should  share,  remember  the  au- 
dience wants  practical  facts  that  are  im- 
pressive and  memorable.  Your  colleagues 
are  not  primarily  interested  in  how  many 
textbooks  you  have  read;  they  want  to 
know  how  to  be  better  doctors  themselves. 
Let  us  help  them  do  it  in  the  most  effective 
way! 

^ ^ 

Report  From  London 

'^HE  following  excerpt  from  a newspaper 
article  was  recently  sent  to  Dr.  Wilfred 
S.  Dennis  of  Denver  by  a friend  who  re- 
sides in  London.  It  is  from  the  London  City 
Press  of  May  6,  1949: 

The  Lord  Mayor,  in  proposing  prosperity  to 
the  Royal  Hospitals,  said  that  after  a lapse  of 
six  months  they  were  told  that  estimates  for 
one  year  would  have  to  be  cut  down  by  33  per 
cent. 

His  estimate  as  treasurer  for  St.  Bartholomew’s 
was  slightly  in  excess  of  £1,000,000. 

The  Chancellor  of  the  Exchequer  said  that  was 
too  much,  and  it  must  be  cut  by  a third. 

Disastrous 

That  was  a policy  which  for  the  National 
Health  Act  would  be  disastrous.  He  thought  the 
Government  would  be  extremely  wise  if  they 
took  the  National  Health  Service  out  of  the 
Chancellor  of  the  Exchequer’s  hands  and  made  a 
Cabinet  minute  to  the  effect  that  the  hospitals 
should  continue  to  be  run  for  the  people. 

Sir  George  Wilkinson,  responding  to  the  toast, 
said  the  association  between  the  city  and  the 
hospitals  made  it  impossible  for  there  to  be  any 
lessening  in  interest  in  their  welfare,  whatever 
changes  in  control  may  take  place. 

Today  one  spoke  with  bated  breath  about  hos- 
pital finance.  Since  the  advent  of  the  new  Health 
Act,  costs  had  soared  by  such  leaps  and  boimds 
that  even  the  Minister  himself  had  become 
alarmed  and  had  proposed  a cut  on  the  budgets 
of  all  hospitals  for  the  current  year. 

The  cut  was  one  of  such  severity  that  it  had 
been  made  abundantly  clear  by  all  the  hospitals 
concerned  and  particularly  by  the  teaching  hos- 
pitals, that  it  would  be  quite  impossible  to  im- 
plement the  new  act  fully  without  radical  cur- 
tailment of  the  services  to  the  patients,  a com- 
plete contradiction  of  the  aims  of  the  National 
Health  Service. 

Until  a decision  had  been  made  by  the  Min- 
ister, all  progress  and  development  had  of  neces- 
sity been  brought  to  a standstill. 


618 


Rocky  Mountain  Medical  Journal 


Incidence  of  Poliomyelitis 

QINCE  poliomyelitis  has  come  to  occupy 
such  a prominent  place  in  news  from  all 
parts  of  the  country  we  naturally  are  inter- 
ested in  available  statistics  from  our  own 
region.  Recent  figures  have  not  come  to 
our  attention.  However,  the  following  is  a 
detailed  list  of  the  poliomyelitis  cases  in 
Utah,  Wyoming  and  Colorado  during  the 
year  1947.  Dr.  Daniel  S.  Cunning,  National 
Chairman  of  the  Committee  for  the  Study 
of  Poliomyelitis  and  Tonsillectomies  of  the 
American  Laryngological,  Rhinological  and 
Otological  Society,  Inc.,  requested  that  Dr. 
James  P.  Rigg  of  Grand  Junction  serve  as 
Chairman  of  the  above  states  for  1947  and 
report  to  him  for  the  Society’s  survey  con- 
cerning the  relation  of  poliomyelitis  to  re- 
cent surgery. 

Colorado  reported  sixty-three  cases  dur- 
ing the  year  1947,  five  of  which  were  fatal 
and  three  cases  with  surgery  of  some  type 
within  sixty  days  prior  to  onset. 

Wyoming  reported  sixteen  cases  during 
the  year  1947,  three  of  which  were  fatal,  no 
cases  with  surgery  within  sixty  days  prior 
to  onset  of  poliomyelitis  (one  case  was  re- 
ported by  the  State  Board  of  Health  but  a 
complete  report  was  not  available  from  the 
attending  physicians  or  family). 

Utah  reported  twenty-eight  cases  during 
the  year  1947,  one  of  which  was  fatal,  no 
cases  with  surgery  within  sixty  days  prior 
to  onset  of  poliomyelitis  (three  cases  re- 
ported by  State  Health  Commissioners,  that 
complete  reports  were  not  received  from  at- 
tending physicians  or  families  of  patients). 


SILHOUETTES 

from  the  A.M.A.  House  of  Delegates 


A CRITICISM 

When,  at  the  June,  1949,  meeting  of  the  A.M.A., 
the  Board  of  Trustees  selected  a new  editor  for 
the  Journal  it  was  not  considered  to  be  a planet 
crashing  announcement.  It  was,  merely,  evolu- 
tion in  action,  the  installation  of  new  blood  and 
brains  in  a top  bracket.  When  the  Board  of  Di- 
rectors of  the  Union  Pacific  Railroad  named  a 
new  president  it  was  a front  page  news  item  for 
one  day  only.  But  since  the  A.M.A.,  in  the  course 
of  minding  its  own  business^  made  a desirable 


change  of  one  official  there  has  been  a veritable 
rash  of  news  and  editorial  comment:  medical 
journals  having  puerile  fits.  Time,  Inc.,  sniffling 
and  one  ex-brain  truster  weeping  into  his  soup. 
If  certain  news  writers  and  their  illegitimate  off- 
spring, the  columnists,  would  evaluate  facts, 
causes  and  policies  (many  of  them  do  so)  their 
emanations  could  be  almost  mature  and  readable. 
But,  as  one  British  journalist  remarked,  “All  of 
us  know  about  American  news.” 

It  is  unnecessary  to  emphasize  further,  with 
orchestrations,  the  virtues  of  the  ex-editor:  “pho- 
tographic brain,  calm,  self-possessed,  assured,  con- 
fident, diarist,  humorist,  indubitably  the  greatest 
medical  editor  in  the  world,  he  has  made  the 
J. A.M.A.  the  greatest  medical  journal  in  the 
world”  (hog  wash  from  the  Jime,  1949,  issue  of 
the  Delaware  State  Medical  Journal).  This  last 
categorical  generalization  is  scarcely  warranted. 
Over  the  decades  much  has  been  given  to  the 
profession  by  the  New  England  Journal  of  Med- 
icine, Annals  of  Surgery,  S.G.O.,  The  Southern 
Medical  Journal,  The  British  Medical  Journal, 
The  American  Journal  of  Obstetrics  and  Gyne- 
cology, California  Medicine  and,  yes,  The  Rocky 
Mountain  Medical  Journal.  It  is  believed  that 
the  day  of  the  paragon,  the  indispensable  man, 
the  modern  Venerable  Bede,  the  reincarnated 
Cincinnatus  is  gone.  It  is  reported  that  the 
ex-editor  amassed  a comfortable  fortune  dur- 
ing his  term  of  employment  by  the  A.M.A.  and 
that  he  would  be  retired  on  an  adequate  pension. 
This  is  altogether  admirable  and  commendable. 
Would  it  be  heresy  to  hope  that  some  of  this 
fortune  be  ploughed  back  into  the  profession 
from  which  it  derived  to  enable  young  men  and 
women  to  learn  about  the  profession  of  medicine? 
But  that  is  none  of  our  business. 

Some  of  my  more  erudite  and  meticulous  pa- 
tients refer  to  a certain  common  bodily  function 
as  an  “elimination.”  The  American  Medical  As- 
sociation has  had  an  “elimination.”  The  King 
is  dead.  Long  live  the  King. 

AN  APPRECIATION 

For  thirty-seven  years,  Dr.  Morris  Fishbein 
gave  the  major  portion  of  his  time,  thought  and 
energy  to  the  American  Medical  Association. 
These  were  productive  years,  golden  years.  What 
is  written  here  is  based,  not  on  personal  acquaint- 
ance, but  on  observation  from  the  sidelines.  Dr. 
Fishbein  was  a sparkling  personality.  When  he 
chatted  and  visited  with  his  friends  in  a crowded 
hotel  lobby  he  gave  the  impression  of  entire 
sincerity.  There  was  never,  to  an  observer,  any 
indication  of  self-seeking  or  flattery.  He  liked 
his  friends.  His  friends  liked  him.  A man  may 
be  separated,  in  fact,  from  his  life  work  but  it  is 
quite  unlikely  that  he  can  be  separated  from  it  in 
spirit.  With  his  vast  and  intimate  knowledge  of 
the  affairs  of  the  American  Medical  Association, 
it  is  hoped  that  he  will  remain  as  a qualified 
counsellor,  a helpful  preceptor,  an  elder  states- 
man. WILLIAM  H.  HALLEY,  M.D. 


for  August,  1949 


619 


riginal  ^rti 

THE  DIFFERENTIAL  DIAGNOSIS  OF  POLIOMYELITIS* 

HENRY  W.  WOLTMAN,  M.D. 

ROCHESTER,  MINNESOTA 


An  epidemic  of  poliomyelitis  is  almost 
unparalleled  in  viciousness,  and  scarcely  a 
summer  passes  without  an  outbreak  of  this 
disease.  Our  only  comfort  lies  in  the  help- 
ing hand  now  given  to  its  victims;  our  in- 
spiration, their  great  courage;  our  hope,  the 
knowledge  that  a fight  is  on  to  end  this 
scourge.  Leading  the  fight  and  observing 
the  best  traditions  of  medicine.  The  Nation- 
al Foundation  for  Infantile  Paralysis  has 
given  every  citizen  his  job.  Until  the  dis- 
ease can  be  prevented,  ours  is  to  treat  the 
patient.  But,  before  we  can  do  so,  we  must 
recognize  this  disease  and  exclude  others. 

The  final  evidence  in  diagnosis  of  an  in- 
fectious disease  is  a demonstration  of  the 
causative  organism.  In  virus  diseases,  how- 
ever, the  technical  difficulties  involved  in 
furnishing  such  proof  are  so  forbidding  to 
the  average  clinician  that  he  must  be  con- 
tent to  rest  his  case  on  less  specific  evi- 
dence. This  is  true  of  the  diagnosis  of  acute 
anterior  poliomyelitis.  In  making  the  diag- 
nosis of  this  disease  the  physician  is  guided 
by  a concatenation  of  ever-changing  signs 
and  events — evidence  of  acute  infection; 
season  of  the  year;  existence  of  other  cases 
of  poliomyelitis;  symptoms  and  signs  of 
meningoradicular  irritation,  nystagmus, 
tremor,  evidence  of  damage  done,  in  hours 
or  days,  to  scattered  groups  of  lower  motor 
neurons  of  cord  and  medulla  with  general 
sparing  of  other  neuronal  systems,  particu- 
larly of  sensation,  and  evidence  given  on 
examination  of  the  spinal  fluid.  No  one  of 
these  observations,  in  and  by  itself,  suffices 
to  justify  the  diagnosis  of  poliomyelitis. 
During  an  epidemic,  suspicion  is  easily 
aroused  by  events  that  ordinarily  attract 

*Read  at  the  annual  meeting-  of  the  Colorado  State 
Medical  Society,  Glenwood  Springs,  Colorado,  Sep- 
tember 22,  1948.  From  the  Department  of  Neurology 
and  Psychiatry,  Mayn  Clinic. 


little  attention — by  headache,  a backache  or 
an  ache  anywhere;  mild  fever;  a cold;  a 
gastro-intestinal  upset,  or  behavior  pre- 
cipitated by  anxious  parents  or  symptomatic 
of  the  end  of  vacation  and  the  prospect  of 
school  and  books.  At  some  other  time  of 
year  the  physician  surveys  the  situation 
with  serenity,  even  though  he  is  aware  that 
poliomyelitis  does  occur  in  the  odd  season 
and  even  though  his  patient  may  exhibit  a 
cardinal  sign  of  the  disease,  muscular  paral- 
ysis. For  my  present  purpose,  I shall  dis- 
regard the  month. 

Differential  Diagnosis  in  the  Preparalytic 
Period 

Early  and  accurate  diagnosis  will  become 
the  most  important  duty  of  clinicians  when 
they  shall  have  at  hand  some  method  of 
treatment  that  will  keep  paralysis  from 
coming  on.  The  preparalytic  stage  of  polio- 
myelitis is  a crucial  period,  for  the  public 
must  be  protected  and  the  patient  must  be 
treated  promptly.  But,  I shall  not  tarry  long 
to  discuss  the  differential  diagnosis  in  this 
period  (Table  1)  since  it  has  been  done  oft- 
en and  well  and  particularly  so  by  Lewin^ 
in  his  book  on  infantile  paralysis.  Suffice 
it  to  say  that  the  preparalytic  period  is  no 
time  to  gloss  over  the  history  of  the  illness, 
to  be  content  with  a perfunctory  general 
physical  examination,  to  neglect  a neuro- 
logic examination,  to  dispense  with  labora- 
tory tests  and  to  sleep  soundly  until  morn- 
ing. Every  hint  of  acute  infection  and  of 
involvement  of  the  nervous  system  must  be 
regarded  seriously  for  life  is  threatened, 
whether  by  meningitis,  myelitis,  encephali- 
tis or  poliomyelitis.  The  danger  lies  more 
in  failure  to  examine  the  patient  from  head 
to  foot  and  less  in  lack  of  knowledge  of 
these  diseases. 


620 


Rocky  Mountain  Medical  Journal 


Differential  Diagnosis  in  the  Paralytic 
Period 

Since  paralysis  is  the  most  urgent,  fright- 
ening and  sinister  event  in  poliomyelitis, 
let  me  confine  my  further  remarks  on  dif- 
ferential diagnosis  to  the  setting  in  which 
this  symptom  occurs.  One  or  another  of 
two  situations  obtains — either  the  paralysis 
is  of  recent  occurrence  or  it  has  been  in 
existence  for  a long  time.  Inevitably  con- 
cern is  greater  when  the  patient’s  muscles 
are  becoming  paralyzed.  The  various  con- 
ditions listed  in  Table  2 must  be  distin- 
guished. 

Epidemic  Parotitis;  I shall  begin  with  a 
disease  that  may  be  complicated  by  rapidly 
oncoming  paralysis  of  one  or  more  limbs  or 
muscles  elsewhere  with  or  without  loss  of 
sensation,  by  fever,  signs  of  meningeal  ir- 
ritation and  cellular  changes  in  the  spinal 
fluid.  These  complications  may,  but  usually 
do  not,  suggest  poliomyelitis,  since  they 
generally  occur  with,  or  shortly  after, 
swelling  of  a parotid  gland  or  testis.  Un- 
fortunately involvement  of  the  nervous  sys- 
tem may  precede  the  mumps  and,  occasion- 
ally, parotitis  or  orchitis  may  be  missing  al- 
together. The  presence  of  an  epidemic 


usually  makes  possible  identification  of  the 
nature  of  these  conditions.  The  pressure  of 
the  spinal  fluid  usually  is  increased  in  cases 
of  epidemic  parotitis  in  which  complications 
referable  to  the  nervous  system  are  present 
and  in  most  cases  the  cell  count  in  the  spinal 
fluid  is  high.  Neutrophils  are  present  but  on 
the  whole  the  cells  are  of  the  lymphocytic 
variety. 

Carcinomatous  Meningoradiculitis;  A sim- 
ilar picture  of  rapidly  advancing  paralysis, 
that,  within  a few  days,  may  require  the 
use  of  a respirator,  may  accompany  growth 
of  metastatic  lesions  in  the  nerve  roots  and 
meninges;  the  metastasis  perhaps  may  be 
from  a carcinoma  of  the  lung,  a breast  that 
is  already  missing  or  even  from  an  other- 
wise asymptomatic  tumor  of  the  brain.  Fe- 
ver may  be  present  and  sensory  changes 
may  be  minimal.  When  such  metastatic 
growths  are  present,  the  concentration  of 
protein  in  the  spinal  fluid  often  is  marked- 
ly increased,  and  in  addition  lymphocytes 
and  neutrophils  are  found  often  and  some- 
times malignant  cells  are  found. 

Periarteritis  Nodosa:  Before  paralysis  oc- 
curs in  a patient  who  has  periarteritis  no- 
dosa, he  usually  has  been  ill  for  some  time. 


The  Differential 

TABLE  1 

Diagnosis  of  Poliomyelitis  in  the 

Preparalytic  Period 

Meningeal 

Irritation 

Disease 

Fever 

Cells* 

Protein  Organism 

Tests 

Poliomyelitis  

. + 

-f- 

P L 

Choriomeningitis  

. -+- 

+ 

L(P) 

Complement  .fixation; 
mouse;  neutralization 

Encephalitis 

Lethargic  

. -t- 

L(P) 

■c  ■ 

St.  Louis  

. + 

+ 

P L 

±: 

Complement  fixation; 
neutralization 

Equine  

. + 

+ 

P L 

Complement  fixation; 
neutralization 

Lymphogranuloma  venereum  . 

+ 

+ 

L 

Complement  fixation; 

, mouse;  Frei  test 

Acute  purulent  meningitis  

- + 

+ 

PPL 

+ 

+ 

Tuberculous  meningitis  

- + 

+ 

LLP 

+ + 

Torula  

. + 

-H 

L P 

Toxoplasmosis  

- -h 

+ 

L P 

+ 

Typhus;  Rocky  Mountain 
spotted  fever  

+ 

+ 

L P 

Complement  fixation; 

guinea  pig;  agglutina- 
tion 

Measles;  chickenpox;  mumps; 

vaccinia;  whooping  cough  ... 

+ 

+ 

L P 



Trichinosis  

Biopsy 

* P means  polymorphonuclear  leukocytes;  L,  lymphocytes. 
for  August,  1949 


621 


TABLE  2 

The  Differential  Diagnosis  of  Poliomyelitis  in  Neuroparalytic  Period 


Disease 

Fever 

Meningeal 

Irritation 

Sensory 
Involve- 
Paralysis  ment 

— Spinal  Fluid — 
Cells*  Protein 

1 Tests 

Epidemic  parotitis 

+ 

-h 

Local 

L P 

+ 

Complement  fixation 

Carcinomatous  men- 
ingoradiculitis  

±: 

Local  ±: 

LPM 

+ 

Malignant  cells 

Periarteritis  nodosa  .. 

+ 

Local; 

symmetrical  ± 

LPB 

+ 

Neuronitis  

Local; 

symmetrical  ± 



+ + 

Diphtheritic  neuritis.. 

± 

— 

Symmetrical  ±: 

— 

± 

Culture 

Porphyric  neuritis  .... 



Local; 

symmetrical  ± 





Urine 

Landry’s  paralysis  .... 

dz 

— 

Symmetrical  — 

— 

— 

Botulism  

— 

Symmetrical  — 

— 

— 

Food 

Tick  paralysis  

— 

Symmetrical  ± 

— 

— 

Tick 

Triorthocresyl  phos- 
phate poisoning 

- 



Local; 

Symmetrical  ± 





Polyneuritis 
recurrens  

_ 

Local  ±: 



_ 

Familial  periodic 
paralysis  





Symmetrical  — 



- 

Low  serum  potassium 
at  times 

Hyperthyroid  crisis  . 

— 

— 

Symmetrical  — 

— 

— 

Brain  tumor  

— 

— 

Local  ± 

± 

Hysterical  paralysis  .. 

— 

Local; 

symmetrical  + 

— 

— 

* L stands  for  lymphocytes; 

P,  polymorphonuclear  leukocytes;  M,  malignant  cells;  B,  erythrocytes. 

but  if  the  paralysis,  which  is  often  rapid 
in  onset,  occurs  early  and  is  unattended  by 
the  usual  sensory  changes,  poliomyelitis 
might  be  considered.  Periarteritis  nodosa 
may  progress  steadily  but  more  often  it  ad- 
vances episodically  in  different  locations. 
This  apparent  concurrence  of  more  than  one 
serious  ailment  in  the  same  patient  should 
suggest  the  possibility  of  periarteritis  no- 
dosa. Leukocytosis  is  present  in  32  per  cent 
of  cases  of  periarteritis  nodosa.  Eosinophilia 
is  a strong  indication  of  periarteritis  but  it 
is  found  in  only  12  per  cent  of  the  cases. 

Neurologic  symptoms  usually  are  marked 
by  paralysis  of  one  or  more  isolated  peri- 
pheral nerves,  especially  those  of  the  upper 
and  lower  extremities;  the  clinical  picture 
usually  is  referred  to  as  mononeuritis  multi- 
plex rather  than  as  multiple  peripheral 
neuritis.  The  spinal  fluid  may  be  under 
increased  pressure  and  may  exhibit  xantho- 
chromia, increased  concentration  of  pro- 
teins and  pleocytosis.  The  diagnosis  also 
may  be  made  on  biopsy  of  some  inflamed 
structure. 

In  most  diseases,  which  must  be  distin- 


guished from  poliomyelitis  in  the  paralytic 
period  that  I shall  discuss,  the  paralysis  is 
not  accompanied  by  an  increase  in  the  num- 
ber of  cells  in  the  spinal  fluid,  a feature 
that  is  of  decided  help  in  differential  diag- 
nosis. 

Neuronitis  or  the  Guillain-Barre  Syn- 
drome: A disease  of  unknown  causation  that 
may  reach  epidemic  proportions  and  that 
recurrently  has  suggested  some  unusual 
type  of  poliomyelitis  is  febrile  polyneuritis, 
the  Guillain-Barre  syndrome  or,  briefly, 
neuronitis.  Like  poliomyelitis,  neuronitis 
often  follows  an  acute  febrile  illness  from 
which  the  patient  may  seem  to  have  recov- 
ered. Presently  there  appears  a rapidly 
progressing  motor  paralysis  of  the  extremi- 
ties, in  which  the  proximal  muscles  of  the 
limb  are  often,  but  not  necessarily,  weaker 
than  are  those  of  the  distal  parts  of  the  limb. 
The  lower  extremities  are  usually  affected 
more  severely  than  the  upper  and  with  in- 
creasing weakness  the  tendon  reflexes  dis- 
appear. In  about  35  per  cent  of  cases,  there 
is  also  paralysis  of  one  or  both  facial  nerves. 
The  patient  may  complain  of  regurgitation. 


622 


Rocky  Mountain  Medical  Journal 


the  muscles  of  mastication  may  be  weak, 
and  diplopia  may  be  present.  Function  of 
the  vesical  and  anal  sphincters  may  be 
impaired.  Paralysis  may  become  so  severe 
that  a respirator  is  needed. 

All  I have  said  thus  far  might  have  been 
said  also  of  poliomyelitis.  The  muscle  weak- 
ness of  neuronitis  tends  to  be  diffuse  and 
symmetrical,  whereas  in  poliomyelitis  it  is 
often  insular  and  asymmetrical.  Sensory 
loss  is  often  minimal  and  may  be  over- 
looked, but  if  present,  serves  as  a further 
distinctive  bit  of  evidence  in  favor  of  neu- 
ronitis. A fairly  constant  feature  is  exces- 
sively high  concentration  of  protein  in  the 
spinal  fluid.  Pleocytosis  is  usually  alto- 
gether lacking,  but  even  this  may  occur  in 
poliomyelitis.  Recovery  may  take  place 
within  a few  months  or  two  years,  and  when 
it  occurs,  it  is  usually  complete  although 
the  mortality  rate  was  14  per  cent  in  a series 
of  thirty-five  cases  which  have  been  re- 
ported. 

Diphtheritic  Polyneuritis;  Occasionally 
diphtheritic  paralysis  enters  into  the  dif- 
ferential diagnosis  of  poliomyelitis.  As  a 
rule  the  initial  infection  and  paralysis  of 
the  soft  palate  and  of  accommodation  call 
attention  to  the  probable  cause  of  the  dis- 
order, but  sometimes  paralysis  begins  in  the 
extremities  and  involves  the  palate  later. 
More  commonly  four  to  six  weeks  pass  after 
development  of  paralysis  of  the  palate  be- 
fore paralysis  of  the  extremities  appears, 
but  it  may  be  delayed  as  long  as  four 
months.  In  the  meantime  the  patient  may 
have  resumed  his  work,  thinking  himself  to 
be  well.  Weakness  may  affect  the  proximal 
muscles  as  much  as  the  distal  muscles. 
Practically  no  cranial  nerve  is  spared  from 
the  possibility  of  involvement,  and  some- 
times the  sphincters  are  included  in  the 
paralysis.  Ataxia  is  striking  and  often  ap- 
pears early.  In  the  spinal  fluid,  as  in  neu- 
ronitis, the  concentration  of  protein  may  be 
elevated,  but  the  cell  count  remains  normal. 
Often  the  Corynebacterium  diphtheriae 
may  still  be  demonstrable  in  the  faucial 
secretions;  the  finding  of  this  organism,  of 
course,  is  of  great  help  in  establishing  the 
diagnosis. 


The  resemblance  of  the  disorders  that  will 
be  considered  subsequently  to  those  that 
have  been  described  may  be  close,  but  ex- 
amination of  the  spinal  fluid  usually  dis- 
closes neither  an  increase  in  cells  nor  in 
protein. 

Acute  Porphyric  Neuritis:  A serious  dis- 
order that  has  not  received  the  attention 
it  deserves  is  acute  porphyric  neuritis.  The 
initial  symptom  is  almost  always  pain  in 
the  abdomen  and  this  too  frequently  leads 
to  abdominal  exploration.  The  patient  may 
give,  usually  on  direct  questioning,  the  his- 
tory of  having  passed  reddish  or  brownish 
urine;  this  color  change  is  hastened  by  the 
exposure  of  the  urine  to  sunlight  or  ultra- 
violet light.  In  the  presence  of  uroporphy- 
rin, a pinkish  fluorescence  occurs  under 
ultraviolet  light. 

Usually  the  pulse  is  rapid,  and  blood 
pressure  increased.  Fever  may  or  may  not 
be  present.  In  50  per  cent  of  cases  in  which 
abdominal  symptoms  occur,  the  nervous  sys- 
tem becomes  involved.  The  distribution  of 
the  paralysis  of  the  limbs  may  suggest  the 
Guillain-Barre  syndrome,  but  in  other 
cases,  as  in  poliomyelitis,  it  is  often  asym- 
metrical and  spotty,  and  pain  and  spasm 
may  occur.  Sensory  disturbances  are  less 
prominent  than  are  motor  disturbances.  Re- 
tention of  urine  may  be  a feature.  The 
cranial  nerves  may  be  involved.  Examina- 
tion of  the  spinal  fluid  usually  has  given 
negative  results. 

Landry’s  Paralysis;  The  designation, 
“Landry’s  paralysis,”  has  come  to  mean 
a rapidly  ascending  flaccid  paralysis  with 
loss  of  tendon  reflexes,  preservation  of  sen- 
sation and  of  sphincteric  control,  normal 
spinal  fluid  and  no  discoverable  pathologic 
change  in  the  spinal  cord.  Cases  of  this 
type  are  encountered,  and  in  respect  to  tra- 
dition may  be  called  “Landry’s  paralysis,” 
but  they  are  unlike  the  ten  cases  Landry 
described  in  1859.  Some  commentators  sug- 
gest that  his  were  cases  of  beriberi;  others, 
that  he  gave  as  good  a description  of  neu- 
ronitis as  any  author  of  that  day  might 
have  attempted. 

The  following  case  might  be  classified  as 
a case  of  Landry’s  paralysis: 


for  August,  1949 


623 


CASE  REPORT 

An  insurance  salesman,  aged  48  years,  was 
brought  to  the  Mayo  Clinic  on  the  afternoon  of 
October  5,  1942.  In  1901,  when  he  was  7 years 
of  age,  he  had  had  an  attack  of  poliomyelitis 
which  left  him  with  weakness  and  atrophy  of 
the  right  leg. 

A week  before  this  patient  came  to  the  clinic 
he  had  had  an  almost  unnoticed  coryza.  On 
October  3,  he  had  witnessed  a football  game. 
On  the  evening  of  October  4,  the  right  hand  had 
felt  somewhat  weak  when  he  tried  to  cut  his 
salad,  and  at  the  time  that  he  went  up  the  stairs 
to  bed,  the  left  lower  extremity  felt  heavy.  On 
the  morning  of  October  5,  he  experienced  dif- 
ficulty in  shutting  off  the  alarm  clock,  and  when 
he  attempted  to  get  out  of  bed,  his  lower  ex- 
tremities were  so  weak  that  he  could  not  stand. 
As  the  day  progressed,  so  did  his  weakness  and 
by  midafternoon,  when  he  arrived  at  the  hospital, 
he  was  unable  to  move  the  lower  extremities 
and  could  barely  move  the  upper  extremities. 
All  tendon  reflexes  were  absent,  sensation  was 
normal,  there  were  no  signs  of  meningeal  irri- 
tation, and  his  temperature  was  normal.  On 
October  6,  he  was  unable  to  cough.  The  sphinc- 
ters were  normal.  Consciousness  was  clear.  The 
administration  of  prostigmine  was  without  effect. 
Examination  of  the  spinal  fluid  showed  a content 
of  protein  of  40  mg.  per  100  c.c.  and  1 cell  per 
cubic  millimeter.  On  October  7,  the  patient  was 
placed  in  a respirator.  On  October  9 he  could 
no  longer  swallow  and  on  October  10,  six  days 
after  the  onset  of  the  paralysis,  he  died. 

Examination  of  the  spinal  cord  disclosed  only 
the  residuals  of  an  old  poliomyelitis  in  the  lum- 
bar region,  otherwise  it  was  entirely  normal. 

Subsequently  it  was  learned  that  this  patient 
had  been  sent  a duck  which  he  had  eaten  on 
the  evening  of  October  3.  No  other  member  of 
the  family  had  partaken  of  it.  The  possibility 
of  botulism  was  considered  but  could  not  be 
proved.  The  case  was  classified  as  Landry’s 
paralysis  of  unknown  cause. 

Botulism;  A series  and  often  fatal  paraly- 
sis that  is  sometimes  misdiagnosed  polio- 
myelitis, particularly  if  it  occurs  in  an  iso- 
lated case,  deserves  mention,  even  though  it 
is  rare.  Overwhelming  prostration  occurs. 
Then  follows  paralysis  of  the  throat,  tongue, 
face,  extrinsic  and  intrinsic  muscles  of  the 
eyes  and  of  respiration.  Meanwhile  con- 
sciousness remains  intact.  The  pulse  is 
usually  rapid,  the  saliva  is  tenacious,  and 
functions  of  bladder  and  bowel  are  at  a 
standstill.  In  a third  of  the  cases,  however, 
there  may  be  signs  of  irritation  such  as 
vomiting,  diarrhea  and  abdominal  pain.  The 
spinal  fluid  is  normal.  Since  more  than 
one  person  generally  becomes  ill,  the  in- 
quiry turns  to  what  may  have  been  eaten. 
I am  referring,  of  course,  to  the  toxin  gen- 
erated by  the  Clostridium  botulinum.  This 
toxin  exerts  a curare-like  action  on  nerve 
endings  of  striated  and  nonstriated  muscles. 


The  presymptomatic  interval  may  range  be- 
yond a hundred  hours,  and  the  illness  may 
run  its  course  in  from  twelve  hours  to  a 
week.  The  prognosis  is  bad,  as  about  two- 
thirds  of  the  patients  die.  Recovery  of  the 
others  may  be  long  and  tedious. 

Tick  Paralysis:  The  possibility  of  tick 
paralysis  is  easily  overlooked.  This  is  not 
presumed  to  be  a virus  disease  and  the  ac- 
tion of  the  etiologic  agent,  whatever  it  is, 
still  is  not  understood.  It  is  reported  in 
the  western  part  of  the  United  States,  the 
Carolinas,  Georgia,  New  York,  Kentucky, 
Texas,  British  Columbia,  South  Africa  and 
Australia.  Young  persons  are  usually  af- 
fected. For  some  unexplained  reason,  the 
bite  is  not  felt.  The  patient  may  retire  in 
normal  health,  and  on  attempting  to  get  out 
of  bed  may  fall  in  a heap  onto  the  floor. 
Usually  the  paralysis  is  progressive  and  ex- 
tends from  the  lower  extremities  upward. 
It  may  involve  the  thorax  and  the  muscles 
of  deglutition  and  phonation,  and  it  may 
result  in  death.  The  paralysis  may  be  asso- 
ciated with  ataxia,  numbness  of  the  hands 
and  toes,  retention  of  urine  and  inconti- 
nence. 

The  tick  is  usually  found  somewhere 
along  the  spinal  column,  frequently  at  the 
hairline.  After  removal  of  the  tick,  recov- 
ery takes  place  within  a few  days. 

Triorthocresyl  Phosphate  Poisoning:  The 
medical  profession  was  introduced  to  jake 
paralysis  in  1930,  when  an  extract  of  Ja- 
maica ginger  became  contaminated  with 
triorthocresyl  phosphate.  Subsequently  a 
similar  condition  was  reported  in  Europe; 
this  time  it  was  due  to  contaminated  apiol, 
or  parsley  camphor,  which  had  been  used 
as  an  abortifacient.  The  most  recent  epi- 
demic, 1946,  was  recorded  in  England^  where 
housewives  used  a cottonseed  oil  for  cook- 
ing. The  same  triorthocresyl  phosphate 
turned  up  as  cause  of  the  paralysis.  Dull 
aching  pain  in  the  calves  often  occurred 
from  two  to  ten  days  after  the  poisoning. 
This  was  accompanied  by  progressive  flac- 
cid paralysis,  particularly  of  the  feet,  legs 
and  thighs,  and  not  infrequently  of  the  up- 
per extremities.  In  some  cases  the  medul- 
lary bulb  was  involved.  Numbness,  if  pres- 


624 


Rocky  Mountain  Medical  Journal 


ent,  was  usually  transient  and  sensation 
was  not  greatly  altered.  Disabling  residual 
effects  resembling  those  of  poliomyelitis, 
however,  often  remained,  especially  in  the 
lower  extremities. 

Administration  of  some  of  the  discarded 
sulfonamide  preparations  was  followed  by 
similar  complications. 

Polyneuritis  Recurrens:  A paralysis  of 
arm,  leg  or  various  cranial  nerves  may  ap- 
pear abruptly  as  an  expression  of  an  un- 
common and  as  yet  unexplained  disorder 
known  as  “polyneuritis  recurrens.”  A dis- 
turbance in  sensation  may  be  associated  and 
the  resemblance  of  polyneuritis  recurrens  to 
serum  paralysis  is  often  close.  The  name 
indicates  its  most  impressive  characteristic, 
that  of  recurrence.  Other  members  of  the 
family  may  suffer  from  the  same  affliction 
and  sometimes  under  the  same  circum- 
stances; that  is,  pregnancy  or  the  menstrual 
cycle.  But  there  is  always  a first  attack, 
and  this  one  may  suggest  the  possibility  of 
poliomyelitis.  A case  previously  reported 
by  Maisel  and  me®  is  illustrative.  The  re- 
port follows: 

CASE  REPORT 

A woman,  aged  31  years,  presented  herself  at 
the  clinic  April  30,  1934,  with  the  complaint  of 
Weakness  of  both  lower  extremities.  Four  and  a 
half  months  before  admission  and  six  weeks  be- 
fore the  birth  of  a third  child,  the  patient  had 
had  severe  right  renal  colic,  which  was  followed 
on  the  next  day  by  hematuria  and  the  passage 
of  small  calculi.  Two  days  after  this  attack  and 
over  a period  of  three  or  four  days,  the  right 
lower  extremity  became  completely  paralyzed, 
the  left  one  weak,  but  not  completely  useless. 
The  muscles  of  the  back  and  abdomen  became 
involved  also,  so  that  the  patient  was  unable 
to  sit  up  in  bed.  There  were  moderately  severe, 
fleeting  pains  in  both  the  arms,  which,  however, 
did  not  become  weak..  During  the  pregnancy 
there  had  been  neither  vomiting  nor  any  gross 
dietary  deficiency.  After  delivery,  the  left  leg 
became  much  stronger,  the  back  and  abdominal 
muscles  became  slightly  stronger,  but  the  right 
leg  remained  paralyzed. 

Examination  at  the  clinic  gave  essentially 
negative  results  save  that  the  muscles  of  the 
back  and  abdomen  were  markedly  diminished 
in  strength,  those  of  the  left  thigh  were  moder- 
ately weak,  those  of  the  left  leg  slightly  weak, 
those  of  the  right  thigh  very  weak,  and  those 
of  the  right  leg  completely  paralyzed.  The  mus- 
cles of  the  right  leg  were  moderately  atrophied. 
The  patellar  reflex  was  absent  on  the  right  and 
was  just  obtainable  with  reinforcement,  on  the 
left.  The  Achilles  tendon  reflex  was  absent  on 
the  right  and  normal  on  the  left. 

Plantar  responses  were  normal.  Sensory  ex- 
amination gave  normal  results.  The  spinal  fluid 


was  normal;  the  content  of  protein  was  40  mg. 
per  100  c.c. 

Further  inquiry  revealed  that  six  weeks  be- 
fore the  birth  of  her  first  child,  in  1929,  this 
patient  had  experienced  a “funny  sensation”  in 
both  arms,  which  seemed  to  be  weak.  The  con- 
dition had  cleared  up  immediately  after  the 
birth  of  a child.  Six  or  eight  weeks  before  the 
birth  of  the  second  child,  in  1931,  the  same 
symptoms  had  developed  in  her  arms,  although 
in  addition  she  now  had  had  numbness  and 
tingling  in  her  legs,  which  at  times  had  sudden- 
ly buckled  under  her.  Again  all  symptoms  had 
disappeared  completely  after  the  child  was  born. 
The  condition  was  classified  as  “neuronitis  of 
pregnancy.”  It  could  also  have  been  called  “re- 
current paralysis.” 

Familial  Periodic  Paralysis:  The  first  at- 
tack of  familial  periodic  paralysis  may  cause 
consternation  in  the  family.  Since  these 
attacks  are  usually  of  short  duration,  this 
disorder  is  seldom  confused  with  poliomye- 
litis. Occasionally,  however,  an  attack  will 
last  for  a week  or  more,  and  when  this 
occurs,  the  question  of  poliomyelitis  does 
arise.  The  attacks  are  of  more  frequent  oc- 
currence in  young  persons  than  those  at 
other  ages.  These  attacks  may  come  on 
while  the  patient  is  asleep  or  at  any  other 
time.  In  the  regions  in  which  the  paralysis 
obtains,  tendon  reflexes  and  electric  ex- 
citability of  the  muscles  may  be  absent.  The 
value  for  serum  potassium  may  be  low. 
Otherwise  the  patient  is  comfortable  and 
really  looks  too  well  to  have  poliomyelitis. 

Hyperthyroid  Crisis:  Muscular  weakness, 
that  may  come  on  within  twenty-four  or 
forty-eight  hours,  may  become  so  marked 
that  gravity  cannot  be  overcome  by  the 
greatest  effort,  and  may  be  so  convincingly 
suggestive  of  poliomyelitis  that  spinal  punc- 
ture may  be  carried  out,  is  sometimes  as- 
sociated with  hyperthyroid  crises.  The 
tendon  reflexes  may  appear  to  be  absent, 
since  they  may  be  so  fast  that  they  coincide 
with  shock  of  the  reflex  hammer.  Here, 
however,  the  resemblance  to  poliomyelitis 
ceases. 

Tumor  of  the  Brain:  It  scarcely  seems 
possible  that  a tumor  of  the  brain  may  give 
rise  to  symptoms  that  suggest  the  possi- 
bility of  poliomyelitis.  On  one  occasion  I 
saw  such  a patient. 

CASE  REPORT 

The  patient  was  an  elderly  man  who  presented 
himself  November  7,  1933,  because  his  left  arm 
dangled  helplessly  at  his  side.  The  history  he 
gave  was  somewhat  vague.  The  weakness  had 
apparently  come  on  rapidly,  within  about  three 


for  August,  1949 


625 


days,  late  in  October.  The  limb  was  hypotonic 
and  flail;  however,  the  tendon  reflexes,  although 
feeble,  still  could  be  elicited.  It  seemed  likely 
that  the  lesion  was  situated  in  the  cervical  part 
of  the  cord,  on  the  left  side.  Three  weeks  later, 
the  left  side  of  the  face  and  the  left  lower  ex- 
tremity were  also  weak,  and  it  was  proper  to 
consider  a lesion  of  the  internal  capsule  on  the 
opposite  side  of  the  brain.  Two  months  after 
the  patient  was  first  seen,  jacksonian  attacks 
occurred  in  the  helpless  arm  and  three  weeks 
after  this  he  passed  away.  A spherical  glioblas- 
toma, about  2 cm.  in  diameter,  was  found  in  the 
right  internal  capsule. 

Hysterical  Paralysis;  Hysterical  paralysis 
or  malingering,  especially  when  it  occurs 
in  a young  child  or  when  there  is  unwill- 
ingness on  the  part  of  the  child  to  move  a 
painful  extremity,  often  causes  great  anx- 
iety, particularly  if  it  occurs  in  the  late 
summer  or  early  fall.  Careful  observation 
usually  discloses  the  nature  of  the  disability. 

Poliomyelitis  Complicating  Injury:  A par- 
ticularly confusing  situation  arises  when 
poliomyelitis  is  superimposed  on  an  already 
injured  and  weakened  limb. 

CASE  REPORT 

On  June  24,  1921,  a child,  aged  2^/2  years, 
became  entangled  in  a rubber  hose,  fell  and 
fractured  the  left  femur.  In  September,  ten 
days  after  the  cast  had  been  removed,  soreness 
of  her  limb  was  ascribed  to  her  energetic  play- 
ing. It  was  expected  after  removal  of  the  cast 
that  this  extremity  would  be  somewhat  atrophied 
and  weaker  than  its  fellow.  On  the  following 
day,  however,  weakness  that  could  not  be  at- 
tributed to  the  fracture  and  disuse  was  noted, 
the  patellar  reflex  was  absent  and  the  rectal 
temperature  was  101  degrees  F.  Serum  for  polio- 
myelitis was  administered.  Lumbar  puncture  on 
the  following  day  revealed  280  cells  per  cubic 
millimeter  of  spinal  fluid. 

Eternal  vigilance  is  also  the  price  in  the 
diagnosis  of  poliomyelitis. 

Diagnosis  in  Retrospect 

A diagnosis  of  poliomyelitis  must  some- 
times be  made  in  retrospect.  Differential 
diagnosis  is  simplified  by  noting  that  the 
wasted  muscles  of  poliomyelitis  are  often 
situated  asymmetrically.  Thus  one  foot  and 
the  opposite  shoulder  may  appear  deformed 
and  partially  paralyzed.  If  sensation  is  nor- 
mal and  if  it  can  be  learned  that  the  disa- 
bility was  abrupt  in  onset  or  more  extensive 
at  that  time  than  at  present,  and  if  it  can  be 
ascertained  also  that  the  disability  came  on 
during  the  summer  or  early  fall,  then  there 
is  usually  little  difficulty  in  identifying  the 
disease. 

Cerebral  Palsy  of  Childhood:  Certain 


residuals  appear  to  be  more  confusing  than 
others.  A condition  that  parents  often  re- 
fer to  as  poliomyelitis  or  infantile  paralysis 
is  cerebral  palsy  of  childhood.  The  causes 
of  this  include  cerebral  birth  injury,  anox- 
ia, developmental  defects  and  encephalitis. 
Frequently  the  involvement  is  confined  to 
one  side  of  the  body,  and  the  wasting,  if 
any,  is  not  great  and  is  uniformly  distrib- 
uted. Movements  may  be  slow  and  dys- 
tonic,  the  tendon  reflexes  are  usually  in- 
creased, sensation  is  intact,  and  Babinski’s 
sign  is  positive. 

Congenital  Anomaly;  A congenital  ab- 
sence of  muscles  is  sometimes  interpreted  as 
the  residual  of  poliomyelitis.  Any  muscle  or 
group  of  muscles  may  be  missing.  Often 
deformities,  such  as  absence  of  a breast,  a 
partially  developed  finger,  or  inability  to 
rotate  the  eyeballs  properly,  are  associated. 

A deformity  of  the  scapula,  known  as 
“Sprengel’s  shoulder,”  may  suggest  the 
winging  caused  by  paralysis  of  muscles  of 
the  shoulder  girdle. 

Myelodysplasia:  The  clawfeet  and  “ca- 
nary” legs  of  myelodysplasia,  a faulty  de- 
velopment of  the  lower  end  of  the  spinal 
cord,  are  sometimes  interpreted  as  residuals 
of  poliomyelitis.  This  deformity  is  closely 
related  to  spina  bifida,  but  there  may  be  no 
hint  of  it  unless  it  be  a sacral  dimple  or  a 
patch  of  hypertrichiasis.  Roentgenograms 
of  the  spinal  column  often  show  the  occult 
variety  of  the  defect. 

Heredofamilial  Degenerative  Disease: 
Lower  extremities  of  the  extraordinarily 
chronic  Charcot-Marie-Tooth  or  peroneal 
atrophy  or  of  Friedreich’s  ataxia  are  some- 
what similar  to  those  in  cases  of  myelodys- 
plasia. The  progress  of  these  degenerative 
diseases  may  be  so  slow  that  they  seem  al- 
most stationary.  Other  members  of  the 
family  who  bring  the  patient  may  be  una- 
ware of  having  the  same  disorder  them- 
selves. 

Summary 

The  differential  diagnosis  of  poliomyelitis 
concerns  the  disease  from  onset  to  residua. 
In  its  most  practical  applications  the  differ- 
ential diagnosis  must  be  tripartite.  First 
and  foremost,  the  diagnosis  must  be  made 


626 


Rocky  Mountain  Medical  Journal 


in  the  febrile  neuro-irritative  period,  when 
various  types  of  meningitis,  encephalitis 
and  myelitis  move  into  focus  (Table  1). 
Then,  since  not  all  patients  are  seen  early, 
comes  the  differential  diagnosis  in  the 
course  of  the  neuroparalytic  period.  At 
this  time  the  physician’s  chief  concern  is 
with  rapidly  oncoming  muscular  paralysis 
and  pseudoparalysis,  of  various  kinds  and 
many  causes  (Table  2).  Eventually,  a diag- 
nosis must  be  made  by  retrospection.  The 
making  of  this  diagnosis  involves  consider- 
ation of  paralytic  residuals  of  non-poliomye- 
litic  origin,  developmental  anomalies  and 
neurodegenerative  diseases  of  such  imper- 
ceptible progression  that  their  sudden  dis- 


covery belies  their  long  existence.  In  the 
differential  diagnosis  in  any  period  it 
should  not  be  forgotten  that  poliomyelitis 
may  complicate  any  physiologic  event,  such 
as  pregnancy,  or  some  other  disease  or  in- 
jury. 

The  urgency  of  poliomyelitis  removes  its 
differential  diagnosis  from  the  realm  of  an 
academic  exercise.  Its  diagnosis  must  be 
conceived,  formulated  and  delivered  at  the 
bedside.  Therein,  exactly,  lies  our  respon- 
sibility as  physicians. 

REFEREiNCBS 

•Eewin,  Philip:  Infntile  Paralysis,  Anterior  Polio- 
myelitis. Philadelphia,  W.  B.  Saunders  Company, 
1941,  372  pp. 

^Hotson,  R.  D.:  Lancet,  1:207,  1946. 

^Maisel,  J.  J.,  and  Woltman,  H.  W. : J.A.M.A. 

• 103:1930,  1934. 


INTESTINAL  OBSTRUCTION* 

PHILIP  THOREK,  M.D. 

CHICAGO,  ILLINOIS 


All  who  come  in  contact  with  the  prob- 
lem of  intestinal  obstruction  realize  that  it 
still  presents  a diagnostic  and  therapeutic 
challenge.  The  mortality  continues  to  re- 
main high  despite  the  many  recent  advances 
in  electrolyte  balance,  intestinal  siphonage, 
caloric  requirements  and  surgical  technic. 
Any  plan  which  aids  in  the  early  diagnosis 
and  treatment  of  the  obstructing  lesion 
helps  further  to  reduce  the  number  of  fa- 
talities. Wangensteen,  Haden,  Orr,  Coller 
and  many  others  have  contributed  monu- 
mental stepping  stones  which  enable  us  to 
understand  the  pathologic  physiology  of 
this  condition. 

Intestinal  obstruction  is  a symptom  com- 
plex and  not  a disease,  hence,  it  is  not 
enough  to  make  a diagnosis  of  “just  intes- 
tinal obstruction.”  In  attacking  this  prob- 
lem we  have  devised  a plan  whereby  we 
can  make  an  earlier  and  more  thorough 
diagnosis,  thus  enabling  proper  therapy  to 
be  instituted  more  rapidly.  To  correctly 
diagnose  the  condition  it  is  necessary  to  ask 
and  answer  the  following  four  questions: 

1.  Is  this  an  intestinal  obstruction? 

2.  Is  it  a large  or  small  bowel  obstruction? 

‘Read  before  the  Eighth  Annual  Western  Colorado 
Spring  Clinic,  Grand  Junction,  Colorado,  April  14, 
1948.  From  the  Departments  of  Surgery,  University 
of  Illinois,  Cook  County  Graduate  School  of  Medi- 
cine, Cook  County  Hospital,  American  Hospital  and 
Alexian  Brothers  Hospital. 


3.  Is  it  strangulated  or  non-strangulated? 

4.  Is  the  obstruction  complete  or  incom- 
plete? 

In  answer  to  question  number  one:  “Is 
this  an  intestinal  obstruction?”  we  expect 
to  find  the  obstructive  triad,  namely,  dis- 
tention, obstipation  and  vomiting.  Even 
though  the  triad  may  be  present  wholly  or 
in  part,  its  individual  parts  call  for  clarifi- 
cation. In  regard  to  distention,  one  must 
define  what  he  means  by  the  term.  Since 
we  have  no  standard  for  measuring  the  dis- 
tended abdomen,  we  have  decided  to  utilize 
the  anatomic  relationship  of  the  umbilicus 
to  the  xiphoid  process.  We  believe  that  the 
normal  abdomen  is  scaphoid  and  not  flat, 
hence,  the  umbilicus  is  normally  placed  be- 
low the  xiphoid.  When  the  umbilicus  is 
on  a level  with  the  xiphoid,  the  abdomen 
is  called  flat,  and  when  the  umbilicus  is 
above  the  xiphoid,  the  abdomen  is  described 
as  being  distended.  Therefore,  when  the 
umbilicus  is  on  a level  with,  or  above  the 
xiphoid,  some  pathologic  condition  exists. 
When  such  an  abnormally  placed  umbilicus 
is  found  we  consider  the  differential  diag- 
nosis of  the  seven  “F’s,”  namely,  Fat,  Feces, 
Fluid,  Flatus,  Fetus,  Fibroids  and  “Ph”an- 
tom  tumors.  In  almost  every  case  one  of  the 
“F’s”  has  been  found  to  be  the  underlying 


for  August,  1949 


627 


cause.  It  is  important  to  record  the  position 
of  the  umbilicus  when  the  patient  enters  the 
hospital,  and  to  re-check  this  every  hour 
thereafter.  If  the  umbilicus  is  below  the 
xiphoid  when  the  patient  is  first  seen,  and 
one  hour  later  is  found  on  a level  with  the 
xiphoid,  this  signifies  early  distension.  In 
this  way  we  can  avoid  the  development  of 
a late  perterminal  distention  that  so  many 
neglected  intestinal  obstructions  present. 
Regarding  obstipation,  we  know  that  the  av- 
erage intestinal  obstruction  passes  neither 
feces  nor  flatus,  but  we  also  recall  that  this 
may  be  lacking  in  incomplete  obstruction, 
as  for  example  in  Richter’s  hernia,  in  which 
only  part  of  the  circumference  of  the  bowel 
is  incarcerated.  In  such  cases  the  resulting 
irritation  and  hyperperitalsis  may  even  lead 
to  a diarrhea  which  can  be  most  mislead- 
ing when  one  makes  a diagnosis  of  intestinal 
obstruction.  Vomiting  will  be  more  thor- 
oughly discussed  under  question  number 
two.  Regardless  of  the  absence  or  presence 
of  the  obstructive  triad,  it  is  far  more  im- 
portant to  elicit  the  one  pathognomonic 
finding  of  intestinal  obstruction,  namely, 
that  pain  and  intestinal  sounds  appear  at 
the  same  time.  This  synchronization  of 
sound  with  pain  differentiates  intestinal 
colic  from  any  other  type  of  intermittent 
pain.  The  physician  should  place  his  steth- 
oscope upon  the  patient’s  abdomen  when 
he  states  that  he  is  getting  his  pain,  and 
if  it  is  of  an  intestinal  nature  he  will  hear 
the  rushing  bowel  sounds  at  this  time. 

Question  number  two,  namely,  “Is  this 
a large  or  small  bowel  obstruction?”  The 
most  important  differentiating  factor  to  this 
question  is  whether  or  not  vomiting  is  pres- 
ent or  absent.  Patients  with  large  bowel 
obstructions  do  not  vomit,  but  those  with 
small  bowel  obstructions  do.  V/e  all  have 
seen  late  cases  of  large  bowel  obstruction 
where  vomiting  has  been  present  as  a late 
and  not  too  distressing  symptom,  but  in  the 
small  bowel  lesions  vomiting  appears  very 
early.  The  higher  the  obstruction  the  more 
fulminating  the  vomiting.  Utilizing  this  one 
fact,  we  can  usually  differentiate  the  small 
from  the  large  bowel  obstructions.  To  use  the 
word  “fecal”  vomiting  as  being  descriptive 
of  intestinal  obstruction  is  incorrect.  The 


lerm  “feculent”  is  more  descriptive  since 
fecal  vomiting  refers  to  a gastrocolic  fistula 
or  some  similar  lesion.  The  flat  x-ray  film 
is  used  to  further  differentiate  the  small 
from  the  large  bowel  obstruction.  It  is  un- 
necessary to  stand  or  turn  the  patient  or 
to  give  him  any  contrast  media.  A flat 
x-ray  picture,  which  can  be  taken  with  a 
portable  machine,  will  usually  give  the  de- 
sired information.  If  the  obstruction  is  a 
large  bowel  lesion,  the  x-ray  film  usually 
reveals  a large  distended  colon  which  ap- 
pears as  a horse-shoe  or  inverted  “U.”  The 
rectosigmoid  is  the  most  common  location 
for  these  lesions.  If,  on  the  other  hand, 
the  obstruction  is  small  bowel  in  nature,  the 
typical  paralleling  or  step-ladder  pattern 
will  be  present.  The  history  also  aids  in 
differentiating  the  two  types  of  obstruc- 
tions. A slow,  progressive,  chronic,  in- 
creasing constipation  speaks  for  a large 
bowel  lesion,  but  a sudden  violent  attack 
signifies  small  bowel  pathology.  Patients 
with  intestinal  obstruction  who  have  had 
previous  surgery  are  small  bowel  obstruc- 
tions until  proved  otherwise.  'The  large 
bowel  obstruction  resulting  from  postopera- 
tive adhesions  is  a rarity.  A two-quart 
diagnostic  enema  is  also  of  help.  The  large 
bowel  can  usually  retain  two  quarts  of  fluid 
plus  its  usual  contents.  If  the  bowel  cannot 
take  the  two  quarts,  this  speaks  for  a large 
bowel  lesion.  There  are  many  other  ways 
of  differentiating  the  two,  but  time  nor 
space  do  not  permit  extending  this  discus- 
sion. 

Question  number  three,  “Is  this  a strangu- 
lated or  non-stranguated  intestinal  obstruc- 
tion?” can  usually  be  answered  by  the 
presence  or  absence  of  tenderness.  Patients 
with  intestinal  obstructions  do  complain  of 
colicky  pain,  but  the  strangulated  lesion  has 
pain  plus  localized  tenderness.  This  tender- 
ness is  best  found  by  the  patient,  who  will 
usually  locate  the  exact  point  of  the  pathol- 
ogy. The  classical  example  of  this  is  a 
strangulated  inguinal  hernia.  The  patient 
has  diffuse  pain  over  his  entire  abdomen, 
but  will  permit  one  to  palpate  it;  however, 
he  resents  having  pressure  made  over  a 
strangulated  mass  because  of  its  exquisite 
tenderness.  Our  incision  is  usually  deter- 


628 


Rocky  Mountain  Medical  Journal 


minded  by  the  location  of  the  patient’s  ten- 
derness. Another  differentiating  point  be- 
tween the  strangulated  and  non-strangu- 
lated  obstruction  is  the  appearance  of  the 
patient.  A patient  who  has  a strangulated 
intestinal  obstruction  is  acutely  and  violent- 
ly ill  and  usually  is  in  shock  or  impending 
shock,  whereas  the  patient  with  an  intes- 
tinal obstruction  without  strangulation  does 
not  present  such  a dramatic  picture.  The 
flat  x-ray  film  may  aid  in  the  differentia- 
tion of  a strangulated  from  a non-strangu- 
lated  small  bowel  obstruction.  If  a small 
bowel,  non-strangulated,  intestinal  obstruc- 
tion is  present  the  typical  step-ladder  pat- 
tern is  observed  and  the  valvulae  conni- 
ventes  are  readily  seen.  If,  on  the  other 
hand,  a small  bowel  strangulated  obstruc- 
tion is  present,  no  characteristic  bowel  pat- 
tern is  assumed  since  the  distended 
loops  arrange  themselves  in  whatever 
portion  of  the  abdomen  that  the  ob- 
struction occurs.  The  valvulae  conniventes 
are  not  easily  detected  or  seen  because  of 
the  extravasation  of  blood  into  the  strangu- 
lated loop  of  bowel  and  into  the  abdominal 
cavity. 

Question  number  four  states:  “It  this  a 
complete  or  incomplete  obstruction?”  As 
has  been  mentioned,  a patient  with  a com- 
plete intestinal  obstruction  passes  neither 
flatus  nor  feces  per  rectum,  but  if  the  ob- 
struction is  incomplete  some  flatus  and 
feces  may  be  expelled,  especially  with  re- 
peated enemas.  It  is  important  not  to  be 
misled  by  the  results  of  the  first  enema, 
since  a copious  movement  and  flatus  may 
be  expelled  following  its  administration. 
This,  however,  is  material  which  is  distal 
to  the  lesion.  If  repeated  enemas  bring 
flatus  and  feces  then  we  assume  that  the 
lesion  is  incomplete;  if  the  returns  of  the 
repeated  washings  are  clear,  we  conclude 
that  the  obstruction  is  a complete  one.  A 
“scout”  film  of  the  abdomen  should  be  taken 
when  the  patient  arrives.  This  immediately 
reveals  the  bowel  pattern  and  also  deter- 
mines whether  or  not  flatus  is  present  in 
the  region  of  the  hollow  of  the  sacrum.  If 
the  flatus  over  the  sacrum  is  absent  follow- 
ing repeated  enemas,  we  consider  the  con- 
dition a complete  obstruction,  but  if  the 


flatus  continues  to  come  down  and  appear 
over  the  sacral  region,  the  lesion  is  an  in- 
complete one.  A patient  with  a complete 
obstruction  will  appear  more  ill  than  one 
with  an  incomplete  lesion;  therefore,  the 
clinical  appearance  and  impression  is  of 
importance. 

Based  on  these  four  questions,  one  may 
make  a proper  diagnosis  instead  of  just 
“intestinal  obstruction.”  The  case,  there- 
fore, may  be  diagnosed  as  a large  bowel, 
non-strangulated,  incomplete  intestinal  ob- 
struction, or  a strangulated,  small  bowel, 
complete  intestinal  obstruction,  depending 
upon  the  findings. 

Treatment 

When  one  labors  through  the  voluminous 
literature  on  the  subject  of  the  treatment 
of  intestinal  obstruction,  it  becomes  difficult 
to  apply  this  maze  of  material.  It  is  wise, 
therefore,  to  have  a plan  based  upon  a 
simple  summary.  We  have  devised  a plan 
based  on  the  six  “S’s,”  since  we  state  that 
the  treatment  of  intestinal  obstruction  con- 
sists of  Suction,  Saline,  Sanguine,  Surgery, 
Sulfa  and  the  “Stir-’em”  technic. 

Suction,  or  gastro-intestinal  siphonage,  has 
done  much  to  lower  the  mortality  of  this  con- 
dition. It  has  its  pitfalls,  however,  and  these 
must  be  kept  in  mind.  It  has  no  place  in 
large  bowel  obstructions  nor  should  it  be 
used  when  strangulation  is  present.  On  the 
other  hand,  it  may  be  curative  in  postoper- 
ative ileus,  non-strangulated  adhesive  ob- 
struction, or  in  obstructions  associated  with 
peritonitis;  these  are  usually  small  bowel 
lesions.  Its  value  as  a pre-  or  postoperative 
adjunct  needs  no  emphasis.  To  keep  a 
patient  with  carcinoma  of  the  rectosigmoid 
and  a large  bowel  intestinal  obstruction  on 
continuous  siphonage  is  to  court  disaster. 
Hence,  its  uses  and  abuses  must  be  thor- 
oughly understood. 

Saline  can  prolong  the  life  of  a patient 
with  an  intestinal  obstruction;  however,  it 
cannot  cure  the  condition.  It  is  an  excellent 
form  of  supportive  therapy.  Chloride  ions 
have  been  lost  in  the  patient  who  has  mani- 
fested a great  deal  of  vomiting  or  in  whom 
continuous  gastro-intestinal  siphonage  has 
been  instituted.  These  must  be  replaced, 
and  it  is  mainly  by  the  use  of  physiological 


for  August,  1949 


629 


saline  that  the  patient's  chloride  balance 
may  be  maintained.  By  restoring  this  elec- 
trolyte balance  one  is  able  to  put  his  pa- 
tient into  better  condition  to  withstand  sur- 
gery, and  in  this  way  also  to  lower  the 
mortality.  Saline,  however,  is  not  the  only 
supportive  therapy  that  the  patient  needs; 
this  will  be  discussed  subsequently. 

Sanguine  is  the  word  used  to  refer  to 
blood  and  its  derivatives.  We  feel  that  the 
only  place  for  the  use  of  whole  blood  is  in 
the  replacement  of  lost  red  cells.  We  pre- 
fer to  keep  the  protein  balance  of  the  pa- 
tient normal  with  plasma,  serum  or  amino 
acid  therapy.  If  the  obstruction  is  asso- 
ciated with  blood  loss,  we  feel  that  the  fluid 
of  choice  is  then  whole  blood.  In  many 
cases  of  strangulated  obstructions,  or  in 
cases  which  might  necessitate  extensive 
bowel  resection,  whole  blood  is  preferred. 
Maintaining  a normal  protein  level  permits 
a patient  to  properly  seal  because  of  his 
good  fibrin  content.  Hypoproteinemia  and 
hyperchloridemia  are  two  conditions  which 
must  be  avoided  in  the  case  of  intestinal 
obstruction  as  well  as  in  all  other  surgical 
emergencies.  Too  little  protein  and  too 
much  chloride  both  produce  tissue  edema 
and  permit  the  patient  to  “drown”  in  his 
own  body  juices.  It  is  because  of  hypo- 
proteinemia and  hyperchloridemia  that  su- 
tures pull  out  of  edematous  tissue.  Faulty 
suturing  or  material  is  not  the  cause  of  in- 
testinal leakage;  this  is  due  to  poor  pre-  and 
postoperative  care.  The  patient’s  vitamin 
needs  must  be  maintained,  especially  the 
water  soluble  vitamins  B and  C which  he 
loses  readily.  Vitamin  C is  truly  the  “sur- 
geon’s” vitamin  because  this  is  the  one 
which  is  essential  to  sound  wound  healing. 

Surgery  is  a subject  which  cannot  be  dis- 
cussed adequately  in  a few  minutes  or  a 
few  pages,  and  I will  only  have  time  to 
touch  upon  the  surgical  highlights  as  they 
pertain  to  the  patient  with  an  obstruction. 
If  a patient  has  a strangulation  he  should 
have  immediate  surgery.  As  has  been 
stated,  the  patient  will  tell  us  where  to 
make  the  incision  if  we  just  permit  him  to 
reveal  his  most  tender  spot.  Complete  large 
bowel,  non-strangulated  lesions  require  im- 
mediate colostomy  for  the  release  of  intra- 


colonic pressure.  We  prefer  the  so-called 
“blind”  cecostomy  in  such  conditions.  This 
is  made  through  an  exaggerated  McBurney’s 
incision  which  hugs  the  anterior  superior 
iliac  spine.  If  the  cecum  is  distended,  and 
it  surely  should  be  in  an  obstructed  colon, 
then  it  bulges  into  the  wound.  It  is  held  in 
place  by  two  hemostats  and  an  iodoform 
pack  is  placed  between  the  cecum  and  the 
parietal  peritoneum.  Following  this  stitch- 
less procedure,  the  patient  is  returned  to 
bed  and  the  cecum  is  opened  some  six  hours 
later  and  after  it  has  had  a chance  to  seal 
off.  Since  the  bowel  wall  is  edematous  and 
will  not  retain  sutures  it  is  unwise  to  di- 
rectly attack  an  obstructed  colonic  lesion. 
It  is  for  this  reason  that  we  leave  the  pri- 
mary pathology  alone  and  do  a preliminary 
cecostomy  away  from  the  site  of  the  lesion. 
For  the  following  ten  days  or  two  weeks 
the  patient  may  be  deflated,  prepared  and 
then  re-operated.  It  is  at  this  time  that  a 
true  evaluation  of  the  pathology  can  be 
made  and  a resection  done.  The  cecostomy 
acts  as  a vent  in  the  event  that  an  intestinal 
anastomosis  is  performed.  In  strangulated 
lesions  we  may  be  confronted  with  the  ques- 
tion: “Is  the  bowel  which  has  been  freed 
viable  or  not?”  It  seems  impractical  to  stand 
about  placing  hot  towels  on  a segment  or 
intestine  and  watch  it  color.  Viability  is 
readily  determined  if  one  merely  flicks  the 
bowel  with  the  finger  and  watches  for  per- 
istaltic waves.  If  it  is  able  to  contract,  re- 
gardless of  the  color  of  the  intestine,  it  is 
viable.  Intestinal  obstruction  is  usually  as- 
sociated with  a transudate  which  is  present 
in  the  peritoneal  cavity;  if  this  is  bloody  a 
strangulation  is  present.  Therefore,  if  a 
blind  cecostomy  is  done  and  a saguinous 
fluid  noted,  we  must  abandon  the  cecos- 
tomy and  explore  for  the  presence  of  a 
strangulated  lesion.  The  type  of  anastomosis 
performed  is  purely  a personal  one;  how- 
ver,  we  feel  that  a lateral  anastomosis  is 
the  safest  in  the  hands  of  the  occasional 
operator.  If  time  is  a factor,  one  should  be 
familiar  with  the  technic  of  the  so-called 
quick  “aseptic”  end  to  end  anastomosis. 

Sulfa  drugs  have  taken  their  place  among 
the  chemotherapeutic  agents  used  in  the 
treatment  of  intestinal  obstruction.  There 


630 


Rocky  Mountain  Medical  Journal 


is  also  a place  for  such  allied  drugs  as 
penicillin  and  streptomycin.  Following  the 
surgery,  we  place  three  to  four  grams  of 
sulfathiozole  or  sulfadiazine  in  the  perito- 
neal cavity  and  follow  this  with  40,000  units 
of  penicillin  every  three  or  four  hours  in- 
tramuscularly. We  do  know  that  penicillin 
will  not  affect  the  colon  group  of  organisms 
but  it  will  attack  streptococci  and  staphy- 
lococci. Sulfadiazine  is  administered  intra- 
venously following  the  first  postoperative 
day  and  streptomycin  is  coming  into  its  own 
as  the  main  chemotherapeutic  agent  against 
the  gram  negative  rods.  Sufasuxidine  and 
sulfathaladine  will  keep  the  bacterial  count 
low  in  the  intestinal  tract  if  these  drugs 
can  be  taken  by  mouth. 

By  “stir-’em”  technic  we  mean  early  am- 
bulation, active  and  passive  movements  and 
breathing  exercises.  The  beneficial  effects 
brought  about  by  getting  patients  out  of 


bed  as  soon  as  possible  have  been  well 
proved.  We  do  not  wish  to  infer  that  early 
ambulation  should  be  carried  to  an  extreme. 
It  is  our  plan  to  have  our  major  surgical 
cases  out  of  bed  on  the  first  postoperative 
day;  however,  each  case  presents  an  indi- 
vidual problem.  Having  the  patient  move 
about,  having  him  take  a few  deep  breaths 
every  hour,  and  encouraging  arm  and  leg 
movements  all  play  their  part  in  lowering 
the  incidence  of  phlebothrombosis,  pulmo- 
nary complications  and  their  sequelae. 

Only  the  surface  has  been  scratched  in 
this  discussion  of  the  vast  subject  of  in- 
testinal obstruction;  however,  we  feel  that 
if  we  approach  the  problem  with  the  “Four 
Questions,”  make  a ‘diagnosis  based  upon 
these,  and  then  summarize  the  treatment 
with  our  “Six  S’s,”  we  should  have  a logical 
approach  to  a given  case. 


LOW  BACK  PAIN* 

THE  VALUE  OF  SPECIFIC  TESTS  IN  DIFFERENTIAL  DIAGNOSIS 

EARL  D.  McBride,  m.d. 

OKLAHOMA  CITY,  OKHA. 


The  differential  diagnosis  of  pain  in  the 
lumbosacral  area  of  the  back  depends  great- 
ly on  the  accuracy  of  the  history  and  the 
exactness  in  which  the  various  tests  are 
applied  for  eliciting  objective  clinical  signs. 
The  pertinent  points  in  the  history,  of  char- 
acteristic significance,  must  match  the  clin- 
ical signs  to  form  a definite  pattern  in- 
dicative of  a specific  diagnosis.  The  various 
examination  maneuvers  designed  to  bring 
out  pain  or  other  symptoms  in  certain  areas, 
such  as  the  sacro-iliac  or  lumbosacral  joints, 
must  be  routinely  thorough  and  fully  com- 
prehensive. The  roentgenographic  exam- 
ination is  important,  but  only  as  supporting 
evidence  to  the  history  and  the  clinical 
signs. 

The  advent  of  the  herniated  interverte- 
bral disk  syndrome  has  greatly  stimulated 
interest  in  the  -lumbosacral  joint.  The  ex- 
istence of  such  definite  symptoms  and  path- 
ology as  is  found  in  a ruptured  interverte- 
bral disk  deprives  irretractable  low  back 

*Read  before  the  Utah  State  Medical  Association's 
Annual  Meeting,  September  2,  1948. 


pain  of  some  of  its  diagnostic  difficulties. 
Recognition  of  the  disk  syndrome  has 
proved  the  sacro-iliac  joint  much  less  fre- 
quently at  fault  than  was  formerly  thought. 
It  is  now  realized  how  useless  were  the 
many  indefinite  therapeutic  measures  that 
were  employed  when  the  all  inclusive  diag- 
nosis of  “lumbago”  was  common.  The  ex- 
traction of  teeth,  the  removal  of  other  focal 
infection  and  the  administration  of  intra- 
venous “shots”  may  be  indicated  in  arthritis 
but  have  no  effect  in  the  treatment  of  her- 
niated intervertebral  disk.  The  term  “her- 
niated intervertebral  disk,”  however,  has 
become  too  frequently  a diagnostic  con- 
venience. The  characteristic  symptoms 
and  signs  are  so  clearly  defined  that  there 
should  be  but  little  excuse  for  confusion. 

General  Physical  Examination 

The  general  physical  examination  must 
be  very  accurate  in  all  back  cases.  A slight 
rise  in  temperature  and  evidence  of  pos- 
tural fatigue  may  be  of  great  significance. 
Often  the  temperature  should  be  observed 


for  August,  1949 


631 


over  a period  of  a week  or  more.  The  his- 
tory of  chronic  indigestion  or  other  sys- 
temic symptoms  should  be  investigated. 
High  blood  pressure  and  over-weight  are 
especially  important.  The  possibility  of  oc- 
cupational strain  or  trauma  must,  be  given 
attention. 

Specific  Tests 

In  the  examination  of  the  back  there  are 
a number  of  tests  that  have  been  long  recog- 
nized for  their  characteristic  clinical  sig- 
nificance. Such  tests  are  of  value  only 
when  coupled  with  experience  and  judg- 
ment. Briefly  the  more  reliable  and  infor- 
mative tests  are  as  follows: 

1.  Standing: 

a.  Location  and  character  of  pain  and  tender- 

ness. 

b.  General  appearance  and  posture. 

c.  Forced  flexion,  extension,  lateral  bending 

and  rotation. 

2.  Lying  on  back: 

a.  Straight  leg  raising  tests. 

b.  Gaenslen’s  sacro-iliac  test. 

c.  Patrick’s  hip  test. 

d.  Laguerre’s  hip  test. 

e.  Forcible  squeezing  of  the  pelvis. 

3.  Turning  over  on  face  or  back  test. 

4.  Lying  on  face: 

a.  Yeoman’s  test  of  forced  hyperextension  of 

either  leg. 

b.  Ely’s  test  of  heel  to  buttocks. 

c.  Passive  hyperextension  of  lumbosacral  area. 

5.  Lying  on  side: 
a.  Ober’s  test. 

6.  Neurologic  tests: 

a.  Reflexes. 

b.  Anesthesia. 

7.  Measurements  of  leg  lengths  and  circumfer- 

ences. 

8.  Novocaine  injections. 

9.  Additional  tests: 

a.  McBride  toe-to-mouth,  sacro-iliac  test. 

b.  McBride  sitting  knee  extension  test. 

Standing 

The  location  and  character  of  the  pain 
must  be  determined  carefully.  Localized 
tenderness  should  correspond  to  the  indica- 
tions of  pain.  Pain  without  localized  ten- 
derness or  involuntary  muscle  spasm  is  in- 
dicative of  sources  of  symptoms  other  than 
in  the  skeletal  system  itself.  It  is  important 
to  determine  whether  pain  is  relieved  by 
rest  in  bed  or  by  immobilization.  Carcinoma 
with  metastasis,  in  particular,  produces  an 
irretractable  pain  which  is  not  relieved  by 
rest;  is  not  of  definite  pattern  and  is  not 
accurately  localized  through  points  of 
tenderness. 

The  general  appearance  of  the  body  in  the 


standing  or  walking  posture  may  give  a 
leading  suggestion  toward  the  diagnosis. 
Such  observations  as  a lateral  or  forward 
list  of  the  trunk,  tilting  of  the  pelvis  or 
favoring  of  either  leg  are  significant  symp- 
toms. The  postural  contour  of  the  back, 
such  as  a lordosis,  a kyphosis  or  a knuckling 
deformity  of  the  spinous  processes,  are  oft- 
en suggestive  of  pathology  which  is  real- 
ized only  by  roentgenographic  studies. 

The  test  of  flexing  forward  or  backward 
must  be  done  with  the  knees  fully  ex- 
tended and  with  equalized  weight  bearing. 
Exaggeration  of  pain  is  often  primarily  de- 
tected in  this  test.  When  the  patient  claims 
he  cannot  bend  forward  at  all,  proof  may 
be  obtained  by  asking  him  to  sit  erect  and 
to  bend  forward  on  the  examining  table 
with  his  knees  extended. 

Lying  on  Back 

The  back  tests  should  be  carried  out  on 
a long,  flat  top  examining  table.  The  ma- 
neuvers of  each  test  should  be  deliberate, 
exacting  and'  purposeful.  For  instance,  the 
straight  leg  raising  test  should  not  be  done 
until  there  is  complete  relaxation.  As  the 
leg  with  the  extended  knee  is  slowly  lifted 
with  the  patient  relaxed,  the  first  indica- 
tion of  pain  should  be  carefully  noted  for 
its  location.  Sacro-iliac  involvement  will 
produce  pain  within  the  first  few  degrees 
of  lifting  the  extended  leg.  Lumbar  pain 
is  elicited  when  the  leg  is  lifted  enough 
to  induce  flexion  of  the  spine.  Letting  the 
leg  back  to  the  table  is  also  important.  If 
the  patient  is  left  to  lower  his  leg  volun- 
tarily the  strain  may  bring  out  pain  that 
otherwise  might  not  be  observed. 

The  Gaenslen  test  for  sacro-iliac  disease 
is  still  valuable.  If  care  is  not  used,  how- 
ever, pain  will  be  mistaken  for  what  is  ac- 
tually a lumbo-sacral  lesion.  The  test  is  that 
of  forcibly  flexing  the  knee  of  one  leg  up 
to  the  trunk  while  the  other  leg  is  held 
straight  and  hyperextended.  This  produces 
pain  in  either  sacro-iliac  joint  in  which 
there  is  pathology. 

Patrick’s  test  is  sometimes  called  the 
“Figure  4”  test.  The  heel  of  one  leg  is 
placed  on  the  patella  of  the  opposite  leg. 
The  “Y”  ligament  of  the  hip  joint  is 


632 


Rocky  Mountain  Medical  Journal 


stretched  in  this  manner  to  bring  out  pain 
if  this  joint  is  involved.  Laguerre’s  test  is 
very  similar.  The  hip  is  forced  in  external 
rotation  with  the  knee  flexed. 

Pain  in  the  sacro-iliac  joint,  in  some  in- 
stances, may  be  elicited  in  no  other  manner 
than  by  having  the  outstretched  patient 
turn  over  on  his  face  or  back.  Consequent- 
ly, close  observation  should  be  made  of  such 
movements  of  the  patient  in  order  to  local- 
ize any  undue  pain.  Squeezing  the  pelvis 
by  pressure  on  each  ilium  may  bring  out 
pain  in  the  sacro-iliac  joint,  but  is  not  a very 
reliable  test. 

Lying  on  Face 

Yeoman’s  test  may  bring  about  pain  in 
the  hip,  sacro-iliac  joint  or  lumbar  spine. 
With  the  patient  on  his  face,  the  foot  is 
picked  up  by  the  examiner  and  the  sus- 
pended leg  hyperextended.  Ely’s  test  of 
placing  the  heel  to  the  buttock  is  of  similar 
significance  to  that  of  Yeoman’s  test. 

Passive  hyperextension  of  the  lumbosac- 
ral area  is  of  great  importance.  It  may  be 
done  by  the  examiner  by  taking  both  legs 
in  his  arms  and  lifting  them  into  hyperex- 
tension. The  patient  may  accomplish  a sim- 
ilar hyperextension  position  by  rising  on 
his  hands  and  extended  elbows  while  per- 
mitting the  pelvis  and  legs  to  remain  flat 
on  the  table. 

Lying  on  Side 

The  Ober  test  is  to  elicit  tightness  of  the 
tensor  fascia  of  the  pelvis  and  thigh.  Such 
a condition  will  hold  the  pelvis  in  mid  flex- 
ion at  the  hip,  creates  tendency  toward  a 
lordotic  posture  and  thus  produces  chronic 
ligamentous  strain.  With  the  patient  on  his 
side  and  knees  slightly  flexed,  the  test  is 
carried  out  by  taking  the  upper,  free  leg  in 
the  arms,  abducting  the  hip  while  extending 
it,  and  then  while  holding  only  the  pa- 
tient’s foot,  permitting  the  patient  to  at- 
tempt to  drop  the  knee  to  the  table.  A tight 
fascia  lata  will  prevent  adduction  toward 
the  table. 

Reflexes 

The  presence  or  absence  of  neurologic 
changes  may  provide  the  deciding  factor  in 
the  diagnosis.  A careful  description  of  the 
exact  location  of  numbness  or  radiating  pain 


is  extremely  important.  Often  there  is  no 
actual  anesthesia  but  the  patient’s  sensation 
of  numbness  is  very  real.  Loss  of  one  ankle 
jerk,  together  with  numbness  on  the  outer 
side  of  the  thigh  and  calf,  when  accom- 
panied by  pain  in  the  same  area  extending 
to  the  outer  foot  or  little  toe,  is  quite  in- 
dicative of  herniated  intervertebral  disk  in 
the  lumbosacral  segment.  Involvement  of 
the  fourth  and  fifth  intervertebral  segment 
is  not  so  likely  to  be  accompanied  by  loss  of 
ankle  jerk  and  the  pain  and  numbness  are 
referred  to  the  inner  side  of  the  foot  and 
great  toe.  Alteration  of  the  knee  jerks  or 
a positive  Romberg  is  indicative  of  systemic 
faults  that  should  demand  thorough  inves- 
tigation. 

Novocaine  Injections 

Novocaine  injected  at  the  point  of  pain 
may  be  very  helpful  in  corroborating  or 
disproving  questionable  clinical  signs.  The 
technic  should  be  developed  to  a degree  of 
dependability  or  not  used  at  all. 

Measurements 

The  actual  or  relative  shortness  of  one  leg 
must  be  determined  by  dependable  meas- 
urements. The  detection  of  atrophy  is  very 
important.  Only  extreme  accuracy  in  meas- 
uring thigh  and  calf  circumferences  will 
prove  the  presence  of  mild  atrophy.. 
Author’s  Toe-to-Mouth  Test 
The  author  has  used  for  many  years  a 
sacro-iliac  test  termed  the  toe-to-mouth 
test.  It  should  be  performed  in  both  the 
standing  and  sitting  positions.  The  patient 
stands  on  the  foot  of  the  affected  side  and 
is  asked  to  lift  the  foot  on  the  opposite, 
unaffected,  side  to  his  mouth.  As  he  bends 
his  head  forward  and  brings  his  foot  to- 
ward his  mouth  there  will  be  pain  on  the 
weight  bearing  side  if  pathology  is  present, 
because  of  the  strain  thrust  upon  the  sacro- 
iliac joint  through  torsion  of  the  pelvis  and 
the  one-legged  standing  position. 

Sitting  Knee  Extension  Test 
The  author  has  described  another  test 
which  is  very  informative,  especially  in 
eliciting  definite  sciatic  pain  in  the  sus- 
pected herniation  of  the  intervertebral  disk. 
The  advantages  of  this  test  are  that  the 
movements  of  the  patient  are  fully  under 


for  August,  1949 


633 


ORTHOPEDIC  BACK  EXAMINATION 


Name  of  Patient 
Make  positive  yes  or  no  answers  to  all  figures 


. Date. 


B.P. 


Weight 

Temp. 


(1)  ANATOMICAL  POINTS  OF  PAIN 

(l<se  abhreviallon  letters  in  columns  tielnw  to 
indicate  region) 

Jp)  Points  of  pain  <T)  Tetidernes.s  tl>)  ItsToimiiy 
tK)  Eo-hymo'is  (S)  Swelling  (A)  Atrophy 


1.  Suboci’ipilal 


5.  Dorso-lumhar 


7.  Lnmbo-sacr&l 


S.  llio-lunibar 


n.  Gluteal  bursa 
T3  troihaiilerlc 


(in  STANDING  POSTLRE 
(D)  Lateral  Morements 

( 1 ) Normal 

(2)  Limited:  degree  niutioii  without  pain,  right. 

left - 

(3)  Pain  on  motion  toward  pain  side 

away  from  pain  side... ........ 


(in  STANDING  POSTLRE 
(A)  Front  and  back  view 
( 1 > Normal 

(2)  Degree  body  list;  to  righ* to  left 

(3)  Shou'der  level:  higher  right higher  left. 

(■1)  Pelvis  level;  higher  right-. higher  left. 

<5>  Curvature:  (draw  outline) 

(C)  Region  referred  pain:  Thigh..... .calf ... 

fool. elsewhere........ 


(11)  STANDING  POSTURE 
(E)  Torsion  Movements 
( 1 ) Normal 

(3)  Limited:  degree  mutlun  without  pain:  right., 
left 


Fig.  3 

(in  STANDING  POSTLRE 
(B)  Side  view 

(Check  figure  nearest  type) 

(1)  A Normal 

(2)  B Lordosis 

Prominent  abdomen ..... 

Obesity 

(3)  C Flat  back 

Slumping 

(4)  D Slender 

Asthenic 

(5)  Skeletal  deformity  (outline  location) 

(6>  Gihbus  (knuckling) 

Lordosis 

Kyphosis 

Location 


(ID  STANDING  POSTURE 

<C)  Flexion,  exten>iui)  movements,  knees  straight 

(1)  Extent  limited:  Finger  tips  within .inches 

of  floor 

(2)  Pain:  on  flexion i.-oii  rising 

e.vlenslon- 

(3)  Lewiti  test:  Suddenly  forcing  cither  or  both  flexed 

knees  straight 

Pain:  Right left 


(in  STANDING  POSTURE 

(Ft  Si-iiitic  -Fixed  (KKlnral  deviation:  Yes.... 


(1)  Body  list:  Itighl ...left forward ... 

(2)  Pain:  location — right left... 

(3)  Referred  pain:  Thigh — front back.. 

calf fool — tight left 

(4)  Numbness — thigh:  outer inner calf; 

outer Inner heel fool; 

outer Inner toes 

<j)  Ktiltocks  atrophy,  right left 

(fi)  Pain  exaggerated  hy  cough:  yo nu...... 

(7)  Ankle  jerks;  right left 

(5)  Knee  jerks:  rlglst left 


Remarks  and  other  special  tests 


Fig*.  1.  Suggested  examination  chart. 


634 


Rocky  Mountain  Medical  Journal 


Fii;.  S 


Fig.  8 

ID  STANDING  POSTURE 
(G)  Standing:  Tue-to-moutli  test  < McBride) 


(1)  Right  kg  up;  Pain  right Left. 

t;i)  Left  leg  np;  Pain  right Left- 


Pnsitive  for  sacro-iliao  when  pain  is  produced  in  sacro* 
iliar  region  on  side  opposite  the  leg  being  raised. 
Positive  for  jlin-lumhar  when  pain  orrurs  in  ilio- 
lunihar  region  on  same  side  as  leg  being  raised. 


Fig.  9 

(III)  SITTI.VG  TESTS  (McBride) 

(A)  Straight  leg  sitting  test. 

Test  Results 

(1)  A Flexion:  normal limited fliigei^ 

lack inches  of  reaching  ankles. 

(2)  B Lumbar  rigidity  prevents  erect  sitting  pos- 

ture; Degrees  limited 

(3)  r Bight  knee  relaxed — left  straight:  Can 

bond  forward  easily:  yes _no 

(4)  n Opposite  true:  yes no 

(5)  Forward  bending  not  improved,  with  either 

knee  relaxed:  yes no 

Positive  for 

(1)  .Sciatic  scoliosis:  Muscle  spasm 

right left 

(2)  Ankylosis  vertebral  articulations.. 

(Si  Si-iatic  neuritis  (with  local  nerve 

tenderness) 


(IV)  LYlNt;  O.V  BACK  TESTS 

(A)  Straight  leg  rai'ing  tests — Coldthwail’s,  Lasegue’s, 
Kernig’s,  Smith-Petersen's  Tests  « 

Pain  produced  in: 

(1)  Saoro-il!iac  right  left — — . 

(2)  Luinhct-sacral ; right  left 

(3)  Sciatic  nerve,  right left 

ri»sitive  for  sciatic  nerve  neuritis  when  pain  is  brought 
on  in  nerve  before  stretch  places  strain  on  sacro-Ulac 
joint. 

Positive  for  saoro-iliac  joint  when  pain  is  brought  on 
in  this  joint  tiefore  lumbar  spine  begins  to  move. 

Positive  fur  lumbo-sacral  spine  when  pain  is  brought 
on  in  Ibis  joint  as  stretching  brings  forth  movement  in 
it.  Also  when  both  extended  legs  flexed  to  same  level 
cause  lumbu'.sacral  pain. 


(IV)  LYING  ON  BACK  TESTS 

(B)  Gaenslen’s  test 

Pain  in  sacro-iliac;  right left - 

Positive  for  sacro-iliac  joint.  Pain  occurs  on 
side  of  lesion,  whether  right  or  left,  as  force 
is  increased  to  limits  involving  either  one  or 
both  joints. 

(C)  Lewin's  method,  same  test 

Carry  out  same  maneuver  with  ))8tient  on  side. 
Positive:  right left - 


(A)  Ober’s  test:  P<Kitive — tight left- 

Positive  for  coiilracicd  tensor  fasciae  lata' 
when  flexed  knee  Mill  nut  drop  to  tabic. 

(B)  CoiiipresNiini  of  pelvis. 

Positive  sacro-iliac — right left 

Positive  when  compression  of  pelvis  cause 
pain  in  either  sacro-iliac  joint. 


(VI)  LMNG  (».\  FACE  TKST.< 

(A)  Nachlas  Knee  Flexion  Tc't 
Positive  for: 

(1)  Sacro-iliac — right  left 

pain  referred 

(2)  Liimbo-sacral — light  left - 

pain  referred . 

Positive  fitr  sacro-iliac  or  Innilio-sacral.  Pain 
occurs  at  site  of  lesion  whether  right  or  left 
as  force  is  increased  to  limit',  involving  either 
one  or  both  joitus. 


(VI)  LYl.VG  ON  FACE  TE.STS 

(B)  Yeoman’s  hip  byperexlensioii  le-t 
Positive  for: 

( I ) Sacro-iliac — right  left - 

Pusitive  for  sacro-iliac  when  pain  occurs  on 
-side  of  lesion  whether  right  or  left  as  force 
of  hypcrextensioti  is  liaiisfirre<l  to  affected 
joint. 


(IV)  LYING  OK  BACK  TESTS 
ID)  Fabere-Patrick’s  test 
positive  for: 

(1)  Hip  joint  pain:  right left 

(2)  Sacro-iliac  pain:  right left 

Positive  when  elicits  pain  in  hip  joint  or  in 
sacro-iliac  joint  region  as  heel  is  placed  on 
opposite  knee  and  leg,  thus  flexed,  is  forced 
to  table. 


(IV)  LYl.VG  ON  BACK  TESTS 
(E)  Laguerre's  tc.sl 
Positive  for: 

(1)  Hip  joint:  right left 

(2)  Psoas  niiiscle  pain;  right left 

(3)  Sarrn-iliHi’  pain:  right left 

Positive  similar  to  Fahere-Palrick's  test.  F'cn-e 
is  applied  to  roiale  hip  eternally  while  in 
abduction. 


Fig.  17 


(VI)  LYING  ON  FACE  TESTS 
(C)  Ely’s  heel  to  buttock  lest 
positive  for: 

( 1 ) Lumbo-sacral — right  left — 

Positive  for  lumho-sacral  if  pehis  rises  as 
heel  is  pressed  to  hi(lto<-K. 


(D)  Passive  Hyperexteiisioii 
Pain  in; 

1 1 > Lumbar  spine 

(2)  Thorai'ic  spine 

Positive  ftir  arthritic  cliimRcs  when  hyperex- 
tension  eaiises  pain. 


Fig.  19 

(VII)  BIEASUREMENTS 


(1) 


(2) 


(3) 


Right  length ( , ,i  , 

Left  knitlll i''"""  '"■>”'"1"'  I"  aiiftfi'T  ilU- 

Right  o.iir I Circnmfereiiec  each  calf  at  p»unt  10 

Left  calf i iiic'ics  above  mediiil  ni.(lleoliis. 

Righi  thigh ( Circiiinrcrence  of  each  thigh  at  taunt 

Lift  thigh ( 1‘)  iiichi-s  at«ive  tibi.il  iiilu r<-)»'. 


Examined  by 

Fig.  2.  Reverse  side  of  examination  chart. 


spine. 


M.  D. 


for  August,  1949 


635 


control.  The  patient  lies  on  his  back  on  the 
examining  table.  He  is  asked  to  sit  up.  The 
examiner  presses  the  knees  flat  to  the  table 
and  assists  him  in  coming  to  the  erect  posi- 
tion. As  he  attempts  to  sit  erect  or  bend 
forward  to  touch  his  toes  there  will  be  a 
definite  restriction  of  movement  if  there  is 
sciatic  pain  or  ankylosis  of  the  lumbar  spine. 
In  case  of  sciatic  pain,  associated  with  her- 
niated intervertebral  disk,  it  is  in  one  leg 
only.  If,  while  the  patient  is  straining  to 
sit  up,  the  knee  of  the  affected  side  is  re- 
laxed through  flexion,  he  can  then  come 
forward  to  sit  erect  much  more  easily.  If 
the  knee  of  the  affected  leg  is  then  held  in 
extension  on  the  table  while  the  opposite 
knee  is  flexed,  the  patient  still  cannot  come 
to  the  erect  position,  and  pain  is  increased 
down  the  extended  leg.  In  ankylosis  of  the 
lumbar  spine  the  sitting  erect  position 
with  the  knees  extended  may  also  be  im- 
possible, but  the  signs  are  symmetrically 
bilateral. 

For  the  purpose  of  regional  differentia- 
tion of  low  back  symptoms  the  following 
classifications  may  be  used: 

1.  Postural  strain  and  fatigue. 

2.  Fractures  of  the  vertebrae  or  lateral  pro- 

cesses. 

3.  Iliolumbar  strain  or  sprain. 

4.  Sacro-iliac  injury  or  disease. 

5.  Extrusion  of  the  intervertebral  disk. 

6.  Bursitis. 

7.  Sciatic  neuritis. 

8.  Arthritis. 

9.  Instability  of  skeletal  structures  from  con- 

genital anomalies  of  spondylolisthesis,  tran- 
sient fifth  lumbar,  etc. 

10.  Disease:  Tuberculosis  or  syphilis. 

11.  Metastasis  of  malignancy. 

Postural  Strain  and  Fatigue 

Symptoms  from  postural  strain  usually 
arise  from  fatigue  which  results  either  from 
occupational  strain  or  systemic  deprecia- 
tion. The  symptoms  are  indefinite.  The 
pain  is  diffuse  and  indefinitely  referred.  Lo- 
calized tenderness  and  muscle  spasm  are 
not  accurately  described  or  found.  The  pa- 
tient is  likely  to  have  a temperature  of  99 
degrees  or  above. 

Fractures 

An  acute  fracture  is  not  difficult  to  diag- 
nose clinically.  The  question  often  arises  as 
to  whether  a wedged  vertebra  is  due  to 


fracture  or  to  some  other  cause.  There  is 
definite  localized  tenderness  over  the  spi- 
nous process  of  the  involved  vertebra. 
There  is  often  a localized  knuckling.  Deep 
pressure  and  forced  hyperextension  pro- 
duce pain.  The  pain  does  not  usually  ra- 
diate to  other  areas  in  the  case  of  fracture. 
Fracture  of  the  lateral  process  also  is  ac- 
companied by  definite  points  of  tenderness 
over  the  exact  position  of  the  pathology. 
Unilateral  muscle  spasm  often  accompanies 
this  tenderness. 

Iliolumbar  Strain  or  Sprain 

The  history  of  the  exact  nature  and  ex- 
tent of  injury,  together  with  the  immediate 
after  effects  and  treatment,  should  be  ob- 
tained. The  nature  of  traumatized  tissues 
is  to  improve  gradually  and  recover.  Long 
periods  of  chronicity  following  injury  in- 
dicate superimposed  systemic  disease  such 
as  chronic  arthritis  or  systemic  weakness. 

The  symptoms  of  injury  are  definitely 
localized  and  are  accompanied  by  localized 
tenderness  with  or  without  muscle  spasm. 
The  lumbosacral  joint  is  notorious  for  its 
many  variations  in  structural  form,  ranging 
from  that  of  spondylolisthesis  and  thinning 
of  the  intervertebral  disk,  to  various  shapes 
and  positions  of  the  laminae  and  articular 
processes.  When  the  ligaments  supporting 
these  structures  become  traumatized, 
through  strain  or  rupture,  the  characteris- 
tic sign  is  that  of  lumbosacral  stiffness  and 
flattening  of  the  low  back.  They  will  not 
produce  a sciatic  scoliosis  except  where 
there  is  nerve  root  irritation,  such  as  is 
found  with  herniated  intervertebral  disk. 
The  pain  is  usually  symmetrically  bilateral 
to  the  fourth  and  fifth  lumbar  spinous  pro- 
cesses, or  if  unilateral,  tenderness  is  present 
in  the  region  of  the  posterior  spine  of  the 
ilium. 

Sacro-Iliac  Injury  or  Disease 

There  has  been  much  argument  in  the 
past  as  to  whether  or  not  motion  exists  in 
the  sacro-iliac,  and  if  subluxation  can  oc- 
cur. Injuries  to  the  sacro-iliac  joint  are 
rare.  They  are  more  frequent  following 
child  birth  than  on  any  other  occasion. 
The  sacro-iliac  belts  which  have  been  used 
routinely  so  long  are  absolutely  of  no  bene- 


636 


Rocky  Mountain  Medical  Journal 


fit  in  95  per  cent  of  the  cases  with  low  back 
pain,  because  the  sacro-iliac  joint  is  not 
involved.  Sacro-iliac  disease  such  as  tuber- 
culosis, however,  should  always  be  thought 
of  in  making  the  examination. 

Extrusion  of  the  Intervetebral  Disk 

The  diagnosis  and  removal  of  the  herni- 
ated intervertebral  disk  is  so  spectacular  in 
prompt  relief  to  the  patient,  that  there  has 
developed  an  enthusiasm  which  has  very 
greatly  overshadowed  the  importance  of 
other  causes  of  pain  in  the  lumbosacral  area. 
The  herniated  intervertebral  disk  can  be 
accurately  diagnosed  by  clinical  signs  with- 
out injection  of  opaque  material  for  roent- 
genogram demonstration.  The  sitting  knee 
extension  test  is  almost  pathognomonic  of 
herinated  intervertebral  disk,  when  positive 
for  unilateral  sciatic  pain.  When  accom- 
panied by  a posture  of  definite  body  list 
from  involuntary  muscle  spasm  or  so-called 
posture  of  sciatic  scoliosis  and  absence  of 
the  ankle  jerk,  a positive  sitting  knee  ex- 
tension test  is  of  final  significance  in  the 
diagnosis.  The  use  of  novocaine  block  in 
the  elimination  of  sacro-iliac  pain  some- 
times is  very  important.  In  case  of  strongly 
suspicioned  tumor,  intra-dural  injection  of 
opaque  material  for  roentgenographic  ex- 
amination may  be  necessary. 

The  best  proof  of  whether  there  is  a 
herniated  intervertebral  disk,  when  there  is 
irretractable  pain,  is  to  explore  the  sus- 
pected lumbar  joints  for  the  disk  and  fuse 
the  involved  joint.  The  added  signs  of 
atrophy  of  the  involved  leg  or  buttock,  the 
pain  on  coughing  or  sneezing  and  the  exact 
neurologic  pattern  of  numbness  and  re- 
flexes are  other  signs  of  importance. 

Bursitis 

The  gluteal  bursa  may  be  involved  or  the 
bursa  posterior  to  the  greater  trochanter 
may  be  very  confusing  in  some  cases  of  low 
back  pain.  The  diagnosis  is  made  chiefly  by 
location  of  the  tenderness  over  the  anat- 
omical region  of  the  bursa. 

Sciatic  Neuritis 

In  true  nerve  inflammation  there  is  pain 
and  corresponding  tenderness  directly  along 
the  course  of  the  sciatic  nerve.  In  the  case 
of  referred  pain,  such  as  that  of  a herniated 


intervertebral  disk,  there  is  little  or  no  ten- 
derness present  except  over  the  lumbosacral 
joint. 

Arthritis 

The  indefinite  symptoms  of  pain  in  the 
back  commonly  called  lumbago  and  treated 
as  a rheumatic  disease  have  about  been 
eliminated  in  light  of  present  information. 
Arthritis  or  myositis,  acute  or  chronic,  do 
exist  and  should  be  recognized.  The  symp- 
toms of  these  diseases  are  very  indefinite, 
with  acute  or  subacute  pain  and  a lack  of 
objective  symptoms.  Pain  referred  down 
the  extremities  from  myositis  radiates  into 
the  buttocks  and  legs  bilaterally.  The  pain 
does  not  follow  the  nerve  root  pattern,  as 
in  a herniated  intervertebral  disk.  In  the 
more  chronic  type  of  case  termed  osteoarth- 
ritis, the  x-ray  shows  marked  lipping  and 
spur  formation,  which  may  or  may  not  be 
associated  with  rather  severe  persistent 
pain.  Here  again,  the  symptoms  are  diffuse 
and  should  not  be  confused  with  a diagnosis 
of  more  definitely  localized  disease  or  in- 
jury. There  usually  are  signs  of  rheumatic 
disease  elsewhere  in  the  body. 

Instability  of  Skeletal  Structures  From 
Congenital  Anomalies 

Anomalies  of  the  bone  structures  may  be 
greatly  misleading.  A mild  scoliosis  or  a 
malformation  of  the  vertebral  body  or  oth- 
er structures  may  exist  for  many  years 
without  symptoms.  The  condition  known  as 
spondylolisthesis  is  more  commonly  seen 
with  definite  and  more  symptoms.  Symp- 
toms from  instability  of  the  lumbar  verte- 
brae are  those  of  chronic  strain.  The  symp- 
toms are  indefinite  and  the  pain  radiates 
symmetrically  into  the  buttocks  and  mani- 
fest disability  in  the  form  of  fatigue  and 
aching  sensations  of  the  lower  back  and 
legs. 

Occasionally  a herniated  intervertebral 
disk  is  associated  with  spondylolisthesis. 
When  this  is  true  the  symptoms  of  herni- 
ated intervertebral  disk  are  present,  in  ad- 
dition to  the  symptoms  of  chronic  back 
strain. 

Disease — Tuberculosis  or  Syphilis 

Specific  disease  may  occur  in  the  sacro- 


for  August,  1949 


637 


iliac  joint  or  in  the  lumbar  vertebrae.  The 
symptoms  are  the  same  as  those  in  other 
joints  involved  in  the  same  disease.  A rou- 
tine Wassermann  is  essential  in  all  back 
examinations.  Tuberculosis  in  adults  is  not 
common  but  can  occur  and  should  always 
be  kept  in  mind. 

Metastasis  of  Malignancy 

Carcinoma  is  not  an  infrequent  cause  of 
pain  in  the  back.  The  pain  is  characterized 
by  a severe,  persisting,  exasperating  pain 
that  cannot  be  localized  definitely.  This 
pain  is  not  relieved  by  heat  or  immobiliza- 
tion and  support.  As  a rule,  the  pain  can- 
not be  relieved  except  through  some  form 


of  narcotics.  A careful  history  will  often 
elicit  some  lead  as  to  the  origin  of  the  met- 
astasis. Multiple  myeloma  occurs  infre- 
quently, but  must  always  be  kept  in  mind. 
Cases  where  metastasis  or  malignancy  are 
considered  possible,  should  have  x-rays 
made  of  the  skull,  pelvis  and  other  bones. 

Routine  Examination  Form 
Outline  drawings  of  the  various  tests 
may  be  assembled  as  an  examination  chart. 
Such  an  arrangement  is  useful  to  record  a 
dependable  routine  and  to  eliminate  con- 
fusion in  the  interpretation  of  exactly  what 
steps  were  taken  in  making  the  examina- 
tion. 


THE  RURAL  HEALTH  PROGRAM* 

FRED  A.  HUMPHREY,  M.D. 

FORT  COLLINS,  COLORADO 


It  is  appropriate  that  the  membership  of 
the  Colorado  State  Medical  Society  should 
know  about  the  program  and  accomplish- 
ments of  its  various  committees.  I hope  that 
the  report  of  the  Rural  Health  Committee 
will  establish  a precedent  and  that  each 
year  we  can  have  a report  from  the  chair- 
man of  a state  committee  as  a part  of  an 
otherwise  scientific  program.  Medical  so- 
ciety committees  are  usually  appointed  for 
a definite  purpose  and  as  a result  of  a series 
of  events  which  focus  attention  on  a par- 
ticular problem.  Of  the  two  outstanding 
pieces  of  propaganda  which  precipitated  the 
formation  of  the  Rural  Health  Committee 
of  the  American  Medical  Association,  one 
was  a fact  and  the  other  has  been  shown  to 
have  been  pure  fiction.  The  fact  was  the 
knowledge  that  the  average  age  of  the  doc- 
tors practicing  in  rural  areas  was  greater 
than  the  age  of  those  practicing  in  cities, 
and  that  upon  their  retirement  or  death 
they  were  not  being  replaced  by  younger 
men.  The  fiction  was  the  unfortunate  pub- 
lication of  the  Selective  Service  figures  by 
an  agency  of  our  Federal  Government.  It 
was  a definite,  if  not  premeditated,  juggling 
of  figures  when  they  claimed  that  the  per- 

*Pi-esented before  the  78th  Annual  Session  of  the 
Colorado  State  Medical  Society  at  Glenwood  Spring’s, 
September  23,  1948. 


centage  of  rejectees  from  rural  areas  was 
higher  than  that  of  rejectees  from  our  cities 
and  metropolitan  areas. 

These  then  were  the  motivating  circum- 
stances which  caused  the  American  Farm 
Bureau  Federation  to  appeal  to  the  Amer- 
ican Medical  Association  for  help  in  solving 
their  rural  health  problems.  The  answer  of 
the  Trustees  was  the  appointment  of  the 
Committee  on  Rural  Health. 

In  order  to  get  a more  accurate  picture 
of  the  actual  rural  health  conditions  in  the 
various  parts  of  the  United  States  and  for 
purposes  of  administration,  the  country  was 
divided  into  eight  regions.  A doctor  re- 
siding in  each  district  was  asked  to  serve 
on  the  national  committee.  He  represents 
the  states  of  his  district  at  the  national 
health  conferences  and  committee  meetings. 
It  is  his  duty  to  contact  each  State  Medical 
Society  and  to  act  in  an  advisory  capacity 
to  each  Rural  Health  Committee  in  his  ter- 
ritory. Immediately  upon  its  being  acti- 
vated, the  National  Rural  Health  Committee 
made  contact  with  such  farm  organizations 
as  the  American  Farm  Bureau  Federation, 
The  National  Grange,  The  Farmers  Union, 
The  National  Milk  Producers  Federation, 
The  Farm  Foundation,  and  the  Extension 
Services  of  the  State  Agricultural  Colleges. 


638 


Rocky  Mountain  Medical  Journal 


After  meeting  with  representatives  of  the 
above  organizations,  both  in  committees 
and  at  general  rural  health  conferences,  it 
was  soon  discovered  that  there  were  many 
points  of  agreement  in  their  and  our  own 
rural  health  programs.  They  have  actively 
joined  with  us  in  promoting  the  program 
of  better  health  for  rural  people.  The  proof 
that  they  are  now  our  friends  and  are  ef- 
ficient allies  has  been  demonstrated  to  me 
in  two  meetings  during  the  past  year.  One 
of  these  was  the  National  Health  Confer- 
ence held  in  Washington,  D.  C.,  which  was 
called  by  Mr.  Oscar  Ewing,  Administrator 
of  the  Social  Security  Board,  and  at  the  re- 
quest of  President  Truman.  That  meeting 
was  packed  with  proponents  of  National 
Compulsory  Health  Insurance.  In  the  panel 
on  rural  health,  the  three  representatives  of 
the  A.M.A.  received  constant  needling  in  an 
effort  to  cause  them  to  lose  their  tempers 
and  make  statements  for  which  they  would 
afterward  be  held  responsible.  In  each  case, 
however,  it  was  unnecessary  to  reply  as  the 
needlers  were  immediately  answered  by  a 
friend  from  one  of  the  farm  organizations 
with  whom  contact  had  been  made  during 
the  past  two  years.  This  association  in  an 
attempt  to  solve  a common  problem  had 
shown  a profit  at  an  unexpected  time  and 
place.  The  success  of  this  conference  from 
the  standpoint  of  the  A.M.A.  is  best  illus- 
trated by  the  fact  that  very  little  news 
emanated  from  the  meeting  in  spite  of  the 
presence  of  reporters  from  every  leading 
newspaper  and  news  magazine.  In  other 
words,  the  recommendations  were  in  ac- 
cordance with  the  principles  of  the  A.M.A. 
This  did  not  make  news  for  the  American 
public. 

Early  in  the  committee’s  discussions,  it 
was  realized  that  although  the  rural  health 
problem  was  present  in  all  sections  of  the 
United  States,  its  solution  was  possible  only 
by  working  through  smaller  political  units. 
With  that  principle  in  mind,  it  was  recom- 
mended that  each  State  Medical  Society  ap- 
point a rural  health  committee  and  through 
this  committee  arrange  for  a rural  health 
conference  where  the  problems  peculiar  to 
that  state  could  be  discussed.  Practically 


every  State  Medical  Society  now  has  such 
a committee  and  they  have  carried  on  the 
program  by  holding  state  conferences.  Colo- 
rado has  held  two  such  conferences,  one 
in  1947  and  one  in  1948.  At  each  of  these, 
a very  fine  program  was  presented.  The 
attendance  of  farm  people  was  not  as  great 
as  expected  and  the  members  of  the  med- 
ical profession  were  conspicuous  by  their 
absence. 

In  spite  of  the  small  attendance,  all  parts 
of  the  state  have  been  represented  at  these 
conferences.  The  discussions  have  been 
adequate  to  form  certain  definite  conclu- 
sions as  to  some  of  the  procedures  to  be 
followed  if  the  farm  areas  of  Colorado  are 
to  receive  the  best  possible  medical  care. 
This  improvement  in  rural  health  can  best 
be  accomplished  by  the  combined  effort  of 
three  separate  and  distinct  groups  and  then 
only  if  each  is  willing  to  put  forth  a strong 
individual  effort.  Possibly  success  can  only 
be  obtained  through  the  endeavors  of  still 
another  or  fourth  group  whose  duty  it  will 
be  to  guide  and  coordinate  the  program  of 
the  other  three. 

Let  us  now  examine  these  groups  sepa- 
rately to  see  what  each  has  done,  or  what 
its  responsibility  is,  in  the  promotion  of  a 
general  health  program.  The  citizens  of  the 
community  to  be  served  comprise  the  first 
group.  It  is  the  largest  and  the  one  which 
should  be  the  most  interested  in  improving 
the  health  of  the  area.  Community  health 
is  a definite  responsibility  of  the  local  com- 
munity where  there  are  common  problems, 
the  same  interests,  and  a similar  type  of 
thinking  and  activity.  This  is  not  true  in 
the  state  as  a whole  and  much  less  so  in 
the  nation.  More  than  that,  such  a local 
community,  which  relies  on  its  own  energy 
and  resources  for  modern  health  protection, 
is  better  off  than  the  one  which  is  looking 
for — and  hence  dependent  upon — outside 
agencies  to  operate  its  health  system.  It  gets 
exactly  what  it  wants,  exactly  what  fits 
its  needs,  not  inelastic,  unadaptable  activi- 
ties dictated  by  a government  bureau  and 
delivered  in  a package  bound  in  a mass  of 
red  tape.  It  has  control  in  its  own  hands 
and  can  change  policies  or  programs  easily 


for  August,  1949 


639 


to  fit  its  own  changing  requirements.  It  is 
not  affected  by  political  changes,  bureau- 
cratic fads,  or  the  directives  and  whims  of 
distant  administrators.  It  is  self-organized, 
self-reliant,  self-sufficient,  and  above  all, 
self-respecting.  The  citizens  of  such  a com- 
munity should  be  willing  to  spearhead  every 
effort  for  better  health. 

If  it  were  necessary  to  describe  the  work- 
ing of  a complete  health  program  from  the 
standpoint  of  the  local  community  in  one 
word,  that  word  would  be  “Education.”  Ed- 
ucation would  impart  a knowledge  of  the 
requirements  of  a good  and  workable  health 
program  for  a particular  community.  Edu- 
cation should  then  explain  the  costs  of  such 
a program  and  the  method  of  procedure 
for  its  institution.  The  Health  Education 
Committee  of  your  State  Medical  Society  is 
sponsoring  a program  which  in  time  will 
be  a great  help  in  furnishing  proper  health 
education  to  all  schools.  This  committee  in 
cooperation  with  other  interested  state 
agencies  is  striving  to  place  courses  of 
health  education  in  our  colleges  which 
would  provide  qualified  instructors  to  teach 
the  fundamentals  of  good  health  in  every 
elementary  and  secondary  school  in  Colo- 
rado. Also  this  group  is  preparing  a hand- 
book in  methods  of  health-teaching  to  be 
used  in  the  schools.  Such  a farsighted  pro- 
gram should  be  encouraged  by  the  doctors. 
Until  sufficient  time  has  elapsed  to  obtain 
the  expected  results,  it  should  be  the  duty 
of  the  doctors  of  the  local  communities  to 
be  the  instructors  in  questions  of  health 
education.  After  the  program  is  in  full 
swing,  the  doctors  should  not  retire  but 
should  continue  to  act,  at  least,  in  an  advis- 
ory capacity. 

There  are  so  many  ramifications  to  a 
complete  health  program  that  no  layman 
can  be  expected  to  know  all  the  answers. 
Education  therefore  also  means  a knowledge 
of  the  proper  source  of  information  for  the 
solution  to  any  question.  Some  of  the  in- 
formation, which  might  be  of  value  in  cata- 
loguing the  requirements  of  a rural  health 
program  in  any  community,  could  be  ob- 
tained in  that  vicinity  by  its  local  citizens. 
A few  of  the  subjects  which  might  be  put 


on  the  agenda  for  detailed  study  and  im- 
provement if  found  lacking  are:  1,  the  prev- 
alence and  control  of  contagious  diseases; 
2,  the  source  and  safety  of  the  water  sup- 
ply; 3,  the  proper  disposal  of  sewage;  4,  the 
prevention  of  farm  accidents;  5,  the  study 
of  proper  nutrition;  6,  the  value  of  health 
and  sex  education  in  the  schools;  7,  the  ef- 
fect of  proper  clothing  and  housing;  8,  the 
condition  of  the  farm  to  market  roads;  9, 
the  need  of  ambulance  service;  10,  the  pro- 
curement of  adequate  health  facilities  and 
personnel. 

The  second  group,  while  smaller,  is  the 
most  powerful  of  all  the  forces  required  to 
promote  a successful  rural  health  program. 
Taken  collectively  in  the  State  of  Colorado, 
it  is  known  as  the  Colorado  State  Medical 
Society.  In  smaller  units,  it  means  the  doc- 
tors in  the  local  communities  or  the  group 
of  doctors  who  comprise  the  County  Med- 
ical Society.  There  is  a moral  obligation  on 
the  medical  profession,  individually  and 
collectively,  to  institute  and  support  any 
movement  which  will  enhance  or 
protect  the  health  of  the  citizens  of  the 
community.  Any  health  measure,  no  matter 
how  trivial  or  by  whom  instigated,  cannot 
obtain  any  degree  of  success  without  the 
support  of  the  medical  profession.  If  we 
are  unwilling  to  expend  our  time,  energy, 
and  knowledge  to  encourage  beneficial 
health  undertakings,  we  should  not  offer 
objections  when  the  people  turn  to  govern- 
mental agencies  who  favor  federal  compul- 
sory health  insurance.  The  people  need 
and  are  entitled  to  receive  honest  and  ade- 
quate health  advice  and  guidance.  The 
most  effective  weapon  we  have  to  combat 
the  Murray-Wagner-Dingle  type  of  legisla- 
tion is  an  active  interest  by  the  individual 
doctor  in  the  health  projects  of  his  local 
community.  Health  problems  with  various 
degrees  of  severity  are  bound  to  arise  in 
every  community  and  to  overcome  such  ob- 
jectionable circumstances  local  health  coun- 
cils should  be  formed,  with  the  doctors  of 
the  community  in  active  participation. 

The  third  group  is  the  medical  school.  It 
is  my  candid  opinion  that  the  University  of 
Colorado  School  of  Medicine  is  out  in  ad- 


640 


Rocky  Mountain  Medical  Journal 


vance  of  the  other  two  groups  and  the  other 
medical  schools  in  the  solution  of  its  part 
of  the  program  of  better  health  for  rural 
people.  In  its  attempt  to  turn  out  doctors 
better  qualified  to  treat  the  “whole  man” 
rather  than  specialists  it  is  traveling  an 
“uncharted  sea”  but  a start  must  be  made 
somewhere  and  by  someone  qualified  to 
instigate  such  a program.  They  are  giving 
rural  health  a definite  boost  by  instituting 
such  new  ideas  as  a section  on  general  prac- 
tice in  both  their  undergraduate  and  gradu- 
ate teaching  staff.  They  have  established  a 
residency  in  general  practice  with  the  resi- 
dents rotating  through  smaller  hospitals  for 
a part  of  their  graduate  training.  It  is 
planned  that  each  of  these  smaller  hospitals 
which  has  a resident  will  be  visited  one  day 
each  month  by  a group  of  the  school’s  teach- 
ing staff,  thereby  bringing  to  the  doctors 
in  that  vicinity  one  day  of  postgraduate 
study  each  month.  This  is  in  addition  to  the 
many  one,  two,  or  three  day  courses  of 
postgraduate  work  which  they  are  now 
holding  frequently  at  the  medical  center. 
The  informative  study  on  “The  Distribution 
of  Physicians  and  Physicians’  Services  in 
Colorado”  as  published  in  the  Rocky  Moun- 
tain Medical  Journal  in  July,  1948,  gives  us 
much  needed  information  on  which  to  base 
an  intelligent  rural  health  program  and  it 
will  be  of  even  greater  value  when  the 
more  detailed  analysis  is  completed. 

The  fourth  group,  whose  duty  is  to  co- 
ordinate the  efforts  of  all  people  interested 
in  rural  health,  should  have  as  its  leaders 
the  various  members  of  the  Extension  Serv- 
ice of  the  Agricultural  College,  which  in- 
cludes the  County  Agents  and  Home  Dem- 
onstration Agents.  The  Extension  Service 
could  either  handle  the  organization  and 
promotion  of  a successful  rural  health  pro- 
gram within  its  own  membership  or  could 
be  the  sparkplug  in  the  formation  of  state 
and  county  health  councils  and  delegate  to 
them  the  duty  of  coordinating  the  health 
programs  of  all  the  organizations  which 
have  signified  an  interest  in  the  health  field 
in  Colorado.  There  are  many  such  organiza- 
tions, including  many  societies  for  the  con- 
trol of  various  diseases,  such  as  cancer,  tu- 


berculosis, polio,  etc.,  as  well  as  the  major 
farm  organizations  which  have  a definite 
health  program.  Each  should  be  represented 
on  the  council.  Many  state  extension  serv- 
ices have  an  individual  on  their  staff  whose 
duty  is  the  organization  and  development  of 
health  councils  and  programs  for  the  bene- 
fit of  the  rural  people.  Colorado’s  health 
program  would  be  greatly  improved  by  the 
employment  of  such  a qualified  person. 

As  a means  of  emphasis  let  me  summa- 
rize the  principal  points  given  in  the  rural 
health  program.  Two  conditions  were 
mentioned  focusing  attention  on  the  rural 
health  problem  and  precipitating  the  for- 
mation of  the  A.M.A.’s  Committee  on  Rural 
Health.  Some  of  the  activities  of  this  com- 
mittee were  followed  briefly,  which  devel- 
oped favorable  friendships  with  the  prin- 
cipal farm  organizations.  The  responsibility 
for  Colorado’s  rural  health  program  has 
been  placed  on  the  active  interest  of  three 
groups:  1,  the  citizens  of  the  community  to 
be  served;  2,  the  medical  profession;  and 
3,  the  Medical  School.  An  attempt  has  been 
made  to  show  how  each  may  contribute  to 
the  success  of  an  overall  health  program. 
The  role  of  coordinator  has  been  assigned 
to  the  Extension  Service  of  the  Colorado 
A.  & M.  College  and  the  recommendation 
made  that  a specially  trained  person  be  in- 
cluded on  its  staff  for  the  purpose  of  or- 
ganizing and  promoting  health  councils  and 
programs  in  the  state. 

In  conclusion,  let  me  repeat  that  because 
of  the  broad  and  varied  aspects  of  the  prob- 
lem, the  rural  health  program  cannot  be 
considered  as  a short  term  plan  of  proce- 
dure. Many  new  projects  have  been  started 
during  the  past  few  years  which  in  time 
will  have  a beneficial  effect  on  the  health 
of  people  living  in  rural  areas.  These  proj- 
ects should  be  continued  and  improved,  as 
well  as  others  started,  until  everything  has 
been  done  to  bring  the  best  possible  condi- 
tion of  health  to  our  neighbors  and  friends, 
the  rural  people. 

No  subject  is  more  intimately  connected  with 
the  happiness  and  prosperity  of  a people  than  the 
degree  of  public  health  that  they  enjoy. — Lemuel 
Shattuck,  Chairman  of  the  Massachusetts  Sani- 
tary Commission,  1851. 


for  August,  1949 


641 


PSYCHOSOMATIC  ASPECTS  OF  GASTRO-INTESTINAL  DISORDERS* 

CLARKE  H.  BARNACLE,  M.D. 

DENVER 


In  recent  years,  particularly  with  World 
War  II,  there  has  been  increased  emphasis 
on  personality  and  emotional  factors  in  the 
production  of  gastro-intestinal  illnesses. 
Psychosomatic  medicine  is  not  new,  but 
merely  a re-emphasized  approach,  consider- 
ing the  “person”  in  the  patient,  as  well  as 
the  clinical  entity.  Consideration , of  the 
psychosomatic  aspects  of  gastro-intestinal 
disorders  is  a problem  of  great  magnitude, 
and  necessarily  one  can  only  hope  to  touch 
upon  certain  generalities  in  a single  presen- 
tation. 

It  is  axiomatic  that  the  abdomen  is  one 
of  the  main  “sounding-boards”  of  emotions, 
giving  off  physiological  reactions  to  per- 
sonality maladjustments  when  the  person  is 
subjected  to  insecurity,  discontent,  conflicts, 
anxiety  and  fears.  You  are  all  aware  of 
laymen’s  expressions  that  typify  the  emo- 
tional causation  of  physical  sensations  and 
symptoms,  many  of  which  apply  to  the 
gastro-intestinal  tract — “nauseating  experi- 
ence,” “it  turns  my  stomach,”  “a  lump  in  my 
throat,”  etc.  Perhaps  you  can  recall  per- 
sonal experiences  of  anorexia,  gas,  diarrhea 
or  constipation  in  direct  relation  to  medical 
school  examinations,  or  to  anticipation  of 
athletic  events.  Children  are  apt  to  reflect 
disgust  toward  unpleasant  situations  with 
nausea  and  vomiting  at  times. 

In  World  War  II,  the  gastro-intestinal 
disorders  constituted  the  most  important 
medical  problem  to  the  British  Army;  dys- 
pepsia and  peptic  ulcer  were  most  frequent 
entities.  There  was  a marked  increase  in 
gastro-intestinal  complaints  of  the  populace 
during  the  German  “blitz”  of  London  in 
1940.  Functional  gastro-intestinal  symp- 
toms constituted  one  of  the  main  causes  of 
rejection  of  draft  selectees  in  the  United 
States  Armed  Forces.  The  commonest  ill- 
ness of  American  soldiers  during  the  war 
was  homesickness,  and  its  chief  physiolog- 
ical manifestations  were  “butterflies  in  the 
stomach,”  gas,  heartburn,  “tightness  in  the 

*Read  before  the  Montana  State  Medical  Associa- 
tion, Billings,  Montana,  June  19,  1948. 


pit  of  the  stomach,”  constipation  and  diar- 
rhea. Homesickness  occurred  most  fre- 
quently in  the  training  centers  and  overseas 
stations';  often  the  army  food  was  given 
credit  for  the  disturbance.  With  further  ex- 
perience, the  Medical  Corps  was  able  to 
recognize  and  treat  homesickness  and  its 
physical  complaints  successfully  through  a 
more  total  understanding  of  the  individual 
soldier,  broader  planning  and  utilization  of 
the  social  and  recreational  facihties  that 
were  available. 

In  Billings’  study  of  approximately  2,000 
unselected  medical  cases  at  Colorado  Gen- 
eral Hospital,  the  majority  of  adult  cases 
had  complaints  referable  to  the  abdomen, 
and  of  these  one-third  presented  symptoms 
and  signs  referable  to  the  gastro-intestinal 
tract. 

Most  gastroenterologists  agree  that  at 
least  one-half  of  their  patients  fall  into  the 
functional  group.  Perhaps  it  would  be  bet- 
ter to  divide  the  psychosomatic  gastro-in- 
testinal disorders  into  two  large  classes:  1. 
Patients  reacting  to  emotional  and  environ- 
mental stress  with  gastro-intestinal  com- 
plaints without  changes  of  organ  structure. 
2.  Patients  with  pathological  structural  and 
functional  changes  in  which  emotional  re- 
actions to  environmental  stresses  play  an 
important  role;  for  example,  peptic  ulcer 
and  ulcerative  colitis. 

The  Role  of  Emotions  in  Gastro-intestinal 
Disorders 

Anxiety  and  tension  result  from  person- 
ality maladjustments,  and  may  lead  to  phy- 
siological expressions  of  this  emotionally, 
made  possible  by  the  hypothalamic  inte- 
gration of  higher  functions  with  the  auto- 
nomic nervous  system  and  the  hormonal 
regulation  of  the  abdominal  organs.  Any 
system  of  organs,  especially  hollow  or 
tubular  ones,  of  which  the  musculature, 
secretory  functions  and  blood  vessels  are 
predominantly  controlled  by  the  autonomic 
nervous  system,  is  inclined  to  participate 
in  emotional  reactions,  giving  rise  to  clinical 


642 


Rocky  Mountain  Medical  Journal 


signs  and  symptoms.  The  stomach,  the  small 
and  large  bowel,  and  the  gallbladder  ac- 
count for  most  abdominal  stress  and  func- 
tional gastro-intestinal  disorders.  The 
threshold  of  awareness  or  sensitivity  to 
pain  and  other  sensations  is  lowered  in 
many  patients  with  emotional  disturbances; 
for  example,  anxiety  states,  agitated  de- 
pressions, and  hypochondriasis. 

The  experimental  work  of  Cushing  and 
his  associates  indicated  that  peptic  ulcers 
could  be  induced  in  animals  by  small  in- 
traventricular injections  of  pilocarpine.  In- 
jections of  the  same  drug  in  man  resulted 
in  hypermotility,  hypertonus,  and  increased 
gastric  secretions,  which  led  to  vomiting 
that  ultimately  contained  occult  blood. 
Other  workers  have  produced  gastric  and 
duodenal  ulceration  in  laboratory  animals 
by  means  of  artificial  hypothalamic  damage. 

Wolff,  et.  ah,  in  studies  of  a patient  with 
gastric  fistula,  observed  that  emotions  of 
anxiety  and  hostility  induced  hypermotility, 
hyperemia,  and  small  areas  of  hemorrhage 
in  the  gastric  mucosa.  They  demonstrated 
that  these  hemorrhagic  areas  ulcerate  read- 
ily if  exposed  to  gastric  secretions.  Their 
observations  indicate  that  “many  peptic  ul- 
cer patients  show  an  exaggeratedly  aggres- 
sive, ambitious,  independent  attitude.” 

The  observations  of  Spencer  and  his  as- 
sociates indicate  that  perforation  and  hem- 
orrhage from  gastro-intestinal  ulceration 
increased  significantly  during  the  London 
air  “blitz,”  emphasizing  the  important  role 
of  emotional  stress  in  the  development  of 
ulceration  in  the  bowel.  There  is  sufficient 
evidence  today  to  indicate  that  autonomic 
dysfunction,  whether  organically  or  emo- 
tionally induced,  can  produce  definite  al- 
teration in  the  function  and  structure  of  the 
gastro-intestinal  system.  There  is  evidence 
that  repressed  hostility  and  anxiety  are 
emotions  productive  of  such  changes,  and 
these  characteristics  are  most  consistently 
found  in  patients  suffering  from  gastro- 
intestinal disorders.  We  know  that  the  re- 
lief of  such  emotional  states  favorably  in- 
fluences the  course  of  peptic  ulcer  and  re- 
lieves symptoms  in  non-ulcer  gastro-intes- 
tinal cases. 


About  40  per  cent  of  the  patients  who 
present  themselves  with  stomach  complaints 
have  neither  hyperacidity  nor  hypoacidity; 
they  have  very  slight  changes  indeed,  hard- 
ly enough  deviation  from  the  normal  to 
enable  you  to  say  that  any  unusual  stimuli 
are  coming  from  that  organ,  and  yet  they 
will  complain  of  distention,  gas,  or  flatu- 
lence. Obviously  they  are  overreacting  to 
minor  changes  in  that  organ. 

Psychoanalytic  Interpretations:  Franz  Al- 
exander and  his  co-workers  in  Chicago 
made  the  following  observations  in  a re- 
search problem  applied  to  patients  re- 
ferred by  the  Gastroenterology  Department 
of  the  University  of  Chicago.  Certain  well 
authenticated  cases  of  gastric  disorder,  par- 
ticularly ulcer,  diarrhea,  and  constipation, 
were  referred  for  psychonalytic  study  and 
treatment. 

“Some  of  the  cases  were  given  psycho- 
analytic treatment  but  a larger  number  re- 
ceived only  psychoanalytic  study.  Early  in 
their  study  these  workers  were  impressed 
with  the  constancy  and  similarity  between 
the  nature  of  the  psychological  conflict  and 
the  type  of  gastro-intestinal  disorder.  It 
was  possible  to  describe  the  patient’s  emo- 
tional trend  in  terms  of  the  three  elemental 
tendencies  applicable  to  both  the  psycholog- 
ical conflict  and  the  gastro-intestinal  symp- 
toms of,  first,  the  wish  to  receive  or  take 
as  related  to  stomach  disorders;  second,  the 
wish  to  give  or  eliminate  as  applying  to  the 
diarrhea  cases;  and  third,  the  wish  to  re- 
tain as  applied  to  the  constipation  cases. 

“Gastric  Disturbances:  In  the  psycho- 
biological  development  of  the  infant,  it  is 
apparent  that  his  first  interest  and  aim  in 
life  is  concerned  with  the  taking  in  oi 
nourishment.  The  infantile  wish  to  re- 
ceive, to  be  taken  care  of,  to  be  loved,  to 
depend  upon  someone  else,  is  most  ideally 
gratified  in  the  parasitic  situation  of  the 
sucking  infant.  Thus,  these  emotional 
qualities  of  receptivity — the  wish  to  be 
loved  and  taken  care  of — become  closely  as- 
sociated in  an  early  period  of  life  with  the 
physiologic  functions  of  nutrition.  Being 
fed  is  thus  equivalent  to  being  loved.  The 
character  attributes  of  the  adult  individuals 


for  August,  1949 


643 


with  gastric  disorder  were  found  to  be  am- 
bition and  aggressiveness,  and  such  per- 
sons often  had  effected  considerable  ac- 
complishment. They  consistently  displayed 
a striving  to  be  independent,  active,  and 
efficient.  An  investigation  of  the  uncon- 
scious desires  of  these  individuals,  how- 
ever, showed  without  doubt  that  this 
marked  desire  for  independence,  ambition, 
great  self-assertiveness  was  an  over-com- 
pensation. That  is,  the  individual  had  to 
lean  over  backwards  consciously,  to  com- 
pletely repress  or  deny  his  unconscious 
wish  to  be  dependent,  to  be  loved,  to  be 
fed.  This  mechanism  of  over-compensation 
can  be  seen  in  many  instances  in  life  when 
the  individual  must  consciously  stress  one 
point  of  view  or  desire,  to  neutralize  an 
unconscious  opposite  point  of  view  or  de- 
sire. Such  reversals  are  frequently  seen  in 
the  personalities  of  individuals  with  psy- 
choses, who  in  their  normal  life  are  exceed- 
ingly thoughtful,  kind,  pleasant  and  clean, 
but  in  their  psychoses  are  extremely  im- 
polite, hostile,  dirty.  In  the  individuals 
with  gastric  neuroses  it  was  thus  apparent 
that  this  unconscious  desire  to  be  loved 
and  to  be  dependent  was  in  the  primitive 
mind  directly  associated  with  the  child’s 
first  form  of  love,  namely  food  and  nourish- 
ment. The  gastric  symptoms  are  thus  pre- 
sumably caused  through  these  unconscious 
tendencies  which  serve  as  chronic  psychic 
stimuli  of  the  stomach,  independent  of  the 
process  of  nutrition.  Consequently,  a peptic 
ulcer  per  se  has  no  psychological  signifi- 
cance, representing  only  the  end  results.  On 
the  other  hand,  the  chronic  hypersecretion 
and  hypermotility  which  may  lead  to  the 
ulcer  are  produced  by  the  continuous  un- 
conscious desire  to  be  fed. 

“Colitis  Studies;  In  the  group  of  cases 
showing  diarrhea  studied  at  the  Institute 
for  Psychoanalysis,  the  general  conscious 
attitude  expressed  by  these  individuals  was 
verbalized  about  as  follows:  T have  the 
right  to  take  and  demand  because  I give 
sufficiently.  I do  not  need  to  feel  inferior 
or  guilty  on  account  of  my  receptive  and 
grasping  wishes  because  I am  giving  some- 
thing in  exchange  for  them.’  In  this  con- 


scious attitude  there  is  apparent  again  the 
parallelism  between  the  nature  of  the  dis- 
order, namely,  diarrhea  and  the  person’s 
attitude  toward  life,  particularly  as  it  is 
reflected  in  his  relations  with  other  people, 
in  that  the  diarrhea  was  found  to  be  a 
substitute  for  giving  something  of  real 
value,  for  making  real  efforts,  and  being 
actually  active.  It  was  also  found  to  be  a 
method  that  the  individual  could  use  to 
express  hate.  This  hate  or  aggressiveness 
was  mentioned  above  as  being  recognized 
even  by  the  layman  as  exemplified  in  the 
colloquial  expressions,  using  the  vulgar 
terms  for  feces.  In  the  individual  with 
colitis  it  was  thus  found  that  the  content  of 
the  unconscious  psychic  stimuli  which 
caused  the  dysfunction  were  in  some  in- 
stances giving  as  a method  of  restitution 
for  taking  or  receiving,  and  in  other  in- 
stances, aggressive  elimination. 

“Constipation  Studies:  In  the  cases  stud- 
ied with  constipation,  the  individual’s  emo- 
tional attitude  to  his  environment  could 
again  be  expressed  in  terms  that  applied 
equally  well  to  his  psychological  problem — 
namely  to  retain  or  to  hold  on.  The  con- 
scious attitude  as  discovered  in  these  in- 
dividuals included  a pessimism  towards  re- 
ceiving help  from  others  or  depending  upon 
them.  They  seemingly  do  not  except  any- 
thing from  anyone  in  contrast  to  the  op- 
timistic attitude  of  the  gastric  type.  At  the 
same  time,  however,  there  is  a more  or  less 
conscious,  very  extreme  sense  of  obligation 
to  give,  of  which  the  patient  tries  to  rid 
himself  by  renouncing  all  conscious  ten- 
dencies to  receive.  Thus  the  conscious  at- 
titude is  summarized  as,  T do  not  take  or 
receive  and  therefore  I do  not  need  to 
give.’  ” 

The  unconscious  dynamic  background  of 
the  symptom  seems  to  be  based  on  the  re- 
jection of  the  obligation  to  give  on  account 
of  a fear  of  loss,  but  on  the  other  hand,  if 
he  is  forced  to  give,  his  gifts  are  of  no 
value.  The  result  of  these  two  stimuli  serve 
as  a chronic  inhibition  of  the  intestinal 
peristalsis  and  result  in  the  constipation. 

In  all  these  types  of  cases — namely,  the 
gastric,  the  colitis,  and  the  constipation — 


644 


Rocky  Mountain  Medical  Journal 


these  research  workers  have  not  claimed 
any  finality  about  their  findings.  They  be- 
lieve that  the  dynamic  relation  of  the  in- 
dividual to  his  environment  cannot  neces- 
sarily be  reduced  to  these  three  groups  of 
alimentary  tendencies.  Their  findings,  how- 
ever, are  highly  significant  in  showing  the 
specificity  of  the  unconscious  demands  of 
the  individual  and  the  very  likely  possibil- 
ity that  the  gastro-intestinal  tract  is  af- 
fected by  these  chronic  stimuli.  They  stress 
the  fact  that  an  adequate  knowledge  of  the 
causative  factors,  namely,  the  unconscious 
desires,  can  be  obtained  only  during  psy- 
choanalytic treatment  of  patients  and  by 
no  other  method.  Furthermore,  the  pa- 
tient’s .immediate  life  situation  has  usually 
only  a precipitating  influence  on  the  dis- 
turbance, and  his  conscious  attitude  plays 
a subordinate  role  in  the  causation  of  the 
symptom.  From  their  study  it  is  the  re- 
pressed tendencies,  the  unconscious  desires, 
that  serve  as  a constant  stimulation  and 
thus  cause  chronic  dysfunction  of  the  or- 
gans. 

Psychobiologic  Viewpoint:  The  apparent 
specificity  of  personal  conflicts  as  brought 
out  by  the  psychoanalytic  studies  is  not 
necessarily  agreed  upon  by  all  psychia- 
trists. Billings’  study  of  gastro-intestinal 
disorders  indicates: 

“The  average  age  at  which  patients  of 
this  group  began  to  experience  difficulties 
was  27.6  years,  the  women  having  their 
first  difficulties  at  26.9  years  and  the  men 
about  three  years  later  (at  29.9  years).  An- 
alysis of  the  records  shows  that  manifesta- 
tion of  tension  and  strain  began  after  about 
three  to  four  years  of  obligation  to  assume 
and  maintain  as  well  as  possible  the  re- 
sponsibilities of  mature  life,  such  as  mar- 
riage, the  bearing  and  supporting  of  chil- 
dren, a more  critical  view  of  the  future 
and  the  handling  of  personal  conflicts  re- 
sulting from  discrepancies  between  ambi- 
tions and  actual  capacity.  The  onset  of 
symptoms  sufficient  to  make  the  patient 
realize  that  he  was  ill — that  is,  the  time 
that  physiological  repercussions  became  dis- 
turbing— usually  followed  some  occurrence 
or  combination  of  circumstances  acting  as 

for  August,  1949 


a precipitating  factor.  In  order  of  fre- 
quency, the  precipitating  factors  were  a 
sudden  increase  in  strain  and  tension,  such 
as  could  be  produced  by  irregularity  in 
work  or  promotion  (in  58  per  cent  of  cases) , 
a specific  emotion  such  as  apprehension, 
fear,  bereavement,  or  anger  (in  48  per 
cent),  medical  statements  incriminating 
some  innocent  organ  or  a diversity  in  med- 
ical opinion,  usually  the  result  of  incom- 
plete examinations  and  failure  to  consider 
the  patient  as  a person  (in  39  per  cent)  and 
marital  problems  leading  to  conflict  (in  34 
per  cent).” 

Study  of  the  individual  as  a total  in- 
tegrated personality,  including  past  life  ex- 
perience and  developmental  childhood  his- 
tory, frequently  reveals  sufficient  evidence 
to  explain  gastro-intestinal  symptoms. 
Treatment  of  the  individual  person  in  his 
life  situation  leads  to  amelioration  of  symp- 
toms in  many  instances  without  formal 
psychoanalysis. 

The  Organic  Approach 

The  usual  medical  approach  to  gastro- 
intestinal disorders  is  the  traditional  one 
that  seeks  out  diseased  organs  or  systems 
of  organs  to  account  for  physiological  symp- 
toms. The  physician  proceeds  with  history- 
taking, observation,  physical  examination, 
and  laboratory  work.  Unless  he  has  an  in- 
terest in  psychosomatic  medicine  or  is  a 
general  practitioner  who  is  aware  of  the 
many  personality  factors,  his  study  of  the 
case  ends  there.  The  “person”  with  the 
complaints,  the  human  being  reacting  to 
stresses  and  strains  of  life  is  apt  to  be  dis- 
regarded in  the  clinical  evaluation. 

It  must  be  emphasized  that  functional 
illnesses  are  due  to  personality  disorders 
and  not  the  result  of  physical  diseases.  The 
physician  may  admit  the  “nervous”  ele- 
ment in  the  case,  and  yet  ignore  it  or  con- 
sider it  secondary  or  a consequence  of  the 
physical  ailment.  If  the  patient  is  “sensi- 
tive” or  apt  to  be  antagonized  by  questions 
about  his  personality  adjustment,  the  phy- 
sician may  simply  follow  the  traditional 
line  of  physical  and  laboratory  investiga- 
tion, avoiding  the  psychological  features 
of  the  illness.  When  the  patient  does  recog- 

645 


nize  and  accept  the  psychological  basis  of 
his  complaints  and  asks  for  treatment  of 
his  nervous  disorder,  many  physicians  do 
not  know  exactly  what  to  do,  or  say,  be- 
cause of  lack  of  training  in  psychological 
medicine.  Emotional  bias  and  inexperience 
may  also  lead  to  a purely  organic  approach. 

Complete  physical  and  neurological  ex- 
amination, together  with  indicated  labora- 
tory studies,  are  essential  to  good  medicine, 
but  the  physician  inadvertently  convinces 
the  patient  of  the  organic  nature  of  his  ill- 
ness if  he  over-emphasizes  laboratory  pro- 
cedures. Over-reliance  by  the  doctor  on 
laboratory  studies  leads  to  a false  sense  of 
scientific  accuracy  and  greater  neglect  of 
the  psychological  factors  that  may  be  truly 
responsible  for  the  illness.  The  relative 
importance  of  psychological  and  physical 
factors  in  disease  may  not  be  carefully 
evaluated.  Too  often  the  attitude  of 
“either,  or”  is  assumed  in  dealing  with  ill- 
ness; that  it  is  either  physical  or  mental — 
instead  of,  how  much  of  the  clinical  picture 
is  a result  of  physical  pathology  and  how 
much  is  on  a psychological  basis? 

The  Psychosomatic  Approach 

The  physician  who  considers  the  individ- 
ual as  well  as  his  physical  complaints  and 
symptoms  is  approaching  the  clinical  prob- 
lem from  a psychosomatic  standpoint.  A 
careful  history  and  physical  examination  is 
a prelude  to  this  approach. 

The  physician-patient  relationship  is  of 
utmost  importance  in  diagnosis  as  well  as 
treatment,  and  I believe  most  doctors  are 
aware  that  treatment  begins  with  the  first 
office  interview  or  contact  in  the  home  or 
hospital.  The  fact  that  the  patient  has 
chosen  you  rather  than  another  doctor  is 
significant.  The  first  words  you  have  with 
the  patient  may  determine  just  what  sort 
of  relationship  is  going  to  develop  between 
you  and  him.  Certain  individuals  respond 
to  a physician’s  authoritative  approach, 
while  others  come  to  a doctor  because  they 
want  understanding  and  sincerity.  They 
have  problems  they  want  to  discuss  with 
somebody.  When  the  individual  has  con- 
sulted a physician,  an  inter-personal  rela- 
tionship is  established,  i.e.,  a relationship 


to  authority,  a relationship  to  a person  who 
knows  about  medical  matters,  who  has  cer- 
tain therapeutic  abilities  and  also  certain 
magical  powers. 

The  physician’s  attitude  should  be  one  of 
encouragement  and  understanding.  The  pa- 
tient is  made  to  feel  at  ease  when  he  finds 
the  doctor  is  sincere  and  has  his  best  inter- 
ests at  heart.  A simple  statement  of  this  na- 
ture may  be  the  beginning  of  successful 
treatment:  “You  know,  your  case  interests 
me;  why  don’t  you  tell  me  more  about  it?” 
The  patient  is  encouraged  to  give  his  own 
story  of  his  complaints  without  fear  or 
trepidation,  and  it  might  be  well  to  note  the 
manner  in  which  he  expresses  himself — 
with  clarity  and  precision,  or  with  vague- 
ness and  many  adjectives  of  a superlative 
nature.  In  any  event,  allow  him  to  tell  his 
story,  let  him  feel  at  ease  and  unhurried. 
The  key  to  history-taking  is  in  the  develop- 
ment of  the  original  complaints,  with  a his- 
tory of  past  illnesses,  the  individual’s  pat- 
tern of  reaction  to  stress  and  strain  in  the 
past.  The  life  setting  of  the  individual  is 
important — one  usually  would  want  to 
know,  in  the  face  of  gastro-intestinal  symp- 
toms, if  the  patient  enjoys  his  work,  is  re- 
laxed in  his  employer-employee  relation- 
ship, happy  in  his  home  life,  and  not  unduly 
preoccupied  with  family  and  personal  wor- 
ries. An  inquiry  about  his  habits  of  rest, 
relaxation,  hobbies,  and  diversions  may  be 
helpful.  Any  attempt  to  know  the  patient 
more  as  a person  may  throw  light  upon 
the  etiological  factors.  Questions  concern- 
ing what  makes  symptoms  increase  and  de- 
crease give  clues  to  the  clinical  picture. 
Frequently  the  patient’s  own  conception  of 
his  illness  is  of  great  importance.  The  phy- 
sician might  ask,  “Now,  you  have  had  these 
symptoms  for  a time,  what  is  your  own  idea 
of  what  is  causing  them?”  The  patient  will 
often  tell  you  of  fears  that  he  entertains  and 
of  preconceived  notions  which  may  serious- 
ly influence  diagnosis  and  treatment. 

In  the  event  the  emotional  disturbances 
are  etiological  in  the  gastro-intestinal  dis- 
order, the  doctor  should  give  the  patient  an 
opportunity  to  unburden  himself  and  re- 
lease his  emotional  load.  Symptoms  are 


646 


Rocky  Mountain  Medical  Jouknal 


then  diminished  because  the  force  back  of 
them  is  gone.  If  you  give  a patient  a chance 
to  unload  repressed  anxiety  and  fear,  he  is 
better  able  to  cope  with  irritating  life  situ- 
ations. Technics  of  suggestion  and  persua- 
sion may  be  indicated.  The  physician  may 
assume  many  roles — that  of  a listener,  a 
mere  sounding-board;  a target  for  the  pa- 
tient’s pent-up  emotions;  a comforter,  in- 
dicating cause  and  effect  relationships; 
orienter,  to  problems  that  have  been  mis- 
interpreted; desensitizer,  to  lessen  feelings 


of  guilt  and  anxiety;  negotiator;  manager; 
and  re-educator. 

In  the  event  the  physician  feels  unquali- 
fied to  handle  the  psychiatric  aspects  pre- 
sented in  gastro-intestinal  disorders,  it 
might  be  well  to  refer  the  case  to  a trained 
psychiatrist  for  consultation.  We  in  psy- 
chiatry believe  that  the  average  general 
practitioner  should  be  as  capable  in  caring 
for  minor  psychiatry  as  he  is  in  caring  for 
minor  surgery. 


GENERAL  PRINCIPLES  IN  THE  TREATMENT  OF  SUPERFICIAL 

CARCINOMA* 

WENDELL  P.  STAMPFLI,  M.D. 

DENVER 


Carcinoma  of  the  skin  is,  without  dispute, 
the  most  common  form  of  cancer.  This  in- 
cidence is  not  apparent  in  mortality  sta- 
tistics since  cancer  of  the  skin  has  the  best 
prognosis  of  all  the  malignant  growths 
which  affect  man.  The  high  rate  of  cur- 
ability is  the  result  of  a high  rate  of  ac- 
cessibility. If  cancer  of  the  gastro-intes- 
tinal tract  were  as  easily  detected  and  were 
as  accessible  for  treatment  as  cancer  of  the 
skin,  its  rate  of  cure  might  be  as  high.  De- 
spite early  accurate  diagnosis  and  accessi- 
bility, not  all  of  these  tumors  are  being 
handled  properly. 

This  article  presents  nothing  new  or 
original.  It  is  merely  a review  of  established 
principles  in  the  management  of  a few 
neoplasms  that  affect  the  skin. 

Epitheliomas 

Epitheliomas  constitute  the  great  major- 
ity of  superficial  malignancies.  These  may 
be  of  a basal  cell  or  squamous  cell  type; 
some  are  mixed.  They  may  be  treated  by 
a number  of  different  methods,  but  better 
results  will  be  obtained  by  the  doctor  who 
has  a knowledge  of  the  factors  affecting 
choice  of  treatment.  There  are  no  hard  and 
fast  rules. 

The  first  objective  is  the  complete  de- 
struction or  elimination  of  every  malignant 
cell.  No  method  of  treatment,  regardless 

•Prom  the  Department  of  Radiology,  St.  Luke’s 
Hospital,  Denver. 


of  what  else  it  offers,  should  ever  be  used 
if  chance  of  cure  must  be  sacrificed.  The 
next  objective  is  good  function  and  the  last 
is  satisfactory  appearance.  These  objectives 
can  be  accomplished  best  with  surgery  or 
by  radiation,  the  choice  depending  upon 
location  and  size  of  the  growth.  Carcinomas 
of  the  face,  including  those  of  the  eyelid, 
the  nose,  and  the  lip,  can  be  controlled  as 
well  by  adequate  excision  as  they  can  by 
intensive  radiation.  It  is  significant,  how- 
ever, that  properly  administered  radiation 
will  produce  equally  good  functional  results 
and,  in  most  cases,  better  cosmetic  results. 
Carcinomas  of  the  hands  and  feet  should  be 
treated  by  excision.  On  the  dorsa  of  the 
hands  and  feet,  superficial  structures  such 
as  tendons  and  nerves,  might  be  damaged 
if  enough  radiation  is  administered  to  de- 
stroy the  cancer.  Radiation  scars  do  not 
wear  well  on  the  soles  of  the  feet  and  on 
the  palms. 

Epitheliomas  can  be  diagnosed  in  the  ma- 
jority of  cases  by  inspection  and  palpation. 
Biopsy  should  always  precede  treatment, 
however,  regardless  of  whether  surgery  or 
radiation  is  planned.  The  danger  of  spread- 
ing small  epitheliomas  of  the  skin  by  biopsy 
has  been  grossly  exaggerated.  The  specimen 
should  be  removed  from  the  clean  border 
of  the  ulcer  and  should  be  deep.  Adjacent 
normal  skin  should  be  included. 


for  August,  1949 


647 


Failures  following  the  treatment  of 
epitheliomas  are  not  usually  due  to  errors 
in  choice  of  treatment  but  are  the  result  of 
errors  in  execution  of  the  treatment  chosen. 
There  is  no  place  in  the  therapeutics  of 
cancer  for  conservatism.  Conservatism  is 
the  principal  cause  for  failures.  The  sur- 
geon who  does  not  excise  wide  enough  or 
deep  enough  is  just  as  blamable  as  the  ra- 
diotherapist or  dermatologist  who  adminis- 
ters radiation  in  “homeopathic”  doses.  The 
most  significant  error  being  made  today  in 
the  radiotherapy  of  epitheliomas  is  under- 
treatment. A great  deal  more  sadness  fol- 
lows under-treatment  of  these  tumors  than 
over-treatment.  There  are  surgeons  who 
consider  the  radiotherapist  a competitor  in 
the  treatment  of  cancer  and  they  sometimes 
criticize,  pointing  out  that  radiologists  treat 
too  intensively,  producing  unpleasant  reac- 
tions. Such  criticism  might  be  destructive 
since  unpleasant  reactions  are  often  neces- 
sary in  the  course  of  adequate  therapy  for 
deep  seated  disease.  More  constructive 
criticism  would  aim  at  the  fact  that  too 
many  physicians  who  use  x-ray  equipment 
do  not  treat  cancer  intensively  enough.  A 
method  that  cannot  be  too  thoroughly  con- 
demned is  the  common  practice  of  ad- 
ministering x-rays  in  weekly  small  doses  by 
the  “watch  and  wait”  method. 

If  a chance  to  cure  a particular  cancer 
exists  at  all,  it  is  when  we  first  see  it.  We 
have  seen  the  results  of  an  inadequate  first 
attempt  by  surgery  or  by  radiation.  We 
know  that  residual  or  recurrent  cancer  is 
more  resistant  to  all  forms  of  treatment 
than  was  the  original  growth.  An  inade- 
quate attempt  with  radiant  energy  produces 
changes  in  the  cancer  cells  as  well  as  in  the 
cancer  bed.  The  cancer  cells  become  more 
radio-resistant  so  that  excessive  doses  may 
be  required  for  their  control.  Such  doses 
are  seldom  indicated  because  the  already 
damaged  tumor  bed  might  not  itself  re- 
cover. Wide  excision  should  almost  always 
be  used  when  epitheliomas  survive  a first 
attempt  with  radiation.  Many  epitheliomas 
that  recur  following  surgery  may  be  con- 
trolled by  intensive  radiation  or  by  more 
radical  surgery. 


Some  surgeons  prefer  to  excise  skin  can- 
cer and  then  refer  the  patient  to  a radiolo- 
gist for  “so-called”  prophylactic  radiation. 
Such  practice  is  unsound.  It  has  never  been 
shown  that  residual  cancer  cells  following 
a poor  surgical  attack  are  any  more  radio- 
sensitive than  the  original  growth.  After 
the  tumor  bed  has  been  disturbed  by  the 
scalpel,  it  seems  more  logical  to  assume  that 
residual  cancer  would  be  more  radio-re- 
sistant. When  a surgeon  feels  that  he  can- 
not assume  complete  responsibility  for  ex- 
cision of  ordinary  skin  cancer,  it  is  time 
that  he  referred  original  growths,  not  resid- 
ual growths,  for  intensive  judicious  radio- 
therapy. Most  radiotherapists  would  rather 
treat  skin  cancer  before,  not  after,  it  has 
been  partially  excised. 

Melanomas  and  Melanocarciomas 

Benign  melanomas  of  the  skin  are  com- 
mon. They  seldom  give  trouble  and  should 
be  left  alone  unless  subject  to  chronic  irri- 
tation. Malignant  melanomas  develop,  as 
a rule,  in  pre-existing  benign  melanomas 
and  the  signs  of  malignant  change  are  in- 
crease in  size  and  pigmentation.  Induration 
or  ulceration  might  follow.  When  malig- 
nant degeneration  is  suspected,  the  tumor 
should  be  widely  excised.  Biopsy  should  not 
be  done.  The  danger  of  insufficient  radia- 
tion, cautery,  or  dessication  cannot  be  too 
strongly  emphasized.  The  best  treatment  is 
local  removal  plus  block  dissection  of  the 
regional  lymph  nodes. 

Carcinoma  of  the  Lip 

The  lower  lip  is  most  often  affected  since 
it  is  the  one  most  frequently  exposed  to  the 
actinic  rays  of  the  sun.  Location  of  the 
growth  is  not  usually  a factor  influencing 
the  choice  of  treatment.  Carcinomas  of  the 
lip  can  be  controlled  surgically  by  wide  ex- 
cision or  radiologically  by  massive  doses. 
The  application  of  roentgen  rays  or  radium 
must  again  be  such  that  sufficient  radiant 
energy  be  absorbed  to  destroy  the  tumor 
completely.  Such  doses,  when  properly 
administered,  will  leave  a minimal  residual 
defect. 

The  management  of  cervical  lymphatics 
constitutes  an  important  part  of  the  treat- 
ment of  carcinoma  of  the  lip.  If  no  firm 


648 


Rocky  Mountain  Medical  Journal 


nodes  are  palpable  at  the  time  the  primary 
growth  is  being  treated,  the  neck  should  be 
left  alone.  The  patient  should  be  seen  at 
regular  intervals  and  examined  for  residual, 
recurrent,  or  metastatic  cancer.  If  a node 
becomes  suspicious,  prompt  excision  is  best, 
or  a block  dissection  of  the  neck  is  in  order, 
depending  upon  the  discretion  of  the  sur- 
geon. When  the  node  is  not  detected  before 
it  becomes  deeply  fixed  and  inoperable,  ra- 
dium implantation  plus  external  radiation 
might  be  the  treatment  of  choice.  External 
radiation  alone  is  generally  inadequate  to 
control  carcinomatous  metastases  from  the 
lip. 

Some  textbooks  and  many  radiologists  ad- 
vocate prophylactic  radiation  of  the  neck 
following  treatment  of  primary  growths  on 
the  lip.  Doses  large  enough  to  sterilize 
metastatic  nodes  would  be  dangerous  if  ap- 
plied to  the  entire  neck.  Such  exposures  are 
never  indicated  as  a routine  prophylactic 
measure.  Smaller  safer  doses  are  not  car- 
cinocidal. 


Another  argument  against  any  kind  of 
prophylactic  treatment  to  the  cervical 
lymphatics  is  the  fact  that  only  10  per  cent 
of  curable  cancers  of  the  lip  metastasize  to 
the  neck.  If  routine  prophylactic  proce- 
dures are  used,  they  would  be  used  need- 
lessly in  about  90  per  cent  of  the  cases.  The 
mortality  rate  following  block  neck  dissec- 
tions is  still  relatively  high  and  should  be 
considered  before  such  treatment  is  ad- 
vocated. 

Conclusion 

The  physician  who  undertakes  the  treat- 
ment of  curable  cancer  is  assuming  a heavy 
responsibility.  Not  only  the  well-being  of 
the  patient,  but  also  the  very  life  of  that 
patient,  depends  upon  his  skill.  Such  re- 
sponsibility should  encourage  surgeons  and 
radiotherapists  to  obtain  as  much  knowl- 
edge as  possible  concerning  the  factors  in- 
fluencing the  choice  of  treatment.  More 
important  than  that,  however,  is  developed 
skill  in  the  execution  of  the  treatment 
chosen. 


BIPRO\  EMENT  IN  PATIENTS’  GENERAL  CONDITION  AFTER 
APPLICATION  OF  SKIN  TEST  FOR  BRUCELLOSIS 

AN  AID  IN  ESTABLISHING  THE  DIAGNOSIS  OF  BRUCELLOSIS 

MAX  L.  WEIKER,  M.D. 

BOULDER,  COLORADO 


The  definite  diagnosis  or  exclusion  of  a 
mild  infection  with  brucellosis  is  at  times 
very  difficult,  even  after  evaluating  the 
clinical  symptoms,  agglutination  test,  skin 
test  and  opsonocytophagic  test,  in  the  pres- 
ence of  a negative  blood  culture.  In  a num- 
ber of  these  cases,  marked  clinical  improve- 
ment or  even  disappearance  of  symptoms 
occurs  following  the  application  of  the  in- 
tradermal  test  and  thus  helps  in  establish- 
ing the  diagnosis  of  brucellosis. 

If  the  intradermal  test  is  being  done  ac- 
cording to  the  recommendation  of  H.  J. 
Harris,*  200,000,000  heat-killed  organisms 
are  being  injected.  On  the  other  hand,  Har- 

*Harris, Harold  J.:  The  Journal  of  the  American 
Medical  Association,  Vol.  131,  pp.  1485-1493,  August 
31,  1946. 


ris’  treatment  schedule  begins  with  the  in- 
tramuscular injection  of  0.1  c.c.  of  the 
1:1000  or  even  1:10,000  dilution  of  the  vac- 
cine, introducing  200,000  or  20,000  heat- 
killed  germs  respectively,  or  in  other  words, 
1/1000  or  1/10,000  the  amount  that  is  being 
used  for  the  intradermal  test.  Hence,  strik- 
ing improvement  in  clinical  symptoms  fol- 
lowing the  introduction  of  such  a compara- 
tively large  amount  of  heat-killed  germs  in 
the  intradermal  test  is  not  astonishing. 

A number  of  my  patients  required  no  fur- 
ther treatment  following  the  intradermal 
test.  This  is  in  accordance  with  the  obser- 
vations of  Dr.  Harris,  who  writes,  “Intra- 
dermal  administration  of  vaccine  may  stim- 
ulate the  development  of  opsonins  and  clin- 
ical response  more  rapidly  than  that  by 


for  August,  1949 


649 


other  routes  in  some  instances.  Occasion- 
ally one  sees  rapid  clinical  and  serologic 
improvement  following  the  initial  intra- 
dermal  test  dose  of  vaccine  which  is  so  sat- 
isfactory as  to  preclude  the  necessity  for 
therapeutic  doses  of  vaccine.  Routine  use 
of  the  intradermal  route  therapeutically  has 
not  seemed  of  value.” 

Summary 

It  is  often  difficult  to  establish  definitely 


or  rule  out  the  diagnosis  of  an  active  bru- 
cella abortus  infection.  In  some  of  these 
patients,  decided  improvement  or  even  dis- 
appearance of  clinical  symptoms  occurs  aft- 
er the  intradermal  test,  thus  confirming  the 
diagnosis  of  brucellosis  and  in  some  cases 
even  rendering  further  treatment  unneces- 
sary, at  least  for  the  time  being. 


COLORADO  PREMATURE  INFANT  CARE  PROGRAM* 

HARRY  H.  GORDON,  M.D.,  and  JOHN  A.  LICHTY,  M.D. 

DENVER 


It  is  the  purpose  of  this  paper  to  present 
briefly  some  of  our  experiences  during  the 
first  year  of  operation  of  the  Colorado  Pre- 
mature Infant  Program.  Since  this  project 
is  the  joint  responsibility  of  a state  health 
department  and  a state  university,  and  since 
it  receives  support  from  the  U.  S.  Children’s 
Bureau,  its  aims  are  broader  than  the  giving 
of  specialized  care  to  a limited  number  of 
infants  at  the  University  of  Colorado  Med- 
ical Center.  Equal  emphasis  has  been 
placed  on  the  prevention  of  prematurity, 
the  obstetrical  problems  of  premature  labor, 
and  on  the  follw-up  home  care  of  these 
small  infants.  Attempts  have  been  made 
to  coordinate  the  efforts  of  doctors,  nurses, 
social  workers,  nutritionists,  and  public  and 
private  agencies.  Furthermore,  the  stimu- 
lation of  research,  statistical,  clinical  and 
laboratory,  and  the  teaching  of  personnel 
constitute  important  facets  of  the  plan. 

Efforts  to  decrease  the  mortality  of  pre- 
maturely born  infants  depend  on  accurate 
knowledge  of  the  incidence  of  prematurity 
and  on  its  geographical,  racial  and  socio- 
economic distribution  in  the  state.  Recent 
adoption  by  the  Health  Department  of  a 
birth  certificate  which  requires  recording 
the  birth  weight  of  every  infant  will  per- 
mit intelligent  planning  for  the  develop- 


♦Presented  before  Health  Officers  and  Maternal 
and  Child  Health  Sections,  November  10,  1948,  at  the 
American  Public  Health  Association  Annual  Meeting-, 
Boston,  1948.  Prom  the  Department  of  Pediatrics, 
University  of  Colorado  Medical  Center,  and  the  Colo- 
rado State  Department  of  Public  Health.  The  author 
is  Assistant  Professor  of  Pediatrics  and  Pediatric 
Consultant  to  Colorado  State  Health  Department. 


ment  of  additional  facilities,  training  of  per- 
sonnel, and  consultation  services. 

Mention  has  already  been  made  of  the 
emphasis  placed  on  prevention  of  prema- 
turity. Although  much  remains  to  be 
learned  concerning  causes  of  premature  la- 
bor, few  will  deny  the  inverse  relationship 
between  the  amount  of  prenatal  care  and 
the  incidence  of  prematurity.  In  the 
antenatal  clinics  of  the  University  Hospital, 
which  serves  as  a teaching  unit  for  nurses 
and  physicians,  both  graduate  and  under- 
graduate, there  is  a careful  appraisal  of  all 
prospective  mothers  with  special  attention 
to  those  mothers  whose  problems  might 
contribute  to  premature  birth.  An  analysis 
of  birth  weights  at  the  Denver  and  Colo- 
rado General  Hospitals,  the  city  and  state 
hospitals  for  which  the  University  profes- 
sional staff  is  responsible,  showed  that  in- 
fants weighing  between  1,000  and  2,500 
grams  comprised  22  per  cent  and  13  per 
cent,  respectively,  of  the  total  births.  Cus- 
tomary figures  for  incidence  are  given  as 
5 per  cent  to  7 per  cent.  This  simple  com- 
parison points  to  one  of  our  most  impor- 
tant problems,  the  determination  of  the 
cause  or  causes — dietary,  racial,  social  or 
medical — for  this  higher  incidence  in  the 
hospital  whose  patients  have  the  lower  av- 
erage income. 

That  the  proper  management  of  prema- 
ture labor  is  of  paramount  importance  in 
reducing  premature  infant  mortality  should 
be  evident  from  the  long-known  fact  that 


650 


Rocky  Mountain  Medical  Journal 


the  majority  of  these  deaths  takes  place 
during  the  first  twenty-four  to  forty-eight 
hours.  Consideration  of  this  aspect  of  the 
problem  has  led  to  the  adoption  of  conser- 
vative policies  such  as  the  extension  of 
intrauterine  life  as  long  as  possible  and  the 
strict  elimination  of  any  form  of  general- 
ized anesthesia  or  analgesia  during  prema- 
ture labor.  Although  other  factors  may 
have  contributed,  it  is  felt  that  this  regime 
is  largely  responsible  for  the  low  neonatal 
death  rate  (9.2  per  cent)  for  1,000-2,500 
gram  infants  at  the  University  of  Colorado 
Medical  Center  during  the  two  years  end- 
ing July  1,  1948. 

The  premature  infant  nurseries  have  ac- 
commodations for  eighteen  infants.  There 
are  four  units:  1.  an  admission  nursery  of 
two  bassinettes  for  observation  of  infants 
born  outside  the  hospital;  2.  a clean  nursery 
of  eight  bassinettes  for  infants  transferred 
from  the  observation  nursery  or  directly 
from  the  delivery  room;  3.  a “graduate” 
nursery  for  care  of  six  infants  being  pre- 
pared for  discharge  from  the  hospital,  and 
4.  a “suspect”  nursery  for  infants  suspected 
of  infectious  disease.  Any  infant  with  a 
definite  infection  can  be  transferred  to  the 
pediatric  service.  Infants  born  in  the  Colo- 
rado General  Hospital,  whose  birth  weights 
are  above  four  and  one-half  pounds,  who 
are  vigorous  enough  to  nurse,  and  whose 
homes  have  been  reported  satisfactory  by 
the  public  health  nurse,  may  be  kept  in  the 
full  term  nursery  until  sent  home  with  their 
mothers.  The  distribution  of  the  incubators 
and  bassinettes  in  several  small  units  has 
provided  great  flexibility  and  protection 
against  infection. 

The  organization  of  the  nursing  service 
for  both  the  full  term  and  premature  nur- 
series under  a single  instructor-supervisor 
has  increased  the  pool  of  specially  trained 
“clean”  nurses  whose  services  can  be  as- 
signed as  needed  to  the  respective  nurseries. 
At  present,  an  average  of  four  hours  of 
nursing  care  is  provided  for  each  baby 
during  the  twenty-four  hours.  A committee 
has  been  formed  to  organize  a study  of  the 
actual  minutes  of  highly  specialized  care 


which  infants  of  different  ages  and  birth 
weights  require. 

The  medical  care  of  the  infants  is  super- 
vised by  full  time  members  of  the  Depart- 
ment of  Pediatrics.  The  pediatric  resident 
assigned  to  the  nurseries  is  responsible  for 
no  other  patients  than  these  infants.  There 
has  been  a liberal  use  of  antibiotics  and 
sulfadiazine  in  suspected  infections,  and  of 
the  laboratory  for  aid  in  diagnosis. 

Because  of  the  demonstrated  advantages 
of  a feeding  mixture  of  partially  skimmed 
cow’s  milk  re-enforced  with  carbohydrate 
for  smaller  premature  infants,  this  has  been 
used  routinely  for  those  infants  who  are 
unable  to  nurse  from  their  mothers.  Table 
1 shows  the  estimated  reduction  of  hospital 
days  which  might  be  expected  if  120  cal/kg 
of  this  mixture,  instead  of  human  milk, 
were  fed  daily  to  a premature  infant  weigh- 
ing 1,500  grams  at  birth  and  2,500  grams  at 
discharge.  This  reduction  in  hospital  days 
saves  money,  nursing  care  and  bed  space. 

To'  insure  adequate  follow-up  care  for 
these  infants  after  they  are  discharged  from 

TABLE  1 

Possible  Reduction  of  Infant’s  Hospitalization  by 
Feeding  One-Half  Skimmed  Milk 

Wt.  (Kg.)  Birth  1.5;  Disch.  2.5;  Av.  2.0 
Total  gain — 1000  gm. 

Av.  gain/day  (calculated) 

a.  Va  skimmed  milk (15.7*x2)  31.4  gms. 

b.  human  milk  (12.5*x2)  25.0  gms. 

Hospital  days 

a.  1000--31.4=32 

b.  1000^25.0=40 

*Av.  wt.  g-ain/Kg./day  when  fed  120  cal. /Kg. 

the  premature  nursery,  the  Maternal  and 
Child  Health  Section  of  the  State  Health 
Department  has  made  its  staff  of  public 
health  nurses  and  medical  social  workers 
readily  available  to  assist  local  physicians 
and  parents  in  providing  the  best  possible 
home  care  for  the  baby  and  its  mother.  The 
importance  of  having  accurate  first  hand 
information  regarding  the  home  environ- 

TABLE  2 

Average  Period  of  Hospitalization  for  Survivors 

Colorado  series  24  days 

New  York  City  EMIC  34  days 

Average  wt.  at  discharge  (Colo.)  ....5  lbs.  10  oz. 

Minimum  wt.  at  discharge  4 lbs.  14  oz. 

Maximum  wt.  at  discharge  7 lbs.  14  oz. 


for  August,  1949 


651 


ment  of  each  infant  cannot  be  overempha- 
sized. This  has  permitted  discharging  the 
patients  from  the  premature  center  on  an 
individualized  basis  in  contrast  to  keeping 
all  babies  until  a certain  body  weight  is 
attained.  Table  2 shows  the  average  pe- 
rio'd  of  hospitalization  to  be  twenty-four 
days  (for  survivors  only)  during  the  past 
nine  month  period.  This  is  about  75  per 
cent  of  the  figure  reported  by  Wallace  and 
Baumgartner  for  E.M.I.C.  in  New  York  City. 
The  average  weight  at  discharge  was  five 
pounds  ten  ounces  with  a minimum  of  four 
pounds  fourteen  ounces  and  a maximum  of 
seven  pounds  fourteen  ounces.  In  most 
instances,  small  babies  have  been  per- 
mitted to  go  home  only  when  conditions 
were  known  to  be  satisfactory  and  the 
mother  wished  to  nurse  the  infant.  This 
policy  seems  to  be  satisfactory  as  judged  by 
follow-up  reports  from  visiting  nurses  and 
by  the  appearance  of  the  infants  when  seen 
at  a special  follow-up  clinic. 

The  follow-up  clinic  has  been  designed  to 
give  intensive  supervision  for  the  first  six 
months  to  premature  infants  who  are  not 
under  the  care  of  a private  physician.  Al- 
though longer  follow-up  is  desirable  for  all 
infants,  limited  space  and  personnel  made 
it  desirable  to  concentrate  on  the  first  six 
months  after  discharge  from  the  hospital. 
By  keeping  the  ratio  of  patients  to  profes- 
sional personnel  relatively  low,  a more  in- 
dividualized type  of  care  can  be  given.  This 
seemed  particularly  desirable  in  the  light 
of  the  increased  anxiety  that  surrounds  the 
birth  of  most  premature  infants. 

Any  baby  weighing  less  than  five  and  one- 
half  pounds  at  birth  is  eligible  for  care  at 
the  Medical  Center  provided  he  is  referred 
by  a physician,  public  health  nurse,  or  some 
appropriate  agency.  As  the  year  progressed 
there  was  a definite  reduction  in  size  of  the 
infants  receiving  this  care  (Table  3).  This 
is  due  to  the  greater  number  of  “outside” 
babies  admiitted  for  treatment  during  the 
second  six  months  of  operation.  The  pro- 
gram is  designed  to  give  care  especially  to 
those  infants  for  whom  it  might  not  other- 
wise be  available.  The  State  Health  Depart- 
ment pays  the  Medical  Center  on  a fixed 


Fig'.  1.  Distribution  of  Colorado  State  Health  De- 
partment incubators  for  premature  infants.  No- 
vember, 1948. 

per  diem  rate,  which  represents  about  one- 
third  the  estimated  cost  of  care.  There  is 
no  charge  to  the  family,  but  those  who  are 
able  to  afford  this  care  are  permitted  to  re- 
imburse the  State  Health  Department  in 
whole  or  in  part. 

Since  the  capacity  of  the  nursery  is  lim- 
ited, the  State  Health  Department  has  dis- 
tributed eighteen  portable  incubators 
throughout  the  state  so  that  premature  in- 
fants may  be  more  properly  cared  for  near- 
er their  place  of  birth  (Fig.  1).  Ambulance 
service  is  available  for  any  infant  born  with- 
in a thirty-five  mile  radius  of  the  Medical 
Center,  but  babies  can  only  be  accepted 
from  areas  outside  this  zone  if  transporta- 
tion is  approved  by  a physician  and  can  be 
arranged  locally.  It  is  anticipated  that  the 
special  educational  program  for  physicians 
and  nurses  will  result  in  the  formation  of 
several  premature  infant  centers  through- 
out the  state  where  babies  will  have  the 
advantage  of  adequate  facilities  and  trained 
personnel.  This  will  bring  the  benefits  of 
Colorado’s  program  to  premature  infants 
born  in  rural  as  well  as  urban  areas. 

TABLE  3 

Change  in  Distribution  of  Admission  Weights 


Birth  Wt. 

July ’47  — 

Jan. ’48;  Jan.*  — i 

1-2  lbs.  ... 

..  1 (2.5%) 

1 (1%) 

2-3  lbs.  ... 

..  1 (2.5%) 

10  (11%) 

17.5% 

3-4  lbs.  ... 

..  6 (15%) 

22  (25%) 

4-5  lbs.  ... 

.15  (38%) 

33  (38%) 

5-5.5  lbs.  . 

.16  (41%) 

22  (25%) 

Total  

.39-100% 

88-100% 

"Premature  Nursery  opened  to  infants  born  out- 
side the  Medical  Center. 


652 


Rocky  Mountain  Medical  Journal 


'^Severe  intractable  asthma 


I 


requires  more  strenuous  measures. . . . Aminophyllin  in 
doses  of  0.25  Gm.  dissolved  in  10  cc.  of  water  is 
often  very  effective  when  injected  intravenously." ^ 


To  relax  spasm,  relieve  congestion  and  re- 
store deep,  regular  breathing. 


SEARLE 


❖ 


SEARLE 

RESEARCH  IN  THE  SERVICE  OF  MEDICINE 


ORAL . . . 
PARENTERAL . . 
RECTAL 

DOSAGE  FORMS 


has  proved  a valuable  drug — generally 
effective  even  in  epinephrine-refractory  cases. 

Searle  Aminophyllin  is  indicated  in  parox- 
ysmal dyspnea,  bronchial  asthma,  Cheyne- 
Stokes  respiration  and  selected  cardiac  cases. 

G.  D.  Searle  & Co.,  Chicago  80,  Illinois 


^Searle  Aminophyllin  contains  at  least  80%  of  anhydrous 
theophylline. 


1,  Rackemann,  F.  M.,  in  Cecil,  R.  L: 
Textbook  of  Medicine,  ed.  7,  Phil- 
adelphia, W.  B.  Saunders  Com- 
pany, 1 948,  p.  539. 


for  August,  1949 


653 


Organization 

National  Affairs  - Proceedings  - Programs  - Society  Notices  - News  - Auxiliary 


COLORADO 

State  Medical  Society 


OfficiJ  CJi 

To  the  Ofiicers,  Delegates,  Committeemen  and  Mem- 
bers oi  the  Colorado  State  Medical  Society — Greet- 
ings: 

The  Seventy-ninth  Annual  Session  of  The 
Colorado  State  Medical  Society  will  be  held  at 
the  Hotel  Shirley-Savoy,  Denver,  Colorado,  Tues- 
day to  Friday,  inclusive,  September  20,  21,  22 
and  23,  1949. 

The  Board  of  Trustees  will  convene  at  9 a.m., 
the  House  of  Delegates  at  10:00  a.m.,  and  the 
Board  of  Councilors  at  2:00  p.m.,  Tuesday,  Sep- 
tember 20,  and  each  subsequently  as  by  them 
ordered. 

The  General  Scientific  Assembly  will  convene 
at  10:30  a.m.,  Wednesday,  September  21,  and 
subsequently  according  to  the  Program  of  the 
Committee  on  Scientific  Work. 

C.^.SPER  F.  Hegner, 
President. 

Attest: 

Harvey  T.  Sethman. 

Executive  Secretary, 

Denver,  Colorado, 

July  27,  1949. 


SPORTS  TOURNAMENTS 

As  at  most  previous  Annual  Sessions  in  recent 
years,  the  first  afternoon  (Tuesday,  September 
20)  will  be  largely  given  over  to  sports  tourna- 
ments. The  Annual  Golf  Tournament,  with  at- 
tractive cups  familiar  to  players  in  previous 
years,  will  be  played  over  the  Cherry  Hills 
Country  Club  course,  one  of  the  finest  in  the 
country.  It  is  being  managed  by  a committee 
composed  of  Drs.  J.  L.  Swigert,  Chairman;  Byron 
I.  Dumm,  and  Samuel  B.  Childs.  The  Bowling 
Tournament  this  year  is  again  returned  to  the 
capable  management  of  Dr.  Cyrus  W.  Anderson, 
who  will  have  a committee  assisting  him.  A 
Skeet  and  Trap  Tournament  will  be  chairmanned 
by  Dr.  George  'P.  Lingenfelter,  aided  by  Dr. 
Harold  Van  der  Schouw. 

Complete  details  about  these  tournaments  will 
be  available  in  the  final  pamphlet  program,  to  be 
mailed  to  all  members  about  September  1.  In 
the  meantime  all  interested  should  bring  with 
them  their  golf  clubs,  their  favorite  bowling 
balls  and  shoes,  or  their  favorite  scatter  gun,  as 
the  case  may  be. 


TELEVISION  AT  THE  ANNUAL  SESSION 
First  Full-Color  Video  in  the  West  to  Fea- 
ture Meeting  at  Shirley-Savoy  in 
September 

Full-color  television,  the  truly  miraculous  mod- 
ern development  which  some  day  will  revolu- 
tionize all  teaching  and  all  entertainment,  will 
come  to  Denver  September  21,  22,  and  23  at  the 
Colorado  State  Medical  Society  Annual  session 
in  the  Shirley-Savoy  Hotel,  Denver. 

Technicians  of  the  American  Telephone  and 
Telegraph  Company,  the  Columbia  Broadcasting 
System  and  Smith,  Kline  and  French  Laboratories 
will  arrive  in  Denver  in  early  August  to  complete 
the  manifold  engineering  and  electrical  arrange- 
ments whereby  this  great  feature  will  be  staged 
for  all  who  attend  the  session  six  weeks  later. 

Television,  the  ordinary  black-and-white  va- 
riety, is  well  known  to  most  large  cities  in  the 
cormtry,  but  has  not  yet  been  established  in 
Denver  or  any  other  Colorado  city.  Full-color 
television  has  been  seen  so  far  by  only  a few 
thousand  persons  in  the  country,  most  of  them 
physicians  who  witnessed  the  remarkable  dem- 
onstrations at  the  June,  1949,  meeting  of  the 
American  Medical  Association  in  Atlantic  City, 
and  one  or  more  specialty  meetings  in  the  East. 
The  television  demonstrations  of  operations, 
clinics,  etc.,  in  Denver  should  attract  the  largest 
attendance  in  the  Society’s  history. 

Complete  details  of  the  television  feature  of 
the  meeting  must  await  decisions  to  be  made 
this  month  by  the  engineers  and  technicians, 
who  will  select  one  or  more  Denver  hospitals 
as  the  telecasting  point  or  points,  their  selection 
depending  upon  unimpeded  “line  of  sight”  dis- 
tance from  the  roof  of  the  Shirley-Savoy  Hotel 
and  other  electrical  engineering  factors,  since 
this  will  be  but  a temporary  installation,  as 
distinguished  from  a permanent  video  broad- 
casting station,  which  could  utilize  a tall  trans- 
mitting tower. 

The  color  television  equipment  was  specially 
built  for  demonstration  purposes  by  the  Colum- 
bia Broadcasting  Company,  the  A.  T.  & T.,  and 
their  manufacturing  subsidiaries,  and  is  owned 
by  the  Smith,  Kline  and  French  Laboratories  of 
Philadelphia.  Smith,  Kline  and  French  is  bring- 
ing the  demonstration  to  the  Colorado  meeting 
without  charge  to  the  State  Society,  although 
the  demonstration  will  cost  many  thousands  of 
dollars,  as  a gesture  of  goodwill  advertising. 
Later  in  the  year  similar  demonstrations  will  be 
arranged  for  several  other  state  medical  societies. 


654 


Rocky  Mountain  Medical  Journal 


Alhydrox 

Builds  solid  immunity  step  by  step 

Like  Mr.  McGinty’s  brick  wall  which  stands 
solidly  against  the  ravages  of  time  because  he 
builds  it  carefully,  solidly,  brick  upon  brick,  the 
immunity  you  build  with  CUTTER  "ALHYDROX” 
vaccine  is  solid. 


"Alhydrox”  is  a CUTTER  exc/nsiue—developed  and 
used  exclusively  by  CUTTER  for  its  vaccines  and 
toxoids.  It  supplements  the  physician’s  skill  by 
producing  these  immunizing  advantages: 

1.  "Alhydrox”  adsorbed  antigens  are  released  slowly  from  tis- 
sue, giving  the  effect  of  small  repeated  doses. 

2.  "Alhydrox”,  because  of  its  more  favorable  pH,  lessens  pain 
on  injection  and  reduces  side  reactions  to  a minimum. 

3.  "Alhydrox”  selectivity  controls  the  absorption  of  antigens, 
reducing  dosage  volume  while  building  a high  antibody  con- 
centration. Reduced  volume  means  less  tissue  distention  and 
less  pain. 


*Cutter  trade  name  for  aluminum  hydroxide  adsorbed  products.  CUTTER  LABORATORIES  • BERKELEY  10,  CALIF. 


Specify  "Alhydrox”  when  you  order  vaccines 

AN  EXCLUSIVE  WITH. 


OrnsR 


for  August,  1949 


655 


CONDENSED  SCHEDULE  OF  EVENTS 
(See  General  Progrram  on  Following  Pages  for 
Details) 

MONDAY,  SEPTEMBER  19 

All  Day — Installation  of  Exhibits. 

2:00  P.M. — Advance  Registration. 

TUESDAY,  SEPTEMBER  20 

All  Day — Exhibits  Open.  (Members  not  taking 
part  in  the  sports  events  are  urged  to 
utilize  this  afternoon  for  study  of  ex- 
hibits in  case  they  will  be  too  busy  on 
later  days  to  do  so.) 

All  Day — College  of  Chest  Physicians. 

9:00  A.M. — Board  of  Trustees. 

10:00  A.M. — House  of  Delegates. 

1:00  P.M. — Golf  Tournament. 

2:00  P.M. — Board  of  Councilors. 

6:00  P.M. — Sportsmen’s  Dinner  and  Smoker. 

WEDNESDAY,  SEPTEMBER  21 
All  Day — Exhibits  Open. 

8:15-10:15— Full  Color  Television. 

10:15-10:30 — Intermission  to  View  Exhibits. 
10:30-12:15 — Scientific  Assembly. 

1:00-  3:00 — Full  Color  Television. 

3:00-  3:15 — Intermission  to  View  Exhibits. 

3:15-  5:00 — Scientific  Assembly. 

5:00  P.M. — House  of  Delegates. 

Evening — Nothing  scheduled;  open  for  private 
parties. 

THURSDAY,  SEPTEMBER  22 

All  Day — Exhibits  Open. 

8:15-10:15 — Full  Color  Television. 

8:30  A.M. — House  of  Delegates. 

10:15-10:30 — Intermission  to  View  Exhibits. 
10:30-12:30 — Scientific  Assembly. 

1:00-  3:00 — Full  Color  Television. 

3:00-  3:15 — Intermission  to  View  Exhibits. 

3:15-  5:15 — Scientific  Assembly. 

Evening — Nothing  scheduled;  open  for  private 
parties. 

FRIDAY,  SEPTEMBER  23 

All  Day — Exhibits  Open. 

8:15-10:45 — Full  Color  Television. 

8:30 — House  of  Delegates. 

11:00 — Scientific  Assembly. 

2:00-  4:00 — Scientific  Assembly  in  Sectional 
Meetings.  (See  general  program  for  time, 
place  and  speakers  at  sectional  meetings.) 

4:15 — ^General  Scientific  Assem.bly. 

7:00 — Annual  Banquet. 

9:00 — Annual  Dance. 


GENERAL  PROGRAM 

Seventy-ninth  Annual  Session  of  the  Colorado 
State  Medical  Society,  Shirley-Savoy  Hotel, 
Denver,  Colo.,  Sept.  20,  21,  22,  23,  1949 

TUESDAY,  SEPTEMBER  20,  1949 

MORNING 

9:00-12:00 — All  Exhibits  Open. 

10:00 — House  of  Delegates.  First  Meeting. 

If  necessary  to  complete  the  usual  first  meet- 
ing's work,  the  House  may  recess  for  the  lunch 
hour  and  reconvene  in  the  afternoon. 

10:00 — Rocky  Mountain  Chapter,  American 
College  of  Chest  Physicians.  (See 
separate  program.) 

AFTERNOON 

1:00 — Sports  Events.  Annual  Golf  Tourna- 
ment, Cherry  Hills  Country  Club. 
Annual  Bowling  Tournament,  place 
to  be  announced  in  final  program. 
Annual  Trap  and  Sheet  Tournament, 
place  to  be  announced  in  final  pro- 
gram. 

2:00 — Board  of  Councilors,  Annual  Meeting. 
2:00-4:00 — All  Exhibits  Open. 

EVENING 

6:00 — Sportmen’s  Dinner  and  Smoker 
(not  limited  to  those  who  took  part 
in  the  tournaments).  Awarding  of 
sports  trophies.  (Place  to  be  an- 
nounced.) 

WEDNESDAY,  SEPTEMBER  21,  1949 
MORNING 

8:00 — All  Exhibits  Open. 

8:15-10:15 — Full  Color  Television. 

Direct,  full-color  television  of  medical  and  sur- 
gical procedures,  telecast  from  one  or  more 
Denver  hospitals  to  special  receivers  in  the 
Shirley-Savoy  Hotel,  through  cooperation  of 
Smith,  Kline  and  French  Laboratories.  {See 
special  announcement  preceding  this  program.) 

10:15-10:30 — Intermission  to  View  Exhibits. 

GENERAL  SCIENTIFIC  ASSEMBLY 
10:30 — Opening  Exercises  and  Call  to  Order 
by  Casper  F.  Hegner,  M.D.,  Denver, 
President. 

John  A.  Weaver,  M.D.,  Greeley, 
Chairman. 

Robert  C.  Lewis,  Jr.,  M.D.,  Aspen, 
Co-Chairman. 

10:30 — “Early  Ambulation;  Its  Application 
and  Results  in  a Community  Hos- 
pital.”— Robert  M.  Lee,  M.D.,  Fort 
Collins,  Colorado. 

In  spite  of  voluminous  literature  advocating 
early  ambulation  after  surgery,  there  is  some 
reluctance  by  surgeons  to  apply  it  to  their  own 
patients.  A study  is  made  of  case  records  from 
two  surgical  services  having  opposing  views  on 
the  proper  time  for  postoperative  ambulation. 
The  findings  indicate  that  both  principals  have 
value,  some  of  them  unexpected. 

Rocky  Mountain  Medical  Journal 


656 


CHECK  LIST 


for  choice  of 
a laxative 


Phospho-  type  of 
ACTION 


^ JFrompt  action 
Thorough  action 
k/  Gentle  action 


SIDE 

EFFECTS 

1/  Free  from 

Mucosal  Irritation 

Absence  of  Con- 
stipation Rebound 

No  Development 
of  Tolerance 

Safe  from  Excessive 
Dehydration 

No  Disturbonce  of 
Absorption  of 
Nutritive  Elements 

Causes  no 
Pelvic  Congestion 

^ No  Patient 
Discomfort 

I/'  Nonhabituating 

Free  from 

Cumulative  Effects 


ADMINIS' 

TRATION 

Flexible  Dosage 
Uniform  Potency 
Pleasant  Taste 


through  controlled  action 


Phospho-Soda  (Fleet)^  over  the  years, 
has  won  discriminating  preference 
by  thousands  of  physicians  . . . 
because  of  its  controlled  oction  — 
its  freedom  from  undesirable  side 
effeet^ond  its  ease  of  administration. 
Your  prescription  of  Phospho-Sodo 
(Fleet)*  assures  effective  (and  safe) 
results.  Liberal  samples  on  request. 

e.  B.  FLEET  CO.  INC. 

LYNCHBURG,  VIRGINtA 

'PHOSPHO-SODA'  and  'FLEET' 

ore  registered  trade-marks  of  C.  B.  fleet  Co.,  Inc. 


PHO$PHO-SODA 

(FLEET)* 

I Phospho-Soda  (Fleet)*  is  a solution 

* containing  in  each  100  cc.  sodium 

biphosphate  48  Gm.  and  sodium  phosphate  18  Gm. 


ACCEPTED  FOR  ADVERTISING  BY  THE  JOURNAL  OF  THE  AMERICAN  MEDICAL  ASSOCIATION 


for  August,  1949 


657 


10:45 — “Surgical  Treatment  of  Carcinoma 
of  the  Tongue.”  — Mason  Morfit, 
M.D.,  Denver,  Colorado. 

10:55 — “Injury  Mechanism  and  Operative 
Treatment  of  Fractures  of  the  Os 
Calcis.” — James  E.  Pollard,  M.D., 
Pueblo,  Colorado. 

A presentation  is  given  o[  the  injury  pathology 

_ o/  os  calcis  fractures  and  a method  of  open 

reduction  using  iliac  hone  grafts  to  rectify  the 
damage  sustained. 

11:10 — “The  Management  of  Tumors  of  the 
Parotid  Gland.” — H.  Calvin  Fisher, 
M.D.,  Denver,  Colorado. 

11:25 — “Recent  Advances  in  Our  Knowledge 
of  the  Etiology  and  Treatment  of 
Uvietis.” — Phillips  Thygeson,  M.D., 
San  Jose,  California  (Guest). 

Almost  invariably  the  general  medical  man  is 
being  called  upon  for  aid  in  determining  the 
etiology  of  uvietis  and  advice  in  its  treatment. 
"While  recent  advancements  have  not  been  star- 
tling, definite  progress  is  being  made.  In  this 
discussion  various  etiological  factors  will  be 
considered  and  treatment  and  prognosis  out- 
lined. 

12:15 — Recess  for  Luncheon. 

AFTERNOON 

1:00-3:00 — Full  Color  Television.  (See  an- 
nouncement in  Wednesday  morn- 
ing’s program.) 

3:00-3:15 — Intermission  to  View  Exhibits. 

GENERAL  SCIENTIFIC  ASSEMBLY 

Carl  S.  Gydesen,  M.D.,  Colorado  Springs, 
Chairman. 

John  C.  Lundgren,  M.D.,  Julesburg, 
Co-Chairman. 

3:15 — “Factors  to  Be  Considered  in  the  Eti- 
ology and  Aggravation  of  Diabetes 
Mellitus.”— A.  J.  Kauvar,  M.D., 
Denver,  and  Martin  G.  Goldner, 
M.D.,  Fort  Logan. 

A review  will  be  given  of  the  role  which  hered- 
ity, obesity,  degenerative  diseases,  psychos- 
matic  factors,  excessive  carbohydrate  intake, 
e.xtra  pancreatic  endocrine  disturbances,  stress 
and  trauma  play  in  the  precipitation  of  aggra- 
vation of  the  disease  diabetes  mellitus.  A criti- 
cal evaluation  of  these  factors  will  enable  the 
practitioner  to  better  care  for  patients  with  dia- 
betes and  its  complications. 

3:30 — “A  Follow-Up  Study  of  Cardiac  Le- 
sions in  a Mass  X-Ray  Survey.” — 
Wesley  Van  Camp,  M.D.,  Pueblo, 
and  Doris  Rowe,  M.D.,  Pueblo. 

The  statistical  reports  of  many  mass  .x-ray  sur- 
veys have  listed  the  number  or  percentage  of 
abnormal  cardiac  findings,  but  apparently  no 
follow-up  studies  have  been  made  of  these  cases. 
Miniature  {70mm. ) x-ray  films  were  made  of 
over  4,000  patients  at  the  Colorado  State  Hos- 
pital in  July,  1947.  One  hundred  five  of  this 
group  were  reported  to  have  abnormal  cardiac 
findings.  These  patients  were  examined  in  the 


Cardiac  Clinic,  had  electro-cardiograms,  and 
large  (14x17)  chest  films  made.  The  great 
majority  of  these  patients  were  found  not  only 
to  have  “heart  trouble"  bat  to  be  in  need  of 
some  type  of  cardiac  treatment.  These  surveys 
should  be  utilized  more  in  the  detection  of 
heart  disease,  as  well  as  pulmonary  lesions,  in 
both  civilian  and  hospital  populations. 

3:45 — “The  Allergic  Problem  of  Our  Nose 
and  Sinuses.” — Kemp  G.  Cooper, 
M.D.,  Denver,  Colorado. 

The  necessity  of  distinguishing  nasal  allergies 
from  sinus  infections  and  the  clinical  methods 
used  are  discussed.  Skin  testing  and  patho- 
logical slides  will  be  shown  and  the  treatment 
of  each  condition  will  be  presented. 

4:00 — “The  Effects  of  Carbon  Dioxide  on 
the  Brain.” — Ralph  M.  Stuck,  M.D., 
Denver,  Colorado. 

This  discussion  will  include  the  effects  of  car- 
bon dioxide,  both  acute  and  chronic,  upon  the 
brain.  Such  problems  as  asphyxia  neonatorum, 
carbon  dioxide  inhalations  for  stimulation  of 
respiration  postoperatively  following  cranial 
surgery,  and  carbon  dioxide  accumulation  in 
anesthesia.  The  effects  of  anesthesia  on  intra- 
cranial pressure  and  brain  function  preoper- 
atively,  operatively  and  postoperatively,  and 
the  pathology  of  chronic  asphyxia  will  be  out- 
lined. The  conclusion  shall  incude  advice  re- 
garding the  use  of  carbon  dioxide  in  dealing 
with  the  central  nervous  system. 

4:15 — “Office  Management  of  the  More 
Common  Foot  Problems  of  Chil- 
dren.”— Edward  L.  Compere,  M.D., 
Chicago,  Illinois  (Guest). 

5:00 — House  of  Delegates.  Second  Meeting. 

EVENING 

Open  for  Private  Arrangements. 

THURSDAY,  SEPTEMBER  22,  1949 

MORNING 

8:00 — All  Exhibits  Open. 

8:15-10:15 — Full  Color  Television.  (See  an- 
nouncement in  Wednesday  morn- 
ing’s program.) 

8:30 — House  of  Delegates.  Third  Meeting. 

10:15-10:30 — Intermission  to  View  Exhibits. 

GENERAL  SCIENTIFIC  ASSEMBLY 
George  E.  Garrison,  M.D.,  Fort  Collins, 

Chairman. 

Charles  W.  Vickers,  M.D.,  Del  Norte, 
Co-Chairman. 

10:30 — “Management  and  Treatment  of  In- 
cipient Tuberculosis.” 

Introduction. — John  I.  Zarit,  M.D., 
Denver,  Chairman,  Tuberculosis 
Control  Committee. 
Roentgenologist’s  Viewpoint. — John 
McGraw,  M.D.,  Pueblo. 

Viewpoint  of  the  Sanatorium  Physi- 
cian.— Harold  M.  Van  der  Schouw, 
M.D.,  Wheatridge. 


658 


Rocky  Mountain  Medical  Journal 


c>yyvp 

for  POSTOPERATIVE 
and  POSTPARTUM 

NEEDS 

Basic  design  and  theunique  sys- 
tem of  adjustment  make  a large 
variety  of  Camp  Scientific  Sup- 
ports especially  useful  as  post- 
operative aids.  Surgeons  and 
physicians  often  prescribe  them 
as  assurance  garments  and  con- 
sider them  essential  after  op- 
eration upon  obese  persons, 
after  repair  of  large  herniae,  or 
when  wounds  are  draining  or 
suppurating.  A Camp  Scientif- 
ic Support  is  especially  useful  in 
the  postoperative  patient  with 
undue  relaxation  of  the  abdom- 
inal wall.  Obstetricians  have 
long  prescribed  Camp  Post- 
operative Supports  for  post- 
partum use.  Physicians  and 
surgeons  may  rely  on  the  Camp- 
trained  fitter  for  precise  execu- 
tion of  all  instructions. 

If  you  do  not  have  a copy  of  the 
Camp  “Reference  Book  for  Phy- 
sicians and  Surgeons”,  it  will 
be  sent  on  request. 


THIS  EMBLEM  is  displayed  only  by  reli- 
able merchants  in  your  community.  Camp 
Scientific  Supports  are  never  sold  by  door- 
to-door  canvassers.  Prices  are  based  on 
intrinsic  value.  Regular  technical  and 
ethical  training  of  Comp  fitters  insures 
precise  and  conscientious  attention  to  your 
recommendations. 


S.  H.  CAMP  AND  COMPANY,  JACKSON,  MICHIGAN 

World’s  Largest  Manufacturers  of  Scientific  Supports 
Offices  in  New  York  • Chicago  • Windsor,  Ontario  • London,  England 


for  August,  1949 


659 


Viewpoint  of  the  Private  Practition- 
er.— W.  J.  Hinzelman,  M.D.,  Gree- 
ley. 

Discussion. — Opened  by  Arthur  Rest, 
M.D.,  and  H.  Dumont  Clark,  M.D., 
Denver. 

The  recently  completed  Denver  and  Tri-County 
Chest  X-ray  Survey  will  affect  in  some  way 
the  practice  of  every  physician  in  Colorado. 
Far  advanced  and  active  cases  of  tuberculosis 
tvill  undoubtedly  be  institutionalized.  However, 
it  is  the  minimal  lesion,  the  early  case,  the 
questionable  shadow  which  will  cause  concern. 
This  symposium  has  been  arranged  to  outline 
the  purely  practical  management  of  these  cases 
by  private  physicians. 

11:15 — “Recent  Advances  in  the  Research 
of  Poliomyelitis.” — Herbert  A.  Wen- 
ner,  M.D.,  Kansas  City,  Kansas 
(Guest) . 

11:45 — “Rheumatoid  Arthritis:  Present  Con- 
cepts of  Therapy.” — Charles  H.  Slo- 
cumb,  M.D.,  Rochester,  Minnesota 
(Guest) . 

The  recent  introduction  of  Compound  "E  ' by 
Drs.  Hench,  Kendall,  and  Slociimb  has  un- 
doubtedly been  a major  advance  in  our  concept 
and  therapy  of  this  most  disabling  disease.  This 
presentation  will  outline  therapy  of  rheumatoid 
arthritis  as  if  is  affected  by  this  discovery. 

12:30“— Intermission  for  Luncheon. 

AFTERNOON 

1:00-3:00 — Full  Color  Television.  (See  an- 
nouncement in  Wednesday  morn- 
ing’s program.) 

3:00-3:15 — Intermission  to  View  Exhibits. 

GENERAL  SCIENTIFIC  ASSEMBLY 

Heman  R.  Bull,  M.D.,  Grand  Junction, 
Chairman. 

Harry  E.  Coakley,  M.D.,  Pueblo, 
Co-Chairman. 

3:15 — “Some  Aspects  of  the  Etiology  and 
Medical  Management  of  Renal 
Stone.” — R.  H.  Flocks,  M.D.,  Iowa 
City,  Iowa  (Guest). 

Some  of  the  theories  and  mechanisms  involved 
in  the  pathogenesis  of  the  upper  urinary  tract 
stone  will  be  discussed. 

4:00 — “Anesthesia  and  Analgesia  in  Obstet- 
ric Labor. — Perry  P.  Volpitto,  M.D., 
Augusta,  Georgia  (Guest). 

4:30 — “The  Management  of  Lesions  of  the 
Stomach,  Duodenum  and  Jejunum.” 
— Frank  H.  Lahey,  M.D.,  Boston, 
Massachusetts  (Guest). 

EVENING 

Open  for  Private  Arrangements. 

FRIDAY,  SEPTEMBER  23,  1949 
MORNING 
8:00 — Exhibits  Open. 


8:15-10:45 — Full  Color  Television.  (See  an- 
nouncement in  Wednesday  morn- 
ing’s program.) 

8:30 — House  of  Delegates.  Fourth  Meeting. 

GENERAL  SCIENTIFIC  ASSEMBLY 

C.  F.  Hegner,  M.D.,  Denver,  Chairman. 

L.  L.  Ward,  M.D.,  Pueblo,  Co-Chairman. 
11:00— -Report  of  the  Committee  on  Necrol- 
ogy.— ^W.  H.  Wilson,  M.D.,  Denver, 
Chairman. 

11:05 — Summary  of  Actions  Taken  by  the 
House  of  Delegates. 

11:10 — Installation  of  Newly  Elected  Of- 
ficers. 

11:15 — President’s  Address.  — Fred  A. 

Humphrey,  M.D.,  Fort  Collins. 

11:35 — “The  First  Year  of  the  British  Na- 
tional Health  Service.”  — William 
Alan  Richardson,  Editor,  Medical 
Economics,  Rutherford,  New  Jersey. 
12:30 — Recess  for  Luncheon. 

AFTERNOON 

2:00  to  4:00— SECTIONAL  MEETINGS. 
(See  individual  section  announce- 
ments below  for  location  of  each  sec- 
tional meeting.) 

For  the  first  time  in  many  years,  definite  sec- 
tional meetings  are  provided  for  part  of  the 
last  afternoon,  _ under  the  sponsorship  of  the 
special  societies  named  below.  One  of  the  So- 
ciety's Guest  Speakers  will  be  in  attendance  at 
each  of  the  Sectional  Meetings,  most  of  which 
ivill  he  on  an  informal  basis  with  topics  for 
discussion  announced  at  the  time  by  the  respec- 
tive presiding  officers. 

2:00  to  4:00— COLORADO  ACADEMY  OF 
GENERAL  PRACTICE.  Lincoln 
Room,  Shirley-Savoy  Hotel. 

C.  W.  Anderson,  M.D.,  Denver, 
President,  Presiding. 

(a)  2:00 — Opening  Address. — Mac  F.  Ca- 
hal,  LLB.,  Kansas  City,  Executive 
Secretary,  American  Academy  of 
General  Practice  (Guest). 

(b)  2:15— “Abdominal  Pain  in  Childhood.” 
—Wilfred  W.  Barber,  M.D.,  Denver. 

(c)  2:45 — “Office  Urology.” — Lawrtnee  D. 
Dickey,  M.D.,  Fort  Collins. 

(d)  3:00 — “Office  Ophthalmology.” — Don- 
ald H.  O’Rourke,  M.D.,  Denver. 

(e)  3:15— “Office  Gynecology.”— Claude 
D.  Bonham,  M.D.,  Boulder. 

(f)  3:30 — “Management  of  the  Anemias 
in  Infancy  and  Childhood.” — Harold 
D.  Palmer,  M.D.,  Denver. 

2:00  to  4:00— DENVER  ACADEMY  OF 
SURGERY.  Main  Dining  Room,  The 
University  Club,  E.  17th  Avenue  and 
Sherman  Street. 

Kenneth  C.  Sawyer,  M.D.,  Denver, 
President,  Presiding. 

Frank  H.  Lahey,  M.D.,  Boston,  Guest. 


660 


Rocky  Mountain  Medical  Journal 


even  after  40 


The  urge  fo  do  creative  or  constructive  work  is  often 
rekindled  in  the  woman  relieved  of  menopausal  symp- 
toms. Restraints  placed  on  her  talents  by  the  nervous- 
ness, hot  Rushes  and  other  manifestations  of  the  climacteric 
may  vanish  entirely  following  the  use  of  ''"Premarin/' 

In  addition,  there  is  a "plus”  in  '"'"Premarin"  therapy. . .the 
gratifying  "sense  of  well-being”  so  frequently  reported  by  the 
patient.  Oral  activity,  comparative  freedom  from  side-effects  and 
flexibility  of  dosage  are  other  advantages  associated  with  this  natu- 
rally-occurring, conjugated  estrogen.  ^''Premarin"  is  supplied  in  tablets 
of  four  different  potencies  and  in  liquid  form. 


a woman  does  creative  work... 


/ 


While  sodium  estrone  sulfate  is  the  principal  estrogen 
in  "Premarin,"  other  equine  estrogens ...  estradiol, 
equilin,  equilenin,  hippulin  . . . are  probably  also  pres- 
ent in  varying  amounts  os  water-soluble  conjugates. 


ESTROGENIC  SUBSTANCES  (WATER-SOLUBLE] 
also  known  as  CONJUGATED  ESTROGENS  (equine) 


Ayerst,  McKenna  & Harrison  Limited  22  East  40th  Street,  New  York  1 6,  New  York 

4904 


for  August,  1949 


661 


2:00  to  4:00— ROCKY  MOUNTAIN  OR- 
THOPEDIC CLUB.  Auditorium  of 
the  Denver  Children’s  Hospital,  East 
19th  Avenue  at  Downing  Street. 
Hamilton  I.  Barnard,  M.D.,  Denver, 
President,  Presiding. 

Edward  L.  Compere,  M.D.,  Chicago, 
Guest. 

2:00  to  4:00— ROCKY  MOUNTAIN  URO- 
LOGICAL ASSOCIATION.  Small 
Dining  Room,  The  University  Club, 
East  17th  Avenue  and  Sherman 
Street. 

Henry  A.  Buchtel,  M.D.,  Denver, 
President,  Presiding. 

R.  H.  Flocks,  M.D.,  Iowa  City,  Guest. 
2:00  to  4:00— ROCKY  MOUNTAIN  SO- 
CIETY OF  ANESTHESIOLOGISTS. 
Library  of  The  University  Club,  East 
17th  Avenue  and  Sherman  Street. 

C.  Walter  Metz,  M.D.,  Denver, 
President,  Presiding. 

Perry  P.  Volpitto,  M.D.,  Atlanta, 
Guest. 

2:00  to  4:00— DENVER  SOCIETY  OF  IN- 
TERNAL MEDICINE.  Lounge  of  the 
University  Club,  East  17th  Avenue 
and  Sherman  Street. 

C.  F.  Kemper,  M.D.,  Denver, 
President,  Presiding. 

Charles  H.  Slocumb,  M.D.,  Rochester, 
Minnesota,  Guest. 

2:00  to  4:00— COLORADO  OPHTHALMO- 
LOGICAL  SOCIETY.  Colorado 
Room  of  the  Shirley-Savoy  Hotel. 

J.  Leonard  Swigert,  M.D.,  Denver, 
President,  Presiding. 

Phillips  Thygeson,  M.D.,  San  Jose, 
California,  Guest. 

GENERAL  SCIENTIFIC  ASSEMBLY 

Lincoln  Room,  Shirley-Savoy  Hotel. 
Fred  A.  Humphrey,  M.D.,  Fort  Collins, 
Presiding. 

4:15 — “The  Management  of  Thyroid  Dis- 
ease, Including  the  Use  of  Anti- 
Thyroid  Agents.” — Frank  H.  Lahey, 
M.D.,  Boston  (Guest). 

5:00 — Adjourn. 

EVENING 

7:00 — Annual  Banquet.  Lincoln  Room  of 
the  Shirley-Savoy  Hotel.  Walter  H. 
Judd,  M.D.,  Minneapolis,  Represent- 
ative in  the  United  States  Congress 
from  the  Fifth  District  of  Minnesota 
(Guest). 

9:00 — Annual  Dance.  Sponsored  by  the 
Woman’s  Auxiliary  to  the  Colorado 
State  Medical  Society. 


SCIENTIFIC  EXHIBITS 

The  following  scientific  exhibits  have  been 
accepted  for  the  Colorado  State  Medical  Society 
Annual  Session  by  the  committee  in  charge  and 
every  physician  attending  the  annual  session  is 
urged  to  study  each  exhibit: 

Slide  Method  of  Culturing  the  Tubercle  Bacillus. 
— John  Berry,  M.D.,  and  Hope  Lowry,  M.D., 
Department  of  Medicine,  University  of  Colo- 
rado, Medical  Center. 

Surgical  Management  of  Malignancies  of  the 
Esophagus  and  Stomach. — Kenneth  C.  Sawyer, 
M.D.,  Alexis  E.  Lubchenco,  M.D.,  and  Ray  G. 
Witham,  M.D.,  Denver,  Colorado. 

Treatment  of  Parotid  Tumors. — H.  Mason  Mor- 
fit,  M.D.,  Denver,  Colorado. 

Lead  Intoxication — Frank  Princi,  M.D.,  Divi- 
sion of  Industrial  Medicine,  University  of  Colo- 
rado, Medical  Center. 

Cerebral  Angiography. — C.  F.  Ingersoll,  M.D., 
Chief,  and  L.  R.  Wurtzeback,  M.D.,  Senior 
Resident,  X-ray  Department,  Veterans  Ad- 
ministration Hospital,  Fort  Logan,  Colorado. 
Teamwork  in  Cancer  Diagnosis. — American  Can- 
cer Society. 

The  Role  of  Anesthesiologist  in  Modern  Medi- 
cine.— The  Colorado  Society  of  Anesthesiolo- 
gists. 

Tuberculosis — Every  Hospital’s  Problem. — Na- 
tional Tuberculosis  Association. 

Congenital  Heart  Disease. — The  Heart  Club  of 
Denver. 

Surgical  Treatment  of  Tuberculosis. — National 
Jewish  Hospital,  Denver,  Colorado. 

Carcinoma  of  the  Cervix. — Kenneth  D.  A.  Allen, 
M.D.,  Denver,  Colorado. 

Carcinoma  of  the  Rectum. — Harry  W.  Le  Fevre, 
Jr.,  M.D.,  and  Thomas  F.  Jacques,  M.D.,  Den- 
ver, Colorado. 

Diabetes  in  Pregnancy. — Paul  Sheridan,  M.D., 
Denver,  Colorado. 

Urologic  Exhibit. — T.  L.  Howard,  M.D.,  and  Henry 
A.  Buchtel,  M.D.,  Denver,  Colorado. 

Lack  of  Correlation  Between  Clinical  Findings 
and  Roentgen  Diagnosis. — Mark  S.  Donovan 
M.D.,  Denver,  Colorado. 

Gall  Stones. — Chauncey  A.  Hager,  M.D.,  Denver, 
Colorado. 

Internal  Fixation. — Murray  Gibbens,  M.D.,  Den- 
ver, Colorado. 

Plastic  and  Reconstructive  Surgery  (Case  Pres- 
entations).— Sidney  E.  Blanford,  Jr.,  M.D.,  Den- 
ver, Colorado. 

Bronchography. — Robert  K.  Brown,  M.D.,  Den- 
ver, Colorado. 

Metastatic  Melanoma. — Samuel  B.  Childs,  Jr., 
M.D.,  Denver,  Colorado. 

Scientific  Projects. — Colorado  State  Society  of 
Medical  Technologists. 

Vascular  and  Pigmented  Nevi. — Douglas  W.  Ma- 
comber,  M.D.,  Denver,  Colorado. 


TECHNICAL  EXHIBITS 

The  day  has  long  since  passed  when  Technical 
Exhibits  at  medical  conventions  are  considered 
a “commercial  show”  or  simply  a “necessary 
evil”  that  the  convention  must  put  up  with  in 
order  to  collect  a few  exhibit  fees. 

It  is  still  true  that  Technical  Exhibitors  pay 


662 


Rocky  Mountain  Medical  Journal 


when  reducers  stray  from  the  dietary  path . . . 


TABLETS, 

2.5  mg.  and  5 mg. 

ELIXIR, 

20  mg.  per  fluidounce 
(2.5  mg.  per  fluidrachm) 

AMPOULES, 

20  mg.  per  cc. 

Prescribe  ' 

■ ® 

desoxyn 


. . . Desoxyn  Hydrochloride  provides  a safe,  simple  and  effective 
curb  on  the  wayward  appetite.  At  the  same  time,  the  stimulating 
action  of  Desoxyn  increases  the  patient’s  sense  of  well-being  and 
desire  for  activity.  To  depress  the  appetite,  one  2.5-mg.  tablet  an 
hour  before  breakfast  and  lunch  is  usually  sufficient.  A third  tablet 
may  be  taken  in  midaftemoon,  if  needed,  and  if  it  does  not  cause 
insomnia.  • It  has  been  shown  that  weight  for  weight  Desoxyn  is 
more  potent  than  other  sympathomimetic  amines  so  that  smaller 
doses  may  be  used  effectively.  In  addition,  Desoxyn  has  a faster 
action,  longer  effect  and  relatively  few  side-effects.  • Orally,  Desoxyn 
is  an  effective  cerebral  stimulant  with  a wide  variety  of  uses. 
Parenteraily,  it  helps  to  restore  and  maintain  blood  pressme  during 
operative  procedure.  For  more  detailed  information,  write  to 
ABBOTT  LABORATORIES,  NORTH  CHICAGO,  ILLINOIS 

HYDROCHLORIDE  , 


(Methamphetamine  Hydrochloride,  Abbott) 


for  August,  1949 


663 


substantial  fees  for  space  in  which  to  demon- 
strate the  latest  technical  adjuncts  of  medical 
practice,  and  these  fees  do  contribute  a substan- 
tial part  of  the  cost  of  arranging  a modern 
scientific  assembly.  But  that  is  not  the  primary 
reason  for  the  ever-expanding  technical  expo- 
sitions at  national,  regional,  and  state  medical 
meetings.  Technical  Exhibitors  in  these  modern 
years  plan  educational  displays  worthy  of  every 
doctor’s  close  attention.  They  are  part  and  parcel 
of  the  educational  endeavor  that  underlies  all 
these  meetings. 

Definite  intermissions  in  the  speaking  pro- 
grams, and  all  other  times  when  members  are 
not  concerned  with  the  part  of  the  program  then 
current,  should  be  utilized  to  scrutinize  the 
Technical  Exhibits  which  will  be  displayed  by 
the  following  named  firms,  all  of  which  will  be 
displayed  in  the  Empire  Room  and  the  Lincoln 
Room  Lobby  of  the  Shirley-Savoy  Hotel. 


Abbott  Laboratories 
Aloe,  A.  S.  Company 
Ames  Company,  Inc. 
Baker  Laboratories, 
Inc.,  The 

Berbert,  George  & Sons 
Blair  X-ray  Supply 
Borden  Company,  The 
Burroughs  Wellcome  & 
Company 

Ciba  Pharmaceutical 
Products,  Inc. 
Coca-Cola  Company 
Colvin  Brothers 
Davis  & Geek,  Inc. 
Denver  Fire  Clay 
Company,  The 
Dictaphone  Corporation 
Durbin  Surgical  Supply 
Company 

General  Electric  X-ray 
Corporation 

narrower  Laboratories, 
Inc. 

Lanteen  Medical 
Laboratories,  Inc. 
Lederle  Laboratories 
Lilly,  Eli  and  Company 
M & R Dietetic 
Laboratories,  Inc. 

Mead  Johnson  and 
Company 


Merrell,  Wm.  S. 
Company 

Mosby,  C.  V.  Company 
Muckle  X-ray  Company 
Mueller  V.  & Company 
Ortho  Pharmaceutical 
Corporation 
Parke,  Davis  and 
Company 
Philip  Morris  & 
Company,  Ltd.,  Inc. 
Republic  Drug 
Company 

Sandoz  Pharmaceuticals 
Schering  Corporation 
Searle,  G.  D.  and 
Company 

Sharp  & Dohme,  Inc. 
Smith,  Kline  & French 
Laboratories 
Squibb,  E.  R.  & Sons 
Stacey,  J.  W.,  Inc. 
Saunders,  W.  B. 
Company 

Westinghouse  Electric 
Corporation 
Wire  Recording 
Company 

White  Laboratories,  Inc. 
Young,  F.  E.  and 
Company 


PROGRAM  OF  THE  ANNUAL  MEETING  OF 
THE  WOMAN’S  AUXILIARY  TO  THE 
COLORADO  STATE  MEDICAL 
SOCIETY 

Wednesday,  September  21 

*3:00-5:00 — All  state  members  are  invited  to  join 
the  members  of  Denver  County  for  their 
annual  tea  at  the  home  of  their  President, 
Mrs.  Kenneth  Sawyer,  165  High  Street,  Den- 
ver. Transportation  will  be  provided  for  at 
the  registration  desk,  information  committee. 

Thursday,  September  22 

2:00-4:00 — Shirley-Savoy  Hotel.  Pre-convention 
Board  Meeting  for  outgoing  officers,  chair- 
men and  County  Presidents  and  the  Past 
State  Presidents. 


Friday,  September  23 

8:30  A.  M. — Brown  Palace  Hotel.  Coffee  by 
Mrs.  Heinz  and  Mrs.  Wearner  honoring  the 
outgoing  and  incoming  County  Presidents. 
*10:00 — Brown  Palace  Hotel,  Onyx  Room.  An- 
nual Meeting  for  all  members  of  the  Wom- 
an’s Auxiliary  to  the  Colorado  State  Medical 
Society. 

*12:30  P.M. — Brown  Palace  Hotel,  Mayfair  Room. 
Annual  Luncheon  for  all  State  members 
honoring  the  members  of  the  Board,  1949- 
1950. 

3:00-5:00 — Brown  Palace  Hotel,  Mayfair  Room. 
Post-convention  Board  Meeting  for  all  new 
County  Presidents,  officers,  chairmen  and 
Past  State  Presidents. 

Note:  We  plan  to  furnish  each  member  who 
registers  a list  of  Denver  activities  of  possible 
interest  to  her  which  will  take  place  on  Thurs- 
day, September  22.  It  was  thought  that  this 
freedom  from  organized  activity  would  be  ap- 
preciated. 


*Open  to  all  Colorado  Auxiliary  Members. 

P R E L I M I NARY  PROGRAM,  ROCKY 
MOUNTAIN  CHAPTER,  AMERICAN 
COLLEGE  OF  CHEST 
PHYSICIANS 

The  meeting  will  be  held  at  the  Shirley-Savoy 
Hotel,  Denver,  Colorado,  on  Tuesday,  September 
20,  1949. 

9:00  A.M. — “Intermittent  Dosage  Schedule  of 
Streptomycin  for  the  Treatment  of  Pulmon- 
ary Tuberculosis” — Col.  Carl  W.  Temple, 
Chief  of  the  Tuberculosis  Division,  Medical 
Service,  Fitzsimons  General  Hospital;  Vern 
Dyke,  M.D.,  Ward  Officer,  Tuberculosis, 
Fitzsimons  General  Hospital. 

9:30  A.M.— “Problems  in  the  Management  of 
Ineffective  Pneumothorax” — B.  T.  McMahon, 
M.D.,  Denver,  Colorado. 

10:00  A.M. — “Pulmonary  Function  Studies  Fol- 
lowing Decortication” — Robert  Brown,  M.D., 
Chief  of  Thoracic  Surgery  Section,  Fort  Lo- 
gan Veterans  Hospital. 

10:30  A.M. — “Some  Unusual  Pulmonary  Condi- 
tions”— Alvis  E.  Greer,  M.D.,  Clinical  Pro- 
fessor of  Medicine,  Baylor  University  Col- 
lege of  Medicine,  Houston,  Texas. 

12:00  Noon — Dinner. — Symposium.  “Fungus  Dis- 
eases of  the  Chest” — Edwin  R.  Levine,  M.D,, 
Chicago,  Illinois;  Alvis  E.  Greer,  M.D.,  Hous- 
ton, Texas;  Col.  Hugh  W.  Mahon,  Chief  of 
the  Pathology  Department,  Fitzsimons  Gen- 
eral Hospital;  Charles  F.  Taylor,  M.D.,  Med- 
ical Director,  Kansas  State  Sanatorium,  Nor- 
ton, Kansas. 

2:00  P.M. — “Progress  of  the  American  College 
of  Chest  Physicians”  — Joseph  C.  Placak, 
Cleveland,  Ohio,  President  of  the  American 
College  of  Chest  Physicians. 

2:30  P.M. — “Treatment  of  Pulmonary  Tubercu- 
losis With  Antihistaminic  Drugs” — Allan 
Hurst,  M.D.,  Medical  Director,  National 
Jewish  Hospital;  Tovy  Millner,  M.D.,  Fellow, 
National  Jewish  Hospital. 

3:00  P.M. — “Association  of  Bronchial  Infection 
With  Pulmonary  Emphysema” — Edwin  R. 
Levine,  M.D.,  Director  of  Chest  Service,  Mi- 
chael Reese  Hospital,  Chicago,  Illinois. 

No  registration  fee.  All  physicians  cordially 
invited  to  attend. 


664 


Rocky  Mountain  Medical  Journal 


A Disability 

Life  Income  Program 

for  Eligible 

Physicians  & Surgeons 

of  your 

State 

Lifetime  Protection 
for  both 

Sickness  & Accidents 


A SILENT  PARTNER  . . . Continentars  Companion  Policies 


Pays  $ 400 

$ 300 

Pays  $ 600 

Pays  $ 7,500 
Pays  $10,000 
$ 5,000 


Monrtily  Benefits  first  2 years  ($200  1 si  mo.)  and 
Monthly  Benefits  thereafter  for  Life. 

Additional  Monthly  Benefits 

First  3 Months  tor  Hospital  Disability. 

Accidental  Death  Benefits,  $12,500  Double  Indemnity. 

Loss  of  Hands  Feet  or  Eyes,  $1  5,000  Double  Indemnity  (or) 
Cash,  & $400  monthly  first  2 years,  $300  monthly  thereofter. 
Adjusted  benefits  for  disabilities  occurring  after  age  60. 


SPECIAL 

No  Conce/laHon  Claus@,~-Standard  Provision  16 
No  Terminating  Age, — Standard  Provision  20 
No  Increase  in  Premium, — Once  Policy  is  Issued 
Groce  Period  15  Days 


FEATURES 

Non  Pro-Rating, — Standard  Provision  IT 
Non-Assessable,~r-No  Contingent  Liability 
Non- Aggregate, — Previous  Claims  Paid 
do  not  limit  Company's  Liability 


Unusually  Complete  Protection 

"A  Pays  Monthly  Benefits  from  1st  Day  to  Life. 

"A’  Pays  Benefits  for  both  Sickness  and  Accident. 

★ Pays  Lifetime  Benefits  for  Time  or  Specific  Losses. 

★ Pays  Regular  Benefits  for  Commercial  Air  Travel. 

'A  Pays  Benefits  for  Non-Disabling  Injuries. 

★ Pays  Benefits  for  Non-Confining  Sickness. 

★ Pays  Benefits  for  Septic  Infections. 

★ Pays  Whether  or  not  Disability  is  Immediate. 

★ Waives  Premiums  for  Total  Permanent  Disability. 

★ Renewal  is  guaranteed  to  individual  active  members,  except 
for  non-payment  of  premium,  so  long  as  the  plan  continues 
in  effect  for  the  members  of  your  designated  organization. 


Continental  Casualty  Company 

Professional  Department,  Intermediate  Division 
30  EAST  ADAMS  STREET— SUITE  1100— CHICAGO  3,  ILLINOIS 

Also  Attractive 
Health  With 

Lifetime  Accident 
Policy  I.P.-1327 
For  Ages  59  to  75 


Only  Companion  Policies  GP-1309  and  IP-1308  pay  the  above  benefits. 

IMPORTANT  — Permit  no  agent  to  substitute  — IMPORTANT 


Name.... 
Address. 
Age 


for  August,  1949 


665 


EDWARD 

LYON 

COMPERE,  M.D. 
Chicago 


ROBERT  G.  PACKARD,  M.D. 

Official  Host  for 
This  Meeting 


RUBIN 

H. 

FLOCKS,  M.D. 
Iowa  City 


HENRY  A.  BUCHTEL,  M.D. 

Official  Host  fro 
This  Meetnig 


FRANK 
HOWARD 
LAHEY,  M.D.  , 

Boston 


CHAUNCEY  A.  HAGER,  M.D. 

Official  Host  for 
This  Meeting 


CHARLES 

H. 

SLOCUMB,  M.D. 

Rochester 

• 

MARSHALL  G.  NIMS,  M.D. 

Official  Host  for 
This  Meeting 


WILLIAM 

ALAN 

RICHARDSON 
New  York  City 


JOHN  S.  BOUSLOG,  M.D. 

Official  Host  for 
This  Meeting 


HERBERT 

A. 

WENNER,  M.D. 
Kansas  City 


F.  HENRY  REYNOLDS,  M.D. 

Official  Host  for 
This  Meeting 


666 


Rocky  Mountain  Medical  Journal 


Edward  Lyon  Compere,  M.D.,  Chicago,  Illinois, 
graduated  from  Baylor  University  in  1922  with 
his  B.A.  degree  and  from  Rush  Medical  College 
of  the  University  of  Chicago  in  1926  with  his 
M.D.  He  has  held  numerous  teaching  and 
hospital  appointments  and  was  Consultant 
in  Orthopaedics,  U.  S.  Naval  Hospital,  Great 
Lake,  Illinois,  in  1946.  Dr.  Compere  is  a member 
of  the  American  Orthopaedic  Association,  Ameri- 
can Academy  of  Orthopaedic  Surgeons,  Clinical 
Orthopaedic  Society,  Chicago  Orthopaedic  So- 
ciety, Fellow  of  the  American  College  of  Sur- 
geons and  Founder  Fellow  of  the  International 
College  of  Surgeons.  He  is  also  editor  of  the 
Year  Book  of  Orthopedics  and  Traumatic  Sur- 
gery. 


R.  H.  Flocks,  M.D.,  Professor  in  the  Depart- 
ment of  Urology,  University  Hospitals,  Iowa 
School  of  Medicine,  Iowa  City,  received  his 
M.D.  degree  from  Johns  Hopkins  Medical 
School  in  1930.  He  was  Resident  House  Officer 
at  Johns  Hopkins  Hospital  from  1930  to  1931 
and  Assistant  Resident  Surgeon,  University  Hos- 
pitals, Iowa  City,  Iowa,  from  1931  to  1932.  Dr. 
Flocks  is  also  Assistant  Instructor,  Assistant  Pro- 
fessor and  Associate  Professor  in  the  Department 
of  Urology,  University  Hospitals,  Iowa  School  of 
Medicin,  Iowa  eCity. 

Frank  Howard  Lahey,  M.D.,  Director  of  Clin- 
ical Surgery  at  the  Lahey  Clinic,  Boston,  Sur- 
geon-in-Chief  to  the  New  England  Baptist  Hos- 
pital and  Surgeon  to  the  New  England  Deaconess 
Hospital  is  a graduate  of  the  Harvard  Medical 
School,  where  he  was  Professor  of  Clinical  Sur- 
gery in  1923  and  1924.  During  World  War  II 
he  was  National  Chairman  of  the  Directing 
Board  for  Procurement  and  Assignment  Service 
for  the  Armed  Forces  and  Chairman  of  the 
Medical  Consulting  Board  to  the  United  States 
Navy.  Among  his  numerous  activities  are  ac- 
tive memberships  in  the  American  Surgical 
Society,  Southern  Surgical  Society,  American 
Association  for  the  Study  of  Goiter,  and  he  is 
Past  President  of  the  American  Medical  Asso- 
ciation, New  England  Surgical  Aociation  and 
Intertate  Postgraduate  Medical  Association. 

Charles  Henry  Slocumb,  B.S.,  M.D.,  M.S.,  was 

born  August  28,  1905,  at  Plainview,  Minnesota; 
received  the  degree  of  B.S.  in  1927,  of  M.D.  in 
1929,  and  of  M.S.  in  1930  from  the  University  of 
Minnesota;  and  was  an  intern  at  Aucker  Hos- 
pital, St.  Paul,  from  July,  1930,  to  July,  1931. 
He  entered  The  Mayo  Foundation  as  a Fellow  in 
Medicine  October  1,  1931.  His  services  included 
medical  hospital,  fifteen  months;  neurology,  six 
months;  and  general  medical  and  surgical  diag- 
nosis, thirty  months.  He  was  First  Assistant  in 
Medicine  from  January  1,  1934,  to  November, 
1935,  when  he  became  Associate  in  Medicine, 
The  Mayo  Clinic.  He  is  also  Instructor  in  Med- 


icine, The  Mayo  Founration.  Dr.  Slocumb  is  a 
member  of  the  American  Medical  Association 
and  the  American  Association  for  the  Study  and 
Control  of  Rheumatic  Diseases. 


William  Alan  Richardson,  Editor  of  Medical 
Economics  Magazine,  graduated  from  Harvard 
University  in  1931,  did  postgraduate  study  in 
economics,  and  newspaper  work  on  the  Evening 
Star,  Washington,  and  the  Boston  Transcript.  He 
is  the  author  of  numerous  articles,  monographs 
and  special  studies  for  newspapers,  magazines 
and  professional  journals  and  has  spoken  before 
national,  state  and  local  medical  associations  and 
lay  organizations.  He  is  a lecturer  in  medical 
economics  at  Long  Island  College  of  Medicine 
in  New  York.  Mr.  Richardson  has  been  editor 
of  Medical  Economics  Magazine  since  1934. 

Phillips  Thygeson,  M.D.,  San  Jose,  California, 
is  a graduate  of  Stanford  with  the  class  of  1928 
when  he  received  his  M.D.  degree.  As  a Fellow, 
National  Research  Council,  he  worked  at  Pasteur 
Institute  of  Tunis  in  1931  and  1932  on  Trachoma. 
He  was  Assistant  Professor  of  Opthalmology, 
Iowa  State  University,  Assistant  Professor  and 
Professor  of  Opthalmology,  College  of  Physicians 
and  Surgeons,  Columbia  University,  and  Asso- 
ciate Clinical  Professor  of  Opthalmology  at  the 
University  of  California  Medical  School.  The 
Research  Medal,  Section  on  Opthalmology, 
American  Medical  Association,  was  awarded  to 
him  in  1936. 


Perry  P.  Volpitto,  M.D.,  Professor  of  Anes- 
thesiology, University  of  Georgia  School  of 
Medicine,  Augusta,  Georgia,  received  his  B.S. 
degree  from  Washington  and  Jefferson  College 
in  1928  and  his  M.D.  degree  in  1933.  He  had 
Western  Reserve  University  Training  in  Anes- 
thesiology, Wisconsin  General  Hospital,  from 
1934  to  1936,  and  at  Bellevue  Hospital  from  1936 
to  1937.  He  was  on  the  American  Board  of 
Anesthesiology  in  1939  and  was  Associate  Pro- 
fessor of  Anesthesiology  and  Professor  at  the 
University  of  Georgia  from  1937  to  1938.  Dr. 
Volpitto  was  Branch  Section  Chief,  Anesthesiol- 
ogy, Branch  No.  5,  Veterans  Administration,  in 
1947,  and  Consultant,  Anesthesiology,  Oliver  Gen- 
eral Hospital  (Army),  Augusta,  Georgia,  in  1947. 

Herbert  A.  Wenner,  M.D.,  Associate  Professor 
of  Pediatrics  at  the  University  of  Kansas,  re- 
ceived his  medical  degree  at  the  University  of 
Rochester,  New  York,  in  1939.  He  is  a Frank 
Lush  Babbott,  Jr.,  Fellow,  Yale  University,  and 
National  Research  Council  Fellow,  Johns  Hop- 
kins University.  From  1944  to  1946  Dr.  Wenner 
was  Instructor  in  Preventive  Medicine  at  Yale 
University.  He  was  Assistant  Professor  of  Pe- 
diatrics and  Bacteriology  at  the  University  of 
Kansas  from  1946  to  1949. 


for  August,  1949 


667 


UTAH 

State  Medical  Association 


ANNUAL  MEETING,  UTAH  STATE 
MEDICAL  ASSOCIATION 

The  Fifty-Fourth  Annual  Meeting  of  the  Utah 
State  Medical  Association  is  to  be  held  Septem- 
ber 1,  2,  3,  1949,  in  the  Union  Building  of  the 
University  of  Utah  in  Salt  Lake  City,  Utah.  All 
doctors  of  the  Intermountain  area  are  cordially 
invited  to  attend. 

The  House  of  Delegates  will  meet  at  4:00  p.m. 
on  September  1 and  2 and  the  meeting  of  the 
stockholders  of  the  Medical  Service  Bureau  will 
be  held  the  evening  of  September  1.  Very  im- 
portant matters  will  come  before  both  of  these 
bodies. 

The  Annual  Banquet  will  be  held  the  evening 
of  September  2. 

Guest  speakers  and  their  subjects  are  as  fol- 
lows: 

A.  N.  Arnesen,  M.D.,  St.  Louis,  Missouri:  “Treat- 
ment of  Carcinoma  of  the  Cervix  Uteri;’’ 
“The  Importance  of  Normal  Pathways  of 
Tumor  Spread  in  Establishing  Methods  of 
Treatment  for  Uterine  Cancer.” 

Warren  H.  Cole,  M.D.,  Chicago,  Illinois:  “Hyper- 
thyroidism;” “Intestinal  Obstruction.” 

Irvin  E.  Hendryson,  M.D.,  Denver,  Colorado: 
“Early  Diagnosis  of  Polio;”  “Treatment  of 
Polio.” 

Elmer  Hess,  M.D.,  Erie,  Pennsylvania:  “Urolog- 
ical Hints  for  the  General  Practitioner;” 
“The  Treatment  of  Urethral  Stricture.” 

E.  M.  Jellenik,  M.D.,  Ft.  Worth,  Texas:  “Syn- 
dromes of  Alcoholism.” 

Chester  S.  Keefer,  M.D.,  Boston,  Mass.:  “New 
Antibiotic  Drugs — Aureomycin,  Chloromyce- 

, tin.  Bacitracin,  Aerosporin;”  “Hypersensi- 
tive Reactions  to  Commonly  Used  Drugs.” 
William  P.  Longmire,  Jr.,  M.D.,  Los  Angeles, 
Calif.:  “Total  Gastrectomy”  (analysis  of  the 
results  of  sixty-three  cases);  “Treatment  of 
Benign  Obstructions  of  the  Extrahepatic 
Biliary  System”  (motion  picture). 

K.  Alvin  Merendino,  M.D.,  Seattle,  Washington: 
“Delay  Factors  in  the  Diagnosis  of  Carcin- 
oma of  the  Esophagus;”  “Esophageal  Hiatus 
Hernia;  Diagnosis  and  Treatment.” 

Eric  Oldberg,  M.D.,  Chicago,  Illinois:  “Diagnosis 
and  Treatment  of  Head  Injuries;”  “Tumors 
of  the  Spinal  Cord.” 

A.  D.  Ruedemann,  M.D.,  Detroit,  Michigan: 
“Acute  Inflammatory  Lesions  Around  the 
Eyes;  Diagnosis  and  Treatment;”  “Head 
Pain  and  Headache  of  Ocular  Origin.” 
Shields  Warren,  M.D.,  Boston,  Massachusetts- 
“Biologic  Aspects  of  Atomic  Energy;”  “Med- 
icolegal Aspects  of  Radiation  Injury.” 


AUXILIARY 

A most  cordial  invitation  is  extended  to  all 
auxiliary  members  and  the  wives  and  guests  of 
physicians  attending  the  convention  of  the  Utah 
State  Medical  Association,  September  1,  2,  3, 
1949. 

You  are  welcome  to  participate  in  all  func- 


tions and  attend  the  general  sessions. 

Auxiliary  headquarters  will  be  at  the  Hotel 
Utah,  Salt  Lake  City.  Please  register  early  and 
obtain  your  badge  and  program.  Registration, 
Mezzanine  Floor. 

An  invitation  has  been  extended  to  Mrs.  Da- 
vid B.  Allman  of  Atlantic  City,  New  Jersey, 
President  of  the  Auxiliary  to  the  American  Med- 
ical Association,  to  be  present  at  our  State  Con- 
vention. 


Utah  was  honored  by  a visit  from  Mrs.  Luther 
H.  Kice,  President  of  the  Auxiliary  of  the  Amer- 
ican Medical  Association,  in  May.  Mrs.  Kice  is 
from  Garden  City,  Long  Island,  New  York,  and 
was  invited  by  Mrs.  Glen  F.  Harding,  immediate 
Past  President,  Auxiliary  to  the  Utah  Medical 
Association,  to  meet  in  conjunction  with  the 
Ogden  Surgical  Society  at  its  annual  meeting. 
Mrs.  Kice  was  honored  guest  at  a tea  at  the 
home  of  Mrs.  Harding  of  Ogden.  Following  this 
delightful  affair,  she  met  with  the  doctors  and 
their  wives  from  the  whole  Intermountain  area 
at  a buffet  supper  and  dance  at  the  Ogden 
Country  Club.  Mrs.  Kice  was  guest  speaker  at 
the  Auditorium  of  the  Nurses  Home  at  St. 
Benedict’s  Hospital,  Ogden,  where  she  spoke  to 
the  Auxiliary  members  and  guests  to  spur  the 
women  for  National  Health  Education.  “Health 
improvement  is  our  greatest  concern,”  she  said. 
Also,  the  Auxiliary  is  vitally  interested  in  en- 
couraging recruitment  of  nurses  and  nurses’  aids. 
Our  National  President  further  said  the  Aux- 
iliary had  been  responsible  for  recruitment  of 
more  than  1,000  nurses’  aids  throughout  the  na- 
tion during  the  postwar  period.  She  attended  a 
breakfast  at  the  home  of  Mrs.  John  Z.  Brown, 
President  of  the  Auxiliary.  The  other  guests 
were  officers  of  the  Auxiliary  to  the  Salt  Lake 
County  Medical  Society.  Following  the  organ 
recital  at  the  Salt  Lake  Tabernacle,  Mrs.  Kice 
and  the  Past  Presidents  of  the  Auxiliary  to  the 
Utah  State  Medical  Association  were  honored 
guests  at  a luncheon  at  the  home  of  Dr.  and 
Mrs.  Silas  S.  Smith.  At  the  conclusion  of  the 
visit  of  our  President,  a tour  was  conducted  of 
special  points  of  interest  in  Salt  Lake  City  and 
she  was  later  entertained  at  the  home  of  Dr.  and 
Mrs.  Grin  A.  Ogilvie.  Dr.  Ogilvie  is  President  of 
the  Utah  State  Medical  Association. 

MRS.  JOHN  Z.  (Alice  D.)  BROWN, 
President,  Auxiliary  to  the  Utah  State 
Medical  Association. 


CANCER  SEMINAR 

A cancer  seminar  is  to  be  held  at  the  Broad- 
moor Hotel,  Colorado  Springs,  September  10, 
1949.  It  will  be  jointly  conducted  by  Dr.  Arthur 
P.  Stout,  Associate  Professor  of  Surgical  Path- 
ology, Columbia  University,  New  York,  and  Dr. 
Lauren  V.  Ackerman,  Associate  Professor  of 
Surgical  Pathology,  Washington  University,  St. 
Louis.  Formal  invitations  have  been  limited  to 
pathologists  in  the  Rocky  Mountain  area,  who 
will  receive  slides  of  the  problem  cases  to  be 
discussed,  but  all  physicians  interested  in  cancer 
will  be  welcome  to  attend  the  discussion  on  the 
afternoon  of  September  10  at  the  Broadmoor 
Hotel  in  Colorado  Springs.  Over  100  pathologists 
will  submit  their  microscopic  diagnoses  on  fif- 
teen cases  and  will  have  an  opportunity  to  defend 
their  point  of  view  after  the  moderators  have 
thoroughly  explained  theirs.  There  will  be  no 
registration  fee.  Those  interested  should  make 
requests  for  their  reservations  at  the  Hotel 
Broadmoor  and  should  inform  Dr.  Erving  F. 
Geever,  Penrose  Cancer  Hospital,  of  their  desire 
to  attend  the  meeting. 


668 


Rocky  Mountain  Medical  Journal 


'fk* 


D 


orseij  Going  Your  Way 


FOLLOWING  a parallel  route  to  a similai 
destination,  the  ethical  pharmaceutical 
maker  necessarily  keeps  the  progress  and 
direction  of  scientific  medicine  constantly 
in  view. 

For  a closer  look  at  medicine’s  progress 
and  full  comprehension  of  its  implications,, 
the  Smith-Dorsey  Company  has  expanded 
its  research  facilities,  secured  increased  re- 
search grants  and  added  research  personnel. 


i SMITH-DORSEY  COMPANY  • Lincoln,  Nebraska 


BRANCHES  AT  LOS  ANGELES  AND  DALLAS 


MANUFACTURERS  OF 

AQUEOUS  SUSPENSION  OF  ESTROGENIC  SUBSTANCES  • DORSEY 
AMINOPHYLLINE  SUPPOSITORIES  • DORSEY 


Advertisement 


From  where  1 sit 
Joe  Marsh 


Who’s  A Foreigner? 

While  I’m  waiting  for  a haircut  a 
couple  of  days  ago,  Slim  Hartman 
lets  slip  with  a crack  about  those 
“foreigners”  who  recently  moved  in 
down  by  the  depot 

“Now  wait  a minute,  Slim,”  snaps 
Doc  Sherman.  “Don’t  forget  we’re  all 
‘foreigners’  more  or  less.  Some  of  our 
families  have  simply  been  here  longer 
than  others.  But  even  if  they  came 
over  on  the  Mayflower,  they  were 
foreigners  to  the  Indians.” 

Slim  gets  a little  red  and  you  could 
see  that  Doc  had  him.  “And  the  reason 
they  came  here,”  he  goes  on,  “was  to 
find  freedom  to  do  and  think  as  they 
wanted  to,  just  so  long  as  they  didn’t 
tramp  on  any  of  the  rights  of  the  other 
fellow.” 

From  where  I sit,  America  became 
the  great  land  it  is  today  through  our 
being  tolerant  of  different  people  and 
different  tastes — whether  it’s  a taste 
for  square  dancing  or  waltzing,  radio 
or  movies,  goat’s  mUk  or  a temperate 
glass  of  sparkling  beer. 


Copyright,  19 United  States  Brewers  Foundation 


WYOMING 

State  Medical  Society 


PROGRAM,  FORTY-SIXTH  ANNUAL 
MEETING,  WYOMING  STATE 
MEDICAL  SOCIETY 

TO  BE  HELD  IN  CASPER,  WYOMING, 
SEPTEMBER  12-14,  1949 

A cordial  invitation  is  extended  to  the  phy- 
sicians of  Colorado,  Montana,  New  Mexico,  Utah 
and  Wyoming  to  attend  the  Annual  Meeting  of 
the  Wyoming  State  Medical  Society  in  Casper. 

Registration  will  be  at  the  Townsend  Hotel 
and  Veterans  Foreign  Wars  Club;  the  Scientific 
Sessions  will  be  held  at  the  Veterans  Foreign 
Wars  Club;  the  smoker  in  the  Rose  Room  of  the 
Townsend  Hotel;  the  banquet  in  the  Crystal 
Room  of  the  Gladstone  Hotel;  and  golf  at  the 
Casper  Country  Club. 

PROGRAM 

Sunday,  September  11 

7:00  P.M.-— Smoker,  Townsend  Hotel. 

Monda^y,  September  12 

9:00-10:00  A.M. — Registration,  Townsend  Hotel 
and  Veterans  Foreign  Wars  Club;  House  of 
Delegates  Meeting,  Veterans  Foreign  Wars 
Club. 

10:00-10:30  A.M. — Opening  of  Meeting — Dr.  M.  C. 
Henrich,  President,  Natrona  County  Medical 
Society;  Hon.  A.  T.  Jessen,  Mayor,  City  of 
Casper;  Dr.  DeWitt  Dominick,  President- 
Elect,  Wyoming  State  Medical  Society. 

10:30  A.M. — Dr.  George  E.  Baker,  Presiding. 
“Surgery  of  the  Gall  Bladder” — Dr.  C.  F. 
Dixon,  Rochester,  Minnesota. 

11:00  A.M. — “Case  Selection  in  Treatment  of 
Carcinoma  of  the  Bladder” — Dr.  D.  R.  Hig- 
bee,  Denver,  Colorado. 

11:30  A.M. — “Observations  on  Rheumatic  Fever” 
— Dr.  David  Flett,  Cheyenne. 

12:00  Noon — Luncheon,  Townsend  Hotel. 

2:00  P.M. — ^Dr.  George  H.  Phelps,  Presiding. 
“Congenital  Abnormalities  of  the  Upper  Ali- 
mentary Tract” — Dr.  L.  Martin  Hardy,  Chi- 
cago, Illinois. 

2:30  P.M. — “Postoperative  Pulmonary  Compli- 
cations”— Dr.  John  W.  Huffman,  Chicago, 
Illinois. 

3:00  P.M.-— “Roentgen  Findings  of  Common  Pul- 
monary Lesions”— Dr.  Earl  E.  Barth,  Chicago, 
Illinois. 

3:30  P.M. — “Bacterial  Pneumonias” — Dr.  Fred 
W.  Fitz,  Chicago,  Illinois. 

Tuesday,  September  13 

9:00  A.M. — Dr.  R.  H.  Reeve,  Presiding.  Presi- 
dential Address — Dr.  George  E.  Baker,  Cas- 
per. 

9:30  A.M. — “Legislative  Problems” — Dr.  George 
H.  Phelps,  Cheyenne. 

10:00  A.M. — Mr.  Frank  E.  Smith,  Director  of  the 
Associated  Medical  Care  Plans. 

10:30  A.M.— “Observations  on  Venereal  Disease” 
— Dr.  Edward  Jon  wick.  Hot  Springs,  Arkan- 
sas. 


670 


Rocky  Mountain  Medical  Journal 


Now  Council-Accepted 

MANDELAMINE 

REG  U.  S.  PAT.  OFF. 

BRAND  OF  METHENAMINE  MANDELATE 

Urinary  Antiseptic 


6 


OUTSTANDING 

FEATURES 


M Has  wide  antibacterial  range 
No  supplementary  acidification  re- 
quired (except  where  urea-split- 
ting organisms  occur) 

3 Little  likelihood  of  drug-fastness 

4 Is  exceptionally  well  tolerated 

5 Requires  no  dietary  or  fluid 
regulation 

Simplicity  of  regimen  — 3 or  4 
tablets  t.i.d. 

SUPPLIED: 

Enteric-coated  tablets  of  0.25  Gm. 
(3^  grains)  each,  bottles  of  120, 
500,  and  1,000. 


N E P E RA  CHEMICAL  CO.,  INC. 

N E P E R A PARK  • YONKERS  2,  N.  Y. 


for  August,  1949 


671 


OL 

BROWN  SCHOOLS 

For  Exceptional  Children 

Four  distinct  units.  Tiny  Tots  through 
the  Teens.  Ranch  for  older  hoys.  Spe- 
cial attention  given  to  educational  and 
emotional  difficulties.  Speech,  Music, 
Arts  and  Crafts.  Full  time  Psychologist. 
Under  the  daily  supervision  of  a Certi- 
fied Psychiatrist.  Registered  Nurses. 
Private  swimming  pool,  fireproof 
building.  View  Book.  Summer  Camp. 
Approved  hy  State  Division  of  Special 
Education. 

BERT  P.  BROWN 

President 

Paul  L.  White,  M.D.,  F.A.P.A., 
Medical  Director 

P.  0.  Box  4008,  Austin,  Texas 


Convention  Greetings 

JOT  IT  DOWN! 

WRITE  IT  DOWN! 

CALL  IT  DOWN! 
Ch-5548 
Ch-5549 

For  direct  contact  with  our  prescription 
Department — 

Dial : Cli-5548 

Ch-5549 

Only  registered  pharmacists  answer 
these  'phones. 

(These  ’phones  are  not  listed  in  the. 

directory,  they  are  for  the  Doctors’ 
use  exclusively.) 

And  of  Course  — KE-5377 
in  addition! 

REPUBLIC  DRUG  CO. 

Lobby  Republic  Bldg. 

1600  TREMONT  ST. 

New  Fast  Delivery  Service 

to  All  Parts  of  the  City 


11:00  A.M. — “Use  of  Endocrines  in  Urological 
Practice” — Dr.  D.  R.  Higbee,  Denver,  Colo- 
rado. 

11:30  A.M. — “General  Surgical  Problems  of  the 
Abdomen” — Dr.  C.  F.  Dixon,  Rochester, 
Minnesota. 

12:00  Noon — Luncheon,  Townsend  Hotel. 

1:30-5:00  P.M. — Meeting,  House  of  Delegates, 
Wyoming  State  Medical  Society. 

6:30  P.M. — Cocktail  Hour  and  Banquet,  Crystal 
Room,  Gladstone  Hotel.  Mr.  Harrison  Brew- 
er, Casper  Tribune  Herald,  Toastmaster; 
Mr.  Frank  E.  Smith,  Director,  Associated 
Medical  Care  Plans,  Speaker. 

Wednesday,  September  14 

9:00  A.M. — Dr.  Earl  Whedon,  Presiding.  “Lower 
Alimentary  Tract  Lesions  in  Newborn  Chil- 
dren”— Dr.  L.  Martin  Hardy,  Chicago,  Illi- 
nois. 

9:30  A.M. — “Clinical  Diagnosis  of  Lesions  in 
the  Right  Upper  Quadrant  and  Epigastrium” 
— Dr.  Fred  W.  Fitz,  Chicago,  Illinois. 

10:00  A.M. — “Roentgen  Findings  of  Right  Upper 
Quadrant  Lesions” — Dr.  Earl  E.  Barth,  Chi- 
cago, Illinois. 

10:30  A.M. — “Lesions  of  the  Large  Bowel  in  re- 
lationship to  Gynecology  and  Obstetrics” — 
Dr.  John  W.  Huffman,  Chicago,  Illinois. 

11:00-12:00  A.M. — Meeting,  House  of  Delegates, 
Wyoming  State  Medical  Society. 

PROGRAM,  WOMAN’S  AUXILIARY 

Sunday  Evening,  September  11 — Registration, 
Townsend  Hotel. 

Monday  Morning,  September  12 — Registration, 
Elks  Club. 

Monday  Noon — Bridge  Luncheon,  Empire  Room, 
Henning  Hotel. 

Tuesday  Morning,  September  13 — Annual  Busi- 
ness Meeting,  10:00  A.M.,  Women’s  Club 
Building.  Coffee — 11:00-12:30  A.M. — Wom- 
en’s Club  Dining  Room. 


THIRD  ANNUAL  SOUTHWEST  REGIONAL 
CANCER  CONFERENCE 

The  third  annual  Southwest  Regional  Cancer 
Conference  will  be  held  in  Fort  Worth,  Texas, 
November  9,  1949,  at  the  Blackstone  Hotel,  un- 
der the  auspices  of  the  Tarrant  County  Medical 
Society  and  the  Tarrant  County  Unit,  American 
Cancer  Society.  Guest  speakers  at  the  Con- 
ference will  include:  Merton  M.  Minter,  M.D., 
Internist,  San  Antonio;  R.  A.  Willis,  M.D.,  Path- 
ologist, London;  Stanley  Reinmann,  M.D.,  Re- 
search Pathologist,  Philadelphia;  Norman  Treves, 
M.D.,  Surgeon,  New  York  City;  Danely  P. 
Slaughter,  M.D.,  Surgeon,  Chicago;  Saul  Sugar, 
M.D.,  Ophthalmologist,  Detroit.  The  one-day 
conference  will  consist  of  morning  and  afternoon 
sessions,  a clinical  luncheon  with  an  open  forum 
question  and  answer  period,  and  a public  meet- 
ing in  the  evening.  There  will  be  no  registration 
fee.  Any  other  information  may  be  obtained  by 
writing  the  Tarrant  County  Medical  Society,  209 
Medical  Arts  Building,  Fort  Worth  2,  Texas. 


The  great  majority  of  patients  with  early 
minimal  pulmonary  tuberculosis  have  no  symp- 
toms. At  present,  the  only  method  available  for 
detection  of  the  truly  incipient  tuberculous  le- 
sion is  routine  chest  x-ray  examination  at  pe- 
riodic intervals. — David  Reisner,  Am.  Rev.  Tu- 
berc.,  March,  1948. 


672 


Rocky  Mountain  Medical  Journal 


FROM  SECRETARY  OF  DEFENSE 


AN  URGENT 
APPEAL  TO 
YOUNG  DOCTORS! 


Your  personal  help  is  needed  to  avert  a serious 
threat  to  our  national  security! 

By  the  end  of  July  of  this  year  we  will  have 
lost  almost  one-third  of  the  physicians  and 
dentists  now  serving  with  our  Armed  Forces. 
Without  an  increased  inflow  of  such  per- 
sonnel, the  shortage  will  assume  even  more 
dangerous  proportions  by  December  of  this 
year. 

These  losses  are  due  to  normal  expiration  of 
terms  of  service.  The  professional  men  who 
are  leaving  the  Armed  Forces  during  this 
critical  period  are  doing  so  because  they 
have  fulfilled  their  duty-obligations  and  have 
earned  the  right  to  return  to  civilian  practice. 

Without  sufficient  replacements  for  these 
losses,  we  cannot  continue  to  provide  ade- 
quate medical  and  dental  care  for  the  almost 
1,700,000  service  men  and  women  who  are 
the  backbone  of  our  nation’s  defense. 

Normal  procurement  channels  will  not  provide 
sufficient  replacements! 

To  alleviate  this  critical,  impending  shortage 
of  professional  manpower  in  the  three  serv- 
ices, I am  urging  all  physicians  and  dentists 
who  were  trained  under  wartime  A.  S.  T.  P. 
and  V-12  programs  under  government 
auspices  or  who  were  deferred  in  order  to 
complete  their  training  at  personal  expense, 
and  who  saw  no  active  service,  to  volunteer 
for  a two-year  tour  of  active  duty,  at  once! 


We  have  written  personally  to  more  than 
10,000  of  you  in  the  past  weeks  urging  such 
action.  The  response  to  this  appeal  has  not 
been  encouraging,  and  our  Armed  Forces 
move  rapidly  toward  a professional  man- 
power crisis! 

Many  responses  have  been  negative,  but 
worse — a great  number  of  doctors  have  not 
replied.  It  is  urgent  that  we  hear  from  you 
immediately! 

We  feel  certain  that  you  recognize  an  obligation 
to  your  fellow  men  as  well  as  to  your  profession 
in  this  matter.  We  are  confident  that  you  will 
fulfill  that  obligation  in  the  spirit  of  public 
service  that  is  a tradition  with  the  physician 
and  dentist. 

There  is  much  to  be  said  for  a tom-  of  duty 
with  any  of  the  Armed  Forces.  You  will 
work  and  train  with  leading  men  of  your 
professions.  You  will  have  access  to  abun- 
dant clinical  material;  have  the  best  medical 
and  dental  facilities  in  which  to  practice. 
You  will  expand  your  whole  concept  of  life 
through  travel  and  practice  in  foreign  lands. 
In  many  ways,  a tour  of  service  will  be 
invaluable  to  you  in  later  professional  life! 

Volunteer  now  for  active  duty.  You  are  urged 
to  contact  the  Office  of  Secretary  of  Defense  by 
collect  wire  immediately,  signifying  your  ac- 
ceptance and  date  of  availability.  Your  services 
are  badly  needed.  Will  you  offer  them? 


for  August,  1949 


673 


Cook  County  Graduate 
School  of  Medicine 

ANNOUNCES  CONTINUOUS  COURSES 

SURGERY — Intensive  Course  in  Surgical  Technique, 
Two  Weeks,  starting  August  22,  September  26, 
October  24.  Surgical  Technique,  Surgical  Anatomy 
•and  Clinical  Surgery.  Four  Weeks,  starting  Sep- 
tember 12,  October  10.  Surgical  Anatomy  and 
Clinical  Surgery,  Two  Weeks,  starting  September 
26,  October  24.  Surgery  of  Colon  and  Rectum,  One 
Week,  starting  September  12,  October  10.  Esopha- 
geal Surgery,  One  Week,  starting  October  10. 
Thoracic  Surgery,  One  Week,  starting  October  3. 
Breast  and  Thyroid  Surgery,  One  Week,  starting 
October  10.  Fractures  and  Traumatic  Surgery,  Two 
Weeks,  starting  October  3. 

GYNECOLOGY — Intensive  Course,  Two  Weeks,  start- 
ing September  |26,  October  24.  Vaginal  Approach 
to  Pelvic  Surgery,  One  Week,  starting  September 
19,  November  7. 

OBSTETRICS — Intensive  Course,  Two  Weeks,  start- 
ing September  12,  November  7. 

MEDICINE — Intensive  General  Course,  Two  Weeks, 
starting  October  3.  Gastroenterology,  Two  Weeks, 
starting  October  24.  Gastroscopy,  Two  Weeks, 
starting  September  26,  October  24.  Electrocardiog- 
laphy  and  Heart  Disease,  Four  Weeks,  starting 
September  7. 

DERMATOLOGY — Formal  Course,  Two  Weeks,  start- 
ing October  24.  Informal  Clinical  Course  every 
two  weeks. 

ROENTGENOLOGY — Diagnostic  and  Lecture  Course 
First  Monday  of  every  month.  Clinical  Course 
Third  Monday  of  every  month.  X-Ray  Therapy 
every  two  weeks. 

UROLOGY — Intensive  Course,  Two  Weeks,  starting 
September  26.  Ten  Day  Practical  Course  in  Cysto- 
scopy every  two  weeks. 

GENERAL,  INTENSIVE  AND  SPECIAL  COURSES 
IN  ALL  BRANCHES  OF  MEDICINE,  SURGERY 
AND  THE  SPECIALTIES 
TEACHING  FACULTY-ATTENDING  STAFF  OF 
COOK  COUNTY  HOSPITAL 
Address:  REGISTRAR,  427  South  Honore  Street, 
Chicago  12,  Illinois 


COLORADO 

State  Health  Department 

DEGREE  OF  SEWAGE  TREATMENT 
NECESSARY 

The  need  for  and  the  degree  of  sewage  treat- 
ment depends  upon  the  condition  of  the  receiving 
stream  and  the  use  of  the  water  of  that  stream. 
Primary  treatment  is  indicated  for  all  sewage  be- 
fore it  enters  any  stream  within  the  State  of 
Colorado.  Complete  treatment  will  be  required 
for  the  protection  of  the  stream  in  some  locali- 
ties, and  will  probably  be  necessary  for  the  treat- 
ment of  most  industrial  wastes  before  they  are 
discharged  to  the  streams.  The  streams  of  this 
area  as  compared  with  some  of  those  in  the  high- 
ly industrialized  areas  of  the  eastern  part  of  the 
United  States  would  not  be  considered  badly 
contaminated.  We  must,  however,  prevent  their 
further  contamination  so  that  they  will  not  lose 
their  value  both  from  the  standpoint  of  public 
water  supplies  and  recreation;  we  must  also 
water  supplies  and  recreation. 

Where  the  receiving  stream  has  sufficient  flow 
to  provide  dilution  of  the  effluent  from  the  pri- 
mary treatment  plant  a permit  will  be  issued  by 
the  State  Board  of  Health  for  the  construction  of 
primary  treatment,  only.  This  permit,  however, 
will  be  revoked  in  case  conditions  change  so  that 
the  treatment  is  not  sufficient  to  prevent  a nui- 
sance or  a public  health  hazard  from  occurring 
by  the  discharge  of  the  primary  treatment  plant 
effluent  to  that  stream. 

The  rate  of  flow  of  the  water  and  the  tur- 
bulence of  the  stream  will  influence  the  stream’s 
ability  to  handle  the  partially  treated  sewage 
and  will  effect  the  degree  of  treatment  required. 

The  Division  of  Sanitation  does  not  recommend 
the  construction  of  either  chemical  precipitation 
plants  or  activated  sludge  plants  in  smaller 
towns.  The  efficiency  of  either  type  of  plant 
depends  entirely  upon  the  way  it  is  operated 
and  maintained  and  in  both  instances  a skilled 
operator  is  required  and  the  cost  of  operation  is 
quite  expensive.  A standard  trickling  filter  plant 
will  absorb  a certain  amount  of  overloading  with- 
out upsetting  of  the  process.  This  is  not  true 
with  the  activated  sludge  process  which  will 
practically  cease  functioning  if  it  is  overloaded. 

Where  river  water  is  to  be  used  for  irrigation 
before  the  river  has  a chance  to  make  full  re- 
covery from  the  contamination  caused  by  the 
sewage  plant  effluent,  it  is  probably  desirable 
to  chlorinate  the  sewage  plant  effluent.  Chlo- 
rination of  sewage  without  previous  treatment  is 
of  little  value,  inasmuch  as  the  chlorine  does 
little  more  than  reduce  the  immediate  B.O.D. 
(Biological  Oxygen  Demand)  of  the  waste.  The 
organisms  are  still  present  to  carry  on  the  pu- 
trefaction of  the  organic  material  and  chlorina- 
tion simply  retards  action. 

The  Division  of  Sanitation  will  make  inspec- 
tions and  surveys  of  the  streams  throughout  the 
state  as  rapidly  as  funds  and  personnel  permit 
to  determine  what  degree  of  treatment  will  be 
required  to  improve  the  quality  of  the  streams 
throughout  the  state.  This  cannot  be  accom- 
plished overnight,  but  the  program  is  so  ar- 
ranged that  we  feel  that  satisfactory  progress 
can  be  made.  The  cities  should  not  wait  until 
their  Department  of  Public  Health  orders  the 
construction  of  proper  treatment,  but  should  go 
ahead  with  their  planning,  and  the  Health  De- 
partment will  always  be  ready  and  willing  to 
help. 


674 


Rocky  Mountain  Medical  Journal 


Use  of  a diaphragm  introducer  is  favored  by  many 
patients  who  find  manual  manipulation  objection- 
able or  difficult.  It  facibtates  the  insertion  and  correct 
placement  of  the  diaphragm,  as  well  as  its  removal. 

The  “RAMSES”*  Diaphragm  Introducer  provides 
the  following  features: 

• Simplicity  and  convenience  in  use 

• Safety  — design  minimizes  possibihty  of  injury  to 
the  cervix  or  accidental  insertion  into  the  urethra 


• Smooth  surface  lessens  bacterial  proliferation  — 
makes  for  easy  cleaning 

• Ease  of  removal  assured  by  bluntly  hooked  end 

The  ‘TAMSES”  Diaphragm  Introducer  is  supplied 
in  the  Physician  s Prescription  Packet  No.  501,  with- 
out charge 


TtADEMARK  lEG.  U.S.  PAT.  OFF. 

PHYSICIAN'S  PRESCRIPTION  PACKET  NO.  501 


A complete  unit  for  conception  control.  Contains  (1)  a 
“RAMSES”  Flexible  Cushioned  Diaphragm  of  the  prescribed  size,  (2)  a “RAMSES”  Dia- 
phragm Introducer  of  corresponding  size,  and  (3)  a tube  of  “RAMSES”  Vaginal  Jelly t 
(regular  size). 


• The  word  “RAMSES”  is  a registered  trademark  of  Julius  Schmid,  Inc. 


f Active  Ingredients:  Dodecaethyleneglycol  Monolaurate  5%\ 
Boric  Acid  1%;  Alcohol  5%. 


“RAMSES”  Vaginal  Jelly  is  accepted 
by  the  Council  on  Pharmacy  and 
Chemistry  of  the  American  Medical 
Association.  The  “RAMSES”  Dia- 
phragm and  Diaphragm  Introducer 
are  accepted  by  the  Council  on 
Physical  Medicine  of  the  American 
Medical  Association. 


We  Recommend 

KARG’S  PAINT  CO. 

Lowe  Bros.  Paints  Kem-Tone 

Wall  Paper  Painters’  Supplies 

Art  Supplies 

FREE  DELIVERY  

Phone  CHerry  3779 

620  Santa  Fe  Drive  Denver 


Denver’s  Fireproof 

COLBURN  HOTEL 

D.  B.  Cerise  is  the  genial  Host  and  Manager 

• CONVENIENT  — Located  only  a ten-minute  wcdlc 
from  the  heart  of  the  city. 

• PLEASANT  — Away  from  — above  the  noise  and 
rush  of  downtown  Denver. 

• EXCELLENT  FOOD  — Dining  that  has  satisfied  the 
demanding  tastes  of  all  patrons. 

• Visit  Our  New  Cocktail  Lounge. 

TENTH  AVE.  at  GRANT  ST. 

Phone  MAin  6261  Denver,  Colo. 


RESTAURANT  240 

MISS  M.  E.  GABRIEL,  Prop. 

SERVING  TRADITIONALLY  GOOD 
FOOD  AT  MODERATE  PRICES 

HOURS:  11:00  A.M.— 2:00  P.M.  4:30—7:30  P.M. 
SUNDAYS:  12  Noon  to  7:00  P.M. 

Closed  Wednesdays 

240  Broadway  Denver,  Colo. 

SPruce  2182 


We  Cater  to  the  Medical  Profession 

CASCADE  LAUNDRY 

10  Per  Cent  Discount  If  You  Bring  Your 
Laundry  in 

HAND  DRY  CLEANING 
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DOWNING  and  ALAMEDA 


JuberculosLS  Abstracts 

Issued  Monthly  by  the  National  Tuberculosis 
Association 

Vol.  XXH  AUGUST,  1»49  N».  8 

There  has  been  little  research  directed  at  testing  the 
elticiency  of  mechanical  barriers  to  the  air-borne  pas- 
sage of  tubercle  bacilli.  Yet  the  importance  of  this 
type  of  study  scarcely  needs  to  be  pointed  out  to  the 
physician  and  the  nurse  whose  duties  bring  them  in 
close  contact  with  cases  of  active  tuberculosis. 


THE  EFFICIENCY  OF  GAUZE  MASKS 

Although  there  is  no  certain  knowledge  as  to  the  size 
c.f  the  infectious  particles  concerned  in  the  origin  of 
human  inhalation  tuberculosis,  there  is  considerable 
evidence  to  suggest  that  the.se  are  much  smaller  than 
the  limits  of  ordinary  visibility.  Primary  pulmonary 
tuberculosis  in  man  takes  root  not  in  the  upper  respira- 
tory  passages  but  deep  in  the  lung  parenchyma,  usually 
beneath  the  pleura.  The  effective  pathogenic  units  must 
be  assumed,  therefore,  to  be  smaller  than  the  lumina 
of  the  terminal  bronchioles.  That  the  tubercle-bacilli- 
containing-particles  responsible  for  naturally  acquired 
air-bome  pulmonary  tuberculosis  in  rabbits  are  of 
microscopic  dimensions  is  indicated  by  the  fact  that 
ultraviolet  irradiation  of  the  air  of  a room  contaminated 
by  tubercle  bacilli  protected  rabbits  from  an  air-borne 
contagion  that  caused  progressive  tuberculosis  in  73 
per  cent  of  animals  of  the  same  genetic  resistance 
similarly  exposed  in  an  unirradiated  room.  The  venti- 
lation of  the  irradiated  room  was  such  that  some  of 
the  droplet  nuclei  of  tubercle  bacilli  floating  in  the 
air  were  exposed  to  irradiation  for  only  one  second 
before  inhalation  by  the  exposed  rabbits. 

Therefore,  it  was  not  certain  whether  gauze  masks 
with  pores  of  relatively  large  magnitude,  such  as  may 
be  worn  by  individuals  exposed  to  air-bome  contagion 
of  human  tuberculosis,  would  filter  out  the  dangerous 
invisible  droplet  nuclei  of  tubercle  bacilli.  There  is 
evidence  that  six  layer  gauze  masks,  especially  after 
repeated  washing,  will  remove  bacteria  floating  in  the 
air  without  interfering  with  respiration. 

Miss  Esta  H.  McNett,  of  the  Veterans  Administra- 
tion, designed  a six-layered  gauze  mask  to  be  worn  by 
nurses  engaged  in  the  care  of  tuberculous  patients.  The 
efficiency  of  these  masks  was  studied  in  an  apparatus 
for  quantitative  air-borne  infection  modelled  after  the 
one  described  by  Wells.  The  protective  action  of  the 
gauze  masks  developed  by  Miss  McNett  was  tested 
against  the  quantitative  inhalation  of  droplet  nuclei  of 
tubercle  bacilli  which  regularly  induce  pulmonary  tuber- 
culosis in  rabbits. 

The  essential  feature  of  the  instrument  was  a nebu- 
lizer which  generated  droplet  nuclei  of  tubercle  bacilli. 
Most  of  these  nuclei  contained  isolated  bacilli:  only  oc- 
casionally were  minute  clumps,  not  larger  in  diameter 
than  a red-blood  cell,  liberated  into  the  air.  This  in- 
fected air  was  drawn  into  an  exposure  chamber,  into 
which  tlie  heads  of  rabbits  to  be  exposed  protruded 
through  a close-fitting  collar.  The  infected  air  cir- 
culated past  the  noses  of  the  rabbits  and  wa.s  removed 
through  an  exhaust  pipe. 

Three  and  six-layer  gauze  masks,  40  by  44  threads 
to  the  square  inch,  were  sewn  to  fit  the  contour  of  the 
rabbit’s  head,  neck  and  ears.  The  gauze  in  front  of 
the  rabbit’s  nose  and  mouth  had  no  seams. 

Rabbits  without  masks  and  rabbits  wearing  masks 
were  expo.sed  simultaneously  to  the  inhalation  of  air 
containing  droplet  nuclei  of  virulent  bovine  tubercle 
bacilli  of  the  Ravenel  strain. 

It  was  fotmd  that,  if  all  the  air  respired  by  rabbits 
exposed  to  the  inhalation  of  droplet  nuclei  of  virulent 
bovine  tubercle  bacilli  passes  through  three  or  six- 


676 


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11 


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treatment  and  rehabilitation  to  return  thousands 
of  Alcoholics  to  normal  living.  Groundwork 


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IN  THERAPY 


for  recovery  is  laid  through  intensive, 
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results  since  1935,  have  shown  that  in  over 
3125  cases  reported*,  40%  remained  abstinent 
for  four  years  or  longer.  Our  object  is  . . . 
Cooperation  with  the  family  physician  in 
mapping  the  road  to  recovery. 


1935  TO  1949 

FOR  CHRONIC  ALCOHOLISM 


BY  THE  CONDITIONED  REFLEX  AND  ADJUVANT  METHODS 
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for  August,  1949 


677 


HAVEN 

PHARMACY 


(Formerly  Wilson’s) 

J.  L PANEK,  jR.,  Prop. 


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DRUGS  AND  SUNDRIES 


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We  Make  Free  Prescription  Deliveries 


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DECORATORS 
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layer  gauze  masks,  there  is  a 90  to  95  per  cent  reduc- 
tion in  the  incidence  of  primary  pulmonary  tuberculosis 
foci  which  develop  within  five  weeks.  It  would  follow 
that,  if  the  respired  air  contains  but  a few  bacili,  the 
masked  cUiimal  will  usually  be  protected  ftom  an 
otherwise  fatal  infection.  Twelve  of  twenty  masked 
animals  were  completely  protected  against  air-borne 
contagion  of  such  intensity  that  from  29  to  1,027  tu- 
bercle bacilli  units  were  deposited  in  the  lungs  of 
simultaneously  exposed  unmasked  rabbits. 

Measurements  of  the  thread  diameters  and  interthread 
spaces  of  these  masks  by  H.  Shapiro  showed  that  the 
superimposition  of  three  to  six  layers  of  this  material 
would  occlude  practically  all  of  the  spaces  and  in  this 
way  explain  the  results  of  the  experiments. 

One  must  be  extremely  guarded  in  applying  these 
data  to  the  protection  of  human  beings.  With  the 
rabbits  all  of  the  respired  air  passed  through  the  masks. 
To  be  equally  effective  for  human  beings  e.xposed  to 
air-borne  infection  of  tuberculosis,  masks  must  be  worn 
in  an  equally  effective  manner.  The  masks  protected 
rabbits  from  air  populated  with  droplet  nuclei  of 
tubercle  bacilli  to  a degree  that  would  rarely,  if  ever, 
be  found  in  the  air  respired  by  human  beings.  Humcin 
primary  tuberculosis  usually  originates  as  a single 
pulmonary  focus,  whereas  the  unmasked  rabbits  in  these 
experiments  developed  an  average  of  fifty-one  primary 
tubercles.  Nevertheless,  it  seems  reasonable  to  advise 
persons  wearing  masks  to  refrain  from  deep  inspiration 
which  may  diminish  the  filtering  efficiency  of  the  masks. 

Conversely,  masks  worn  by  coughing  patients  can 
hardly  be  expected  to  retain  the  invisible  droplet  nuclei 
containing  tubercle  bacilli  propelled  through  them  dur- 
ing fits  of  coughing. 

Summary — Under  the  conditions  of  these  experiments, 
from  90  to  95  per  cent  of  pathogenic  droplet  nuclei  of 
virulent  bovine  tubercle  bacilli  in  the  respired  air  can 
be  removed  by  gauze  masks  properly  worn  by  rabbits 
during  quiet  breathing  of  heavily  infected  air. 

The  Efliciency  of  Gauze  Masks.  Max  B.  Lurie,  M.D., 
and  Samuel  Abrahamson,  V.M.D.,  American  Review 
at  Tuberculosis,  January,  1949. 

THE  FACE  MASK  IN  TUBERCULOSIS 

The  major  obstacle  to  the  rapid  expansion  of  better 
care  for  tuberculosis  patients  and  to  the  education  of 
student  nurses  in  tuberculosis  nursing  seems  to  be  the 
recognized  danger  of  contagion.  The  only  known 
methods  of  protection  for  nurses  against  tuberculosis  are: 
BCG  (Bacillus  Calmette  Guerin)  vaccine,  available 
only  to  tuberculin-negative  nurses,  and  communicable 
disease  technic,  based  upon  the  use  of  mechanical  agents 
— cap,  mask,  gown,  and  hand-washing.  None  of  these 
agents  except  the  ma.sk  protects  nurses  and  auxiliary 
workers  from  infection  by  inhalation  which  modem 
medical  opinion  regards  as  one  of  the  most  important 
mechanisms  in  the  transmission  of  tuberculosis. 

The  Face  Mask  in  Tuberculosis.  Esta  H.  McNett, 
R.N.,  American  Journal  of  Nursing,  January,  1949. 

Of  the  deaths  from  respiratory  tuberculosis  in 
1947,  32.1  per  cent  occurred  outside  of  institu- 
tions, and  67.9  per  cent  occurred  in  institutions. 
Of  the  total  respiratory  tuberculosis  deaths,  25.8 
per  cent  occurred  in  general  hospitals,  30.9  per 
cent  in  tuberculosis  hospitals  and  sanatoria,  and 
9.0  per  cent  in  mental  hospitals. — Sara  A.  Lewis 
(biostatistician).  Pub.  Health  Rep.,  April  1,  1949. 


WANTADS 


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Rocky  Mountain  Medical  Journal 


IT’S  NEW 


ALLISON  TABLE 


“Visit  Our  Booths  Nos.  19  and  20 
During  the  79th  Annual  Session” 

☆ 

THE  J.  DURBIN  SURGICAL 
SUPPLY  COMPANY 

1625  Court  Place,  Denver  KEystone  5287 


for  August,  1949 


679 


YOUR  COSMETIC  BUDGET 

During  the  course  of  the  year  you  spend  a certain  sum  of  money  for  beauty 
preparations.  This  sum  of  money  represents  your  Cosmetic  Budget.  As  with  all 
budgets,  it  can  be  spent  intelligently  or  squandered  aimlessly. 

Regardless  of  economic  trends,  it  is  always  wise  to  give  careful  consideration 
to  the  act  of  buying. 

We  suggest  it  is  both  economical  and  more  effective  to  buy  a well-balanced 
cosmetic  service  composed  of  preparations  selected  with  regard  to  your  particular 
requirements  and  preferences,  and  that  you  will  therefore  welcome  the  services 
of  the  Cosmetic  Consultants  who  distribute  our  preparations  in  your  community. 

LUZIER’S  FINE  COSMETICS  AND  PERFUMES 
Are  Distributed  in  Colorado  and  Wyoming  by: 

BURBRIDGE  & BURBRIDGE,  Divisional  Distributors 
519-20  Continental  Bank  Building 
Lincoln,  Nebraska 

District  Distributors 

Elizabeth  Haskin  Baker  & Baker  Cecile  Armstrong 

649  Adams  Delta,  Colo.  1352  Jasmine  St. 

Denver,  Colo.  Denver,  Colo. 

Catherine  Phelps  Nellye  Knight 

Sterling  Hotel  P.  O.  Box  156 

Greeley,  Colo.  Casper,  Wyo. 

Local  Distributors 


Irene  K.  Reece 
1337  Madison 
Denver,  Colo. 


Joyce  Kilgore 

250  Collins 
Pueblo,  Colo. 


Funderburk  & Funderburk 
324  So.  7th  St. 
Grand  Junction,  Colo. 


Selma  Sollee 
1426  Grand  Ave. 
Pueblo,  Colo. 


Phil  and  Fern  Pliley 
P.  O.  Box  902 
Laramie,  Wyo. 


Cecelia  Jenkins 

911  San  Pedro 
Trinidad,  Colo. 


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METROPOLITAN  BUILDING 

A WELL  - KNOWN  ADDRESS 


At  Sixteenth  Street  and  Court  Place-— in  Denver’s 
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AGENTS 

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COISVEISTION  GREETINGS 

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yiiercy  Jiospital 

Conducted  by  the  Sisters  of  Mercy 

School  of  Nursing  in  Connection 

A General  Hospital  Scientifically  Equipped 

1619  Milwaukee  St.,  Denver  FRemont  2771 


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LIVERMORE  SANITARIUM 


• The  Hydropathic  Department 
devoted  to  the  treatment  of  gen- 
eral diseases,  excluding  surgical 
and  acute  infectious  cases.  Special 
attention  given  functional  and  or- 
ganic nervous  diseases.  A well 
equipped  clinical  laboratory  and 
modern  X-ray  Department  are  in 
use  for  diagnosis. 


• The  Cottage  Department  (for 
mental  patients)  has  its  own  fa- 
cilities for  hydropathic  and  other 
treatments.  It  consists  of  small 
cottages  with  homelike  surround- 
ings, permitting  the  segregation  of 
patients  in  accordance  with  the 
type  of  psychosis.  Also  bungalows 
for  individual  patients,  offering 
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tions with  privacy  and  comfort. 


1.  Climatic  advantages  not  excelled  in  United  States.  Beautiful  grounds  and  attractive  surrounding  country. 

2.  Indoor  and  outdoor  gymnastics  under  the  charge  of  an  athletic  director.  An  excellent  Occupational  Department. 

3.  A resident  medical  staff.  A large  and  well-trained  nursing  staff  so  that  each  patient  is  given  careful  individual  attention. 

Information  and  circulars  upon  request.  CITY  OFFICES' 

Address:  O.  B.  JENSEN,  M.D. 

Superintendent  and  Medical  Director  San  FRANCISCO  OAKLAND 

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for  August,  1949 


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1700  E.  6th  Ave.  EAst  7743 

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Kincaid^s  Pharmacy 

JESS  L.  KINCAID,  Prop. 

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Phone  Lakewood  436 
LAKEWOOD,  COLORADO 

ROBERTS  PHARMACY 

East  23rd  Ave.  at  Onedia  St. 

Phones:  EAst  7783-EAst  7784 

D.  Lyall  Roberts,  Prop. 

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EARNEST  DRUG  COMPANY 

T.  H.  BRAYD'EN,  Prop. 

PRESCRIPTION  SPECIALISTS 
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Denver,  Colorado 

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HYDE’S  PHARMACY 

ACCURATE  PRESCRIPTIONS 

Chas  W.  Hyde,  Prop. 

Rocky  Mountain  Distributor  for  Sherman 
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21  Years  in  the  Heart  of  North  Denver 

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PRESCRIPTIONS  ACCURATELY 
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We  Recommend 

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DRUG  COMPANY 

Alfred  C.  Andersen,  Owner  and  Manager 
Prescriptions  Accurately  Compounded 
Drugs  - - - Sundries 

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763  South  University  Boulevard 

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WE  RECOMMEND 

Whittaker’s  Pharmacy 

“The  Friendly  Store" 

PRESCRIPTION  SPECIALISTS 

West  32nd  and  Perry,  Denver,  Colo. 
Phone  GLendale  2401 

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WALTERS  DRUG  STORE 
801  COLORADO  BLVD. 
Denver,  Colorado 

'A 

Telephone  FRemont  5391 


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A 

Colfax  and  Elm  Denver,  Colorado 

Phone  EAst  1814 


We  Recommend 

VAN'S  PHARMACY 

THOS.  A.  VANDERBUR 

Prescriptions,  Dmes,  Cosmetics,  Magrasines 
Sundries  Excellent  Fountain  Service 

2859  ITmatllla  St.,  Cor.  29th  Ave.  at  Umatilla 
GRand  7044  Denver,  Colo. 


Dansberry’s  Pharmacy 

“New  Ultra  Modern  Prescription  Service” 
JAMES  F.  DANSBERRY 
Owner  and  Manager 

Champa  at  14th  Street  Denver,  Colorado 
Phone  KEystone  469 


Harl  Cleveland,  Owner 

CLEVELAND  PHARMACY 

W.  2Pth  Ave.  at  Speer  Ph.  GL.  9272 

Modem  Prescription  Department 
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HOURS:  Week  Days.  8 a.m.  to  10  p.m. 

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Prescriptions  Delivered  Promptly 


WE  RECOMMEND 

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R.  W.  Holtgren,  Prop. 
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West  Colfax  at  Wadsworth 
Lakewood  Colorado 

Phone  Lakewood  65 


Downing  Street  Pharmacy 

GEORGE  M.  HILL,  Prop. 

PROFESSIONAL  PHARMACIST 

901  Downing  St.  Denver,  Colo. 

Phone  CHerry  2767 

Complete  Merchandise  Line 
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East  Denver’s  Prescription  Drug  Store 


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Bert  C.  Corgan,  Prop. 
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KEystone  7241 


OVERSTAKE’S  PHARMACY 

Gail  E.  Overstake 
Prescription  Specialists 

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We  Deliver 

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PROFESSIONAL  MEN  RECOMMEND 

D.  MALCOLM  CAREY,  Pharmacist 

Phone  AComa  3711 

224  Sixteenth  Street  Denver,  Colorado 


.ilSIlllIM 


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685 


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in  the 

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For  other  iaforaotion  write  or  call 

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Kirkland,  Wash. 

Situated  one  mile  north  of  Juanita 

TREATING  NERVOUS  AND 
MENTAL  DISEASES 

Beautiful  and  restful  surroundings  affording 
recreational  facilities.  Cottage  plan  for  segre- 
gation of  patients.  Insulin  and  Electro-shock 
Therapy  when  indicated. 

Attending  Physicians 
FREDERICK  LEMERE,  M.D. 

NATHAN  K.  RICKLES,  M.D. 

JAMES  H.  LASATER,  M.D. 

MORTON  E.  BASSAN,  M.D. 

JACK  J.  KLEIN,  M.D. 

Manager:  A.  G.  HUGHES 
Route  2,  Box  365,  Kirkland 
Phone:  Kirkland  2391 


WESTERN  ELECTRIC 

HEARING  AIDS 

Engineered  by  Bell  Telephone  Laboratories 


686 


Rocky  Mountain  Medical  Journal 


A private  hospital  for  the  scientific  treatment  of  neuro-psychiatric  disorders,  including 
alcoholism  and  drug  addiction.  Beautiful  landscaping  and  home-like  surroundings  afford 
a restful  atmosphere.  Accommodations  vary  from  single  rooms  with  or  without  bath  to 
rooms  en  suite,  allowing  for  segregation  of  guests. 


Detailed  information  furnished  on  request. 

Karl  J.  Waggener,  M.D.  Wendell  T.  Wingett,  M.D. 


THE  CHILDREN’S  HOSPITAL  ASSOCIATION 

of  DENVER 

NON-SECTARIAN NON-PROFIT 

Providing  medicinal  and  surgical  aid  to  sick  and  crippled  children  of  the  Rocky 
Mountain  Region  from  Birth  to  Maturity 

Every  modern  scientific  aid  available  to  the  physicians  and  surgeons 
of  Colorado  and  Wyoming 

Approved  by  the  American  Medical  Association  and  Full  Three-Year 

the  American  College  of  Surgeons  Nurses’  Training  Course 


for  August,  1949 


687 


W.D.I^ocL 

Ambulance 

Service 


Prompt,  Careful  and  Courteous 
Serving  Denver  25  Years 

Approvedi  by  Physician*  Oenerally 

ISth  Ave.  at  Gilpin  St.,  Phone  EA.  7733 


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Surgical  Supports  Expertly  Fitted. 

Miss  Mabel  P.  Cliff,  Authorized  Fitter 


2). 


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Stodghiirs  Imperial  Pharmacy 

Prescriptions  Exclusively 

For  your  prescriptions  we  stock  a complete  line  of  ALMAY — non-allergic— cosmetics. 

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319  16th  St.  TAbor4231  Denver,  Colo. 


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Medical  Publications  of  AU  PuhUshers 
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Rocky  Mountain  Medical  Journal 


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MEDICAL  CENTER 
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PHOTOELECTRIC  COLORIMETERS 

Leading  makes  of  photoelectric  colorimeters  with  and 
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Prompt  delivery  can  usually  be  made  on: 

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Rocky  Mountain  Medical  Journal 


Technical  Equipment  Corporation 

2548  West  29th  Avenue 

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New,  Modern,  Drug  Store  Service 

PRESCRIPTIONS  A SPECIALTY 
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DENVER 


Bonita  Pharmacy 

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Prescription  Pharmacists 

6th  Avenue  at  St.  Paul  Street 
"RICHT-A-WAY”  SERVICE 

GERALD  P.  MOORE,  Manager 
Phone  FRemont  2797 


30  ^eari  of  ^tliicai  Prescription 

Service  to  the  2^octorS  of  C^lie^enne 


ROEDEL’S 

PRESCRIPTION  DRUG  STORE 

CHEYENNE,  WYOMING 


-for  August,  1949 


691 


St,  Anthony  Hospital 

Write  or  Phone  Registrar  for  Information 

West  16th  Ave.  and  Perry  AComa  1761 

Denver,  Colorado 


DAVIS  BROS.  DRUG  CO. 

WHOLESALE  DRUGS 

1628  15th  Street,  Denver,  Colorado  Phone  KEystone  5131 


H.  C.  Stapleton  Drug  Company 

Service  Wholesalers  for  the  Prescription  Department 
RAPID— INTELLIGENT-SERVICE 

1252-54  Arapahoe  St.,  Denver,  Colo.  Phone  MAin  4152 


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All  Types  and  Makes 

FOR  RENT  OR  FOR  SALE 
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614  27th  St.  TAbor  5121 


692 


Rocky  Mountain  Medical  Journal 


Presbyterian  hospital 

Nineteenth  Avenue  and  Gilpin  Street,  Denver,  Colorado 

A General  Hospital  for  Surgical,  Medical  or  Maternity  Cases 

One  hundred  sixty  beds  and  twenty-five  bassinets.  Fireproof.  Telephone  service  to  every 
bed.  Hot  and  cold  running  water  and  toilet  service  in  every  room.  Complete  laboratory 
and  x-ray.  facilities,  including  x-ray  therapy.  Inquiries  welcomed. 


ATTENTION,  DOCTORS 

DURING  YOUR  CONVENTION  AND  STAY,  IT’S 

REYNOLDS  - URLINC 

Exclusive  Service 

FORD  — MERCURY  — LINCOLN 

2014  Welton  Street  AComa  0262 

Denver,  Colorado 


SHIRLEY-SAVOY  HOTEL 

At  Your  Service 

New  Lincoln  Auditorium  and  Private  Dining  Room 
Ed  C.  Bennett,  Manager  J.  Edgar  Smith,  President  Ike  Walton,  Managing  Dir. 
Broadway  and  East  17th  Ave.,  Denver,  Colo.  TAbor  2151 


UTUR  ALLY 
FORTIFIED 

An  evaporated  milk  of  high  qual- 
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developed  especially  for  infant 
feeding.  It  is  fortified  (from  the 
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units  vitamin  D and  2000  U.S.P. 
units  vitamin  A per  reconstituted 
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M 0 R HI  I HI 


NEWTON  OPTICAL  COMPANY 

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Phone  KEystone  0806 

Catering  to  Medical  Pioiession  Patronage 

A TELEPHONE  SERVICE 
THAT’S  INVALUABLE 

TO  PROFESSIONAL  MEN 

The  Physicians  & Surgeons  Exchange 

965  Gas  & Electric  Bldg.  KE.  8173 

We  take  your  phone  calls — get  them 
to  you.  On  the  job  24  hours  every  day. 

HOPWOOD  STUDIOS 

Commercial  Photographers 

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DENVER,  COLORADO 

WHEATRIDGE  FARM  DAIRY 

COMPLETE  LINE  OF  GRADE  A 

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Special  Milk  for  Babies 
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We  Welcome  the  Business  of  the  Doctors  and  the  Hospitals 

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Joe  Lynch.,  Sr.  Joe  Lynch,  Jr. 

LICENSED  AND  BONDED  ELECTRICAL  CONTRACTING 

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REPAIRING,  CHROME  PLATING  AND  ELECTRICAL  REPAIRS 
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Rocky  Mountain  Medical  Journal 


r 

! 


:7 

ft. 


I 


I 

i 

• V 

I 

I 


Index  to  Advertisers 


Page 


Abbott  Laboratories  663 

Alba  Dairy  690 

American  Medical  and  Dental 
Association  608 

Ayerst,  McKenna  & Harrison_661 

Blair  X-Ray  Company 689 

Bonita  Pharmacy  691 

Bonnie-Brae  Drug  684 

Brown  Schools  672 

Burroughs  Wellcome  & Co — 613 

Cambridge  Dairy  604 

Camel  Cigarette  605 

Camp  & Co.,  S.  H 659 

Capital  Chevrolet 674 

Cascade  Laundry 676 

Children’s  Hospital  Assn 687 

Church  & Company 688 

City  Park  Dairy 610 

Cleveland  Pharmacy  685 

Colburn  Hotel  676 

Colorado  Artificial  Limb  Co., 
The 682 

Colorado  Springs 

Psychopathic  Hospital 696 

Colorado  State  Bank 696 

Colvin  Medical  Books 688 

Continental  Casualty  Co 665 

Cook  County  Graduate 

School  of  Medicine 674 

Country  Club  Pharmacy 684 

Cutter  Laboratories  6i55 

Dansberry’s  Pharmacy 685 

Davis  Bros.  Drug  Company 692 

Deep  Rock  Water 692 

Dellinger,  Lee  W , 682 

Denver  Fire  Clay  Co.,  The 690 

Denver  Oxygen  Co 612 

Denver  Surgical  Suppily  Co 688 

Denver  Tent  & Awning  Co 682 

Denver  Towel  Supply  Co 690 

Dorr  Optical  Co 614 

Downing  Street  Pharmacy 685 

Doyle’s  Pharmacy  684 

Durbin  Surgical  Supply  Co 679 


Page 


Earnest  Drug  Company 684 

Ehret  Engraving  Co._, 612 

Fairfax  Sanitarium  686 

Fairhaven  Maternity 

Hospital  604 

Fleet,  C.  B.  Company,  Inc 657 

Franklin  Drug  Company 685 

Glockner  Penrose  Hospital 6S6 

Haven  Pharmacy  678 

Hopwood  Studios  694 

Hyde’s  Pharmacy 684 

Jackson’s  Cut  Rate  Drug 676 

Karg  Paint  Co 676 

Kendrick-Bellamy  Co 602 

Kincaid’s  Pharmacy 684 

Lakewood  Pharmacy 685 

Lederle  Laboratories  611 

Lilly,  Eli  & Co. 

Insert  Between  616-617 

Livermore  Sanitarium  683 

Luzier’s,  Inc.  . 680 

Lynch  Electric  Company 694 

Malone  Drug  Store 691 

Mead,  Johnson  & Co Cover  IV 

Medical  Center  Pharmacy 690 

Mercy  Hospital 682 

Metropolitan  Building  681 

Morning  Milk  693 

Nepera  Chemical  Co.,  Inc 671 

Nestle  Company,  Inc.,  The 609 

Newton  Optical  Company 694 

Otto  Drug  Co 684 

Overstake’s  Pharmacy  j685 

Park  Floral  Company 612 

Parke,  Davis  & Co._Cover  11-601 

Physicians  and  Surgeons 

Supply  691 

Physicians  and  Surgeons 

'Telephone  Service  Exch 694 

Pierre  Roofing  Company 678 

Presbyterian  Hospital  693 

Professional  Pharmacy 685 

Reed’s  Ambulances  682 

Republic  Building Cover  III 


Page 


Republic  Drug  Company 672 

Restaurant  240  676 

Reynolds-Urling  693 

Roberts  Pharmacy  684 

Roche  Ambulance  Service 688 

Rockmont  Envelope  Co 683 

Roedel’s  Prescription  Drug_-691 

St.  Anthony  Hospital 692 

St.  Mary  Hospital 694 

Scherlng  Corporation  607 

Schmid,  Julius,  Inc 675 

Searle,  G.  D.  & Co 653 

Shadel  Sanitarium 677 

Shadford-Fletcher  Optical  Co. 610 

Shirley-Savoy  Hotel 693 

Shumake  Drug,  Guido 684 

Smith-Dorsey  Company,  The_669 

Stdpleton,  H.  C.  Drug  Co 692 

Starco  Products  Company 696 

Stodgill’s  Imperial 

Pharmacy  688 

Surgical  Specialties 694 


Technical  Equipment  Corp 691 

Telephone  Answering  Service  604 


Thornton,  George  R 602 

Udry,  Edward  G.  Agency 696 

United  States  Army 673 

United  States  Brewing 

Industry  670 

Upjohn  Company,  The 615 

Van’s  Pharmacy  ! 685 

Walter’s  Drug  Store 685 

Wander  Company 616 

Wantads  678 

Weiss  Drug ; 685 

Weiss,  Paul 686 

Western  Electric 

Hearing  Aids  686 

Wheatridge  Farm  Dairy 694 

Whittaker’s  Pharmacy 684 

Winthrop-Stearns,  Inc. 603 

Woodcroft  Hospital  687 

York  Pharmacy 690 


l- 


kt;:  jor  August,  1949 

I. 


COLu-.  , 

OF 


:iAr(iS 


ATTEISTIOIS! 

Members  of  Colo.  State  Medical 
Society  Not  Already  Enrolled! 

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A Private  Hospital  lor  Nervous  and  Mental  Diseases 

Situated  in  a beautiful  valley  two  miles  south  of  Colorado  Springs,  which  is  nationally  known  as  a health 
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C.  F.  Rice,  Saperintendent,  Colorado  Sptrincra,  Colorado 


696 


Rocky  Mountain  Medical  Journal 


Denver's  Outstanding 
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THE  REPUBLIC  BUILDING 


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. . . FOR  38  YEARS  COW’S  MILK -DEXTRI-MALTOSE  FORMULAS 
HAVE  BEEN  EMPLOYED  BY  PHYSICIANS  TO  MEET  THE  VARY- 
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WITH  EVAPORATED  MILK 


Anterior  Resection  or  Abdominoperineal  Proc- 
tosigmoidectomy FOR  CaRINOMA  of  THE  ReCTUM 
— Harry  E.  Bacon,  M.D.,  and  Howard  D.  Trimpi, 
M.D.,  Philadelphia. 

Purulent  Meningitis  in  Childhood — F.  Howell 
Wright,  M.D.,  Chicago. 

Changing  Conceptions  in  the  Management  of 
Carcinoma  of  the  Left  Portion  of  the  Colon — 
B.  Harden  Black,  M.D.,  Rochester,  Minn. 

The  Use  and  Abuse  of  Spinal  Puncture  and  Cere- 
brospinal Fluid  Studies — Alexander  C.  Johnson, 
M.D.,  Great  Falls. 

Surgical  Diseases  of  the  Thyroid  Gland — Samuel 
B.  Childs,  M.D.,  Denver. 

“Eleoma”  of  the  Rectum — William  B.  Swigert, 
M.D.,  Denver. 

Botulism  in  Human  Beings — Delmer  E.  Johnson, 
M.D.,  Alamosa,  and  Geo.  W.  Styles,  M.D.,  Den- 
ver. 

The  Use  of  Nisulfazole  in  the  Treatment  of 
Ulcerative  Colitis — C.  B.  Wills,  M.D.,  Denver. 

Remote  Recording  of  Physiological  Data  by 
Radio — Norman  J.  Holter,  M.A.,  M.S.,  Helena. 


25c  Per  Copy 


$2.50  Per  Year 


criteria  in 


syphilotherapy 


mapharsen 


“Therefore,  more  than  in  any  other  disease,  it  is  necessary  in  the 
treatment  of  an  individual  patient  with  syphilis  to  follow  a thera- 
peutic regimen  which,  after  long-term  study  in  large  series  of 
patients,  has  been  established  as  satisfactory  for  the  particular 
type  of  syphilis  under  consideration/’* 


I 


long-term  study 

more  than  a decade  of  clinical  evaluation. 


large  series  of  patients 

over  two  hundred  million  injections  already  administered. 


satisfactory 

high  therapeutic  effectiveness  with  notable  safety  in  causing  dis- 
appearance of  spirochetes,  healing  of  lesions  and  reversal  of  sero- 
positivity  in  a large  percentage  of  cases. 

MAPHARSEN  ( oxophenarsine  hydrochloride,  P.  D.  & Co.)  is  supplied  in 
single  dose  ampoules  of  0.04  Cm.  and  0.06  Gm.,  boxes  of  10,  and  in  mul- 
tiple dose  ampoules  of  0.6  Gm.  in  boxes  of  10. 

* Cecil,  R.  A.:  A Textbook  of  Medicine.  Philadelphia,  W.  B.  Saunders  Co.,  1947,  p.  376. 


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Table  of  Contents 


VOLUME  46  NUMBER  9 

SEPTEMBER,  1949 


Editorials 


Medical  Reporting  in  the  Lay  Press 713 

Fate  of  Damaged  Mammary  Ducts 714 

Now  That  Vacation  Days  Are  Over 714 

Silhouettes  From  the  A.M.A.  House  of 
Delegates 715 


• Most  widely  used  stenographic  and  clerical 
chair  in  the  world.  Has  five  adjustments  to  fit 
tall,  short,  thin  or  stout  persons,  and  provide 
good  seating  posture.  Comfortable — shaped  seat 
and  back  both  cushioned  with  foam  rubber.  Re- 
duces fatigue,  promotes  health,  improves  morale. 

• Made  of  aluminum,  will  last  indefinitely.  Mfd. 
by  Gieneral  Fireproofing  Company,  sold  in  Den- 
ver exclusively  by  Kendrick-Bellamy. 

Try  It  Now  — Phone  KE.  0241 

sMmyChie^- 

KEystone 

1641  California  St.  Denver  2,  Colorado 


Qeo-.  R,. 

Orthopedic  Brace 
and  Appliance  Co. 

1628  Court  Place  MAin  3026 

Write  for  Measuring  Chart 


-f 


Original  Articles 

Anterior  Resection  or  Abdominoperineal 
Proctosigmoidectomy  for  Carcinoma  of 
the  Rectum,  Harry  E.  Bacon,  M.D.,  and 

Howard  D.  Trimpi,  M.D 716 

Purulent  Meningitis  in  Childhood,  F. 

Howell  Wright,  M.D 718 

Changing  Conceptions  in  the  Management 
of  Carcinoma  of  the  Left  Portion  of  the 

Colon,  B.  Marden  Black,  M.D 726 

The  Use  and  Abuse  of  Spinal  Puncture 
and  Cerebrospinal  Fluid  Studies,  Alex- 
ander C.  Johnson,  M.D 730 

Surgical  Diseases  of  the  Thyroid  Gland, 

Samuel  B.  Childs,  M.D 734 

“Eleoma”  of  the  Rectum,  William  B.  Swi- 

gert,  M.D 739 

Botulism  in  Human  Beings,  Delmar  E. 

Johnson,  M.D.,  and  Geo.  W.  Styles,  M.D...  740 
The  Use  of  Nisulfazole  in  Treatment  of 

Ulcerative  Colitis,  C.  B.  Wills,  M.D 743 

Remote  Recording  of  Physiological  Data 
by  Radio,  Norman  J.  Holter,  M.A.,  M.S., 


Case  Report 

Acute  Diffuse  Interstitial  Fibrosis  of  the 
Lung,  J.  A.  Weaver,  Jr.,  M.D 751 


Organization 

Colorado 

Obituaries  756 

New  Mexico 

Albuquerque  Plans  Joint  Meeting  in  No- 
vember   756 

Utah 

Obituary  758 

Colorado  Medical  School  Notes 758 

Colorado  State  Health  Department 760 

Tuberculosis  Abstracts  762 

Book  Corner 764 


698 


Rocky  Mountain  Medical  Journal 


w 


New  yoBK  13,  N:  Y.  WiNDsm,  Om. 


A conservative  estimate  places 
the  incidence  of  peptic  ulcers 
at  5 per  cent  of  the  U.  S.  population* 


PEPTIC  ULCERS. 


The  great  majority  of  this  vast  group  of  patients 
need  o yeor-in  and  year-out  program  of  rest, 
diet  and  acid  neutralization. 

Creqmalin,  the  first  aluminum  hydroxide  gel, 
readily  and  safely  produces  sustained  reduction 
in  gastric  acidity.  With  Creamalin  there  is  no 
compensatory  reaction  by  the  gastric  mucosa,  no 
acid  "rebound,"  and  no  risk  of  alkalosis.  Through 
the  formation  of  a protective  coating  and  a mild 
astringent  effect,  nonabsorbable  Creamalin 
soothes  the  irritated  gastric  mucosa.  Thus  it 
rapidly  relieves  gastric  pain,  speeds  heal- 
ing and  helps  to  prevent  recurrence. 

AVERAGE  DOSE:  2 to  4 teaspoonfuls 
in  V2  glass  of  milk  or  water  every 
two  to  four  hours. 

Supplied  in  8 fl.  oz.,  12  fl.  oz. 


WINTHROP-STEARNS 


Trademork  Reg.  U.  S.  Pat.  Off.  & Canada  . 


' * Bureau  of  Health  Edueation.  A.M.A.  Hygeia,  24:352.  May,  1946. 


L 


ROCKY  MOUNTAIN  MEDICAL  JOURNAL 

Title  Registered,  U.S.  Patent  Office 
Publication  Office: 

835  Republic  Building  (1612  Tremont  Plage),  Denver  2,  Colorado 
Telephone  C Kerry  5521. 

EDITORIAL  BOARD 

Colorado:  Douglas  W.  Macomber,  M.D.,  Scientific  Editor,  1820  Gilpin  St.,  Denver;  Lyman  W.  Mason, 
M.D.,  Associate  Editor,  1214  Republic  Bldg.,  Denver,  (Chairman  of  Editorial  Board). 

Montana:  Raymond  F.  Peterson,  M.D.,  Scientific  Editor,  Butte,  Mont.;  Herbert  T.  Caraway,  M.D., 
Associate  Editor,  Billings,  Mont. 

New  Mexico:  Carl  H.  Gellenthein,  M.D.,  Scientific  Editor,  Valmora,  New  Mexico;  Harold  L.  Janu- 
ary, M.D.,  Associate  Editor,  First  National  Bank  Bldg.,  Albuquerque,  New  Mexico. 

Utah:  Richard  P.  Middleton,  M.D.,  Scientific  Editor,  Boston  Bldg.,  Salt  Lake  City;  W.  H.  Tibbals, 
Associate  Editor,  42  South  Fifth  East  St.,  Salt  Lake  City. 

Wyoming:  Earl  Whedon,  M.D.,  Scientific  Editor,  Sheridan;  Arthur  R.  Abbey,  Associate  Editor,  P.O. 
Box  897,  Cheyenne. 


Managing  Editor:  Harvey  T.  Sethman,  835  Republic  Bldg.,  Denver. 
Business  Manager:  Helen  Kearney,  835  Republic  Bldg.,  Denver. 


Ownership  and  Sponsorship.  The  Hocky  Mountain 
Medical  Journal  is  owned  by  the  Colorado  State 
Medical  Society  and  is  published  monthly  as  a non- 
profit enterprise  for  the  mutual  benefit  of  the  or- 
ganizations which  jointly  sponsor  It.  It  Is  published 
under  the  direction  of  the  Board  of  Trustees  of  the 
Colorado  State  Medical  Society,  assisted  by  an  Edi- 
torial Board  representing  the  sponsoring  organiza- 
tions. It  is  the  Official  Journal  of  the  Colorado  State 
Medical  Society,  the  Montana  State  Medical  Associa- 
tion, the  New  Mexico  Medical  Society,  the  Utah 
State  Medical  Association,  the  Wyoming  State  Medi- 
cal Society,  the  Rocky  Mountain  Medical  Conference, 
and  the  Colorado  Hospital  Association. 

Manuscripts:  Scientific  Articles,  Case  Reports,  etc., 
from  any  state  for  which  this  is  the  Official  Journal 
should  be  submitted  to  the  Scientific  Editor  for  that 
state  as  named  in  the  Editorial  Board,  above.  Other 
material  from  any  participating  state  should  be  sub- 
mitted to  the  Associate  Editor  for  that  state  as 
named  above.  Manuscripts  from  outside  the  Rocky 
Mountain  area  should  be  sent  direct  to  the  Journal 
office.  Manuscripts  must  be  typewritten,  double  or 
triple  spaced,  using  only  one  side  of  each  sheet.  It 
is  the  policy  of  this  Journal  to  omit  bibliographies. 


Advertising:  National  representatives:  The  Coop- 
erative Medical  Advertising  Bureau,  535  North  Dear- 
born Street,  Chicago  10,  111.  Local  advertising  from 
firms  in  the  Rocky  Mountain  area  should  be  submit- 
ted to  the  Associate  Editor  of  the  appropriate  state 
or  to  the  Journal  office.  Advertising  forms  close  on 
the  20th  of  the  month  preceding  publication;  allow 
ten  days  additional  to  insure  submitting  proofs  for 
approval. 

Subscription:  $2.50  per  year  in  advance,  postpaid  in 
the  United  States  and  its  possessions;  single  copy, 
25  cents  plus  postage.  Subscription  is  included  in 
medical  society  dues  of  sponsoring  state  medical 
organizations. 

Copyright:  This  Journal  is  copyright,  1949,  by  the 
Colorado  State  Medical  Society.  Requests  for  permis- 
sion to  reproduce  anything  from  the  columns  of  this 
Journal  should  be  addressed  to  the  Journal  office. 

Second  Class  Matter:  Entered  as  second  class  mat- 
ter Jan.  22,  1906,  at  the  Postoffice  at  Denver,  Colo., 
under  the  Act  of  Congress  of  March  3,  IS?®.  Accepted 
for  mailing  at  special  rates  of  postage  provided  for 
in  Section  1103,  Act  of  Oct.  3,  1917;  authorized  July 
17,  1918. 


The  Fairhaven  Maternity  Hospital 


Mrs.  H.  E.  Lowther,  Superintendent 


Seclusion  for  the  unwed  mother. 


1349  JOSEPHINE 


DExter  1411 


Write  for  descriptive  booklet. 

DENVER 


Don't  miss  important  telephone  calls 

. Let  us  act  as  your  secretaty  while  you  are  away,  day  or  night: 
^ our  kindly  voice  conscientiously  tends  your  telephone  business, 

accurately  reports  to  you  when  you  return. 

Telephone  ANSWERING  Service  call  ALpine  mm 


Cambridge  Dairy  Grade  “A”  Milk  Is  Produced  and  Processed  at  690  S.  Colo.  Blvd. 

We  do  not  handle  Shipped-in  Milk  produced  Where?  How  and  by  Whom?  Doctors  know  the  difference 
Now  Homogenized  Vitamin  D Milk  is  available  for  baby  feeding  and  family  use. 

We  Invite  Your  Inspection  and  Appreciate  Your  Recommendation. 


30-DAY  TEST  REVEALED 

^^Not  one  single  case  of 
throat  irritation  due  to 

smoking  CAMELS! 


Yes,  that’s  what  throat 
specialists  reported  after 
making  weekly  examina- 
tions of  the  throats  of 
hundreds  of  men  and 
women  from  coast  to 
coast  who  smoked  Camels, 
and  only  Camels,  for  30 
consecutive  days. 


iff 


iii 


According  to  a Nationwide  survey 


R.  J.  Reynolds 
Tobacco  Co., 
Winston-Salem, 
N.C. 


More  Doctors  Smoke  CAMELS 


than  any  other  cigarette 

Doctors  smoke  for  pleasure,  too ! When  three  leading  independent  research  organizations 
asked  113,597  doctors  what  cigarette  they  smoked,  the  brand  named  most  was  Camel! 

^or  September,  1949 


701 


THE  COLORADO  STATE  MEDICAL  SOCIETY 


Next  Annual  Session:  Shirley-Savoy  Hotel,  Denver;  Sept.  20,  21,  22,  23,  1949 


OFFICERS 

Terms  of  Officers  and  Committees  expire  at  the  Aimual  Session 
in  the  year  indicated.  Where  no  year  Is  indicated,  the  term 
is  for  one  year  only  and  expires  at  the  1949  Annual  Session. 

President;  Casper  F.  Hegner,  Denver. 

President-elect:  Fred  A.  Humphrey,  Fort  Collins. 

Vice  President:  Lester  L.  Ward.  Pueblo. 

Constitutional  Secretary  (three  years):  George  K.  Buck,  Denver,  1951. 
Treasurer  (three  years):  George  C.  Shivers,  Colorado  Springs,  1950. 

Additional  Trustees  (three  years);  Ervin  A.  Hinds,  Denver,  1949;  E.  H. 
Munro,  Grand  Jurction,  1949;  S.  P.  Newman,  Denver,  1950;  Claude  D. 
Bonham.  Boulder,  1951. 

(The  above  nine  officers  compose  the  Board  of  Trustees  of  which  Dr. 
Ervin  A.  Hinds  Is  the  1948-1949  Chairman.) 

Board  of  Councilors  (three  years):  District  No.  1:  Clemens  F.  EaUns, 
Brush,  1951;  No.  2:  Ella  A.  Mead,  Greeley,  1951;  No.  3:  L.  G.  Crosby, 
Denver,  1951;  No.  4;  Lannlng  E.  Likes,  Lamar,  1950;  No.  5:  Guy  H. 
Hopkins.  Pueblo,  1950;  No.  6;  Lester  E.  Thompson,  Sallda,  1950;  No.  7: 
A.  L.  Burnett,  Durango.  1949;  No.  8;  Lavrrence  L.  Hick,  Delta,  1949; 
No.  9:  W.  W.  Sloan,  Hayden,  1949  (Chairman  of  Board  for  1948-49). 

Board  of  Sopervlson  (two  years):  A.  B.  OJellum,  Del  Norte,  1949;  L.  W. 
Lloyd,  Durango,  1949;  R.  G.  Hewlett,  Golden,  1949;  Scott  A.  Gale, 
Pueblo,  1949;  L.  D.  Dickey,  Fort  CoUlns,  1949;  N.  A.  Madler,  Greeley, 
1949  (Chairman  of  Board  for  1948-49);  L.  D.  Buchanan,  Wray,  1950; 
W.  F.  Deal,  Craig,  1950;  0.  C.  Cary,  Grand  Junction,  1950;  W.  A. 
Campbell,  Colorado  Springs,  1950;  Ralph  S.  Johnston,  Sr.,  La  Junta, 
1950;  William  A.  Liggett,  Denver,  1950,  Secretary. 

Delegates  to  American  Medical  Association  (two  years) : George  A.  Dnfug, 
Pueblo,  1949  (Alternate:  Herman  C.  Graves,  Grand  Junction,  1949); 
William  H.  Halley.  Denver,  1960  (Alternate:  Kenneth  C.  Sawyer,  Denver, 
1950). 

Foundation  Advocate:  Walter  W.  King,  Deotw. 

Executive  Office  Staff:  Mr.  Harvey  T.  Sethman,  Executive  Secretary: 
Hiss  Helen  Kearney,  Assistant  Executive  Secretary;  Mr.  Evan  A.  Edwards, 
Field  Secretary;  MIm  Mary  E.  McDonald,  Committee  Secretary;  835  Be- 
oubllc  Building,  Denver  2,  Colo.,  Telephone  CHerry  5521. 

General  Counsel;  Mr.  J.  Peter  Nordlund,  Attomey-at-Law,  Denver. 

STANDING  COMMITTEES 

Credentials:  George  R.  Buck,  Denver,  Chairman,  ex-officio;  Harold  E. 
Haymond,  Greeley;  E.  C.  Likes,  Lamar;  Scott  A.  Gale,  Pueblo;  J.  L. 
McDonald,  Colorado  Springs. 

Public  Policy:  Kenneth  C.  Sawyer,  Denver,  Chairman;  McKlnnle  L. 
Phelps.  Denver.  Vice  Chairman;  John  S.  Bouslog,  Denver;  F.  B.  Calhoun, 
Denver;  Frank  B.  McGlone,  Denver;  Lloyd  Anderson,  Sterling;  Sidney  An- 
derson. Alamosa;  Richard  L.  Davis,  La  Junta;  Herman  C.  Graves,  Grand 
Junction:  John  L.  McDonald,  Colorado  Springs;  George  E.  Rice,  Pueblo; 
Duane  Hartshorn,  Fort  Collins;  John  D.  Gillaspie,  Boulder.  Ex-Officio 
members:  Casper  F.  Hegner,  President;  Fred  A.  Humphrey.  President-elect; 
George  R.  Buck,  Constitutional  Secretary. 

Sub-Committee  on  Legislation:  H.  I.  Barnard,  Denver,  Chairman. 

Health  Education  (two  years):  A.  C.  Sudan,  Denver,  (Bialrman,  1949; 

J.  D.  Bartholomew.  Boulder,  1949;  R.  J.  Savage,  Denver,  1949;  R.  T. 
Porter,  Greeley,  1949;  Robert  B.  Bradshaw,  Alamosa.  1949;  L.  W.  Bortree, 
Colorado  Springs,  1950;  F.  0.  Robertson,  Denver,  1950.;  J.  L.  Sadler,  Fort 
Collins,  1950;  Harold  T.  Low,  Pueblo,  1950;  John  H.  Amesse,  Denver, 
19.50:  E.  H.  Munro,  Grand  Junction,  1950. 

Scientific  Work;  W.  B.  Condon,  Denver,  Chairman;  Robert  S.  Liggett, 
Karl  F.  Arndt.  Frank  T.  Joyce,  Marshall  G.  Nims,  Vincent  Q.  Cedar- 
blade,  all  of  Denver. 

Sub-Committee  on  Scientific  Exhibits:  Frank  C.  CampbeU,  (Rialrman; 
Nolle  Mumey,  Edgar  W.  Barber,  B.  W.  Vines,  all  of  Denver. 

Arrangements;  J.  L.  Swigert,  Chairman;  Byron  I.  Dumm,  S.  B.  Childs, 
Jr.,  all  of  Denver. 

Medicolegal  (two  years):  B.  W.  Arndt,  1960,  Chairman;  George  B. 
Packard.  Jr.,  1950:  K.  D.  A.  Allen,  1950.;  C.  S.  Bluemel,  1949;  Lyman 
W.  Mason,  1949;  Harry  C.  Hughes,  1949;  all  of  Denver. 

Medical  Education  and  Hospitals:  George  F.  WoUgast,  Denver,  (Rialrman; 
W.  W.  Sloan,  Hayden;  F.  R.  Plngrcy,  Durango;  E.  B.  Mugrage,  Denver; 
D.  W.  McCarty,  Longmont;  A.  E.  Lubchenco,  Denver. 

Library  and  Medical  Literature:  A.  J.  Markley,  Denver,  Chairman;  T.  E. 
Beyer,  Denver;  J.  J.  Connor,  Delta;  H.  Dumont  Clark,  Denver. 

Medical  Service  Plans:  F.  H.  Good,  Denver,  Chairman;  C.  E.  Honstein, 
Fort  Collins;  James  B.  Blair,  Denver;  Vernon  L.  Bolton,  Colorado  Springs; 
Scott  A.  Gale,  Pueblo;  John  A.  Weaver,  Jr.,  Greeley;  John  E.  ^land, 
Monte  Vista;  Thomas  K.  Mahan,  Grand  Junction. 

Necrology:  W.  H.  Wilson.  Denver,  Chairman. 

PUBLIC  HEALTH  COMMITTEES 

General  Committee  on  Pnblle  Health:  Consists  of  the  chairmen  of  the 
following  eleven  public  health  subcommittees,  presided  over  by  Robert  W. 
Dickson,  Denver,  as  General  Chairman. 

Cancer  Control:  J.  C.  Mendenhall,  Denver,  Chairman;  John  B.  Grow, 
Denver;  S.  W.  Holley,  Greeley;  T.  Leon  Howard,  Denver;  James  B.  Mo- 
Naught.  Denver;  Boger  G.  Howlett,  Golden;  James  W.  M^uUen,  Colorado 
Springs;  James  E.  Donneliy,  Trinidad;  Lanning  E.  Likes,  Lamar;  Thomas 

K.  Mahan.  Grand  Junction. 


Crippled  Children;  I.  E.  Hendryson,  Denver,  Chairman;  Mary  L.  Monro, 
Grand  Junction;  Richard  H.  Mellen,  Colorado  Springs;  Sidney  E.  Bland- 

ford,  Jr.,  Denver;  Paul  R.  Hildebrand,  Brush;  Samuel  P.  Newman,  Denver. 

Industrial  Health;  R.  F.  Bell,  Louviers.  Chairman;  A.  R.  Woodbume, 
Denver:  Vincent  E.  Kelly,  LeadvlUe:  D.  W.  Boyer,  Pueblo;  H.  0.  Harvey,  Jr., 
Denver:  Robert  Woodruff,  Denver;  Frank  J.  McDonough,  Grand  Junction. 

Local  Health  Units;  Monroe  R.  Tyler,  Denver,  Chairman;  Harold  E. 
Haymond.  Greeley;  R.  B.  Richards.  Fort  Morgan:  Nicholas  S.  Salihs,  Wal- 
senburg:  Marvel  L.  Crawford,  Steamboat  Springs;  R.  Sherwln  Johnston,  Jr., 
La  Junta. 

Maternal  and  Child  Health:  John  R.  Evans,  Denver,  Chairman;  Joseph 

H.  Lyday,  Denver;  John  M.  Nelson,  Denver;  Tracy  D.  Peppers,  Greeley: 
J.  H.  Woodbrldge,  Pueblo;  M.  E.  Snyder,  Colorado  Springs. 

Mental  Hygiene:  Bradford  Murpbey,  Denver,  Chairman;  E.  James  Brady, 
Colorado  Springs;  Frank  H.  Zimmerman,  Pueblo:  Paul  A.  Draper,  Colorado 
Springs:  J.  P.  Hilton,  C.  S.  Bluemel,  John  M.  Lyon,  G.  B.  Ashley,  Lewla 
C.  Overholt,  Clarke  H.  Barnacle,  Harold  R.  Carter,  all  of  Denver. 

Milk  Control:  George  W.  Stiles,  Denver,  Chairman;  Max  M.  Glnsburg, 
Denver;  N.  J.  Miller,  D.V.M.,  Eaton;  Millard  F.  Schafer,  Colorado  Springe; 
Robert  W.  Vines,  Denver;  Mr.  Wendell  Vincent,  Denver. 

New  Hospital  Construction;  D.  R.  Collier,  Wheatrldge.  Chairman; 

Henry  M.  Powell,  Colorado  Springs;  Mr.  John  R.  Peterson,  Fort  ColUnu; 

Florence  R.  Sabin,  Denver;  Herbert  A.  Black,  Pueblo. 

Public  Water  Supplies:  E.  I.  Dobos,  Denver.  Chairman;  Robert  Barnard, 
Eagle;  William  C.  Shontz,  San  Luis;  Carl  W.  Maynard,  Pueblo;  W.  B. 
Crouch,  Colorado  Springs:  H.  D.  Palmer,  Denver,  E.  Robert  Orr,  Fnilta. 

Tuberculosis  Control:  John  I.  Zarit,  Denver,  Chairman;  W.  J.  Hliuel- 
man,  Greeley;  H.  M.  Van  Der  Schouw,  Wheatrldge;  John  P.  McGraw,  Pueblo; 
Arthur  Rest,  Denver:  H.  Calvin  Fisher,  Denver;  T.  D.  Cunningham,  Denvor. 

Venereal  Disease  Control;  Sam  W.  Downing,  Denver,  Chairman;  Paul  B. 
Stidham,  Grand  Junction;  H.  E.  Coakley,  Pueblo;  D.  E.  Newland,  Denver; 
Joseph  H.  Patterson,  Denver.  James  R.  McDowell,  Denver. 

SPECIAL  COMMITTEES 

Rocky  Mountain  Medical  Conference  (five  years) : L.  Clark  Hepp,  Denver. 
1953;  G.  P.  Lingenfelter,  Denver,  1952,  Chairman;  Ward  Darlcy,  Denver, 
1951;  L.  W.  Bortree.  Colorado  Springs,  1950;  George  H.  Gillen,  Denver, 
1949. 

Advisory  to  Auxiliary:  Fred  A.  Humphrey,  Fort  Collins,  Chairman;  Ervin 
A.  Hinds,  George  R.  Buck,  Denver. 

Midwinter  Clinics:  Samuel  B.  Childs,  Jr.,  Chairman;  Raymond  C.  Chat- 
field,  E.  L.  Binkley.  Jr.,  A.  J.  Kauvar,  Terry  J.  Gromer,  all  of  Denver. 

Rehabilitation;  W.  W.  Haggart,  Denver,  Cbairman;  Atfaa  Thomas,  Den- 
ver; Lawrence  T.  Brown,  Denver;  J.  E.  A.  Connell,  I^eblo;  Tbad  P.  Sean, 
Ft.  Logan;  Kennetb  C.  Sawyer,  McKlnnle  L.  Phelps,  George  B.  Buck, 
Bradford  Murphey,  all  of  Denver. 

Advisory  to  the  Goodwill  Industries’  Rehabilitation  Program:  Lewis  C. 
Overholt,  (Rialrman;  William  H.  Halley.  Maurice  Katzman,  Terry  J. 
Gromer.  Lorenz  W.  Frank,  WllUam  R.  Lipscomb,  Irvin  E.  Hendryson, 
all  of  Denver. 

Rural  Health  Commission:  Leonard  N.  Myers,  Cheyenne  Wells,  Chairman; 
V.  V.  Anderson,  Del  Norte;  James  S.  Orr,  Frulta;  Keith  F.  Krauanlek, 
Lamar;  Robert  M.  Lee,  Fort  Collins.  Ex-offlclo  member;  Fred  A.  Hum- 
phrey, Fort  Collins. 

Medical  Disaster  Commission;  Foster  Matchett,  Denver,  Chairman;  Karl 
Arndt,  Denver,  Secretary;  Mark  S.  Donovan,  Harry  C.  Hughes,  Adolph  J. 
Kafka,  Roderick  J.  McDonald,  William  F.  Stanek,  Henry  Swan,  Karl  F. 
Sunderland,  K D.  A.  Allen,  all  of  Denver;  Lawrence  W.  Holden,  Boulder; 
Richard  H.  Mellen.  Colorado  Springs;  Richard  H.  Altmix.  Englewood;  Jacob 
0.  Mali,  Estes  Park;  Thad  P.  Sears,  Fort  Logan;  Donald  E.  Cowen,  Fort 
Morgan;  Kenneth  E.  Prescott,  Grand  Junction;  Walter  A.  Schoen,  Greeley; 
David  W.  McCarty,  Longmont;  David  W.  Boyer,  Pueblo:  J.  G.  Espey,  Craig; 
Leo  W.  Loyd.  Durango;  Keith  F.  Krausnlck,  Lamar;  Robert  M.  Lee,  Ft  Col- 
lins; George  H.  Lord,  Aurora;  J.  Gordon  Hedrick,  Wray;  James  P.  Rla, 
Grand  Junction. 

Lay  Organization  Standards;  George  R.  Buck,  Fredrick  H.  Good,  Ken- 
neth C.  Sawyer,  Frank  B.  McGlone,  T.  D.  Cunningham,  Bradford  Murpbey, 
Casper  F.  Hegner,  John  S.  Boaslog,  all  of  Denver. 

Study  of  Child  Welfare  Clinics:  Ralph  H.  Verploeg,  Denver,  Chairmus; 
J.  W.  White,  Pueblo;  Jae^n  L.  Sadler,  Fort  Collins;  L.  B.  Maurer, 
Boulder;  Harvey  M.  Tupper,  Grand  Junction;  Harvey  S.  Rusk,  Pueblo. 

Advisory  to  D.M.W.  Welfare  Fund  (Executive  Committee,  three-year 
terms;  others,  one-year):  Executive;  W.  W.  Haggart,  1951,  Chairman; 
F.  H.  Good,  1951;  J.  S.  Bouslog,  1951,  all  of  Denver:  W.  H.  Halley, 
1950;  C.  F.  Hegner,  1960,  both  of  Denver;  R.  F.  Bell,  1950,  Louviers: 
McKlnnie  Phelp.-).  1949,  Denver;  F.  A.  Humphrey,  1949,  Fort  Collins; 
J.  M.  Lamme,  1949,  Walsenburg.  Other  members:  K.  C.  Sawyer,  A.  C. 
Sudan,  Bradford  Murphey,  all  of  Denver:  C.  D.  Bonham,  Boulder;  J.  W. 
Craighead,  Pueblo;  J.  E.  Donnelly,  Trinidad;  Llgon  Price,  Mt.  Harris;  H.  J. 
McCaUum,  Erie. 

Liaison  to  Colorado  State  Nunos  Association:  John  B.  Evans,  Samuel  P. 
Newman,  Denver. 

Liaison  to  Colorado  Bar  Association:  W.  S.  Dennis,  Chairman;  A.  C. 
Sudan,  E.  W.  Arndt,  all  of  Denver. 

Medical-Dental  Liaison:  Guy  W.  Smith,  Denver.  Chairman;  George  B. 
Warner,  Denver;  Calvin  N.  Caldwell,  Pueblo. 

Representative  to  Rocky  Mountain  Radio  Connell:  WllUam  E.  Bay, 
Denver;  (Alternate:  Chauncey  A.  Hager,  Denver). 

Representative  to  Belle  Bonfiis  Memorial  Blood  Bank:  0.  S.  Philpott, 
Denver. 

Representatives  to  Liaison  Council  on  Graduate  Education  (two  yean) : 

L.  R.  Safarik,  Denver,  1949;  Harold  I.  Goldman,  Denver,  1950. 

Delegate  to  Colorado  Interprofessional  Coancil  (five  years):  K.  D.  A. 
Allen,  Denver,  1949;  (Alternate.  Carl  A.  McLautbUn,  Denver,  1949). 


702 


Rocky  Mountain  Medical  Journal 


Wherever  your  pollen-sensitive  patient 
spends  his  vacation,  Trimeton*  may  add  to  his  enjoyment 
and  rest  by  alleviating  his  symptoms  of  pollinosis.  Trimeton  is  an 
unusual  antihistaminic.  Essentially  different  in  chemical  composition,  it  is  so 
potent  that  only  one  25  milligram  tablet  is  usually  required  to  attain  the  desired  relief 
in  fifteen  to  thirty  minutes.  Best  of  all,  your  patient  isn’t  likely  to  sleep  away  his 
vacation  because  the  small  milligram  dosage  lessens  side  effects. 

Your  patient  will  also  appreciate  that  the  high  potency  of 
^ Trimeton  also  means  lower  cost  of  therapy. 

Irimeton 

Dosage ; One  25  mg.  tablet  one  to  three  times  daily. 

Trimeton,  brand  of  prophenpyridamine,  25  mg.  tablets,  scored,  are  available  in  bottles  of  100  and  1000. 

♦Trimeton  trade-mark  of  Schering  Corporation 

CORPORATION  • BLOOMFIELD,  NEW  JERSEY 

IN  CANADA,  SCHERING  CORPORATION  LIMITED.  MONTREAL 
Serving  the  ff^EST  COAST,  Schering  Corporation 
149  New  Montgomery  St.,  San  Francisco  5,  Calif.  ♦ Douglas  2-1544 


“A 


TRIMETON* 


MONTANA  STATE  MEDICAL  ASSOCIATION 

Next  Annual  Session:  Finlen  Hotel,  Butte;  Aug.  1,  2.  3,  4,  1949 


OFFICERS 

Terms  of  Officers  and  Committees  expire  at  the  Annual  Session 
In  the  year  Indicated.  Where  no  year  is  Indicated,  the  term  Is 
for  one  year  only  and  expires  at  1949  Annual  Session. 

President;  Thomas  L.  Bawkins,  Helena. 

President-elect:  Thomas  F.  Walker,  Great  Falls. 

Vice-President;  R.  0.  Johnson,  Harlowton. 

Seeretary-Treasorer:  Herbert  T.  Caraway,  Billings. 

Delegate  to  American  Medical  Association;  Raymond  F.  Peterson,  Butte, 
1950;  Alternate,  Thomas  B.  Moore,  Kalispell,  1950. 


STANDING  COMMITTEES 

Execntlve  Committee:  T.  L.  Bawkins,  Helena,  Chairman;  T.  F.  Walker, 
Great  Falls;  H.  T.  Caraway,  Billings;  L,  W.  Allard,  BiUings;  M.  A. 

Shllllngton,  Glendlre. 

Economies  Committee;  J.  C.  Shields,  Butte,  Chairman;  C.  P.  Brooke,  St. 
Ignatius;  R.  B.  Durnin,  Great  Falls;  Leland  G.  Russell,  Billings;  S.  D. 

Whetstone,  Cut  Bank. 

Legislative  Committee;  J.  M.  Fllnn,  Helena.  Chairman;  F.  D.  Hurd, 

Gnat  Falls;  P.  E.  Kane.  Butte;  J.  C.  MacGregor,  Great  Falls;  Claude 

M Mears,  Helena. 

Necrology  and  History  of  Medicine  Committee:  L.  W.  Brewer,  Missoula, 
Chairman;  I.  J.  Bridenstine.  Missoula;  J.  H.  Irwin,  Great  Falls;  Claude 
M.  Mears.  Helena-  J.  P.  Ritchey,  Missoula. 

Pnblle  Relations  Committee:  H.  W.  Gregg,  Butte,  Chairman;  W.  L.  DuBols, 
Cut  Bank;  R.  V.  Morledge,  Billings;  W.  H.  Stephan,  DiUon;  Dora  Walker, 
Great  Falls. 

Legal  Affairs  and  Malpractice  Committee;  J.  C.  MacGregor,  Great  Falla, 
Chairman;  Raycend  Eck,  Lewistown;  W.  E.  Harris,  Livingston;  John  E. 
Hynes,  Billings;  R.  D.  Knapp,  Wolf  Point. 

Program  Committee:  C.  H.  Fredrickson,  Missoula,  Chairman;  H.  T. 
Caraway,  Billings-  H.  W.  Gregg,  Butte;  J.  J.  McCabe,  Helena;  E.  S. 
Murphy,  Missoula. 

Interprofessional  Relationship  Committee:  L.  W.  AUard,  Billings,  Chair- 
man; C.  R.  Canty,  Butte;  S.  A.  Cooney,  Helens;  S.  N.  Preston,  Missoula; 
F.  I.  Sabo,  Bozeman. 


Nominating  Committee:  B.  H.  James,  Butte.  Chairman;  E.  L.  Andenon. 
Fort  Benton;  R.  D.  Harper,  Sidney;  J.  J.  Malee,  Anaconda;  W.  B.  Me- 
Elwee,  Townsend. 

Aoditing  Committee:  E.  H.  Llndstrom,  Helena,  Chairman;  F.  H.  Crago, 
Great  Falls;  R.  D.  Harper,  Sidney;  G.  W.  Setzer,  Malta;  B.  G.  Johnson, 
Harlowton. 

Cancer  Committee:  Mary  E.  Martin,  BllUngs,  Chairman;  W.  F.  Cash- 
more,  Helena;  C.  H.  Fre(Mckson,  Missoula;  R.  F.  Peterson,  Butte;  W.  C. 
Robinson,  Shelby. 

Maternal  and  Child  Welfare  Committee:  F.  L.  MePhaU,  Great  Falk, 
Chairman;  L.  W.  Brewer,  Missoula;  P.  L.  Eneboe,  Bozeman;  Maude  H. 
Gerdes,  Billings;  D.  L.  Gillespie,  Butte;  A.  L.  Gleason,  Great  Falls;  K L. 
Hall,  Great  FaUs;  D.  S.  MacKenzle,  Jr.,  Havre;  R.  E.  Mattlson,  BUUnv; 
0.  M.  Moore,  Helena;  F.  W.  Paul,  Kalispell;  C.  W.  Pemberton,  Butte; 
S.  N.  Preston,  Missoula;  A.  E.  Bitt,  Great  Falls. 

Tabercnlosis  Committee:  F.  I.  Terrill,  Galen,  Chairman;  C.  B.  Craft, 
Bozeman;  E.  A.  Dolan,  Anaconda;  A.  B.  Klntner,  Missoula;  J.  A.  Layne, 
Great  Falls. 

Fracture  and  Orthopedic  Committee:  J.  K.  Colman,  Butte,  Chairman;  L.  C. 
AUard,  BllUngs;  W.  H.  Hagen,  BllUngs;  S.  L.  Odgers,  Butte;  J.  C.  Wol- 
gamot.  Great  Falls. 

Rural  Health  Committee;  B.  C.  Farrand,  Jordan,  Chairman;  B.  A. 
Benke,  KaUspeU;  W.  A.  Lacey,  Havre;  W.  G.  TangUn,  Poison;  J.  H. 
WilUams,  Culbertson. 

Industrial  Welfare  Committee:  R.  B.  Richardson,  Great  Falls,  Chairman; 
M.  A.  Gold,  Butte;  P.  E.  Logan,  Great  Falls;  D.  S.  MacKenzle,  Jr.,  Havre; 
R.  E.  Walker,  Livingston. 

Rheumatic  Fever  and  Heart  Committee:  F.  B.  Schemm,  Great  FaUs, 
Chairman;  D.  T.  Berg,  Helena;  H.  W.  Gregg,  Butte;  A.  B.  EUntner,  Mis- 
soula; P.  E.  Logan,  Great  Falls;  F.  H.  Lowe,  Missoula;  J.  J.  Males, 
Anaconda;  0.  M.  Moore,  Helena;  H.  W.  Power,  Conrad;  R.  E.  Smalley, 
BllUngs. 

SPECIAL  COMMITTEES 

Emergency  Medical  Service  Cotnmlttee:  B.  F.  Peterson,  Butte,  Chairman; 
Paul  J.  Gans,  Lewistown;  J.  J.  McCabe,  Helena;  S.  A.  Olson,  GlentHve; 
L.  G.  BusseU,  BllUngs. 

lAR  Foe  Schedule  Committee;  H.  H.  James.  Butte,  Chairman;  E.  B. 
Llndstrom,  Helena;  J.  J.  Malee,  Anaconda;  D.  S.  McKenzie,  Jr.,  Havre; 
F.  K.  Wanlata,  Great  Falls. 


Collection 


Accounts 


All  reports  show  a trend  toward  slower  and  harder  collections  in  the 
months  ahead. 

At  the  first  sign  of  neglect  you  will  save  money  if  they  are  turned  over 
to  us  for  collection. 

Comparison  of  collection  results,  hacked  by  35  years  of  experience,  proves 
you  obtain  greater  results  at  less  cost,  when  you  list  your  accounts 

with 


The  American  Medical  and  Dental  Association 


Suite  524,  810  14th  St. 


TAbor  2331 


Denver,  Colorado 


704 


Rocky  Mountain  Medical  Journal 


Untreated  menopause.  Epithelial 
cells  are  relatively  smalt,  targe  nuclei  4 
predominate;  bacteria,  leukocytes,  I 
free-floating  nuclei  and  other  debris  * 
cloud  the  smear  picture. 


m 


2 a a Smears  showing 
W u progressive  im- 
provement  dur- 
ing estrogen  treatment.  The  pic- 
ture is  beginning  to  clear.  The 
cells  are  enlarging  and  becoming 
more  discrete. 


IL.-yi  -Aai  ;' 

[■XM  A#'' 


4 Smear  showing  effects  of 
full  estrogen  replacement. 
The  smear  is  clean  and  free 
of  leukocytes  indicating  resto- 
ration of  a normal  vaginal  epi- 
thelium. 


CONESTRON 


ESTROGENIC 

SUBSTANCES 

WATER-SOLUBLE 

CONJUGATED 

ESTROGENS 


For  action  with  little  or  no  side  action  in  control  of  menopause  and 
certain  other  ovarian  disorders. 

CONESTRON,  a complex  of  estrone,  estradiol,  equilin,  equilenin  and 
hippulin  in  the  physiological  conjugate  obtained  from  the  pregnant 
mare,  supplies  estrogens  from  natural  sources,  in  the  original,  orally 
active  form, 

Conestron  therapy  produces  a sense  of  well-being  and  is  almost 
completely  devoid  of  side  reactions.  Given  in  small,  frequent,  oral  doses, 
Conestron  permits  a more  uniform  rate  of  absorption  and  maintains  an 
effective  level  of  blood  estrogens. 

Tablets  of  0.625  and  1.25  mg.,  expressed  as  estrone  sulfate.  Bottles 
of  100  and  1000. 


WYETH  INCORPORATED,  PHILADELPHIA  3,  PA. 


for  September,  1949 


705 


NEW  MEXICO  MEDICAL  SOCIETY 


OFFICERS— 1949-1950 

President:  .7.  W.  Hannett,  Albuquerque. 

President-Elect:  I,  J.  Marshall,  Boswell. 

Vice  President:  Leland  S.  Evans,  Las  Cruces. 

Secretary-Treasurer:  H.  L.  January,  Albuquerque. 

Councilors  (o  years):  Carl  Mulky,  Albuquerque;  J.  C.  Sedgwick,  Las 
Cruces.  (2  years):  VV.  D.  Dabbs,  Clovis;  A.  C.  Shuler,  Carlsbad.  (1  year); 
A.  S.  Latbrop,  Santa  Fe;  C.  H.  Gellentbien,  Valmora. 

COMMITTEES— 1949-1950 

Basic  Science:  Raymond  L.  Young,  Santa  Fe,  Cbairman;  W.  E.  Nissen, 
Albuquerque;  Walter  A.  Stark,  Las  Vegas.  ' 

Rural  Medical  Service:  Stuart  Adler.  Albuquerque,  Cbairman;  Samuel  R. 
Zeigler,  Espanola,  A.  T.  Gordon,  Tucumcari;  L.  G.  Foster,  Reserve;  J.  P. 
Turner,  Cariizozo. 

Cancer:  Murray  Friedman,  Santa  Fe,  Chairman;  Van  A.  Odle,  Roswell; 
J.  R.  Van  Atta,  Albuquerque;  J.  W.  Grossman,  Albuquerque;  B.  C.  Derby- 
shire, Artesia. 

Venereal  Disease  Control:  Sam  Jelso,  Albuquerque,  Chairman;  V.  E,  Berch- 
told.  Santa  Fe:  L.  M.  Miles.  Albuquerque;  Vincent  Accardi,  Gallup;  F.  C. 
Bohannon,  Carlsbad. 


Legislative  and  Public  Policy:  A.  S.  Lathrop,  Santa  Fe,  Chairman;  H.  T. 
Watson,  Gallup;  C.  B.  Elliott,  Eaton;  John  F.  Conway,  Clovis;  H.  M.  Mor- 
timer, Las  Vegas:  G.  S.  Morrison,  Roswell;  D.  B.  Marsh,  Demlng;  R.  A. 
Watts,  Silver  City;  Ashley  Pond,  Taos;  W.  L.  Minear,  Hot  Springs;  L.  S. 
Evans,  Las  Cruces;  W.  M.  Thaxton,  Tucumcari;  William  C.  White,  Los 
Alamos;  W,  0.  Connor,  Albuquerque;  C.  S.  Stone,  Hobbs;  A.  C.  Shuler, 
Carlsbad. 

Public  Relations:  C.  P.  Bunch,  Artesia,  Chairman;  Earl  L.  Malone,  Ros- 
well; 0.  S.  Cramer,  Albuquerque;  Eric  P.  Hausner,  Santa  Fe. 

Tuberculosis:  C.  H.  Gellentbien,  Valmora,  Chairman;  William  H.  Thearle, 
Albuquerque;  D.  0.  Shields,  Albuquerque;  Carl  Mulky,  Albuquerque;  H.  S. 
A.  Alexander,  Santa  Fe. 

Advisory  Con  mittee  on  Insurance  Compensation:  L.  M.  Overton,  Albuquer- 
que, Chairman:  R.  E.  Forbis,  Albuquerque;  Edward  PamaJl,  Albuquerque;  H. 
D.  Corbusier,  Santa  Fe. 

National  Emergency  Medical  Service:  A.  E.  Reymont,  Santa  Fe,  Chair- 
man; L.  G.  Rice,  Albuquerque;  C.  M.  Thompson,  Albuquerque. 

Board  of  Supervisors:  L.  G.  Rice,  Bernalillo  County;  Van  A.  Odle,  Chaves 
County;  Milton  Floersheim,  Colfax  County;  John  F.  Conway,  Curry  County; 
C.  P.  Bunch,  Eddy  County;  Frank  W.  Parker,  Jr.,  McKinley  County;  V.  E. 
Berchtold,  Santa  Fe  County;  W.  A.  Stark,  San  Miguel  County. 


Oculist  Prescription  Service  Exclusively 

SHADFORD-FLETCHER  OPTICAL 


Dispensing  O pticians 

228  16th  Street,  Denver,  Colo.  AComo  2611 
3705  East  Colfax  (Medical  Center  Building).  FLorido  0202 


CO 


. 


These  fine  Dairy  Cattle,  a portion  of  City  Park’s  large  herd  of  Guernsey  and  Holstein  • 
cows,  are  scientifically  fed  and  cared  for,  continuously  tested  by  competent  veterin-j,’ 
arians.  Only  through  such  precise  watchfulness  does  City  Park  Milk  receive  Grad' 
“A”  designation  which  it  enjoys.  Ghoose  City  Park’s  regular  Grade  “A”  Pasteurizi 
or  Homogenized  milk  today  — notice  the  particularly  clean,  fresh  flavor. 


’Phone 
EAsf  7707 


dlti^  PafL 


Cherry  Creek 
Drive— Denver 


ide|j 

I 


706 


Rocky  Mountain  Medical  Journal 


Essential 
food 
factors 

Several  decades  ago,  vitamins, 
minerals,  and  other  noncaloric  but  use- 
ful components  of  the  diet  were  known 
as  "accessory  food  factors.”  Today,  it 
is  recognized  that  these  accessory  factors 
are  in  fact  essential  factors. 

Hypernutrition  aids  the  recovery  proc- 
ess and  tends  to  hasten  tissue  repair. 
Vitamin  A,  vitamin  D,  thiamine  (Bi), 
riboflavin  (B2),  niacinamide,  ascorbic 
acid  (C)  and  folic  acid  have  enjoyed 
wide  usage  for  convalescent  and  repar- 
ative states. 


Lederle  has  consistently  advocated  such 
use  of  the  vitamins. 


LABORATORIES  DIVISION 


AMER/CA/V 


G^anamid  l 


30  ROCKEFELLER  PLAZA 
NEW  YORK  20.  N.Y. 


for  September,  1949 


707 


THE  UTAH  STATE  MEDICAL  ASSOCIATION 

Next  Annual  Session:  Salt  L ake  City,  Sept.  1,  2,  3,  1949 


OFnCERS  1&48-1949 
Fretident:  0.  A.  Ogllfie,  Salt  Lake  Cltr. 

Fresldent-eleet:  C.  H.  Jenson,  Ogden. 

Past  President;  J.  C.  Hubbard,  Price. 

Honorary  President:  0.  W.  Fnncb,  Coalrille. 

First  Vice  President:  J.  0.  McQuarrie,  Ricbtleld. 

Second  Vice  President;  Ezra  Cragun,  Lewiston. 

Third  Vice  President:  R.  W.  Farnsworth,  Cedar  City. 

Secretary:  Ray  T.  Woolsey,  Salt  Lake  City. 

Executive  Secretary:  Mr.  W.  H.  Tibbals,  42  South  5th  East,  Salt  Lake  City. 

Treasurer:  L.  B.  White,  Salt  Lake  City. 

Counellor  First  District:  J.  G.  Olson,  Ogden. 

Connellor  Second  District:  V.  L.  Rees,  Salt  Lake  City. 

Councilor  Third  District:  L.  W.  Oaks,  Provo. 

Delegate  to  A.M.A.,  1948:  James  P.  Kerby,  Salt  Lake  City. 

Alternate  Delegate  to  A.M.A..  1948:  J.  J.  Weight,  Provo. 

Editor  of  the  Utah  Section  of  the  Rocky  Moonnain  Medical  Journal: 
t.  P.  Middleton,  Salt  Lake  City. 

STANDING  COMMITTEES 
Rocky  Mountain  Medical  Conference  Continuing  Committee:  R.  P.  Mid- 
dleton Chairman,  Salt  Lake  aty,  1949;  K.  B.  Castleton,  Salt  Lake  City, 
1950;  Clark  Rich,  Ogden,  1951;  Noall  Z.  Tanner,  Layton,  1952;  T.  R. 
Seager,  Vernal,  1953. 

Scientific  Program  Committee:  Ray  T.  Woolsey,  Chairman,  Salt  Lake 
City;  Drew  M.  Peterson,  Ogden;  Stanley  N.  Clark,  Provo;  P.  M.  Howard, 
Balt  Lake  City;  V.  P.  White,  Salt  Lake  City;  L.  V.  Broadbent,  Cedar 
City;  Paul  A.  Pemberton,  Salt  Lake  City. 

Public  Policy  and  Legislation  Committee:  F.  B.  King,  Chairman.  Price, 
1951;  Jesse  J.  Weight,  Provo,  1949;  M.  L.  Crandall,  Salt  Lake  City. 
1949;  V.  L.  Stevenson,  Salt  Lake  City,  1949;  N.  F.  Hicken,  Salt  Lake 
aty,  1950;  Omar  Budge,  Logan,  1950;  John  Colettl,  Salt  Lake  aty,  1950; 
W.  B.  West,  Ogden,  1951;  R.  V.  Larson.  Roosevelt,  1951. 

Medical  Defense  Committee:  W.  J.  Thomson.  Chairman,  Ogden,  1949; 
1.  W.  Owens,  Salt  Lake  aty,  1949;  J.  L.  Hansen.  Vernal,  1949;  Homer 
Smith,  Salt  Lake  aty,  1950;  L.  N.  Ossman,  Salt  Lake  aty,  1950;  Erwin 

D.  Zeman,  Ogden.  1950;  Charles  W.  Woodruff,  Salt  Lake  aty,  1951; 

James  Westwood,  Provo,  1951;  L.  H.  Merrill,  Hiawatha,  1951. 

Medical  Edneatlon  and  Hospitals  Committee:  I.  Bruce  McQuarrie,  (Mr- 
man,  Ogden,  1949;  L.  J.  Paul,  Salt  Lake  aty,  1949;  0.  A.  OgUTle, 
Balt  Lake  aty,  1949;  G.  G.  Richards,  Salt  Lake  aty,  1950;  Ray  T. 
Woolsey,  Salt  Lake  aty,  1950;  T.  E.  Robinson,  Salt  Lake  City,  1950; 

BHh  E.  Smoot,  Provo.  1951;  George  H.  Curtis,  Salt  Lake  City,  1951; 

R.  0.  Porter,  Logan,  1951;  R.  H.  Toung,  Ex-Officio,  Salt  Lake  City. 

Medical  Economics  Committee:  Russell  Smith,  Chairman,  Provo,  1949; 
A.  B.  Denman.  Helper,  1949;  W.  T.  Ward.  Salt  Lake  City,  1950;  W.  B. 
Merrill,  Brigham  City,  1951;  Balph  Pendleton.  Salt  Lake  aty.  1951- 


i3eller  ’3'ioweri  at  l^eaionaLie  i 


ricei 


“Orders  Delivered  to  Any  City  by 
Guaranteed  Service” 

Special  attention  given  to  floral  tributes 
Also  Hospital  Flowers 

CaU  KEystone  5106 

Park  yioral  Co.  Store 


1643  Broadway 


Denver,  Colo. 


Public  Health  Committee:  John  R.  Bourne,  Chairman,  Roosevelt,  1949; 
F.  D.  Spencer,  Salt  Lake  City,  1950;  Ralph  Ellis,  Ogden,  1951. 

Military  Affairs  and  National  Emergency  Committee:  Chrles  Woodruff, 
Cliairman,  Salt  Lake  aty;  L.  J.  Paul,  Salt  Lake  aty;  Maze]  Skolflold, 
Salt  Lake  City;  W.  M.  Gorishek,  Standardville  L.  R.  CuUlmore,  Orem; 

Ray  H.  Barton.  Magna:  D.  T.  Madson,  Price;  Riley  G.  Clark,  Provo; 

Willis  Hayward,  Logan;  Dean  Tanner,  Ogden. 

Tuberculosis  and  Cardiovascular  Diseases  Committee:  Elmer  M.  KU- 
patrick.  Chairman,  Salt  Lake  aty;  Ray  Rumel,  Salt  Lake  City;  D.  0.  N. 
Lindherg,  Ogden;  W.  C.  Walker,  Salt  Lake  City;  Donald  M.  Moore,  Ogden; 
Don  C.  Merrill,  Provo. 

Cancer  Committee;  0.  A.  Ogilvie,  Chairman,  Salt  Lake  City;  8.  W. 

Fenneraore,  Price;  E.  D.  Zeman,  Ogden;  W.  G.  Noble,  Richmond;  Harold 

Austin.  Provo;  Stanley  G.  Rees,  Gunnison;  Paul  K.  Edmunds,  Cedar  aty; 
F.  G.  Eskelson,  Vernal;  K.  B.  Castleton,  Salt  Lake  City. 

Fracture  Committee:  A.  M.  Okelberry,  Chairman,  Salt  Lake  aty;  Clark 
Rich,  Ogden;  Roy  H.  Robinson,  Kenilworth;  S.  M.  Budge,  Logan;  Norman 
B.  Beck,  Salt  Lake  City;  Louis  Perry,  Ogden;  J.  G.  McQuarrie,  Richfield; 
D.  C.  Evans,  Fillmore. 

Necrology  Committee:  W.  T.  Hasler,  Chairman,  Provo;  L.  A.  Steveimon, 
Salt  Lake  City;  Jos.  A.  Phipps,  Salt  Lake  City. 

Industrial  Health  Committee:  Paul  S.  Richards,  Chairman,  Bingham 
Canyon;  L.  J.  Taufer,  Sait  Lake  City;  Frank  Gorishek,  Helper;  Byron  Daynea, 
Salt  Lake  City;  E.  B.  Kuhe,  Salt  Lake  City;  D.  C.  Barker,  Ogden. 

Advisory  Committee  to  the  Woman’s  Auxiliary;  Vernal  Johnson,  Chair- 
man, Ogden;  0.  P.  Heninger,  Provo;  L.  G.  Moench,  Salt  Lake  aty;  Jamea 

K.  Palmer,  Salt  Lake  City. 

Public  Relations  Committee:  R.  P.  Middleton,  Chairman,  Salt  Lake  aty; 
Louis  P.  Matthei,  Ogden;  R.  W.  Farnsworth,  Cedar  City;  Quinn  A.  Whit- 
ing, Price;  Clyde  J.  Daines,  Logan;  Ray  E.  Spendlove,  Vernal;  H.  L 
Goodwin,  Salt  Lake  City;  Gilbert  Wright,  Salt  Lake  aty;  Roy  B.  Hammond, 
Provo. 

Inter-Professional  Committee;  J.  Leroy  KimbaU,  Chairman,  Salt  Laka 
aty;  C.  C.  Hetzel,  Jr.,  Ogden;  T.  E.  Bauman,  Park  City;  Paul  Clayton. 
Salt  Lake  City;  Ralph  G.  Rigby,  Salt  Lake  City. 

Mental  Hygiene  Committee:  Roy  A.  Darke,  Chairman,  Salt  Lake  aty; 

L.  G.  Moench,  Salt  Lake  City;  Wm.  D.  Pace,  Salt  Lake  City;  George  Cochran, 
Salt  Lake  City;  E.  L.  Weimers,  Provo. 

Fee  Schedule  Committee:  K.  B.  Castleton,  Chairman,  Salt  Lake  aty; 
Howard  K.  Belnap,  Ogden;  J.  E.  Trowbridge,  Bountiful;  U.  B.  Brynir, 
Salt  Lake  aty;  W.  Leroy  Smith,  Salt  Lake  aty;  J.  B.  Wbenltt,  Hober 
City;  0.  W.  Budge,  Logan. 

Special  Committee  to  Study  Dues:  B.  R.  Reichman,  Chairman,  Salt 
Lake  aty;  Eliot  Snow,  Salt  Lake  City;  Ezra  aagun,  Lewiston. 

Rural  Health  Committee:  J.  J.  Weight,  Chairman,  Provo;  J.  G.  McQuanlo, 
Richfield;  J.  P.  Burgess,  Hyrum;  Noall  Z.  Tanner,  l.ayton. 


^I^enuer  Ox^g.en  ^nc. 

Comer  10th  and  Lawrence  Sts. 
TAbor  5138 


Medical  Gas  Division 
MEDICAL  OXYGEN 
CARBON  DIOXIDE-OXYGEN 
MIXTURES 

AVIATORS’  BREATHING  OXYGEN 
WATER  COMPRESSED  NITROGEN 
WATER  COMPRESSED  AIR 
Twenty-Four  Hour  Service 


COLOR.  PROCESS. 

LINE  & HALFTONE 
BEN  DAY  ...... 

ILLUSTRATOR5-DES1GNER5 


PHOTO 

ENGRAVERS 


708 


Rocky  Mountain  Medical  Journal 


...was  developed  to  fill  the 
“need  for  an  insulin  with 
activity  intermediate  between 
that  of  regular  insulin  and  that 
of  protamine  zinc  insulin.”^ 


IN  1939,  Reiner,  Searle  and  Lang  described  a new 
“intermediate  acting”  insulin. 

IN  1943,  after  successful  clinical  testing,  the  new  sub- 
stance was  released  to  the  profession  as  ‘Wellcome’ 
brand  Globin  Insulin  with  Zinc  ‘B.W  & Co.’ 


TODAY,  according  to  Rohr  and  Colwell,  “Fully  80% 
of  all  severe  diabetics  can  be  balanced  satisfactorily”^ 
with  Clobin  Insulin  ‘B.W.  & Co.’—  or  with  a 2 :1  mixture 
of  regular  insulin : protamine  zinc  insulin.  Ready-to-use 
Clobin  Insulin  ‘B.W.  & Co.’  provides  the  desired  inter- 
mediate action  without  preliminary  mixing  in  vial  or 
syringe. 

In  10  cc.  vials,  V-40  and  U-80. 


1.  Rohr,  J.H.,  and  Colwell,  A.R.:  Arch.  Inf. 
Med.  82:54,  1948. 

2.  ibid  Proc.  Am.  Diabefes  Assn.  8:37,  1948. 


‘B.W.&CO.’— a mark  to  remember 


BURROUGHS  WELLCOME  & C0.(U.S.A.)  INC.  Tuckahoer.NewVork 


for  September,  1949 


709 


THE  WYOMING  STATE  MEDICAL  SOCIETY 

Next  Annual  Session:  Elks  Club,  Casper;  Sept.  IZ,  13,  14,  1949 


OFFICERS 


President:  George  E.  Baker,  Casper. 

President-Elect:  DeWltt  Dominick,  Cody. 

Vice  President:  K.  E.  Krueger,  Bock  Springs. 
Treasurer:  V.  M,  Schunk,  Sheridan. 

Correspondlnri  Secretary:  George  H.  Phelps.  Cheyenne. 
Delegate  A M. A.:  R.  H.  Beeve,  Casper. 

Alternate  Delegate  A.M.A.:  W.  A.  Bunten,  Cheyenne. 
Executive  Secretary:  Mr.  Arthur  Ahbey,  Cheyenne. 


COMMlTTEJES 

Rocky  Mountain  Medical  Conference:  Earl  Whedon,  Chairman,  Sheridan; 
George  N.  Phelps,  Cheyenne;  H.  L.  Haney,  Casper;  C.  W.  Jeffrey,  Rawlins; 
L.  W.  Storey,  Laramie. 

Syphilis  Committee:  N.  E.  Morad,  Cbalrmao,  Caaper;  Q.  H.  Groshait, 
Worland;  L.  H.  Wilmoth,  Lander;  L.  G.  Booth,  Sheridan;  F.  H.  Haigler, 
Midwest. 

Cancer  Committee:  Earl  Whedon,  Chairman,  Sheridan;  John  Gramlidi, 
Cheyenne;  DeWitt  Dominick,  Cody;  J.  B.  Newman,  Kemmerer;  E.  W.  New- 
man, Cheyenne. 

Medical  Economics  Committee:  C.  L.  Rogers,  Chairman,  Sheridan;  Nels 

A.  Vicklund,  Thermopolls;  R.  A.  Corbett,  Saratoga;  G.  B.  James,  Casper; 
S.  S.  HelleweU,  Evanston. 

Fracture  Committee:  Philip  Teal,  Chairman,  Cheyenne;  Silva  J.  Glovale, 
Cheyenne;  ftobert  V.  Batterton,  Rawlins;  LoweU  D.  Kattenhom.  Powell; 
Joseph  E.  Hoadley,  Gillette. 

Medical  Defense  Committee:  George  Baker,  Chairman,  Casper;  Andrew 
Bunten,  Cheyenne;  E.  W.  DeKay,  Laramie. 

Coanclllon:  Earl  Whedon,  Chairman,  Sheridan;  B.  J.  Boesel,  Cheyenne; 

B.  W.  DeKay,  Laramie;  George  Baker,  President,  Casper;  George  Phelps, 
Secretary,  Cheyenne. 

Adelsory  to  Woman’s  Anxillary:  John  B.  Bunch,  Chairman,  Laramie; 
VligU  L.  Thorpe,  Newcastle;  H.  J.  Aldrich,  Sheridan;  G.  B.  Savory,  Chey- 
enne. 

Advisory  to  Workmen’s  Compensation  Department:  J.  D.  Shingle,  Chair- 
man, Cheyenne;  G.  H.  Phelps,  Cheyenne;  W.  A.  Bunten,  Cheyenne;  R.  H. 
Reeve,  Casper;  Albert  T.  Sudman,  Green  R^ver;  P.  H.  Schunk,  Sheridan. 


Industrial  Health  Committee;  K.  E.  Krueger,  Chairman,  Bock  Springs; 
Willard  Pennoyer,  Cheyenne;  Thomas  B.  Croft,  Lovell;  Eogene  Pelton, 
Laramie. 

Veterans’  Affairs  and  Military  Service  Committee:  A.  J.  AUegretU,  Chair- 
man, Cheyenne;  Jack  Rowlett,  Laramie;  Everett  ElUs,  Cheyenne;  Bernard 
Sullivan,  Laramie;  G.  W.  Koford,  Cheyenne;  Bernard  Stack,  ThermopoUs; 
J.  W.  Sampson,  Sheridan;  DeWltt  Dominick,  Cody;  Panl  R.  Holtz,  Lander; 
George  E.  Baker,  President,  Casper;  George  Phelps,  Secretary,  Cheyenne. 

Blue  Cross  Hospital  Committee:  R.  I.  WllUams,  Chairman,  Cheyenne,  1950; 
W.  A.  Bunten,  Cheyenne,  1949;  E.  W.  DeKay,  Laramie,  1951;  Cedric 
Jones,  Cody,  1962. 

Public  Policy  and  Legislation:  George  Phelps,  Chairman,  Cheyenne; 

Andrew  Bunten,  Cheyenne;  George  Baker,  President,  Casper;  G.  W.  Koford, 
Cheyenne;  E.  W.  DeKay,  Laramie;  0.  W.  Henderson,  Casper. 

National  Physicians  Committee:  George  Phelps,  Chairman,  Cheyenne; 

Andrew  Bunten,  Treasurer,  Cheyenne;  E.  W.  DeKay,  Laramie;  George  Baker, 
Casper. 

Poliomyelitis  Committee;  H.  L.  Harvey,  Chairman,  Casper;  N.  A.  Vicklund, 
ThermopoUs;  Leo  Keenan,  Torrington;  DeWitt  Dominick,  Cody;  PhlUp  Teal, 
Cheyenne;  Franklin  Toder,  Cheyenne;  F.  A.  l^ls,  Rawlins. 

State  Institutions  Advisory  Committee:  J.  F.  Whalen,  Chairman,  Evans- 
ton: George  Phelps,  Cheyenne;  C.  W.  Jeffrey,  BawUns;  Earl  Whedon,  Sheri- 
dan; G.  H.  Groshart,  Worland;  B.  H.  Kanahle,  Basin. 

Necrology.  Committee:  Earl  Whedon.  Chairman,  Sheridan;  John  B. 
Krahl,  Torrington;  FrankUn  Yoder,  Cheyenne. 

Rural  Hdalth  Committeo:  Paul  Holtz,  Chairman,  Lander;  Andrew  Bun- 
ten, Cheyenne;  Samuel  Worthen,  Alton;  Wm.  K.  Bosene,  Wheatland;  Claude 
Baffl,  Basin. 

Public  Health  DepartmeRt  Liaison  Connittee:  E.  C.  Ri^way,  Chair- 
man, Cody;  R.  P.  Fitzgerald,  Casper;  B.  V.  Batterton,  BawUns;  J.  W. 
Sampson,  Sheridan;  R.  C.  Stratton,  Green  River;  WUlard  Pennoyer, 
Cheyenne. 

Child  Health  Committeo:  Paul  W.  Emerson,  Chairman,  Cheyenne;  John 
GramUch,  Cheyenne;  Thomas  Croft,  LoveU;  Bernard  SulUvan,  Laramie; 
Paul  B.  Holtz,  Lander;  Geo.  E.  Baker,  Casper;  A.  R.  Ahbv,  Cheyenne. 

Council  on  National  Emergency  Medidal  Service:  George  H.  Fhelka, 
Chairman,  Cheyenne;  R.  H.  Reeve,  Casper;  DeWltt  Dominick,  Co^;  E.  W. 
DeKay,  Laramie;  K.  S.  Krueger,  Rock  Springs;  P.  M.  Schunk.  Sheridan. 


COLORADO  HOSPITAL  ASSOCIATION 


OFFICERS 

President:  Hubert  W.  Hughes,  St.  Anthony  Hospital,  Denver. 
President-Elect:  Walter  G.  Christie,  Presbyterian  Hospital,  Denver. 

Vice  President:  Sister  M.  Domnina,  St.  Anthony  Hospital,  Denver. 
Traasurer:  M.  A.  Moritz,  Denver  General  Hospital,  Denver. 

Acting  Executive  Secretary:  Boy  R.  Anderson,  Presbyterian  Hospital,  Denver. 
Trustees:  Boy  R.  Prangley,  St.  Luke’s  Hospital,  Denver  (1949);  James 
P.  Dixon,  M.D..  Denver  General  Hospital,  Denver  (1949);  Louis  Liswood, 
National  Jewish  Hospital,  Denver  (1950);  DeMoss  TaUaferro,  Children’s 
Hospital,  Denver  (1950);  Boy  B.  Anderson,  Presbyterian  Hospital,  Den- 
ver (1951);  Rev.  AUen  H.  Erb,  Mennonite  Hospital,  La  Junta,  (k)lo. 
(1951). 

Delegate  to  the  American  Hospital  Association:  Herbert  A.  Black,  M.D., 
Parkview  Hospital,  Pueblo. 

Alternate:  Msgr.  John  B.  Mulroy,  Catholic  Hospitals,  Denver. 

STANDING  COMMI’TTEES 
Auditing:  R W.  Pontow,  Chairman  (1949),  Colorado  General  Hospital, 
Denver;  Rev.  E.  J.  Friedrich  (1950),  Lutheran  Sanatorium.  Wheatridge; 
Karl  Mortensen  (1951),  St  Luke’s  Hospital,  Denver. 

Constitution  and  Rules:  Samuel  S.  Golden,  M.D.,  Chairman,  Beth  Israel 
Hospital,  Denver;  Henry  H.  HIU,  Weld  County  Hospital,  Greeley;  Sister 
M.  Johanna,  Suo.red  Heart  Hospital,  Lamar. 

Legislative:  Msgr.  John  B.  Mulroy,  Chairman,  Catholic  Hospitalsi,  Den- 
ver; DeMoss  Taliaferro,  (Mldren’s  Hospital,  Denver;  CmI  Ph.  Sdiwalh, 
Denver;  Herbert  A.  Black,  M.D.,  Parkview  Hospital,  Pueblo. 

Membership:  Sister  M.  Alphonsus  Chairman,  Mercy  Hospital,  Denver; 
Boy  R.  Prangley,  St  Luke's  Hospital,  Denver. 

Resolutions:  W'alter  G.  Christie,  Chairman.  Presbyterian  Hospital,  Denver; 
Carl  Ph.  Schwalb,  Denver. 

Nominating:  Msgr.  John  R.  Mulroy,  Chairman  (1949),  Catholic  Hos- 
pitals, Denver;  Herbert  A.  Black,  M.D.  (1950),  Parkview  Hospital,  Pueblo; 

C.  S.  Bluemel,  M.D.  (1951),  Mount  Airy  Sanatorium,  Denver. 

Program:  George  A.  W.  Curte,  M.D.,  Chairman,  UMversity  of  Colorado 
Medical  Center,  Denver;  Boy  Anderson,  Presbyterian  Hospital,  Denver. 


Nursing:  DeMoss  Taliaferro,  Chairman,  Children’s  Hospital,  Denver; 
Sister  M.  HugoUna,  St  Anthony  Hospital,  Denver;  Margaret  E.  Paetznick, 
Director  of  Nurses,  Denver  General  Hospital,  Denver;  Sister  Maria  Gratia, 
R.N.,  Glockner  Sanatorium,  Colorado  Springs;  S.  Buss  Denzler,  M.D., 
Colorado  Hospital,  Canon  City. 

Public  Education:  Owen  B.  Stubben,  Chairman,  Denver  General  Hoepltal, 
Denver;  Mr.  Torgeisen,  Longmont  Hospital  and  CUnic,  Longmont;  Ward 
Darley,  M.D.,  Director,  University  of  Colorado  Medical  Center,  Denver; 
Chas.  Levine,  J.C.R.S.,  Spivak. 

SPBlCIAI,  COMMITTEES 

Public  Relations:  James  P.  Dixon,  M.D.,  Chairman,  Denver  General 
Hospital,  Denver;  Sister  Mary  Lina,  St.  Prands  Hospital,  Colorado  Springs. 

Rates  and  Charges;  Boy  Anderson,  Chairman,  Presbyterian  Hospital, 
Denver;  Msgr.  John  E.  Mulroy,  Catholic  Hospitals,  Denver:  Boy  E. 
Prangley,  St.  Luke’s  Hospital,  Denver;  Walter  G.  Christie,  Presbyterian 
Hospital  Denver;  DeMoss  Taliaferro,  Children’s  Hospital,  Denver;  Ben 
M.  Blumberg,  General  Rose  Memorial  Hospital,  Denver. 

State  Board  of  Health  Advisory:  Msgr.  Jdin  B.  Mulroy,  Chairman, 
Catholic  Hospials,  Denver;  DeMoss  Taliaferro,  Children’s  Hospital,  Denver; 
Herbert  A.  Black.  M.D.,  Parkview  Hospital,  Pueblo, 

Committee  on  Hospital  Licensing  Regulations  and  Standards:  Msgr.  John 
R.  Mulroy,  Chairman,  Catholic  Hospitals,  Denver;  Roy  B.  Prangley,  SL 
Luke’s  Hospital,  Denver:  Owen  B.  Stubben,  Denver  General  Hospital,  Denver; 
DeMoss  Taliaferro.  Children’s  Hospital,  Denver;  Roy  Anderson,  Presbyterian 
Hospital,  Denver. 

Premature  Infant  Care:  DeMoss  Taliaferro,  Chairman,  Chldlren’s  Hos- 
pital, Denver;  Roy  Anderson,  Presbyterian  Hospital,  Denver. 

Rehabilitation  Center;  James  P.  Dixon,  M.D.,  Denver  General  Hospital, 
Denver;  Msgr.  John  R.  Mulroy,  Catholic  Hospitals,  Denver;  Louis  M. 
Liswood,  National  Jewish  Hospital,  Denver. 

Inter- Professional  Council;  Hubert  W.  Hughes,  St.  Anthony  Hospital, 
Denver. 


ytion  ..Si 


eruLce 


.^ccurac^  and  ^peed  in 

DORR  OPTICAL  COMPANY 

421  16th  Street  Denver,  Colorado  KEystone  5511 


710 


Rocky  Mountain  Medical  Journal 


delayed  diagnosis 

is  enemy  number  one  of 

DIABETICS 

A million  or  more  diabetics  are  undetected  and  untreated.!  But  only  about 

55,000  new  eases  are  being  discovered  each  year  in  the  course  of  insurance 
examinations  and  routine  checkups.  Early  diagnosis  and  prompt  treatment 
give  the  physician  his  best  opportunity  to  ameliorate  the  disease 
and  to  avert  or  delay  its  complications. 

An  urgent  problem 

How  shall  the  unknown  diabetic  be  detected  and  directed  to  the 
doctor’s  office  for  diagnosis  and  proper  treatment? 

An  important  answer 

AMES 

a quick  home  screening  test  that  brings 
those  with  glycosuria  to  you  for  diagnosis 

The  Ames  Selftester  for  detection  of  sugar  in  urine  is  approved 
by  the  Council  of  the  American  Diabetes  Association.  It  is  a 
simple,  reliable  screening  test  to  establish  the  presence  or 
absence  of  urine-sugar  and  “refer”  those  with  glycosuria 
to  you  for  diagnosis. 

The  directions  state: 

I 1.  The  Selftester  does  not  diagnose  diabetes  or  any  other  disease.  Its  m 
I sole  function  is  the  detection  of  sugar  (glucose)  or  sugar-like  substances.  V 

I 2.  If  reaction  is  positive,  see  your  doctor  at  once.  Sugar  in  your  urine  f 
1 does  not  necessarily  mean  you  have  diabetes  (nor  does  a negative  result  def-  1 
\ initely  exclude  the  presence  of  disease).  But  only  your  doctor,  by  medical  exam-  1 
I ination  and  by  additional  laboratory  tests,  can  tell  you  why  you  show  sugar,  b 

t Wilkerson,  H.  L.  C.  and  Krall,  L.  P.:  Diabetes  in  a New  England  Town, 

Journal  of  the  American  Medical  Association,  135:209  CSept.  27)  1947. 

♦Ames  Self  tester  TRADE  MARK 

AMES  COMPANY,  INC*ELKHART,  INDIANA 
for  September,  1949 


711 


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712 


Rocky  Mountain  Medical  Journal 


Penicillin  Products  for  Every  Indication 


Whether  you  prescribe  a troche,  tablet,  suppository, 
ampoule,  ointment,  or  ophthalmic  ointment,  a 
dependable  Lilly  penicillin  product  is  available. 

Various  sizes  and  strengths  are  offered  for  every 
indication.  The  Lilly  penicillin  product  of  your  selection 
may  be  easily  obtained  from  your  retail  or  hospital 
pharmacist.  Depend  upon  him  to  serve  you. 


ELI  LILLY  AND  COMPANY,  INDIANAPOLIS  6,  INDIANA,  U.S.A. 


The  word  “pneumonia”  once  had  a dreadful  ring.  Small 
wonder,  for  a little  more  than  a decade  ago  pneumonia  ranked 
third  as  a leading  cause  of  death.  In  rapid  succession  appeared 
type-specific  serums,  sulfonamides,  and  penicillin,  which 
enabled  physicians  to  halt  this  fearful  toll  almost  in  its  tracks. 
Today,  pneumonia  as  a cause  of  death  has  dropped  to  eighth 
place  and  is  still  losing  ground. 

Penicillin,  the  most  potent  foe  of  the  pneumococcus,  was 
discovered  and  named  by  a physician-baeteriologist.  Its 
source  was  identified  by  a myeologist.  Problems  of  production 
and  purification  were  solved  by  chemists  and  biologists.  The 
names  of  Fleming,  Florey,  Chain,  and  others  are  justifiably 
featured  in  the  dramatic  story,  but  the  supporting  cast  was 
legion.  Lilly,  now  one  of  the  world’s  largest  producers  of 
penieillin,  has  contributed  extensively.  As  further  advances 
take  place  in  the  field  of  antibiotics,  practical  dosage  forms 
will  be  made  available  to  medical  practitioners  everywhere. 


A 15^  X 12''  reproduction  of  this  illustration 
by  Andrew  Loomis  is  available  upon  request 


DIAGNOSIS:  PNEUMONIA 


b 
’ ! 


LILLY  SPECIALISTS  SERVE  THE  MEDICAL  PROFESSION 


SEPTEMBER 

1949 


JRocky  J^ountain 

y^edical  Journal 

Eg/  i torial * 


Colondo 
Montana 
New  Mexico 
Utah 
Wyoming 


Medical  Reporting 
In  the  Lay  Press 

QCIENTIFIC  medical  matters,  once  limited 
^ almost  entirely  to  treatment  in  profes- 
sional journals,  are  now  being  reported  in 
increasing  volume  in  the  daily  press  and  in 
magazines  of  general  circulation.  The 
growth  of  such  reporting,  noted  for  several 
years,  shows  no  signs  of  slackening;  if  any- 
thing, it  is  still  accelerating.  This  trend 
while  possessing  interesting  facets,  is  never- 
theless a cause  of  real  concern  to  physicians 
with  their  historic  antipathy  toward  lay 
publicity  in  the  scientific  field,  and  their 
intense  interest  in  complete  scientific  ac- 
curacy. 

Nevertheless,  the  pattern  is  set  and  there 
will  be  more  and  more  journalistic  handling 
of  medical  stories  in  the  lay  press.  We  be- 
lieve this  is  as  it  should  be  in  a free,  demo- 
cratic nation  in  the  atomic  year  of  1949. 
Public  interest  in  good  health  and  in  medi- 
cal advances  seems  to  be  at  an  all-time  peak. 
And  the  peak  is  still  growing!  Ask  any  edi- 
tor. Such  interest  must  be  and  will  be  satis- 
fied. It  should  be  satisfied  by  the  medical 
profession  itself,  in  cooperation  with  lay 
writers.  If  we  do  not  fulfill  our  obligation 
to  keep  the  people  informed,  someone  else 
will  do  it.  It  should  not  be  too  difficult  to 
perceive  such  sources. 

There  is  an  understandable  difference  of 
opinion  between  the  average  physician  and 
the  editor  with  respect  to  the  writing  of 
medical  news.  The  physician  is  allergic  to 
premature  publicity  about  new  drugs  and 
new  technics.  He  naturally  fears  that  the 
public  will  be  misled  into  believing  that  a 
“miracle”  has  been  accomplished  — and 
sometimes  that  is  just  the  way  an  irre- 
sponsible writer  has  handled  such  news.  On 


the  other  hand,  the  editor  is  in  the  business 
of  reporting  all  legitimate  news,  including 
medical  news.  The  editor  wants  to  do  it 
fairly  and  accurately  but  he  has  a responsi- 
bility to  his  readers  and  he  believes  they 
are  capable  of  assimilating  the  facts  of  life. 
Furthermore,  careless  and  sensational  re- 
porting of  medical  news  is  becoming  less 
frequent  as  this  nation  fortunately  boasts 
an  increasing  number  of  top-flight  science 
writers  and  a continually  higher  type  of 
capable  newspaper  reporters.  Most  major 
newspapers  now  retain  one  or  more  quali- 
fied science  writers  who  do  nothing  else  and 
to  whom  all  medical  news  is  referred  for 
final  preparation. 

One  difficulty  lies  in  the  fact  that  not  one 
physician  in  a thousand  has  had  any  edi- 
torial training  or  experience.  Thus,  a pro- 
cedure like  a corneal  transplantation  or  a 
“blue  baby  operation”  which  may  appear 
almost  routine  to  him  are  dramatic  and 
brimming  with  human  interest  in  the  view 
of  the  trained  editor  who  knows  his  reading 
public.  New  drugs  which  offer  hope  to  the 
sick  make  news,  even  in  their  experimental 
phases,  and  such  news  reminds  people  that 
our  profession  is  constantly  endeavoring  to 
win  the  war  against  pain  and  disease.  When 
such  matters  are  reported  with  complete  ac- 
curacy, their  publication  does  a world  of 
good  and  harms  no  one;  when  reported  care- 
lessly and  sensationally  the  opposite  is 
equally  true. 

It  would  appear  that  the  best  way  to  keep 
the  public  informed  about  medical  progress 
and  medical  news  is  through  close  and  mu- 
tual cooperation  between  our  profession,  our 
hospitals,  our  press,  and  our  radio.  This  has 
been  undertaken  in  Colorado,  where  a “Code 
of  Cooperation”  developed  nearly  two  years 
ago  has  enabled  reporters  and  editors  to 


for  September,  1949 


713 


reach  authoritative  sources  for  their  infor- 
mation. It  is  significant  that  several  other 
states  are  adopting  similar  plans  and  that ' 
the  National  Association  of  Science  Writers 
requested  a copy  of  the  Colorado  Code  and 
is  seeking  to  implement  it  nationally. 

There  will  always  be  a certain  minimum 
of  sensational  or  irresponsible  medical  re- 
porting in  lay  publications,  but  reliable  edi- 
tors welcome  the  cooperation  of  our  profes- 
sion in  maintaining  the  highest  possible 
reportorial  standards.  Mutual  respect  and 
cooperation,  with  a maximum  effort  toward 
mutual  understanding  of  each  other’s  pe- 
culiar problems,  can  correct  all  major  dif- 
ficulties. 

A free  press  and  a free  medical  profession 
have  much  in  common.  If  both  can  ignore 
minor  irritations  as  has  been  done  in  Colo- 
rado, and  work  together  in  the  public  inter- 
est, the  level  of  medical  reporting  will  con- 
tinue to  improve  and  the  American  people 
will  become  so  well  informed  that  profes- 
sional bureaucrats  will  be  unable  to  come 
between  physician  and  patient. 

^ ^ ^ 

Fate  of  Damaged 
Mammary  Ducts 

Tl^ANY  operations  performed  upon  the  fe- 
male breast  entail  more  or  less  division 
of  mammary  ducts.  Obviously  it  is  impos- 
sible to  remove  all  or  part  of  a nipple  with- 
out severance  of  lactiferous  ducts;  re- 
moval of  benign  cysts  or  specimens  for 
microscopic  study  entails  unavoidable  in- 
cision through  deeper  structures.  Recon- 
struction of  breasts  for  relief  of  mastoptosis 
demands  massive  removal  of  tissue,  even  to 
the  extent  of  several  pounds.  In  some  of 
these  cases  nipples  are  transplanted  as  free 
skin  grafts,  thus  leaving  underlying  ducts 
with  no  normal  drainage  to  the  skin  sur- 
face. Much  speculation  and  discussion  con- 
cerning potential  dangers  or  serious  con- 
sequences of  this  technic  have  taken  place 
during  the  past  several  years.  We  know 
of  no  report  of  evil  consequences. 

Incidental  to  a discussion  at  the  last 
meeting  of  the  Western  Surgical  Associa- 


tion, Dr.  Herbert  Davis  reported  that  fifteen 
years  after  the  removal  of  a nipple,  no  ab- 
normah  changes  were  demonstrable.  Thirty- 
nine  other  cases  which  showed  small  cysts 
or  tumors,  centrally  located  with  possible 
mammary  duct  involvement,  had  been  ex- 
cised. Twenty-four  of  these  were  treated 
and  no  trouble  found.  A search  of  the  liter- 
ature disclosed  no  report  of  carcinoma  or 
other  malignancy  developing  following  re- 
moval of  nipple  or  severing  of  ducts. 

Perhaps  these  observations  will  assuage 
the  worries  of  surgeons  who  have  hesitated 
to  perform  some  of  the  more  recently  per- 
fected operations  upon  breasts  for  fear  of 
ultimate  unfavorable  consequences.  Many 
surgeons  have  found  that  women  relieved 
of  the  burden  of  ptosed  and  heavy  breasts 
are  among  their  most  grateful  patients. 

<4  ^ 

Now  That  Vacation 
Days  Are  Over — 

'^HERE  will  still  be  some  week-end  fish- 
ing,  and  in  October  many  of  us  will 
steal  a day  or  two  or  three  to  stalk  a buck, 
but  when  September  1 rolls  around  the  va- 
cation season  is  over.  So  now  to  work. 

And  what  will  our  biggest  job  be  this 
fall?  Well,  we  see  it  as  a multiplicity  of 
jobs.  First,  we  must  refresh  ourselves  sci- 
entifically, and  get  acquainted  with  some  of 
our  conferees.  We’ll  do  that  at  our  State 
Meeting,  in  Utah  the  first  three  days  of  this 
month,  in  Wyoming  in  the  middle  of  the 
month,  in  Colorado  a week  later.  Next, 
we’ll  offer  our  services  to  the  new  president 
of  our  local  and  state  societies.  He  is  prob- 
ably searching  for  a few  more  willing  hands 
on  committee  work,  and  no  society  can 
prosper  without  them. 

Finally,  we  will  roll  up  our  mental 
sleeves  with  a determination  to  practice 
better  medicine  than  ever  before,  to  treat 
every  single  patient  as  we  would  want  to  be 
treated  when  sick  ourselves,  remembering 
that  each  one  of  us  is  in  the  last  analysis 
a public  servant  and  a public  representa- 
tive— public  relations  man  if  you  please — 
of  our  great  profession. 


714 


Rocky  Mountain  Medical  Journal 


SILHOUETTES 

from  the  A.M.A.  House  of  Delegates 


On  July  31,  1949,  some  thirty  physicians  repre- 
senting fourteen  western  states  held  an  informal 
conference  in  Denver.  The  meeting  was  given  a 
semblance  of  authority  by  the  presence  of  two 
AMA  trustees — Drs.  Murray  and  Blasingame. 
The  announced  agenda  was  the  consideration  of 
Reorganization  Plan  1 and  of  Senate  Resolution 
147  which  is  in  opposition  to  that  plan.  Reor- 
ganization Plan  1,  briefly,  would  establish  a De- 
partment of  Welfare  which  would  include  the 
functions  of  health,  education,  social  security 
and  welfare,  headed  by  the  present  Federal  Se- 
curity Administrator.  He  would  become,  auto- 
matically, the  Secretary  of  Welfare  with  Cabinet 
status.  Reorganization  Plan  1 was  to  become 
law  on  August  19,  1949,  if  not  previously  re- 
jected by  resolution  of  either  the  House  of  Rep- 
resentatives or  the  Senate,  passed  by  a con- 
stitutional majority. 

The  necessity  of  marshalling  opposition  to 
Plan  1 and  of  supporting  Senate  Resolution  147 
was  obvious.  After  the  presentation  of  the  prob- 
' lem  and  discussion,  resolutions  were  written  and 
approved  and  forwarded  to  the  Board  of  Trustees 
of  the  AMA.  It  was  decided,  and  properly  so, 
that  organized  medicine  should  have  representa- 
tives in  Washington  to  supplement  the  efforts 
of  the  Washington  office  in  support  of  Senate 
Resolution  147.  While  such  meetings  may  act  as 
a “booster  shot,”  the  thought  emerges  as  to  the 
value  or  usefulness  of  an  unofficial  rump  con- 
ference. There  was  an  intimation  that  the  Wash- 
ington office  was  sleeping,  that  the  Public  Re- 
lations Coimsellors  were  in  mild  coma  and  that 
the  Board  of  Trustees  was  reading  a book.  Such 
generalities  are  unfair  and  unwarranted.  Nothing 
was  accomplished  at  this  hybrid  conference 
which  could  not  have  been  activated  by  a few 
well  placed  telephone  conversations. 

Oklahoma  Lays  an  Egg 

Added  to  the  original  agenda,  and  quite  un- 
necessarily in  the  opinion  of  Colorado  repre- 
sentatives, was  a discussion  of  the  “suggested 
principles  for  lay  sponsored  Health  plans.” 
(Journal  AMA  June  25,  1949,  pages  686-687). 
After  a semi-hysterical  and  emotional  analysis 
of  the  suggested  principles  in  which  it  was 
stated  that  these  principles  were  “jammed  down 
the  throat  of  the  House  of  Delegates,”  a motion 
was  presented  to  request  or  direct  or  order  the 


Board  of  Trustees  of  the  AMA  to  take  no  action 
on  the  suggested  principles  until  the  Interim 
Meeting  of  the  AMA  in  Washington,  D.  C.,  in 
December,  1949.  Unfortunately,  no  official  rec- 
ord of  the  minutes  of  the  meeting  was  made. 
We  have  not  obtained  a copy  of  the  motion  as 
approved.  No  dissenting  votes  were  heard  but 
the  vote  was,  definitely,  NOT  unanimous.  After 
the  vote  on  the  motion  or  resolution  was  taken 
it  was  announced  that  the  Board  of  Trustees  had 
been  memorialized  on  the  subject  previously.  It 
was  interesting  to  see,  again,  politics  on  the  high 
school  level.  In  Colorado,  we  eliminated  such  an- 
tics twenty-five  years  ago.  The  top  sergeant 
technic  of  an  unauthorized  group  is  of  doubt- 
ful value.  It  seems  to  have  been  rejuvenated  by 
the  war.  In  the  high  country  it  is  called  “brass 
poisoning.” 

The  suggested  principles  were  written  by  the 
Council  on  Medical  Service  at  the  request  of  the 
House  of  Delegates.  They  had  the  sanction  of 
our  legal  department.  No  doubt,  they  were  re- 
viewed by  the  Trustees.  There  was  an  open 
hearing  in  the  House  of  Delegates  in  Atlantic 
City  in  June,  1949,  where  they  were  fully  dis- 
cussed. The  reference  committee  on  Insurance 
Plans  and  Medical  Service  reported  as  follows 
(Journal  AMA,  July  2,  1949,  page  799,  4b); 

“Your  reference  committee  recommends  that 
these  points  be  forwarded  by  the  House  of  Dele- 
gates to  all  state  and  county  medical  societies, 
which  societies  should  use  them  as  a guide  in 
determiiiing  the  eligibility  of  any  such  plans  for 
approval  by  those  state  or  county  societies  ...  It 
should  be  recognized  that  local  areas  may  find 
it  necessary  to  make  minor  modifications  with- 
out changing  the  fundamental  intent  involved. 
Your  committee  recommends  that  any  lay  spon- 
sored plan  desiring  approval  by  a proper  accred- 
iting body  of  the  AMA  shall  come  bearing  the 
endorsement  of  the  state  or  county  medical  as- 
sociation involved.” 

There  can  be  no  objection  to  reconsidering, 
reanalyzing  or  rewriting  the  suggested  prin- 
ciples. However,  there  are  legitimate,  open  and 
official  channels  for  such  recommendations, 
criticisms  and  discussions.  The  intimation  that 
the  members  of  the  Council  on  Medical  Service 
are  dumb  and  that  the  OTHER  members  of  the 
committee  on  Insurance  Plans  and  Medical  Serv- 
ice are  wooden  heads  is  politely  resented  on  their 
behalf.  For  myself,  I accept  the  compliment. 

So,  an  egg  was  laid  at  the  high  school  level. 
The  conference,  rump  session,  or  what-was-it 
was  called  for  a different  purpose.  Why  were 
the  Oklahoma  delegates  and  physicians  inarticu- 
late? It  would  have  been  preperable  to  have 
heard  them.  An  officers’  call  does  not  accept 
bawlings  out  from  a top  sergeant  and  neither  do 
physicians  like  to  be  harangued  by  their  house- 
maid— even  though  a competent  housemaid. 

WILLIAM  H.  HALLEY,  M.D. 


for  September,  1949 


715 


Original  Articles 

ANTERIOR  RESECTION  OR  ABDOMINOPERINEAL  PROCTOSIG- 
MOIDECTOMY FOR  CARCINOMA  OF  THE  RECTUM* 

HARRY  E.  BACON,  M.D.,  and  HOWARD  D.  TRIMPI,  M.D. 

PHILADELPHIA,  PENNSYLVANIA 


During  the  past  few  years  progress  in 
surgery  of  the  rectum  for  carcinoma  has 
shown  certain  definite  and  influential 
trends.  Foremost  among  these  has  been  the 
increasing  tendency  to  popularize  proce- 
dures which  preserve  the  continuity  of  the 
bowel  and  avoid  creation  of  an  abdominal 
colostomy.  Among  such  operations,  that  of 
anterior  resection  has  gained  strikingly  in 
prominence.  It  is  now  technically  possible 
for  the  average  general  surgeon  to  perform 
anterior  resection  with  end-to-end  anasto- 
mosis above  or  below  the  peritoneal  reflec- 
tion with  a reasonable  assurance  of  a com- 
paratively low  postoperative  morbidity  and 
mortality. 

The  advantages  of  anterior  resection  are 
readily  appreciated  by  those  of  us  who  seek 
to  discourage  the  all  too  frequent  perform- 
ance of  unnecessarily  debilitating  resections 
which  call  for  abdominal  colostomies.  Cer- 
tainly there  can  be  little  question  as  to  the 
desirability  of  choosing  an  operation  which 
will  eliminate  the  abdominal  colostomy 
when  we  have  at  our  command  equally  rad- 
ical and  curative  sphincter-preserving  pro- 
cedures. 

In  the  progress  of  surgery  of  the  rectum 
many  early  attempts  were  made  to  develop 
resection  operations  which  would  preserve 
anal  continence.  Most  of  the  procedures 
were  entirely  inadequate.  The  postopera- 
tive mortality  was  high  and  the  recurrence 
rate  of  the  malignant  growth  in  those  sur- 
viving was  deplorable.  Later  a trend  in  the 
opposite  direction  began,  culminating  with 
the  radical  abdominoperineal  excision  of 
Miles  which  was  employed  to  treat  all 

•Read  before  the  Salt  Lake  Surgical  Society,  Feb- 
ruary 15,  1949,  (Salt  Lake  City,  Utah.  From  the  De- 
partment of  Proctology,  Temple  University  Medica'l 
School  and  Hospital. 


growths  from  the  anal  orifice  to  the  sig- 
moid colon.  The  modern  trend  has  been  to 
re-evaluate  the  older  methods  carefully  and 
to  determine  wherein  they  failed.  This  has 
led  to  the  present  increasing  employment 
of  the  anterior  type  of  resection  and  the  ab- 
dominoperineal method  of  proctosigmoidec- 
tomy. Some  of  us^  2 3 4 5 is  have  been  re- 
warded by  witnessing  excellent  results 
achieved  by  the  latter  operation,  results 
favorable  not  only  from  the  standpoint  of 
a low  rate  of  local  recurrence  but  in  estab- 
lishing a well-functioning  artificial  anus  as 
well. 

It  is  clear,  therefore,  that  there  are  two 
alternative  operations  of  proved  value  to 
help  us  reduce  the  census  of  patients  with 
abdominal  colostomy  — the  abdominoperi- 
neal resection  with  sphincter  preservation, 
and  the  anterior  resection.  It  remains  to 
study  fully  the  indications  for  each,  and  to 
evaluate  the  conditions  which  make  an  ab- 
dominal colostomy  unavoidable.  The  pau- 
city of  suitable  statistics  upon  which  to  base 
a final  opinion  is  only  too  plain.  Standardi- 
zation has  not  been  entirely  possible,  yet  by 
supplementing  the  available  statistical  data 
with  anatomic  and  physiologic  studies  now 
in  progress  we  can  go  far  in  outlining  justi- 
fiable working  precepts. 

Of  utmost  importance  in  determining 
which  operation  to  perform  is  the  level  of 
the  carcinoma  as  measured  from  the  anal 
margin.  In  this  respect  we  concur  with 
Gray^^  that  local  recurrence  is  not  entirely 
related  to  the  stage  of  growth  of  the  car- 
cinoma nor  to  the  degree  of  lymph  node 
involvement,  but  is  distinctly  related  to  the 
level  of  the  tumor  in  the  bowel.  Waugh 
and  Kirklin^®  reviewed  453  cases  of  carcin- 
oma of  the  rectum  subjected  to  abdomi- 


716 


Rocky  Mountain  Medical  Journal 


noperineal  excision  with  abdominal  colos- 
tomy. Analysis  of  388  of  the  453  cases  re- 
vealed that  prognosis  improved  the  higher 
the  level  of  the  lesion  was  above  the  ano- 
rectal line.  Growth  within  2 cm.  of  the 
anorectal  line  had  the  least  favorable  prog- 
nosis. Those  at  11  cm.  or  above  had  the 
best.  There  was  a striking  increase  in  the 
favorability  for  lesions  immediately  above 
5 cm.  Dixon^,  in  evaluating  the  Miles  oper- 
ation, found  the  poorest  survival  rate  in 
patients  with  rectal  lesions  at  the  lowest 
levels.  In  his  series  the  five-year  survival 
rate  for  lesions  near  the  dentate  line  with 
nodular  involvement  was  only  28.8  per  cent, 
whereas  in  those  with  lesions  10  to  14  cm. 
above,  the  rate  increase  to  57.9  per  cent. 

It  has  also  been  our  experience  that  lower 
lesions  have  a higher  local  recurrence  rate. 
The  explanation  for  these  observations  is 
understandable.  Older  surgeons  have  sim- 
ply been  incorrect  in  underestimating  the 
importance  of  the  lateral  lymphatic  spread. 
The  studies  of  McVay^'*,  Westhues^^,  Gil- 
christ and  David®  ®,  Collar,  Kay  and  Mc- 
Intyre®, Grinnell  and  Kay^®  have  clearly 
shown  that  in  the  main  the  direction  of 
lymphatic  spread  is  upward  via  the  superior 
hemorrhoidal  channels.  These  workers  have 
also  been  able  to  show  the  presence  of 
a lateral  or  intermediate  zone  of  lym- 
phatics which  drain  to  pelvic  nodes  by  direct 
routes.  This  zone  has  been  found  to  extend 
upward  from  the  pectinate  line  for  a dis- 
tance of  4 or  5 cm.  Although  the  exact 
pathways  of  lateral  drainage  have  not  been 
agreed  upon  by  all,  it  is  thought  that  those 
lymphatics  which  follow  the  middle  hem- 
orrhoidal arteries  are  of  most  significance. 
As  yet,  no  satisfactory  type  of  resection  has 
been  devised  which  offers  adequate  an- 
terolateral pelvic  dissection  in  this  zone. 
The  Miles  operation  is  our  nearest  approach 
but,  as  Dixon  says^,  it  too  falls  short  of 
the  desired  goal.  Prognosis  improves  with 
growths  situated  6 cm.  and  above  the  skin 
margin  because  there  is  but  little  lateral 
spread  and  we  have  generally  speaking 
only  to  extirpate  the  superior  lymphatic 
structures.  For  such  lesions  we  are  justi- 
fied in  employing  the  sphincter-preserving 


operations.  With  growths  below  this  level 
we  must  use  the  best  method  available, 
the  Miles  abdominoperineal  method  of  ex- 
cision. 

Since  we  are  here  interested  in  sphincter- 
preserving  procedures  we  shall  confine  our 
remarks  to  the  treatment  of  lesions  6 cm. 
above  the  skin  margin.  Radicability  is  the 
chief  concern.  As  demonstrated  by  West- 
hues^’',  McVay^*,  Gilchrist  and  David®,  and 
Glover  and  Waugh^°,  retrograde  or  down- 
ward spread  of  cancer,  though  uncommon, 
does  occur,  and  resection  of  the  rectum  to 
include  the  possible  lower  metastases  must 
be  done.  Furthermore, ' as  noted  by  the  oc- 
casional occurrence  of  other  primary  lesions 
arising  in  the  rectum,  it  is  of  additional 
value  to  remove  this  structure. 

There  are  many  technical  difficulties 
which  beset  the  surgeon  who  elects  to  do 
an  anterior  resection  for  rectal  carcinoma. 
The  lower  the  lesion  is  situated  the  greater 
is  the  task,  and  unless  conditions  are  very 
favorable  we  feel  that  the  resection  of  the 
entire  rectum  and  the  construction  of  an 
artificial  anus  by  the  pull-through  technic 
offers  the  least  morbidity  and  the  best  op- 
portunity for  earlji"  return  of  bowel  func- 
tion. It  is  our  opinion,  then,  that  lesions 
located  from  6 cm.  to  the  peritoneal  reflec- 
tion should  be  treated  by  abdominoperineal 
resection  with  sphincter  preservation.  This 
operation  removes  the  entire  rectum  and 
includes  the  lateral  ligaments  with  the  mid- 
dle hemorrhoidal  arteries  as  well  as  the 
levator  muscles.  Here  the  operation  of  an- 
terior resection  is  limited  in  its  scope  and 
does  not  include  the  entire  rectum,  the 
levators,  nor  enough  of  the  perirectal  tissue. 
Nevertheless,  in  the  hands  of  Dixon  and 
others,  excellent  results  have  been  achieved 
by  its  employment,  particularly  in  the  man- 
agement of  high  rectal  and  sigmoidal  can- 
cer. Our  experience  with  the  abdomino- 
perineal method  of  resection  with  sphincter 
preservation  for  middle  and  upper  rectal 
lesions  has  been  excellent  and  its  value  has 
been  further  attested  by  our  very  low  rate 
of  local  recurrence^®. 

Conclusions 

1.  In  the  management  of  rectal  cancer 


for  September,  1949 


717 


the  most  important  trend  today  is  the  em- 
phasis being  placed  upon  the  need  for  more 
pertinent  information,  particularly  with 
reference  to  levels  at  which  lesions  occur. 

2.  The  most  popular  trend  is  the  increas- 
ing performance  of  operations  designed  to 
eliminate  abdominal  colostomy. 

3.  Of  these  procedures  we  feel  that  the 
method  of  abdominoperineal  resection  with 
sphincter  preservation  is  most  satisfactory. 

4.  Until  a more  radical  method  of  resec- 
tion is  devised,  low  rectal  carcinoma  must 
be  dealt  with  by  the  Miles  operation. 


RSKEREIN  crs 

m’Allaine,  F.,  LeRoy,  A.,  and  Dubost,  C.:  Traite- 
ment  Chirurg'ical  du  Cancer  du  Rectum.  Editions 
Medical  Flamarion,  1946. 

^Babcock,  W.  W.:  Carcinoma  of  the  Rectum.  One- 
stage  Simplified  Proctosigmoidectomy  With  the 
Formation  of  a Perineal  Anus.  Surg.  Ciin.  N.  Amer- 
ica, 12:1937,  1932. 

•Bacon,  H.  E. : Abdominal  Proctosigmoidectomy  for 
Cancer  of  the  Rectum.  J.A.M.A.,  35:158,  1943. 

‘Bacon,  H.  E.,  and  Rowe,  R.  J.:  Radicability  of 
Methods  to  Eliminate  Colostomy:  A Critical  Review. 
J.  Internat.  Coll.  Surg.,  11:243,  1948. 

•Bacon,  H.  E. : Evolution  of  Sphincter  Muscle  Pres- 
ervation and  Re-establishment  of  Continuity  in  the 


Operative  Treatment  of  Rectal  and  Sigmodal  Cancer. 
Surg.  Gynec.  & Obst.,  81:113,  1945. 

•Collar,  F.  A.,  Kay,  E.  B.,  and  McIntyre,  R.  S. : Re- 
gional Lymphatic  Metastasis  of  Carcinoma  of  the 
Rectum.  Surgery,  8:294,  1940. 

•Dixon,  C.  F. : Anterior  Resection  for  Malignant 
Lesions  of  the  Upper  Part  of  the  Rectum  and  Lower 
Part  of  the  Rectum.  Ann.  Surg.,  128:425,  1948. 

•Gilchrist,  R.  K.,  and  David,  V.  C. : Lymphatic 
Spread  of  Carcinoma  of  the  Rectum.  Ann.  Surg., 
108:621,  1938. 

•Gilchrist,  R.  K.,  and  David,  V.  C. : Prognosis  in 
Carcinoma  of  the  Bowel.  Surg.,  Gynec,  & Obst.,  86:359, 
1948. 

“Glover,  R.  P.,  and  Waugh,  J.  M. : Retrograde 
Lymphatic  Spread  of  Carcinoma  of  the  Rectum.  Surg., 
Gynec.  & Obst.,  82:434,  1946. 

“Gray,  J.:  An  Evaluaton  of  Conservative  Resec- 
tion for  Malignancy  of  the  Rectum.  Arch.  Surg., 
57:361,  1948. 

“Grinnell,  R.  S. : The  Lymphatic  and  Venous  Spread 
of  Carcinoma  of  the  Rectum.  Ann.  Surg.,  116:200, 
1942. 

“Kay,  E.  B.:  Regional  Lymphatic  Metastases  of 
Carcinoma  of  the  Gastro-Intestinal  Tract.  Surgery, 
12:553,  1942. 

“MeVay,  J.  R.:  Involvement  of  the  Lymph  Nodes  in 
Carcinoma  of  the  Rectum.  Ann.  Surg.,  76:755,  1922. 

“Nichel,  W.  F.,  Jr.,  and  Chenoweth,  A.  I.:  Resection 
of  the  Rectum  With  Preservation  of  the  Anal 
Sphincter.  Surgery,  23:480,  1948. 

“Waugh,  J.  M.,  and  Kirklin,  J.  W.:  Importance  of 
the  Levtl  of  the  Lesion  in  the  Prognosis  and  Treat- 
ment of  Carcinoma  of  the  Rectum  and  Sigmoid  Colon. 
Ann.  Surg.,  129:22,  1949. 

“Westhues,  H. : Die  pathologisch  - anatomischen 
Grundlagen  der  Chirurgie  des  Relftum  Karzinos. 
Leipzig,  1934. 

“Bacon,  H.  E.,  and  Vaughan,  G.  D. : Abdominoperi- 
neal Proctosigmoidectomy:  Incidence  of  Local  Recur- 
rence. Ohio  State  Medical  Journal,  1949. 


PURULENT  MENINGITIS  IN  CHILDHOOD* 

F.  HOWELL  WRIGHT,  M.D. 

CHICAGO,  ILLINOIS 


A quarter  of  a century  ago  when  Dr. 
Josephine  Neal  made  her  classic  analysis  of 
the  age  incidence  of  bacterial  meningitis  in 
New  York  City^,  the  topics  of  prognosis  and 
treatment  were  scarcely  worthy  of  discus- 
sion. Invasion  of  the  meninges  by  bacteria 
other  than  the  meningococcus  resulted  in 
disease,  the  prognosis  of  which  was  so  uni- 
formly hopeless  that  recoveries  were  re- 
garded as  miracles  or  errors  in  diagnosis. 
Depending  upon  the  epidemic  strain  of  or- 
ganism, meningococcus  meningitis  mortal- 
ity varied  from  30  to  75  per  cent.  Survivors, 
particularly  infants,  ran  an  additional  risk 
of  permanent  damage  to  the  central  ner- 
vous system.  Therapy  was  then  confined  to 
spinal  drainage  and  to  the  administration 
of  horse  antiserum,  practices  which  had  a 
modest  effect  upon  meningococcus  meningi- 
tis but  none  whatsoever  upon  other  types. 
Today  meningitis  is  still  a serious  disease, 

•Presented  before  the  78th  Annual  Session  of  the 
Colorado  State  Medical  Society  at  Glenwood  Springs, 
September  23,  1948.  From  the  Department  of  Pediat- 
rics, University  of  Chicago. 


but  antisera  and  the  antibiotic  drugs  when 
properly  used  can  cure  about  90  per  cent 
of  those  suffering  from  meningococcus  men- 
ingitis, about  70  per  cent  of  those  whose 
meningitis  is  caused  by  other  pyogenic  or- 
ganisms, and  even  an  occasional  victim  of 
tuberculous  meningitis. 

Just  as  the  physician’s  power  to  alter  the 
course  of  meningitis  is  improved  by  these 
new  products,  so  must  he  bear  a greater 
measure  of  responsibility,  for  now  his  skill 
in  prompt  and  accurate  diagnosis  and  treat- 
ment has  become  the  crucial  determinant 
of  the  outcome  for  his  patient.  Particularly 
disconcerting  are  those  Pyrrhic  victories  in 
which  bacteriologic  cure  is  obtained  but  ir- 
reparable damage  to  the  nervous  system 
remains.  They  leave  the  annoying  suspi- 
cion that  complete  recovery  might  have  fol- 
lowed earlier  or  more  adequate  treatment. 
Full  realization  of  the  potential  benefits  of 
modern  methods  will  always  depend  upon 
the  practicing  physician  whose  alertness  de- 


718 


Rocky  Mountain  Medical  Journal 


termines  the  length  of  delay  before  a lum- 
bar puncture  reveals  the  true  character  and 
gravity  of  the  illness. 

Old  as  they  are,  Dr.  Neal’s  figures^  give 
us  a picture  of  the  incidence  of  bacterial 
meningitis  which  is  probably  still  valid. 
They  show  first  that  it  is  a relatively  infre- 
quent disorder.  During  the  period  from 
1910  to  1924,  which  the  study  covers,  there 
were  roughly  100  cases  reported  annually  in 
New  York  City  with  its  5-6,000,000  popula- 
tion. A similar  order  of  frequency  may  be 
inferred  from  recent  figures  which  are 
available  only  for  meningococcus  meningi- 
tis, but  which  undoubtedly  constitute  more 
than  half  the  total.  For  the  past  fifteen 
years,  between  2,000  and  8,000  cases  have 
been  reported  each  year  in  the  United 
States  except  for  two  epidemic  years  during 
mobilization  when  the  figure  was  doubled^. 
It  seems  clear  that  the  average  practition- 
er will  have  little  opportunity  to  exercise 
his  diagnostic  skill. 

A second  feature  of  meningitis  empha- 
sized by  Dr.  Neal’s  study  is  its  relative  fre- 
quency among  children.  Within  her  1,500 
cases,  two  out  of  five  were  less  than  10 
years  old,  and  one  in  five  was  under  a year. 
This  concentration  of  cases  within  the  pedi- 
atric age  has  important  connotations  for  di- 
agnosis and  prognosis.  Modern  treatment 
has  been  least  successful  in  reducing  mortal- 
ity and  neurologic  residua  among  infants 
less  than  2 years  of  age.  Unfortunately,  this 
is  most  often  retarded  by  the  absence  of  dis- 
tinctive clues.  Whereas  the  adult  or  older 
child  may  present  subjective  complaints  of 
fever,  chills,  headache,  nausea,  vertigo, 
pains  in  the  back  or  neck,  or  objective  leads 
such  as  delirium,  coma,  stiff  neck  or  back 
or  positive  Kernig’s  sign,  the  infant  is  more 
prone  to  an  indefinite  and  insidious  onset. 
His  illness  may  be  announced  by  fever, 
vomiting,  anorexia,  diarrhea,  irritability  or 
generalized  convulsions,  but  these  events 
do  not  necessarily  attract  attention  to  the 
nervous  system  for  they  are  common  symp- 
toms of  many  infantile  disorders.  Suspicion 
of  infantile  meningitis  should  always  be 
aroused  by  retraction  of  the  head,  abnormal 
tenseness  of  the  fontanelle,  a high-pitched 


cry,  persistent  or  localized  muscular  twitch- 
ing, a vacant  stare,  ocular  palsy,  bizarre 
respiratory  rhythm  or  a positive  Brudzinski 
response.  Absence  of  the  classical  signs  of 
meningeal  irritation  can  provide  no  re- 
assurance in  infancy,  and  where  the  slight- 
est doubt  exists  a diagnostic  lumbar  punc- 
ture should  be  done.  In  some  instances  the 
clinical  findings  are  so  indefinite  that  dis- 
covery depends  upon  a systematic  search  for 
infection,  instituted  because  the  degree  of 
illness  seems  out  of  proportion  to  the  phy- 
sical findings. 

Dr.  Neal’s  data  also  show  the  relative  fre- 
quency with  which  the  various  bacteria  in- 
vade the  meninges.  In  her  series  the  menin- 
gococcus and  tubercle  bacillus  were  found 
in  approximately  85  per  cent  of  the  cases, 
occurring  about  equally.  Most  of  the  re- 
maining 15  per  cent  were  caused  by  pneu- 
mococci, hemolytic  streptococci  and  influ- 
enza bacilli,  each  constituting  about  5 per 
cent  of  the  total.  Less  than  1 per  cent  were 
produced  by  staphylococci  and  by  the  colon 
bacillus  group  of  organisms.  Judging  from 
the  volume  of  cases  reported  in  the  litera- 
ture, the  same  general  relations  obtain  today 
except  for  a decline  in  the  importance  of 
tuberculous  and  hemolytic  streptococcus 
meningitis.  The  diagnosis  and  treatment  of 
each  type  must  be  considered  separately. 

Meningococcus  Meningitis 

Meningococcus  infections  always  appear 
as  primary  diseases  spread  by  respiratory 
contact.  The  factors  which  determine  sus- 
ceptibility are  poorly  understood.  The  ro- 
bust are  affected  as  well  as  the  debilitated, 
young  infants  and  septuagenarians.  The 
meningococci  enter  through  the  respiratory 
tract  and  pass  by  way  of  the  blood  stream  to 
the  meninges.  Toxins  which  they  produce 
damage  the  endothelium  of  capillaries  and 
produce  petechiae  and  ecchymoses  in  the 
skin  and  mucous  membranes.  The  extent  of 
these  clinical  manifestations  of  meningo- 
coccemia  is  quite  variable.  Small  infants 
seldom  present  any  skin  lesions  at  all;  in 
older  individuals  the  lesions  may  be  few 
and  small,  particularly  if  the  infection  is 
mild;  but  in  severe  or  fulminating  cases, 
the  number  and  size  of  the  hemorrhages 


jor  September,  1949 


719 


may  be  so  great  that  the  patient’s  life  is 
threatened  more  by  vascular  collapse  than 
by  the  meningitis  itself.  The  combination 
of  hemorrhagic  manifestations  and  men- 
ingeal irritation  can  be  taken  as  presump- 
tive evidence  of  meningococcus  meningitis, 
but  definite  confirmation  should  always  be 
sought  through  blood  culture  and  careful 
spinal  fluid  examination. 

Isolation  and  bacteriologic  identification 
of  meningococci  from  the  spinal  fluid  is  the 
only  conclusive  etiologic  proof.  Proper 
handling  of  the  first  specimen  is  important. 
Meningococci  are  less  hardy  than  other  or- 
ganisms which  may  be  encountered  in  spinal 
fluid,  and  inoculation  upon  warm  media 
containing  blood  should  be  completed  be- 
fore the  fluid  cools.  If  possible  a set  of 
media  should  also  be  incubated  at  reduced 
oxygen  tension.  The  chorio-allantoic  fluid 
of  fertile  eggs  offers  a highly  successful 
means  of  isolation  to  those  familiar  with  the 
technic®.  Even  when  isolation  is  successful, 
the  result  cannot  be  known  for  eight  to 
thirty-six  hours  and  consequently  a more 
immediate  confirmation  of  the  diagnosis 
must  be  sought  through  direct  examination 
of  centrifuged  spinal  fluid  stained  by  the 
Gram  method.  If  the  examiner  has  patience 
and  a little  experience  he  can  usually  find 
the  typical  Gram  negative  biscuit-shaped 
diplococci  either  within  or  apart  from  leu- 
cocytes unless  invasion  of  the  meninges  is  a 
very  recent  event. 

Accessory  examinations  of  the  spinal 
fluid  lend  support  to  the  nonspecific  diag- 
nosis of  bacterial  meningitis  and  give  a 
rough  measure  of  its  severity.  The  pressure 
is  regularly  elevated  except  in  neglected 
cases  where  the  circulation  of  spinal  fluid 
has  been  blocked  by  thick  exudate  in  the 
subarachnoid  space.  With  increasing  sever- 
ity of  the  infection,  polymorphonuclear  leu- 
cocytes range  from  a few  hundred  to  many 
thousand  per  cubic  millimeter,  the  protein 
content  from  50  to  several  hundred  milli- 
grams per  cent,  and  the  sugar  content  de- 
clines from  80  milligrams  per  cent  toward 
zero. 

In  vitro,  meningococci  are  sensitive  to  all 
the  common  sulfonamide  drugs  and  to  peni- 


cillin. Extensive  clinical  trials  have  shown 
that  sulfanilamide,  sulfapyridine,  sulfathia- 
zole,  sulfadiazine,  or  sulfamerazine  all  give 
results  which  are  superior  to  serum  therapy 
alone.*  In  municipal  contagious  disease  hos- 
pitals which  must  accept  all  the  neglected 
and  complicated  cases,  the  gross  mortality 
rate  has  been  reduced  from  levels  of  25-35 
per  cent  to  around  10-20  per  cent  or  even 
lower.  5 6 r 8 9 10  units  of  the  Armed  Serv- 
ices where  the  patients  are  in  optimal  phy- 
sical condition  and  diagnosis  is  hastened  by 
continuous  medical  surveillance,  the  mor- 
tality has  been  reduced  as  low  as  3 per 
cent.**  General  preference  among  the  sul- 
fonamides now  favors  sulfadiazine  because 
it  is  easy  to  administer,  diffuses  readily 
into  the  spinal  fluid  and  has  a low  incidence 
of  toxic  reactions.  Blood  levels  of  8-12  mgm. 
per  cent  should  be  established  and  main- 
tained until  clinical  cure  is  assured.  In  most 
cases  this  provides  an  adequate  concentra- 
tion in  the  spinal  fluid  and  at  the  same  time 
avoids  the  danger  of  hematuria  if  an  ade- 
quate urine  flow  is  maintained.  For  rapid 
initial  dosage,  0.1  gm.  of  sodium  sulfadiazine 
per  kilogram  of  body  weight  diluted  to  a 
5 per  cent  solution  or  less  can  be  injected 
subcutaneously  or  intravenously.  Similar 
parenteral  dosage  should  be  repeated  two 
or  three  times  a day  until  the  patient  is  able 
to  accept  the  drug  orally.  Injections  should 
be  made  slowly  and  should  be  controlled 
by  determinations  of  the  sulfadiazine  blood 
levels.  Additional  insurance  against  hema- 
turia and  renal  blockage  may  be  derived 
from  scrupulous  attention  to  the  daily  fluid 
intake  which  in  infants  should  be  about 
150-175  c.c.  per  kilogram  of  body  weight; 
in  older  children  proportionately  a little 
less.  The  urine  pH  should  be  kept  at  7 
or  above  and  can  be  tested  easily  with  ni- 
trazene  paper.  Alkalinization  may  be  ini- 
tiated either  by  the  oral  administration  of 
sodium  bicarbonate  in  doses  equal  to  the 
amount  of  sulfadiazine  given,  or  by  in- 
cluding within  the  daily  parenteral  fluids 
from  one  to  three  injections  of  1/6  molar 
sodium  lactate  solution  in  individual  doses 
of  10  c.c.  per  kilogram  of  body  weight.  The 
urine  should  be  examined  at  least  daily  to 


720 


Rocky  Mountain  Medical  Journal 


assess  the  degree  of  microscopic  hematuria 
and  through  it  the  degree  of  renal  irrita- 
tion. 

Although  penicillin  alone  is  less  reliable 
than  sulfadiazine^^  it  is  an  important  ad- 
juvant in  therapy.  It  does  not  antagonize 
the  action  of  the  sulfonamides,  has  prac- 
tically no  important  toxicity,  and  is  now 
generally  available.  Where  septicemic  man- 
ifestations are  prominent,  the  growth  of 
organisms  must  be  stopped  as  rapidly  as 
possible.  Intramuscular  or  intravenous  in- 
jections of  penicillin  should  be  given  every 
three  hours  in  doses  of  20,000  to  100,000 
units  according  to  age  and  the  gravity  of 
infection.  Combinations  of  penicillin  with 
procaine  should  not  be  used  since  the  pro- 
caine molecule  interferes  with  the  action  of 
sulfonamides  and  confuses  the  chemical  de- 
termination of  their  concentration  in  blood 
or  spinal  fluid.  In  cases  of  average  severity, 
the  adjuvant  use  of  penicillin  is  less  urgent 
but  equally  logical.  The  possible  penalty 
for  insufficient  therapy  is  too  severe  to 
justify  its  omission. 

If  the  patient  is  sensitive  to  sulfonamides 
and  penicillin  must  be  used  alone,  it  should 
be  given  intrathecally  as  well  as  intramus- 
cularly because  its  rate  of  diffusion  into  the 
spinal  fluid  is  insufficient  to  produce  ade- 
quate levels.  Doses  of  5,000  to  20,000  units 
in  a concentration  of  1,000  to  2,000  units  per 
c.c.  in  saline  should  be  injected  two  or  three 
times  a day.  The  volume  injected  ought  not 
to  exceed  the  quantity  of  spinal  fluid  re- 
moved. 

The  routine  use  of  antiserum  in  the  treat- 
ment of  meningococcus  meningitis  has  been 
abandoned  by  most  authorities  because  it 
appears  to  contribute  little  more  than  se- 
rum disease.  A notable  exception  is  Too- 
mey®  who  still  advises  routine  administra- 
tion of  100,000  to  200,000  units  of  antitoxin. 

Vascular  collapse  may  appear  during  the 
late  stages  of  neglected  meningitis  or  dur- 
ing any  stage  when  endothelial  damage  is 
marked.  If  initial  treatment  with  antibiot- 
ics, intravenous  fluids,  warmth  and  spinal 
drainage  fails  to  improve  the  peripheral  cir- 
culation within  two  to  three  hours,  adrenal 
insufficiency  must  be  considered.  Except 


where  unusual  facilities  are  available  for 
rapid  determination  of  the  blood  concen- 
trations of  sodium,  potassium,  chloride  and 
sugar,  the  diagnosis  must  be  assumed  and 
the  usual  treatment  supplemented  with  in- 
travenous saline,  glucose,  adrenalin  and 
cortical  extract  until  the  blood  pressure  and 
general  appearance  of  the  patient  indicate 
that  he  is  responding.  If  the  clinical  mani- 
festations are  actually  due  to  adrenal  in- 
sufficiency, recovery  is  unlikely.  Reports  of 
survival  from  the  Waterhouse-Friderichsen 
syndrome  are  few  and  the  diagnosis  is 
usually  open  to  question. 

Patients  with  meningococcus  meningitis 
of  average  severity  usually  respond  rapidly 
to  penicillin  and  sulfonamides.  Improve- 
ment can  be  expected  within  twelve  to 
twenty-four  hours  and  in  many  instances 
the  temperature  reaches  normal  and  symp- 
toms begin  to  subside  within  two  days. 
Termination  of  treatment  may  be  consid- 
ered after  the  temperature  has  been  normal 
for  two  days  provided  there  are  no  com- 
plications and  the  spinal  fluid  is  sterile 
with  falling  cell  count  and  rising  sugar  con- 
tent. Relapses  which  follow  too  early  with- 
drawal of  treatment  and  late  complications, 
such  as  arthritis,  ordinarily  yield  in  a sat- 
isfactory manner  to  the  resumption  of 
therapy.  In  young  infants  the  danger  of 
adhesive  interference  with  spinal  fluid  cir- 
culation demands  a more  cautious  with- 
drawal of  therapy. 

Influenza  Bacillus  Meningitis 

Influenza  bacillus  meningitis  selects  a 
rather  narrow  age  range  between  6 months 
and  3 years.  A sprinkling  of  cases  occurs 
among  younger  infants  and  older  chil- 
dren, but  the  disease  is  quite  rare  in  adults. 
Ordinarily  it  appears  as  the  first  manifesta- 
tion of  illness.  Demonstrable  infection  of  the 
blood  stream  is  commonly  present.  Among 
infants  it  is  almost  universal  and  is  occa- 
sionally associated  with  other  localizations 
such  as  otitis  media,  pneumonia,  empyema 
or  arthritis. 

The  influenza  bacillus  is  Gram  negative 
and  pleomorphic.  In  artificial  media  it  ap- 
pears as  long  and  short  thin  rods,  but  in 


for  September,  1949 


721 


spinal  fluid  a short  bacillus,  almost  coccoid 
in  form,  usually  predominates  and  may  be 
easily  confused  with  the  meningococcus.  It 
withstands  temperature  changes  poorly  so 
that  prompt  inoculation  upon  chocolate  agar 
is  essential  for  successful  isolation.  Biolog- 
ically the  influenza  bacillus  resembles  the 
pneumococcus  in  that  its  capsule  contains 
a polysaccharide  which  determines  its  type 
specificity.  With  few  exceptions  the  in- 
fluenza bacilli  which  produce  meningitis  in 
man  belong  to  Pittman’s  type  b.  If  a suffi- 
cient concentration  of  organisms  is  present 
in  the  spinal  fluid,  direct  typing  and  im- 
mediate identification  can  be  accomplished 
by  using  the  Neufeld  technic,  for  the  or- 
ganisms demonstrate  capsular  swelling 
when  placed  in  homologous  rabbit  anti- 
serum. With  light  infections,  such  positive 
identification  must  await  cultural  isolation. 

The  bacilli  exude  specific  carbohydrate 
into  the  body  fluids  where  it  is  presumed 
to  serve  some  function  in  facilitating  their 
invasion  of  the  tissues.  The  carbohydrate 
is  excreted  in  the  urine. 

Treatment  of  influenzal  meningitis,  of 
course,  aims  to  kill  all  the  bacteria  present 
within  the  body  and  to  eliminate  their 
products.  Infection  of  the  subarachnoid 
space  which  remains  unchecked  for  several 
days  forms  adhesions  which  may  localize 
pockets  of  infected  pus  and  bacteria  and 
shield  the  latter  from  therapeutic  agents. 
Even  if  the  infection  is  eradicated,  the  re- 
maining adhesions  sometimes  interfere 
permanently  with  the  circulation  of  spinal 
fluid.  Therapy  should  be  prompt  and  vig- 
orous in  order  to  avoid  such  complications 
which  are  all  too  common  in  this  form  of 
meningitis. 

No  less  than  three  specific  types  of  treat- 
ment must  be  considered  — sulfadiazine, 
type  specific  anti-influenzal  rabbit  serum, 
and  streptomycin.  A fourth,  penicillin,  is 
reported  to  be  effective  in  very  large 
doses^*,  but  it  should  never  be  used  as  the 
sole  agent  in  treatment  unless  the  penicillin 
sensitivity  of  the  strain  isolated  is  defi- 
nitely known. 

Mouse  protection  tests^®  and  clinical 
studies  leave  no  doubt  that  sulfadiazine 


alone^®.,  streptomycin  alone^’^  or  sufadia- 
zine  combined  with  rabbit  serum^®  are  ail 
forms  of  therapy  which  will  save  some  of 
the  90-95  per  cent  of  patients  who  would 
otherwise  die.  Evaluation  of  the  relative 
effectiveness  of  these  methods  is  hampered 
by  the  necessity  of  making  allowances  for 
age,  duration  and  severity  of  infection  and 
for  drug  resistance  of  individual  strains.  In 
expert  hands  the  mortality  has  been  de- 
pressed below  10  per  cent  by  the  use  of 
sulfadiazine  combined  with  rabbit  serum^® 
and  almost  as  low  with  streptomycin 
alone^®.  Alexander^®  correctly  recommends 
that  cases  which  are  not  under  special 
study  should  receive  the  benefit  of  all  three 
agents  in  the  initial  treatment.  This  pro- 
vides the  maximum  insurance  against  un- 
foreseen difficulties. 

In  such  a program,  sulfadiazine  forms  the 
basic  and  prolonged  element  of  treatment. 
The  principles  of  its  administration  have 
already  been  described.  Blood  levels  of 
8-12  mgm.  per  cent  should  be  maintained 
until  two  weeks  after  clinical  and  bacterio- 
logic  cure  seems  complete. 

Anti-influenzal  rabbit  serum  is  standard- 
ized in  terms  of  milligrams  of  antibody 
nitrogen  which  is  determined  chemically 
from  the  precipitate  formed  by  the  union 
of  antibody  and  specific  carbohydrate. 
Antibody,  of  course,  combines  with  the  car- 
bohydrate whether  it  is  attached  to  a bacil- 
lus or  freely  floating  in  body  fluids.  The 
initial  therapeutic  dose  of  serum  ranges 
from  25  to  150  mgm.  of  nitrogen  depend- 
ing upon  the  severity  of  the  infection. 
Alexander^®  uses  a graded  scale  of  dos- 
age, giving  25  mgm.  when  the  spinal 
fluid  sugar  concentration  is  40  mgm.  per 
cent  or  over^  and  100-150  mgm.  of  nitrogen 
if  the  spinal  fluid  sugar  has  fallen  to  15 
mgm.  per  cent  or  less.  If  intradermal  and 
conjunctival  tests  for  sensitivity  are  nega- 
tive, the  calculated  dose,  well  diluted  in 
saline,  should  be  administered  by  intramus- 
cular or  intravenous  drip  over  a one  to  two- 
hour  period.  The  rabbit  antibody  molecules 
are  sufficiently  small  to  permeate  into  the 
spinal  fluid  where  they  agglutinate  the  or- 
ganisms and  combine  with  soluble  carbo- 


722 


Rocky  Mountain  Medical  Journal 


hydrate.  Direct  intrathecal  injection  is  not 
advisable  early  in  treatment  for  the  patient 
is  usually  made  worse  by  the  sudden  com- 
bination of  large  amounts  of  antibody  and 
antigen  in  the  subarachnoid  space.  Its  use 
should  be  reserved  for  desperate  cases 
which  have  failed  to  respond  to  the  usual 
methods.  The  initial  intravenous  or  intra- 
muscular dose  of  serum  should  be  repeated 
daily  until  the  patient’s  serum  in  a dilution 
of  1:10  can  produce  capsular  swelling  of  the 
organisms  originally  isolated  from  his  spinal 
fluid.  Four  injections  or  less  usually  suf- 
fice, but  the  number  should  be  controlled 
with  daily  tests  for  excess  of  circulating 
antibody.  Immediate  serum  reactions  are 
not  uncommon,  but  are  readily  controlled 
with  adrenalin.  Serum  disease  appears  in 
about  half  the  patients  after  one  to  three 
weeks.  The  anti-histamine  drugs  are  useful 
in  prevention  and  treatment  of  both  the 
immediate  and  the  delayed  ractions.  There 
is  logic  also  in  the  practice  of  giving  at  least 
small  daily  injections  of  serum  until  it  is 
certain  that  no  more  will  have  to  be  used. 
This  avoids  the  possibility  of  anaphylactic 
reactions  if  serum  therapy  is  interrupted 
for  several  days  and  then  has  to  be  resumed 
because  of  a relapse. 

Streptomycin  is  the  most  potent  destroyer 
of  Hemophilus  influenzae  but  it  has  imfor- 
tunate  toxic  reactions  and  is  useless  against 
the  resistant  strains  of  organisms  which 
sometimes  emerge  during  treatment.  The 
chief  toxic  reactions  of  deafness  and  ataxia 
seem  to  be  a function  of  the  total  dosage 
and  length  of  administration  of  the  drug. 
If  large  doses  of  streptomycin  are  given  for 
a brief  time,  the  risk  of  toxicity  will  be 
minimized  but  the  major  lethal  action  of 
the  drug  against  susceptible  organisms  may 
still  be  utilized.  There  is  no  point  in  con- 
tinuing its  use  if  the  presence  of  resistant 
strains  has  been  recognized.  The  drug 
should  be  given  intramuscularly  every  three 
hours  in  a daily  dose  of  40  mgm.  per  kilo- 
gram of  weight.  The  rate  of  its  diffusion 
into  the  spinal  fluid  is  insufficient  to  main- 
tain adequate  concentrations  so  that  a daily 
intrathecal  dose  of  25  to  50  mgm.  is  also 
required.  Both  routes  of  administration 


should  be  terminated  after  five  days  to  a 
week.  Persistence  of  a mild  pleocytosis  is 
not  necessarily  an  indication  of  continuing 
infection  since  streptomycin  stimulates 
some  . increase  in  spinal  fluid  cell  count 
when  used  intrathecally. 

To  summarize,  the  therapy  which  seems 
to  offer  the  maximum  chance  for  full  re- 
covery consists  of  (1)  sulfadiazine  with 
adequate  fluid  and  alkalinizing  agents  given 
from  the  start  and  continued  until  recovery 
has  been  assured  for  at  least  a week;  (2) 
anti-influenzal  rabbit  serum  in  initial  dos- 
age sufficient  to  provide  an  excess  of  cir- 
culating antibody  and  maintained  at  this 
level  by  supplementary  injections  as  neces- 
sary; and  (3)  streptomycin  in  heavy  dosage 
intramuscularly  and  intrathecally  for  a 
brief  period  at  the  onset. 

Pneumococcus  Meningitis 

Pneumococci  may  reach  the  meninges  in 
the  same  fashion  as  the  meningococci — via 
the  blood  stream  after  initial  entry  through 
the  upper  or  lower  respiratory  tract.  Some- 
times there  is  evidence  of  pneumonia  or  in- 
fection of  the  middle  ear.  In  other  instances, 
the  pathway  to  the  meninges  appears  to  be 
more  direct  and  not  necessarily  mediated 
by  general  bacteremia.  Direct  entry  may 
occur  through  trauma  or  operative  disturb- 
ance of  the  cribriform  plate  of  the  ethmoid 
bone,  after  internal  extension  of  a necrotic 
focus  of  mastoiditis,  or  by  extension  of 
purulent  labyrinthitis  through  the  internal 
auditory  meatus^\  When  such  a pathway 
is  clinically  apparent,  the  existence  of  men- 
ingitis due  to  some  organism  other  than  the 
meningococcus  may  be  suspected.  However, 
the  clinical  picture  is  not  a reliable  guide 
to  bacteriologic  differentiation  and  the  or- 
ganisms must  be  identified  in  the  spinal 
fluid. 

The  spinal  fluid  displays  the  general  fea- 
tures of  increased  pressure,  pleocytosis, 
increased  protein  and  decreased  sugar  de- 
scribed for  meningococcus  meningitis.  Usu- 
ally, however,  even  when  the  fluid  is  not 
very  cloudy  and  the  cell  count  is  relatively 
low,  pneumococci  appear  in  great  profusion 
and  are  easily  discovered  in  strained  smears 


for  September,  1949 


723 


although  the  inexperienced  may  confuse 
them  with  meningococci.  Often  the  con- 
centration of  organisms  in  the  initial  spinal 
fluid  is  sufficient  to  permit  immediate  iden- 
tification and  typing  through  the  appear- 
ance of  capsular  swelling  in  type  specific 
serum  using  the  Neufeld  technic.  When  this 
is  impossible  the  organisms  will  grow  out 
readily  upon  blood  agar  or  in  blood  broth 
under  ordinary  incubator  conditions.  Ulti- 
mate typing  of  pneumococci  is  essential  to 
the  appropriate  use  of  specific  serum. 

Untreated  pneumococcus  meningitis  is  al- 
most universally  fatal.  The  use  of  sulfona- 
mides alone,  or  with  specific  anti-pneumo- 
cocci rabbit  serum  may  save  from  one-third 
to  two-thirds  of  patients  over  2 years^ 
Penicillin  alone  is  about  equally  effective, 
but  the  results  are  somewhat  better  if  both 
sulfadiazine  and  penicillin  are  given^^ 
Infants  who  survive  are  commonly  left  with 
permanent  cerebral  damage^®.  Alexander 
reports  complete  recovery  in  six  out  of  eight 
small  infants  who  received  combined  treat- 
ment with  sulfadiazine,  penicillin  and  type 
specific  antipneumococcus  rabbit  serum^®. 
When  the  pneumococcus  is  typable  and  the 
corresponding  serum  can  be  obtained,  pa- 
tients at  any  age  ought  to  receive  all  three 
agents. 

The  general  principles  of  sulfadiazine  and 
penicillin  administration  have  been  de- 
scribed above.  Because  of  the  less  favorable 
prognosis,  the  level  of  sulfadiazine  in  the 
blood  should  be  maintained  at  20  mgm.  per 
cent  or  as  high  as  microscopic  hematuria 
will  permit.  Penicillin  is  very  effective 
against  most  strains  of  pneumococci  in  vitro 
and  maximum  doses  should  be  administered 
intramuscularly  with  a daily  intrathecal 
dose  of  5,000  to  20,000  units,  depending  upon 
age.  When  type-specific  rabbit  serum  is 
available,  the  patient  should  be  tested  for 
sensitivity  by  intradermal  and  conjunctival 
injection  before  administration.  The  usual 
dose  for  a child  is  20,000  to  40,000  units 
given  intravenously,  well  diluted  in  saline. 
Such  serum  is  now  scarce  because  the  com- 
mercial houses  have  stopped  producing  it 
in  quantity.  Termination  of  the  sulfadia- 
zine and  penicillin  should  be  delayed  for  at 


least  a week  after  consistently  negative 
spinal  fluid  cultures  are  obtained.  Pneu- 
mococcus meningitis  is  notorious  in  its  pro- 
pensity to  relapse  after  apparent  cure. 
Repeated  examination  of  spinal  fluid  is 
advisable  for  two  or  three  weeks  after  the 
cessation  of  treatment  to  be  sure  that  infec- 
ion  has  been  permanently  controlled. 

The  therapy  used  to  control  meningitis  is 
amply  sufficient  for  complications  such  as 
pneumonia  and  for  the  simpler  varieties  of 
upper  respiratory  infection.  If  mastoid  in- 
fection demands  operative  intervention,  it 
should  be  deferred  until  there  is  some  as- 
surance that  the  meningitis  is  responding. 

Hemolytic  Streptococcus  and  Staphylo- 
coccus Meningitis 

Treatment  of  these  less  common  forms  of 
meningitis  is  similar  to  that  described  for 
pneumococcal  meningitis.  In  both  varieties 
the  organisms  are  usually  found  on  direct 
smear  of  the  spinal  fluid  and  are  easily  cul- 
tivated in  blood  broth  or  upon  blood  agar 
plates.  Streptococcus  meningitis  occurs 
among  small  infants  with  general  bactere- 
mia, and  in  older  children  as  a result  of 
cranial  extension  of  streptococcus  mastoid- 
itis. All  strains  of  beta  hemolytic  strepto- 
cocci which  are  pathogenic  for  man  are 
highly  susceptible  to  penicillin^®,  which 
should  be  used  as  the  main  therapeutic 
agent.  Transfusion  for  anemia  and  ultimate 
surgical  attention  to  suppurative  mastoidi- 
tis should  be  included  in  the  management. 

Meningitis  produced  by  staphylococci  is 
most  commonly  associated  with  bacteremia 
and  metastatic  abscesses.  In  small  infants 
it  may  follow  direct  penetration  through 
meningoceles  or  congenital  dermal  sinuses. 
Strains  of  staphylococci  vary  so  much  in 
their  sensitivity  to  sulfonamides  and  peni- 
cillin that  in  vitro  testing  of  individual  or- 
ganisms is  highly  desirable  in  order  to  guide 
treatment.  If  such  testing  is  not  possible, 
sulfadiazine  should  be  given  to  the  limit  of 
renal  tolerance  combined  with  penicillin  in 
maximum  doses  intramuscularly  and  intra- 
thecally. 

Meningitis  Due  to  Other  Bacteria 

The  colon  bacillus  and  other  enteric  or- 


724 


Rocky  Mountain  Medical  Journal 


ganisms  produce  meningitis  in  newborn 
infants  and  may  invade  the  spinal  fluid  of 
older  children  and  adults  during  septicemia 
or  urinary  tract  infections.  Sulfadiazine 
and  streptomycin  are  generally  effective 
against  such  organisms,  but  each  individual 
strain  should  be  subjected  to  an  in  vitro 
test  for  sensitivity  to  the  antibiotics  which 
are  available  to  provide  the  best  guide  for 
therapy.  When  these  organisms  enter  the 
subarachnoid  space  directly  through  leak- 
ing meningoceles  or  the  less  common  con- 
genital dermal  sinuses,  permanent  cure  can- 
not be  expected  unless  the  portal  of  entry 
can  be  extirpated  surgically. 

Numerous  other  bacteria  may  be  found 
in  isolated  cases  of  meningitis.  Treatment 
and  prognosis  depend  upon  bacteriologic 
definition  and  the  determination  of  anti- 
biotic susceptibility  in  each  instance. 

Tuberculous  meningitis  presents  a sep- 
arate and  more  difficult  problem.  Since  1945 
occasional  complete  cures  have  been  re- 
ported^^  from  prolonged  and  vigorous 
streptomycin  therapy  given  intramuscu- 
larly and  intrathecally.  The  results  are  not 
predictable.  Prolongation  of  life  is  usual, 
but  survival  is  nearly  always  at  the  expense 
of  serious  neurologic  residua  or  represents 
a temporary  remission  preceding  fatal  re- 
lapse. The  hazards  of  streptomycin  toxicity 
should  not  deter  treatment  if  the  diagnosis 
is  assured. 

The  preceding  discussion  has  attempted 
to  set  forth  the  technic  of  diagnosis  and 
treatment  of  bacterial  meningitis  under  op- 
timal conditions.  Bacteriologic  facilities 
sufficient  to  carry  out  all  the  tests  men- 
tioned are  found  in  relatively  few  hospitals 
and  even  under  the  best  circumstances 
some  therapeutic  decisions  must  be  made 
without  accurate  bacterial  diagnosis.  As 
soon  as  the  lumbar  puncture  reveals  puru- 
lent spinal  fluid,  immediate  therapy  must 
be  considered.  While  the  needle  is  still  in 
place,  3,000  to  10,000  units  of  crystalline 
penicillin  may  be  instilled  into  the  spinal 
canal.  A blood  culture  should  be  obtained 
rapidly  thereafter  and  injection  of  par- 
enteral sulfadiazine,  penicillin,  fluids  and 
alkalinizing  substances  started.  Such  meas- 


ures initiate  proper  therapy  against  men- 
ingococci, pneumococci,  streptococci  and 
staphylococci,  but  may  be  insufficient  for 
Hemophilus  influenzae  and  other  gram- 
negative bacilli.  The  spinal  fluid  should  be 
immediately  cultured  upon  blood  agar, 
blood  broth  and  two  chocolate  agar  plates 
or  slants.  To  favor  the  growth  of  meningo- 
cocci, one  chocolate  agar  preparation  and 
a blood  culture  flask  should  be  incubated 
at  reduced  oxygen  tensions  in  a vacuum 
jar  or  in  a dessicator  in  which  a candle  is 
burned  to  exhaust  the  oxygen  supply.  If 
inoculation  is  made  quickly  onto  warm 
media  of  this  sort,  there  is  an  excellent 
chance  that  the  offending  organism  will  be 
recovered.  If  the  spinal  fluid  smears  clearly 
define  the  infecting  agent,  therapy  can  be 
rapidly  shifted  in  favor  of  the  appropriate 
substances.  If,  however,  neither  bacterio- 
logic diagnosis  nor  clinical  improvement  is 
available  within  twenty-four  to  forty-eight 
hours  at  most,  streptomycin  and  anti-influ- 
enzal rabbit  serum  should  be  added  to  the 
therapeutic  program,  particularly  if  the 
child  is  under  3 years  of  age.  Such  an  unsci- 
entific approach  may  subject  the  patient  to 
unnecessary  treatment,  but  if  bacteriologic 
guidance  cannot  be  obtained  there  is  no 
other  way  to  protect  him  against  the  dan- 
gers of  chronic  meningitis  and  its  usual 
residua. 

In  conclusion  it  should  be  emphasized 
that  treatment  is  more  often  made  difficult 
and  unsatisfactory  by  delayed  diagnosis 
than  by  exceptional  severity  of  the  infec- 
tion. The  practitioner  alone  has  the  power 
to  minimize  this  all-important  obstacle  to 
full  recovery  from  bacterial  meningitis. 

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CHANGITNG  CONCEPTIONS  IN  THE  MANAGEMENT  OF  CARCINOMA 
OF  THE  LEFT  PORTION  OF  THE  COLON* 

B.  MARDEN  BLACK,  M.D. 

ROCHESTER,  MINN. 


Before  considering  the  changes  in  the 
management  of  carcinoma  of  the  left  portion 
of  the  colon  which  have  taken  place  during 
the  past  few  years,  a brief  review  of  some  of 
the  principles  and  practices  in  vogue  a dec- 
ade ago  might  be  in  order.  The  methods  em- 
ployed at  that  time  had  resulted  from  half 
a century  of  experience  and  were  rather 
well  standardized.  Segmental  resection 
with  primary  intraperitoneal  anastomosis 
had  been  virtually  abandoned,  having  been 
replaced  by  procedures  involving  the  prin- 
ciple of  exteriorization  originally  devised 
by  Block  and  by  Paul  and  publicized  by 
Mikulicz. 

The  adoption  of  exteriorizations  had  been 
a gradual  process  extending  over  many 
years  in  spite  of  the  fact  that  as  early  as 
1903  Mikulicz  had  publicized  widely  that 
the  then  prevailing  mortality  rate  of  ap- 
proximately 40  per  cent  could  be  reduced  to 
about  15  per  cent  by  substituting  exteriori- 
zation for  segmental  resection  with  primary 
anastomosis.  Much  of  the  delay  was  due  to 
the  complexity  of,  and  the  morbidity  asso- 
ciated with,  exteriorization  procedures  and 
to  the  prolonged  time  necessary  to  carry 
out  the  several  stages  of  the  operation.  The 
management  of  lesions  so  low  in  the  bowel 
that  exteriorization  was  not  possible  was 
usually  by  means  of  combined  abdomino- 
perineal resection,  carried  out  in  stages,  and 
the  permanent  abdominal  colonic  stoma 
was  accepted  as  inevitable.  Combined  ab- 

*Read  at  the  meeting  of  the  Wyoming  State  Medi- 
cal Society,  Laramie,  Wyoming,  September  1,  2 and 
3,  1948.  From  the  Division  of  Surgery,  The  Mayo 
Clinic. 


dominoperineal  resection,  or  one  of  the  sev- 
eral modifications  of  Miles’  operation,  had 
comparatively  quickly  replaced  segmental 
resection  for  lesions  of  the  upper  part  of  the 
rectum,  particularly  in  English-speaking 
countries.  Perineal  amputation  with  abdomi- 
nal colostomy  was  used  commonly  to  man- 
age lesions  of  the  lower  part  of  the  rectum 
since  it  could  be  carried  out  with  less  risk 
than  could  the  combined  procedure.  In  Cen- 
tral Europe,  the  earlier  methods  of  manag- 
ing lesions  of  the  rectum  were  never  aban- 
doned as  completely  as  they  were  in  Eng- 
lish-speaking countries®.  The  Hochenegg 
“pull-through”  operation  and,  particularly 
in  France,  sphincter-saving  operations  con- 
tinued to  be  employed  commonly^. 

Chemotherapy 

The  mortality  rate  associated  with  re- 
moval of  a segment  of  colon  dropped  pre- 
cipitously during  the  two  years  of  1939  and 
1940,  and  the  increased  safety  of  surgical 
procedures  on  the  colon  since  has  been  fol- 
lowed by  profound  changes  in  technical 
methods.  The  cause  of  the  decrease  in  mor- 
tality has  been  widely  discussed  and  is 
largely  beyond  the  scope  of  this  presenta- 
tion. However,  I feel  strongly  that  it  re- 
sulted from  the  local  use  of  sulfonamide 
drugs.  During  the  period  of  two  years  when 
the  risk  of  removing  a segment  of  the  colon 
decreased  from  more  than  12  per  cent  to 
less  than  5 per  cent  at  the  Mayo  Clinic  (the 
figures  are  approximations) , the  only 
change  in  preoperative  management,  tech- 


726 


Rocky  Mountain  Medical  Journal 


nical  methods  or  post-operative  care  was 
the  addition  of  the  sulfonamide  drugs^®. 
There  were  no  changes  in  the  surgical  staff 
and  the  operability  rate  actually  increased. 
I know  of  no  other  rational  explanation  for 
the  halving  of  the  hospital  mortality  rate 
over  a two-year  interval  whereas  by  all 
other  means,  including  the  development  of 
elaborate  preoperative  and  postoperative 
care,  special  training  on  the  part  of  both 
internist  and  surgeon,  free  use  of  blood 
transfusion  and  parenteral  fluids  to  correct 
fluid,  protein  and  electrolyte  balance,  intra- 
peritoneal  vaccines,  and  the  development  of 
complex  surgical  methods,  the  mortality 
rate  had  been  reduced  by  only  a few  per 
cent  during  the  preceding  twenty  years. 

Since  1940  other  advances  in  chemotherapy 
have  been  made  which  undoubtedly  have 
added  further  to  the  safety  of  colonic  oper- 
ations. These  newer  agents  have  not,  how- 
ever, materially  reduced  further  the  hos- 
pital mortality.  Poth  and  co-worker^^ 
were  responsible  for  the  development  and 
introduction  of  sulfasuxidine  in  1941  and 
1942  and  of  sulfathaladine  in  1943,  and  one 
or  the  other  of  these  drugs  is  now  used 
routinely  preoperatively.  The  value  of  pen- 
icillin in  colonic  surgery  is  more  equivocal 
but  there  are  no  serious  objections  to  using 
it  either  intraperitoneally  or  systemically. 
The  use  of  streptomycin  in  surgery  of  the 
colon  is  so  recent  that  its  value  cannot  be 
properly  evaluated  as  yet^^  While  bacterial 
counts  in  the  colon  can  be  reduced  incred- 
ibly with  the  drug,  the  counts  soon  return 
to  their  former  levels  and  this,  along  with 
the  seriousness  of  eighth  nerve  complica- 
tions, has  limited  the  use  of  the  drug. 

Lesions  of  the  Left  Part  of  the  Transverse 
Colon  to  the  Sigmoid 

Perhaps  the  most  striking  change  in  sur- 
gery of  the  colon  during  the  past  few  years 
has  been  the  substitution  of  segmental  re- 
section with  primary  intraperitonea],  an- 
astomosis for  exteriorization  procedures  in 
the  management  of  lesions  of  the  left  part 
of  the  colon.  The  hazards  of  intraperitoneal 
anastomosis  had  become  so  well  known  that 
the  revival  of  the  older,  discredited  opera- 


tion met  with  hostility.  The  earlier  primary 
anastomosis,  after  the  introduction  of  chemo- 
therapy, was  almost  invariably  protected 
by  a proximal  colonic  stoma  which  diverted 
the  fecal  stream  completely.  The  addition 
of  the  stoma,  established  either  at  the  same 
time  as  the  resection  or  as  a preliminary 
operation,  made  the  entire  surgical  pro- 
cedure as  time-consuming  as  an  exterioriza- 
tion operation.  As  confidence  in  the  anasto- 
mosis increased,  the  stoma  was  omitted  in 
more  and  more  cases,  and  at  present,  in  se- 
lected cases  at  least,  the  proximal  stoma  is 
omitted.  During  the  past  few  years,  the 
hospital  mortality  rate  associated  with  seg- 
mental resection  with  primary  anastomosis 
but  without  a colonic  stoma  has  never  risen 
above  4 per  cent  at  the  institution  with 
which  I am  associated. 

It  should  be  added  immediately  that  cases 
must  be  selected  carefully  and  that  certain 
conditions  must  be  met  for  the  successful, 
safe  employment  of  primary  intraperitoneal 
anastomosis.  Acute  obstruction  is  the  most 
rigid  contraindication,  and  any  degree  of 
chronic  obstruction  adds  materially  to  the 
risk.  Similarly,  the  anastomosis  does  not 
work  out  well  when  inflammatory  changes 
are  present  in  the  wall  of  the  bowel.  It  is 
perhaps  superfluous  to  add  that  the  an- 
astomosis must  be  under  no  tension  and 
that  adequate  circulation  must  be  present 
in  both  segments,  the  resected  ends  of 
which  are  to  be  anastomosed.  More  rarely, 
marked  obesity  and  particularly  a heavy, 
fat  mesocolon  will  prevent  the  use  of  pri- 
mary anastomosis.  When  these  fairly  rigid 
conditions  cannot  be  met,  the  procedure  of 
choice  remains  an  exteriorization  operation. 
In  the  presence  of  obstruction,  it  is  usually 
possible  after  establishing  a proximal  co- 
lonic stoma,  to  subsequently  carry  out  an 
intraperitoneal  anastomosis  with  safety,  and 
this  constitutes  one  of  the  two  indications 
for  a proximal  stoma  and  segmental  resec- 
tion. The  other  indication  has  to  do  with 
the  technical  aspects  of  the  anastomosis.  If 
for  any  reason  the  anastomosis  does  not 
seem  technically  satisfactory,  it  is  safer  by 
far  to  establish  a proximal  stoma,  or  even 
to  abandon  the  method  and  finish  the  oper- 


for  September,  1949 


727 


ation  as  an  exteriorization  rather  than  to 
replace  a doubtful  anastomosis  in  the  peri- 
toneal cavity.  At  the  Mayo  Clinic  in  1946, 
in  the  management  of  lesions  of  the  sig- 
moid, approximately  twice  as  many  seg- 
mental resections  with  primary  anasto- 
moses as  exteriorization  procedures  were 
carried  out.  It  can  be  implied  from  this  that 
patients  for  the  one-stage  operation  were 
selected  and  that  exteriorization  procedures 
still  have  a definite  place  when  conditions 
necessary  for  a satisfactory  intraperitoneal 
anastomosis  cannot  be  met. 

In  addition  to  changes  in  technical  meth- 
ods and  as  a result  of  them,  a second  im- 
portant advance  has  taken  place  in  the 
management  of  lesions  of  this  segment  of 
colon.  This  advance  has  been  toward  in- 
creasing the  amount  of  bowel  and  particu- 
larly of  mesocolon  removed.  The  limited 
extent  of  resection  of  both  bowel  and  meso- 
colon employing  traditional  exteriorizations 
has  long  been  recognized,  and  many  tech- 
nical modifications,  such  as  the  obstructive 
resection  of  Rankin,  were  devised  to  in- 
crease the  magnitude  of  resection.  When 
primary  intraperitoneal  anastomosis  is  used, 
the  extent  of  resection  is  almost  automati- 
cally increased,  compared  to  that  following 
exteriorizations.  In  addition,  there  is  a 
growing  tendency  to  substitute  massive  re- 
section of  the  left  part  of  the  colon  for  the 
more  limited  resections  of  the  past®.  This 
is  a natural  development  following  decline 
in  risk,  and  it  is  now  not  uncommon  to  re- 
move the  entire  descending  colon,  parts  of 
the  transverse  and  sigmoid  colons  and  cor- 
responding mesocolon  for  lesions  of  the 
splenic  flexure  and  descending  colon.  It  is 
anticipated  that  survival  rates  will  be  in- 
creased following  the  more  radical  opera- 
tion. 

Lesions  of  the  Rectosigmoid  and  Upper 
Part  of  the  Rectum 

Until  the  past  few  years,  colonic  surgeons, 
with  a few  notable  exceptions,  have  been 
content  to  carry  out  combined  abdomino- 
perineal resection  or  one  of  its  modifica- 
tions when  the  lesion  was  too  low  in  the 
bowel  for  exteriorization.  The  combined 
abdominoperineal  resection  of  Miles  is  so 


satisfactory  from  the  standpoint  of  risk, 
freedom  from  complications  and  late  sur- 
vival rate  that  proposals  to  modify  funda- 
mentally the  operation  have  been  vigor- 
ously opposed^  However,  the  necessity  of 
the  permanent  colonic  stoma  is  a real 
disadvantage  of  Miles’  operation,  and  oc- 
casional surgeons  have  tried  for  years  to 
devise  operative  procedures  to  preserve 
continence.  Indeed,  operations  preserving 
either  the  sphincters  or  a segment  of  the 
lower  part  of  the  rectum  preceded  Miles’ 
operation  by  a full  quarter  of  a century. 
Dixon^,  almost  twenty  years  ago,  became 
convinced  that  removal  of  the  entire  rectum 
was  not  necessary  from  the  standpoint  of 
satisfactory  late  survival  and  proposed  that 
many  lesions  of  the  rectosigmoid  and  upper 
part  of  the  rectum  could  be  managed  satis- 
factorily by  segmental  resection  with  pri- 
mary anastomosis  between  the  sigmoid  and 
rectum  (low  anterior  resection).  At  about 
the  same  time,  Babcock  reintroduced  in 
America  the  conception  of  preservation  of 
the  external  anal  sphincter  and  perineal 
stoma.  Neither  operative  procedure  was 
widely  accepted  until  after  the  risk  of  co- 
lonic surgery  had  decreased  to  its  present 
level. 

After  the  demonstration  that  primary  an- 
astomosis was  not  unduly  hazardous  at 
more  proximal  levels  of  the  colon,  consider- 
able interest  was  shown  in  applying  the 
method  to  lesions  of  the  rectosigmoid.  Sim- 
ilarly, with  the  increased  freedom  from 
infectious  complications,  the  entire  question 
of  sphincter-preserving  operations,  or  more 
generally,  of  abdomino-endorectal  resec- 
tions, is  being  re-evaluated.  Such  operations 
are  the  most  controversial  in  surgery  of  the 
colon  at  this  time.  Such  is  the  favored  posi- 
tion of  Miles’  operation  that  in  spite  of  the 
demonstration  that  mortality  rates  follow- 
ing low  anterior  resections  and  sphincter- 
preserving operations  are  about  the  same 
as,  or  even  less  than,  those  following  com- 
bined abdominoperineal  resection  and  that 
late  survival  rates  are  about  the  same  fol- 
lowing the  three  types  of  operation,  the 
combined  abdominoperineal  resection  re- 
mains the  standard  method  of  treatment. 


728 


Rocky  Mountain  Medical  Journal 


At  present,  and  emphasizing  again  that 
technical  procedures  are  not  standardized 
and  are  most  controversial,  there  is  an  in- 
creasing trend  toward  low  anterior  resec- 
tion in  the  management  of  more  proximal 
lesions,  and  toward  operations  preserving 
the  external  anal  sphincter  or  anal  canal  in 
the  management  of  more  distal  lesions.  A 
proximal  colonic  stoma  is  generally  estab- 
lished at  the  same  time  as  low  anterior 
resection  is  carried  out,  since  it  is  generally 
agreed  that  an  anastomosis  employing  non- 
peritonized  rectum  is  more  hazardous  than 
one  between  peritonized  segments  of  bowel. 
A proximal  stoma  is,  of  course,  not  neces- 
sary with  operations  of  the  pull-through 
type.  Low  anterior  resection  has  become  so 
widely  accepted  that  it  probably  can  be  ele- 
vated to  the  dignity  of  a standard  operative 
procedure®.  Sphincter  - saving  operations, 
however,  essentially  because  of  dissatisfac- 
tion with  fecal  control  after  the  procedure, 
have  not  been  widely  accepted.  Certain 
clinical  observations  have  suggested  that 
the  anal  canal  must  be  preserved  intact  for 
normal  control,  and  Gaston  has  recently 
shown,  by  measuring  changes  in  intralumi- 
nal pressure  following  graded  distention  of 
the  rectum,  that  control  is  dependent  not 
alone  on  the  intact  sphincter  but  that  a few 
centimeters  of  the  lower  part  of  the  rectum 
must  be  preserved  as  well.  In  other  words, 
control  is  dependent  on  an  intact  anal  canal. 

1 have  recently  been  able  to  carry  out  suc- 
cessful end-to-end  anastomoses  as  low  as 

2 to  3 cm.  above  the  dentate  margin,  using 
the  pull-through  principle  of  Hochenegg. 
Following  this  operation,  control  is  essen- 
tially normal  as  would  be  expected  from 
preserving  the  intact  anal  canal,  and  I be- 
lieve that  survival  rates  will  amply  prove 
the  contention  that  continence  need  not  be 
sacrificed  with  lesions  higher  than  6 cm. 
above  the  dentate  margin. 

Lesions  of  the  Lower  Part  of  the  Rectum 

The  controversy  concerning  the  manage- 
ment of  lesions  of  the  rectosigmoid  and 
upper  part  of  the  rectum  has  not  extended 
to  the  methods  of  treatment  of  lesions  of 
the  lower  part  of  the  rectum  and  the  anus. 
In  the  latter  case,  amputation  of  the  bowel 


along  with  wide  resection  of  the  levator 
ani  muscles,  ischiorectal  fat  and  perianal 
skin  is  mandatory,  and  the  patient  must  be 
content  with  a permanent  colonic  stoma. 
The  former  practice  of  packing  the  posterior 
wound  to  prevent  primary  healing  has  been 
largely  superseded  by  primary  or  delayed 
primary  closure,  thus  saving  the  patient 
several  months  of  dressings.  The  increased 
safety  of  Miles’  operation  has  led  to  the 
virtual  eclipse  of  the  posterior  resection 
(Lockhart-Mummery  type)  except  for  the 
patient  for  whom  the  risk  is  unusually  great 
or  particularly  for  the  patient  who  is  un- 
usually obese.  The  double-barrelled  colonic 
stoma,  the  blind  segment  of  bowel  distal 
to  the  stoma  and  the  limited  removal  of 
proximal  lymphatics  are  such  serious  lim- 
itations that  posterior  resection  should 
probably  be  employed  only  when  Miles’ 
operation  is  contraindicated,  and  not,  as 
formerly,  to  remove  most  lesions  of  the 
lower  part  of  the  rectum. 

Summary 

As  a result  of  the  increased  safety  of 
colonic  operations,  due  to  chemotherapy, 
segmental  resection  with  primary  anasto- 
mosis has  largely  replaced  exteriorization 
operations  for  the  management  of  lesions 
of  the  left  part  of  the  colon.  The  conditions 
necessary  for  safe  primary  intraperitoneal 
anastomosis  are  adequate  blood  supply  to 
the  cut  ends  of  the  bowel,  no  tension  on 
the  suture  line,  no  obstruction  and  no  in- 
flammatory changes  in  the  wall  of  the 
bowel.  When  such  conditions  are  not  pres- 
ent, some  type  of  exteriorization  remains 
the  procedure  of  choice.  The  standard 
method  of  treatment  of  lesions  of  the  recto- 
sigmoid and  rectum  is  the  single-stage  com- 
bined abdominoperineal  resection.  However, 
the  question  of  preserving  fecal  continence 
is  being  increasingly  raised,  and  there  is 
reason  to  believe  that  low  anterior  resection 
for  higher  lesions  and  that  some  type  of 
combined  abdomino-endorectal  or  endo-anal 
operation  for  lesions  situated  from  approxi- 
mately 7 to  11  cm.  above  the  dentate  mar- 
gin will  be  increasingly  employed.  Miles’ 
operation  remains  the  treatment  of  choice 
for  lesions  of  the  lower  part  of  the  rectum. 


jor  September,  1949 


729 


The  mortality  rate  associated  with  the  seg- 
mental removal  of  a segment  of  the  left 
part  of  the  colon  is  now  approximately  3 
per  cent  while  that  associated  with  com- 
bined abdominoperineal  resection  is  approx- 
imately 5 per  cent. 

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THE  USE  AND  ABUSE  OF  SPINAL  PUNCTURE  AND  CEREBRO- 
SPINAL FLUID  STUDIES 

ALEXANDER  C.  JOHNSON,  M.D. 

GREAT  FALLS,  MONTANA 


Lumbar  puncture  was  introduced  by 
Quinke  in  1891,  and  since  that  time  has  de- 
veloped into  an  invaluable  and  routine 
clinico-laboratory  procedure  in  the  study  of 
diseases  of  the  nervous  system. 

Two  groups  of  data  are  obtained  by  spinal 
puncture.  These  may  be  classified  as  dy- 
namic and  biological — the  former  being  con- 
cerned with  the  pressure  studies,  and  the 
latter  with  the  chemical,  cytologic,  and 
bacteriologic  factors.  Thus,  a clear  under- 
standing of  the  hydrodynamics  and  the  bio- 
logical properties  of  the  cerebrospinal  fluid 
in  health  and  disease  is  essential  in  order 
that  not  only  the  proper  information  be  ob- 
tained, but  that  certain  dangers  be  appre- 
ciated and  avoided. 

Briefly,  the  cerebrospinal  fluid  may  be 
regarded  as  a protein  poor  dialysate  of  the 
blood  plasma,  with  certain  minor  differ- 
ences which  are  of  slight  clinical  impor- 
tance. The  fluid  is  formed  by  dialysis 
through  the  choroid  plexuses  of  the  cerebral 
ventricles.  The  fluid  circulates  through  the 
ventricular  system,  emerging  into  the  sub- 


arachnoid space  via  the  lateral  foramina 
(of  Luschka)  of  the  fourth  ventricle.  The 
existence  of  the  midline  foramina  (of  Ma- 
gendie)  is  still  open  to  question.  From  here 
the  fluid  circulates  down  and  up  the  spinal 
subarachnoid  space;  and  at  the  same  time 
circulates  upward  and  forward  through  the 
basilar  cisternae,  and  up  over  the  convexity 
of  the  cerebral  hemispheres.  Some  dispute 
as  to  the  site  of  resorption  of  the  spinal 
fluid  still  exists;  but  it  seems  likely  that 
the  largest  portion  is  resorbed  into  the 
blood  vascular  system  by  way  of  the  arach- 
noidal villi  along  the  superior  sagittal  sinus; 
and,  to  a lesser  extent,  in  the  perineural 
spaces,  the  perivascular  spaces  of  Virchow- 
Robin,  the  ventricular  ependyma,  and  even 
the  choroid  plexuses. . 

The  principal  function  of  the  cerebro- 
spinal fluid  is  that  of  a protective  and  in- 
sulating support  for  the  tissues  of  the  cen- 
tral nervous  system.  Differences  in  the 
chemical  constituents  of,  say,  ventricular 
and  lumbar  fluid  specimens  in  the  same  in- 
dividual indicate  metabolic  functions  as 


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Rocky  Mountain  Medical  Journal 


well.  Variation  in  the  total  fluid  volume 
from  time  to  time  is  the  sole  means  by 
which  intracranial  pressure  is  maintained 
within  normal  limits  in  compensation  for 
changes  in  blood  vascular  volume  within 
the  rigid  craniovertebral  cavity.  By  the 
same  mechanism,  the  brain  is  able  to  com- 
pensate, for  a time,  for  pathologic  increases 
in  brain  volume  by  edema,  abscess,  hemor- 
rhage, or  neoplastic  growth. 

The  technic  of  lumbar  puncture  is  more 
or  less  standardized.  The  puncture  should 
be  done  at  the  third  or  fourth  lumbar 
spaces  in  most  cases,  as  these  are  the  easiest 
to  enter.  Puncture  should  never  be  done 
above  the  second  lumbar  interspace  be- 
cause of  danger  of  injury  to  the  conus 
medullaris  or  the  spinal  cord.  The  patient 
should  be  in  the  lateral  decubitus  position, 
with  sufficient  flexion  of  the  spine  to  spread 
the  interlaminal  spaces,  but  never  with  the 
head  flexed  as  is  often  seen.  The  skin  of 
the  back  is  antiseptically  prepared  and  pro- 
caine is  infiltrated  from  the  skin  to  the 
ligamentum  flavum.  The  spinal  needle  is 
then  passed  into  the  subarachnoid  space, 
preferably  without  striking  the  ventral  wall 
of  the  spinal  canal.  In  most  cases  it  is  pos- 
sible to  identify  the  sensation  of  the  needle 
passing  through  the  ligamentum  flavum; 
less  often  through  the  dural  sac.  The  stop- 
cock and  manometer  should  be  attached  as 
the  stylet  is  being  withdrawn  so  that  no 
fluid  is  lost.  In  cases  where  a high  spinal 
fluid  pressure  is  expected,  the  stop-cock 
and  manometer  should  be  attached  when 
the  ligamentum  flavum  is  reached,  before 
entering  the  dural  sac,  to  prevent  the  loss 
of  even  a drop  of  fluid.  I have  thus  implied, 
and  would  like  to  clearly  state,  that  the  de- 
termination of  cerebrospinal  fluid  pressure 
is  an  inseparable  part  of  all  spinal  punc- 
tures; and  if  a manometer  is  not  available 
the  puncture  should  not  be  done. 

The  so-called  “drip  method”  of  pressure 
estimation  does  not  give  even  an  estimate 
of  the  correct  pressure  and  is  mentioned 
only  to  condemn  its  use.  The  rate  of  fluid 
drip  is  dependent  not  only  on  the  gauge  of 
the  needle,  but  on  variable  and  unpredict- 
able factors  such  as  needle  position,  ob- 


struction of  the  needle  by  arachnoid  fila- 
ments, viscosity  of  the  fluid,  especially  in 
the  case  of  purulent  or  high  protein  fluids, 
etc.  These  factors  do  not  materially  alter 
a manometric  destermination.  The  most 
satisfactory  size  of  needle  for  all  adults  is  a 
No.  18,  and  never  smaller  than  a No.  20, 
due  to  the  unreliability  of  dynamic  studies 
with  smaller  needles.  For  children  a short 
length  No.  20  is  the  needle  of  choice. 

Normal  spinal  fluid  pressure  generally 
varies  from  about  100  mm.  of  fluid,  often 
less,  to  about  160  or  170  mm.  Readings 
above  this  to  200  mm.  should  be  regarded 
with  suspicion,  while  those  above  200  mm. 
are  definitely  pathological.  The  correct 
pressure  determination  in  any  individual 
case  is  the  lowest  manometric  reading  that 
can  be  obtained  with  the  patient  completely 
relaxed,  in  the  lateral  decubitus  position, 
neck  slightly  extended  to  minimize  com- 
pression of  the  jugular  veins,  and  with  the 
legs  nearly  straight  to  avoid  any  abdominal 
compression.  It  is  commonly  noted  that  the 
less  experienced  operators  usually  obtain 
higher  pressure  readings,  probably  due  to 
a failure  to  realize  the  lability  of  spinal 
fluid  pressure  and  the  physiological  factors 
upon  which  this  lability  depends.  It  is  not 
uncommon  to  find  a spinal  fluid  pressure 
recorded  at  an  abnormal  level,  and  to  find 
on  inquiry  that  the  patient  was  frightened 
and  struggling  with  the  head  and  legs  held 
in  extreme  flexion  during  the  measurement 
of  the  pressure.  Such  a reading  does  not 
represent  the  basal  spinal  fluid  pressure, 
but  is  merely  a demonstration  of  the  effect 
of  elevated  intra-thoracic  and  intra-abdom- 
inal pressure  on  the  cerebrospinal  fluid 
pressure;  and  is  of  as  little  value  as  a blood 
sugar  determination  taken  from  a patient 
receiving  intravenous  dextrose  in  the  other 
arm. 

At  this  point  it  should  be  stated  that  lum- 
bar puncture  is  indicated  in  the  diagnostic 
work-up  of  all  patients  with  diseases  of  the 
nervous  system,  except  those  suspected  of 
harboring  a space-occupying  lesion.  Gen- 
erally speaking,  lumbar  puncture  has  no 
place  in  the  diagnosis  of  brain  tumor,  or 
any  other  mass  lesion  of  the  cranial  cavity. 


for  September,  1949 


731 


In  such  cases  spinal  puncture  contributes 
nothing  but  the  risk  of  sudden  death  due 
to  herniation  of  the  temporal  lobe  through 
the  tentorial  incisura  or  to  herniation  of 
the  cerebellar  tonsils  through  the  foramen 
magnum.  This  is  far  from  a theoretical  risk, 
and  all  neurosurgeons  have  had  the  experi- 
ence of  being  called  in  at  the  last  moment 
to  see  a patient  who  suddenly  became 
comatose  after  an  injudicious  spinal  puncr 
ture  had  been  performed.  Where  there  is 
the  possibility  of  an  intracranial  tumor, 
abscess,  or  hematoma,  the  indication  is  for 
neurosurgical  intervention  at  the  earliest 
moment;  and  any  further  diagnostic  proce- 
dures are  best  left  to  the  neurosurgeon. 

There  is  no  complete  agreement  among 
neurosurgeons  as  to  the  indications  for 
spinal  puncture  in  cases  of  cranio- 
cerebral trauma.  It  does,  however  seem 
certain  that  neurosurgeons  perform  consid- 
erably fewer  lumbar  punctures  in  such 
cases  than  do  other  physicians.  The  reason 
is  simply  that  the  proper  management  of 
head  injuries  bears  no  relationship  to  the 
cerebrospinal  fluid  findings,  but  is  almost 
entirely  dependent  on  the  clinical  evalua- 
tion and  judgment  of  the  attending  neuro- 
surgeon or  neurologist.  In  cases  of  acute 
head  trauma  the  pressure  of  the  spinal  fluid 
may  be  high,  low,  or  normal;  and  the  fluid 
itself  may  be  bloody  or  clear.  It  must  be 
realized  that  should  an  unrecognized  epi- 
dural or  subdural  hematoma  be  present,  the 
danger  of  producing  a tentorial  or  cere- 
bellar pressure  cone  is  as  great  or  greater 
than  in  the  case  of  brain  tumor  or  brain 
abscess.  If  the  presence  of  an  intracranial 
hematoma  has  been  ruled  out  surgically  or 
is  manifestly  unlikely,  there  is  no  objection 
to  a moderate  reduction  of  pressure  by 
spinal  puncture;  and,  indeed,  this  is  often 
of  great  value  in  quieting  restless  or  de- 
lirious patients.  The  pressure  elevation  in 
these  cases  is  due  to  a combination  of 
hypersecretion  of  fluid,  decreased  resorp- 
tion of  fluid  due  to  obstruction  of  the  re- 
sorptive  areas  by  blood  cells,  and  the 
meningeal  irritation  of  bloody  cerebrospinal 
fluid.  So-called  cerebral  edema  is  a nebu- 
lous entity,  and  its  existence  is  open  to 


question.  The  apparent  volume  of  the  brain 
is  often  reduced  rather  than  increased  after 
trauma. 

Lumbar  puncture  for  the  removal  of 
bloody  fluid  is  unsound.  If  there  is  no 
further  bleeding,  hemolysis  takes  place 
within  forty-eight  hours;  and  the  removal 
of  a large  volume  of  fluid  would  not  re- 
move all  of  the  blood,  especially  if  any 
bleeding  was  continuing. 

The  other  dynamic  factor,  the  mechanism 
of  which  is  apparently  uniformly  misunder- 
stood, in  view  of  its  general  abuse,  is  the 
Queckenstedt  test.  This  procedure  is  based 
on  the  fact  that  cerebrospinal  fluid  pres- 
sure is  largely  variable  in  proportion  to  the 
intracranial  venous  pressure.  A sudden  rise 
in  intracranial  venous  pressure  produces  a 
nearly  equally  rapid  rise  in  cerebrospinal 
fluid  pressure.  Prolonged  increase  in  intra- 
cranial venous  pressure  likewise  acts  in  the 
same  manner,  and  probably  also  through  an 
increased  transudation  of  fluid  through  the 
choroid  plexuses,  producing  an  oversecre- 
tion of  spinal  fluid.  Thus,  it  can  be  seen 
that  if  a manometer  is  attached  to  a needle 
in  the  lumbar  subarachnoid  space,  pressure 
applied  to  the  jugular  veins  will  be  mani- 
fested by  a rapid  rise  in  lumbar  spinal  fluid 
pressure  and  a prompt  fall  in  this  pressure 
when  the  venous  compression  is  released. 
It  must  be  pointed  out  that  the  patient 
should  be  completely  relaxed  and  that  any 
pressure  on  the  abdomen  will  produce  the 
same  rise  and  fall  in  spinal  fluid  pressure, 
due  to  transmission  of  intra-abdominal 
pressure  to  the  epidural  venous  plexus  by 
way  of  the  paravertebral  veins.  There  is 
only  one  important  indication  for  perform- 
ance of  the  Queckenstedt  test  and  if  this 
indication  is  not  present,  performance  of 
the  Queckenstedt  test  is  not  only  valueless 
but  often  extremely  dangerous  and,  there- 
fore, contraindicated.  This  indication  is  the 
suspicion  of  a spinal  fluid  block,  such  as 
that  due  to  fracture-dislocation  of  the  spine, 
cord  tumor,  inflammatory  adhesions,  etc. 
A moment’s  thought  to  the  physiological 
mechanism  of  the  Queckenstedt  test  will 
make  its  utter  uselessness  as  a diagnostic 
procedure  for  all  suspected  pathology  above 


732 


Rocky  Mountain  Medical  Journal 


the  foramen  magnum,  quite  apparent.  A 
complete  block  below  the  foramen  magnum 
is  manifested  by  a failure  of  spinal  fluid 
pressure  to  increase  with  jugular  compres- 
sion, and  partial  blocks  may  be  indicated 
by  abnormally  slow  rise  and  fall  of  fluid 
pressure.  There  is  only  one  possible  excep- 
tion to  the  previously  stated  contraindica- 
tion and  this  is  in  a case  of  suspected 
lateral  sinus  thrombosis,  in  which  case 
compression  of  the  jugular  vein  on  the 
thrombosed  side  will  produce  no  rise  in 
spinal  fluid  pressure,  since  the  opposite 
jugular  vein  is  maintaining  the  principal 
venous  drainage  of  the  cranial  cavity.  A 
normal  reaction  (often  exaggerated)  is  ob- 
tained from  the  uninvolved  side.  As  a prac- 
tical matter,  this  is  a rather  poor  use  of  the 
Queckenstedt  test,  since  there  is  consider- 
able variation  in  the  size  of  the  lateral 
sinuses  in  the  two  sides  of  normal  indi- 
viduals, which  may  lead  to  a false  interpre- 
tation of  partial  thrombosis.  The  diagnosis 
can  generally  be  made  without  the  use  of 
this  procedure,  and  there  is  at  least  a theo- 
retical risk  of  encouraging  detachment  of 
septic  emboli  from  the  thrombosed  sinus. 

A tremendous  amount  of  data  involving 
a multitude  of  chemical  and  biological 
factors  has  been  compiled  since  the  intro- 
duction of  spinal  fluid  examination  as  a 
diagnostic  procedure.  Many  of  these  de- 
terminations are  of  little  practical  value, 
although  there  seems  to  be  a trend  for 
physicians  to  order  every  test  which  the 
laboratory  can  perform,  and  then  wait  for 
a laboratory  technician  to  make  a diagnosis 
which  could  have  been  made  from  the  clin- 
ical history  and  the  physical  and  neurologic 
findings.  The  establishment  of  routine 
procedure  in  the  evaluation  of  a clinical 
problem  is  never  advisable;  but,  neverthe- 
less, it  is  true  that  a cell  count,  proteiTi,  and 
Wassermann  determination  are  adequate  to 
confirm  the  diagnosis  of  practically  all  dis- 
eases of  the  central  nervous  system  which 
can  be  diagnosed  by  cerebrospinal  fluid 
findings.  The  cell  count  should  always  be 
reported  as  a differential  count  between 
mononuclear  and  polynuclear  forms.  Total 
protein  determination  is  usually  adequate; 


and,  generally  speaking,  extremely  high 
proteins  are  due  largely  to  an  increase  in 
the  albumen  fraction,  such  as  in  the  pres- 
ence of  spinal  fluid  block,  in  which  case 
the  fluid  will  be  clear  and  often  yellow  in 
color,  or  in  the  presence  of  high  cell  counts 
as  in  pyogenic  infections,  in  which  case 
the  fluid  will  be  cloudy  to  purulent.  The 
purpose  of  the  Wassermann  test  is  self- 
evident  and  should  be  determined  routinely 
for  the  same  reasons  that  the  blood  Wasser- 
mann is  routinely  determined.  It  should  be 
noted  that  neuro-syphilitic  relapses  are 
most  common  after  inadequate  treatment, 
even  though  such  inadequate  treatment 
may  have  resulted  in  a reversal  of  the  blood 
Wassermann. 

In  the  presence  of  suspected  bacterial 
infection,  smear  and  culture  are  the  only 
additional  determinations  of  much  value. 
The  determination  of  spinal  fluid  sugar, 
while  not  essential,  is  of  some  prognostic 
interest,  since  extremely  low  spinal  fluid 
sugars  indicate  an  overwhelming  infection 
by  glycolytic  organisms,  which  include  all 
of  the  common  pyogenic  bacteria.  On  the 
other  hand,  the  presence  of  a normal  spinal 
fluid  sugar  in  a patient  presenting  signs 
and  symptoms  of  meningeal  inflammation 
is  strongly  suggestive  of  infection  near  to, 
but  not  involving,  the  subarachnoid  space, 
such  as  early  brain  abscess,  subdural  em- 
pyema, epidural  abscess  and,  at  times,  acute 
infections  of  the  middle  ear,  mastoid,  and 
paranasal  sinuses.  The  spinal  fluid  sugar  is 
roughly  one-third  to  one-half  the  blood 
sugar  level,  and  there  is  a more  or  less  pro- 
portionate variation  in  the  same  individual, 
so  that  an  individual  with  hypoglycemia 
may  also  be  expected  to  have  some  lower- 
ing of  spinal  fluid  sugar;  while  a diabetic 
with  hyperglycemia  will  have  an  elevated 
spinal  fluid  sugar. 

The  determination  of  spinal  fluid  chlor- 
ides is  likewise  often  superfluous,  since  a 
lowering  of  spinal  fluid  chlorides  is  present 
to  some  extent  in  all  types  of  meningeal 
infection.  An  elevation  of  spinal  fluid 
chlorides  is  noted  where  there  is  retention 
of  this  ion  in  the  blood  stream,  as  in 
renal  failure,  and  in  either  event  the  diag- 


;for  September,  1949 


733 


nosis  should  be  evident  for  other  reasons. 
The  only  important  use  of  a spinal  fluid 
chloride  determination  is  in  the  presence 
of  signs  of  meningitis  in  which  no  organism 
can  be  cultured  or  identified,  in  which  case 
a strong  suspicion  of  tuberculous  meningitis 
should  be  considered. 

At  one  time  great  significance  was  at- 
tached to  the  colloidal  gold,  mastic,  and 
similar  tests,  in  the  differential  diagnosis  of 
various  diseases  of  the  nervous  system.  De- 
tailed discussion  of  these  tests  is  of  no 
value,  since  various  curves  can  be  produced 
by  almost  any  disease  of  the  central  nerv- 
ous system  in  which  there  is  an  alteration 
in  the  spinal  fluid  proteins,  either  in  total 
quantity  or  in  albumen-globulin  ratio,  as 


well  as  other  unknown  factors,  since  fluids 
with  equal  total  proteins  and  identical  al- 
bumen-globulin ratios  may  give  different 
gold  curves.  Any  of  the  qualitative  or 
quantitative  determinations  which  may  be 
performed  on  blood  plasma,  serum,  or  pro- 
tein-free blood  filtrates  may  likewise  be 
performed  on  spinal  fluids,  but  the  majority 
of  these  determinations  are  of  little  value, 
since  the  corresponding  determinations  on 
the  blood  are  simpler  to  perform  and  of 
identical  diagnostic  value. 

In  summary,  it  can  be  stated  that  while 
lumbar  puncture  and  spinal  fluid  studies 
are  of  great  value  in  neurologic  cases,  such 
studies  are  an  adjunct  to  careful  neurologi- 
cal examination,  not  a substitute  for  it. 


SURGICAL  DISEASES  OF  THE  THYROID  GLAND* 

SAMUEL  B.  CHILDS,  M.D. 

DENVER 


The  principal  function  of  this  ductless 
gland  is  to  distribute  to  the  bodily  tissues 
the  equivalent  of  180  mg.  of  desiccated  thy- 
roid every  day.  The  activity  of  the  thyroid 
gland  is  regulated  by  intracranial  and 
neurohumeral  mechanisms.  Within  the 
gland  itself  there  are  several  enzyme  sys- 
tems concerned  with  the  manufacture,  stor- 
age, and  release  of  the  thyroid  hormone. 
For  the  synthesis  of  thyroid  hormone,  thy- 
rotropin, manufactured  by  the  pituitary 
gland,  is  essential;  thyrotropin  is  also  essen- 
tial for  the  release  of  thyroid  hormone  to 
the  tissues.  An  over-secretion  of  thyroid 
hormone  results  in  the  so-called  hyperthy- 
roidism, with  clinical  sequelae  of  tachy- 
cardia, excessive  heat  production,  nervous- 
ness, and  an  increase  in  the  basal  metabolic 
rate.  Hypothyroidism  is  manifested  by  a 
lowered  basal  metabolic  rate  and  myxe- 
dema, the  clinical  symptoms  of  which  are 
due  to  localized  edema,  as  in  the  tissues  of 
the  face,  the  larynx,  etc. 

With  this  brief  summary  of  the  physi- 
ology of  the  thyroid  gland,  I should  like  to 
discuss  the  clinical  picture  of  the  disease 
termed  by  the  Committee  on  Standard 

•Read  before  the  staff  of  Fltzslmons  General  Hos- 
pital, January  20,  1949. 


Nomenclature  “toxic  diffuse  goitre.”  This 
disease  has  also  been  termed  “exophthal- 
mic goitre,”  “Graves’  Disease,”  and  “pri- 
mary hyperthyroidism.”  There  are  objec- 
tions to  any  of  these  several  terms — the 
disease  may  be  manifest  as  toxic  diffuse 
goitre,  yet  without  palpable  goitre,  as  ex- 
ophthalmic goitre  without  exopthalmos, 
and  without  goitre;  Parry  and  not  Graves 
is  accredited  with  first  describing  the  clm- 
ical  syndrome;  and  there  is  not  general 
agreement  that  the  disease  is  primary 
hyperthyroidism.  Usually,  but  not  always, 
the  term  toxic  applies,  and  as  the  term 
toxic  goitre  was  chosen  by  consensus  of  the 
Committee  on  tandard  Nomenclature,  that 
terminology  shall  be  used  in  this  discussion. 

Toxic  goitre,  then,  is  characterized  by 
symptoms  affecting  the  general  appearance 
of  the  individual  who  may  exhibit  nervous- 
ness, psychic  disturbances,  tremors,  opthal- 
mopathy,  weight  loss  and  purposeless  move- 
ment. The  skin  is  warm  and  moist.  The 
pulse  pressure  elevated.  A history  of  palpi- 
tation, tachycardia,  dyspnea  and  edema 
related  to  the  cardiovascular  system  may 
be  elicited;  increased  irritability,  instabil- 
ity, and  fatigueability  may  have  been  noted; 


734 


Rocky  Mountain  Medical  Journal 


there  may  have  been  increased  appetite, 
vomiting  and  diarrhea;  symptoms  related  to 
increased  heat  production  — sweating  and 
intolerance  to  hot  weather — may  have  been 
present,  and  finally  amenorrhea  and  men- 
strual irregularity  may  have  been  noted. 

The  gland  may  be  diffusely  enlarged,  and 
usually  is,  but  there  are  many  severe  cases 
recorded  where  the  thyroid  gland  was  not 
palpably  enlarged.  Section  of  the  toxic 
gland  typically  reveals  an  increased  mean 
height  of  the  acinar  cells,  which  become 
tall  columnar,  scant  colloid,  papillary  in- 
folding of  the  epithelium,  and  lymphatic 
infilitration  of  the  gland  with  follicle  for- 
mation. There  may  be  general  wasting  of 
the  skeletal  muscles,  manifest  first  in  quad- 
riceps femoris  weakness.  The  orbital  path- 
ology is  chiefly  extrinsic  muscle  infiltra- 
tion with  fat,  and  deposition  of  retrobulbar 
fat  with  edema  of  the  lids,  widening  of  the 
palpebral  fissure,  and  proptosis  in  combi- 
nation or  singly.  There  is  no  character- 
istic pathology  of  the  pituitary  gland  unless 
there  is  an  associated  acromegaly.  There 
may  be  a diffuse  lymphoid  hyperplasia  and 
lymphocytosis.  Liver  changes  have  been 
described  but  may  be  secondary  to  tissue 
depletion.  There  may  be  an  abnormally 
rapid  glycogenolysis  which  results  in  gly- 
cosuria with  variable  hyperglycemia.  Char- 
acteristically the  blood  cholesterol  levels 
are  depressed  and  there  is  a negative  nitro- 
gen, calcium  and  phosphorus  balance. 

The  basal  metabolic  rate  is  characteris- 
tically elevated  but  cases  of  severe  toxic 
goitre  without  elevation  of  basal  rate  have 
been  recorded.  The  basal  metabolic  rate  is 
after  all  a determination  of  the  rate  of 
oxygen  consumption  and  is  not  necessarily 
associated  with  the  transport,  utilization, 
and  breakdown  of  thyroid  hormone. 

The  diagnosis  of  toxic  goitre  may  be 
ridiculously  easy;  often  it  is  extremely  dif- 
ficult, The  importance  of  the  clinical 
history  cannot  be  overemphasized  in  the 
differentiation  of  the  toxic  thyroid  which 
has  no  eye  signs  and  no  palpable  goitre 
from  other  conditions  which  may  also  ex- 
hibit an  elevated  basal  metabolic  rate.  Such 
conditions  to  be  differentiated  include  some 
of  the  anxiety  states  and  neurocirculatory 

for  September,  1949 


asthenia,  tuberculosis,  incipient  diabetes, 
malignancy  and  leukemia,  hypertensive 
cardio  - vascular  disease,  acromegaly  and 
adreno-cortical  disturbance,  and  menopau- 
sal syndrome.  At  times  the  response  to 
iodine  or  to  propylthiouracil  must  deter- 
mine the  diagnosis.  Bartels  in  the  Lahey 
Clinic  has  utilized  general  anesthesia  in 
determining  the  basal  metabolic  rate,  to 
rule  out  the  false  high  rates  of  the  anxiety 
states.  Curtis  has  advocated  determinations 
of  the  protein  bound  iodine  of  the  blood 
as  a more  sensitive  and  reliable  determina- 
tion of  the  toxic  goitre  than  the  elevation 
of  the  B.M.R.  The  per  cent  uptake  of  radio- 
active iodine  is  also  an  index. 

At  this  point  before  discussing  the 
therapy  of  toxic  goitre  it  becomes  neces- 
sary to  discuss  the  condition  termed  by 
Standard  Nomenclature  toxic  nodular  goi- 
tre. It  has  also  been  referred  to  as  ade- 
nomatous goitre  with  hyperthyroidism,  by 
Plummer.  Plummer  further  stated  that  the 
condition  which  he  referred  to  as  exoph- 
thalmic goitre  differed  from  the  condition 
which  he  referred  to  as  adenomatous  goitre 
with  hyperthyroidism  in  a qualitative  way. 
In  the  latter  condition  he  stated  that  the 
physiologic  status  is  identical  with  that 
produced  by  feeding  excessive  quantities  of 
desiccated  thyroid,  and  that  the  additional 
phenomena  of  exopthalmos,  stare  and  other 
eye  signs,  the  characteristic  psychic  status, 
the  frequent  useless  purposeless  movements, 
the  development  of  gastro-intestional  crisis, 
and  the  presence  in  nearly  all  cases  of 
diffuse  hypertrophy  of  the  thyroid,  were 
not  present  and  did  not  occur.  This  differ- 
entiation, in  my  opinion,  no  longer  serves 
any  useful  purpose.  Kent  states  that  nodu- 
lar goitres  are  not  controlled  by  iodine, 
except  where  exophthalmic  goitre  is  a com- 
plicating factor  and  that  crisis  never  fol- 
lows a partial  thyroidectomy  for  an  ad- 
enomatous goitre.  With  the  concept  that 
iodine  is  not  beneficial  in  toxic  nodular 
goitre  and  that  thyroid  crisis  does  not  oc- 
cur postoperatively  there  is  not  general 
agreement. 

The  important  decision  to  make  when 
confronted  by  a patient  with  suspected  dis- 
ease of  the  thyroid,  is  whether  the  indi- 

735 


vidual  is  suffering  from  thyrotoxicosis  or 
not.  Whether  the  gland  to  clinical  palpa- 
tion is  smooth  or  nodular  is  of  secondary 
importance.  The  clinical  diagnosis  of  ad- 
enoma cannot  be  made  with  any  degree  of 
accuracy.  It  is  a microscopic  diagnosis. 
Nodules  may  be  adenoma,  carcinoma,  cysts, 
areas  of  calcification,  fibrosis,  hemorrhage 
or  areas  of  localized  hyperplasia  and  in- 
volution. Diffusely  enlarged  glands  fre- 
quently are  not  associated  with  ophthalmop- 
athy, while  Means  states  that  nodular 
glands  are  occasionally  associated  with  eye 
signs.  Thyroid  crisis  (storm)  occurred  in 
sixteen  cases  of  nodular  goitre  out  of  thirty- 
six  cases  from  the  thyroid  clinic  of  the 
Massachusetts  General  Hospital  in  a twenty- 
five-year  series. 

While  it  may  be  conceded  that  not  all 
toxic  nodular  goitres  are  benefited  by  pre- 
operative iodine  therapy,  it  is  certainly  as 
true  that  the  favorable  response  to  iodine 
therapy  in  many  will  be  dramatic.  I see  no 
contraindicatio  nto  instituting  pre-operative 
iodine  therapy  in  toxic  nodular  goitre.  In 
the  literature  of  the  mid-twenties  there  was 
considerable  discussion  of  a severe  hyper- 
thyroidism in  nodular  goitre  being  exacer- 
bated by  the  use  of  iodine.  This  condition — 
the  induction  or  exacerbation  of  hyperthy- 
roidism by  the  therapeutic  use  of  iodine 
— is  referred  to  as  Jodbasedow.  I person- 
ally do  not  believe  it  exists  and  there  are 
no  cases  of  such  an  instance  recorded  in 
several  of  the  large  clinics,  the  Henry  Ford 
Hospital,  and  the  thyroid  clinic  at  the 
Massachusetts  General  Hospital. 

The  disease  of  toxic  goitre,  in  its  sys- 
temic effects,  is  one  of  remission  and  ex- 
acerbation, a waxing  and  a waning,  and  if 
iodine  is  instituted  in  one  of  the  periods, 
or  just  preceding  a cycle  of  exacerbation, 
it  may  well  appear  that  the  iodine  is  the 
injurious  agent.  What  then  is  the  proper 
treatment  of  toxic  goitre?  Is  a differentia- 
tion to  be  made  in  the  therapy  of  toxic 
diffuse  goitre  and  toxic  nodular  goitre? 

For  twenty  years,  from  1923,  when  the 
therapeutic  use  of  iodine  pre-operatively 
in  toxic  diffuse  goitre  was  advocated  by 
Plummer,  until  1943,  when  the  effect  of  the 


thiourea  drugs  on  the  toxic  gland  was  de- 
scribed by  Astwood,  the  treatment  of  toxic 
diffuse  goitre  was  comparatively  standard- 
ized. Ideal  treatment  of  this  type  consists 
of  three  weeks  of  pre-operative  iodine, 
usually  administered  as  Lugol’s  solution,  a 
week  or  ten  days  of  hospitalization  pre- 
operatively  and  then  partial  thyroidectomy, 
removing  five-sixths  or  six-sevenths  of  the 
thyroid  gland.  The  pre-operative  hospital 
routine  consists  of  partial  bed  rest,  sedation 
and  emphasis  on  a high  caloric,  high  vita- 
min diet  so  that  the  patient  gains  weight. 
Too  much  emphasis  cannot  be  placed  upon 
gain  in  weight  in  the  pre-operative  patient. 
A successful  operative  result  may  be  pre- 
dicted if  the  pre-operative  patient  has  re- 
sponded to  treatment  as  manifested  by  gain 
in  weight,  a slowing  of  the  pulse,  improve- 
ment in  general  appearance,  and  last  (and 
least)  in  a diminution  in  the  basal  meta- 
bolic rate.  Under  this  regime  certain  pa- 
tients, if  postoperative  complications  and 
thyroid  crisis  are  to  be  avoided,  will  not 
tolerate  the  complete  operation  at  one 
stage.  Rather,  multiple  stage  operations 
must  be  resorted  to  in  those  patients  pre- 
determined by  the  operator’s  clinical  judg- 
ment to  be  too  poor  risks  for  a one-stage 
procedure.  Most  patients,  however,  will  re- 
spond well  pre-operatively  to  this  regime. 
The  gland  becomes  firmer,  its  vascularity 
diminishes,  and  operative  difficulties  of 
dealing  with  a friable  vascular  gland  are 
eliminated.  Operation,  before  pre-operative 
use  of  iodine,  on  the  toxic  thyroid,  was  to 
say  the  least  a harrowing  experience  for 
the  operator,  and  a procedure  fraught  with 
high  risk  for  the  patient. 

In  a few  patients,  regardless  of  prepara- 
tion, as  witnessed  by  reports  from  Belle- 
view  Hospital,  and  from  Massachusetts 
General  Hospital,  thyroid  storm  will  de- 
velop. Storm  may  develop  pre-operatively. 
Of  the  thirty-six  cases  of  storm  reported 
from  Massachusetts  General  Hospital  in  a 
series  of  2,033  cases,  eleven  developed  pre- 
operatively,  the  so-called  “medical  storm,” 
twenty-five  developed  postoperatively,  the 
“surgical  storm.”  Storm  is  characterized  by 
restlessness  increasing  to  delirium,  tachy- 
cardia, vomiting,  diarrhea,  dehydration,  and 


736 


Rocky  Mountain  Medical  Journal 


fever  mounting  to  very  high  levels.  Death 
has  occurred  in  half  the  reported  cases. 
Besides  the  supportative  measures  of  par- 
enteral glucose,  oxygen,  and  measures  di- 
rected at  lowering  the  surface  temperature 
of  the  body,  Mulholland  has  recently  re- 
ported the  parenteral  use  of  sulfadiazine 
to  be  of  great  benefit.  He  feels  this  drug 
may  have  some  specific  beneficial  action, 
as  well  as  inhibiting  the  development  of 
wound  infection  and  pulmonary  infections. 
Most  cases  of  thyroid  storm  develop  in 
those  individuals  exhibiting  severe  thyro- 
toxicosis, who  are  nutritionally  depleted, 
and  in  whom  therapy,  despite  the  best  in- 
tentions, has  been  relatively  ineffective. 
Serious  complicating  diseases  are  also  pre- 
disposing to  storm.  As  previously  men- 
tioned, storm  occurred  in  toxic  nodular 
goitre  in  sixteen  out  of  the  thirty-six  re- 
corded instances.  An  aqueous  extract  of 
thyroid  hormone  somewhat  paradoxically 
has  also  been  reported  to  have  been  of 
benefit  in  treating  cases  of  thyroid  storm. 

The  type  of  treatment  outlined,  consist- 
ing of  proper  pre-operative  treatment  plus 
the  daily  ingestion  of  iodine,  followed  by 
* partial  thyroidectomy,  has  had  in  the  best 
of  hands  an  operative  mortality  of  from 
1 to  2 per  cent,  and  a recurrence  rate  of 
toxic  symptoms  from  5 to  10  per  cent.  The 
technic  of  partial  thyroidectomy  is  difficult, 
and  technical  accidents,  such  as  tetany  from 
ablation  of  parathyroids,  as  well  as  recur- 
rent nerve  paralysis,  have  occurred.  How- 
ever infrequent  these  accidents  have  been, 
they  must  be  listed  on  the  red  side  of  the 
ledger  for  this  type  of  therapy.  In  cases 
complicated  by  severe  exophthalmos,  sur- 
gery has  seemed  on  occasion  to  hasten  fur- 
ther exophthalmos,  and  is  contraindicated 
in  those  cases  where  the  exophthalmos  is 
the  cardinal  symptom,  and  the  toxic  com- 
ponent is  minimal.  If  the  Naffziger  pro- 
cedure is  not  done  in  progressive  exoph- 
thalmos, enucleation  is  the  end  result. 

Radiotherapy  and  the  definitive  use  of 
iodine  without  operation  have  almost  been 
discarded  as  a treatment  of  choice  in  toxic 
goitre.  In  my  opinion,  before  the  advent 
of  the  goitrogenic  drugs,  the  treatment  of 


toxic  nodular  goitre  was  the  same  as  that 
just  mentioned  for  toxic  diffuse  goitre. 

We  come  then  to  the  advent  of  thiourea 
derivatives  in  the  treatment  of  the  toxic 
goitre.  As  far  as  is  known  currently  these 
drugs  act  uniformly  on  the  thyroid  gland 
and  differ  only  in  their  toxic  side  effects. 
Since  1945  propyl-thiouracil,  as  the  least 
toxic  of  the  group,  has  been  used  almost 
exclusively.  Agranulocytosis  and  leuko- 
penia, the  most  serious  toxic  side  effect  of 
therapy  with  the  drug,  have  been  reported 
but  in  a low  incidence.  Fever,  rash,  gastro- 
intestional  disturbance  have  been  reported, 
usually  have  been  transitory,  and  have  been 
of  minor  consequence.  Penicillin  has  been 
efficacious  in  the  treatment  of  the  inevi- 
table infection  accompanying  agranulocy- 
tosis so  that  this  complication  is  not  as 
formidable  as  formerly. 

Propyl-thiouracil  acts  on  the  thyroid 
gland  by  inhibiting  the  formation  of  thy- 
roid hormone.  It  has  no  effect  upon  thy- 
rotropin. Presumably,  it  blocks  one  or  more 
enzyme  systems  within  the  thyroid  cell.  It 
has  no  effect  upon  circulating  thyroid  hor- 
mone. The  time  required  for  its  therapeutic 
result  to  become  apparent  is  the  same  as 
is  that  of  the  so-called  thyroxine  decay 
curve.  Any  case,  toxic  diffuse  or  toxic 
nodular  goitre,  barring  cessation  of  therapy 
due  to  toxic  side  effects,  can  be  brought  to 
euthyroidism,  as  witnessed  by  clinical  symp- 
toms, normal  BMR,  lowered  PBI  and  in- 
ability to  take  up  radioactive  iodine.  Con- 
tinuation of  treatment  results  in  myxedema 
and  athyroidism.  The  microscopic  section 
of  the  gland  does  not  reveal  involution, 
however,  but  reveals  hyperplasia  without 
change  in  the  mean  acinar  height  of  the 
cells,  or  a storing  of  colloid.  Its  vascularity 
does  not  decrease.  The  mode  of  action  of 
propylthiouracil  and  iodine  then  are  differ- 
ent. Iodine  exerts  its  beneficial  action  by 
inactivating  thyrotropin  and  temporarily, 
at  least,  inactivating  enzyme  systems  re- 
leasing thyroid  hormone  from  the  thyroid 
follicle.  Athyroidism  cannot  be  produced 
by  the  continued  use  of  iodine.  With  iodine 
the  gland  involutes,  colloid  is  stored,  and 
the  gland  becomes  firm  and  less  vascular. 


for  September,  1949 


737 


If  surgery  is  contemplated  after  treatment 
with  propyl-thiouracil,  iodine  should  be 
used  in  addition  for  the  week  or  ten  days 
preceding  surgery,  to  facilitate  the  mechan- 
ics of  the  surgery. 

Propyl-thiouracil  should  be  used  in  the 
pre-operative  treatment  of  the  toxic  thy- 
roid, in  my  opinion,  if  there  is  any  doubt 
that  the  case  can  be  brought  to  a state  of 
euthyroidism  with  iodine  alone.  No  case 
should  be  operated  today  that  is  not  in  a 
state  of  euthyroidism.  The  procedure  then 
becomes  one  attended  by  no  more  post- 
operative reaction  than  is  seen  following 
herniorraphy,  and  the  mortality  rate  has 
been  reduced  in  the  Lahey  Clinic  from  1.5 
to  .5  per  cent  which  is  a reduction  to  one- 
third  that  previously  obtained.  There  is 
no  reason  for  staging  procedures,  and  no 
postoperative  thyroid  storm  has  been  re- 
corded. Propyl-thiouracil,  like  thiouracil, 
may  have  a low  incidence  of  permanent 
remissions  in  the  treatment  of  thyrotoxi- 
cosis. Statistical  evidence  at  present  is  in- 
conclusive. Perhaps,  however,  a drug  with 
no  toxic  side  effects  and  a high  incidence 
of  permanent  remissions  will  be  developed. 
If  so,  it  will  without  doubt  become  the 
agent  to  be  used  as  the  definitive  treatment. 
At  present  propyl-thiouracil  may  be  stated 
to  be  the  agent  of  choice  in  the  following 
categories: 

1.  Those  in  which  surgery  has  been  re- 
fused, has  been  ineffective,  or  is  inadvis- 
able. 

2.  Those  in  which  malignant  exophthal- 
mos is  feared. 

3.  Those  which  are  in  the  adolescent  age 
group. 

4.  Those  cases  where  the  gland  is  small, 
and  surgery  is  notoriously  unreliable. 

Radioactive  iodine,  given  orally,  has  been 
heralded  with  enthusiastic  response  in  cer- 
tain quarters.  Preliminary  reports  indicate 
that  it  is  very  effective  in  producing  a re- 
mission of  symptoms  in  toxic  goitre.  Wheth- 
er or  not  it  may  be  carcinogenic  in  its  late 
effects  has  not  yet  been  determined.  Per- 
haps radioactive  iodine  will  become  the 
ideal  drug  for  the  definitive  treatment  of 
toxic  goitre.  Early  reports  indicate  that  it 


is  relatively  ineffective  in  the  treatment 
of  carcinoma  of  the  thyroid,  as  the  carcin- 
oma cells  do  not  take  up  the  iodine  in  as 
high  a concentration  as  do  the  thyroid  cells 
which  are  not  carcinoma,  and  the  percent- 
age uptake  in  metastases  from  carcinoma  of 
the  thyroid  is  extremely  low — below  the 
level  of  therapeutic  effect. 

If  ablation  of  normal  thyroid  tissue  is  ac- 
complished, then  the  percentage  uptake  in 
metastases  of  the  thyroid  carcinoma  is 
higher,  and  beneficial  therapeutic  results 
have  been  reported. 

Non-toxic  nodules  of  the  thyroid  gland 
in  adults  should  be  operatively  removed 
in  order  to  avoid  intrathoracic  goitre,  sub- 
sequent development  of  hyperthyroidism, 
and  carcinoma.  Report  from  the  thyroid 
clinic  of  the  Presbyterian  Hospital,  New 
York  City,  reveals  that  roughly  10  per  cent 
of  their  cases  were  at  least  partly  intra- 
thoracic, 6 per  cent  of  all  their  nodular 
goitres  were  at  least  strongly  suspect  of 
being  malignant,  and  most  clinics  report  a 
high  incidence  of  proven  malignancy  in 
single  discrete  nodules. 

Riedel’s  struma  and  Hashimoto’s  struma 
are  indicated  by  diffuse,  sometimes  very 
firm,  swellings  of  the  thyroid  gland.  Pre- 
operative differentiation  from  carcinoma 
may  be  uncertain,  in  which  event  a biopsy 
must  be  undertaken.  Biopsy  customarily 
is  taken  in  such  a manner  as  to  free  the 
trachea  from  the  constricting  effect  of  a 
contracting  thyroiditis.  The  end  point  of 
many  a thyroiditis  is  a state  of  myxedema. 

A discussion  of  carcinoma  of  the  thyroid 
is  too  lengthy  a topic  for  consideration 
within  this  paper.  Suffice  it  to  say  that 
early  total  lobectomy  on  the  affected  side, 
if  the  tumor  is  well  differentiated,  has  met 
with  a high  percentage  of  five-year  cures, 
and  that  carcinoma  in  a so-called  lateral 
aberrant  thyroid  casts  suspicion  upon  the 
thyroid  gland  as  being  the  primary  source. 

Summary 

1.  A brief  review  of  the  physiology  of 
the  thyroid  gland  is  given,  and  the  current 
ideas  on  the  pharmacology  of  iodine  and 
propyl-thiouracil  are  stated. 


738 


Rocky  Mountain  Medical  Journal 


2.  The  individual  with  thyrotoxicosis,  re- 
gardless of  type,  should  be  brought  to  a 
state  of  euthyroidism,  utilizing  propyl-thi- 
ouracil  if  necessary,  before  surgical  inter- 
vention is  attempted. 


3.  In  order  to  avoid  intrathoracic  goitre, 
subsequent  development  of  hyperthyroid- 
ism, and  carcinoma,  the  early  removal  of 
non-toxic  nodules  of  the  thyroid  gland  is 
indicated. 


“ELEOMA”  OF  THE  RECTUM 

WILLIAM  B.  SWIGERT,  M.D. 

DENVER 


Tumor  masses  in  the  rectum  following 
injection  of  oils,  chemical  or  other  media 
for  hemorrhoids  are  not  uncomman.  A.  T. 
Bazin,  Hiram  Fried,  and  Harvey  B.  Stone 
reported  cases  of  paraffinoma  of  the  rec- 
tum, similar  to  the  case  I will  report. 

Curtis  Rosser  and  Stuart  A.  Wallace 
have  written  a very  comprehensive  report 
on  tumor  formation  due  to  injection  of  oils 
under  the  rectal  mucosa.  R.  J.  Jackson 
discusses  the  differential  diagnosis,  patho- 
logical aspects,  and  treatment  of  rectal 
tumors  of  chemical  origin  with  several  case 
reports. 

CASE  REPORT 

Mrs.  C.  K.,  housewife,  aged  48,  came  to  the 
office  January  10,  1948.  Past  history— -pelyic 
surgery  (hysterectomy),  1947;  hemorrhoids  in- 
jected, 1940;  otherwise  essentially  a normal 
history.  She  believed  her  father  died  of  rectal 
cancer.  Her  present  complaint  was  burning, 
itching,  pressure  on  and  off  in  the  rectum  for 
the  past  three  months.  There  was  no  protrusion 
or  bleeding.  Questioning  her  further,  there  was 
no  history  of  constipation,  but  there  were  several 
spells  of  gas  and  difficulty  in  starting  her  bowel 
movements.  These  were  relieved  by  enemas  or 
laxatives.  She  was  becoming  increasingly  ner- 
vous, but  attributed  this  to  possible  menopause 
and  her  pelvic  surgery,  and  she  noticed  more 
pressure  in  the  rectum  when  she  was  nervous. 
There  was  no  loss  of  weight.  Her  appetite  was 
good,  and  she  was  in  good  health. 

Digital  examination  revealed  at  finger  tip  a 
stenosis  or  stricture  of  the  rectum  which  barely 
admitted  the  tip  of  the  index  finger.  This  was 
an  annular  stenosis,  rough,  suggesting  an  annular 
adenocarcinoma  with  narrowing  of  the  bowel 
lumen.  Proctosigmoidoscopic  examination  with 
three-quarter-inch  scope  was  unsuccessful,  as  the 
scope  was  unable  to  pass  beyond  6 cm.,  the  lu- 
men being  narrow  and  firm.  There  was  no  break 
or  ulceration  in  the  mucosal  lining  of  the  bowel. 
The  lumen  was  narrowed  to  approximately  one- 
half  inch,  and  a half  inch  sigmoidoscope  was 
passed  successfully  to  25  cm.  The  narrowing  was 
irregular,  extending  from  6 to  9 cm.  in  depth. 
A biopsy  was  obtained  at  about  7 cm.,  the  area 
cutting  hard  and  bleeding  freely.  The  patholog- 
ical report  of  the  biopsy  is  as  follows: 

“Microscopic  examination  of  tissue  from  the 
rectum  shows  it  to  be  covered  by  typical  rectal 
mucosa.  The  glands  are  lined  by  cylindrical 


cells  with  basally  located  nuclei  and  clear  cyto- 
plasm. In  the  mucosa  and  in  the  submucosa  are 
.small  vascular  spaces  lined  by  a single  row  of 
flattened  cells.  In  the  supporting  stroma,  which 
is  edematous,  are  dense  accumulations  of  eosino- 
philic leukocytes  and  round  cells.  There  is  no 
evidence  of  malignancy. 

“Diagnosis:  lymphangioma  of  rectium.” 

To  rule  out  possible  pathology  above  sig- 
moidoscopic  level,  a barium  enema  x-ray  was 
taken.  The  report  showed  a persistent  irregular 
defect  in  the  rectal  pouch  which  involved  ap- 
proximately 3 cm.;  otherwise,  the  enema  was 
negative.  The  supposition  by  the  roentgenologist 
was  “probable  carcinoma,  although  positive  dif- 
ferential diagnosis  between  neoplasm  and  an 
inflammatory  process  could  not  be  established.” 

Despite  the  supposition  we  were  dealing  with 
a lymphangioma,  surgery  was  decided  upon  to 
enlarge  the  opening  in  the  ampulla  and  further 
study  the  area  under  anesthesia.  The  operative 
report  was  as  follows: 

“Under  spinal  anesthesia,  the  stenosis  was  ex- 
amined measuring  1 to  IVz  cm.  in  diameter,  and 
located  about  6 cm.  above  the  anus.  With  grad- 
ual dilatation,  a finger  was  finally  gotten  through 
and  the  depth  of  the  stenosis  measured  2 cm. 
A “V”  shaped  dissection  was  made  through  the 
mass  and  specimen  sent  to  the  laboratory.  The 
area  was  then  dilated  up  to  two  fingers.  With 
electro-dessication,  a section  in  the  anterior  wall 
of  the  mass  was  made  to  permit  dilatation  to 
three  fingers.  Bleeding  was  controlled  by  coagu- 
lation.” 

The  pathological  specimen  report  was  as  fol- 
lows: 

“Microscopic  examination  of  tissue  from  the 
rectum  reveals  a layer  of  columnar  epithelium 
beneath  which  is  edematous  fibrous  tissue.  In 
the  fibrous  tissue  are  cyst-like  spaces,  many  of 
which  are  bounded  by  multinucleated  giant  cells 
of  the  foreign  body  type.  Others  are  bounded 
by  reticulum  cells  with  large  amounts  of  glassy 
cytoplasm.  In  the  fibrous  tissue  are  polynu- 
clear cells  and  eosinophiles. 

“Diagnosis:  Acute  and  chronic  inflammatory 
tissue  from  the  rectum  with  foreign  body  giant 
cell  reaction.” 

This  changed  the  picture  of  lymphangioma  to 
one  of  foreign  body  reaction  when  larger  spe- 
cimens were  obtained  for  examination.  There 
was  further  questioning  of  the  injection  for 
hemorrhoids  done  in  1940.  It  was  found  she  was 
injected  by  an  osteopath  for  hemorrhoids,  using 
the  Blanchard  formula,  mainly  consisting  of  5 
per  cent  phenol  in  Wesson  oil.  She  believes 
about  one  year  later  she  can  remember  symp- 
toms of  distress,  which  bothered  her  off  and  on 
since  then.  The  diagnosis  then  was  changed  to 


for  September,  1949 


739 


“eleoma  of  the  rectum  with  stricture  of  the  rec- 
tal pouch.” 

She  was  followed  up  for  one  year  after  surgery 
with  dilatation  to  15  cm.  by  a soft  rubber  dilator 
and  frequent  sigmoidoscopic  examination.  Three 
months  after  surgery  she  developed  nodule  of 
granulation  tissue  at  the  area  of  surgery  (diag- 
nosed by  miscroscopic  examination  of  biopsy  on 
April  22,  1948),  which  was  thoroughly  removed. 
Since  then  she  has  had  free  bowel  movements, 
no  distress  and  negative  to  examination  by  the 
scope. 

Discussion 

In  examining  the  literature,  I find  the  ma- 
jority have  done  what  amounts  to  proctec- 
tomy, dissecting  out  the  lesion  and  bringing 
the  mucosa  and  bowel  wall  down  and  ap- 
proximating it  to  the  sphincter  muscles. 
But,  believing  I was  dealing  with  lymphan- 
gioma, the  most  conservative  measures  were 
followed,  with  good  results.  However,  it  is 
believed  to  give  only  temporary  relief.  But 
I have  noticed  in  the  literature  where  many 
constricting  lesions  of  the  rectum  due  to 
chemical  injection  have  responded  to  hot 
saline  irrigations  through  the  rectum  and 
vagina  with  beneficial  and  evidently  lasting 


results.  I believe  I would  not  attempt  a 
proctectomy  in  this  type  of  lesion  unless  all 
conservative  measures  failed. 

Summary  and  Conclusion 

History  and  pathologic  findings  are  given 
in  a case  of  eleoma  of  the  rectum  in  a wom- 
an aged  48,  due  to  previous  injection  treat- 
ment of  hemorrhoids  using  an  oil  based 
sclerosing  agent  and  which  has  responded 
excellently  to  a modified  conservative  pro- 
cedure and  apparent  complete  cure.  In  con- 
clusion, I quote  Dr.  R.  J.  Jackson,  “When 
a submucosal  tumor  mass  or  stricture  of  the 
rectum  is  found  and  when  a patient  gives  a 
history  of  having  had  injection  treatment 
for  hemorrhoids,  the  possibility  of  the  le- 
sion being  a tumor  of  chemical  origin  should 
strongly  be  considered.  The  use  of  oil  base 
sclerosing  preparation  should  be  con- 
demned.” 

BIBLIOGRAPHY 

'British  Medical  Journal,  2:1101-1102. 

'SGO.,  50:762-68,  April,  1930. 

M.A.M.A,  33:2167-2171,  December,  1932. 

'Proctology  Staff  Meeting’,  Mayo  Clinic,  15:188-192, 
March,  1940. 


BOTULISM  IN  HUMAN  BEINGS 

FROM  HOME  AND  COMMERCIALLY  CANNED  FOODS 

DELMER  E.  JOHNSON,  M.D.,  Alamosa,  Colo.,  and  GEO.  W.  STYLES,  M.  D.,  Denver 


Botulism  is  an  acute  poisoning  caused  by 
eating  spoiled  foods  containing  the  toxin 
produced  by  bacilli  of  the  group  Clostridium 
botulinum. 

HulP  lists  five  different  species  in  this 
group  of  “A,”  “B,”  “C,”  “D,”  and  “E.”  Of 
these  species,  according  to  Hull,  the  most 
common  cause  of  botulism  in  man  is  “A,” 
with  “B”  of  lesser  occurrence.  Types  “A” 
and  “C”  botulinum  are  reported  by  Hagan^ 
as  toxic  for  poultry;  the  latter  is  the  cause 
of  Western  duck  sickness  in  wild  fowl.  The 
toxicity  of  these  two  species  are  included 
with  human  cases  because  spoiled  canned 
foods  are  often  thrown  to  the  chickens  with 
fatal  results.  Types  “C”  and  “D”  are  con- 
sidered non-toxic  for  man. 

Geiger^  records  three  cases  of  human 
botulism  ascribed  to  type  “E”  toxin  demon- 

Dr.  Johnson  is  a practicing  physician.  First  Na- 
tional Bank  Building,  Alamosa,  Colorado;  Dr.  Stiles 
is  Director  of  Laboratory  Section,  Colorado  State 
Department  of  Public  Health,  430  State  Office  Build- 
ing, Denver  Colorado. 


strated  in  a commercial  can  of  mushroom 
sauce.  K.  F.  Meyer,  who  made  the  labora- 
tory diagnosis,  reported,  “The  evidence 
strongly  suggests  that  a rare  type  of  C. 
botulinum  type  “E”  was  responsible  for  the 
illness.” 


Prevalence  and  Regional  Distribution 

The  statistics  on  human  cases  indicate 
that  the  various  types  of  organism  causing 
botulism  are  widely  distributed  in  nature, 
being  especially  prevalent  in  the  Rocky 
Mountain  and  the  Pacific  Coast  areas.  Mey- 
er^ lists  463  outbreaks  of  human  botulism 
(1899  to  February,  1948)  in  the  United 
States  and  Canada,  with  the  ten  highest 
ranking  states  as  follows: 


California 
Washington 
Colorado 
Oregon 
New  York 


New  Mexico 

Montana 

Nebraska 

Wyoming 

Idaho 


740 


Rocky  Mountain  Medical  Journal 


In  the  463  outbreaks  reported  by  Meyer, 
1,255  persons  were  afflicted  and  816  of  these 
victims  died;  a mortality  of  65  per  cent. 

Home  and  Commercial  Food  Sources  of 
Botulism 

Many  people  believe  that  botulism  is 
caused  only  by  home-canned  vegetables. 
This  is  not  true,  for  two  reasons.  First, 
cases  have  occurred  from  commercially 
canned  products.  Second,  foods  other  than 
vegetables  may  be  sources  of  the  poisoning. 
In  former  years  many  cases  of  botulism 
were  traced  to  inadequately,  commercially 
canned  foods.  In  recent  years,  however,  the 
National  Canners  Association  has  made 
marked  improvement  in  commercial  can- 
ning methods,  and  botulism  now  is  rarely 
encountered  in  such  products. 

Human  botulism  cases  recorded  by  the 
California  State  Department  of  Public 
Health  involve  thirty-two  kinds  of  foods, 
including  eighteen  vegetables,  six  kinds  of 
meats  and  cheeses,  three  of  fish,  and  five 
varieties  of  fruit.  Data  compiled  by  the  G. 
W.  Hooper  Foundation,  University  of  Cali- 
fornia, show  string  beans  to  head  the  long 
list  of  foods  that  have  caused  human  botu- 
lism. Canned  corn  is  second,  with  spinach, 
beets,  and  asparagus  following. 

Community  canning  centers,  supervised 
by  competent,  trained  personnel,  have  done 
much  toward  reducing  the  incidence  of 
botulism  in  localities  where  this  disease  is 
known  to  be  prevalent.  In  such  areas,  es- 
pecially at  high  altitudes,  properly  checked 
and  regulated  pressure  cookers  should  be 
used  for  all  types  of  nonacid  home  canning. 

Heat  Resistance  of  Botulinum  Spores 

Spores  of  C.  botulinum  are  very  resistant 
to  heat.  For  example,  a strain  recorded  by 
one  of  the  authors  (G.W.S.)  from  home- 
canned  string  beans  survived  six  hours  of 
boiling  temperature  in  an  open  kettle  at 
Denver  (mile-high  altitude),  where  water 
boils  at  about  95  degrees  C or  203  degrees  F. 
The  beans  in  question  were  raised  and 
canned  near  Sterling,  Colorado  (1924).  A 
family  of  five  persons  was  served  the  un- 
heated beans  in  a salad.  Three  died,  and 


two  received  repeated  doses  of  botulinus 
antitoxin  and  eventually  recovered. 

Hull  gives  the  following  periods  of  time 
required  to  destroy  C.  botulinum  spores: 


4 

minutes 

at 

120°C 

(248°F) 

10 

minutes 

at 

115°C 

(115°F) 

32 

minutes 

at 

110°C 

(230°F) 

100 

minutes 

at 

105°C 

(221 °F) 

330 

(5y2  hrs) 

at 

100°C 

(212°F) 

Canned  corn  on  the  cob,  spinach,  and 
string  beans  require  more  heat  and  longer 
exposure  than  most  other  vegetables  in  or- 
der to  sterilize  them  completely  during 
canning. 

Destruction  of  the  Toxin  by  Boiling 

While  it  is  recognized  that  the  spores  of 
C.  botulinum  are  very  resistant  to  heat,  the 
toxin  produced  by  them  is  readily  destroyed 
by  boiling. 

The  tasting  of  a mere  drop  of  unheated 
fluid  from  botulinus-tainted  food  may  cause 
death.  Suspicious  home-  or  commercially- 
canned  foods  should  never  be  tasted  by  the 
housewife  or  cook  before  heating.  Thorough 
boiling  of  such  products  fifteen  minutes  or 
more,  depending  upon  the  type  of  food, 
should  destroy  any  toxin  present  and  ren- 
der it  harmless.  The  average  person,  how- 
ever, does  not  relish  spoiled  foods,  even 
though  they  are  made  harmless  through 
cooking. 

A CASE  OF  BOTULISM 

For  the  evening  meal  on  Friday,  November  5, 
1948,  a Spanish-American  family  living  at  Ala- 
mosa, Colorado,  was  served  home-canned  whole 
grain  corn  on  the  cob.  Other  items  of  food  con- 
sumed at  this  meal  were  freshly  cooked  dried 
beans,  mashed  potatoes  and  freshly  cooked  wein- 
ers.  No  canned  food  of  any  description  had 
been  served  this  family  for  several  weeks  pre- 
viously. 

Clinical  History:  Of  the  five  persons  served 
the  canned  corn  the  father,  aged  54,  was  reported 
as  only  taking  “one  bite”  of  the  corn.  He  failed 
to  develop  any  visible  symptoms.  It  was  stated 
ihe  mother,  aged  47,  ate  the  corn  from  one  cob 
only  and  became  ill  the  second  morning,  about 
thirty-six  hours  after  ingesting  the  product.  Her 
symptoms  consisted  of  stomach  pain,  vomiting, 
and  disturbed  double  vision,  followed  by  prostra- 
tion and  difficulty  in  talking,  labored  breathing, 
and  possibly  mild  throat  paralysis ' preventing 
freedom  of  expectoration. 

After  considerable  persuasion  the  wife  was 
hospitalized.  On  admission  her  temperature 
was  98.2°F;  pulse,  66;  respiration,  20.  On  the 
second  day  the  temperature  increased  to  99.6 °F, 
with  the  pulse  rate  of  120.  The  day  after  ad- 
mission the  hemoglobin  was  112  per  cent;  R.B.C. 


for  September,  1949 


741 


5,670,000;  W.B.C.  10,900,  with,  a differential  count; 
P.  neutrophils  78  per  cent;  small  lymphocytes  21 
per  cent;  eosinophils  1 per  cent.  The  urine 
analysis  was  normal  except  for  traces  of  sugar 
and  albumin.  This  patient  showed  the  absence 
of  deep  reflexes.  Subsequent  observation  re- 
vealed the  beginning  return  of  abdominal  re- 
flexes. It  is  believed  (by  D.  E.  J.)  that  the  ab- 
sence of  abdominal  reflexes  may  be  of  some 
diagnosistic  value  in  botulism,  hkewise  the  cre- 
masteric reflexes. 

One  daughter,  aged  13,  ate  one  small  ear  of 
corn;  she  developed  a stomachache  twenty  hours 
later.  Following  a mild  laxative  the  abdominal 
cramps  were  relieved  without  subsequent  serious 
illness.  A second  daughter,  aged  8,  consumed 
two  cobs;  she  became  ill  the  following  morning 
about  12  hours  after  the  evening  meal.  The 
symptoms  in  this  case  were  more  pronounced 
than  in  the  elder  sister.  She  complained  of  head- 
ache, abdominal  distress,  slight  fever,  and  diar- 
rhea. This  patient  also  received  a mild  laxative 
and  was  reported  quite  normal  the  following  day. 

A grandson,  2 years  and  2 months  of  age,  was 
very  fond  of  corn.  It  was  said  he  ate  from 
three  to  five  ears  of  the  canned  corn,  one  of 
which  came  directly  from  the  jar  without  heat- 
ing. The  first  symptoms  of  disturbed  vision  was 
observed  about  twelve  hours  later.  He  became 
dizzy,  kept  falling  down,  and  refused  to  eat. 
The  family  became  alarmed  and  rushed  the  child 
to  a physician’s!  office,  where  his  illness  was 
attributed  to  acute  gastro-enteritis.  About  one 
hour  later,  following  an  enema,  a foul-smelling 
stool  was  passed  containing  whole  grains  of  corn. 
The  patient  died  soon  after,  approximately  twen- 
ty-three hours  following  the  ingestion  of  canned 
corn. 

Epidemiological  investigation : After  being 
called  on  the  case  (D.  E.  J.)  suspected  possible 
poisoning  from  botulism.  The  history  strongly 
incriminated  home-canned  corn  on  the  cob  as 
the  hkely  source  of  the  trouble.  Other  items  of 
food  already  mentioned  were  considered  as  non- 
essential. 

The  corn  was  picked  the  previous  September, 
kept  in  the  cellar  one  week  and  reported  boiled 
in  an  open  kettle  fifteen  minutes,  then  placed 
in  a pressure  cooker  for  seventy-five  minutes 
(1  h.  15  min.).  The  pressure  was  raised  to 
10  pounds,  but  the  time  interval  included  the 
time  required  to  raise  the  pressure  up  to  10 
pounds.  The  physical  condition  of  the  pressure 
cooker  was  not  determined,  nor  were  the  valves 
checked  before  using.  The  corn  was  processed  in 
half-gallon  jars.  Since  such  products  are  dif- 
ficult to  sterilize  it  is  probable  the  heat  pene- 
tration only  slowly  reached  the  center  of  the 
can,  insufficient  to  destroy  the  very  resistant 
spores.  The  altitude  at  Alamosa  is  7,546  feet. 
Water  in  open  vessels  should  boil  at  a tempera- 
ture of  about  92.2'’C  or  198°F;  hence,  the  length 
of  time  and  the  temperature  are  the  two  im- 
portant factors  to  consider  in  sterilizing  canned 
goods  at  high  elevations.  After  standing  about 
two  months  imder  favorable  conditions  of  tem- 
perature and  the  absence  of  free  oxygen 
(anaerobic),  sufficient  toxin  was  produced  to 
render  the  product  dangerous.  The  fluid  in  the 
jar  around  the  corn  was  cloudy,  it  smelled  sour, 
and  tasted  spoiled.  Two  jars  had  previously  been 
served  with  no  ill  effect,  but  the  liquid  in  these 
cans  was  clear.  On  inspection  eight  additional 
jars  showed  varying  degrees  of  turbidity.  The 
corn  on  the  cob  of  the  toxic  jar  was  said  to 
have  been  heated  about  five  minutes,  beginning 
with  the  cold  product,  before  serving.  There 


may  have  been  some  destruction  of  toxin  from 
this  brief  cooking  which  could  have  explained 
the  comparatively  mild  symptoms  noticed  in  the 
father  and  two  daughters. 

Treatment:  In  addition  to  the  administration 
of  laxatives  and  systemic  treatment,  depending 
on  the  degree  of  illness,  botulinus  bivalent 
antitoxin  was  secured  by  the  State  Depart- 
ment of  Public  Health  and  given  all  the  sur- 
viving members  of  the  family.  The  antitoxin 
was  secured  from  the  Lederle  Laboratories  in 
Denver,  and  sent  by  plane.  It  was  administered 
within  five  hours  after  one  of  the  authors 
(D.  E.  J.)  first  saw  the  patients.  Since  the 
mother  showed  the  most  marked  symptoms,  she 
received  10,000  units  intramuscularly,  followed 
in  four  hours  by  the  same  dose,  and  a final 
10,000  units  the  next  morning.  Other  members 
of  the  family  received  5,000  units  each,  all  intra- 
muscularly. 

Whether  the  administration  of  the  antitoxin 
was  hfe  saving  in  this  family  may  be  questioned. 
However,  the  most  critical  patient,  the  mother, 
showed  marked  improvement  after  the  injection 
of  the  antitoxin,  and  she  returned  home  four  days 
later  from  the  hospital,  and  after  one  month 
was  considered  90  per  cent  recovered  from  her 
illness.  No  serious  results  developed  in  the  other 
three  members  of  the  family. 

Laboratory  examination:  Since  the  clinical 
evidence  suggested  probable  botulism,  due  to  the 
home-canned  com,  a microscopic  examination  of 
the  com  grains  was  made  at  Alamosa.  A ^am- 
positive,  spore-bearing  bacillus,  morphologically 
resembling  C.  botulinum,  was  demonstrated. 

One  sm^l  ear  of  corn,  also  the  original  rinsed 
can,  were  secured  and  forwarded  to  the  Central 
Laboratory  of  the  State  Department  of  Public 
Health  in  Denver  for  further  investigation. 

Upon  receipt  of  the  corn  and  can,  anaerobic 
cultures  were  prepared  by  the  author  (G.  W.  S.). 
Likewise,  emulsions  were  made  from  the  com 
v/ith  sterile  saline,  and  injected  into  white  mice. 
About  one  dozen  mice  and  several  guinea  pi^ 
were  used  in  demonstrating  the  presence  of  toxin 
and  typing  the  product. 

Small  quantities  of  dilute  washings  killed  white 
mice  within  twenty-four  hours,  the  length  of 
time  depending  on  the  amoimt  given.  The 
paralytic  symptoms  were  typical  of  botulism  in 
all  fatal  animal  inoculations.  A series  of  guinea 
pigs  received  types  “A”  and  “B”  botulinum 
antitoxin  subcutaneously ; at  the  same  time,  small 
amounts  of  toxic  material  were  administered  to 
each  experimental  animal.  All  guinea  pigs  re- 
ceiving type  “A”  antitoxin  survived;  those  re- 
ceiving a lethal  dose  of  toxin  and  type  “B”  died. 

Anaerobic  cultures  from  the  infected  corn  re- 
vealed the  presence  of  C.  botulinum.  The  spores 
from  this  culture  withstood  boiling  in  an  open 
kettle  for  three  hours;  longer  exposures  were 
not  made.  A small  quantity  of  the  original 
specimen  of  com  on  the  cob  was  submitted  to 
Dr.  Richard  Thompson,  Bacteriologist,  Colorado 
University  Medical  School,  who  recovered  C. 
botulinum  Type  ‘‘A”  from  the  product. 

Summary 

1.  Important  facts  regarding  botulinus 
poisoning,  types,  and  resistance  of  the  or- 
ganism are  presented. 

2.  A case  of  botulism  is  reported  in  which 
five  members  of  a family  ate  varying 
amounts  of  home-canned  corn  on  the  cob. 


742 


Rocky  Mountain  Medical  Journal 


One  child  who  consumed  a considerable 
quantity  of  the  toxic  food  died. 

REFERENCES 

'Geiger,  J C. : An  Outbreak  of  Botulisrn,  Journal 
A.M.A.,  July  5,  1941,  p.  22. 


*Hagan,  William  Arthur:  The  Infectious  Diseases 
of  Domestic  Animals,  1943,  Comstock  Publishing  Co., 
Ithica,  N.  Y. 

'Hull,  Thomas  G.:  Diseases  Transmitted  From  Ani- 
mals to  Man,  1947.  Charles  C.  Thomas,  Springfield, 
Illinois.  , 

'Meyer,  K.  F. : Personal  correspondence,  including 
tabulated  reports. 


THE  USE  OF  NISULFAZOLE  IN  THE  TREATMENT  OF 
ULCERATIVE  COLITIS 

C.  B.  WILLS,  M.D. 

DENVER 


While  ulcerative  colitis  is  primarily  a 
medical  problem  and  two-thirds  of  the  cases 
respond  satisfactorily  to  medical  care,  many 
cases  come  under  the  observation  of  the 
proctologist  for  sigmoidoscopic  diagnosis, 
evaluation  of  treatment,  and  surgical  care 
of  complications.  The  cases  herein  reported 
comprise  a group  in  which  a new  medica- 
tion, nisulfazole,*  was  supplied  for  the  eval- 
uation of  its  efficacy  in  ulcerative  colitis  by 
repeated  sigmoidoscopic  examination  of  the 
rectum  and  lower  colon  after  its  use. 

This  paper  reports  the  use  of  nisulfazole 
in  twenty-four  cases  of  ulcerative  colitis. 
Nisulfazole,  2-  (p-nitro-benzene  s u 1 f o n a- 
mide) -thiazole  was  supplied  in  two  forms, 
tablets  of  0.3  gm.  with  50  mgs.  ascorbic  acid 
for  oral  administration,  and  as  a 10  per  cent 
suspension  in  pectin  for  rectal  instillation. 
It  has  been  demonstrated  that  the  growth 
of  bacillus  typhosus  and  bacillus  dysenteria 
(Shiga,  Flexner,  and  Hiss  strains)  is  in- 
hibited by  the  presence  of  nisulfazole. 
Nisulfazole  markedly  inhibits  the  growth  of 
streptococcus  viridans,  streptococcus  fecalis 
and  streptococcus  hemolyticus.  Given  oral- 
ly it  is  reduced  in  the  intestinal  tract  to 
sulfathiazole,  a faint  trace  of  which  is  dis- 
cernible in  the  blood  after  eight  hours.  Most 
of  this  conversion  takes  place  in  the  colon. 
The  rectal  instillation  of  nisulfazole  sus- 
pension produces  no  concentration  in  the 
blood  stream. 

In  the  majority  of  cases,  ulcerative  colitis 
begins  in  the  rectum  and  the  more  proximal 
colon  is  involved  by  direct  extension. 
Hence  the  use  of  a medication  which  can 
be  administered  directly  or  topically  has 
much  to  recommend  it.  In  this  series  of 

‘Supplied  through  the  courtesy  of  George  A.  Breon 
& Co.,  Inc.,  Kansas  City,  Missouri. 


twenty-four  cases  the  majority  were  treated 
by  rectal  instillations  of  nisulfazole  alone. 
A few  that  showed  little  or  no  improvement 
on  this  regime  were  treated  by  oral  ad- 
ministration of  the  tablet  form  in  addition 
to  the  rectal  instillation. 

The  term  ulcerative  colitis  as  used  in  this 
report  is  synonymous  with  “idiopathic  ul- 
cerative colitis,”  “non-specific  colitis,”  and 
“thrombo-ulcerative  colitis.”  It  describes 
that  large  group  of  cases  which  show  a char- 
acteristic type  of  diffuse  ulcerative  inflam- 
mation of  the  rectum  and  colon  which 
cannot  be  ascribed  to  any  etiological  agent. 
The  patients  used  in  this  report  represent 
all  stages  of  ulcerative  colitis.  Borderline 
cases  of  subacute  and  non-specific  proctitis 
are  not  included.  The  differentiation  of 
amebic  infestation  and  of  bacillary  dysen- 
tery was  as  thorough  as  possible  within  the 
scope  of  my  experience  and  the  available 
laboratory  facilities  by  repeated  cultures 
and  smears  of  direct  scrapings  and  of  saline 
purged  specimens. 

Ordinarily  the  sigmoidoscopic  appearance 
of  acute  amebic  colitis  is  totally  different 
from  that  of  ulcerative  colitis.  However,  a 
diffuse  ulcerative  colitis  may  develop  as  a 
result  of  secondary  infection  and  confuse 
the  diagnosis.  In  differentiating  bacillary 
dysentery  and  ulcerative  colitis  most  ex- 
perienced observers  agree  that  chronic  bac- 
illary dysentery  is  identical  both  clinically 
and  pathologically  with  chronic  ulcerative 
colitis  and  that  many  cases  of  ulcerative 
colitis  are  an  aftermath  of  acute  bacillary 
dysentary. 

Classification 

These  cases  represent  all  stages  of  ulcer- 
ative colitis.  I prefer  Bockus’*  classifi- 

‘Bockus,  Henry  L.:  Gastroenterology,  Vol.  II,  p.  273. 


for  September,  1949 


743 


tion  based  on  the  sigmoidoscopic  picture. 

Acute  phase  of  ulcerative  colitis:  Cases  in 
this  group  represent  those  wherein  the 
changes  are  believed  to  be  reparable  al- 
though the  fulminating  cases  may  terminate 
fatally. 

Stage  1.  A mottled  discoloration  due  to 
a shower  of  petechiae  under  the  mucosal 
surface.  The  mucosa  may  present  a finely 
granular  character  and  show  a few  small 
bleeding  points. 

Stage  2.  General  hyperemia  and  the  mu- 
cosa appears  swollen.  There  is  an  excess  of 
mucoid  secretion.  Ulcerations  may  or  may 
not  be  present.  If  present,  they  are  usually 
small  and  shallow. 

Stage  3.  The  mucosa  is  red  and  edematous, 
showing  the  characteristic  pitted  and  gran- 
ular appearance.  There  is  usually  a con- 
stant oozing  of  blood  from  the  surface. 
Ulceration  is  extensive  and  little  or  no  nor- 
mal appearing  membrane  can  be  found. 
There  is  a thick  muco-purulent  exudate. 

Stage  4.  The  very  severe  fulminating  case. 
Large  areas  covered  with  a thick  diphtheri- 
tic-like membrane.  The  mucosal  surface  ap- 
pears coarsely  pitted,  edematous,  granular 
and  ulcerous. 

Chronic  phase  of  ulcerative  colitis:  These 
represent  cases  which  have  passed  beyond 
the  above-described  acute  stages  and  have 
suffered  irreparable  damage. 

1.  Active:  The  lumen  is  narrowed  and 
tubular  with  complete  loss  of  normal  archi- 
tecture. Diffuse  oozing  of  blood,  mucosa 
edematous  and  congested.  Hyperplastic 
polypoid  areas  are  common. 

2.  Quiescent:  Similar  to  above  with  the 
exception  that  the  evidence  of  edema  and 
congestion  is  lacking,  little  or  no  bleeding 
or  exudate.  Areas  of  polypoid  change  fre- 
quently seen. 

3.  Polypoid  Hyperplasia:  Pseudopolyps  oc- 
cur as  a result  of  hyperplasia  of  the  islands 
of  intact  mucosa  or  at  margins  of  ulcera- 
tions. These  are  soft  in  comparison  to  true 
adenomas.  Normally  they  do  not  bleed  easily 
and  may  become  smaller  and  disappear 
over  a long  period  of  quiescence. 

This  classification  is  only  for  description 
of  average  changes.  Great  differences  are 


encountered  in  various  patients  and  many 
varieties  of  the  above  lesions  may  be  pres- 
ent in  the  same  patient. 

Following  the  above  classification  the 
twenty-four  cases  used  in  this  series  fell 
into  the  following  order  as  of  their  first 
visit: 

Active  Phase  Chronic  Phase 

Stage  1 0 Active  10 

Stage  2 2 Quiescent  0 

Stage  3 7 Hyperplastic  4 

Stage  4 1 

Administration 

Major,*  in  his  report,  used  the  tablet  form 
for  oral  administration  almost  entirely.  All 
of  this  series  received  nisulfazole  as  rectal 
instillations  of  1 to  3 ounces  by  means  of  a 
No.  18  catheter  and  bulb  syringe.  If  the  sus- 
pension was  too  thick  for  easy  use  it  was 
diluted  with  a small  amount  of  distilled  wa- 
ter. Cases  in  which  the  involvement  ap- 
peared to  be  confined  mainly  to  the  rectum 
and  lower  colon  were  treated  with  nisulfa- 
zole suspension  alone.  The  suspension  as 
viewed  at  intervals  through  the  sigmoido- 
scope spread  well  above  sigmoidoscopic 
range  in  a few  minutes  and  evenly  coated 
the  mucosal  surfaces  for  observed  periods  of 
two  to  six  hours  without  redosage  in  some 
cases.  Acute  cases  received  as  many  as  eight 
to  twelve  instillations  daily  of  one  to  two 
ounces  without  ill  effect.  There  were  no 
complications  of  any  kind  noted  with  the 
use  of  the  nisulfazole  suspension.  Cases  in 
which  x-rays  showed  involvement  of  entire 
colon,  often  including  the  terminal  ileum, 
were  treated  with  nisulfazole  tablets  orally 
4 to  6 gms.  daily  and  nisulfazole  suspension 
rectally.  Two  cases  showed  persistent  nau- 
sea and  the  tablets  were  finally  discontin- 
ued in  these  patients. 

Results 

All  of  the  patients  classified  as  being  in 
the  second  and  third  stages  of  the  acute 
phase  showed  prompt  improvement.  One 
case  improved  rapidly  with  the  initial 
treatment  but  suffered  a relapse  eight 
months  later.  Nisulfazole  treatment  at  this 
time  had  no  effect.  Ileostomy  performed 
eight  months  later  (chronic  phase)  with 

•Major,  Ralph  H. : Journal,  Laboratory  and  Clinical 
Medicine,  31:219-226,  Feb.,  1946. 


744 


Rocky  Mountain  Medical  Journal 


good  results.  The  one  patient  seen  in  the 
acute  fulminating  stage  died  despite  emer- 
gency ileostomy.  Seven  of  the  ten  patients 
classified  as  being  in  the  active  stage  of  the 
chronic  phase  showed  improvement  and 
have  continued  without  undue  symptoms 
to  the  present  time.  Three  of  this  group 
have  had  intermittent  exacerbations  and 
remissions  of  varying  severity  and  I believe 
all  three  will  require  ileostomy.  The  four 
cases  in  the  polypoid  hyperplastic  stage 
were  little  affected  by  nisulfazole  orally 
and  rectally.  Two  of  these  have  had  ileos- 
tomy performed  and  the  other  two  should 
have  surgery  soon. 

Nine  cases  out  of  the  twenty-four  then 
have  shown  little,  or  only  temporary,  im- 
provement with  treatment  by  nisulfazole. 
Of  these,  four  have  had  ileostomies  with 
one  fatality  and  the  remaining  four  are 
likely  candidates  for  surgery. 

Following  are  typical  cases  with  emphasis 
on  those  which  were  least  tractable  to 
therapy. 

CASE  1 

In  April,  1946,  a 15-year-old  white  female  had 
a sudden  onset  of  acute  diarrheal  attacks,  eight 
to  ten  daily;  cramping,  bloody,  muco-purulent 
bowel  movements.  Sigmoidoscopy  revealed 
characteristic  picture  of  granular,  highly  in- 
flamed, easily  bleeding,  rectal  mucosa.  Repeated 
smears  were  negative  for  ameba.  Cultures  were 
negative. 

Nisulfazole  instillations,  1 to  2 ounces  four 
times  daily  in  addition  to  bland,  low-residue, 
high  vitamin  diet  and  rest.  There  was  remark- 
able clinical  improvement  in  one  week.  Examina- 
tion by  sigmoidoscope  showed  evidence  of  rapid 
healing;  the  ulcers  disappeared  and  the  rectal 
mucosa  was  only  moderately  inflamed  and  gran- 
ular. Examination  in  two  weeks  showed  very 
little  pathology  present  and  complete  absence 
of  any  clinical  symptoms.  Nisulfazole  instilla- 
tions continued  twice  daily,  checked  every  six 
to  eight  weeks  with  negative  findings. 

Acute  exacerbation  eight  months  later  in  Jan- 
uary, 1948,  with  cramping,  bloody  diarrhea,  ten 
to  fifteen  times  daily.  Examination  revealed 
similar  picture  to  first  examination.  Patient 
and  patient’s  family  stated  she  had  not  followed 
regime  of  treatment  for  several  months.  Nisul- 
fazole instillations,  up  to  six  to  eight  times  daily 
for  one  week,  had  no  effect  upon  course.  Patient 
was  hospitalized  under  the  care  of  her  physician 
where  blood  transfusions,  plasma,  sulfadiazine, 
vitamins,  etc.,  brought  about  a gradual  improve- 
ment. Discharged  in  fourteen  days.  X-ray  im- 
pression: Advanced  chronic  ulcerative  colitis. 
The  terminal  ileum  has  become  involved. 

Patient  continued  to  have  intermittent  ex- 
acerbations and  remissions,  culminating  Septem- 
ber, 1948,  in  an  acute  episode  and  ileostomy  was 
performed  with  uneventful  recovery. 

Comment:  In  this  case,  treatment  with  nisul- 
fazole had  but  little  effect  upon  her  acute  re- 


currence in  contrast  to  its  marked  success  when 
used  at  the  onset  of  the  illness. 

CASE  2 

In  February,  1947,  a 23-year-old  white  female 
reporteu  broody  diarrnea  for  ten  months;  eight 
to  ten  Dower  movements  daily.  I'Jo  cramping  or 
tenesmus,  bigmoidoscopy  revealed  typical  ulcer- 
ative colitis  picture.  Diagnosis,  idiopathic  ul- 
cerative colitis.  Secondary  anemia,  smears  nega- 
tive for  ameba;  cultures,  negative.  X-ray  impres- 
sion, early  ulcerative  colitis. 

Nisuiiazoie  instillations,  rectally,  three  times 
daily,  i^atient  has  been  checked  every  two 
months  up  to  the  present  time  and  is  completely 
free  of  symptoms  and  sigmoidoscopy  reveals 
normal  appearing  mucosa.  Patient  states  that  if 
she  stops  tne  nisulfazole  she  has  immediate  re- 
turn Of  symptoms,  uses  at  present,  nisulfazole, 
one  ounce  daily. 

Comment:  it  is  interesting  that  this  patient  has 
immediate  exacerbations  wnen  she  stops  the  use 
of  nisulfazole. 

CASE  3 

In  May,  1947,  a 15-year-old  white  male  gave 
a nistory  of  biooay  diarrhea  (four  to  six  bowel 
movements  daily!  for  five  months.  Periods  of 
short  remissions.  Cramping  pain  in  abdomen. 
Sigmoidoscopy  revealed  granular,  easily  bleeding 
mucosa  witn  small  shallow  ulcerations  as  high 
as  sigmoidoscope  could  be  passed.  X-ray  impres- 
sion, colitis  of  mac  colon  and  sigmoid,  ulceration 
of  cecum  in  region  of  ileocecal  valve.  Smears, 
negative  for  parasites;  cultures,  negative. 

Nisulfazole  instillations, , 2 ounces,  t.i.d.  Nisul- 
fazole tablets,  4 gms.  daily. 

Prompt  clinical  improvement  in  ten  days. 
Sigmoidoscopy  appearance  showed  gradual  im- 
provement over  a period  of  six  weeks.  At  last 
examination  showed  no  ulcerations  or  bleeding, 
but  some  residual  inflammation.  Patient  has  oc- 
casional attacKs  of  loose  bowel  movements  with 
cramping  but  no  bleeding,  and  of  short  (one  to 
two  days)  duration.  Taken  off  nisulfazole  tablets 
without  apparent  clinical  effect.  Rectal  instilla- 
tions stopped  for  short  time  with  immediate 
return  of  symptoms. 

Comment:  Tnis  patient,  while  he  has  improved 
clinically  and  by  sigmoidoscopic  examination, 
shows  very  little  improvement  by  re-check  ba- 
rium enema  one  year  later. 

CASE  4 

In  August,  1947,  a 25-year-old  white  male  de- 
scribed loose  bowel  movements  for  six  weeks, 
four  to  eight  daily,  no  bleeding  or  cramping. 
History  of  “dysentery”  overseas  in  1945  with  ap- 
parent cure.  Repeated  smears  and  cultures  neg- 
ative. Sigmoidoscopy  showed  an  acutely  inflamed 
rectum  as  high  as  the  recto-sigmoid  junction. 
Membrane  granular,  congested  with  coalescing 
ulcerations  involving  wide  areas.  Old  and  fresh 
blood,  pus  and  mucus.  Several  areas  of  polypoid 
hyperplasia  visible.  X-ray  impression,  ulcerative 
colitis. 

Nisulfazole  instillations  two  to  six  times  daily 
for  six  weeks  with  only  slight  improvement.  A 
course  of  sulfathalidine  was  of  no  apparent  bene- 
fit. Penicillin  brought  about  no  change  in  clinical 
or  sigmoidoscopic  picture. 

He  was  referred  by  his  internist  to  a southern 
clinic  where  ameba  were  found  and  a specific 
diagnosis  of  bacillary  dysentery,  Shiga  strain, 
was  made.  He  improved  rapidly  under  specific 
therapy  and-  heavy  doses  of  diodoquin  and  neo- 
prontosil.  When  again  seen  he  was  symptom- 
free.  His  sigmoidoscopic  picture  was  tyfical  of 


for  September,  1949 


745 


the  quiescent  phase  of  chronic  ulcerative  colitis. 
The  areas  of  hyperplasia  were  still  present.  Ap- 
proximately one  year  later,  noted  recurrence  of 
original  symptoms  which  were  complicated  by 
ischio-rectal  abscesses.  Nisulfazole  rectally  and 
orally  was  of  no  apparent  value.  The  abscesses 
and  fistulae  healed  promptly,  however,  follo'wing 
its  use  after  surgery.  I believe  an  ileostomy  will 
eventually  be  necessary  in  this  case. 

CASE  5 

During  February,  1948,  an  18-year-old  white 
female  stated  she  had  “mucus  colitis.”  Varied 
treatments  for  several  months  without  relief. 
Complaining  of  bloody  diarrhea,  abdominal 
cramping  and  weight  loss.  Had  ten  to  fifteen 
bowel  movements  daily.  Sigmoidoscopy  re- 
vealed a highly  inflamed,  granular,  easily  bleed- 
ing, mucus  membrane  as  high  as  it  was  possible 
to  pass  sigmoidoscope.  Repeated  smears  and  cul- 
tures were  negative.  X-ray  impression,  ulcera- 
tive colitis. 

Patient  was  placed  on  nisulfazole  instillations 
with  gradual  improvement.  In  six  weeks  was 
symptom  free  and  sigmoidoscopy  revealed  mere- 
ly a granular,  moderately  inflamed  membrane. 
Since  then  and  up  to  present  time  patient  has 
had  several  acute  exacerbations  of  original  symp- 
toms. One  particularly  acute  flareup  subsided 
rapidly  after  patient  contracted  a severe  case 
of  measles. 

Comment:  This  patient,  in  the  chronic  phase, 
showed  poor  response  to  nisulfazole  treatment. 
Other  types  of  treatment  have  been  uniformly  of 
little  or  only  temporary  value.  It  is  interesting 
to  speculate  the  role  played  by  the  measles  in 
bringing  about  a remission  which  has  lasted  sev- 
eral months.  This  patient  will  eventually  re- 
quire an  ileostomy. 

CASE  6 

February,  1947,  a 59-year-old  white  female 
complained  of  acute  rectal  pain,  bleeding  and 
rectal  discharge.  On  examination  there  was  a 
posterior  fistula  present  with  involvement  of 
major  portion  of  external  sphincter.  There  was 
a purulent  discharge  from  a sinus  tract  and  an 
acute  proctitis  was  present.  Patient  gave  history 
of  “colitis”  since  age  of  20.  Sigmoidoscopy 
showed  a mucus  merribrane  which  was  scarred 
and  granular  but  without  ulceration.  X-ray 
showed  involvement  of  entire  colon  and  terminal 
ileum  with  narrowing  and  scarring.  Impression, 
chronic  ulcerative  colitis. 

In  face  of  the  existing  ulcerative  colitis,  the 
necessary  surgery  was  viewed  with  some  appre- 
hension. Patient  was  placed  on  nisulfazole  in- 
stillations, 2 ounces  four  times  daily  for  several 
days  prior  to  surgery  and  continued  postopera- 
tively.  Patient  convalesced  uneventfully  with 
rapid  healing,  and  no  recurrence  to  date. 

Comment:  Nisulfazole  has  been  used  in  similar 
cases  where  surgery  was  necessary  in  the  face 
of  acute  inflammation,  with  excellent  results.  It 
is  possible  that  nisulfazole  may  prove  to  be  a 
most  useful  adjunct  in  the  surgical  treatment 
of  ano-rectal  pathology  complicating  ulcerative 
colitis. 

Summary 

Despite  the  small  number  of  cases  in 
which  nisulfazole  has  been  used,  a certain 
degree  of  enthusiasm  is  warranted  regarding 
its  efficacy.  It  cannot  be  considered  a cure 
but  its  efficacy  in  controlling  the  active 


746 


stages  of  ulcerative  colitis  is  unquestioned. 
In  my  opinion  nisulfazole  is  of  particular 
value  in  those  cases  where  all,  or  most,  of 
the  involvement  is  confined  to  the  rectum 
and  lower  sigmoid.  Those  that  show  in- 
volvement of  the  entire  colon  and  evidence 
of  chronic  damage  and  polypoid  hyperplasia 
fail  to  show  improvement.  Results  must  be 
considered  conservatively  in  view  of  the 
tendency  for  spontaneous  remission  regard- 
less of  treatment  in  many  cases.  However, 
most  all  of  these  cases  showed  prompt  ex- 
acerbation when  nisulfazole  was  discon- 
tinued temporarily.  There  were  no  toxic  or 
ill-effects  noted  in  any  case  regardless  of 
the  total  amount  of  nisulfazole  suspension 
used  or  length  of  time  employed.  It  appears 
to  be  a valuable  adjunct  to  the  pre-opera- 
tive and  postoperative  care  of  cases  requir- 
ing surgery. 


BRITISH  AMERICAN  EXCHANGE  FELLOW- 
SHIP IN  CANCER  RESEARCH 

During  a visit  of  the  delegation  from  the  Brit- 
ish Empire  Cancer  Campaign  to  the  National 
Office  of  the  American  Cancer  Society  last  sum- 
mer an  international  exchange  of  fellowships  in 
cancer  research  was  arranged.  American  inves- 
tigators in  fundamental  cancer  research  and 
clinical  investigation  in  cancer  will  study  on  a 
fellowship  basis  in  Great  Britain  where  oppor- 
tunities exist  for  study  in  facets  of  research  in 
malignant  disease  not  widely  available  here. 
Provision  has  been  made  for  training  an  equal 
number  of  young  British  scientists  selected  by 
the  campaign  at  research  centers  in  this  country. 

The  Committee  on  Growth  of  the  National  Re- 
search Council  will  screen  applicants  and  will 
recommend  to  the  Cancer  Society  their  selection 
of  candidates  on  application  similar  to  those  fel- 
lowships granted  by  the  Committee  on  Growth. 

Fellowships  are  open  to  citizens  of  the  United 
States  who  possess  the  degree  of  Doctor  of  Med- 
icine, Doctor  of  Philosophy,  or  Doctor  of  Science. 
Applications  should  state  the  institution  where 
the  fellow  plans  to  work  in  Great  Britain;  the 
individual  under  whom  the  fellow  desires  to 
work;  what  problem  he  intends  to  investigate; 
when  he  wishes  to  start. 

Fellowships  will  be  awarded  for  a period  of 
one  year.  The  annual  stipend  will  be  1,000 
pounds  ($4,020).  An  allowance  is  made  for  travel 
to  the  site  of  the  fellowship  in  Great  Britain. 

University  staff  appointment,  with  teaching 
duties  agreeable  to  the  fellow,  is  permitted,  pro- 
vided it  carries  no  additional  salary  and  pro- 
vided it  is  acceptable  to  the  Committee  on 
Growth,  the  American  Cancer  Society,  and  the 
British  Empire  Cancer  Campaign.  No  other  re- 
munerative work  will  be  permitted  during  the 
tenure  of  the  fellowship. 

Application  forms  may  be  procured  from  and 
submitted  at  any  time  to  the  Executive  Secre- 
tary, Committee  on  Growth,  Division  of  Medical 
Sciences,  National  Research  Council,  2101  Con- 
stitution Ave.,  Washington  25,  D.  C. 

Rocky  Mountain  Medical  Journal 


REMOTE  RECORDING  OF  PHYSIOLOGICAL  DATA  BY  RADIO* 

NORMAN  J.  HOLTER,  M.A.,  M.S.,  Helena,  Mont,  and  JOSEPH  A.  GENERELLI,  Ph.D., 

Los  Angeles,  Calif. 


It  is  proposed  to  examine  the  general  sub- 
ject of  the  observation  and  recording  of 
physiological  data  with  a view  towards  ex- 
tending the  usefulness  of  such  data  by  the 
use  of  electronic  technics  which  will  allow 
a subject  more  freedom  of  activity  during 
the  actual  course  of  such  measurements.  A 
human  subject  resting  comfortably  in  a 
chair  or  bed  is  exhibiting  but  one  of  many 
types  of  normal  activity  and  it  is  usually 
only  under  this  condition  that  measure- 
ments of  blood  pressure,  pulse  rate,  cortical 
activity,  blood  oxygen  content  and  a host  of 
other  phenomena  are  made.  The  research 
physiologist  has  occasion  to  inquire  into 
how  various  bodily  functions  are  modified 
by  exercise,  excitement,  emotion  or  other 
activity  which  renders  it  impracticable  to 
limit  the  subject  to  a fixed  resting  position. 
Equipment  has  been  developed  to  dem- 
onstrate the  feasibility  of  transmitting 
physiological  data  by  radio  using  portable 
equipment  attached  to  the  subject  in  such 
a manner  that  he  is  not  restricted  by  such 
attachments  as  power  cord  connections, 
electrode  leads,  etc.  The  equipment  devel- 
oped to  date  is  portable  in  the  scientific 
sense  though  further  electronic  develop- 
ment work  remains  to  be  done  before  it  can 
be  said  to  be  portable  from  the  standpoint 
of  personal  comfort.  No  real  obstacles  are 
foreseen  in  taking  this  next  step;  the  use 
of  sub-miniature  vacuum  tubes  and  so-called 
printed  circuits  will  reduce  the  bulk  of  the 
circuits  to  something  analagous  to  hearing- 
aid  equipment. 

Telemetering 

In  discussing  the  possible  usefulness  of 
the  above  proposal,  it  is  convenient  to  refer 
to  “telemetering,”  a term  widely  used  in  the 
electronics  field.  A ready  definition  is  “a 
means  of  observing  or  recording  data  at  one 
place,  originated  by  phenomena  occurring 

*From  the  Medical  Physics  Laboratory  of  the 
Holter  Re.search  Foundiation,  Inc.,  Helena,  Montana, 
and  the  Department  of  Psychology,  University  of 
California  at  Los  Angeles.  Presented  at  the  annual 
meeting  of  the  Montana  State  Medical  Association, 
Butte,  August  1,  1949. 


at  another  place.”  The  connection  between 
such  places  can  be  by  radio,  wires,  infra- 
red rays,  sound  waves,  or  other  media  for 
transmitting  energy. 

Telemetering  originated  in  those  fields  of 
measurement  where  it  was  practically  the 
only  method  of  obtaining  any  data  at  all, 
whereas  the  present  work  is  concerned  with 
asking  the  question,  “Have  we  anything  to 
gain  by  using  telemetering  in  fields  such  as 
that  of  physiology  where  the  system  being 
studied  can  be  readily  connected  directly  to 
the  measuring  equipment?”  For  example, 
workers  in  cosmic  ray  physics  found  that 
these  ionizing  rays  increased  'in  intensity 
with  an  increase  in  altitude  and  in  order  to 
study  them  at  points  higher  than  mountain 
peaks,  balloons  were  used  to  carry  instru- 
ments to  points  where  humans  could  not 
ascend.  Data  were  broadcast  to  the  ground 
where  a continuous  recording  was  made;  it 
was  not  necessary  to  retrieve  the  instru- 
ments which  were  frequently  never  found 
again.  More  recently,  V-2  rockets  have  pen- 
etrated to  regions  where  many  types  of 
phenomena  have  been  measured  by  tele- 
metering, the  only  means  available.  At- the 
Bikini  atomic  bomb  experiments,  hundreds 
of  measurements  had  to  be  made  at  points 
unsafe  for  observers,  but  telemetering  sup- 
plied the  information  immediately  at  safe 
points  miles  away. 

In  looking  over  any  list  of  physiological 
measurements  one  can  immediately  dis- 
miss many  of  them  as  being  in  a category 
allowing  of  no  advantage  through  tele- 
metering. An  extreme  example  would  be 
that  of  a . person’s  height  or  weight,  data 
normally  independent  of  physical  activity 
at  the  moment.  An  item  like  blood  pressure, 
on  the  other  hand,  cannot  be  so  readily  dis- 
missed. To  the  worker  studying  the  funda- 
mentals of  muscle  potential  generation,  tele- 
metering would  be  essential  when  the  mus- 
cle is  that  of  an  athlete  lifting  weights  or 
climbing  a rope.  Likewise  to  the  neurolo- 
gist who  would  like  to  have  an  electro- 


for  September,  1949 


747 


encephalogram  simultaneously  with  neurol- 
ogical tests  involving  freedom  of  motion  of 
the  subject. 

We  have  selected  various  bioelectric  po- 
tentials for  use  in  exploring  this  general 
idea.  Functions  which  do  not  result  directly 
in  generating  electricity  can  usually  be 
made  to  result  in  an  electrical  signal  by  the 
use  of  suitable  pickups  (e.g.,  microphone  for 
detecting  body  sounds) ; our  choice  of  bio- 
electricity was  motivated  more  by  an  inter- 
est in  the  possible  usefulness  of  studying 
cortical  and  muscle  potentials  at  a distance. 

Bioelectric  Potentials 

Perhaps  the  most  familiar  of  these  poten- 
tials is  that  originating  in  working  muscles, 
especially  those  of  the  heart,  used  to  provide 
the  signals  for  an  electrocardiogram.  Tele- 
metering of  heart  muscle  potentials  under 
conditions  of  physical  activity  is  of  course 
handicapped  by  the  presence  of  other  mus- 
cle potentials  and  may  not  be  of  practical 
value,  although  there  is  some  evidence  that 
a “radiocardiogram”*  can  be  properly  inter- 
preted in  the  presence  of  certain  other  mus- 
cle activity. 

Potentials  existing  between  points  of  the 
brain  cortex  are  of  considerably  less  magni- 
tude (10-50  millionths  of  a volt)  than  those 
generated  by  muscle  and  this  is  another 
reason  for  using  them  in  most  of  this  work. 
The  electronic  problems  are  greater  with 
smaller  voltages,  hence  in  demonstrating 
the  feasibility  of  broadcasting  brain  poten- 
tials, it  follows  that  such  is  also  possible  for 
other  physiological  functions  which  gener- 
ate directly  or  can  be  converted  to  voltages 
in  excess  of  those  of  the  brain  (e.g.,  blood 
oxygen  content  measurable  by  an  oximeter, 
a photo-electric  pickup  unit  attached  to  the 
ear  lobe) . The  name  radio-electroencephalo- 
graph (REEG  or  REG)  is  proposed  for  the 
instrument  carried  by  a subject  to  broad- 
cast “brain  waves.” 

*This  might  better  be  termed  a radioelectrocardio- 
gram (RE'KG)  to  avoid  confusion  with  the  record  of 
the  change  of  electric  impedance  of  the  body  result- 
ing from  pulsatile  volume  changes  at  each  heart 
beat.  Thi.s  latter  has  been  called  a radiocardiogram 
because  of  the  use  of  radio  frequency  electricity  in 
making  the  record,  but  we  suggest  that  the  prefix 
"radio”  is  more  properly  used  when  referring  to 
wireless  transmission  than  when  referring  to  a par- 
ticular frequency. 


A less  familiar  bioelectric  potential  is  the 
non-alternating  voltage  existing  for  exam- 
ple at  a given  moment  between  the  two 
index  fingers  in  the  human,  which  potential 
varies  with  the  menstrual  cycle  in  the  fe- 
male. More  recently  Burr  of  Yale,  continu- 
ing this  work,  has  found  a steady  potential 
difference  between  cancer  of  the  cervix  and 
surrounding  normal  tissue.  Off  hand,  one 
sees  no  practical  advantage  in  telemetering 
such  data  although  it  remains  to  be  seen 
whether  such  effects  have  any  dependence 
upon  locomotion. 

Equipment 

The  equipment  is  not  yet  refined  beyond 
the  point  necessary  to  demonstrate  the 
workability  of  the  basic  idea.  Many  obvious 
improvements  have  been  postponed  as  being 
non-essential  at  this  stage  of  development. 
Standard  electrodes  are  applied  to  the  scalp 
or  chosen  region  of  muscle  and  lead  to  a 
battery-operated  amplifier  carried  on  the 
back.  The  amplifier  increases  the  signal 
strength  more  than  one  million  times  in  the 
case  of  cortical  potentials.  All  leads  are 
soldered,  there  being  no  contact  type  con- 
nections such  as  sockets  or  jacks.  The  am- 
plifier has  four  stages  of  vacuum  tubes  and 
terminates  in  an  amplitude  modulated  radio 
frequency  stage  broadcasting  at  about  50 
million  cycles.  At  this  frequency  no  diffi- 
culty has  been  observed  with  standing  wave 
interference  as  the  subject  moves  about  the 
room.  The  receiver  is  a converted  war  sur- 
plus aircraft  type  terminated  with  a nine- 
inch  high  persistence  cathode  ray  screen.  A 
motor  driven  mechanical  system  sweeps  the 
light  spot  horizontally  on  the  screen  at  a 
rate  convenient  for  resolving  the  waves  be- 
ing studied.  For  the  alpha  waves  (approxi- 
mately ten  per  second)  from  the  occipital 
area  of  the  cortex,  the  spot  takes  a little 
over  a second  to  traverse  the  screen  and 
leaves  a wave  record  which  persists  until 
the  next  sweep.  Thus  groups  of  waves  are 
under  continuous  observation;  permanent 
tape  records  could  be  made  at  this  point  al- 
though a camera  has  been  used  to  obtain 
the  present  records  directly  from  the  screen. 
Details  of  the  electronic  equipment  will  be 
published  elsewhere. 


748 


Rocky  Mountain  Medical  Journal 


Results 


Results  to  date  are  typified  by  Figs.  1-a 
and  1-b,  which  also  demonstrate  the  general 
idea  itself.  The  screen  of  the  cathode  ray 
tube  is  seen  at  the  left  with  a nearby  sub- 
ject actively  cycling  (rear  wheel  off  the 
floor) . The  power  source  is  suspended  from 
the  front  of  the  shoulder  straps.  Also  seen 
are  the  scalp  electrode  leads,  the  top  of  the 
amplifying  and  broadcasting  equipment,  and 
the  transmitting  and  receiving  antennae. 
On  the  screen  in  Fig.  1-a  can  be  seen  the 
alpha  waves  characteristic  of  the  occipital 
area  of  the  cortex  when  the  eyes  are  closed. 
(The  spot  in  the  center  of  the  screen  is  a 
reflection  of  a light  used  in  taking  the  pho- 
tograph). In  Fig.  1-b*  the  subject  has 
opened  his  eyes  with  consequent  typical 
“flattening  out”  of  the  alpha  waves. 


Fig.  1-a.  Cortical  potentials  from  the  occipital  area 
being  broadcast  from  a cycling  subject.  Typical 
alpha  waves  can  be  seen  on  the  screen  of  the 
cathode  ray  tube.  Eyes  closed. 

In  tests  where  the  subject’s  eyes  were  not 
visible  to  a group  of  screen  observers  it  was 
possible,  by  observing  a few  sweeps  of  the 
light  spot,  to  correctly  say  whether  the  sub- 
ject’s eyes  were  open  or  closed  (119  out  of 
120  trials;  one  failure  due  to  an  observer  not 
paying  attention) . Thus  the  information 
contained  in  these  brain  waves  has  been 

*Of  incidental  interest  is  the  method  by  which 
these  photographs  were  taken.  The  signal  on  the 
screen  was  taken  by  opening-  the  lens  for  one  sweep 
with  the  room  dark  and  just  as  the  sweep  was  com- 
pleted, the  subject  was  taken  by  flash.  For  the  eyes- 
open  photograph  and  with  the  room  dark,  the  sub- 
ject stared  at  a light  in  another  room  in  order  to 
provide  enough  “attention”  to  suppress  the  alpha 
waves. 


Fig.  1-b.  Same  as  Fig.  1-a  but  with  the  subject’s 
eyes  open.  Note  the  typical  “flattening  out”  of  the 
alpha  waves. 

telemetered  with  sufficient  fidelity  for 
many  purposes. 

Another  test  was  made  by  recording  the 
brain  signals  on  tape  at  the  point  of  origin 
and  comparing  them  with  the  signal  after 
broadcasting  and  presentation  on  the  screen. 
Fig.  2 shows  an  enlarged  portion  of  the  tape 
record  in  juxtaposition  with  a simultaneous 
photograph  of  the  cathode  ray  screen.  The 
general  equivalence  is  apparent,  although 
a small  amount  of  interference  from  a neon 
sign  is  present  on  the  lower  trace.  (The  lab- 
oratory is  located  in  the  center  of  the  busi- 
ness district  with  consequent  intermittent 
interference  from  signs,  elevators,  etc.;  in- 
strumental sources  of  60  cycle  troubles  have 
been  eliminated.)  Figs.  3-a  and  3-b  are  close- 
up  photographs  of  the  receiver  screen  show- 
ing brain  waves  with  a subject  cycling  and 
with  eyes  closed  and  open  respectively. 


Fig.  2.  Comparison  of  enlarged  record  of  brain  wave 
tape  recording  at  source,  with  photograph  of  same 
signal  after  broadcasting  and  photography  of 
cathode  ray  screen.  Upper  trace  is  tape  record'  at 
source. 


for  September,  1949 


749 


Fig.  3-a.  Close-up  of  transmitted  alpha  waves,  sub- 
ject cycling  with  eyes  closed.  We  have  given  the 
name  "re dio-electroencephalogram"  (REG)  to  such 
records. 


Fig.  3-b.  Same  as  Fig.  3-a  but  with  eyes  open. 


Figs.  4-a  and  4-b  are  typical  records  of 
potential  variations  between  points  on  the 
biceps.  In  these  examples  the  subject  was 
lifting  weights,  under  different  conditions, 
with  flexure  of  the  elbow;  Fig.  4-a,  left, 
shows  the  trace  before  starting  to  use  the 
muscle. 


Fig.  4-a.  Transmitted  muscle  potentials. 


Fig.  4-b.  Transmitted  muscle  potentials,  biceps,  sub- 
ject lifting  weight. 


Fig.  5 is  a “radiocardiogram”  using  a rest- 
ing subject.  No  particular  attempt  has  been 
made  here  to  adjust  the  base-line  or  to  pro- 
vide the  timing  marks  ordinarily  needed  in 
clinical  practice.  A simple  grid  overlay 
would  provide  the  latter.  As  discussed  pre- 
viously, further  work  remains  to  be  done 
in  order  to  evaluate -the  feasibility  of  “radio- 
cardiography” during  physical  activity. 


Fig.  5.  “Radiocardiogram.”  See  text. 


Discussion 

A cursory  listing  of  various  phenomena 
which  might  merit  examination  by  this 
technic  includes  such  diverse  items  as  pain 
threshold,  measurable  by  a quantitative 
heat  source  together  with  subjective  re- 
sponse; blood  circulation,  measurable  with 
an  electromagnetic  flowmeter  without  hav- 
ing to  open  the  blood  vessel;  temperature, 
and  others  in  addition  to  those  mentioned 
in  the  introduction.  The  necessary  modifi- 
cation of  appropriate  present  instruments 
to  allow  broadcasting  would  usually  be  a 
routine  matter  for  a good  electronics  en- 
gineer so  that  one  need  not  consider  each 
separate  case  as  having  to  be  a full  scale 
research  project.  In  general,  interest,  funds, 
and  time  would  be  all  that  is  required  to 
develop  additional  instruments  in  this  field. 

Telemetering  need  not  necessarily  be  over 
any  great  distance  to  be  useful,  nor  must 
radio  transmission  be  used.  For  example, 
the  nature  of  cortical  potentials  for  some 
epileptics  is  such,  and  electronic  methods 
are  such,  that  it  is  not  unreasonable  to  pro- 
pose an  “epilepsy  alarm,”  an  instrument  to 
be  carried  in  the  pocket  and  attached  to 
scalp  electrodes,  such  instrument  to  sound 
an  alarm  to  the  bearer  shortly  before  an 
epileptic  seizure.  This  would  involve  tele- 
metering combined  with  electronic  filters  to 
detect  the  change  of  brain  wave  frequency 
just  preceding  certain  attacks.  Other  possi- 
bilities should  occur  to  anyone  taking  part 
in  developments  along  the  lines  suggested. 

Summary 

It  is  proposed  that  telemetering  technics 
be  applied  to  instrumentation  in  the  field  of 
physiological  measurements  in  those  cases 
where  physiological  function  is  modified  by 
physical  activity.  As. an  illustration  of  this 


750 


Rocky  Mountain  Medical  Journal 


concept,  the  radio  - electroencephalograph 
(REG)  has  been  developed  and  shown  to  be 
feasible.  Suggestions  have  been  made  for 
further  developments  which  might  lead  to 
new  and  useful  tools  for  the  research  work- 
er and  clinician. 

Particular  thanks  are  due  Mr.  Wilford  R. 
Glasscock  and  Mr.  Reynold  A.  Shunk,  physi- 
cists in  the  Helena  laboratory,  for  their  tire- 
less efforts  and  invaluable  technical  assist- 
ance. We  also  wish  to  thank  the  Great  Falls 
Clinic  for  the  loan  of  some  equipment,  John 
Collins  and  Eleanor  Holter  for  miscellaneous 
assistance,  and  numerous  Helena  people 
who  undertook  the  tedious  task  of  acting  as 
subjects.  This  project  was  supported  finan- 
cially by  the  Holter  Research  Foundation,  a 
non-profit  Montana  corporation. 


Case  Report 


ACUTE  DIFFUSE  INTERSTITIAL 
FIBROSIS  OF  THE  LUNG 

J.  A.  WEAVER,  JR.,  M.D. 

GREELEY,  COLORADO 

A very  unusual  and  confusing  case  was 
referred  for  care  to  the  Weld  County  Hos- 
pital, presenting  bizarre  and  conflicting 
symptoms  of  lung  and/ or  cardiac  pathology. 
Three  physicians  from  three  different  com- 
munities of  Colorado  had  examined  the  pa- 
tient just  prior  to  admission.  These  exam- 
inations had  resulted  in  three  different 
diagnoses.  Each  of  the  treatments  insti- 
tuted had  given  no  relief.  The  man  ap- 
peared to  be  in  extremus  when  first  seen, 
yet  lived  almost  two  months. 

After  autopsy  and  investigation  it  became 
clear  that  the  clinical  and  pathological 
characteristics  of  the  case  were  extremely 
similar  to  a condition  described  by  Hamman 
and  Rich^  as  Acute  Diffuse  Interstitial  Fi- 
brosis of  the  Lung.  Very  few  of  these 
cases  have  been  described  in  literature. 
Therefore,  due  to  the  rarity  of  this  disease, 
an  additional  case  is  reported. 

CASE  REPORT 

Mr.  G.  H.  B.  was  admitted  to  the  hospital  July 
8,  1947,  complaining  of  severe  dyspnea,  persistent 
cough,  distressing  expectoration  of  tenacious  mu- 
cous, fatigue,  loss  of  appetite  and  palpitation 


and  pain  around  the  heart.  He  was  a married 
man,  72  years  of  age,  and  a farmer  by  occupa- 
tion. The  past  history  revealed  his  farming  had 
always  been  in  a moist  climate  (Missouri)  except 
for  two  years  spent  in  the  dust  bowl  nine  years 
previously.  He  had  never  been  a miner  or  a 
quarry  worker.  He  had  syphilis  twenty  years 
previously,  but  took  treatments  for  two  years 
and  was  pronounced  cured.  There  was  no  his- 
tory of  pneumonia  or  tuberculosis,  but  he  had 
had  frequent  attacks  of  grippe  or  flu. 

Approximately  five  months  previous  to  ad- 
mission to  the  hospital,  while  on  his  farm  in  the 
Ozark  Mountains,  he  began  to  develop  a cough 
which  gradually  became  a little  worse.  At  first 
he  expectorated  small  amounts  of  yellowish 
liquid  which  gradually  became  thicker  and  more 
productive.  Three  weeks  previous  to  admission  he 
started  on  a trip  to  Colorado.  Reaching  southern 
Colorado  he  became  dyspneic,  the  sputum  and 
cough  increased,  and  he  stopped  for  medical 
advice  and  rest.  The  physician  diagnosed  his 
condition  as  myocarditis  and  placed  him  on 
digitalis.  His  condition  was  not  improved  and  he 
reached  central  Colorado  where  a second  phy- 
sician believed  he  had  cardiovascular  renal  dis- 
ease, and  gave  him  diuretics  and  expectorants. 
By  the  time  he  reached  northern  Colorado  his 
pulmonary  symptoms  predominated  and  he  was 
referred  to  the  hospital  with  a diagnosis  of 
pneumonia. 

Examination:  Fairly  well  nourished,  elderly, 
white  male  lying  in  bed  with  a distressing  dysp- 
nea, severe  persistent  productive  cough  and 
marked  cyanosis.  He  appeared  almost  as  com- 
fortable flat  as  he  did  in  a semi-Fowler’s  posi- 
tion. Temperature  was  98  degrees  when  ad- 
mitted and  at  the  first  examination;  pulse,  90; 
respiration,  38;  blood  pressure,  136/96.  Pupils 
reacted ' sluggishly  to  light  and  accommodation. 
His  teeth  were  poor,  gums  spongy,  mucous 
membrane  had  a fairly  good  color.  There  was 
moderate  congestion  of  the  posterior  pharyngeal 
wall.  The  cough  recurred  constantly.  The  neck 
was  negative  to  palpation,  but  the  neck  veins 
were  quite  prominent.  The  chest  was  dull  to 
percussion  over  both  lungs  posterially,  and  a few 
rales  wefe  heard  over  the  bases.  The  findings 
did  not  seem  compatible  with  the  severe  dyspnea 
and  cyanosis.  'The  expiration  phase  seemed 
slightly  prolonged.  Excursion  was  equal  but 
increased.  The  heart  did  not  seem  to  be  grossly 
enlarged.  The  apex  beat  was  in  the  fifth  inter- 
space and  to  the  left  of  the  mid-clavicular  line. 
The  pulsations  seemed  unusually  strong  over  the 
apex.  No  murmur  was  heard,  but  a faint  rough- 
ening of  the  systolic  sound  was  detected  at  the 
apex. 

The  abdomen  was  negative  to  palpation  for 
tenderness,  distention,  or  masses.  The  liver  was 
one  finger  breadth  below  the  costal  margin.  The 
extremities  appeared  slightly  cyanotic  and  cold. 
No  clubbing  of  the  fingers  was  present.  The 
genitalia  were  negative.  Neurological  examina- 
tion was  essentially  normal. 

Laboratory  data:  The  Wasserman  test  was 
negative.  Urine,  1,021;  albumen,  sugar  and  ace- 
tone were  all  negative.  The  microscopic  exam- 
ination was  negative  for  pus  or  red  cells;  there 
were  no  casts.  The  red  cell  count  was  4,700,000 
and  the  hemoglobin  was  105  per  cent.  The 
white  count  was  11,450  with  a Shilling  index 
showing  one  baseophile,  3 eosinophils,  76  seg- 
mentals,  16  lymphocytes  and  2 monocytes. 
Sputum  examination:  The  smear  disclosed  mixed 
bacterial  flora,  including  a gram  positive  diplo- 
coccus.  The  cultures  were  negative  for  acid  fast 
bacilli.  No  growth  of  fungi  developed  on  Sabour- 


for  September,  1949 


751 


aud’s  agar.  Additional  cultures  gave  the  same 
negative  findings.  No  stool  or  blood  culture  was 
done.  The  spinal  fluid  was  entirely  negative. 
Tuberculin  test  was  negative.  X-ray  films  of  the 
chest  disclosed  extensive  mottling  throughout  all 
lobes  of  both  lungs,  resembling  closely  a miliary 
tuberculosis.  The  mottling  seemed  equally  dense 
in  each  lung  field.  The  roentgenologist’s  original 
report  was  indecisive,  suggesting  (1)  silicosis,  (2) 
fungus  infection,  (3)  syphilitic  paribronchitis,  and 
(4)  a bizarre  fibrosis  from  passive  congestion. 
The  second  and  third  films  taken  at  weekly  in- 
tervals gave  these  additional  possibilities;  (1) 
Bi-lateral  broncho-pneumonia,  (2)  periarteritis 
nodosa,  (3)  Boeck’s  sarcoid.  Iodides  were  sug- 
gested as  a therapeutic  test  for  mycosis.  Three 
additional  films  showed  almost  no  change  in  the 
x-ray  picture.  The  cardiac  silhouette  was  en- 
larged slightly  to  the  right  and  left.  The  electro- 
cardiogram showed  right  axis  deviation  and 
slight  arrhythmia.  No  evidence  of  infarction  or 
coronary  disease. 

Hospital  course:  The  patient  was  placed  in  an 
oxygen  tent  immediately  upon  admission,  which 
seemed  to  relieve  his  severe  dyspnea,  but  cyano- 
sis remained.  His  temperature  was  98  degrees 
at  this  time  and  at  no  time  did  it  rise  above 
100.8  rectally.  For  the  most  part  the  temperature 
remained  subnormal,  extending  down  to  as  low 
as  96.4  degrees.  The  pulse  at  first  remained 
relatively  normal  and  stable  (68  to  90)  but  later 
in  the  course  of  his  hospitalization  it  became 
extremely  erratic,  ranging  from  60  to  120.  Respira- 
tions were  generally  rapid,  averaging  about  36 
to  40  per  minute.  However,  here  again  early, 
the  respirations  were  from  20  to  24  but  soon 
became  much  more  rapid.  It  was  noted  that 
removal  from  the  oxygen  tent  did  not  materially 
increase  respiratory  rate,  although  the  patient 
generally  seemed  more  comfortable  when  in  the 
tent.  The  blood  pressure  continued  within  nor- 
mal range  at  all  times  recorded.  The  patient 
complained  frequently  of  severe  cramping  pains 
in  both  legs,  and  also  often  requested  a hot 
water  bottle  due  to  coldness  of  the  lower  ex- 
tremities. Nausea  was  a common  complaint  and 
his  appetite  was  poor  at  all  times.  The  most 
distressing  symptom  was  a constant  productive 
cough  with  large  amoimts  of  yellowish-white, 
rather  tenacious  sputum.  A few  rales  heard  in 
the  bases  disappeared,  but  both  lungs  posterially 
remained  slightly  dull  to  percussion.  It  was  felt 
that  this  was  due  to  intertitial  edema  from  par- 
tial decompensation.  No  peripheral  edema  de- 
veloped, however. 

Due  to  the  uncertainty  of  diagnosis  and  to  the 
belief  that  this  condition  might  be  infectious  or 
fungoid  in  nature,  various  antibiotics  were  given 
in  large  doses  at  first.  Penicillin  and  streptomy- 
cin were  alternated.  Aerosol  inhalations  were 
used.  Large  doses  of  potassium  iodide  were  given 
and  were  well  tolerated.  Often  following  a new 
treatment,  the  patient  seemed  to  respond  but 
would  soon  regress.  Eventually  all  medicine  was 
discontinued  except  supportive  measures  for  his 
heart. 

The  patient  often  complained  of  precordial 
distress,  and  aminophyllin,  gr.  3 q.i.d.,  improved 
this  condition,  but  did  not  relieve  it  completely. 
Crystodigen,  0.2  mg.,  was  given  daily  throughout 
the  hospitalization.  On  September  1,  1947,  he 
complained  of  “fullness  in  the  lungs,”  increased 
dyspnea,  and  stated  that  “he  could  not  live  long 
this  way.”  However,  he  was  able  to  sit  on  the 
edge  of  the  bed  to  void.  He  suddenly  complained 
of  extreme  dyspnea,  developed  marked  air  hun- 
ger, and  died  very  shortly,  becoming  pulseless 
previous  to  respiratory  cessation. 


Autopsy:  The  pleural  cavity  contained  a few 
c.c.  of  slightly  bloody  fluid.  There  were  no  ad- 
hesions. Grossly,  the  lungs  were  fairly  heavy. 
The  surfaces  were  slightly  nodular  and  generally 
alike.  The  lungs  were  rubbery  and  nodular  by 
palpation.  On  the  pleural  surfaces  there  were 
numerous  slight  grayish  areas  about  1 to  2 mm., 
some  of  which  suggested  fibrous  or  necrotic  sub- 
pleural  areas.  The  bronchi  and  blood  vessels 
throughout  were  normal.  The  cut  surfaces  of 
both  lungs  were  markedly  fibrotic,  particularly 
in  the  posterior  two-thirds  of  the  lobes,  and  still 
more  specifically,  the  greatest  change  was  in 
each  upper  lobe,  although  not  specifically  in  the 
apecies.  The  fibrous  tissue  was  light  gray,  and 
arranged  irregularly,  and  in  many  places  it  was 
diffuse  with  only  small  areas  of  emphysematous 
lung  tissue  intermixed.  There  were  no  areas  of 
caseation  or  other  abnormal  changes.  Very  little 
edema  was  present.  The  anterior  area  of  each 
lung  showed  much  fibrous  tissue,  but  was  better 
aerated. 

Microsopically  the  sections  of  lung  showed 
widespread  fibrous  tissue  proliferation  most  con- 
centrated about  the  bronchioles  and  small  bron- 
chi. The  fibrous  tissue  had  no  specific  arrange- 
ment. No  granuloma  were  present.  In  some 
portions  of  the  lung  the  fibrosing  process  was 
diffuse  while  in  others  it  was  restricted  to  the 
alveolar  walls  which  were  often  thickened  two 
to  three  times  that  of  normal  by  fibroblasts  and 
fibrocytes.  In  the  more  diffusely  fibrous  areas 
the  cells  were  predominately  of  fibroblastic 
type.  Almost  none  was  present  in  the  bronchi- 
olar  epithelium.  Lymphocytic  infiltration  was 
present  in  various  degrees  and  an  occasional 
eosinophil  was  present  in  the  interstitial  tissues. 
Numerous  capillaries  were  found  throughout  the 
areas  of  fibrosis,  but  only  rarely  was  there 
thickening  of  these  blood  vessel  walls.  The  bron- 
cheal  walls  did  not  show  any  unusual  amount  of 
cellular  infiltration,  and  the  lumina  often  con- 
tained homogeneous  protein  precipitate,  with 
scattered  macrophages  and  a few  polymorphonu- 
clears.  The  broncheal  epithelium  was  desqua- 
mated in  most  instances.  In  several  of  the 
smaller  bronchioles,  there  were  one  or  more 
foreign  body  giant  cells,  a few  of  them  contain- 
ing a slit  characteristic  of  lipoid  crystalline  ma- 
terial. Special  stain  reveals  a few  fat  laden 
macrophages  in  the  lumina  of  the  bronchioles. 
A few  such  cells  were  found  in  the  alveoli.  No- 
where else,  however,  did  fibrous  tissue  contain* 
fatty  material.  Acid  fast  bacteria  and  fungi 
failed  to  be  demonstrated. 

The  fibrous  tissue  proliferation  was  not  char- 
acteristic of  any  definite  etiological  agent.  There 
was  no  whorling  or  hyalinization  of  fibrous  tis- 
sue, and  no  local  concentration  of  an  anthrocotic 
pigment.  Absence  of  granuloma  excluded  the 
likelihood  of  fungi,  syphilis,  tuberculosis  or  fat 
as  a causative  agent.  These  diffuse  fibrotic 
changes  in  the  lungs  with  an  increase  of  fi- 
brous tissue  in  the  septa  and  alveolar  walls  is 
almost  identical  to  the  cases  described  by  Ham- 
man  and  Rich  in  1944  and  Eder,  et  aP.,  in  1945. 

The  heart,  likewise,  was  similar  to  these  cases 
reported.  The  empty  heart  weighed  about  360 
grams.  Right  and  left  ventricle  were  moderately 
dilated.  All  of  the  myocardium  was  flabby.  The 
left  auricle  was  moderately  dilated.  No  abnor- 
mality of  the  cardiac  valves  was  present.  No 
fibrosis  of  the  myocardium.  The  wall  of  the  right 
ventricle  was  almost  twice  its  normal  thickness 
(8  mm.).  The  left  ventricular  wall  was  12  to  16 
mm.  thick  and  the  interventricular  septum  12 
mm.  Only  a slight  degree  of  atherosclerosis  of 
the  coronary  vessels  was  present  with  moderate 


752 


Rocky  Mountain  Medical  Journal 


narrowing  of  the  anterior  descending  branch. 
■ITiere  was,  however,  no  thrombosis  or  other 
acute  change.  No  significant  abnormality  was 
found  microscopically.  A few  lymphocytes  were 
found  in  the  sub-epicardial  fat,  which  was  con- 
sidered of  no  importance.  All  other  organs  were 
essentially  negative.  No  infarcts  were  found  in 
the  liver,  spleen,  or  pancreas. 

Discussion 

The  case  presented  showed  the  typical 
evidence  of  advanced  pulmonary  disease, 
characteristic  of  all  cases  previously  re- 
ported, with  increasing  right  heart  embar- 
rassment and  eventual  failure.  The  most 
distressing  symptoms  of  cough  and  dyspnea 
are  a constant  sign  in  all  cases.  One  of  the 
most  striking  conditions  noted  was  the  al- 
most total  lack  of  physical  pulmonary  evi- 
dence in  spite  of  the  extensive  fibrosis  in 
the  lungs.  Only  early  in  the  hospital  course 
were  rales  in  evidence,  although  slight  dull- 
ness persisted  posterially  throughout.  These 
contradictory  findings,  of  marked  x-ray  and 
laboratory  evidence  of  pathology,  and  a min- 
imum of  physical  evidence,  combine  to  give 
this  disease  a very  puzzling  clinical  picture. 
No  friction  rub  developed  in  this  case  and 
there  was  no  ascites  or  peripheral  edema. 
Apparently,  interstitial  edema  of  the  lungs 
was  absent,  or  very  slight. 

The  clinical  course  of  the  case  reports  ex- 
amined lasted  from  four  to  twenty-four 
weeks.  This  case  survived  approximately 
twenty  weeks  from  the  time  the  first  symp- 
tom began.  The  question  arises  as  to  how 
long  this  fibrosis  is  in  actual  existence  be- 
fore the  onset  of  symptoms  and  whether 
the  condition  is  actually  acute  or  one  of 
chronic  nature.  The  diffuse  nature  and  the 
extensive  fibrosis  would  point  to  a rather 
prolonged  and  chronic  condition.  Contrari- 
wise, the  presence  of  fibroblasts  would  in- 
dicate an  acute  or  active  pathological  proc- 
ess. Actually,  however,  depending  upon 
the  length  of  survival,  both  conditions  do 
exist  pathologically.  Certainly,  it  is  a rapid- 
ly progressive  disease.  Some  similarity  ex- 
ists in  the  fact  that  three  of  the  four  cases 
described  by  Hamman  and  Rich  had  syph- 
ilis and  had  been  treated  with  arsenic  and 
bismuth.  The  fourth  case  had  no  Wasser- 
man  report  and  no  venereal  history  was 
given.  The  case  of  Eder’s  had  gonorrhea. 
The  case  herein  reported  had  syphilis  with 


treatment  by  arsenic  and  bismuth.  The 
Germans,  Belt  and  Doenecke'*,  believed  a 
case  of  theirs  was  the  result  of  exposure 
for  two  years  to  another  heavy  metal,  ra- 
dium. 

The  autopsy  findings  of  the  lungs  of  the 
cases  reviewed  appear,  with  minor  excep- 
tions, to  be  extremely  similar  to  this  case. 
The  outstanding  similarity  was  the  marked 
interstitial  proliferation  of  fibrous  tissue 
throughout  all  lobes  of  both  lungs  with 
proliferation  and  thickening  of  the  alveolar 
walls.  Absence  of  demonstrable  bacteria 
throughout  pulmonary  tissue  is  common  in 
all  cases,  except  where  a terminal  broncho- 
pneumonia intervened. 

The  origin  of  this  condition  is  obscure  but 
there  is  some  evidence  to  support  a theory 
that  a virus  may  be  the  etiological  factor. 
Kneeland  and  Smetana®  in  1940  described 
several  cases  of  broncho-pneumonia  of  un- 
usual character  and  undetermined  etiology, 
which  had  a possible  virus  background. 
Their  Case  No.  9 corresponded  closely  to  the 
above  described  cases.  Dr.  Milton  C.  Win- 
ternitz  stated  that  the  changes  found  in  the 
lungs  “bear  a striking  resemblance  to  those 
found  in  the  lungs  of  animals  during  my 
experimental  investigations  on  influenzal 
pneumonia.” 

Although  the  end  result  is  similar,  this 
condition  is  not  to  be  confused  with  “Lung 
Failure”  which  was  presented  in  St.  Louis 
by  Dr.  J.  D.  Adamson^  of  the  University  of 
Manitoba.  This  latter  condition  is  a gradual 
failure  of  pulmonary  elasticity  as  age  ad- 
vances, with  a complicating  interstitial 
edema,  slowly  progressive  emphysema,  etc. 
The  resultant  right  heart  failure  is  similar 
to  that  seen  in  fibrosis  of  the  lung. 

Summary 

Points  of  similarity  to  one  or  more  cases 
previously  reported  include: 

A.  Clinically. 

1.  A progressive  and  rapidly  fatal  clinical 
and  pathological  ejitity. 

2.  A clouded  clinical  picture  with  first 
pulmonary  and  then  cardiac  symptoms  pre- 
dominating. Hamman  and  Rich  point  out 
several  times  the  confusion  in  the  minds  of 
the  clinicians  viewing  their  early  cases. 


for  September,  1949 


753 


3.  Severe  dyspnea  and  cyanosis. 

4.  Persistent  productive  and  distressing 
cough. 

5.  X-rays  resembling  miliary  tuberculosis. 

6.  Increasing  cardiac  distress  without 
marked  cardiac  pathology. 

7.  Absence  of  sufficient  pulmonary  phy- 
sical findings  to  account  for  the  extensive 
x-ray  evidence. 

8.  Probably  unimportant,  but  interesting, 
four  of  six  patients  with  history  of  syphilis 
and  earlier  treatment. 

9.  Cramping  and  cold  lower  extremities. 

10.  Prominent  neck  veins. 

Negative  findings  in  this  case  include  no 
clubbing  of  fingers,  no  ascites,  negative 
sputum  culture. 

B.  Pathologically. 

1.  The  extensive,  diffuse,  progressive  in- 
terstitial proliferation  of  fibrous  tissue 
throughout  all  lobes  of  both  lungs. 

2.  Slight  necrosis  of  alveolar  epithelium. 

3.  Marked  thickening  of  the  alveolar 
walls. 

4.  Absence  of  stainable  bacteria. 

5.  Presence  of  eosinophiles  in  interstitial 
tissue. 

Negative  findings:  No  hyalinization  and 
relatively  little  edema.  Very  little  thicken- 
ing of  alveolar  lining  epithelial  cells. 

ItEPER.E.NCBiS 

'Hammar,  Louis,  and  Rich,  Arnold  R. : Bull.  Johns 
Hopkins  Hospital,  Vol.  74,  1944,  pp.  177-228. 

^Eder,  Howard,  et  al.:  Bull.  Johns  Hopkins  Hospi- 
tal, Vol.  76,  1945,  pp.  163-177. 

®Belt  a,nd  Doencke;  Frank.  Ztsch.  Fur  Path.,  1931, 
42:170.  Case  of  fibrosis  following  radium  exposure. 

’Adamson,  J.  D. : University  of  Manitoba.  Lecture 
on  “Lung  Failure.”  St.  Louis,  194  7.  Paper  to  be  pub- 
lished shortly. 

®Kneeland,  Y.,  Jr.,  and  Smptana,  H.  F. : Current 
broncho-pneumonia  of  unusual  character,  undeter- 
mined etiology.  Bull.  Johns  Hopkins  Hospital,  1940, 
67:229. 


HOUSE  OF  DELEGATES  MEETINGS 

Meetings  of  the  all-important  House  of  Dele- 
gates have  been  scheduled  this  September  sim- 
ilarly to  the  successful  schedule  adopted  first  in 
1947  and  followed  again  in  1948.  The  busiest  day 
will  be  Tuesday,  September  20,  but  there  is 
ample  time  set  aside  on  following  days  for  the 
necessary  follow-up  meetings. 

In  the  final  program  a list  of  all  Delegates  and 
Alternates  who  have  been  certified  to  the  Cre- 
dentials Committee  will  be  published. 


DO  YOU  LIKE  DETAIL  MEN? 

Personally,  we  like  most  “detail  men.”  In  case 
you  haven’t  had  contact  with  one  recently,  may 
we  refresh  your  mind  on  the  subject?  Were  we 
Linnaeus,  we  might  describe  him  thus:  Genus: 
Homo  Sapiens;  Habitat:  Distribution  almost  uni- 
versal, but  becoming  scarcer  in  Middle  West 
due  to  the  draft  and  lack  of  enforcement  of 
game  laws.  (Most  Dox  think  there  is  a perpetual 
open-season  on  these  chaps.)  Description:  A 
hardy  perennial  (Webster’s  definition  of  per- 
ennial: “continuing  or  enduring  through  the 
year  or  many  years.”)  And,  Boy,  does  he  con- 
tinue to  endure  a lot! 

Further  description:  This  sub-order  of  Homo 
Sapiens  not  infrequently  is  married,  and  sires  one 
or  more  detailettes  who  depend  upon  the  parent 
shrub  for  food  and  raiment.  He  has  the  cus- 
tomary complement  of  manual  and  pedal  ap- 
pendages; also,  two  ears;  two  eyes,  two  lungs 
and — believe  it  or  not — a heart. 

Usually  he  is  a gentleman,  which  in  itself  is 
saying  a lot.  Obviously  this  rare  specimen  has 
an  inexhaustible  fund  of  patience,  otherwise  he 
would  not  be  willing  to  cool  his  heels  in  your 
reception  room  for  long  periods  of  time,  await- 
ing your  willingness  and  readiness  to  see  him 
for  five  minutes.  He  knows,  of  course,  that  in 
order  to  impress  him  with  your  importance,  he 
will  have  to  sit  on  his  quadriceps  in  the  outer 
sanctum  until  you  get  darn  good  and  ready  to 
admit  him  to  your  august  presence. 

He  is  a non-poisonous  plant.  Contact  with 
him  engenders  no  long  and  lingering  ailment. 
He  may  be  touched  with  impunity.  (In  fact,  we 
have  known  instances  where  he  was  “touched” 
for  several  dollars’  worth  of  valuable  samples, 
simply  for  the  asking.)  He  is  odorless  and  taste- 
less, but  is  not,  as  we  have  implied,  without 
feeling.  He  may  be,  at  his  worst,  the  rambler 
type  of  plant,  in  that  he  rambles  on  past  the 
few  minutes  allotted  to  him,  but  still  he  cannot 
be  classed  with  Rhus  Toxicodendron  or  the  Spiny 
Cactus. 

Often  he  is  addicted  to  tobacco,  but  unless  you 
first  light  a cigarette,  usually  he  will  refrain 
from  doing  so  while  in  your  presence.  He 
knov^s  from  long  and  bitter  experience  that 
while  he  is  non-toxic,  some  Dox  can  be  poisonous 
as  toad  stools^ — especially  to  “detail  men.” 

So,  if  you  see  one  of  those  roving,  self-abneg- 
ative,  hard-working,  patient  and  pleasant  fellows 
beginning  to  take  root  in  your  reception  room, 
for  Heaven’s  sake  have  the  girl  bring  him  in 
before  he  becomes  a permanent  potted  plant 
before  your  very  eyes.  Because  all  of  you  know 
how  much  easier  it  is  to  dispose  of  cut  flowers 
than  a jardiniere  full  of  flowering  hydrangeas. 

But  seriously,  fellows,  let’s  give  these  boys  a 
break.  We  are  busy,  of  course,  but  not  too  busy 
to  spare  a few  minutes  of  our  time  when  it 
easily  might  be  of  mutual  benefit.  Ever  hear 
of  the  Golden  Rule?  Think  it  over  sometime; 
it  will  do  you  good. — New  Orleans  Medical  and 
Surgical  Journal. 


In  the  entire  United  States  about  270,000 
mental  patients  are  coming  back  into  the  com- 
mimity  each  year.  The  spread  of  the  disea^ 
from  those  who  may  have  contracted  tuberculosis 
while  in  mental  hospitals  therefore  becomes  a 
community  problem  which  we  cannot  afford  to 
Ignore. — Robert  J.  Anderson,  M.D.,  Pub.  Health 
Rep.,  Jan.  7,  1949. 


754 


Rocky  Mountain  Medical  Journal 


matri,  fo, 


Principles  ascribed  by  this  author*  to  Metamucil— the^  "smoothage”  management  of  con- 
stipation—are:  - 

. . . demulcent  actimr 
. . . ability  to  absorb  and  hold  water 
. . . nonirritating  to  the  intestinal  mucosa 
. . . providing  a soft  matrix  for  bulk  in  the  stools 

Metamucil  promotes  smooth,  normal  evacuation  by  furnishing  a nonirritating,  water-retain- 
ing  colloidal  residue  in  the  large  bowel. 

Metamucil  is  the  highly  refined  mucilloid  of  Plantago  ovata  (50%),  a seed  of  the 
psyllium  group,  combined  with  dextrose  {50%)  as  a dispersing  agent. 

G.  D.  Searle  8c  Co.,  Chicago  80,  Illinois. 


Metamucil^ 


Searle 

^search  in  the  Service  of  Medicine 


jor  September,  1949 


755 


Orgamzahon 

Nationr.!  Affairs  - Proceedings  - Prograns  - Society  Notices  - News  - Auxiliary 


COLORADO 

State  Medical  Society 

Obituaries 

DAVID  D.  FELD 

Dr.  David  D.  Feld,  medical  director  of  the 
Jewish  Consumptives’  Relief  Society  Sanatorium, 
died  ®n  July  3,  1949,  of  a cardiac  accident  at  the 
age  of  44.  He  had  been  in  Denver  seven  months, 
having  come  here  to  take  the  position  of  medical 
director. 

Born  in  Plymouth,  Wisconsin,  Dr.  Feld  was 
educated  at  Milwaukee  Normal  College  and  the 
Marquette  University  School  of  Medicine.  He  in- 
terned at  Milwaukee  General  Hospital  and  served 
residencies  at  Wisconsin  State  Sanitarium,  J.  N. 
Adams  Memorial  Hospital  at  Perrysburg,  New 
York,  and  the  Iowa  State  Sanitarium  at  Oakdale, 
Iowa. 

Dr.  Feld  was  a fellow  of  the  American  College 
of  Chest  Physiciam  and  a member  of  the  Ameri- 
can Trudeau  Society.  He  had  contributed  gen- 
erously to  the  medical  literature  in  his  field. 


LAWRENCE  A.  HICK 

Dr.  Lawrence  A.  Hick,  a widely  known  Delta, 
Colorado,  physician,  died  on  June  25,  1949,  at 
the  age  of  80. 

Born  on  December  19,  1868,  at  Rensselaer,  New 
York,  Dr.  Hick  received  his  medical  education 
at  the  Omaha  Medical  College,  which  has  since 
become  the  University  of  Nebraska  College  of 
Medicine.  He  came  to  Delta  in  1895  shortly 
after  marrying  Miss  Gertrude  Luce  of  Omaha. 

Dr.  Hick  literally  grew  with  Delta  and  the 
surrounding  valley.  He  started  practice  there 
when  the  population  was  only  700.  A charter 
member  and  the  first  President  of  the  Delta 
Coimty  Medical  Society,  Dr.  Hick  was  a true 
medical  pioneer  in  the  region.  He  was  close 
to  its  people  and  his  death  will  be  keenly  felt 


Environment  is  part  of  the  treatment  of  tu- 
berculosis. It  is  well  established  that  recovery 
from  infection  is  facilitated  by  good  nutrition, 
adequate  sleep,  mental  peace,  and  the  many  in- 
tangible factors  which  may  be  included  in  the 
term  “environment.”  Any  hospital  or  sana- 
torium which  does  not  give  full  cognizance  to 
these  fundamental  physiologic  and  psychoso- 
matic factors  is  not  carrying  out  a complete 
therapeutic  program.  It  may  even  be  delaying 
the  date  of  dismissal  of  patients  and  adding  to 
the  misery  of  patients  and  the  expense  borne 
by  taxpayers.  Money  expended  for  job  training, 
decorations,  music,  and  flowers  may  be  justified 
as  truly  as  money  spent  for  opiates  or  surgical 
treatment. — H.  Corwin  Hinshaw,  M.D.,  Nat.  Tu- 
berc.  A.  Tr. 


SOUTHWESTERN  SURGICAL  CONGRESS 

The  First  Annual  Meeting  of  the  Southwestern 
Surgical  Congress  will  be  held  September  26,  27, 
and  28,  1949.  at  the  Shamrock  Hotel,  Houston, 
Texas.  All  the  doctors  in  the  Rocky  Moimtain 
Region  are  invited  to  attend  this  meeting. 

NEW  MEXICO 

Medical  Society 

ALBUQUERQUE  PLANS  JOINT  MEETING 
IN  NOVEMBER 

The  Southwestern  Medical  Conference  and 
New  Mexico  Division  of  the  American  Cancer 
Society  will  meet  jointly  at  the  Hilton  _ Hotel, 
Albuquerque,  New  Mexico,  November  9,  10,  11 
and  12,  1949.  Members  who  plan  to  attend  are 
urged  to  make  reservations  as  soon  as  possible 
through  Dr.  A.  H.  Follingstad,  care  of  the  Cham- 
ber of  Commerce,  Albuquerque.  Those  whom 
the  hotels  will  be  unable  to  accommodate  are 
assured  of  reservations  in  one  of  Albuquerque’s 
many  excellent  motor  courts.  An  impressive 
list  of  speakers  on  a variety  of  timely  subjects 
includes: 

E.  W.  Pernokis,  Associate  Professor  Medicine, 
University  of  Illinois,  on  Anemias  and  Leukemia. 

Elmer  Belt,  Director  of  Belt  Urologic  Group, 
Los  Angeles,  on  Ureteral  Intestinal  Anastomosis, 
and  Urology  for  the  General  Practitioner. 

Herbert  Willy  Meyer,  Professor  of  Chnical 
Surgery,  Postgraduate  Medical  School,  New  York 
University,  on  Cancer  of  the  Breast,  Diaphrag- 
matic Hernia,  and  Perforation  of  the  G-I  Tract. 

Donald  M.  Pillsbury,  Professor  of  Dermatology 
and  Syphilology,  University  of  Pennsylvania,  on 
Mahgnant  Skin  Lesions,  and  Dermatology  as 
Applied  to  the  G.  P. 

Allan  Butler,  Associate  Professor  Pediatrics, 
Harvard  University,  on  Malignancies  in  Child- 
hood, and  Fever  of  Undetermined  Origin. 

Herbert  F.  Traut,  Professor  of  Obstetrics  and 
Gynecology,  University  of  California  Medical 
School,  on  Use  of  Vaginal  Smear  in  General 
Gynecologic  Diagnosis,  and  Bleeding  in  the  Third 
Stage  of  Labor. 

Otto  C.  Brantigan,  Professor  of  Clinical  Sur- 
gery and  Surgical  Anatomy,  University  of  Mary- 
land, on  Carcinoma  of  Limg,  and  Surgical  Treat- 
ment of  Peptic  Ulcers. 

E.  T.  Bell,  Professor  of  Pathology,  University 
of  Minnesota,  on  Experimental  Production  of 
Carcinoma. 

William  Rettberg,  Associate  Professor  of  Medi- 
cine, University  of  Colorado  School  of  Medicine, 
on  the  Present  Status  of  Antibiotics. 

William  Boyd,  Professor  of  Pathology,  Uni- 
versity of  Toronto,  Canada,  on  a subject  to  be 
announced. 

Kenneth  D.  A.  Allen,  Roentgenologist,  Denver, 
Colorado,  on  a subject  to  be  announced. 

There  will  be  novel  entertainment  for  guests 
and  their  wives.  The  Bernalillo  County  Aux- 
iliary will  entertain  the  ladies  with  a Mexican 


756 


Rocky  Mountain  Medical  Journal 


Just  as  a great  dam  stores  and  releases  water 
only  as  fast  as  the  fertile  lands  below  can  uti- 
lize it,  so  does  Alhydrox*  adsorb  antigens  and 
release  them  slowly  from  tissue  after  injection. 
This  gives  the  effect  of  continuous  small  doses. 

Aiydrox  is  a Cutter  exclusive— developed  and  used 
by  Cutter  for  its  vaccines  and  toxoids.  It  supple- 
ments the  physician’s  skill  by  producing  these 
immunizing  advantages: 

1.  Alhydrox  selectivity  controls  the  absorption 
of  antigens,  reducing  dosage  volume  while 
building  a high  antibody  concentration. 

2.  Alhydrox,  because  of  its  favorable  pH,  lessens 
pain  on  injection  and  reduces  side  reactions  to 
a minimum. 

3.  Alhydrox  adsorbed  antigens  are  released 
slowly  from  tissue,  giving  the  effect  of  small 
repeated  doses. 

* Trade  name  for  Aluminum  Hydroxide  Adsorbed 


Specify  these  Cutter  Alhydrox  Vaccines: 

• Tetanus  Toxoid  Alhydrox 

• Diphtheria  Toxoid  Alhydrox 

• Diptussis  Alhydrox® 

Cufter  Dlphiher’ia  Toxoid  ph$  20,000  milHon  H 
pertussis  per  cc.  for  simultaneous  immunization 
against  pertussis  and  diphtheria 

• Diphtheria  Toxoid-Tetanus  Toxoid  Alhydrox 

For  simultaneous  immunization  against  diphtheria 
and  tetanus 

• Dip- Pert -Tet  Alhydrox** 

Cutter  diphtheria,  pertussis,  tetanus  combined 
vaccine  for  simultaneous  immunization  against 
diphtheria,  pertussis,  tetanus 

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CUTTER  LABORATORIES  • BERKELEY  1 0,  C A L I F. 


CumR 


for  September,  1949 


757 


dinner  and  a tour  of  the  Isleta  Indian  Pueblo,  in 
addition  to  which  a number  of  luncheons  and 
sightseeing  tours  are  being  arranged.  Golf  for 
those  who  desire,  smoker,  round  table  luncheons 
and  the  New  Mexico-Colorado  University  foot- 
ball game  on  Saturday  afternoon  of  the  12th. 
All  in  all,  an  interesting  meeting  is  assured. 

H.  J.  BECK,  M.D.,  Secretary. 

UTAH 

State  Medical  Association 


Obituary 

M.  J.  SEIDNER 
1894-1947 

Dr.  M.  J.  Seidner,  54,  prominent  Ogden  physi- 
cian, died  Wednesday,  June  15,  1949,  at  the 
Mayo  Clinic,  Rochester,  Minnesota. 

Dr.  Seidner  was  born  in  Tomashon,  Russia. 
His  early  education  was  obtained  in  Mannheim, 
Germany.  Coming  to  the  United  States  at  the 
age  of  17,  he  completed  his  preliminary  educa- 
tion in  Chicago  and  was  graduated  from  Loyola 
University  Medical  School  in  1916,  serving  his 
internship  at  the  Thomas  D.  Dee  Memorial 
Hospital  in  Ogden. 

In  the  first  World  War  he  was  first  attached 
to  the  infantry.  In  the  course  of  the  war  he 
received  his  citizenship  papers  and  eventually 
was  transferred  to  the  Medical  Corps,  receiving 
a commission  as  lieutenant.  Hisi  early  medical 
practice  was  done  as  a mining  camp  physician, 
first  in  Rock  Springs,  Wyoming,  and  then  for 
five  years  in  Storrs,  Utah.  He  moved  to  Ogden 
in  1923. 

Dr.  Seidner  was  a member  of  the  American 
Medical  Association,  the  Utah  State  Medical  As- 
sociation and  the  Weber  County  Medical  Society, 
also  Weber  Lodge  No.  6,  A.  F.  and  A.  M.;  Utah 
Consistory,  El  Kalah  Temple,  Ogden  Shrine  Club, 
National  Sojourners,  and  the  Ogden  Golf  and 
Country  Club. 

Dr.  Seidner  is  survived  by  his  wife  and  four 
children. 

COLORADO 

Medical  School  Notes 

SECOND  ANNUAL  POSTGRADUATE  COURSE 
IN  PSYCHOSOMATIC  MEDICINE 

The  Department  of  Psychiatry  of  the  Uni- 
versity of  Colorado  School  of  Medicine  is  spon- 
soring a five-day  postgraduate  course  in  Psycho- 
somatic Medicine  between  September  12  and 
September  16,  1949,  inclusive.  The  course  aims 
to  present  prevalent  points  of  view  regarding 
psychosomatic  disorders,  including  history  tak- 
ing, interviewing  technics,  patient-physician  rela- 
tionships, and  general  principles  of  psychother- 
apy. The  main  content  of  instruction  will  be 
given  in  seminars  based  upon  clinical  examina- 
tion of  selected  patients  from  medical  wards  and 
the  out-patient  clinics  of  the  University  of  Colo- 
rado Medical  Center.  Three  students  will  be 
assigned  to  each  instructor  who  will  be  required 
to  present  their  findings  in  daily  afternoon  semi- 
nars. Dr.  Leo  H.  Bartemeier,  Professor  of 
Psychiatry,  Wayne  University  School  of  Medi- 


cine, will  be  in  daily  attendance  as  guest  in- 
structor. 

The  course  is  open  to  all  doctors  in  medicine 
and  psychiatry,  but  general  practitioners  will  be 
given  preference.  A registration  fee  of  $5.00  is 
charged.  This  is  required  and  is  not  refundable 
if  the  candidate  is  accepted  for  the  course.  Tui- 
tion is  $20.00  payable  at  the  time  of  registration. 


POSTGRADUATE  COURSE:  PROBLEMS  OF 
NEWBORN  INFANTS,  PREMATURE 
AND  FULL  TERM 

Wednesday,  November  2 
MORNING 

8:00-9:00 — Registration. 

9:15-9:45 — Aims  of  the  Colorado  Premature  In- 
fant Program. — Harry  H.  Gordon,  M.D. 

10:00-11:45 — Obstetric  Complications  Predisposing 
to  Prematurity  and  Their  Management: 
Short,  practical  discussions  will  be  given  on 
the  following  subjects:  (a)  Adequate  diet 
during  pregnancy;  (b)  Management  of  pa- 
tients with  premature  rupture  of  membranes, 
placenta  previa  or  toxemia  of  pregnancy, 
and  a previable  fetus;  (c)  Pregnancy  com- 
plicated by  heart  disease,  tuberculosis  or 
diabetes. — Paul  Bruns,  M.D.,  Chairman  of 
Panel;  Wilbur  F.  Manley,  M.D.,  Warren  W. 
Tucker,  M.D.,  E.  Paul  Sheridan,  M.D. 

AFTERNOON 

1:30-2:30 — Management  of  Newborn  Infant  With 
the  Following  Problems:  (a)  Convulsions, 
Henry  F.  Reynolds,  M.D.;  (b)  Vomiting, 

Jean  L.  McMahon,  M.D.;  (c)  Suspect  of 
Congenital  Syphilis,  LaMeta  F.  Dahl,  M.D. 

2:45-3:45 — A Case  to  Illustrate  the  Working  Re- 
lationship Between  the  Hospital,  the  Health 
Department  and  Other  Commimity  Services. 
— John  A.  Lichty,  M.D.,  Chairman  of  Panel; 
Doris  M.  Greene,  R.N.;  Ruth  Cohig,  Medical 
' Social  Worker,  I^blic  Health  Nurse. 

4:00-4:45 — Clinical  Pathological  Conference:  A 
full-term  infant  who  was  found  dead  in  his 
crib  on  the  18th  day  of  life  will  be  discussed. 
— Harry  H.  Gordon,  M.D.,  Chairman  of 
Panel;  Edith  Boyd,  M.D.,  Marion  Maresh, 
M.D. 

Thursday,  November  3 
MORNING 

9:00-9:45 — Nutritional  Requirements  and  Feeding 
on  Premature  Infants:  Generalizations  and 
their  individualized  application  will  be  pre- 
sented under  three  headings:  Problems  dur- 
ing the  first  week  of  life;  after  the  first 
week;  and  on  discharge  home.-^Harry  H. 
Gordon,  M.D.,  Doris  M.  Greene,  R.N. 

10:00-10:45 — Community  and  Hospital  Planning 
for  the  Care  of  Premature  Infants:  Various 
facets  of  city,  county  and  state  plans  will  be 
discussed. — Jackson  L.  Sadler,  M.D.,  Chair- 
man of  Panel;  Donald  J.  Bourg,  M.D.;  David 
R.  Duncan,  M.D.;  Ruth  J.  Raatama,  M.D. 

11:00-11:45 — Management  of  the  Infant  With 
Diarrhea. — Clifton  D.  Govan,  Jr.,  M.D., 
Chairman  of  Panel;  Wayne  H.  Danielson, 
Ph.D.;  Seymour  E.  Wheelock,  M.D. 


758 


Rocky  Mountain  Medical  Journal 


• • • 


The  Seal  of  Acceptance  denotes  that 
the  nutritional  statements  made  in 
this  advertisement  ate  acceptable  to 
the  Council  on  Foods  and  Nutrition 
of  the  American  Medical  Association. 


And  the  Meat  They  Eat 

The  established  relationship  between  sound  dietary  planning 
and  a state  of  maintained  good  health  emphasizes  the  nutri- 
tional importance  of  meat,  man’s  favorite  protein  food. 

Not  only  does  meat  taste  good,  but  of  greater  significance, 
it  provides  a host  of  nutritional  benefits.  Developments  in  the 
field  of  nutrition*  have  proved  that  complete  protein— the 
kind  that  meat  supplies  in  abundance— aids  in  building  and 
maintaining  immunity,  hastens  recovery  after  acute  infectious 
diseases  and  following  injury  and  burns,  promotes  health 
during  pregnancy,  aids  in  the  growth  and  development  of 
husky  children,  and  is  needed  to  maintain  everyone  in  top 
physical  condition. 

No  matter  from  what  walk  of  life  your  patients  come,  and 
whether  their  pocketbooks  demand  economy  or  permit  satis- 
faction of  that  urge  for  the  fanciest  cuts,  meat  gives  them  full 
value  for  their  money. 

*McLester,  J.  S.:  Protein  Comes  Into  Its  Own,  J.A.M.A.  139:897  (April  2)  1949. 

American  Meat  Institute 

Main  Office,  Chicago. ..Members  Throughout  the  United  States 


for  September,  1949 


759 


AFTERNOON: 


1:30-2:45 — Surgery  in  the  Newborn. — George 
Packard,  M.D.,  Chairman  of  Panel;  G.  Rob- 
ert Fisher,  M.D.;  Philip  Leif,  M.D. 

3:00-4:15 — Emotional  Aspects  of  Early  Infancy: 

1.  Emotional  Factors  Associated  with  Prema- 
turity.— (a)  Emotional  factors  in  mother  pre- 
disposing to  premature  birth;  (b)  Emotional 
problems  in  the  mother  accompanying  pre- 
mature birth;  (c)  Role  of  prematurity  in 
later  emotional  development  of  the  child. 

2.  Therapeutic  Management  of  Common 
Emotional  Problems  in  Mothers  Before  and 
After  Delivery.  3.  Emotional  Implications 
of  Infant  Care — (a)  Feeding;  (b)  Family  Re- 
lationships.— Jules  Coleman,  M.D.,  and  staff 
of  the  Mental  Hygiene  Clinic. 

4:30-5:00 — Demonstration  of  X-Ray  Pelvimetry. 
— Paul  Bruns,  M.D.,  or  Observation  of  Nur- 
series. 

Friday,  November  4 
MORNING 

8:30-9:15 — Respiratory  Difficulties  in  the  Pre- 
mature Neonate. — Harry  H.  Gordan,  M.D., 
Chairman  of  Panel;  Paul  Bruns,  M.E).;  Ed- 
ward B.  Plattner,  M.D 

9:30-10:30 — Iso-Immunization:  Clinical  features 
and  laboratory  tests  which  guide  rational 
treatment  of  iso-immunization  with  Rh  and 
other  factors. — Harold  D.  Palmer,  M.D. 

10:45-12:00 — Prevention  and  Treatment  of  Infec- 
tion in  the  Newborn. — William  L.  Bradford, 
M.D. 

AFTERNOON 

1:30-2:30 — Special  Problems  in  Growth  and  De- 
velopment.— John  Nelson,  M.D.,  Chairman: 

(a)  Vitamin  Deficiency,  Peter  Hoch,  M.D.; 

(b)  Anemia,  John  R.  Connell,  M.D.;  (c) 
Retrolental  fibroplasia,  Lula  O.  Lubchenco, 
M.D.;  (d)  Mental  and  physical  problems, 
Robert  McCammon,  M.  D. 

2:45-4:00 — Clinical  Conference:  (a)  A full  term 
infant  with  ecchymosis  noted  at  birth  and 
a sudden  attack  of  cyanosis  in  the  third 
week  of  life;  (b)  A very  small  premature 
infant  who  developed  neurological  symptoms 
after  3 months  of  age. — Alfred  Washburn, 
M.D.,  Chairman  of  Panel;  Harold  D.  Palmer, 
M.D.;  John  M.  Griffin,  M.D.;  William  L. 
Bradford,  M.D.;  Harry  H.  Gordon,  M.D. 

4:15-4:45 — Question  Period,  or  Observation  of 
Nursery. 

Saturday,  November  5 

MORNING 

9:00-10:30 — Demonstrations  and  Exhibits. 

10:45-11:45 — Obstetric — Pediatric  Morbidity  Con- 
ference.—Paul  Bruns,  M.D.;  John  A.  Lichty, 
M.D. 

Please  direct  inquiries  to  the  office  of  Grad- 
uate and  Postgraduate  Medical  Education,  Uni- 
versity of  Colorado  Medical  Center,  Denver  7, 
Colorado. 


COLORADO 

State  Health  Department 

DON’T  KILL  THAT  DOG! 

The  Colorado  State  Department  of  Public 
Health  urgently  requests  physicians  to  remind 
all  patients,  and  spread  the  word  wherever 
possible,  of  the  proper  procedure  in  case  of  dog 
or  other  animal  bites  where  rabies  might  be 
suspected.  The  department  cites  the  following 
recent  example: 

A small  child  in  Colorado  is  currently  re- 
ceiving, perhaps  unnecessarily,  anti-rabies  treat- 
ment. She  was  bitten,  by  a dog  which  was 
killed  immediately  because  it  was  suspected  of 
harboring  rabies.  The  dog’s  head  was  sent  to 
the  State  Health  Department’s  laboratory,  un- 
iced. It  arrived  as  a decomposed  mess,  making 
any  diagnosis  impossible.  Treatment  of  the  child 
against  rabies  was  the  only  recourse. 

To  avoid  such  situations,  the  department  asks 
that  the  following  five  points  be  emphasized: 

1.  Don’t  kill  an  animal  that  has  bitten  a per- 
son unless  it  is  absolutely  necessary. 

2.  Keep  suspected  animals  under  veterinary 
observation  for  fourteen  days;  if  rabid,  the  ani- 
mal will  show  symptoms  within  that  period. 

3.  Remove  the  head  of  the  animal  immediately 
after  its  death. 

4.  Don’t  shoot  the  animal  in  the  head,  if  the 
animal  must  be  killed. 

5.  Always  ice  the  head  immediately  after  re- 
moval, and  ship  it  iced  to  the  state  laboratory. 


TWENTIETH  ANNUAL  POSTGRADUATE 
SYMPOSIUM  OF  HEART  DISEASE 

Dr.  William  Dock  of  Brooklyn,  New  York,  and 
Dr.  Arnold  Rich  of  Baltimore,  Maryland,  will 
be  the  guest  speakers  for  the  Twentieth  Annual 
Postgraduate  Symposium  on  Heart  Disease  pre- 
sented by  the  Heart  Division  of  the  San  Fran- 
cisco Tuberculosis  Association.  The  sessions  will 
be  held  October  12,  13,  14,  15,  1949,  at  the  St. 
Francis  Hotel.  Dr.  Dock  is  Professor  of  Medi- 
cine at  the  Long  Island  College  of  Medicine  in 
Brooklyn  and  Dr.  Rich,  Professor  of  Pathology 
at  Johns  Hopkins  Medical  School. 

Dr.  Dock  will  talk  on  “Sodium  Depletion,  Its 
Indications,  Hazards,  and  Techniques,”  and  “The 
Management  of  Coronary  Disease.”  Dr.  Rich’s 
subjects  are  “Circulatory  Failure  in  Acute  In- 
fections” and  a report  of  his  “Studies  in  Rheu- 
matic Fever,  Periarteritis  Nodosa,  Disseminated 
Lupus  Erythematosus  and  Rheumatoid  Arthritis.” 

Official  programs  will  be  ready  in  August. 
This  year  the  Heart  Division  is  offering  a new 
feature,  two  concurrent  courses  in  electrocardi- 
ography, to  be  given  Wednesday  morning,  Oc- 
tober 12,  at  the  St.  Francis  Hotel.  Physicians 
who  wish  to  register  for  these  courses,  one  ele- 
mentary and  one  advanced,  should  do  so  in  ad- 
vance. The  program  this  year  will  include  two 
clinical  sessions  instead  of  one. 

The  Wednesday  afternoon  session  will  be 
planned  for  pediatricians,  as  usual,  and  will  be 
sponsored  by  the  Academy  of  Pediatrics.  Dr. 
Rich  will  discuss  rheumatic  fever  at  this  session. 
The  Wednesday  evening  session  will  be  in  col- 
laboration with  the  University  of  California  Ex- 
tension Division. 


760 


Rocky  Mountain  Medical  Journal 


MSI  VI06**^ 


The  incidence  of  mild  protein  deficiencies  in 
children,  predisposing  toward  infections  and 
edema,  is  reported'-^  much  greater  than 
generally  realized.  Infant  and  adolescent 
requirements— not  only  for  tissue  repair 
and  maintenance,  but  also  for  growth— 
are  much  higher  than  in  adulthood.^  To 
insure  adequate  protein  intake  in  infancy, 
Dryco  — Borden's  high-protein  infant  food 
— is  ideally  suited  as  a basis  for  formula 
building.  It  furnishes  all  the  essential 
amino  acids.  Its  low  fat  content  minimizes 
gastro-intestinal  upsets  due  to  fat  intolerance, 
^ while  its  intermediate  carbohydrate  content 
lends  itself  for  prescription  with  or  without  added 
carbohydrate.  Quickly  soluble  in  cold  or  warm 
water,  Dryco  contains  adequate  vitamins 
A,  B|,  B:>  and  D,  plus  essential  milk  minerals. 

RcfarencM:  1.  Dodd,  K.  and  Minot,  A.  S.;  ].  Pediat.,  9:442, 1936. 

a.  Dodd.  K.  and  Minot,  A.  S.:  /.  Pediat.,  8:452.  1936. 
3.  Sahyun,  M.:  Am.  J.  Dig.  Dis.,  13:59,  1946. 

BORDEN’S  PRESCRIPTION  PRODUCTS  DIVISION 

350  Madison  Avenue,  New  York  17,  N.  Y. 


In  Canada  write  The  Borden  Company,  Limited 
Spadina  Crescent,  Toronto. 

DRYCO  is  made  from  spray-dried, 
pasteurized,  superior  quality  whole 
milk' and  skim  milk.  Provides 
2500  U.S.P.  units  vitamin  A 
and  400  U.S.P.  units  vitamin 
D per  reconstituted  quart. 
Supplies  5IV2  calories  per 
tablespoon.  Available 
at  all  drug  stores  in  1 
and  2t/2  lb.  cans. 


/or  September,  1949 


761 


ZJuberculosis  Abstracts 

Issued  Monthly  by  the  National  Tuberculosis 
Association 

Vol.  XXII  SEPTEMBER,  1949  No.  9 

Today  there  are  thousands  o[  workers  whose  prime 
objective  is  the  control  of  tuberculosis.  A method  of 
attaining  that  objective  is  known.  It  consists  of  find- 
ing and  pursuading  each  person  with  tuberculosis  to 
seek  medical  care  and  providing  his  physician  with  the 
knowledge  necessary  to  treat  the  disease  effectively . In 
it  is  included  restoring  the  individual  to  the  fullest  pos- 
sible usefulness,  and  protecting  others  from  contagion. 


THE  PRESENT  STATUS  OF  TUBERCULOSIS 
CONTROL 

The  control  of  tuberculosis  involves  acquiring  new 
knowledge — research;  and  distributing  existing  knowl- 
edge— education.  Education  involves  the  public  and 
the  medical  profession.  The  doctor  in  his  office  is 
impotent  unless  the  patient  comes  to  him.  The  patient 
is  in  jeopardy  unless  he  knows  that  he  is  a patient, 
and  unless  the  doctor  knows  how  to  treat  him.  These 
principles  are  inseparable.  The  physician  and  the 
health  educator  are  mutually  dependent  and  inseparable 
allies  in  the  campaign  against  tuberculosis. 

One  of  the  ways  in  which  the  progress  of  tuber- 
culosis control  is  being  retarded  is  putting  the  em- 
phasis upon  accomplishments,  not  upon  the  unfilled 
tasks.  To  believe  the  job  is  nearly  done  is  dangerous, 
and  the  facts  should  be  faced. 

Forget  about  the  reduction  in  tuberculosis  mortality 
statistics  for  a moment  and  look  at  the  present  situa- 
tion! Tuberculosis,  today  in  the  United  States,  re- 
mains the  most  important  chronic  fatal  disease  to  be 
caused  by  a "germ,”  the  most  important  of  all  dis- 
eases of  young  people,  the  most  important  of  the 
truly  preventable  diseases. 

More  than  this  should  be  said — much  more.  Mortality 
statistics  list  tuberculosis  in  comparison  with  groups 
of  other  diseases.  "Heart  disease"  is  not  one  disease 
but  many.  It  includes  arteriosclerotic  heart  diseases 
of  the  aged,  rheumatic  heart  disease  of  the  young, 
hypertensive  heart  disease  of  middle  life,  infectious 
diseases  of  the  heart,  and  many  rarer  conditions. 

Cancer  is  not  a single  disease,  presenting  one  medi- 
cal problem.  Yet  the  various  cancerous  diseases  are 
■grouped  for  comparison  with  tuberculosis.  Most  cancer 
appears  to  be  a degenerative  disease  of  older  age; 
most  deaths  from  heart  disease  are  incident  to  old 
age.  Everyone  has  to  die  some  day  from  some  cause 
and  these  degenerative  conditions  will  increase  as 
our  people  live  longer  and  longer  lives. 

Tuberculosis  is  also  displaced  on  the  list  of  causes 
of  death  by  accidental  deaths  of  all  types — obviously 
an  unfair  comparison.  Tuberculosis  would  rank  high- 
er if  mortality  tables  grouped  diseases  properly.  If 
listed  according  to  preventability,  or  to  age  groups 
affected  or  to  years  of  potential  life  lost,  or  to  actual 
cost  in  dollars,  or  according  to  sorrow,  hardship  and 
frustration  caused — there  would  be  less  complacency 
and  more  alarm  at  the  present  tuberculosis  death  rate. 

If  causes  of  death  were  listed  according  to  organs 


affected,  diseases  of  the  lungs  would  stand  high  on 
the  list.  Diseases  such  as  tuberculosis,  asthma,  bron- 
chiectasis and  pneumonia  stand  high.  Pulmonary 
embolism  and,  among  males,  cancer  of  the  lung  are 
also  extremely  important. 

There  has  been  so  much  talk  about  scientific  medi- 
cine that  some  people  seem  to  think  of  medical  practice 
as  a technological  pursuit — applying  fixed  formulas  to 
compute  the  diagnosis.  Medicine  is  a ministry  as  well 
as  a science,  and  the  practice  of  medicine  a calling 
as  well  as  an  occupation. 

Patients  are  people.  They  have  intellect,  imagina- 
tion and  emotions — they  have  souls.  No  two  people 
react  alike  to  the  same  disease  and  few  humem  miseries 
are  caused  entirely  by  pathologic  alterations  of  body 
structure.  Symptoms  are  almost  always  caused  by  a 
blend  of  pathology  with  fear,  apprehension,  and  per- 
haps fatigue.  The  majority  of  persons  seeking  medical 
advice  have  no  significant  organic  disease.  Their 
symptoms  are  due  to  misbehaving  organs,  not  diseased 
organs.  These  complaints  are  called  "functional”  as 
distinguished  from  "organic"  or  structural  defects.  But 
functional  complaints  are  real,  not  imaginary,  and 
often  they  are  curable.  And  when  organic  disease 
strikes — tuberculosis,  heart  disease,  cancer — the  emo- 
tional aspects,  the  functional  disturbances  are  as  real 
and  often  more  disturbing  than  are  the  pathologic 
alterations.  Even  major  surgery  is  to  the  normal 
person  frequently  more  of  an  emotional  than  a physical 
experience. 

The  modem  school  of  medical  practice  believes  in 
full  and  complete  instruction  of  the  patient.  He  not 
only  may,  but  must  know  the  facts,  good  and  bad. 
He  is  not  the  subject  of  medical  treatment  but  the' 
partner  of  his  physician  and  shares  the  task  of  achiev- 
ing recovery.  Patients  see  their  x-rays:  they  know 
about  laboratory  tests:  they  know  the  diagnosis  and 
something  of  the  future. 

The  modem  physician  sees  a greater  duty  than  that 
of  restoring  to  a state  of  health  people  who  feel  ill. 
He  advises  normal  well  people  how  to  remain  well, 
happy,  and  productive.  He  is  learning  how  to  ex- 
amine well  people  and  to  avert  many  of  the  tragedies 
which  occur  when  his  advice  is  sought  belatedly. 
Through  his  knowledge  of  personal  hygiene,  immuni- 
zation, nutrition,  and  the  nervous  system,  he  may 
prevent  disease  and  interpret  functional  symptoms. 

In  the  prevention  of  disease  the  physician  has  allied 
himself  with  public  health  experts,  field  workers,  and 
executives.  These  are  trained  educators,  inspired  and 
diligent  cmsaders,  who  not  only  work  beside  the 
physician — they  work  ahead  of  him.  They  make 
possible  the  application  of  his  skills  and  arts  to  vast 
numbers  of  people  otherwise  beyond  the  doctor’s 
reach.  Physicians  should  know  more  of  these  pro- 
fessional allies  and  the  knowledge  and  training  which 
they  may  possess.  He  should  use  them  as  consultants 
in  medical  problems  of  social  and  community  signifi- 
cance. 

We  are  now  on  the  right  track  to  achieve  the  great 
task  remaining— the  control  of  tuberculosis.  There  are 
vastly  more  effective  methods  of  detecting  and  treat- 
ing tuberculosis  and  other  chest  diseases  than  ever 
before.  The  relative  roles  of  health  educators,  epi- 
demiologists, sanatorium  physicians,  private  practition-- 
ers  is  beginning  to  be  seen  quite  clearly.  Let  no 
disrupting  revolution  in  medical  practice  prevent  this 
major  achievement  of  the  progressive  American  system 
of  medicine. 

The  Present  Status  of  Tuberculosis  Control,  H.  Cor- 
win Hinshaw,  M.D.,  National  Tuberculosis  Association 
Bulletin,  July,  1949. 


762 


Rocky  Mountain  Medical  Journal 


of  your  patients..  • The  farm  housewife  whose  work  is  truly  never  done  may 

find  that  the  distressing  symptoms  of  the  climacteric  make 
the  smallest  chore  an  arduous  project.  She  depends  on 
your  help  to  resume  normal  efficiency  in  the  performance  of 
her  daily  tasks  as  well  as  to  maintain  a positive  outlook  during 
this  trying  period. 


'"'Premarin''  offers  a solution.  Many  thousand  physicians  prescribe 
this  naturally-occurring,  oral  estrogen  because... 


7.  Prompt  symptomatic  improvement  usually  follows  therapy. 

2.  Untoward  side-effects  are  seldom  noted. 


3.  The  sense  of  well-being  so  frequently  imparted  tends  to  quickly  restore 
the  patient's  confidence  and  normal  efficiency. 

4.  This  "Plus”  (the  sense  of  well-being  enjoyed  by  the  patient)  is  conducive  to 
a highly  satisfactory  patient-doctor  relationship. 

5.  Four  potencies  permit  flexibility  of  dosage:  2.5  mg.,  1 .25  mg.,  0.625  mg.,  and  0.3 
mg.  tablets;  also  in  liquid  form,  0.625  mg.  in  each  4 cc.  (1  teaspoonful). 


ft 


While  sodium  estrone  sulfate  is  the  principal  estrogen 
in  "Premarin,"  other  equine  estrogens ..  .estradiol, 
equilin,  equilenin,  hippulin . . .are  probably  also  pres- 
ent in  varying  amounts  as  water-soluble  conjugates. 


ESTROGENIC  SUBSTANCES  (WATER-SOLUBLE) 
also  known  os  CONJUGATED  ESTROGENS  (equine) 


Ayerst,  McKenna  & Harrison  Limited  22  East  40th  Street,  New  York  1 6,  New  York 

4917 


for  September,  1949  ■ 


763 


■ * , .1 

.4 

New  Books  Received 

The  American  Nurses  Directory:  The  Definition  and 
Pronunciation  of  Terms  In  the  Nursing  Vocabu- 
lary: By  Alice  L..  Price,  B.S.,  R.N.,  Instructor  of 
Nursing:  Arts  at  Columbia  Hospitai,  Milwaukee. 
W.  B.  Saunders  Company,  Philadelphia  and  Lon- 
don, 1949. 


Clinical  Auscultation  of  the  Heart:  By  Samuel  A. 
Levine,  M.D.,  Clinical  Professor  of  Medicine,  Har- 
vard Medical  School;  Physician,  Peter  Bent  Brig- 
ham Hospital;  and  W.  Proctor  Harvey,  M.D.,  Re- 
search Fellow  in  Medicine,  Harvard  Medical  School; 
Assistant  in  Medicine,  Peter  Bent  Brigham  Hospi- 
tal. Illustrated.  Philadelphia  and  London,  W.  B. 
Saunders  Company,  1949. 


Fundamentals  of  Internal  Medicine:  By  Wallace 
Mason  Yater,  A.B.,  M.D.,  M.S.  (in  Med.),  F.A.C.P. ; 
Director,  Yater  Clinic,  Washington,  D.  C. ; for- 
merly Professor  of  Medicine  and  Director  of  the 
Department  of  Medicine,  Georgetown  University 
School  of  Medicine;  Physician-in-Chief,  George- 
town University  Hospital;  Physician-in-Chief,  Gal- 
linger  Municipal  Hospital,  Washington,  D.  C. ; and 
Fellow  in  Medicine,  The  Mayo  Foundation.  Third 
Edition.  APPleton-Century-Crofts,  Inc.,  New  York. 


Handbook  of  Materia  Medlca,  Toxicology,  and  Phar- 
macology; For  Students  and  Practitioners  of  Med- 
icine: By  Forrest  Ramon  Davison,  B.A.,  M.Sc., 
Ph.D.,  M.B.,  Consultant  and  Toxicologist,  Minneap- 
olis, Minnesota;  formerly  Assistant  Professor  of 
Pharmacology  in  the  School  of  Medicine,  Univer- 
sity of  Arkansas,  Little  Rock;  Medical  Depart- 
ment, The  Upjohn  Co.,  Kalamazoo,  Mich.;  Assist- 
ant Professor  of  Pharmacology,  University  of 
Tennessee  Medical  School;  Toxicologist  to  Univer- 
sity Clinics,  Memphis,  Tennessee.  Fourth  Edi- 
tion. With  35  Illustrations,  Including  4 in  Color. 
St.  Louis,  the  C.  V.  Mosby  Company,  194’9.  $8.50. 


How  to  Become  a Doctor;  A Complete  Guifle  to  the 
Study  of  Medicine,  Dentl.stry,  Pharmacy,  Veterina- 
rian Medicine,  Occupational  Therapy,  Chiropoflu 
and  Foot  Surgery,  Optometry,  Hospital  Admini.s- 
tration.  Medical  Illustration,  and  the  Sciences:  By 
George  R.  Moon,  A.B.,  M.A.,  Examiner  and  Re- 
corder, University  of  Illinois  College  of  Medi- 
cine, Dentistry  and  Pharmacy.  Published  by  The 
Blakiston  Company,  Philadelphia  and  Toronto. 
$2.00. 


Manual  of  Medical  Etuergencles:  By  Stuart  C.  Cul- 
len, M.D.,  Professor  of  Surgery;  Chairman,  Divi- 
sion of  Anesthesiology,  State  University  of  Iowa 
College  of  Medicine;  and  B.  G.  Gross,  M.D.,  Pro- 
fessor and  Head  of  Department  of  Pharmacology, 
State  University  of  Iowa  College  of  Medicine. 
The  Year  Book  Publishers,  Inc.,  Chicago,  Illinois. 
Price,  $3.75. 


Medicine  Throughout  Antiquity:  By  Benjamin  Lee 
Gordon,  M.D.,  Member  American  Association  of  the 
History  of  Medicine  and  American  Academy  of 
Ophthalmology  and  Otolaryngology;  Certified  by 
American  Board  of  Ophthalmology;  Attending 
Ophthalmologist  to  Shore  Memorial  Hospital,  Som- 
ers Point,  New  Jersey,  and  to  Atlantic  County  Hos- 
pital for  Tuberculous  Diseases  and  Atlantic  (lounty 
Hospital  for  Mental  Diseases,  Northfleld,  N.  J. ; 
Authorized  Medical  Examiner  for  Civil  Aeronau- 
tics Administration,  Department  of  Commerce, 
Washington,  D.  C. ; Author  of  “The  Romance  of 
Medicine.’’  Foreword  by  Dr.  Max  Neuburger.  157 
Illustrations.  Philadelphia,  F.  A.  Davis  Company, 
Publishers,  1949.  $6.00. 


ucabulary  Guide;  a Teacherts  Supplement  to  the 
.\merlcaii  Nurses’  Dictionary:  By  Alice  C.  Price, 
R.N.  W.  B.  Saunders  Company,  Philadelphia  and 
London,  1949; 


Care  of  tbt  Surgical  Patient;  Including  Pathologic 
Physiology  and  Principles  of  Diagnosis  and  Treat- 
ment: By  Jacob  Fine,  M.D.,  Surgeon-in-Chief,  Beth 
Israel  Hospital;  Professor  of  Surgery  at  Beth 
Israel  Hospital,  Harvard  Medical  School.  W.  B. 
Saundv^rs  Company,  Philadelphia  and  London,  1949. 


Medical  Etymology — The  History  and  Derivation  of 
Medical  Terms  for  Students  of  Medicine,  Dentistry, 
and  Nursing:  By  O.  H.  Perry  Pepper,  M.D.,  Pro- 
fessor ot  Medicine,  University  of  Pennsylvania. 
W.  B.  Saunders  Company,  Philadelphia,  London, 
1949.  Price,  $5.50. 


Syphlli.s:  Its  Course  and  Management:  By  Evan  W. 
Thomas,  M.D.,  Professor  of  Clinical  Medicine,  New 
York  University  College  of  Medicine;  Director, 
Rapid  Treatment  Center,  and  Visiting  Physician, 
Bellevue  Hospital,  New  York;  Consultant,  United 
State  Public  Health  Service.  Foreword  by  John 
F.  Mahoney,  M.D.,  Director  of  Venereal  Disease 
Research  Laboratory,  United  States  Public  Health 
Service.  Chapter  on  "Public  Health  Aspects  of 
Syphilis”  by  Theodore  J.  Bauer,  M.D.,  Chief, 
Venereal  Disease  Division,  United  States  Public 
Health  Service.  The  MacMillan  Company,  New 
York,  1949.  Price,  $5.50. 


The  Compleat  Pediatrician;  Practical  Diagnostic, 
Therapeutic  and  Preventive  Pediatries,  Sixth  Edi- 
tion; For  the  Use  of  Medical  Students,  Internes, 
General  Practitioners,  and  Pediatricians:  By  Wil- 
burt  C.  Davison,  M.A.,  D.Sc.,  LL.D.,  .M.D.,  Pro- 
fessor of  Pediatrics',  Duke  University  School  of 
Medicine,  and  Pediatrician,  Duke  Hospital;  for- 
merly Acting  Head  of  Department  of  Pediatrics, 
The  Johns  Hopkins  University  School  of  Medicine; 
Acting  Pediatrician  in  Charge,  The  Johns  Hopkins 
Hospital,  and  Member  American  Board  of  Pe- 
diatrics; Fellow,  American  Academy  of  Pediatrics 
and  American  College  of  Physicians;  Member, 
American  Pediatric  Society,  and  Division  of  Medi- 
cal Sciences,  National  Research  Council.  Durham, 
N.  C.  Printed  by  Seeman  Printery  for  Duke  Uni- 
versity Press,  1949.  Price,  $4.75  by  check  with 
order,  or  for  $5.00  on  credit. 


The  Practice  of  Refraction:  By  Sir  Stewart  Duke- 
Elder,  K.C.V.O.,  M.A.,  D.Sc.  (St.  And.),  Ph.D. 

(Lond.),  M.D.,  P.R.C.S.,  Hon.  D.Sc.  (North  West- 
ern); Surgeon-Oculist  to  H.M.  The  King;  .Knight 
of  Grace  of  the  Order  of  St.  John;  Consulting 
Ophthalmic  Surgeon  to  the  Army  and  the  Royal 
Air  Force;  Director  of  Research,  Institute  of 
Ophthalmology,  University  of  London;  Consulting 
Ophthalmic  Surgeon,  Moorflelds  Westminister  and 
Central  Eye  Hospital:  Ophthalmic  Surgeon,  St. 
George’s  Hospital.  Fifth  Edition  with  216  Illus- 
trations. The  C.  V.  Mosby  Company,  St.  Louis', 
1949.  Price,  $6L25. 


Medicine  on  the  March:  A Progress  Report  by  Mar- 
guerite Clark.  A Newsweek  Book.  Published  for 
Newsweek  by  Funk  & Wagnalls  Company,  New 
York.  Price,  $3.50. 


Shearer’s  Mannual  of  Human  Dissection:  Edited 
by  Chafles  E.  Tobin,  Ph.D.,  Associate  Professor 
Anatomy,  The  University  of  Rochester  School  of 
Medicine  and  Dentistry.  Second  Edition.  The 
Blakiston  Company,  Philadelphia-Toronto.  Price, 
$4.50. 


Atlas  of  Roentgenographic  Positions;  By  Vinita 
Merrill  while  Educational  Director,  Picker  X-Ray 
Corporation.  In  two  volumes;  Volume  I.  The  C. 
V.  Mosby  Company,  S't.  Louis,  1949. 


Atlas  of  Roentgenographlc  Positions:  By  Vinita 
Merrill  while  Educational  Director,  Picker  X-Ray 
Corporation.  In  two  volumes;  Volume  II.  The  C. 
V.  Mosby  Company,  St.  Louis,  1949. 


764 


Rocky  Mountain  Medical  Journal 


Mrs.  Sipper’s  restricted  diet  is  somewhat 
lacking  in  essential  nutrients.  Through 
no  fault  of  her  own,  she  becomes 
sibling  to  the  food  faddist  and  first 
cousin  to  the  hurrier,  the  worrier,  the 
excessive  smoker  and  toper.  Their  faulty 
or  inadequate  diets  are  a telling  cause 
behind  today’s  widespread  prevalence 
of  subclinical  vitamin  deficiencies. 

In  all  of  these  cases,  can  newly  pre- 
scribed eating  habits  carry  the  full 
brunt  of  the  therapy?  Isn’t 
it  wise  to  make  use  of  the 
aid  and  assurance  which 
vitamin  supplementation 
can  provide? 

For  your  prescribing 
convenience,  there’s  an 
Abbott  vitamin  product  to 
serve  nearly  every  vitamin 
need — for  supplementary  or  therapeutic 
levels  of  dosage,  for  oral  or  parenteral 
administration.  Your  pharmacist  can 
supply  Abbott  vitamin  products  in  a 
variety  of  forms  and  package  sizes. 
Abbott  Laboratories,  North  Chicago,  111. 


/or  September,  1949 


765 


Advertiaement 


Book  Reviews 


From  where  1 sit 
Joe  Marsh 


For  the  Ladies:  A Diet 
That  Really  Works 

We  went  out  visiting  the  other  night 
and  the  ladies  were  talking  away  about 
weight-reducing  diets.  One  of  them 
had  a special  “15-day  Hollywood  diet” 
guaranteed  to  slim  her  down  fifteen 
pounds'  worth.  Another  was  living 
on  bananas  and  skim  milk! 

I might  have  known  the  missus 
would  get  the  bug,  too,  and  sure 
enough  the  other  day  she  asks  me, 
“Joe,  what  kind  of  a diet  do  you  think 
I ought  to  go  on?” 

“Mother,”  I says,  “the  only  diet 
I would  ever  recommend  to  anyone  is 
simply  moderation.  I wouldn’t  trust 
any  of  those  get-thin-quick  diets.  Sim- 
ply cut  down  on  desserts,  bread,  butter, 
sweets  and  fats — but  when  you  do, 
even  do  your  cutting  down  moderately.’  ’ 

From  where  I sit,  moderation  is  the 
watchword.  Moderation  with  food, 
with  smoking  or  with  the  enjoyment 
of  a friendly  glass  of  temperate  beer  or 
ale.  Actually,  moderation  adds  to  the 
enjoyment  of  just  about  anything. 


Copyright,!  9 U9,  United  States  Brewers  Foundation 


Contemporarj-  R.eIi^ious  Jurisprudence;  By  I.  H.  Ru- 

benstein  of  the  Illinois  Bar.  The  Wa'idain  Press, 

Chicago,  1948.  Price,  ?2.50. 

This  attorney’s  monograph  reviews  prevailing 
statutes  and  court  decisions  to  demonstrate  “Law, 
with  its  consequence  in  Justice  ...  as  the  bul- 
wark of  Society  against  the  onslaughts  of  those 
who  would  use  religion  as  a sword  to  gain  their 
fanatical  desires  and  ends.”  Referring  to  three 
general  categories  [(a)  fortune  telling,  (b)  faith 
healing,  and  (c)  pacifism]  the  author  illustrates 
the  necessity  of  legal  restrictions  and  control  of 
such  practices,  for  “if  they  [the  adherents  of 
these  tenets]  possessed  the  unbridled  power, 
these  zealots,  under  the  cloak  of  religion,  if  paci- 
fists, would  strip  the  nation  of  its  armed  might, 
even  in  the  face  of  invasion;  if  faith  healers, 
would  repeal  all  medical  and  sanitary  legislative 
safeguards,  and  expose  the  nation  to  the  menace 
of  epidemics  of  infectious  and  contagious  dis- 
eases; if  fortune  tellers,  would  abrogate  the  laws 
against  speculation  and  false  pretenses,  and 
thrust  the  nation  into  a maelstrom  of  archaic 
superstitions  and  frenzied  speculations.” 

To  the  physician-reader  having  some  curiosity 
filtering  into  a socio-medico-legal  limbo,  this 
book  contributes  a legal  orientation  and  a fur- 
ther appreciation  of  humanity’s  gullibility.  One 
is  impressed  with  the  pragmatism  of  our  legal 
colleagues,  demonstrated  in  an  Ohio  statute  held 
constitutional  and  valid  which  declares  that 
“whoever  not  having  been  legally  licensed  to 
do  so,  represents  himself  to  be  ...  a fortune 
teller,  is  subject  to  criminal  prosecution,”  but 
then  the  statute  fortuitously  remains  silent  about 
granting  such  a license! 

Medical  practice  acts  constitute  control  meas- 
ures when  affectedly  religious  or  mystic  prac- 
titioners seek  either  personal  gain  or  utilize  phy- 
sical (including  pharmacologic)  devices.  Ill- 
advised  applications  of  faith  healing  to  critical 
affilictions  is  the  legal  right  of  the  sane  adult 
where  he  himself  is  concerned,  and  his  death  or 
worsening  under  a faith-healing  practitioner’s 
care  imposes  no  liability  upon  the  latter.  On 
the  other  hand,  the  law  is  severe  in  the  protec- 
tion of  children  from  such  medical  negligence 
stemming  from  their  parents’  beliefs.  As  enun- 
ciated by  a New  York  Court:  “The  peace  and 
safety  of  the  State  involve  the  protection  of  the 
lives  and  health  of  its  children  as  well  as  obe- 
dience to  its  laws.  . . . Children,  when  born  into 
the  world,  are  utterly  helpless,  having  neither 
the  power  to  care  for,  protect,  or  maintain  them- 
selves ...  A person  . . . cannot,  under  the  belief 
or  profession  of  (religious)  belief  that  he  should 
be  relieved  from  the  care  of  children,  be  excused 
from  punishment  for  slaying  those  who  have 
been  borne  to  him.”  A Pennsylvania  Court  de- 
clared: “If  the  case  of  sickness  be  such  that 
ordinary  prudence  would  suggest  the  services 
of  a physician  and  the  use  of  proper  medicines, 
then  such  services  and  medicines  would  be  neces- 
saries in  that  case,  and  failure  to  employ  one 
and  use  the  other,  if  reasonably  within  reach, 
would  be  negligence  on  the  part  of  the  person 
on  whom  the  duty  rested,  and  if  by  reason  of 
such  neglect  . . . the  death  of  a child  ensues,  he 
would  be  guilty  of  manslaughter.”  Should  the 
faith  healer  have  employed  any  physical  agen- 
cies or  have  advised  the  parents  against  medical 
or  surgical  care  of  a child  who  subsequently  dies, 
he  can  be  convicted  as  an  accessory,  or  even  as  a 
principal,  on  manslaughter  charges. 


766 


Rocky  Mountain  Medical  Journal 


Going  Your  Way 

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A significant  legal  deduction  from  the  principle 
of  Christian  Science  that  pain  is  an  illusion  was 
established  in  1907,  in  connection  with  a suit  to 
recover  damages  for  personal  injuries  and  men- 
tal suffering  caused  by  expulsion  of  the  [Chris- 
tian Scientist]  plaintiff  from  a train.  Said  the 
Court  of  Appeals,  “If  she  had  such  control  of 
her  feelings,  or  thought  she  had,  as  to  render 
her  insensible  to  pain  when  she  willed  to  be,  we 
see  no  reason  why  that  circumstance  should  not 
have  been  considered  by  the  jury  in  determining 
the  extent  of  her  suffering.”  The  author  com- 
ments that,  “In  substance,  the  holding  in  this 
case  is  that  Christian  Scientists  can  recover  little 
or  no  damages  for  personal  injuries,  mental  an- 
guish, pain  and  suffering.  This  rule  also  is  ap- 
plicable to  those  cases  in  which  a Christian 
Scientist  brings  suit  for  breach  of  promise, 
alienation  of  affections,  seduction,  slander,  libel 
and  other  suits  of  like  character  in  which  dam- 
ages for  mental  suffering  or  mental  anguish  is 
the  gist  of  the  action.” 

Cases  and  opinions  cited  by  the  author  with 
reference  to  a multiplicity  of  cults  and  quasi- 
medical practices  take  on  a slightly  ludicrous 
hue  for  the  physician,  expressed  as  they  are  in 
humorless  legalese;  viz.,  “Mr.  New”  of  “New- 
thot  Science;”  “The  Great  Exorcism”  movement; 
“I  AM  Movement;”  “Neological  Foundation” 
founded  by  a professed  ex-monk  from  the  “Kum 
Bum  Lamasery”  in  Tibet  who  incidentally  mar- 
keted a laxative  named  “Happy  Hearts.”  Other 
entrepeneurs  have  been  denied  use  of  the  U.  S. 
mails  for  the  purpose  of  implementing  “blessed” 
handkerchiefs  from  one,  and  “cosmic  ray  heal- 
ing” by  another  who  possessed  a “cosmic  gener- 
ator which  gathered  from  the  ether  Positive  Cos- 
mic Affinity  which  the  customer’s  prayer  card 
would  absorb.”  Lest  the  physician  dismiss  these 
ventures  as  trivial,  he  should  note  the  case  of 
a plaintiff  corporation,  the  “American  School  of 
Magnetic  Healing,”  which  erected  several  large 
buildings,  did  a “heavy  mail  order  business 
from  all  over  the  world,  receiving  about  3,000 
letters  a day,  and  averaging  about  $10,000  a 
week”  without  the  use  of  any  pretense  of  divine 
healing  or  Christian  Science. 

In  short,  the  credulity  of  the  human  race  is 
exposed  not  only  by  popular  tastes  in  current 
fiction  and  cinema;  it  is  likewise  mirrored  in 
Attorney  Rubenstein’s  analysis  of  the  Law’s  op- 
eration as  it  attempts  to  quarantine  some  of  the 
more  flagrant  departures  from  reality  and  rea- 
son. 

C.  E.  STANFIELD. 


British  Surgical  Practice:  Under  the  General  Editor- 
ship of  Sir  Ernest  Rock  Carling,  F.R.C.S.,  F.R.C.P., 
Consulting  Surgeon,  Westminster  Hospital;  and 
J.  Paterson  Ross,  M.S.,  F.R.C.S.,  Surgeon  and  Di- 
rector of  Surgical  Clinical  Unit,  St.  Bartholomew’s 
Hospital;  Professor  of  Surgery,  University  of  Lon- 
don. In  eight  volumes  (with  Index  Volume),  Vol- 
ume 3.  524  pages  with  Illustrations.  Butterworth 

& Company  (Publishers),  Ltd.,  London,  England. 
The  C.  V.  Mosby  Company,  St.  Louis,  Mo.,  U.  S.  A., 
1948.  $15.00. 

This  is  a set  of  surgical  practice  books  con- 
sisting of  eight  volumes.  The  third  volume  has 
been  reviewed.  This  volume  deals  with  diseases 
and  procedures  listed  in  alphabetical  order  from 
caesarean  section  to  diseases  of  the  eye. 

Each  chapter  is  written  by  a different  con- 
tributor. Many  of  these  contributors  are  na- 
tionally and  internationally  known  and  are  out- 
standing in  their  particular  subjects.  Heading 
each  chapter  is  a very  useful  and  comprehensive 
index  of  the  subject  covered  in  that  particular 


768 


Rocky  Mountain  Medical  Journal 


QUESTION: 


When  is  it  good  practice  to  suggest  ^'Change  to 
Philip  Morris  Cigarettes"? 

ANSWER: 

When  patients  under  treatment  for  throat  condi- 
tions persist  in  smoking,  many  eminent  nose  and 
throat  specialists  suggest  "Change  fo  Philip  Morris"* 
...the  only  cigarette  proved**  less  irritating. 

• in  fact,  for  all  smokers,  it  is  good  practice  to 
suggest  "Change  to  Philip  Morris." 

PHILIP  MORRIS 

Philip  Morris  Si  Co.,  Ltd.,  Inc. 

119  Fifth  Avenue,  New  York 

DO  YOU  SMOKi  A PIPE?  . . . We  suggest  an  unusually  fine 
new  blend  — Countrt  Doctor  Pipe  Mixture.  Made  by  the  same 
process  as  used  in  the  manufacture  of  Philip  Morris  Cigarettes. 


*Complafsfy  documented  evidence  on  file. 

**R9f»rmfs  of  published  papers  on  request; 

Laryngoscope,  Feb.  1935,  Vol.  XLV.  No.  2,  149-154;  Laryngoscope.  Jan.  1937,  Vol.  XLVIl,  No.  I,  58-60; 
P.foc.  Soc.  Exp.  Biol,  and  Med.,  1934  , 32-241;  N.  Y.  Stale  Journ.  Med.,  Vol.  35,  6-1-25,  No.  II.  590-592. 


Cook  County  Graduate 
School  of  Medicine 

ANNOUNCES  CONTINUOUS  COURSES 

SURGERY — Intensive  course  in  Surgical  Technique, 
two  weeks,  starting  September  26,  October  24,  No- 
vember 28.  Surgical  Technique,  Surgical  Anatomy 
and  Clinical  Surgery,  four  weeks,  starting  Sep- 
tember 12,  October  10,  November  7.  Surgical  Anat- 
omy and  Clinical  Surgery,  two  weeks,  starting  Sep- 
tember 26,  October  24,  November  21.  Surgery  of 
Colon  and  Rectum,  one  week,  starting  September 
12,  October  10,  November  28.  Esophageal  Surgery, 
one  week,  starting  October  10.  Thoracic  Surgery, 
one  week,  starting  October  3.  Breast  and  Thyroid 
Surgery,  one  week,  starting  October  10.  Fractures 
and  Traumatic  Surgery,  two  weeks,  starting  Octo- 
ber 3. 

GYNECOLOGY — Intensive  course,  two  weeks,  start- 
ing September  26,  October  24.  Vaginal  Approach 
to  Pelvic  Surgery,  one  week,  starting  September 
19,  November  7. 

OBSTETRICS — Intensive  course,  two  weeks,  starting 
September  12,  November  7. 

MEDICINE — Intensive  general  course,  two  weeks, 
starting  October  3.  Gastroenterology,  two  weeks, 
starting  October  24.  Gastroscopy,  two  weeks,  start- 
ing September  26,  October  24. 

DERMATOLOGY — Formal  course,  two  weeks,  start- 
ing October  24.  Informal  Clinical  course  every 
two  weeks. 

ROENTGENOLOGY — Diagnostic  and  Lecture  course 
first  Monday  of  every  month.  Clinical  course  third 
Monday  of  every  month.  X-Ray  Therapy  every 
two  weeks. 

UROI.OGY — Intensive  course,  two  weeks,  starting 
September  26.  Ten  day  practical  course  in  Systos- 
copy  every  two  weeks. 

GENERAL,  INTENSIVE  AND  SPECIAL  COURSES 
IN  ALL  BRANCHES  OF  MEDICINE,  SURGERY 
AND  THE  SPECIALTIES 

TEACHING  FACULTY-ATTENDING  STAFF  OF 
COOK  COUNTY  HOSPITAL 
Address:  Registrar,  427  South  Honore  Street, 
Chicago  12,  Ilinois 


chapter.  A brief  bibliography  is  given  at  the  end 
of  each  chapter,  and  meiny  outstanding  American 
surgeons  are  given  as  references, 
ous  fine  illustrations  and  photographs. 

The  chapter  on  carcinoma  of  the  colon  by  Sir 
Hugh  Devine  is  especially  good.  It  covers  the 
symptoms,  signs,  diagnosis,  and  treatment  very 
well.  The  various  surgical  technics  for  treat- 
ment of  such  lesions  are  described  and  illustrated 
in  detail.  The  author  indicates  which  procedure 
for  a particular  situation  has  been  most  success- 
ful in  his  hands. 

This  surgical  practice  book  should  appeal  to 
the  specialist  as  well  as  the  general  practitioner 
who  does  surgery. 

VINCENT  G.  CEDARBLADE. 


Pain  Syndromes,  Treatment  by  Paravertebral  Nerve 
Bloek:  By  Bernard  Judovich,  B.S..  M.D.,  Instructor 
in  Neurology,  Graduate  School  of  Medicine,  Uni- 
versity of  Pennsylvania;  Consulting  Surgeon,  Ba- 
bies’ Hospital  and'  Philadelphia  Home  for  Incur- 
ables; Consulting  General  Surgeon,  Wills  Hospital, 
Philadelphia,  Pa.  Foreword  by  Joseph  C.  Yaskin, 
M.D.,  Professor  of  Neurology,  Graduate  School  of 
Medicine,  University  of  Pennsylvania,  Philadel- 
phia, Pa.  181  Illustrations.  Third  Edition.  F.  A. 
Davis  Company,  Publishers,  Philadelphia,  1949. 
$6.00. 

So  far  as  I know,  this  volume  has  no  counter- 
part in  current  medical  literature.  It  is  a soimd, 
practical,  and  valuable  work;  sound,  because  it 
is  based  on  many  years  of  thorough  and  pains- 
taking study  by  the  authors  of  their  clinical 
material;  practical,  because  of  the  concise  and 
explicit  directions  leading  to  the  diagnosis  and 
treatment  of  the  various  pain  SAmdromes  de- 
scribed, not  by  the  printed  word  alone,  but  also 
by  clear  and  instructive  photographs  and  dia- 
grams; and  valuable,  because  it  sheds  much 
needed  light  on  many  puzzling  clinical  condi- 
tions where  the  common  denominator  is  pain, 
usually  chronic  in  nature,  and  usually  of  obscure 
origin. 

Both  medical  and  surgical  points  of  view  are 
represented  in  this  particular  joint  authorship. 
This  circumstance  insures  a breadth  of  view 
which  embraces  both  the  operative  and  non- 
operative fields  of  neurology.  Hence  it  is  not 
surprising  that  within  these  pages  is  found  re- 
warding material  for  general  practitioner,  in- 
ternist, surgeon,  and  orthopedist. 

This  work  is  based  upon  the  fact  that  clinically 
the  combination  of  segmental  pain  and  tender- 
ness usually  is  due  to  factors  which  irritate 
roots,  ganglia,  or  trunks  of  the  spinal  sensory 
nerves,  and  not  due  to  painful  impulses  origi- 
nating in  diseased  viscera.  The  authors  empha- 
size that  the  various  forms  of  therapy  should 
be  applied  to  the  source  of  pain  and  not  to 
areas  of  referred  pain,  where  treatment  is  close 
to  valueless. 

The  text  and  illustrations  demonstrate  how 
the  interpretation  of  pain  can  be  greatly  facili- 
tated by  eliciting  tender  skin  zones  which  accom- 
pany the  pain,  and  that  the  presence  of  tender- 
ness and  its  distribution  is  of  great  aid  in  diag- 
nosis and  treatment. 

The  concept  of  intercostal  neuralgia  has  long 
been  generally  accepted  with  reference  to  the 
chest  wall.  It  is  paradoxical  that,  although  the 
same  anatomical  ingredients  concerned  in  its 
pathologic  physiology,  i.e.,  vertebrae,  spinal 
nerves,  and  body  wall,  are  present  below  the 
diaphragm  as  well  as  above  it,  the  same  con- 
cept of  pain  causation  with  regard  to  the  ab- 
dominal wall  has  not  yet  received  the  same 
general  acceptance.  Can  it  be  because  the 


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Rocky  Mountain  Medical  Journal 


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for , September,  1949 


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average  surgeon  is  more  at  home  within  the 
abdomen  than  in  the  thorax?  Why  should  any 
pain  in  the  abdominal  area  almost  automatically 
initiate  his  thinking  in  terms  of  intra-abdominal 
viscera?  And  particularly  those  from  which  the 
patient  can  be  separated  surgically  without  too 
great  jeopardy,  such  as  the  appendix,  the  gall 
bladder,  and  the  female  generative  organs.  In 
this  connection,  apt  reference  is  made  to  Walter 
Alvarez’  survey  (p.  168)  of  255  patients  after 
appendectomy.  He  states  that  “a  patient,  es- 
pecially an  adult,  who  submits  to  appendectomy, 
having  never  had  an  acute  attack,  has  one 
chance  in  one  hundred  of  getting  a permanently 
satisfactory  result.  Also  that  he  has  one  chance 
in  one  hundred  of  not  surviving  the  operation.” 
Other  compelling  references  are  also  made  in 
this  connection,  and  a warning  to  the  surgeon 
is  herein  implied,  which  is  particularly  timely, 
since  the  laity  is  hearing  increasingly  of  “unnec- 
essary operations”  and  the  “removal  of  normal 
organs.”  The  authors  thus  constructively  widen 
the  mental  horizon  for  the  diagnostician  in  the 
field  of  abdominal  pain. 

In  this  field  of  abdominal  wall  neuralgia  vs. 
visceral  disease  the  authors  state  (p.  175)  that 
postoperative  adhesions  which  cause  pain  do  so 
by  interference  with  the  function  of  a hollow 
viscus.  Further,  that  other  related  symptoms 
are  usually  present,  such  as  nausea  or  vomiting, 
in  addition  to  the  subjective  complaint  of  pain. 
The  intensely  practical  suggestion  is  made  that 
it  is  hazardous  to  proceed  as  though  symptoms 
were  due  to  adhesions  when  abdominal  pain 
and  tenderness  only  are  present.  Under  such  cir- 
cumstances, other  diagnostic  possibilities  should 
be  carefully  appraised  before  still  another  sur- 
gical operation  is  assumed  to  be  necessary. 

The  helpful  suggestions  in  this  book  are  nu- 
merous. For  example  (p.  200),  “when  segmental 
tenderness  can  be  demonstrated  in  the  associa- 
tion with  pain,  it  probably  is  due  to  irritation 
at  some  portion  of  the  intraspinal  or  paraspinal 
elements  (roots  or  trunks),  which  constitute  the 
segmental  supply. 

“The  source  of  back  pain  ...  is  more  ac- 
curately defined  when  approached  not  only  from 
the  viewpoint  of  localization  by  segmental  ten- 
derness, but  by  distinguishing  pain  with  tender- 
ness from  pain  without  tenderness.” 

This  third  edition  possesses  certain  helpful 
additions  not  present  in  the  first  edition.  (The 
second  edition  is  not  available  for  comparison). 
Brachial  plexus  pain  and  the  scalenus  anticus 
syndrome  are  now  treated  in  separate  chapters. 
The  scalenus  anticus  syndrome  particularly  is 
much  better  delineated,  and  its  differential  diag- 
nosis further  elucidated  in  the  latest  edition. 
Endometriosis,  in  relation  to  backache,  receives 
attention  denied  it  in  earlier  editions.  Two  en- 
tirely new  chapters  received  the  headings,  “Atyp- 
ical Facial  Neuralgia,”  and  “Intravenous  Pro- 
caine.” 

The  authors  and  publishers  are  to  be  com- 
plimented on  the  readability  of  the  volume  be- 
cause of  its  pleasantly  clear  and  uncrowded 
print.  The  frequent  diagrams  and  photographs 
are  clear  and  informative.  The  photographs 
relating  to  postural  exercises  (pp.  37-45)  are 
especially  helpful.  The  reading  material  is  well 
organized  and  the  concise  case  histories  which 
appear  at  the  end  of  the  description  of  each  pain 
syndrome  are  advantageous. 

In  a captious  mood,  one  can  be  mystified,  if 
not  incredulous,  at  the  occasional  case  report 
(e.g,  S.  L.,  physician,  age  48,  p.  191)  of  chronic 
pain,  presumably  existing  solely  on  a somatic 


772 


Rocky  Mountain  Medical  Journal 


From  birth  to  the  end  of  the  bottle-feeding  period 


YOU  will  be  pleased  by  the  highly  satisfactory 
growth,  firm  muscle  tone  and  tissue  turgor 
when  you  prescribe  Baker’s  Modified  Milk,  be- 
cause Baker’s  is  a highly  nutritious  food  complete 
(except  for  Vitamin  C)  for  infants  from  birth 
throughout  the  bottle-feeding  period. 

Closely  conforming  to  human  milk.  Baker’s  is 
well  tolerated  by  both  premature  and  full-term 
infants.  No  change  in  formula  is  required  as  the 
baby  grows  older— just  increase  the  quantity 
of  feeding. 

These  are  qualities  making  Baker’s  Modified  Milk 
a fast-growing  favorite  among  doctors.  Obstetrical 
department  personnel  and  mothers  are  especially 
pleased  when  Baker’s  is  prescribed,  because 
Baker’s  requires  no  complicated  feeding  direc- 
tions. For  normal  feeding  strength,  merely  dilute 
liquid  Baker’s  with  equal  parts  of  boiled  water. 

Just  leave  instructions  with  the  obstetrical  super- 
visor at  the  hospital.  She  will  be  glad  to  put  your 
bottle-fed  babies  on  Baker’s. 


BAKERy' 

MODIFIEDMILK 


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BAKER’S  MODIFIED 

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ILK 


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Denver,  Seattle  and  Greensboro,  N.  C. 


for  September,  1949 


773 


NEWTON  OPTICAL  COMPANY 

GUILD  OPTICIANS 

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Phone  KEystone  0806 

Cotaring  to  Madical  Proiassion  Patronaga 


WANTADS 


FOR  SALE 

Used  60  Mi'lllampere  Victor  X-Ray  Machine.  At- 
tractive price  for  quick  disposal.  Write  United 
States  Vanadium  Corporation,  Box  1169,  Grand 
Junction,  Colorado. 


WANTEID 

A grood  Zimmer  Arm  and  Leg  reduction  apparatus 
in  good  condition.  Box  1,  Rocky  Mountain  Medi- 
cal Journal. 


basis,  apparently  relieved  permanently  follow- 
ing a single  paravertebral  infiltration  in  the 
absence  of  any  other  treatment. 

Furthermore,  %-inch  discrepancy  in  leg  length 
is  frequently  emphasized  (and  rightly  so)  in 
dealing  with  back  pain.  Yet  the  authors  seem 
discrepant  in  never  referring  to  the  important 
factor  of  obesity  alone  in  connection  with  the 
same  problem. 

The  book  is  marred  by  too  many  minor  im- 
perfections. They  are  enough  to  make  a per- 
fectionist morose  for  days.  Without  any  effort 
to  be  all-inclusive  the  following  examples  are 
cited; 

On  p.  18  the  reader  is  asked  to  see  p.  9,  Fig.  2, 
but  there  is  no  figure  on  p.  9. 

Although  your  reviewer  has  not  experienced 
the  lightning  pain  of  tabes,  he  doubts  that  one 
who  has  would  consent  to  have  the  pain  de- 
scribed as  “lightening”  (p.  18) 

On  p.  20  the  reader  is  referred  to  Figs.  13  and 
14  in  Chapter  10,  upon  turning  to  which  no 
such  figures  are  found. 

Under  Fig.  27  on  p.  42  the  instruction  here 
would  seem  to  be  more  rational  if  the  word 
“complete”  were  replaced  by  the  word  “op- 
posite.” 

The  caption  under  Fig.  29,  p.  44,  contains  the 
instruction  to  “‘bend  ^owly  to  side  of  lower 
head  three  times.”  “Hand”  is  obviously  intended 
instead  of  “head”  for  the  photograph  of  the  sub- 
ject shows  him  not  to  be  dicephalous. 

Another  typographical  error,  p.  177,  permits 
reference  to  a 12th  lumbar  nerve! 

“First  percussion”  (p.  195)  should  read  “fist 
percussion.” 

“Flufly”  (p.  297)  presumably  should  be 

“fluffy.” 

Many  of  these  errors  are  inexcusable,  especial- 
ly since  most  of  them  appear  in  the  first  edition 
and  remain  uncorrected  in  the  third,  but  to  the 
physician  of  average  literacy  the  errors  will  not 
be  a barrier  to  the  book’s  rich  substance.  This 
volume  is  recommended  for  thoughtful  perusal, 
and  for  repeated  reference  to  any  physician  who 
sees  patients  complaining  of  bodily  pain. 

IRA  DIXSON. 

I'raetical  Aspects  ot  Thyroid  Disease:  By  George 

Crile,  Jr.,  M.D.,  F.A.C.S.,  Department  of  Surgery, 

Cleveland  Clinic.  355  pages,  illustrated.  W.  E. 

Saunders  Company,  Philadelphia  & London,  1949. 

This  compact,  well-illustrated  monograph  pre- 
sents the  author’s  conclusions  on  problems  re- 
lating to  the  thyroid  gland  based  upon  his  per- 
sonal experience  in  the  surgical  treatment  of  ap- 
proximately 1,000  patients  and  from  observations 
made  on  several  hundred  patients  with  hyper- 
thyroidism treated  with  anti-thyroid  drugs  under 
the  direction  of  Dr.  E.  Perry  McCullough. 

This  book  should  be  of  interest  to  internists 
and  medical  students  as  well  as  surgeons.  Al- 
though the  author  does  discuss  certain  purely 
surgical  and  technical  problems,  including  the 
pre-  and  post-operative  management  of  patients 
with  thyroid  disease,  the  book  is  primarily  con- 
cerned with  the  pathology,  physiology  and  man- 
agement of  various  types  of  diseases  of  the 
thyroid  gland.  The  chapters  on  iodine,  anti- 
thyroid drugs  and  radio-active  iodine  in  the 
treatment  of  hyperthroidism  are  of  extreme  in- 
terest as  the  author  presents  a sane  attempt  to 
arrive  at  rational  indications  for  surgery  in  the 
treatment  of  thyroid  disease. 

In  regards  to  propylthirourocil  in  Graves’  dis- 
ease he  states  as  follows:  “Any  drug  which  is  as 


774 


Rocky  Mountain  Medical  Journal 


Your  local  pharmacy 
stocks  Neo-Antergan  Maleate 
in  25  mg.  and  50  mg.  tablets, 
supplied  in  packages  of  100  and  1,000. 


IN  HAY  FEVER 


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Antihistaminic 

Potency 

HIGH 

Index  of  Safety 

High  antihistaminic  potency,  com- 
bined with  a high  index  of  safety  and  a 
relatively  low  incidence  of  side  effects, 
recommend  Neo-Antergan*  for  prompt, 
safe,  symptomatic  relief  in  hay  fever 
and  other  aUergic  manifestations. 

In  a recent  clinical  studyi  in  which 
several  leading  antihistaminic  com- 
pmmds  were  employed,  Neo-Antergan 
was  foimd  to  have  little  or  no  sedative 
effect  in  the  majority  of  patients,  and 
became  the  favorite  medication  of  am- 
bulatory patients  who  were  treated  with 
more  than  one  antihistaminic  agent. 

*Neo-Antergan  is  the  registered  trade-mark  of 
Merck  & Co.,  Inc.  for  its  brand  of  pyranisamine. 

1.  Brewster,  J.  M.,  U.  S.  Naval  Med.  Bull.  49:  1-11, 
January-February  1949. 


MALEATE 

(Brand  of  Pyraniseminn  Moloote) 

(N-p-meihoxybenzyl-N'/N'-dlmethyi-N^o-pyndylethylenediamme  maleote) 

COUNCIL  ACCEPTED 


MERCK  & CO.,  Inc.  RAHWAY,  N.  J. 


for  September,  1949 


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The  Craving  for  Candy  Often  is 

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Recommend  Brecht’s 

For  Your  Patients  . . . 


SUGAR  PtiUMS  . . . tendereat  of  fruit-flav- 
ored Jelly  Candies,  made  with  susar,  corn 
syrup,  dextrose,  citrus  fruit  pectin,  U.  S. 
Certified  Colors.  Cellophane-topped  Party 
Packages. 

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safe  as  a surgical  operation  and  which  can  accom- 
plish the  same  ends  without  incurring  discom- 
fort, morbidity,  loss  of  time  from  work,  and  the 
expense  of  hospitalization  is  a better  therapeutic 
measure  than  surgery.  Propylthirourocil  fulfills 
these  qualifications  and  does  not  have  the  dis- 
advantage of  serious  toxicity  and  can  safely  and, 
apparently  in  many  cases,  completely  break  the 
vicious  circle  of  thyroid  stimulation.  Moreover, 
it  often  produces  a lasting  remission.  If  the 
remissions  obtained  after  physiologic  thyroidec- 
tomy induced  by  propylthirourocil  do  not  prove 
to  be  permanent  it  will  be  necessary  either  to 
give  small  maintenance  doses  of  propylthirourocil 
for  an  indefinite  period  of  time  or,  at  some  sub- 
sequent date,  with  the  hyperthyroidism  com- 
pletely controlled,  to  resort  to  thjrroidectomy. 
For  the  present,  at  least,  there  seem  to  be  few 
indications  for  thyroidectomy  as  a primary  treat- 
ment of  Graves’  disease  unless  the  gland  is  en- 
larged or  enlarges  under  treatment,  imless  the 
patient  is  uncooperative,  the  response  to  the 
anti-thyroid  drugs  is  incomplete  or  slow,  or  the 
patient  is  intolerant  of  the  drug. 

“When  goiters  contain  adenomas  of  real  size  the 
situation  is  different.  Tumors  are  present  in  the 
thyroid.  These  are  of  cosmestic  importance  and 
tend  to  enlarge  and  tend  to  produce  symptoms  of 
pressure  and  are  of  possible  significance  in  respect 
to  malignancy.  Because  the  risk  of  operation  is 
slight  xmless  the  patient  is  old  and  debilitated, 
because  hj^perthyroidism  rarely  recurs  after 
removal  of  a nodular  goiter,  thyroidectomy  re- 
mains the  treatment  of  choice  for  nodular  goiter 
with  hyperthyroidism.” 

During  1948  approximately  fifty  patients  with 
hyperthyroidism  were  treated  with  radio-active 
iodine  at  the  Cleveland  Clinic.  From  this  ex- 
perience the  author  draws  the  following  con- 
clusions: The  treatment  of  hyperthyroidism  with 
radio-active  iodine  is  extraordinarily  simple  from 
the  standpoint  of  both  patient  and  the  physician. 
Radiation  sickness  or  symptoms  of  local  irrita- 
tion have  not  occurred.  The  beneficial  effects 
are  noted  in  about  one  week  and  at  the  end  of 
two  months  the  full  effect  is  usually  apparent. 
The  average  initial  dose  for  mild  hyperthroidism 
is  3 to  4 millicuries  and  for  patients  with  severe 
hyjierthyroidism,  4 to  6 millicuries.  With  this 
dosage  approximately  three-quarters  of  the  pa- 
tients will  require  an  additional  dose  subse- 
quently. From  the  economic  standpoint,  radio- 
active iodine  has  advantages  over  thyroidectomy 
and  prolonged  treatment  with  propylthirourocil. 
The  actual  cost  of  the  iodine  used  in  the  average 
treatment  is  less  than  ten  dollars. 

The  author  concludes,  “Irradiation  given  by 
this  superior  method  of  treatment  is  so  con- 
trolled that  only  as  much  as  is  necessary  to 
control  the  hyperthyroidism  is  given.  'liiere 
would  seem  to  be  little  danger  of  late  ill-effects. 
Radio-active  iodine,  therefore,  bids  fair  to  be- 
come the  preferred  treatment  for  all  patients 
with  Graves’  disease  and  may  be  of  value  also 
in  selected  cases  of  nodular  goiter  with  hyper- 
thyroidism.” 

Almost  one-third  of  this  book  is  devoted  to 
the  problem  of  neoplastic  and  inflammatory  dis- 
eases of  the  thyroid  and  includes  many  carefully 
studied  case  histories  and  pathologic  examina- 
tions. This  section  of  the  book  will  serve  as  ex- 
ceUent  source  reading  for  any  physician  who 
might  be  called  upon  to  care  for  a patient  with 
thyroiditis  or  carcinoma  of  the  thyroid  gland. 

HENRY  SWAN. 


776 


Rocky  Mountain  Medical  Journal 


. HIGH  IN  PR0TEIN-19%-as  a result,  a single  ounce  of  Cerevim  provides  5)^  grams 
of  protein-plus: 

2.  THIAMINE-0.6  mg.  per  ounce  of  Cerevim  "The  cumulative  effects  throughout  a 
lifetime...  (of  thiamine )... may  spell  the  difference  between  alert,  successful 
living  and  a marginal  ef  fectiveness."i-plus : 

3.  NIACINAMIDE-6.0  mg.  per  ounce  of  Cerevim  in  accord  with  The  National  Research 
Council's  recommended  allowance^-since  "Nicotinic  acid  is  found  in  natural  foods 
only  in  limited  amounts."3-plus:. 

4.  RIBOFLAVIN-0.9  mg.  per  ounce  of  Cerevim  for  this  factor  is  directly  related  to 
growth^  and  is  "essential  to  the  defense  powers  of  the  organism"®- plus: 

5.  CALCIUM-300  mg.  per  ounce  of  Cerevim  thus  supplying  8 times  the  calcium  in  a 
fluid  ounce  of  milk-plus: 

6.  IRON-7.5  mg.  per  ounce  of  Cerevim  since  "a  child's  increasing  need  for  iron 
cannot  safely ibe  left  to  chance. "®-plus: 

7.  COPPER-0.3  mg.  per  ounce  of  Cerevim  '^9  in  the  1:25  ratio  which  Elvehjem,  et  al.'' 
and  Cason®  found  particularly  effective  in  raising  hemoglobin  levels  in  infancy. 


With  such  natural  foods  of  high  biologic  value  as: 


8.  WHOLE  WHEAT  MEAL  9.  OATMEAL  10.  CORN  MEAL  11.  NON-FAT  MILK  SOLIDS  12.  BARLEY 
13.  WHEAT  GERM  14.  BREWERS'  DRIED  YEAST  15.  MALT 

Leading  to  such  benefits  as  the  literature®  reports: 


16.  "increase  in  urinary  output  of  riboflavin"  17.  "improvement  in  pediatricians' 
scores"  18.  "improvement  in  skeletal  maturity"  19.  "improvement  in  skeletal 
mineralization"  20.  "retardation  of  increase  in  dental  caries"  21.  "recession 
of  corneal  vascularization"  22.  "improvement  in  the  condition  of  the  gums" 


23.  Better  Bowel  Function^® 


24.  PALATABILITY- Cerevim 
infants  and  children. 


makes  all  the  above  acceptable  as  well  as  available  to 


in  all— 24  good  reasons 
why  CEREVIM  • is 
a first  among  first  foods 

a pre-cooked  cereal  for  professional  specification  now 
produced  exclusively  at  the  M & R Dietetic  Laboratories 


BIBLIOGRAPHY: 

(1)  Harrell,  R.  F. : J.  Nutrition  31:283  ( Mar.)  1946. 

(2)  National  Research  Coun  c il,  Re  commended 
Dietary  Allowances,  1945. 

(3)  McLester,  J.  S. : Nutrition  and  Diet  in  Health 
and  Disease,ed.4,Phila.,W.B.  Saunders  Co.,  1943, p. 78. 

(4)  Sherman,  H.  C.:  Chemistry  of  Food  and  Nutri- 
tion, ed.  7,  N.  Y.,  Macmillan  Co.,  1946. 

(5)  Council  on  Pharmacy  and  Chemistry  and  Coun- 
cil on  Foods  of  the  A.M.  A. : The  Vitamins,  Chicago. 
American  Medical  Association,  1939. 


(6)  Dickson,  M.  A. : Yearbook  of  Agriculture,  U.S. 
Gov’t  Printing  Office, Supt. of  Documents.  Wash- 
ington, D.  C.,  1939,  p.  203. 

(7)  Elvehjem,  C.  A.;  Siemens,  A.,  and  Mendenhall, 
D.R. ; Am.  J.  Dis.  Child.  50:  28  (July)  1935. 

(8)  Cason,  J.  F. ; J.  Pediat.  614  (May)  1934. 

(9)  Urbach,  C.;  Mack,  P.  B.,  and  Stokes,  J.,  Jr. : Pedia- 
trics 1^:70  (Jan.)  1948. 

(10)  Joslin,  C.  L.,  and  Helms,  S.  T.:  Arch.  Pediat. 
54:547  (Sept.)  1937. 


for  September,  1949 


777 


Council  Accepted 


tUe.  6eidaii4*& 


prescribe  Bromural  for  daytime  sedation, 
one  tablet  every  three  to  five  hours.  For 
sleepy  2 or  3 tablets  upon  retiring  or 
when  wakeful  during  the  night. 

BROMURAL,  brand  of  Bromisovaium,  mono* 
bromisovalerylurea,  is  available  as  5-grain  tab- 
lets and  in  powder  form. 


ORANGE,  NEW  JERSEY 


Rocky  Mountain  Medical  Journal 


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FREE  IMMEDIATE  DELIVERIES 

ON  EMERGENCY  PRESCRIPTIONS 

763  South  University  Boulevard 

Phone  RAce  2874  — Denver,  Colorado 

WE  RECOMMEND 

Wbittaker’s  Pharmacy 

“The  Friendly  Store” 

PRESCRIPTION  SPECIALISTS 

West  32nd  and  Perry,  Denver,  Colo. 
Phone  GLendale  2401 

22  Years  in  North  Denver 

OTTO  DRUG  COMPANY 

TRY  US  FIRST 

Prescriptions  Accurately  Compounded 

Free  Delivery  Service 

(New  Location) 

5070  Federal  Boulevard  Denver,  Colorado 

Phone  GRand  9832 

780 


Rocky  Mountain  Medical  Journal 


RELIABLE  DRUGGISTS 

PATRONIZE  DENVER’S  INDEPENDENT  DRUGGISTS 


WALTERS  DREG  STORE 

WE  RECOMMEND 

801  COLORADO  BLVD. 

1.AKEWOOD  PHARMACY 

Denver,  Colorado 

R.  W.  Holtgren,  Prop. 

PRESCRIPTION  SPECIALISTS 

West  Colfax  at  Wadsworth 

Telephone  FRemont  5391 

Lakewood  ■ Colorado 

Phone  Lakewood  65 

UUut  to  at 

Downing  Street  Pharmacy 

WEISS  DRUG 

GEORGE  M.  HILL,  Prop. 

PROFESSIONAL  PHARMACIST 

PRESCRIPTION  SPECIALISTS 

901  Downing  St.  Denver,  Colo. 

Phone  CHerry  2767 

Colfax  and  Elm  Denver,  Colorado 

Complete  Merchandise  Line 

Phone  EAst  1814 

Free  Delivery  on  Prescriptions 

We  Recommend 

VAN'S  PHARMACY 

THOS.  A.  VANDERBUR 

Prescriptions,  nruga.  Cosmetics,  Magazines 
Sundries  Excellent  Fountain  Service 

28S9  Umatilla  St.,  Cor.  2&th  Ave.  at  Umatilla 

East  Denver’s  Prescription  Drug  Store 

^ i;i  n n i 0 tlUfJLiLJ 

Bert  C.  Corgan,  Prop. 

3401  FRANKLIN  STREET 

GRand  7044  Denver,  Colo. 

KEystone  7241 

Dansberry’s  Pharmacy 

OVERSTAKE’S  PHARMACY 

Gail  E.  Overstake 

“New  Ultra  Modern  Prescription  Service” 

Prescription  Specialists 

JAMES  F.  DANSBERRY 

DRUGS  — SUNDRIES  — 

Owner  and  Manager 

COSMETICS  — CANDIES 

Champa  at  14th  Street  Denver,  Colorado 

We  Deliver 

Phone  KEystone  469 

1000  So.  Gaylord  — RAce  4401 

Harl  Cleveland,  Owner 

PROFESSIONAL  MEN  RECOMMEND 

CLEVELAND  PHARMACY 

W.  29th  Ave.  at  Speer  Ph.  GL.  9272 

Modem  Prescription  Department 

^ 

Registered  Pharmacist 

Drugs  — • Sundries  — Soda  Fountain 

D.  MALCOLM  CAREY,  Pharmacist 

HOUBS:  Week  Days,  8 a.m.  to  10  p.m. 

Sundays.  10  am.  to  1 p.m.,  S pda.  to  S p.nu 

Prescriptions  Delivered  Promptly 

Phone  AComo  3711 

224  Sixteenth  Street  Denver,  Colorado 

for  September,  1949 


781 


MEDICAL  CENTER 
PHARMACY 

Located  in  the  New  Medical  Building 

3701  East  Colfax  DExter  5467 

DENVER,  COLO. 

Prescriptions  and  Medical  Supplies 

Wm.  K.  VAN  SANT,  Mgr. 

Free  Delivery 


YORK 

PHARMACY 

Denver’s  Finest  Prescription  Store 

Free  Delivery 

Phone  FR.  8837 

2300  East  Colfax  Avenue  at  York  Street 

Almay  Cosmetics 


yllba  Dairy 

Properly  Pasteurized  Milk 

Ice  Cream — Butter — Buttermilk 

a. 


Phone  1101 


Boulder,  Colo 


^ Your  Best 


BUY 


* PRINTING 


From 

DRYER-ASTLIR  PRINTING  CO. 


I 

^ 1936  Lawrence  Street  ^ 

^ KEystonc  6348  ^ 


The  Complete 

RENTAL  SERVICE 


Cooler  — Water  — Cups 
Modernize  Your  Office  With 

PURE  DEEP  ROCK 

Artesian  Water 


COLD  STORAGE  SPACE 

For  Biological  Supplies 


ICE  CUBES 

A Generous  Supply 


ELEC.  WATER  COOLERS 

All  Types  and  Makes 


FOR  RENT  OR  FOR  SALE 


DEEP  ROCK  WATER  CO. 

614  27th  St.  TAbor  5121 


782 


Rocky  Mountain  Medical  Journal 


SAVE  TIME 


With  a Ritter  Motor-Elevated  Table  you  save 
time,  save  effort.  Easily  accessible  foot  pedals  for 
raising,  lowering  and  rotating  with  slight  toe 
pressure  . . . tilting  lever,  and  automatic  locks 
within  easy  arm’s  reach.  This  popular  model  has 
range  of  elevations  2 5"  to  4l"  or  21"  to  45"  from 
top  of  table  to  floor.  Easily  adjusted  to  full  hor- 
izontal, chair,  head  low,  or  gynecological  posi- 
tions. Rotates  180°.  Tilting  position  approx- 
imately 33°  head  low;  about  5°  foot  low  position. 
Air  foam  rubber  cushions  give  exceptional  com- 
fort for  patients. 


MULTI-PURPOSE 

TABLE 

MODEL  "A”  TYPE  1 


INCREASE  PRACTICE 


Illustration  at  left  shows  same  model  in  position 
for  gynecological  examination.  Quickly,  easily 
adjusted  to  dozens  of  positions  and  arrangements 
for  every  type  examination  and  treatment.  Stir- 
rups compactly  fold  under  table,  yet  instantly 
available;  adjustable  9"  horizontal  by  slight 
finger  pressure  and  4"  vertically.  Stirrup  support 
will  also  accommodate  Bierhoff  crutches. 


lULTI-PURPOSE 
TABLE  ^ 
AODEL "A” 
fYPE  2 


Ideal  for  proctological  work.  Features  special 
Knee  Rest  . . . low  position  31",  high  position 
49"  from  top  of  table  to  floor  . . . extreme  tilt 
approximately  55°.  Special  offset  mounting 
assures  perfect  balance. 

Have  your  Ritter  surgical  dealer  demonstrate  how  Ritter  equip- 
ment can  lighten  your  work  and  save  your  time  immediately. 


Distributed  by 


PHYSICIANS  AND  HOSPITALS  SUPPLY  CO.,  Inc. 

MINNEAPOLIS  MINNESOTA 


MALONE  DRUG  CO. 

New,  Modern,  Drug  Store  Service 

PRESCRIPTIONS  A SPECIALTY 
FREE  DELIVERY 

100  So.  Broadway  SPruce  6226 

Denver,  Colorado 


Bonita  Pharmacy 

(Established  1921) 

Prescription  Pharmacists 

6th  Avenue  at  St.  Paul  Street 
“RICHT-A-WAY”  SERVICE 

GERALD  P.  MOORE,  Manager 

Phone  FRemont  2797 


50  ^eari  Icai  f^reicription 

Service  to  the  ^^ociorS  (^lie^enne 

ii 

ROEDEL^S 

PRESCRIPTION  DRUG  STORE 

CHEYENNE.  WYOMING 


KE  4271  Burnace  Hadley 

OUT  PATIENT  HOTEL  SERVICE 

for 

CONVALESCENTS 

offered  by 

TOURS  HOTEL 


East  Colfax  at  Lincoln 
Denver,  Colorado 


60  Rooms 
36  Baths 


Free  Parking 
Nurse  Escort 


Qolorado  Springs  ^Psychopathic  Hospital 

A Private  Hospital  for  Nervous  and  Mental  Diseases 

Situated  in  a beautiful  valley  two  miles  south  of  Colorado  Springs,  which  is  nationally  known  as  a health 
center.  New  building  for  mild  cases  of  Functional  Neurosis,  affording  complete  classification  of  patients. 
Home-like  surroundings,  scientific  medical  treatment  and  nursing  care.  Booklet  and  rates  on  applicotian. 

C.  P.  Rice,  Snperintendenf,  Colorado  Springs,  Colorado 


784 


Rocky  Mountain  Medical  Journal 


for  September,  1949 


785 


B»jar- 


WiNNiNG  Health 

in  the 

Pikes  Peak  Region 


COLORADO  SPRINGS 


Inquiries  Solicited 


GliOCKMER  PEimOSE  HOSPITAE 

Sisters  of  Charity 

HOME  OF  MODERN  SANATORIA 


WESTERN  ELECTRIC 

HEARING  AIDS 

Engineered  by  Bell  Telephone  Laboratories 


SOME  of  the  exclusive  features  of  thii 
new  Vacuum  Tube  Hearing  Aid  are; 
Sealed  Crystal  Microphone— gives  same 
dependable  service  under  all  conditions  of 
temperature  and  humidity.  Stabilized  Feed- 
back — amplification  without  distortion. 
No  sudden  blast  from  loud  sounds  when 
volume  is  turned  up. 

Foi  oihm  miomiaitieii  wiite  or  call 

M.  F.  Taylor  Laboratories 

721  Republic  Building 
MAin  1920  Denver,  Colo. 


FAIRFAX  SANITARIUM 

Kirkland,  Wash. 

Situoted  one  mite  north  of  Juanita 

TREATING  NERVOUS  AND 
MENTAL  DISEASES 

Beautiful  and  restful  surroundings  affording 
recreational  facilities.  Cottage  plan  for  segre- 
gation of  patients.  Insulin  and  Electro-shock 
Therapy  when  indicated. 

Attending  Physicians 

FREDERICK  LEMIRE,  M.B. 

NATHAN  K.  RlCKLiS,  M.D. 

JAMES  H.  LASATIR,  M.D. 

MORTON  E.  BASSAH,  M.D. 

JACK  J.  KLEIN,  M.D. 

Maneger:  A.  G.  HUGHES 
Route  2,  Box  365,  Kirkland 
Phone;  Kirkland  2391 


SERVICE 

QUALITY 

PAUL  WEISS 

PRESCRIPTION 

OPTICIAN 

1620  ARAPAHOE  ST.  DENVER 

MAin  1722 

783 


Rocky  Mountain  Medical  Journal 


^yUoodcro^t  Jdo6pita(—f^uelj(oy  C^oiorado 

A private  hospital  for  the  scientific  treatment  of  neuro-psychiatric  disorders,  including 
alcoholism  and  drug  addiction.  Beautiful  landscaping  and  home-like  surroundings  afford 
a restful  atmosphere.  Accommodations  vary  from  single  rooms  with  or  without  bath  to 
rooms  en  suite,  allowing  for  segregation  of  guests. 


Detailed  information  furnished  on  request. 


Karl  J.  Waggener,  M.D. 


Wendell  T.  Wingett,  M.D. 


THE  CHILDREN’S  HOSPITAL  ASSOCIATION 

of  DENVER 

NON-SECTARIAN NON-PROFIT 

Providing  medicinal  and  surgical  aid  to  sick  and  crippled  children  of  the  Rocky 
Mountain  Region  from  Birth  to  Maturity 

Every  modem  scientific  aid  available  to  the  physicians  and  surgeons 
of  Colorado  and  Wyoming 

Approved  by  the  American  Medical  Association  and  Full  Three-Year 

the  American  College  of  Surgeons  Nurses’  Training  Cour^se 


for  September,  1949 


787 


OFFICIAL 

REGISTRY 

Established  to  Meet  the  Community’s 
Every  Need  for  Nursing  Care 

★ -K  + 

GRADUATE  REGISTERED  NURSES 

Hourly  Nursing  Service  Positions 
Filled — -Information  on  All 
Nursing  Service 

This  reg'stry  is  endorsed  by  the 
Colorado  State  Graduate  Nurses’ 
Association  and  American  Nurses’ 
Association 

■K  dt 

Undergraduates  and  Practical  Nurses 
Furnished  Upon  Request 

KEvstone  0168 

ARGONAUT  HOTEL 


— ^ Complete 
l^roduction  S. 


et*uice 


ELECTROTYPES 

MATRICES 

STEREOTYPES 

PRINTING 

TYPOGRAPHY 


l/Uedtern 


Denver 
New  York 

Chicago  - - 


'6papei 


U 


nion 


~ - 1S30  Curtis  St. 

- - - 310  last  4Sth  St. 

- - 210  So.  Desplaines  St. 


And  33  Other  Cities 


SCHOOLDAYS 

ARE 

EYESTRAIN 
DAYS 


ClRTIFliD  LAMPS  

► Generous  light  for  eye  comfort  ► Proper  light  distribution 

► Smart  styling  to  fit  many  needs  ► Protection  against  glare 

CerfMedF  lamps  on  Display  af  Dealers  Stares 


Public  Service  Company  of  Colorado 


788 


Rocky  Mountain  Medical  Journal 


Shadel  Sanitarium  has  combined  research*, 
treatment  and  rehabilitation  to  return  thousands 
of  Alcoholics  to  normal  living.  Groundwork 
for  recovery  is  laid  through  intensive, 
individualized  therapy.  Statistical  evaluation  of 
results  since  1935,  have  shown  that  in  over 
3125  cases  reported*,  40%  remained  abstinent 
for  four  years  or  longer.  Our  object  is  . . . 
Cooperation  with  the  family  physician  in 
mapping  the  road  to  recovery. 


RECOGNIZED  BY  THE 

A.  M.  A. 


MEMBER  OF  THE 

A.  H.  A. 


1935  TO  1949 

SPECIALISTS  IN  THERAPY  FOR  CHRONIC  ALCOHOLISM 


BY  THE  CONDITIONED  REFLEX  AND  ADJUVANT  METHODS 
7106  35th  AVE.  S.  W.  SEATTLE  6,  WASH.,  WEST  7232,  CABLE  ADDRESS:  "REFLEX" 


/or  .September,  1949 


789 


LIVERMORE  SANITARIUM 


• The  Hydropathic  Department 
devoted  to  the  treatment  of  gen- 
eral diseases,  excluding  surgical 
and  acute  infectious  cases.  Special 
attention  given  funaional  and  or- 
ganic nervous  diseases.  A well 
equipped  clinical  laboratory  and 
modern  X-ray  Department  are  in 
use  for  diagnosis. 


• The  Cottage  Department  (for 
mental  patients)  has  its  own  fa- 
cilities for  hydropathic  and  other 
treatments.  It  consists  of  small 
cottages  with  homelike  surround- 
ings, permitting  the  segregation  of 
patients  in  accordance  with  the 
type  of  psychosis.  Also  bungalows 
for  individual  patients,  offering 
the  highest  class  of  accommoda- 
tions with  privacy  and  comfort. 


GENERAL  FEATURES 

1.  Climatic  advantages  not  excelled  in  United  States.  Beautiful  grounds  and  attractive  surrounding  country. 

2.  Indoor  and  outdoor  gymnastics  under  the  charge  of  an  athletic  director.  An  excellent  Occupational  Department. 

3.  A resident  medical  staff.  A large  and  well-trained  nursing  staff  so  that  each  patient  is  given  careful  individual  attention. 


Information  and  circulars  upon  request. 

Address:  O.  B.  JENSEN,  M.D. 
Superintendent  and  Medical  Director 
Livermore,  California 
Telephone  313 


CITY  OFFICES: 

San  Francisco  Oakland 


450  Sutter  Street 
GArfield  1-5040 


1624  Franklin  Street 
GLencourt  1-5988 


If  You  Send  Out  Statements 

ir  4 />££ 

ROCKMONT  Statement  Envelopes  save  time  in  your 
office  and  make  it  easy  for  the  patient  to  remit. 

The  statement  is  an  envelope  addressed  back  to  your 
office  and  goes  out  to  the  patient  in  a crystalite  window 
envelope,  thus  saving  one  complete  addressing  opera- 
tion, for  your  secretary.  All  the  patient  has  to  do  is 
simply  insert  check  and  mail. 

For  those  slow-pay  patients,  ROCKMONT 
"COLLECTELOPES”  will  get  results.  Three  colors 
identify  the  message  of  collection.  Proved  copy  brings 
payment  in  fast,  without  offending. 


and 

SPEEDS  UP 
COLLECTIONS! 


SPECIAL  OFFER  . . . ask  for  Assortment  "X"  . . . 500  Statement  envelopes/  plus 
500  "Collectelopes"  plus  1,000  window  envelopes  ALL  FOR  ONLY  $20.26  postpaid! 

Price  includes  imprinting 


ROCKMOHT  EMVEIOPE  COMPAHY 

Alameda  and  Cherokee  • PEarl  2484  • Oenver,  Colorado 


790 


Rocky  Mountain  Medical  Journai. 


Index  to  Advertisers 


Page 

Abbott  Laboratories 765 

Alba  Dairy 782 

American  Ambulance  Co 776 

American  Meat  Institute 759 

American  Medical  and  Dental 

Association 704 

Ames  Company,  Inc 711 

Ayerst,  McKenna  & Harrison_763 

Baker  Laboratories,  Inc 773 

Berber!,  George  and 

Sons Cover  III 

Bilhuber-Knoll  Corp. 778 

Boggio’s  Rotisserie 792 

Bonita  Pharmacy 784 

Bonnle-Brae  Drug 780 

Borden  Company 761 

Brecht  Candy  Company 776 

Brown  Schools 768 

Burroughs  Wellcome  & Co 709 

Cambridge  Dairy 700 

Camel  Cigarette 701 

Camp  & Co.,  S.  H 771 

Capital  Chevrolet 770 

Cascade  Laundry 772 

Children’s  Hospital  Assn 787 

City  Park  Dairy . 706 

Cleveland  Pharmacy 781 

Coca-Cola  Co.  778 

Colburn  Hotel 772 

Colorado  Springs 

Psychopathic,  Hospital 784 

Colvin  Medical  Books 792 

Continental  Casualty  Co 778 

Cook  County  Graduate 

School  of  Medicine 770 

Coors,  Adolph  Company 785 

Country  Club  Pharmacy 780 

Cutter  Laboratories 757 

Dansberry’s  Pharmacy 781 

Deep  Rock  Water 782 


Page 

Denver  Chemical  Manufac- 
turing Company 792 

Denver  Oxygen  Co 708 

Denver  Surgical  Supply  Co 792 

Dorr  Optical  Co.: 710 

Downing  Street  Pharmacy 781 

Doyle’s  Pharmacy 780 

Dryer-Astler  Printing  Co. 782 

Earnest  Drug  Company 780 

Ehret  Engraving  Co 708 

Fairfax  Sanitarium 786 

Pairhaven  Maternity 

Hospital  700 

Franklin  Drug  Company 781 

Glockner  Penrose  Hospital 786 

Holland-Rantos  Co.,  Inc 712 

Hyde’s  Pharmacy' 780 

Jackson’s  Cut  Rate  Drug 772 

Karg  Paint  Co 772 

Kendrick-Bellamy  Co. 698 

Kincaid’s  Pharmacy 780 

Lakewood  Pharmacy 781 

Lederle  Laboratories 707 

Lilly,  Eli  & Co. 

Insert  Between 712-713 

Livermore  Sanitarium 790 

M & R Dietetic  Labs.,  Inc 777 

Malone  Drug  Store 784 

Mead,  Johnson  & Co Cover  IV 

Medical  Center  Pharmacy 782 

Merck  & Company,  Inc 775 

Newton  Optical  Company 774 

Nurses  Official  Registry 788 

Otto  Drug  Co 780 

Overstake’s  Pharmacy 781 

Park  Floral  Company 708 

Parke,  Davis  & Co Cover  11-697 

Philip  Morris  & Company 769 

Physicians  & Hospitals 

Supply  Co. 783 


Page 


Physicians  and  Surgeons 

Supply  792 

Physicians  and  Surgeons 

Telephone  Service  Exch 774 

Physicians  Casualty  Assn 768 

Professional  Pharmacy 781 

Public  Service  Company 788 

Restaurant  240  772 

Roberts  Pharmacy 780 

Roche  Ambulance  Service 792 

Rockmont  Envelope  Co 790 

RoedeTs  Prescription  Drug 784 

Sobering  Corporation 703 

Searle,  G.  D.  & Co 755 

Shadel  Sanitarium 789 

Shadford-Fletcher  Optical  Co._706 

Shumake  Drug,  Guido 780 

Smith-Dorsey  Company,  The 767 

Stodgill’s  Imperial 

Pharmacy 792 

Telephone  Answering  iStervice_700 

Thornton,  George  R 698 

Tours  Hotel 784 

United  States  Brewing 

Industry  766 

Van’s  Pharmacy 781 

Walter’s.  Drug  Store 781 

Wantads  774 

Weiss  Drug 781 

Weiss,  Paul  786 

Western  Electric 

Hearing  Aids 786 

Western  Newspaper  Union 788 

Wheatridge  Farm  Dairy 774 

Whittaker’s  Pharmacy 780 

Winthrop-Stearns,  Inc — ^ 699 

Woodcroft  Hospital 787 

Wyeth,  Incorporated 705 

York  Pharmacy  782 


for  September,  1949 


791 


No  Test  Tubes  • No  Measuring  • No  Boiling 

Diabetics  welcome  “Spot  Tests”  (ready  to  use  dry 
reagents) , because  of  the  ease  and  simplicity  in  using. 

No  test  tubes,  no  boiling,  no  measuring;  just  a little 
powder,  a little  urine — color  reaction  occurs  at  once 
if  sugar  or  acetone  is  present. 

(dsnco) 

FOR  DETECTION  OF  FOR  DETECTION  OF 

SUGAR  IN  THE  URINE  ACETONE  IN  THE  URINE 


SAME  SIMPLE 
TECHNIQUE  FOR  BOTH 

1.  A LiniE  POWDER 

2.  A LITTLE  URINE 
COLOR  REACTION  IMMEDIATELY 


A carrying  case  containing  cne 
vial  of  Acetone  Test  (Denco) 
and  one  vial  of  Galatest  is  now 
available.  This  is  very  conven- 
ient for  the  medical  bag  or  for 
the  diabetic  patient.  The  case 
also  contains  a medicine  dropper 
and  a Galatest  color  chart.  This 
handy  kit  or  refills  of  Acetone 
Test  (Denco)  and  Galatest  are 
obtainable  at  all  prescription 
pharmacies  and  surgical  supply 
houses. 


Accepted  for  advertising  in  the  Journal  of  the  A.M.A. 
WRITE  FOR  DESCRIPTIVE  LITERATURE 


The  Denver  Dhemical  Manufacturing  Co.,  Inc. 

163  Vofick  Street,  New  York  13,  N.  Y.  • 


YOU  ARE  INVITED  TO  VISIT  OUR 
NEW  MODERN  STORE 

Conveniently  Located  to  Meet  the  Needs 
of  the  Doctor 


Pk 


DL 


Su 


■Supaiu  (^o. 


i^dicianS  kJJ  — jur^eoni 

Metropolitan  Bldg. 

221  Sixteenth  Street  TAbor  0156 

DENVER 


A SPECIFIC 

/or  that  awful  empty  feeling 
Boggio’s  fine  food,  excellent  service  and 
friendly  atmosphere  are  always  an  easy- 
to-take  prescription — relaxing,  soothing 

and  . . . 

Oh,  shucks,  you  know  what  we  mean. 
THERE  IS  STILL  ONLY  ONE  BOG- 
GIO’S.  Luncheons  from  50c.  Cocktails, 
Dinners,  Banquets. 

BOGGIO’S  ROTISSERIE 

Tremont  and  Broadway 

Denver  Colorado 


Stodghill's  Imperial  Pharmacy 

Prescriptions  Exclusively 


For  your  prescriptions  we  stock  a complete  line  of  ALMAY — non-allergic — cosmetics. 

Five  Pharmacists 

319  16th  St.  TAbor  4231  Denver,  Colo. 


COLVIIV-Medical  Books 

Medical  PubUcations  of  All  Publishers 

Books  Sent  for  Examination  on  Request 
We  Maintain  This  Book  Store  for  Your  Convenience 
Books  Make  Fine  Christmas  Gifts 
Write  or  Come  to 
705-706  MAJESTIC  BUILDING 

Denver  2,  Colorado  Call  MAin  3866 


Surgical  Supports  Expertly  Fitted. 

Miss  Mabel  P.  Cliff,  Authorized  Fitter 


^^enver  ^urqicai Suapiu  dc 


urqical  K^ompant^ 


“For  better  service  to  the  profession." 

1438-40  Tremont  Place  CHerry  4458 

Denver  2,  Colorado 


W.D.f^ocL 

Ambulance 
Service 

Prompt,  Careful  and  Courteous 
Serving  Denver  25  Years 

Approved  by  Physiciana  Genarally 

18th  Ave.  at  Gilpin  St.,  Phone  EA.  7733 


792 


Rocky  Mountain  Medical  Journal 


MADE  FOR  OFFICE  USE- 
PRICED  FOR  OFFICE  USE! 

SURGICALLY  ENGINEERED 
For  All  Minor  Electrosurgery 

*Here  is  a worthy  namesake  of  the  larger  hos- 
pital Bovies,  the  kind  used  and  preferred  by 
the  world's  leading  surgeons  and  hospitals. 
The  Office  Bovie  incorporates  many  of  the 
outstanding  features  of  the  big  Bovies — yet  it 
is  a elector's  Bovie — a compact,  easy-to-use 
electrosurgical  unit  made  especially  for  office 
electrosurgery. 

Bovie  Spark-gap  Cutting  as  well  as  Spark-gap 
Coagulating,  plus  a special  current  for  epila- 
tion are  features  of  this  unit.  It  will  perform 
a host  of  useful  surgical  techniques  — tech- 
niques which  will  be  of  invaluable  aid  in  your 
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BOILS,  DESICCATION  OF  WARTS,  CONIZA- 
TION OF  CERVIX,  ERADICATING  SKIN 
BLEMISHES,  EPILATION  (destruction  of  hair 
follicles  in  permanent  removal  of  unwanted 
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Prevention  and  Treatment  of  Roci 
Spotted  Fever — George  E.  Bak^ 

Presidential  Address- 
Fort  Collins. 

The  Psychology  op  th: 

Crisp,  M.D.,  Den 


Fred 


Maternal  Death; 
— Prepared 
fare  Com 
Associate 
Divisio, 

COLLES’ 
hu 


h 1945 
lid  Wel- 
'te  Medical 
Child  Health 
hard  of  Health. 

Merton,  M.D.,  Al- 


Serum  Jaundice  in 
ODUCTS  From  the  Belle 
Blood  Bank — Robert  S. 
Marion  R.  Rymer,  Ph.D., 

Annual  Meetings  of  the  Mon- 
"New  Mexico  State  Medical  So- 

(For  Complete  Table  of  Contents, 
turn  the  first  page) 


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DILANTIN' 

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of  epileptic  attacks  and,  at  the  same  time,  is  relatively  free  from 
hypnotic  side  actions.  There  is  little  or  no  tendency  to  habituation; 
the  dosage  initially  found  effective  usually  remains  so. 


PARKE,  DAVIS  & COMPANY 


THE  EPILEPTIC  PATIEXT 


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Table  of  Contents 


VOLUME  46  NUMBER  10 

OCTOBER,  1949 


Editorials 

This  Is  the  Month  to  Be  Generous 809 

Find  That  Diabetic 809 

The  Washington  Front 810 

Short  Scientific  Papers 811 


■f 


Original  Articles 

Prevention  and  Treatment  of  Rocky  Moun- 
tain Spotted  Fever,  George  E.  Baker, 

M.D 812 

Presidential  Address,  Fred  A.  Humphrey, 

M.D 828 

The  Psychology  of  the  Poor  Reader,  Wil- 
liam H.  Crisp,  M.D 833 

Maternal  Deaths  in  Montana  1940  Through 


1945,  a Preliminary  Report  Prepared  by 
the  Maternal  and  Child  Welfare  Com- 
mittee of  the  Montana  State  Medical  As- 
sociation and  the  Maternal  and  Child 
Health  Division  of  the  Montana  State 
Board  of  Health 836 

Colles’  Fracture,  Lewis  M.  Overton,  M.D...  842 

Incidence  of  Homologous  Serum  Jaundice 
in  Recipients  of  Blood  Products  From 
the  Belle  Bonfils  Memorial  Blood  Bank, 
Robert  S.  Liggett,  M.D.,  and  Marion  R. 
Rymer,  Ph.D 845 


4- 


Organization 

Colorado 

Ervin  A.  Hinds,  President-elect 850 

Second  Rocky  Mountain  Anesthesiologi- 

cal  Conference  Program 850 

Obituaries  852 

New  Mexico 

Annual  Meeting  of  the  House  of  Dele- 
gates, New  Mexico  Society 854 

Obituary  866 

Montana 

Council  Proceedings,  1949  Annual  Meet- 
ing   866 

Proceedings,  1949  Annual  Meeting, 
House  of  Delegates  of  the  Montana 
State  Medical  Association 866 

Colorado  State  Health  Department 827 

Book  Corner  878 

Tuberculosis  Abstracts  880 


794 


Rocky  Mountain  Medical  Journal 


A/^ 


...Nasal  Engorgement  Reduced 
...Soreness,  Congestion  Relieved 
...Aeration  Promoted 
...Drainage  Encouraged 


with 


^Afhen  Neo-Synephrine  comes  in  contact  with  the 
swollen,  irritated  mucous  membrane  of  the  nose,  the  patient 
soon  experiences  relief. 


This  powerful  vasoconstrictor  acts  quickly  to  shrink  engorged  mucous 
membranes,  restoring  easy  breathing,  and  promoting  free  drainage. 


The  prolonged  effect  of  Neo-Synephrine  makes  fewer  applications 
necessary  for  the  relief  of  nasal  congestion  — permitting  longer 
periods  of  comfort  and  rest. 


Neo-Synephrine  does  not  lose  its  effectiveness  on  repeated 
application  ...  It  may  be  employed  with  good  results 
throughout  the  hay  fever  season  ...  It  is  notable  for 
relative  freedom  from  sting  and  absence  of 
compensatory  congestion  . . . Virtually  no 
systemic  side  effects  are  produced. 


NEW  yoJtx  13,  N.  y.  Windsor,  Out. 


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Supplied  as: 

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14%  in  aromatic  isotonic  solution  of 
three  chlorides— 1 oz.  bottles. 

water  soluble  felly— % oz.  tubes. 


liiiMih, 


ROCKY  MOUNTAIN  MEDICAL  JOURNAL 

Title  Registered.  U.S.  Patent  Office 
Publication  Office: 

835  Republic  Building  (1612  Tremont  Place),  Denver  2,  Colorado 
Telephone  C Kerry  5521. 

EDITORIAL  BOARD 

Colorado:  Douglas  W.  Macomber,  M.D.,  Scientific  Editor,  1820  Gilpin  St.,  Denver;  Lyman  W.  Mason, 
M.D.,  Associate  Editor,  1214  Republic  Bldg.,  Denver,  (Chairman  of  Editorial  Board). 

Montana:  Raymond  F.  Peterson,  M.D.,  Scientific  Editor,  Butte,  Mont.;  Herbert  T.  Caraway,  M.D., 
Associate  Editor,  Billings,  Mont. 

New  Mexico:  Carl  H.  Gellenthein,  M.D.,  Scientific  Editor,  Valmora,  New  Mexico;  Harold  L.  Janu- 
ary, M.D.,  Associate  Editor,  First  National  Bank  Bldg.,  Albuquerque,  New  Mexico. 

Utah:  Richard  P.  Middleton,  M.D.,  Scientific  Editor,  Boston  Bldg.,  Salt  Lake  City;  W.  H.  Tibbals, 
Associate  Editor,  42  South  Fifth  East  St.,  Salt  Lake  City. 

Wyoming:  Earl  Whedon,  M.D.,  Scientific  Editor,  Sheridan;  Arthur  R.  Abbey,  Associate  Editor,  P.O. 
Box  897,  Cheyenne. 


Managing  Editor:  Harvey  T.  Sethman,  835  Republic  Bldg.,  Denver. 
Business  Manager:  Helen  Kearney,  835  Repubhc  Bldg.,  Denver. 


Ownership  and  Sponsorahlpi  The  Rocky  Mountain 
Medical  Journal  is  owned  by  the  Colorado  State 
Medical  Society  and  is  published  monthly  as  a non- 
profit enterprise  for  the  mutual  benefit  of  the  or- 
ganizations which  jointly  sponsor  it.  It  is  published 
under  the  direction  of  the  Board  of  Trustees  of  the 
Colorado  State  Medical  Society,  assisted  by  an  Edi- 
torial Board  representing  the  sponsoring  organiza- 
tions. It  is  the  Official  Journal  of  the  Colorado  State 
Medical  Society,  the  Montana  State  Medical  Associa- 
tion. the  New  Mexico  Medical  Society,  the  Utah 
State  Medical  Association,  the  Wyoming  State  Medi- 
cal Society,  the  Rocky  Mountain  Medical  Conference, 
and  tlie  Colorado  Hospital  Association. 

MannseriiitH:  Scientific  Articles,  Case  Reports,  etc., 
from  any  state  for  which  this  is  the  Official  Journal 
should  be  submitted  to  the  Scientific  Editor  for  that 
state  as  named  in  the  Editorial  Board,  above.  Other 
material  from  any  participating  state  should  be  sub- 
mitted to  the  Associate  Editor  for  that  state  as 
named  above.  Manuscripts  from  outside  the  Rocky 
Mountain  area  should  be  sent  direct  to  the  Journal 
office.  Manuscripts  must  be  typewritten,  double  or 
triple  spaced,  using  only  one  side  ot  each  sheet.  It 
is  the  policy  of  this  Journal  to  omit  bibliographies. 


Advertising:  National  representatives:  The  Coop- 
erative Medical  Advertising  Bureau,  535  North  Dear- 
born Street,  Chicago  10,  111.  Local  advertising  from 
firms  in  the  Rocky  Mountain  area  should  be  submit- 
ted to  the  Associate  Editor  of  the  appropriate  state 
or  to  the  Journal  office.  Advertising  forms  close  on 
the  20th  of  the  month  preceding  publication;  allow 
ten  days  additional  to  insure  submitting  proofs  for 
approval. 

Subscription:  |2.60  per  year  in  advance,  postpaid  in 
the  United  States  and  its  possessions;  single  copy, 
25  cents  plus  postage.  Subscription  is  included  in 
medical  society  dues  of  sponsoring  state  medical 
organizations. 

Copyright:  This  Journal  is  copyright,  1949,  by  the 
Colorado  State  Medical  Society.  Requests  for  permis- 
sion to  reproduce  anything  from  the  columns  of  this 
Journal  should  be  addressed  to  the  Journal  office. 

Second  Clasa  Matter:  Entered  as  second  class  mat- 
ter Jan.  22,  1906,  at  the  Postoffice  at  Denver,  Colo., 
under  the  Act  of  Congress  of  March  3,  1&7S.  Acceiked 
for  mailing  at  special  rates  of  postage  provided  for 
in  Section  1103,  Act  of  Oct.  3,  1917;  authorized  July 
17,  1918. 


The  Fairhaven  Maternity  Hospital 

Mrs.  H.  E.  Lowther,  Superintendent 

Seclusion  for  the  unwed  mother.  Write  for  descriptive  booklet. 

1349  JOSEPHINE  DExter  1411  DENVER 


Don't  miss  important  telephone  calls  . 


Let  us  act  as  your  secretai^  while  you  are  away,  day  or  night: 
our  kindly  voice  conscientiously  tends  your  telephone  business, 
accurately  reports  to  you  when  you  return. 


Telephone  ANSWERING  Service  call  ALpine  iam 


Cambridge  Dairy  Grade  “A”  Milk  Is  Prod  iced  and  Processed  at  690  S.  Colo.  Blvd. 

We  do  not  handle  Shipped-in  Milk  produced  Where?  How  and  by  Whom?  Doctors  know  the  difference 
Now  Homogenized  Vitamin  D Milk  is  available  for  baby  feeding  and  family  use. 

We  Invite  Your  Inspection  and  Appreciate  Your  Recommendation. 


■ ...A 

>•  . J 

i that's  whdJ  throat 

|i  specialists  reported  ■ ..j 

after  making  weekly 
HJ,  examinations  of  the 
WI  fhroots  of -hundreds  of 
Cl  men  and  women  from  ^ 
C coast  to  coast  who-  1|| 
smoked  ComeJs,  :and  ,i 

only  Camels,  for  30 
consecutive  days.  ’ 


E.  J. 
Reynolds 
Tobacco 
Co.. 


According  to  a Nationwide  survey: 


than  any  other  cigarette 

When  three  leading  independent  research  organizations  asked  113,597 
doctors  what  cigarette  they  smoked,  the  brand  named  most  was  Camel! 


for  October,  1949 


797 


THE  COLORADO  STATE  MEDICAL  SOCIETY 

Next  Annual  Session:  Broadmoor  Hotel,  Colorado  Springs,  September  20,  21,  22,  23,  1950 


OFPICE3RS 

Terras  oi  Officers  and  Comraittees  expire  at  the  Annual  Session 
in  the  year  indicated.  Where  no  year  is  indicated,  the  term 
is  for  one  year  only  and  expires  at  the  1950.  Annual  Session. 

President:  Fred  A.  Humphrey.  Fort  Collins. 

President-Elect:  Ervin  A.  Hinds,  Denver. 

Vice  President:  A.  B.  Gjeilum.  Del  Norte. 

Constitutional  Secretary  (three  years):  George  E.  Buck,  Denver,  1951. 

Treasurer  (three  years):  George  C.  Shivers,  Colorado  Springs,  1950. 

Additional  Trustees  (three  years) : Samuel  P.  Newman,  Denver,  1950; 

Claude  D.  Bonham,  Boulder,  1951;  Cyrus  W.  And"rson,  Denver,  1952; 

E.  H,  Munro,  Grand  Junction,  1952. 

(The  above  nine  officers  compose  the  Board  of  Trustees  of  which  Dr. 
Samuel  P.  Newmdn  is  the  1949-1950  Chairraaa) 

Board  of  Councilors  (three  years):  District  No.  1:  Clemens  F.  Eakins, 
Bnish.  1951;  No.  2:  Ella  A.  Mead,  Greeley,  1951;  No.  3;  L.  G.  Crosby, 

Denver.  1951  (Chairman  of  Board  for  1949-50);  No.  4;  Banning  B. 

Likes,  Lamar,  1950;  No.  5;  Guy  H.  Hopkins,  Pueblo,  1950;  No.  6;  C.  Bex 
Fuller,  Salida,  1950;  No.  7,  Leo  W.  Lloyd,  Durango,  1952;  No.  8;  Arch 
H.  Gould,  Grand  Junction,  1952;  No.  9:  Marvel  L.  Crawford,  Steamboat 
Springs,  1952. 

Board  of  Supervisors  (two  years):  L.  D.  Buchanan,  Wray,  1950;  W.  F. 
Deal,  Craig,  1950;  G.  C.  Caiy,  Grand  Junction,  1950;  W.  A.  Campbeii, 
Colorado  Springs,,  1950;  Ralph  S.  .Johnston,  Sr.,  La  Junta,  1950;  William 
A.  Liggett,  Denver,  1950;  Edgar  A.  Elliff,  Sterling,  1951;  Keith  F. 

Krausnick,  Lamar,  1951;  Charles  L.  Mason,  Durango,  1951;  Ira  L. 

Howell,  Alamosa.  1951;  Howard  H.  Heuston,  Boulder,  1951;  George  M. 
Myers,  Pueblo,  1951. 

Delegates  to  American  Medical  Association  (two  years) : William  H. 
Halley,  Denver.  1950;  (Alternate:  Kenneth  C.  Sawyer,  Denver,  1950); 

George  A.  Unfug,  Pueblo,  1951;  (Alternate:  Herman  C.  Graves,  Grand 
Junction,  1951). 

Foundation  Advocate:  Walter  W.  King,  Denver. 

Executive  Office  Staff:  Mr.  Harvey  T.  Sethman,  Executive  Secretary: 
Miss  Helen  Kearney,  Assistant  Executive  Secretary:  Mr.  Evan  A.  Edwards, 
Public  Relations  Director  and  Field  Secretary,  835  Republic  Building, 
Denver  2,  Colorado,  Telephone  CHerry  5521. 

General  Counsel;  Mr.  J.  Peter  Nordlund,  Attoniey-at-Law,  Denver. 


STANDING  COMMITTEES 

Credentials:  George  R.  Buck,  Denver,  Chairman;  others  to  be  appointed. 

Public  Policy:  M.  L.  Phelps,  Denver,  Chairman:  C.  F.  Hegner,  Denver: 
I.  E.  Hendryson.  Denver,  Vice  Chairman;  F.  B.  McGlone,  Denver:  W,  R. 
Lipscomb,  Denver;  T.  M.  Rogers,  Sterling;  Sidney  Anderson,  Alamosa; 
Harvey  M.  Tupper,  Grant  Junction;  C.  S.  Gydesen,  Colorado  Springs;  R.  L. 
Davis,  La  Junta;  R.  T.  Porter,  Greeley;  G.  C.  Milligan,  Englewood;  Francis 
S.  Adams,  Pueblo:  Ex-Officio  Members:  F.  A.  Humphrey,  Fort  Collins,  Presi- 
dent: Ervin  A.  Hinds,  Denver,  President-Elect;  George  R.  Buck,  Denver, 
Constitutional  Secretary. 

Sub-Committee  on  Legislation:  John  B.  Farley,  Pueblo,  Chairman. 

Health  Education  (two  years):  B.  H.  Munro,  Grand  Junction,  1950: 
F.  0.  Robertson,  Denver,  1950;  R.  B.  Bradshaw,  Alamosa,  1950;  .James 
A.  Matson,  Denver,  1950.;  Miss  Norma  Johannis,  Denver,  1950:  H.  T. 
Low,  Pueblo,  1950;  .1.  D.  Bartholomew,  Boulder,  Chairman,  1951:  A.  C. 
Sudan,  Denver,  1951;  R.  J.  Savage,  Denver,  1951. 

Sub-Committee  on  Weekly  Health  Column:  J.  L.  Campbell,  Denver,  Chair- 
man: F,  C.  Campbell,  Denver;  E.  L.  Binkley,  Denver;  H.  F.  Bramley, 
Denver. 

Scientific  Work:  Terry  J.  Gromer,  Denver,  Chairman;  William  B.  Condon, 
Denver:  Robert  S.  Liggett,  Denver;  E.  L.  Binkley,  Jr.,  Denver;  T,  E.  Best. 
Denver:  James  -M.  Perkins,  Denver;  Joseph  H.  Patterson,  Denver. 

Arrangements:  To  be  appointed. 


Medicolegal  (two  years):  R.  W.  Arndt,  Denver,  1950;  George  B.  Packard, 
Denver,  1950;  K.  D.  A.  Allen,  Denver,  1950;  C.  S.  Bluemel,  Denver, 
Chairman,  1951;  Lyman  W.  Mason,  Denver,  1951;  Atha  Thomas,  Denver, 
1951. 

Medical  Education  and  Hospitals:  W.  H.  Halley,  Denver,  Chairman; 
George  F.  Wollgast,  Denver;  Ervin  A.  Hinds,  Denver;  James  E.  Hutchison, 
Denver:  Robert  S.  Liggett,  Denver;  Henry  Swan,  Denver;  J.  B.  McNaught, 
Denver.  Ex-Officio  Members:  F.  A.  Humphrey,  Fort  Collins,  ITesident, 
C.S.M.S. ; Mr.  Hubert  W.  Hughes,  Denver,  President,  Colo.  Hosp.  Assoc.; 
Ward  Darley,  Dir.  of  the  Univ.  of  Colo.  Medical  Center. 

Library  and  Medical  Literature:  W.  W.  King,  Denver,  Chairman;  A.  J. 
Markley,  Denver;  T.  E.  Beyer,  Denver. 

Medical  Service  Plans:  James  R.  Blair,  Denver,  Chairman:  F.  H.  Good, 
Denver;  T.  K Mahan.  Grand  .Junction;  V.  L.  Bolton,  Colorado  Springs; 
Scott  A,  Gale.  Pueblo;  L.  W.  Holden,  Boulder;  J.  A.  Weaver,  Jr.,  Greeley. 

Necrology:  R.  C.  Chatfield,  Denver,  Chairman. 


PUBLIC  HEALTH  COMMITTEES 

General  Committee  on  Public  Health:  Consists  of  the  chairmen  of  the 
following  eigiit  public  health  sub -committees,  presided  over  by  James  S. 
Cullyford,  Denver,  as  General  Chairman. 

Cancer  Control:  Stanley  K.  Kurland,  Denver,  Chairman;  J.  C.  Mendenhall, 
Denver;  L.  E.  Likes,  Lamar. 

Tuberculosis  Control:  John  I.  Zarit,  Denver,  Chairman;  W.  J.  Hinzelman, 
Greeley:  J.  P.  McGraw,  Jhieblo. 

Sanitation:  H.  D.  Palmer,  Denver,  Chairman;  G.  W.  Stiles,  Denver; 
S.  W.  Downing,  Denver. 

Rural  Health  and  Health  Units:  Robert  M.  Lee,  Fort  Collins,  Chairman: 

L.  N.  Myers,  Cheyenne  Wells;  M.  R.  Tyler,  Denver. 

Industrial  Health:  R.  F.  Bell,  Louviers,  Chairman;  David  W.  Boyer, 
Pueblo:  Nicholas  S.  Saliba,  Walsenburg. 

Maternal  and  Child  Health:  J.  L.  Sadler.  Fort  Collins,  Chairman;  J.  H. 
AmesSe,  Denver:  J,  ,'D.  WTiitmore,  Denver. 

Rehabilitation  and  Crippled  Children:  H.  C.  Hughes,  Denver,  Chairman; 
Lewis  Barbato,  Denver;  M.  G.  Nims,  Denver;  W.  W.  Haggart,  Denver; 

R.  H.  Mellen,  Colorado  Springs;  John  Nelson,  Denver. 

Mental  Hygiene:  F.  H.  Zimmerman,  Pueblo,  Chairman;  Bradford  Murphey, 
Denver;  J,  M.  Lyon,  Denver. 

SPECIAL  COMMITTEES 

Rocky  Mountain  Medical  Conference  (five  years) ; D.  W.  Macoraber, 
Denver,  1954;  L.  Clark  Hepp,  Denver,  1953;  G.  P.  Lingenfelter,  Denver, 
Chairman,  1952;  Ward  Darley,  Denver,  1951;  L.  W.  Bortree,  Colorado 

Springs,  1950. 

Advisory  to  Auxiliary:  Ervin  A.  Hinds,  Denver,  Chairman;  Samuel  P. 

Newman,  Denver;  M.  L.  Phelps,  Denver. 

Medical  Disaster  Commission:  Foster  Matchett,  Denver,  Chairman;  0.  S. 
Philpott,  Denver,  Vice  Chairman;  Karl  F.  Amdt,  Denver,  Secretary;  Harry 
C.  Hughes,  Denver;  R.  J.  McDonald,  Denver;  Karl  F.  Sunderland,  Denver: 

Henry  Swan,  Denver:  Rudolph  E.  Glehm,  Denver;  William  S.  Curtis,  Denver; 

M.  S.  Donovan,  Denver;  T.  P.  Sears,  Port  Logan.  Others  to  be  appointed. 

Advisory  to  U.M.W.  Welfare  Fund  (Executive  Committtee,  three-year 

terms;  others,  one  year);  Executive:  Ligon  Price,  Hayden,  1952;  J.  H. 

Lamme,  Walsenburg.  1952;  W.  W.  Haggart,  Chairman,  1951;  F.  H.  Good, 
1951;  J.  S.  Boiislog,  1951,  all  of  Denver;  W.  H.  Halley,  1950;  C.  F. 
Hegner,  1950.,  both  of  Denver;  R.  P.  Bell,  1950,  Louviers.  Other  mem- 

bers: D.  W.  McCarty,  Longmont,  1950:  J.  W.  Craighead,  Pueblo,  1950; 
F.  A.  Humphrey,  Port  Collins,  1950;  Miliard  P.  Smith,  Trinidad,  1950. 

Delegate  to  Colorado  Interprofessional  Council  (five  years) : L.  R. 

Safarik,  Denver,  1954;  (Alternate,  J.  R.  Evans,  Denver,  1954). 

Representative  to  Rocky  Mountain  Radio  Council:  I.  E.  Hendryson,  Denver. 


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Flexible  tablet  dosage  ranges  from  one  0.02  mg. 
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MONTANA  STATE  MEDICAL  ASSOCIATION 


NEXT  ANNUAL  SESSION:  BOZEMAN,  MONTANA,  SUMMER,  1950 


OFFICERS,  1»49-1»50 

Terms  of  Officers  and  Committees  expire  at  the  Annual  Session 
in  the  year  indicated.  Where  no  year  is  indicated,  the  term 
is  for  one  year  only  and  expires  at  1950  Annual  Session. 

President:  Thomas  F.  Walker,  Great  Falls. 

President-Elect:  C.  H.  Fredrickson,  Missoula. 

Vice  President:  F.  L.  McPhaH,  Great  Falls. 

Secretary-Treasurer:  Herbert  T.  Caraway,  Billings. 

Delegate  to  Ameriean  Medical  Association:  Raymond  F.  Peterson,  Butte, 
1950;  Alternate,  Thomas  B.  Moore,  Kalispell,  1950. 


STANDING  COMMITTEES 

Executive  Committee:  Thomas  F.  Walker.  Great  Falls.  Chairman;  C.  H. 
Fredrickson.  Missoula:  H.  T.  Caraway,  Billings;  L.  W.  Allard,  Billings: 
T.  L.  Hawkins,  Helena. 

Economics  Committee:  J.  C.  Shields,  Butte,  Chairman;  C.  P.  Brooke,  St 
Ignatius;  B.  B.  Dumln,  Great  Falls;  Leland  0.  RusscU,  Billings;  S.  D. 
Whetstone,  Cut  Bank. 

Legislative  Committee:  J.  M.  FUnn.  Helena,  Cbalrman;  F.  D.  Hurd, 
Gnat  Falls;  P.  E.  Kane,  Butte;  J.  C.  MacGregor,  Great  Falls;  Claude 
M.  Hears,  Helena. 

Necrology  and  History  of  Medicine  Committee:  L.  W.  Brewer,  Missoula, 
Chairman;  I.  J.  Brldenstine.  Missoula;  J.  H.  Irwin,  Great  Falls;  Claude 
M.  Hears.  Helena'  J.  P.  Bitchey,  Missoula. 

Public  Relations  Committee:  H.  W.  Gregg,  Butte,  Chairman;  W.  L.  DuBois, 
Cut  Bank;  R.  V.  Morledge,  BllUnga;  W.  H.  Stephan,  DiUon;  Dora  Walker, 
Great  Fails. 

Legal  Affairs  and  Malpractice  Committee:  J.  C.  MacGregor,  Great  Falls, 
Chairman;  Raymond  Eck,  Lesrlstown;  W.  E.  Harria,  Livingstoa;  John  E. 
Hynes,  Billings;  R.  D.  Knapp,  Wolf  Point. 

Program  Committee:  C.  H.  Fredrickson,  Missoula,  Chairman;  H.  T. 
Caraway,  BlUings  H.  W.  Gregg,  Butte;  J.  J.  McCabe,  Helena;  E.  S. 
Murphy.  Missoula. 

interprofessional  Relationship  Committee;  L.  W.  AUard,  Billings.  Chair- 
man; C.  R.  Canty.  Butte;  S.  A.  Cooney,  Helena;  S.  N.  Preston,  Missoula; 
F.  I.  Sabo,  Bozeman. 


Nominating  Committee:  H.  H.  Janies,  Butte,  Chairman;  E.  L.  Andenon, 
Fort  Benton;  R.  D.  Harper,  Sidney;  J.  J.  Malee,  Anaconda;  W.  B.  Ma- 
Elwee,  Townsend. 

Auditing  Committee:  E.  H.  Llndstrom,  Helena,  Chairman;  F.  H.  GHga, 
Great  Falls;  R.  D.  Harper,  Sidney;  G.  W.  Setzer,  Malta;  B.  G.  Johnsno, 
Harlowton. 

Cancer  Cemmittee;  Mary  E.  Martin,  BlUlngs,  Chairman;  W.  F.  Caah- 
more,  Helena;  C.  H.  Fredrickson,  Missoula;  R.  F.  Peterson,  Butte;  W.  C. 
Robinson,  Shelby. 

Maternal  and  Child  Welfare  Committee:  F.  L.  McFhall,  Great  Falla, 
Chairman;  L.  W.  Brewer,  Missoula;  P.  L.  Eneboe,  Bozeman;  Mauda  M. 
Gerdes,  Billings;  D.  L.  GlUesple,  Butte;  A.  L.  Gleason,  Great  Falls;  E.  L. 
Hall,  Great  FaUs;  D.  S.  MacKeuzle,  Jr.,  Havre;  B.  E.  Mattlson,  BilUnga; 
0.  M.  Moore,  Helena;  F.  W.  Paul,  Kalispell;  C.  W.  Pemberton,  Butte; 
S.  N.  Preston,  Missoula;  A.  E.  Bltt,  Great  Falls. 

Tuberculosis  Committee:  F.  I.  TerriU,  Galen,  Chairman;  C.  B.  Craft, 
Bozeman;  E.  A.  Dolan,  Anaconda;  A.  R.  Klntner,  Missoula;  J.  A.  Layno. 
Great  Falls. 

Fracture  and  Orthopedic  Committee:  J.  K.  Colman,  Butte,  Chairman;  L.  C. 
Allard,  Billings;  W.  H.  Hagen,  Billings;  S.  L.  Odgets,  Butte;  J.  C.  Wol- 
gamot.  Great  Falls. 

Rural  Health  Committee:  B.  C.  Farraod,  Jordan,  Chairman:  B.  A. 
Benke,  KalispeU;  W.  A.  Lacey,  Hayre;  W.  G.  TangUn.  Poison;  J.  H. 
WilUams,  Culbertson. 

Industrial  Welfare  Committee:  R.  B.  Richardson,  Great  Falla,  Qialnnan; 
M.  A.  Gold,  Butte;  P.  E.  Logan,  Great  Falls;  D.  S.  HacEenzle,  Jr.,  Ham; 
R.  E.  Walker,  Livingston. 

Rheumatic  Fever  and  Heart  Committee:  F.  B.  Scfaemm,  Great  Falla, 
Chairman;  D.  T.  Berg,  Helena;  H.  W.  Gregg,  Butte;  A.  B.  Klntner,  Mli- 
soula;  P.  E.  Logan,  Great  Falls;  F.  H.  Lowe,  Missoula;  J.  J.  MalM, 
Anaconda;  0.  M.  Moore,  Helena;  H.  W.  Power,  Conrad;  B.  E.  Smalley, 
Billings. 


SPECIAE  COMMITTEES 

Emergency  Medical  Service  Committee:  B.  F.  Peterson.  Butte.  Chalnun; 
Paul  J.  Gans,  Lewlstown;  J.  J.  McCabe,  Heleu;  S.  A.  Olson,  GSeadin; 
L.  G.  RusseU,  BlUlngs. 

lAB  Fee  Schedule  Committee;  H.  E.  James.  Butte,  Cbainnan;  S.  E. 
Llndstrom,  Helena;  J.  J.  Malee,  Anaconda;  D.  S.  McKenzie.  Jr,,  Bavra; 
F.  K.  Waniata,  Great  FaUs. 


Collection 


Accounts 


All  reports  show  a trend  toward  slower  and  harder  collections  in  the 
months  ahead. 

At  the  first  sign  of  neglect  you  will  save  money  if  they  are  turned  over 
to  us  for  collection. 

Comparison  of  collection  results,  hacked  by  35  years  of  experience,  proves 
you  obtain  greater  results  at  less  cost,  when  you  list  your  accounts 


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Rocky  Mountain  Medical  Journal 


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M 


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Aqueous  Suspension 
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Plain 


Ifigrtditfif. 
f*!in«r»l  OW  85%. 

D'lRtCTtONSs  Adults,  one  table- 
iisoontgl,  CtiiW'fen  <sve-f  Six  years 
Old;  on«  teaspbonful.  May  be 
thinned  with  wtier,  mifk  or  fruit 
juice  if  desired. 

CAUTION;  To  be  taken  only  at 
bedtime,.  Do  riot  use  at  any  other 
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upon  the  advice  of  a physician. 

SHAKE  WELL 

iHCOtiroRxreD  • rNiuioEirHr« . pa. 


■for  October,  1949 


801 


NEW  MEXICO  MEDICAL  SOCIETY 


OFFICERS— 1949-1950 

President:  .1.  W.  Hannett,  Albuquerque. 

President-Elect:  I.  J.  Marshall,  Roswell. 

Vice  President:  Leland  S.  Evans,  Las  Cruces. 

Seeretary-Treasiirer:  H.  L.  January,  Albuquerque. 

Executive  Secretary:  Mr.  Ralph  R.  Marshall,  Albuquerque. 

Conneilors  (3  years) : Carl  Mulky,  Albuquerque;  J.  C.  Sedgwick,  Las 
Cruces.  (2  years):  W.  D.  Dabbs,  Cloris;  A.  C.  Shuler,  Carlsbad.  (1  year): 
A.  S.  iathrop,  Santa  Fe;  C.  H.  Gellenthien,  Valmora. 

Delegate  to  A.M.A. : John  F.  Conway,  Clovis,  1950. 

Alternate  Delegate  to  A.M.A.:  C.  H.  Gellenthien,  Valmora,  1950. 

COMMITTEES— 1949-1950 

Basie  Science:  Raymond  L.  Young,  Santa  Fe.  Chairman;  W.  E.  Nissen, 
Albuquerque;  Walter  A.  Stark,  Las  Vegas. 

Rural  Medical  Smite:  Stuart  Adler,  Albuquerque,  Chairman;  Samuel  E. 
Zeigler,  Espanola,  A.  T.  Gordon,  Tucumcaii;  L.  G.  Foster,  Reserve;  J.  P. 
Turner,  Carrlzozo. 

Cancer;  Murray  Friedman,  Santa  Fe,  Chairman;  Van  A.  Odle,  Boswell; 
J.  R.  Van  Atta,  Albuquerque;  J.  W.  Grossman,  Albuquerque;  R.  C.  Derby- 
shire, Artesia. 


Vcneria!  Disease  Control:  Sam  Jelso,  Albuquerque,  Chairman;  V.  E.  Berch- 
told,  Santa  Fe;  L.  M.  Miles,  Albuquerque;  Vincent  Accardi,  Gallup;  F.  C. 
Bohannon,  Carlsbad. 

Legislative  and  Fsblie  Policy:  A.  S.  Lathrop,  Santa  Fe,  ChairmaB;  H.  T. 
Watson,  Gallup;  C.  B.  Elliott,  Baton;  John  F.  Conway,  Clovis;  H.  M.  Mor- 
timer, Las  Vegas:  G.  S.  Morrison,  Roswell;  D.  B.  Marsh,  Demlng;  E.  A. 
Watts,  Silver  City;  Ashley  Pond,  Taos;  W.  L.  Mlnear,  Hot  Springs;  L.  S. 
Evans,  Las  Cruras;  W.  M.  Thaxton,  Tucumcari;  William  C.  White,  Los 
Alamos;  W.  0.  Connor,  Albuquerque;  C.  S.  Stone,  Hobbs;  A.  C.  Shuler, 
Carlsbad. 

Piblic  Relations:  C.  P.  Baneh,  Artesia,  Chairman;  Earl  L.  Malone,  Bos- 
well; 0.  S.  Cramer,  Albuquerque;  Eric  P.  Hausner,  Santa  Fe. 

Tabcrenlosis:  C.  H.  Gellenthien,  Valmora,  Chairman;  William  H.  Thearie, 
Albuquerque;  P.  0.  Shields,  Albuquerque;  Carl  Mulky,  Albuquerque;  H.  S. 
A.  Alexander,  Santa  Fe. 

Advisory  Con.mittee  on  Insoranee  C®miieiisati®ii:  L.  M.  Overton.  Albuquer- 
que, Chairman;  E.  E.  Forbis,  Albuqwniue;  Edward  Pamall,  Albuquerque;  H. 
D.  Corbusier,  Santa  Fe. 

National  EroergiBcy  Medical  Senrfee:  A.  E.  Keymont,  Santa  Fe,  Chair- 
man; L.  G.  Rice,  Albuquerque;  C.  M.  Thompson,  Albuquerque. 

Board  of  Supervisors:  L.  G.  Bice,  Bernalillo  County;  Van  A.  Odle,  Chaves 
County;  Milton  Floersheim,  Colfax  County;  John  P.  Conway,  Cuny  County; 
C.  P.  Buneh,  Eddy  County;  Frank  W.  Parker.  Jr.,  MeKlnley  County; 
LeGrand  Ward,  Santa  Fe  County:  W.  A.  Stark,  San  Miguel  County. 


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Dispensing  Opticians 
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3705  East  Colfax  (Medical  Center  Building).  FLorido  0202 


These  fine  Dairy  Cattie,  a portion  of  City  Park’s  large  herd  of  Guernsey  and  Holstein 
cows,  are  scientifically  fed  and  cared  for,  continuously  tested  by  competent  veterin- 
arians. Only  through  such  precise  v/atchfulness  does  City  Park  Milk  receive  Grade 
"A”  designation  which  it  enjoys.  Choose  City  Park’s  regular  Grade  “A”  Pasteurized 
or  Homogenized  milk  today  — • notice  the  particularly  clean,  fresh  flavor. 


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addition  to  attacking  the  Gram-positive  cocci  with  great  effectiveness,  it  is  useful  against 
many  Gram-negative  organisms,  particularly  those  of  the  coli-aerogenes  group.  It  is  also  effective 
against  rickettsial  infections  and  certain  diseases  of  unknown  etiologies,  such  as  primary  atypical 
pneumonia.  Aureomycin  in  solution  with  sodium  borate  has  been  found  highly  effective  in  the 
eye  in  a concentration  of  one-half  per  cent.  Among  others  it  is  active  against  the  diplobacillus  of 
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for  October,  1949 


803 


THE  UTAH  STATE  MEDICAL  ASSOCIATION 


OFFICERS,  1»49-105O 
President:  Conrad  H.  Jenson,  Ogden. 

President-Elect;  V.  P.  White,  Salt  Lake  City. 

Past  President:  0.  A.  OgUrie,  Salt  Lake  City. 

Honorary  President:  D.  G.  Edmunds,  Salt  Lake  City. 

First  Vice  President:  Sims  E.  Duggins,  Pangultch. 

Second  Vice  President:  Jules  E.  Trowbridge,  Bountiful. 

Third  Vice  President:  Seth  E.  Smoot,  Provo. 

Secretary:  T.  C.  Weggeland,  Salt  Lake  City. 

Executive  Secretary:  Mr.  W.  H.  Tibbals,  Salt  Lake  City. 

Treasurer:  L.  J.  Paul,  Sait  Lake  City. 

Counciior  First  District:  J.  G.  Olson,  Ogden. 

Councilor  Second  District:  Vincent  L.  Rees,  Salt  Lake  City. 

Councilor  Third  District:  L.  W.  Oaks,  Provo. 

Delegate  to  A.M.A.,  1950  and  1951:  George  Pister,  Ogden. 

Alternate  Delegate  toi  A.M.A.,  1950  and  1951:  J.  J.  Weight,  Provo. 
Editor  of  the  Utah  Section  of  the  Rocky  Mountain  Medical  Journal: 
R.  P.  Middleton,  Salt  Lake  City. 

Board  of  Supervisors:  1951,  Clark  Rich,  Ogden;  1952,  Ezra  Cragun, 
Logan;  1953,  Paul  K.  Edmunds,  Cedar  City;  1954,  J.  G.  McQuarrie, 
Richfield;  1955,  J.  C.  Hubbard,  Price. 

STANDING  COMMITTEES 
Rocky  Mountain  Medical  Conference  Continuing  Committee:  1950,  K.  B. 
Castleton,  Chairman,  Salt  Lake  City;  1951,  Clark  Rich,  Ogden;  1952, 
Noall  Z.  Tanner,  Layton;  1953,  T.  R.  Seager,  Vernal;  1954,  R.  P. 
Middleton,  S.alt  Lake  City. 

Scientific  Program  Committee:  T.  C.  Weggeland,  Chairman,  Salt  Lake 
City;  Vincent  L.  Kees,  Salt  Lake  City. 

Public  Policy  and  Legislation  Committee:  1950,  N.  F.  Hlcken,  Chair- 

man, Salt  L.ake  City;  1950,  Omar  Budge,  Logan;  1950,  George  A.  Allen, 
Salt  Lake  City;  1951,  F.  R.  King,  Price;  1951,  R.  V.  Larson,  Roose- 

velt; 1951,  W.  B.  West,  Ogden;  1952,  Chas.  Buggeri,  Salt  Lake  City; 
1952,  J.  C.  Hubbard,  Price;  1952,  Wllford  G.  Biesinger,  SpringvHle. 

Medical  Defense  Committee:  1950,  Homer  Smith,  Salt  Lake  City; 
1950,  L.  N.  Ossman,  Chairman,  Salt  Lake  City;  1950,  Edwin  D.  Zeman. 
Ogden;  1951,  Charles  W.  Woodruff,  Salt  Lake  City;  1951,  James  West- 
wood,  Provo;  1951,  L.  H.  MerriU,  Hiawatha;  1952,  E.  L.  Hanson, 
Logan;  1952,  Reed  Farnsworth,  Cedar  City:  1952,  H.  A.  Dewey,  Richfield. 

Medical  Education  and  Hospitals  Committee:  1950,  G.  G.  Richards, 
Chairman,  Sait  Lake  City;  1950,  Ray  T.  Woolsey,  Salt  Lake  City;  1950, 
T.  E.  Robinson,  Salt  Lake  City;  1951,  John  Bowen,  Provo;  1951,  George 


H.  Curtis,  Salt  Late  City;  1951,  R.  0.  Porter,  Logan;  1952,  Ralph 
EUis,  Ogden;  1952,  PhUip  Price,  Salt  Lake  City;  1952,  W.  H.  Ander- 
son, Ogden, 

Medical  Economies  Committee:  1950,  W.  T.  Ward,  Salt  Lake  City; 
1951,  W.  R.  MerriU,  Brigham  City;  1951,  Ralph  Pendleton,  Chairman,’ 
Salt  Lake  City;  1952,  Grant  F.  Kearns,  Ogden;  1952,  Preston  Hughes, 
Spanish  Fork. 

Public  Health  Committee:  1950,  F.  D.  Spencer,  Salt  Lake  City;  1951, 
R.  N.  Hirst,  Ogden;  1952,  Seth  E.  Smoot,  Provo;  1952,  James  Z. 
Davis,  Chairman,  Salt  Lake  City. 

Military  Affairs  and  National  Emergency  Committee:  Charles  Woodruff, 
Chairman,  Salt  Lake  City;  L.  J.  Paul,  Salt  Lake  City;  Mazel  Skolfield, 
Salt  Lake  City;  W.  M.  Gorlshek,  StandardvUle;  L.  K.  CulUmore,  Orem; 
Ray  H.  Barton.  Magna;  D.  T.  Madsen,  Price;  Riley  G.  Clark,  Provo; 
Willis  Hayward,  Logan;  Leo  Benson,  Ogden. 

Tuberculosis  and  Cardiovascular  Diseases  Committee:  Elmer  M.  Kirkpatrick. 
Chairman,  Salt  Lake  City;  Kay  Rumel,  Salt  Lake  City;  W.  C.  Walker, 
Salt  Lake  City;  Donald  M.  Moore,  Ogden;  Don  C.  MerriU,  Provo;  D.  0. 
N.  Lindberg  (Associate  Member),  Ogden. 

Cancer  Committee:  James  P.  Kerby,  Salt  Lake  City;  E.  A.  Lawrence, 
Salt  Lake  City;  J.  Elmer  Nielson,  Chairman,  Salt  Lake  City;  E.  D.  Zeman, 
Ogden;  James  Westwood,  Provo;  W.  J.  Reichman,  St.  George;  J.  Clare 
Hayward,  Logan;  K.  V.  Larsen,  Roosevelt;  T.  R.  GledhiU,  Eichfield; 
Quinn  A.  Whiting,  Price. 

Fracture  Committee:  A.  M.  Okelberry,  Chairman,  Salt  Lake  City;  Boyd 
G.  Holbrook,  Salt  Lake  City;  Louis  Peery,  Ogden;  Paul  A.  Pemberton, 

Salt  Lake  City. 

Necrology  Committee:  E.  B.  Muir,  Chairman,  Salt  Lake  City;  A.  S. 
Crandall,  Salt  Lake  City. 

Industrial  Health  Committee:  Frank  J.  Winget,  Chairman,  Salt  Lake 
City;  Byron  W.  Daynes,  Salt  Lake  City;  Wayne  Aired,  Orem;  W.  F. 
Loomis.  Ogden;  Sherman  Brinton,  Salt  Lake  City. 

Advisory  Cotamittee  to  the  Woman’s  Auxiliary:  Silas  S.  Smith,  Chair- 

man, Salt  Lake  City;  A.  A.  Imus,  Ogden;  J.  R.  Smith,  Provo. 

Public  Relations  Committee:  Ray  T.  Woolsey,  Chairman,  Salt  Lake  City; 
L.  V.  Broadbent,  Cedar  City;  Geo.  H.  Lowe,  Jr.,  Ogden;  0.  P.  Henlnger, 
Provo;  R.  .N.  Malouf,  Eichfield;  Ray  E.  Spendlove,  Vernal;  Paul  Burgess, 
Hyrum;  J.  Leroy  KimbaU,  Salt  Lake  City. 

Mental  Health  Committee:  E.  L.  Weimers,  Provo;  Wm.  D.  O’Gormaa, 

Ogden;  L.  G.  Moench,  Salt  Lake  City;  Roy  A.  Darke,  Chairman,  Salt 
Lake  City. 

Rural  Health  Committee:  J.  J.  Weight,  Chairman.  Provo;  Joseph 
Tanner,  Layton;  T.  R.  Aldous,  Tooele;  Harold  E.  Young.  Midvale;  J.  H. 
Rasmussen,  Brigham  City. 

Professional  and  Hospital  Relationships  Committee:  James  P.  Kerby, 
Chairman,  Salt  Lake  City;  V.  P.  White,  Salt  Lake  City;  R.  P.  Middle- 
ton,  Salt  Lake  City;  Leland  B.  Cowan,  Sait  Lake  City;  V.  L.  Ward, 

Ogden;  J.  Russell  Smith,  Provo;  Hugh  0.  Brown,  Salt  Lake  City. 


([better  ^iowerS  at  ^eaSonaLie  f^ricei 

“Orders  Delivered  to  Any  City  by 

Corner  10th  and  Lawrence  Sts. 

Guaranteed  Service” 

TAbor  5138 

Special  attention  given  to  floral  tributes 
Also  Hospital  Flowers 

Medical  Gas  Division 

MEDICAL  OXYGEN 

Call  KEystoiie  5106 

CARBON  DIOXIDE-OXYGEN 
MIXTURES 

Vark  3loral  Co.  Store 

AVIATORS’  BREATHING  OXYGEN 
WATER  COMPRESSED  NITROGEN 

WATER  COMPRESSED  AIR 

1643  Broadway  Denver,  Colo. 

Twenty-Four  Hour  Service 

COLOR  PROCESS. 
LINE  & HALFTONE 


ILLUSTRATOR5-DESIGNER5 


804 


Rocky  Mountain  Medical  Journal 


30  day  wonder 


The  new-born  infant  is  truly  a "30-day  wonder"  taking  in  his 
stride  the  sudden  changes  birth  imposes  and  adjusting  accord- 
ingly. The  rapid  increase  in  weight  is,  alone,  a feat  no  adult  could 
duplicate.  The  right  start  on  the  right  feeding  is  of  vital  import- 
ance—particularly  during  the  first  30  days  when  infant  mortality 
is  at  its  highest  and  when  he  not  only  must  regain  his  birthweight 
but  keep  on  gaining  if  he  is  to  survive. 

'Dexin'  has  proved  an  excellent  "first  carbohydrate"  because  of 
its  high  dextrin  content.  It  (l)  resists  fermentation  by  the  usual 
intestinal  organisms,-  (2)  tends  to  hold  gas  formation,  distention 
and  diarrhea  to  a minimum,  and  (3)  promotes  the  formation  of 
soft,  flocculent,  easily  digested  curds. 

Simply  prepared  in  hot  or  cold  milk,  'Dexin'  brand  High  Dextrin 
Carbohydrate  provides  well-taken  and  well-retained  nourishment. 
'Dexin'  does  make  a difference.  Literature  on  request 


k 

HIGH  DEXTRIN  CARBOHYDRATE 

BRAND 

Composition — Dextrins  75%  • Maltose  24%  • Mineral  Ash  0.25%  • Moisture 
0.75%  • Available  carbohydrate  99%  • 115  calories  per  ounce  • 6 level  packed 
tablespoonfuls  equal  1 ounce  • Containers  of  twelve  ounces  and  three  pounds  • 
Accepted  by  the  Council  on  Foods  and  Nutrition.  American  Medical  Association. 

•Dexin’  Reg.  Trademark 

^3  BURROUGHS  WELLCOME  & CO.  (U.S.A.)  INC,  9 & 11  East  41st  St.,  New  York  17,  N.  Y. 


/or  October,  1949 


805 


THE  WYOMING  STATE  MEDICAL  SOCIETY 


OFFICERS 


PrMidont:  George  E.  Baker,  Casper. 

President-Elect:  DeWltt  Dominick,  Cody. 

Vice  President:  K.  E.  Krueger,  Rock  Springs. 
Treasurer:  V.  M.  Schunk,  Sheridan. 

CorrespondlnB  Secretary:  George  H.  Phelps,  Cheyenne. 
Delegate  A M. A.:  R.  H.  Reeve,  Casper. 

Alternate  Delegate  A.M.A.:  W.  A.  Bunten,  Cheyenne. 
Executive  Secretary:  Mr.  Arthur  Abbey,  Cheyenne. 


COMMITTEES 

Rocky  Mountain  Mcdicai  Conference;  Earl  Whedon,  Chairman,  Sheridan; 
George  N.  Phelps,  Cheyenne;  H.  h.  Harvey,  Casper;  C.  W.  Jeffrey,  RawUm; 
L.  W.  Storey,  Laramie, 

Syphilis  Committee;  N.  E.  Morad,  Chairman,  Casper;  0.  M.  Gniehmt, 
Worland;  L.  H.  Wilmoth,  Lander;  L.  G.  Booth,  Sheridan;  F.  H.  Halgler, 
Midwest. 

Cancer  Committee:  Earl  Whedon,  Chairman,  Sheridan;  John  Gramlleh, 
Cheyenne;  DeWitt  Dominick,  Co)^;  J.  R.  Newman,  Kemmerer;  E.  W.  New- 
man, Cheyenne. 

Medical  Economics  Committee:  C.  L.  Rogers,  Cbaliman,  Sheridan;  Nels 
A.  VicUund,  TbermopoUs;  R.  A.  Corbett,  Saratoga;  0.  B.  James,  Casper; 
S.  S.  Hellewell,  Evanston. 

Fracture  Committee:  Philip  Teal,  Chairman,  Cheyenne;  Silva  J.  Giovale, 
Cheyenne:  Robert  V.  Batterton,  Rawlins;  Lowell  D.  Kattenhom,  Powell; 
Joseph  E.  Hoadley,  Gillette. 

Medical  Defense  Committee:  George  Baker,  Chairman,  Casper;  Andrew 
Bunten.  Cheyenne;  E.  W.  DeKay,  Laramie. 

Councillors:  Earl  Whedon,  Chairman,  Sheridan;  B.  J.  Boesel,  Cheyenne; 
E.  W.  DeKay,  Laramie;  George  Baker,  President,  Casper;  George  Phelps, 
Secretary,  Cheyenne. 

Advisory  to  Woman’s  Auxiliary:  John  B.  Bunch,  Chairman,  Laramie; 
Virgil  L.  Thorpe,  Newcastle;  H.  J.  Aldrich,  Sheridan;  Q.  B.  Savory,  Chey- 
enne. 

Advisory  to  Workmen’s  Compensation  Department:  J.  D.  Shingle,  Chair- 
man, Cheyenne:  G.  H.  Phelps,  Cheyenne;  W.  A.  Bunten,  Cheyenne;  K H. 
Reeve,  Casper;  Albert  T.  Sudman,  Green  River;  P.  M.  Schunk,  Sheridan. 


Industrial  Health  Committee;  K.  E.  Krueger,  Chatman,  Bo^  Sprlnga; 
Willard  Pennoyer,  Cheyenne;  Thomas  B.  Croft,  Level!;  B«geae  Ptlton, 
Laramie. 

Veterans’  Affairs  and  Military  Senrica  Committee;  A.  J.  AUqprettl,  Chair- 
man, Cheyenne;  Jack  Rowlett,  Lanule;  Everett  ElUs,  Cheyenne;  Bernard 
Sullivan,  Laramie;  G.  W.  Koford,  Cheyenne;  Bernard  Stack,  thknoDoUi: 
J.  W.  Sampson,  Sheridan;  DeWitt  Domiidek,  Cody;  Paul  B.  Holti,  Lander; 
George  E.  Baker,  President,  Casper;  George  Phelps,  Secretary,  Oteyenne. 

Blue  Cross  Hospital  Committee;  R.  I.  Williams,  Chairman,  Cheyenne,  19S0; 
W.  A.  Bunten,  Cheyenne,  1949;  E.  W.  DeKay,  Laramie,  1951;  Cedkie 
Jones,  Cody,  1952. 

Public  Policy  and  Legislation:  George  Phelps,  Chairman,  Cheyenne; 

Andrew  Bunten,  Cheyenne;  George  Baker,  President,  Casper;  0.  W.  Koford, 
Cheyenne;  E.  W.  DeKay,  Laramie:  G.  W.  Henderson,  Casper. 

National  Physicians  ComnlttM;  George  Phelps,  Chairman,  Cheyenne; 

Andrew  Bunten.  Treasurer,  Cheyenne;  E.  W.  DeKay,  Laramie;  Omge  Baker, 
Casper. 

Poliomyelitis  Committee;  H.  L.  Harvey,  Chairman,  Casper;  N.  A.  Vieklund, 
Thermopolls : Leo  Keenan,  Torrington;  DeWitt  Dominick,  Cody;  Philip  Teal, 
Cheyenne;  Franklin  Yoder,  Cheyenne:  F.  A.  Mills,  BawUns. 

State  institetions  Advisory  Committee;  J.  F.  Whalen,  Chairman,  Evam- 
ton;  George  Phelps,  Cheyenne;  C.  W.  Jeffrey,  Rawlins;  Earl  WhedM,  Sheri- 
dan; G.  M.  Groshart,  Worland;  B.  H.  Kanable,  Basin. 

Necrology  Committee:  Earl  Whedon,  Chairman,  Sheridan;  J^  B. 
Krahl,  Torrington;  Franklin  Yoder,  Cheyenne. 

Rural  Hdalth  Committee;  Paul  HolU,  Chairman,  Lander;  Andrew  Bun- 
ten.  Cheyenne;  Samuel  Wortben,  Afton;  Wm.  K.  Rosene,  t^eatland;  Claude 
Raffl,  Basin. 

Public  Health  Department  Liaison  Committee;  E.  C.  Blckieway,  Chair- 
man, Cody;  B.  P.  Fitzgerald,  Casper;  E.  V.  Batterton,  RawUiu:  J.  W. 
Sampson,  Sheridan;  R.  C.  Stratton,  Green  River;  WiUatd  Penniver, 
Cheyenne.  ' 

Child  Health  Committee;  Paul  W.  Emerson,  Chairman,  Cheyenne;  John 
Gramlleh,  Cheyenne;  Thomas  Croft,  Lovell;  Bernard  Sullivan,  Laramie; 
Paul  B.  Holtz,  Lander;  Geo.  E.  Baker,  Casper;  A.  B.  Abbey,  Cheymine. 

Council  on  National  Ementeney  Mediiml  Service;  George  E.  Phel^, 
Chairman,  Cheyenne;  R.  H.  Reeve,  Casper;  DeWitt  Dominick,  Cody;  E.  W. 
DeKay,  Laramie;  K.  S.  Krueger,  Radt  Springs;  P.  M.  Schunk,  Sheridan. 


COLORADO  HOSPITAL  ASSOCIATION 


OFFICX2RS 

President:  Hubert  W.  Hughes,  General  Rose  Hospital,  Denver. 
President-Elect:  Walter  G.  Christie,  Presbyterian  Hospital.  Denver. 

Vice  President:  Sister  M.  Domnina,  SL  Anthony  Hospital,  Denver. 
Traaserer:  M.  A.  Moritz.  Denver  General  Hospital,  Denver. 

Acting  Executive  Secretary:  Roy  R.  Anderson,  Presbyterian  Hospital,  Denver. 
Trustees:  Boy  B.  Prangley,  St.  Luke’s  Hospital,  Denver  (1949);  James 
P.  Dixon,  M.D..  Denver  General  Hospital,  Denver  (1949);  Louia  Liswood, 
National  Jewish  Hospital,  Denver  (1950);  DeMoss  Taliaferro,  Children’s 
Hospital,  Denver  (1950);  Boy  B.  Anderson,  Presbyterian  Hospital.  Den- 
ver (1951);  Rev.  AUen  H.  Erb,  Mennonlte  Hospital,  La  Junta,  Colo. 
(1951). 

Delegate  to  the  American  Hospital  Association;  Herbert  A.  Black,  M.D., 
Parkview  Hospital,  Pueblo. 

Alternate:  Msgr.  John  B.  Mulroy,  Catholic  Hospitals,  Denver. 

STANDING  COMMITTEIEJS 
Auditing;  B W.  Pontow,  Chairman  (1949),  Colorado  General  Hospital, 
Denver:  Rev.  E.  J.  Friedrich  (1950.),  Lutheran  Sanatorium,  Wbeatrlike; 
Karl  Mortensen  (1951),  St.  Luke’s  Hospital,  Denver. 

Constitutiot)  and  Rules:  Samuel  S.  Golden,  M.O.,  Chairman,  Beth  Israel 
Hospital,  Denver;  Henry  H.  HiU,  Weld  County  Hospital,  Greoley;  Slater 
M.  Johanna,  Sacred  Heart  H(»pital,  Lamar. 

Legislatlvo:  Mv.  John  B.  Mulroy,  Chairman,  CatboUe  Hospitala^  Den- 
ver; DeMrms  Taliaferro,  Children’s  Hospital,  Denver;  Carl  Sdhwalb, 
Denver;  Herbert  A.  Black,  M.D.,  Parkview  Hospital,  PueblOk 

Membership:  Sister  M.  Alpbonsus  Chairman,  Mercy  Hospital,  Denver; 
Boy  B.  Prangley,  St  Luke’s  Hospital,  Denver. 

RMolitlons:  Walter  0.  Christie,  Chatman,  Pr^yterian  Hospital,  Denver; 
Carl  Ph.  Schwalb.  Denver. 

Nominating;  M«r.  John  R.  Mulroy,  Chairman  (1949),  CathoUc  Hos- 
pitals, Denver;  Herbert  A.  Black,  M.D.  (1950),  Parkview  Hospital,  Pu^lo; 
C.  S.  Bluemel,  M.D.  (1951),  Mount  Airy  Sanatorium,  Denver. 

Program:  George  A.  W.  Currie,  M.D.,  Chairman,  Hnlvmlty  <rf  Colorado 
Medical  Ohter.  Denver;  Boy  Anderson,  Presbyterian  Hospital.  Denver. 


Nursing:  DcM^  TaUaferro,  Chairman,  Children’s  Hospital,  Denver; 
Sister  M.  Hugolina,  St  Anthony  Hospital,  Denver;  Margaret  E.  Faerimldc, 
Director  of  Ni.rses,  Denver  General  Hospital,  Denver;  Sister  Maria  Gratia, 
R.N.,  Glockner  Sanatorium,  Colorado  Spring;  8.  Buss  Denzlef,  H.D., 
Colorado  Hospital,  Canon  City. 

Public  Education:  Owen  B.  Stubben,  Chairman,  Denver  General  Hoepital, 
Denver;  Mr.  Torgersen,  Lon^ont  Hospital  and  CMnie,  Longmont;  Ward 

Barley,  M.D.,  Director,  University  of  Colorado  Medical  Center,  Denver; 
Chas.  Levine,  J.C.R.S.,  Spivak. 

SFBJCIAl,  COMMITTESBS 

Public  Relations;  Jam^  P.  Dixon,  M.D.,  Oialrman,  Denver  General 
Hospital,  Denver;  Sister  Mary  Lina.  St  Francis  Hospital,  Colorado  Springs. 

Rates  and  Charges:  Roy  Andemon,  Cbaimmn,  Pr^yterlao  HospltsH, 
Denver;  Msgr.  John  R.  Mulroy,  CathoUc  Hospitals,  Denver:  Boy  B. 

Prangley,  St  Luke’s  Hospital,  Denver;  Walter  Q.  Christie,  ProsbyteriaB 
Hospital  Denver;  DeMoss  Taliaferro,  Children’s  Hospital,  Denver;  Ben 
M.  Blumberg,  General  Bose  Memorial  HtBpltal,  Denver. 

State  Board  of  Hmilth  Advisory:  Bihgr.  John  B.  Mulroy,  Chalimaii. 
Catholic  Hosplals,  Denver;  DeMoss  Tallafenta,  Chtldren’a  Hospital,  Denver; 

Herbert  A.  Black.  M.D.,  Parkview  Hospital,  Pueblo. 

Committee  on  Hospital  Licensing  Rwulatimi  and  Staniardi;  Msgr.  Jdbn 
B.  Mulroy,  Chairman.  Catholic  Hospitals,  Denver:  Boy  B.  Praugl^,  St 
Luke’s  Hospital,  Denver;  Owen  B.  Stubben,  Denver  General  Hospital,  Dmvw; 
DeM^  TaUaferro,  Children’s  Ho^ltal,  Denver:  Boy  Anderson,  Presbyterian 
Hospital,  Denver. 

Premature  Infant  Care:  DcMms  Taliaferro,  Chairman,  Ohldlren’i  Bm- 
pital,  Denver;  Boy  Anderson,  Presbyterian  Hospital,  Denver. 

Rehabilitation  ^nter:  P.  Dixon,  M.D.,  Denver  General  Hospital, 

Denver;  Msgr.  John  B.  Mulroy,  CathoUc  EospitaJa,  Denvw;  Loots  M. 
Liswood.  National  Jewish  Hospital,  Denver. 

Inter-Professional  Coundl;  Hubert  W.  Hughes,  St  Anthony  Hosidtal, 
Denver. 


and  Sp&ed  in  pr&scnption  Sa 


jpeea  in  p^reScripi 

DORR  OPTICAL  COMPANY 

421  16th  Street  Des’rer,  Colorado  KEyitoae  SSIl 


806 


Rocky  Mountain  Medical  Journal 


DIPHTHERIA  TETANUS  PERTUSSIS 


SIMPLIFIED 

simultaneous 

immunization 


, a decrease  in  the  number  of  injections  will  go  far  to  make  the 
practice  of  pediatrics  more  tolerable. ' (Fischer-,  j.  a.  m.  a.  I34:1064,  1947) 

OflBce  routine  simplified  . . . each  injection  is  the  same— 0.5  cc. 
Patient  discomfort  and  reactions  minimized 
Lower  expense  for  physicians  and  institutions 
Easier  injection  because  the  product  is  exceptionally  fluid 

13  cc»  via/s-"?  comp/efe  immunizafion;  7.5  cc.  via/s  — 5 complefe  Immunizations, 

DIPHTHERIA 

and 

TETANUS  TOXOIDS 

Alum  Precipitated  and 

PERTUSSIS  VACCINE 
COMBINED  SQUIBB 


for  October,  1949 


807 


CHECK 

LIST 

for  choice  of 
a laxative 

Phospho-  type  of 

s®**®  action 

y'  Prompt  action 
^ Thorough  action 
^ Gentle  action 


SIDE 

EFFECTS 

^ Free  from 

Mucosal  Irritation 

^ Absence  of  Con- 
stipation Rebound 

^ No  Development 
of  Tolerance 

Safe  from  Excessive 
Dehydration 

No  Disturbance  of 
Absorption  of 
Nutritive  Elements 

^ Causes  no 

Pelvic  Congestion 

^ No  Patient 
Discomfort 

^ Nonhabituating 

^ Free  from 

Cumulative  Effects 


Judicious  Laxation 

...through  freedom  from 
undesirable  side  effects 

The  clinical  preference  for  Phospho-Soda  (Fleet)* 
stems  in  targe  port  from  its  freedom  from  unde- 
sirable side  effects.  This  desideratum,  together 
with  its  controlled  action  and  ease  of  adminis- 
tration, assure  safe,  effective  anticostive  therapy 
from  every  prescription  of  this  "tried  and  true" 
laxative  agent.  Clinical  samples  on  request, 

C.  B.  FLEET  CO.,  INC.  • LYNCHBURG,  VIRGINIA 

♦'PHOSPHO-SODA'  'FLEET' 
ore  registered  irade^morks  of  C.  B.  Fleet  Co,^  Inc, 


adminis- 

tration 

^ Flexible  Dosage 
1/  Uniform  Potency 
1/  Pleasant  Tasf© 


PHOSPHO-SODA 


iniiTi 


Phospho-Soda  (Fleet)  is  a so- 
lution containing  in  each  100 
cc.  sodium  biphosphote  48  Gm. 
and  sodium  phosphate  18  Grn. 


ACCEPTED  FOR  ADVERTISING  BY  THE  JOURNAL  OF  THE  AMERICAN  MEDICAL  ASSOCIATION 


808 


Rocky  Mountain  Medical  Journal 


tenffiTinwiffigiS 


mssssi^M^ 


■gyu^^ 


^ee.sue  Hs-J 

i.5  mg.  5S 
038-^ 
^ isitv  « c0^ 

“eiANAiWUS.'^ 


TTASI^ETS 

DIETHIfL- 

STU-BESTKOL 

«.*«  «ng*  __ 


SeeSiieP®«® 


Low-Cost  Estrogonic  Therapy 


Today,  not  one  of  your  patients  need  be  denied  the 
benefits  of  estrogenic  therapy  whenever  it  is  indicated.  The 
physiological  effects  of  diethylstilbestrol  are  almost  in- 
distinguishable from  those  of  natural  estrogens.  Scores  of 
published  reports  testify  to  the  effectiveness  of  diethylstilbestrol 
in  relieving  symptoms  of  the  menopause,  senile  vaginitis, 
painful  engorgement  of  the  breasts  postpartum,  and 
“functional  uterine  bleeding.” 

Diethylstilbestrol,  Lilly,  is  available  in  tablets,  ampoules, 
and  vaginal  suppositories  in  dosages  to  fit  every 
indication.  Complete  literature  is  available  upon  request. 


ELI  LILLY  AND  COMPANY,  INDIANAPOLIS  6,  INDIANA,  U.S.A. 


Take  away  the  joy  of  participating  in  the  affairs  of  youth, 
and  life  would  lose  much  of  its  sparkle.  This  middle-aged 
mother  is  enjoying  the  occasion  of  her  daughter’s  first 
formal  “prom”  as  much  as  if  it  were  her  own. 

Fortunately,  most  women  undergoing  the  menopause  do  not 
need  the  help  of  an  endocrinologist.  For  those  who  do,  his 
knowledge  and  services  may  mean  the  difference  between 
semi-invalidism  and  comparatively  normal  health. 

Pharmaceutical  preparations  of  the  sex  hormones,  whenever 
indicated,  are  valuable  tools  of  the  physician.  Many  useful 
products  have  already  been  made  available.  At  the  Lilly 
Research  Laboratories,  pharmacologic  and  clinical 
investigations  are  being  energetically  pursued  with  the  view  of 
further  clarifying  this  complex  subject.  Significant  developments 
are  reported  to  the  medical  profession  without  delay. 


A 15"  X 12"  reproduction  of  this  illustration 
by  George  Garland  is  available  upon  request 


MEDICAL  RESEARCH 
IS  IN  THIS  PICTURE 


LILLY  SPECIALISTS  SERVE  THE  MEDICAL  PROFESSION 


IRocky 

Colorado 
Montana 
New  Mexico 
Utah 
Wyoming 


OCTOBER 

1949 


y^ountain 

yAedical  Journal 

Editor  lai * 


This  Is  the  Month 
To  Be  Generous 

We  are  proud  to  display  on  our  cover  this 
month  the  familiar  red  feather  of  the  Com- 
munity Chest.  October  is  the  month  of  the 
Chest  campaigns  throughout  the  country. 
It  is  a month,  too,  of  autumn  color,  signal 
of  the  start  of  another  year  of  activity  for 
. most  of  us. 

The  red  feather  reminds  us  that  in  this 
glorious  autumn  period  in  our  Rocky  Moun- 
tains we  should  remember  our  community 
responsibilities.  We  ought  to  think  of  more 
than  football,  hunting,  and  late  vacations. 
We  want  to  think  a little  bit  more  about 
people. 

It  is  the  job  of  the  Community  Chest 
agencies  to  do  something  for  people  who 
have  problems.  Some  1,250  Chests  and  14,- 
000  Red  Feather  agencies  in  the  United 
States  and  Canada  are  constantly  at  work 
bettering  the  lot  of  the  unfortunates  who 
comprise  a part  of  every  city  and  town 
in  our  two  nations. 

Too  often  some  of  us  forget  that  Com- 
munity Chest  funds  lend  support  to  such 
worthwhile  programs  as  those  of  the  Boy 
Scouts  and  Girl  Scouts,  the  Y.M.C.A.  and 
the  Y.W.C.A.,  the  Salvation  Army,  Travel- 
ers Aid,  U.S.O.,  Family  Service  Societies, 
day  nurseries,  maternity  homes,  visiting 
nurses,  and  a host  of  other  Red  Feather 
services.  Every  community  is  a better  place 
to  live  because  of  these  agencies  and  their 
services.  But  these  programs  cost  money. 
They  are  financed  by  voluntary  contribu- 
tions during  the  annual  campaign,  and  that 
campaign  comes  this  month. 

We  physicians  have  a professional  re- 
sponsibility beyond  our  traditional  donation 
of  gratuitous  medical  services  to  some  of 
these  agencies.  We  were  all  citizens  before 


we  were  doctors  and  we  must  continue  to 
be  good  citizens  to  be  truly  good  doctors. 
Our  dollars  this  October  will  do  much  for 
humanity.  Our  generosity  will  make  our 
communities  better  places  for  everyone. 

^ 

Find  That  Diabetic! 

''jj^HE  American  Diabetes  Association  has 
set  aside  October  10-16  as  Diabetes 
Week.  This  move  has  been  approved  by 
the  American  Medical  Association  and 
many  state  and  local  societies.  Its  pur- 
pose is  to  intensify,  for  one  week,  a year- 
round  drive  for  the  detection  or  diagnosis 
of  those  in  our  midst  who,  have  diabetes 
and  do  not  know  it. 

For  the  last  few  years  much  evidence  has 
been  accruing  to  prove  that  needless  dia- 
betic complications  and  some  diabetic 
deaths  have  occurred  simply  because  the 
patients  were  unaware  that  they  had  dia- 
betes. This  is  not  surprising  when  we  con- 
sider that  by  diagnostic  sampling  of  typical 
segments  of  our  population  it  has  been 
shown  that  quite  as  many  persons  have 
diabetes  and  do  not  know  it  as  there  are 
those  who  do.  This  is  easily  understand- 
able when  we  reflect  that  all  but  severe  or 
complicated  diabetes  is  painless  and  often 
symptomless.  Consequently  in  such  situa- 
tions medical  counsel  is  not  even  considered. 

Retinopathies,  peripheral  vascular  dis- 
ease, coronary  thromboses,  nephroscleroses, 
heightened  incidence  to  infections  and  a host 
of  other  disabling  diabetic  conditions  may 
occur  in  many  cases  simply  because  the 
lay  public  does  not  know.  It  is  the  con- 
fident belief  of  the  American  Diabetes  As- 
sociation that  there  are  a million  such  per- 
sons in  the  United  States.  It  also  believes 
that  most  of  these  could  be  found  and 


for  October,  1949 


809 


brought  under  scientific  therapy,  should  all 
doctors  become  keenly  conscious  of  the  in- 
cidence and  seriousness  of  diabetes.  So 
with  Diabetes  Week  it  hopes  to  initiate  or 
at  least  intensify  this  doctor  interest  in  a 
perennial  diabetic  detection  drive. 

Aside  from  giving  the  movement  such 
general  support  and  publicity  as  is  natural 
in  every  doctor’s  daily  practice  he  can  and 
should  do  the  following  specific  things  for 
at  least  the  week  of  October  10-16: 

1.  Test  himself  and  every  member  of  his 

family  for  glycosuria. 

2.  Make  the  same  test  for  every  ne-w  pa- 

tient, particularly  those  who  have  had 
recent  acute  infection  or  who  are  obese. 

The  test  is  cheap,  quick  and  easy.  It  is 
most  decisive  when  made  one  to  three 
hours  after  a full  meal.  If  for  any  reason 
the  doctor  is  unwilling  or  unable  to  make 
the  tests  he  may  advise  such  persons  to 
make  their  own  tests.  Self-testing  outfits 
with  explicit  instructions  may  now  be  had 
at  most  drug  stores  at  the  nominal  price 
of  39  cents.  In  any  such  case  when  the 
test  reagent  changes  from  blue  to  green, 
yellow,  orange  or  red  sugar  is  its  most  like- 
ly cause  and  it  indicates  immediate  blood 
sugar  studies  by  the  family  physician. 
Should  diabetes  be  so  diagnosed  a scientific 
diabetic  program  should  be  advised  with- 
out delay. 

V 

The  JFashington  Front 

Tt^ANY  of  us,  busy  with  our  practices, 
^ wonder  whether  our  present  knowl- 
edge is  abreast  with  the  legislative  prob- 
lems in  Washington-  A few  doctors  have 
depended  upon  cloak  room  conversation 
and  the  newspapers;  others — we  hope  most 
— have  read  our  journals,  the  Whitaker  and 
Baxter  sheets,  and  have  attended  our  So- 
ciety meetings.  Regardless  of  classifica- 
tion, serious  contemplation  is  indicated. 

At  a recent  meeting  of  the  Denver  County 
Medical  Society,  Dr.  McKinnie  Phelps  gave 
an  excellent  talk  upon  the  present  medical- 
political  national  picture.  Dr.  Phelps, 
among  many  other  physicians,  has  taken  a 
renewed  and  enthusiastic  interest  in  the 
problem  during  the  past  year.  He  speaks 
clearly  and  well  upon  interpretation  of  the 

810 


present  status.  It  has  not  been  long  since 
the  medical  profession  was  seriously  abused 
by  proponents  of  the  Murray-Wagner-Din- 
gell  Bill  and  many  others.  They  thought 
we’d  take  it  lying  down.  But  we  haven’t! 
The  AMA  educational  program,  with  the 
help  of  Whitaker  and  Baxter,  has  promul- 
gated a fighting  but  dignified  front.  The 
program  has  had  character,  urging  the  sub- 
ject as  a matter  of  principle — not  what  is 
going  to  happen  to  the  doctor  (as  in  Eng- 
land) but  what  will  happen  to  our  people. 
The  AMA  has  publicly  accounted  for  all  of 
the  financial  figures  in  running  its  cam- 
paign; there  are  no  secrets.  The  principles 
and  philosophy  are  now  grasped  by  the 
medical  profession  and  a large  portion  of 
the  populace,  more  than  ever  before.  Think- 
ing people  have  come  to  realize  that  our 
objective  is  to  widen  the  application  and 
usefulness  of  medical  service,  not  to  pad 
our  own  pocketbooks.  It  has  become  an 
obvious  fact  that  ultimate  benefit  to  the 
people  in  America  could  not  follow  the 
Truman  plan. 

At  the  present  time,  there  are  some  61,- 
000,000  people  in  America  partaking  of  vol- 
untary prepaid  hospital  insurance.  Another 
31,000,000  have  availed  themselves  of  pre- 
paid surgical  coverage.  We  emphasize  the 
term  voluntary — which  is  the  American 
way!  No  other  business  ever  grew  like 
this,  and  upon  such  a tremendous  scale. 
Obviously  we  can  “take  the  ball”  from  the 
Administration  if  we  keep  up  the  good 
work. 

Thus  far,  we  have  netted  a broad  educa- 
tion of  the  profession  as  well  as  of  the  peo- 
ple. Most  of  the  doctors  have  studied  it 
and  many  have  rightfully  influenced  their 
Congressmen.  If  the  compulsory  program 
isn’t  put  through  Congress  soon,  the  volun- 
tary program  will  have  become  so  large 
that  it  will  be  preponderant,  capable  of 
defeating  adverse  initiative  by  sheer  vot- 
ing power.  We  have  many  strong  fighting 
workers  on  our  behalf;  they  are  enthusiastic 
and  responsible  to  oiir  wishes  for  action. 
But  they  must  have  our  continued  help. 
We  must  read  all  we  can  find  on  the  sub- 
ject— both  sides  of  the  question.  Our  pro- 
fession must  know  what  kind  of  opposition 

Rocky  Mountain  Medical  Journal 


we  have  and  admit  our  adversaries  have 
brains,  if  not  principles,  and  they  have  the 
ability  and  means  of  giving  us  a tough 
fight  for  a long  time  to  come.  Many  of 
our  opponents  can  “rise  above  principle” — 
to  quote  Isidore  Falk.  Remember  that  ev- 
erybody is  not  for  us!  Some  of  the  adverse 
comment  directed  to  our  profession  is  un- 
fortunately true,  and  we  have  errors  to 
correct. 

The  medical  profession  is  now  on  the  of- 
fensive, having  turned  from  the  defensive 
position  within  a year.  We  are  now  at  the 
front  of  progress  on  behalf  of  the  people  of 
America  to  keep  governmental  fingers  out- 
side of  the  private  practice  of  medicine  and 
management  of  our  hospitals.  Let  the  gov- 
ernment manage  the  national  manipula- 
tions of  health  control  and  some  phases  of 
hospital  management,  such  as  the  Public 
Health  Service  and  veterans’  care,  but  keep 
it  out  of  the  doctor-patient  relationship 
which  is  our  heritage  and  ideal. 

Short  Scientific  Papers 

■^^OUR  Editors  have  occasionally  harped 
upon  the  subject  of  suitable  material 
for  publication  in  this  Journal.  A principal 
theme  has  been  the  need  for  shortening 
papers.  The  problem  is  becoming  more 
acute  with  soaring  costs  of  printing,  more 
societies  and  members  to  serve,  and  plenty 
of  good  scientific  material  worthy  of  print- 
ing. An  excellent  article  upon  the  subject 
of  good  medical  writing  has  just  appeared 
in  the  Staff  Meetings  of  the  Mayo  Clinic, 
by  Dr.  Walter  C.  Alvarez.  His  experience 
is  well  known  and  he  speaks  authoritative- 
ly. His  ideas  have  inspired  us  to  renew 
our  editorial  comment  upon  medical  writing. 

The  articles  which  are  read,  talked  about, 
and  which  are  of  most  educational  value 
are  the  ones  which  are  short  and  interest- 
ing. Many  readers  glance  first  to  the  sum- 
mary and  conclusion.  If  these  have  a 
“punch,”  they  return  to  the  beginning  to 
sort  out  the  meat. 

Few  papers  are  injured  by  being  abridged. 
Most  useful  messages  can  be  practically 
conveyed  within  ten  minutes’  reading  time. 
Our  good  writers  rarely  are  the  ones  who 


write  easily;  they  are  rather  the  authors 
who  apply  themselves  laboriously,  set  the 
work  aside,  sleep  on  it,  returning  after  a 
few  weeks  to  see  if  they  still  feel  the  same 
way  about  it.  The  material  is  then  re- 
viewed, modified,  changed  and — fortunately 
— shortened.  When  the  author  asks  himself 
whether  his  message  fills  a gap  in  the 
world’s  knowledge  or  whether  it  settles  a 
controversy,  he  may  decide  it  does  not.  If 
such  is  the  case,  the  wastebasket  should  re- 
ceive another  contribution. 

The  article  should  start  in  such  a man- 
ner as  to  incite  interest,  which  is  main- 
tained through  the  absence  of  uninteresting 
material.  Historical  comment,  inconclusive 
statistics,  and  minor  technical  details  are  the 
first  to  dispel  reader  interest.  Dr.  Alvarez 
agrees  with  our  convictions  that  few  bibli- 
ographies should  be  published,  especially 
the  large  ones.  Some  authors  are  disap- 
pointed if  readers  are  not  impressed  by  in- 
numerable articles  the  author  seems  to  have 
studied. 

In  case  reports,  there  is  no  need  for  pa- 
tients’ initials,  hospital  number,  exact  date 
of  admission,  or  irrelevant  family  or  per- 
sonal history.  Likewise  findings  at  opera- 
tion or  at  autopsy  should  be  positive  find- 
ings only.  Voluminous  case  reports  do  not 
impress  readers  with  an  author’s  thorough- 
ness but  rather  that  the  author  is  inef- 
ficient and  that  his  brain  is  muddled. 

Work  your  material  over  several  times, 
cut  out  all  irrelevant  and  negative  data. 
Shorten  your  sentences;  delete  most  ad- 
jectives and  all  superfluous  words.  Speak 
in  plain  English  and  use  the  shortest  gen- 
erally accepted  spelling.  Impress  your  read- 
ers with  your  clear  thinking,  practical  in- 
terpretation of  your  problem,  efficient  man- 
agement and  sensible  approach — not  your 
erudite  background  and  worldly  perspec- 
tive. 

Your  summary  should  state  more  than 
that  such  and  such  has  been  reviewed,  or 
this  and  that  conclusion  drawn.  It  should 
be  a true,  but  brief  and  pointed,  abridge- 
ment of  the  paper  for  benefit  of  readers 
who  read  no  more  and  to  show  students 
what  they  may  expect  to  find  in  some- 
what more  detail  in  the  body  of  the  article. 


for  October,  1949 


811 


Original  Articles 


PREVENTION  AND  TREATMENT  OF  ROCKY  MOUNTAIN  SPOTTED 

FEVER* 

GEORGE  E.  BAKER,  M.D. 

CASPER,  WYOMING 


The  last  five  years  have  brought  forth 
new  and  startling  developments  in  treat- 
ment of  Rocky  Mountain  spotted  fever.  The 
disease,  long  a step-child  of  American  medi- 
cine, has  never  occasioned  national  concern, 
chiefly  because  of  its  limited  distribution 
and  the  relatively  small  number  of  cases 
reported.  No  more  than  500  individuals 
contract  Rocky  Mountain  spotted  fever  each 
year,  but  of  this  number,  unfortunately, 
every  fourth  victim  succumbs  to  its  ravages. 
The  recent  armed  conflict  focused  attention 
on  rickettsial  infections,  because  American 
troops  were  placed  in  contact  with  typhus 
fevers  and  tsutsugamushi  diseases  (scrub 
typhus)  in  the  various  war  areas.  More  ef- 
fective means  of  management  were  devised 
and  Rocky  Mountain  fever,  also  a rickettsial 
infection,  shared  in  the  new  discoveries. 
The  overall  picture  is  now  an  encouraging 
one  and  a source  of  satisfaction  to  physi- 
cians who  supervised  the  treacherous  dis- 
ease in  the  past. 

Modern  supportive  therapy  of  Rocky 
Mountain  spotted  fever  is  based  on  an  in- 
terpretation and  correlation  of  the  patho- 
logical alterations  which  accompany  the  dis- 
ease. These  are  found  for  the  most  part 
in  the  endothelial  and  smooth  muscle  cells 
of  the  small  blood  vessels  of  the  skin  and 
subcutaneous  tissues.  Rickettsial  invasion 
results  in  formation  of  intravascular  throm- 
bi and  necrosis  of  the  vessel  walls.  Ex- 
travasation of  blood  into  the  tissue  spaces 
occurs. 

In  addition  to  formed  elements  of  the 
blood  which  escape  through  the  damaged 
blood  vessel  walls,  fluid,  chloride  and  plasma 
protein  are  also  lost.  The  blood  non-pro- 

*This paper  has  been  granted  an  unusual  amount 
of  space  in  this  issue  of  the  Rocky,  Mountain  Medi- 
cal Journal  because  of  its  timeliness,  completeness, 
and  because  of  its  Interest  and  importance  in  all 
of  the  states  which  we  serve. 


tein  nitrogen  is  increased.  The  shift  of 
plasma  protein  and  chloride  from  the  blood 
to  the  tissues  alters  the  osmotic  pressure 
relationships  and  brings  about  edema  of 
the  areas  involved.  The  level  of  the  plasma 
protein  is  further  reduced  by  failure  of  the 
liver  to  synthesize  proteins  adequately.  Loss 
of  fluid  and  plasma  protein  from  the  cir- 
culating blood  results  in  a reduced  blood 
volume.  Lowering  of  the  blood  pressure 
and  glomeruler  filtration  pressure  which 
follows  predisposes  to  circulatory  collapse 
and  prerenal  azotemia.  Azotemia  is  further 
promoted  by  the  marked  destruction  of 
body  protein  which  accompanies  the  dis- 
ease process.  Circulatory  collapse  which 
ensues  results  from  peripheral  circulatory 
failure  rather  than  from  failure  of  the 
heart. 

Properly  directed  intravenous  manage- 
ment plays  an  extremely  important  function, 
since  it  serves  to  interrupt  the  cycle  which 
has  been  established.  A comprehensive 
plan  of  intravenous  therapy  is  essential. 
Frequent  determinations  of  the  blood  non- 
protein nitrogen,  serum  chlorides  and  plas- 
ma proteins  are  indicated.  The  fluid  and 
electrolyte  balance  should  be  restored  by 
intravenous  injections  of  glucose  in  saline 
or  lactate-ringers  solution  and  maintained 
by  oral  fluids  and  added  sodium  chloride. 
Intravenous  injections  of  electrolytes  in  pa- 
tients whose  serum  protein  is  too  low  only 
washes  out  more  protein  from  the  blood 
vessels  into  the  tissue  spaces,  increases  the 
edema  and  invites  possible  circulatory  fail- 
ure. The  use  of  amino  acids  alone  will 
not  always  raised  the  blood  protein  concen- 
tration, since  the  ability  of  the  liver  to 
synthesize  protein  is  often  impaired.  For 
that  reason  the  serum  protein  level  of  the 
blood  must  be  restored  by  plasma  and  in 


812 


Rocky  Mountain  Medical  .Toubnal 


emergencies  by  injections  of  serum  albumin. 
The  level  must  be  maintained  by  further 
administrations  of  plasma  at  appropriate  in- 
tervals. It  is  often  necessary  to  give  large 
amounts  of  plasma  or  serum  albumin  if  it 
is  available  in  order  to  maintain  an  ade- 
quate circulation.  Transfusions  should  be 
given  if  anemia  is  present.  Administration 
of  blood  must  be  repeated  as  often  as  in- 
dicated. 

The  diet  should  be  low  in  fat  because  of 
known  damage  to  the  liver,  adequate  in 
carbohydrate  and  high  in  protein  to  replace 
protein  which  has  been  destroyed  or  plasma 
protein  which  has  been  lost  in  the  tissue 
spaces.  A high  vitamin  intake  must  be  as- 
sured. Thiamin  helps  to  prevent  shock, 
ascorbic  acid  obviates  blood  vessel  damage 
and  vitamin  B complex  and  K assist  to  cor- 
rect liver  damage  and  bring  the  prothrom- 
bin time  to  normal. 

Replacement  programs  form  the  basis  for 
up-to-date  management  of  Rocky  Mountain 
spotted  fever.  In  some  cases  of  the  disease, 
unfortunately,  damage  to  blood  vessels  has 
been  extensive.  Proper  diet  and  protein 
restoration  therapy  cannot  repair  injured 
capillaries  or  decrease  their  permeability. 
It  can,  however,  maintain  a normal  blood 
volume  during  the  days  or  weeks  while 
healing  takes  place.  From  the  very  be- 
ginning of  the  illness,  evidences  of  peri- 
pheral circulatory  failure  must  be  watched 
for  and  corrected.  The  unforeseen  develop- 
ment usually  takes  place  at  the  height  of 
the  infection  when  the  edema  is  maximal, 
although  it  may  make  its  appearance  early 
or  late  if  severe  dehydration  is  present.  It 
can  take  place  in  a few  hours,  frequently 
without  premonitory  warning.  Development 
may  be  so  insidious  that  recognition  at  an 
early  stage  is  possible  only  by  careful  and 
repeated  examinations.  A rising  pulse  rate, 
especially  one  of  above  140,  indicates  im- 
pending danger.  The  appearance  of  a 
thready  pulse  and  a drop  in  pulse  pressure 
are  ominous  signs.  Peripheral  circulatory 
failure  is  serious  and  energetic  measures 
are  necessary  to  bring  it  under  control. 

Carefully  directed  symptomatic  care  plays 
an  important  role  in  the  treatment  of 
Rocky  Mountain  spotted  fever.  Bed  rest 


with  good  ndrsing  care  is  necessary  from 
the  beginning  of  the  illness  in  order  to  con- 
serve strength  as  much  as  possible  for  the 
impending  struggle.  At  the  onset  patients 
frequently  do  not  appear  ill  enough  to  make 
the  precautions  necessary,  but  the  rapidity 
with  which  serious  manifestations  can  oc- 
cur make  those  in  attendance  thankful  that 
they  had  been  insisted  on.  Patients  must 
be  kept  as  quiet  as  possible,  both  mentally 
and  physically;  baths,  packs  and  simple 
sedation  are  often  effective.  Barbiturates 
are  usually  adequate.  If  codein  or  even 
morphine  is  indicated,  they  must  be  used 
as  freely  as  necessary.  Bath  temperatures 
should  be  70  degrees  F.  (21.1  degrees  C.)  or 
above  to  be  safely  tolerated.  Cold  or  tepid 
bathing  is  -dangerous;  it  often  results  in 
shock  to  seriously  ill  victims  of  the  disease. 

The  gastrointestinal  tract  needs  careful 
watching.  Regular  elimination  must  be 
facilitated  by  enemas  or  mild  cathartics. 
The  diet  should  be  nourishing,  adequate  and 
easily  digestible.  Frequent  urinary  exami- 
nations are  indicated.  They  detect  path- 
ologic alterations  at  their  onset.  Fluids 
\ 

must  be  given  freely  by  mouth  if  tolerated. 
If  vomiting  is  excessive  they  may  be  ad- 
ministered by  other  routes.  It  is  now  con- 
ceded that  properly  directed  intravenous 
therapy  plays  an  important  role  in  treat- 
ment. It  must,  however,  be  governed  by 
repeated  laboratory  examinations  and  by  a 
careful  evaluation  of  the  pathological  alter- 
ations which  have  taken  place. 

It  may  be  necessary  to  support  the  heart 
should  myocardial  weakening  appear  im- 
minent. An  increase  in  venous  pressure,  a 
gallop  rhythm  or  enlargement  of  the  liver 
should  suspicion  severe  myocardial  involve- 
ment. If  clinical  signs  suggest  congestive 
heart  failure  rapid  digitalization  and  the  use 
of  oxygen  are  indicated.  Care  of  the  skin 
is  important  in  order  to  prevent  bedsores 
and  ulcers.  Equal  parts  of  hamamelis 
water  (witch  hazel)  and  alcohol  applied 
once  or  twice  a day  in  water  as  a sponge 
often  comfort  and  invigorate  severely  ill 
patients.  They  remove  muscular  soreness. 
Revived  individuals  are  less  mentally 
dulled,  appearing  stronger  for  several  hours 
following  the  procedure.  Mouth  hygiene  is 


for  October,  1949 


813 


important  as  is  care  to  the  eyes.  Oral  anti- 
septic washes,  varied  from  time  to  time,  rid 
the  region  of  accumulated  waste  products, 
so  that  sufferers  are  made  more  comfortable 
during  the  acute  phase  of  the  disease. 

Sulfonamides  must  not  be  used  for  treat- 
ment of  Rocky  Mountain  spotted  fever. 
Penicillin  and  streptomycin  have  a role  only 
in  the  treatment  of  complications  of  the 
disease.  Penicillin  should  be  given  in  lib- 
eral amounts  for  the  slightest  indication  of 
pneumonia.  Even  though  the  process  is 
usually  rickettsial  in  etiology,  it  is  useful 
since  it  controls  secondary  bacterial  infec- 
tion which  may  take  place. 

Immune  rabbit  serum  still  has  a place  in 
treatment.  It  is  prepared  by  using  highly 
infected  yolk  sac  material  as  the  antigen 
and  contains  large  amounts  of  antibodies. 
If  adequate  amounts  of  serum  are  adminis- 
tered on  or  before  the  third  day  of  the 
eruption,  reduction  in  severity  of  the  dis- 
ease can  be  anticipated.  The  recommended 
dose  is  1 cubic  centimeter  per  kilogram  of 
body  weight.  A single  cubic  centimeter  is 
administered  intramuscularly.  If  there  is 
no  reaction  after  ten  minutes,  the  remainder 
of  the  dose  up  to  40  cubic  centimeters  is 
injected  by  the  same  route.  If  more  serum 
is  required,  the  remainder  should  be  given 
twelve  hours  later.  It  is  recommended  that 
serum  be  repeated  in  full  doses  every  two 
or  three  days. 

The  rickettsiae  of  Rocky  Mountain  spotted 
fever  are  at  first  intracellular,  but  as  the 
disease  progresses,  they  become  intranu- 
clear as  well.  Any  therapeutic  agent  aimed 
at  their  destruction  must  then  pass  through 
two  membranes.  It  is  reasoned,  therefore, 
that  serum  can  be  effective  only  before 
rickettsiae  in  large  numbers  have  been  es- 
tablished in  the  cellular  nuclei.  This  means 
that  serum  must  be  administered  very  early 
in  the  disease. 

In  the  search  for  agents  which  might  prove 
effective  in  controlling  the  ravages  of  Rocky 
Mountain  spotted  fever,  sulfonamides  were 
tried.  Results  from  their  use  were  dis- 
appointing and  they  were  soon  discarded. 
It  was  observed  that  patients  who  received 
the  drug  instead  of  being  improved  were 


made  worse  by  its  use.  Later  studies  re- 
vealed that  sulfa  compounds  augmented  the 
development  of  rickettsiae  in  infected  tis- 
sues, thus  explaining  their  deleterious  ef- 
fect. 

It  was  known  that  intracellular  rick- 
ettsiae, unlike  bacteria  and  viruses,  failed  to 
multiply  under  conditions  of  high  meta- 
bolic activity.  Para-aminobenzoic  acid 
(PABA),  a factor  of  the  vitamin  B complex, 
stimulated  certain  metabolic  functions.  By 
virtue  of  its  effect  on  the  enzyme  system 
essential  to  bacterial  growth  it  was  con- 
ceded to  be  hostile  to  sulfonamides.  Ad- 
versity of  the  two  drugs  raised  the  concept 
that  the  antagonisms  between  sulfonamides 
and  para-aminobenzoic  acid  on  bacterial 
growth  might  be  present  in  rickettsial  in- 
fections in  the  reverse  direction. 

The  timely  observation  was  the  basis  for 
PABA  for  Rocky  Mountain  spotted  fever. 
It  is  now  agreed  that  the  drug  owes  its 
effectiveness  to  an  inherent  ability  to  stim- 
ulate cellular  metabolism,  this  in  turn  in- 
hibiting the  infecting  rickettsiae  sufficient- 
ly to  develop  an  enduring  immunity.  The 
high  metabolic  activity  exerted  by  para- 
aminobenzoic  acid  on  the  enzyme  system  is 
unfavorable  for  the  development  of  intro- 
cellular  rickettsiae.  The  drug  is  not  a 
rickettsiocidal  agent;  it  possesses  only  rick- 
ettsiostatic  properties.  The  infection  is  over- 
come by  the  immunity  mechanisms  of  the 
host,  PABA  serving  merely  to  arrest  the 
growth  and  development  of  invading  rick- 
ettsiae until  this  has  been  brought  about. 
Significantly,  although  para-aminobenzoic 
acid  inhibits  the  rickettsiae  of  Rocky  Moun- 
tain spotted  fever,  it  has  no  effect  on  those 
already  in  the  body,  nor  does  it  repair  dam- 
age previously  done  by  the  disease.  _ 

PABA  can  be  given  in  several  ways.  The 
dose  is  0.5  to  1 gram  per  pound  of  body 
weight  a day.  The  initial  amount  in  adults 
is  6 to  8 grams,  followed  by  2 to  3 grams 
every  two  hours  day  and  night.  The  drug 
must  be  properly  neutralized  by  sodium  bi- 
carbonate, which  tends  to  overcome  gastric 
irritation  and  combat  acidosis  resulting 
from  its  use.  Each  tablet  of  PABA  con- 
tains 0.5  gram  of  the  drug.  Twenty  grains 


814 


Rocky  Mountain  Medical  Journal 


of  sodium  bicarbonate  should  be  given  with 
every  2 grams.  If  the  powdered  drug  is 
administered,  10  cubic  centimeters  of  a 
chilled  5 per  cent  sodium  bicarbonate  solu- 
tion is  used  with  each  gram. 

These  doses  usually  produce  therapeutic 
concentrations  of  30  to  60  milligrams  per 
100  cubic  centimeters  of  blood  within  two 
days.  In  order  to  attain  similar  blood  con- 
centrations in  children,  recommended  doses 
range  from  0.5  to  1 gram  per  pound  of  body 
weight  daily,  depending  on  the  size  and  age 
of  the  patient.  These  are  given  in  divided 
amounts  administered  at  the  same  time  in- 
tervals. Chilled  orange  juice  or  grape  juice 
can  be  substituted  for  sodium  bicarbonate 
solution  in  children.  When  more  palatable 
vehicles  are  used,  the  sodium  salt  of  PABA 
must  be  used,  or  equal  amounts  of  sodium 
bicarbonate  solution  must  be  given  at  the 
same  time. 

Patients  who  are  semi-comatose,  delirious 
or  uncooperative  should  never  be  given 
PABA  by  mouth.  Aspiration  can  lead  to 
unfortunate  consequences.  Gavage  therapy 
may  be  undertaken,  but  care  must  be  ex- 
ercised that  the  drug  does  not  block  the 
duodenal  tube  because  of  its  relative  insolu- 
bility. The  sodium  salt  may  be  administered 
in  a 2 to  5 per  cent  solution  intravenously 
in  physiologic  saline,  the  rate  of  flow  being 
adjusted  to  permit  infusion  of  the  indicated 
amounts  of  PABA  in  twenty-four  hours.  In- 
travenous para-aminobenzoic  acid  is  ex- 
creted rapidly.  It  is  preferable,  therefore, 
if  parenteral  administration  is  undertaken, 
to  use  a continuous  intramuscular  drip.  A 
25  per  cent  solution  of  the  sodium  salt  in 
isotonic  saline  is  well  tolerated,  although 
it  has  a tendency  to  give  uncertain  blood 
levels.  Subcutaneous  administration  is  not 
advisable.  Most  patients  with  Rocky  Moun- 
tain spotted  fever  are  edematous  and,  as  a 
result,  subcutaneous  fluids  are  not  well  ab- 
sorbed. Administration  of  the  sodium  salt 
of  PABA  may  be  sufficient  to  precipitate 
edema  or  to  increase  edema  already  pres- 
ent. Irrespective  of  the  route  of  administra- 
tion of  para-aminobenzoic  acid,  the  essential 
considerations  are  to  secure  therapeutic 
concentrations  as  quickly  as  the  body  will 
permit  and  to  maintain  them  at  this  level 


until  recovery  from  the  disease  has  been 
assured. 

The  Marshall  and  Litchfield  method  for 
sulfanilimide  determination  is  used  to  cal- 
culate blood  concentrations  of  para-amino- 
benzoic acid,  with  the  exception  that  a 
standard  solution  of  PABA  (30  milligrams 
of  the  sodium  salt  per  100  cubic  centime- 
ters) is  substituted  for  sulfanilimide.  As  has 
been  stated,  the  best  results  from  therapy 
are  obtained  when  concentrations  of  the 
drug  in  the  blood  are  maintained  between 
30  to  60  milligrams  per  100  cubic  centime- 
ters. In  exceptional  instances,  levels  of  80 
milligrams  may  be  necessary,  but  higher 
levels  are  not  advantageous.  Excessively 
high  levels  are  often  accompanied  by  de- 
lirium. If  the  PABA  level  rises  above  what 
is  considered  safe,  omission  of  one  dose  and 
reduction  of  the  maintenance  dose  will  usu- 
ally effect  the  proper  correction.  Samples 
of  blood  for  drug  concentrations  should  be 
taken  two  hours  following  the  last  dose. 
The  lowest  levels  in  the  intervals  between 
doses  are  determined  at  that  time. 

Para-aminobenzoic  acid  is  excreted  rapid- 
ly from  the  body.  Within  four  hours  after 
administration,  nearly  all  of  the  drug  has 
disappeared  from  the  blood  stream.  During 
this  time  70  to  80  per  cent  can  be  recovered 
from  the  urine.  Patients  vary  in  their 
ability  to  build  up  and  maintain  satisfactory 
levels,  chiefly  because  of  differences  in 
urinary  secretion.  The  more  urine  that  is 
passed,  the  lower  the  blood  concentration. 
It  has  been  advocated  that  urinary  excre- 
tion of  the  drug  can  be  controlled  by  lim- 
iting the  fluid  intake,  thus  maintaining 
therapeutic  levels  in  the  blood  with  small- 
er doses.  Patients  with  Rocky  Mountain 
spotted  fever  require  fluids  in  large  amounts 
if  dehydration  is  to  be  avoided.  It  is  pref- 
erable, therefore,  to  increase  the  dosage  of 
PABA  as  occasion  demands. 

Effectiveness  of  para-aminobenzoic  acid 
in  the  treatment  of  Rocky  Mountain  spotted 
fever  cannot  be  questioned.  Response  to 
use  of  the  drug  is  never  dramatic;  judged 
by  our  present  standards  it  must  be  con- 
sidered gradual  rather  than  precipitous. 
The  duration  of  the  illness  in  patients  who 
receive  the  drug  approximates  two  weeks. 


for  October,  1949 


815 


Better  responses  are  obtained  if  PABA  is 
administered  before  the  seventh  day;  the 
optimal  time  for  beginning  therapy  is  dur- 
ing the  first  four  days  of  the  disease.  Un- 
fortunately, an  accurate  diagnosis  of  Rocky 
Mountain  spotted  fever  is  often  difficult  to 
make  that  soon.  Instances  of  favorable  re- 
sponses are  recorded  in  those  who  have  re- 
ceived the  drug  late  in  the  illness,  but  these 
recoveries  are  exceptions  to  the  general 
rule. 

In  the  ordinary  case,  the  duration  of  fever 
is  shortened  from  five  days  to  a week.  De- 
cided clinical  improvement  is  noted  within 
two  to  four  days  after  PABA  is  begun. 
Coincidental  with  lowering  of  the  tempera- 
ture, the  eruption  gradually  fades.  It  is 
highly  important  that  treatment  not  be  dis- 
continued too  soon.  After  the  temperature 
has  returned  to  normal,  PABA  must  be  ad- 
ministered for  an  additional  two  to  five  days 
in  order  to  prevent  a secondary  rise  which 
occasionally  occurs.  Recurrent  temperature 
elevations  are  usually  attributable  to  too 
early  discontinuance  of  the  drug,  although 
they  can  be  brought  about  by  the  develop- 
ment of  complications.  Secondary  bacterial 
invasions  which  develop  during  PABA  ther- 
apy are  not  a contraindication  for  ad- 
ministration of  penicillin,  streptomycin  or 
other  antibiotics. 

Para-aminobenzoic  acid  is  a potent  drug 
and  yet  large  amounts  are  required  to  estab- 
lish and  maintain  therapeutic  blood  levels 
in  the  treatment  of  Rocky  Mountain  spotted 
fever.  Use  of  the  drug  can  be  attended  by 
toxic  manifestations.  Delirium  has  already 
been  discussed;  it  is  usually  controlled  by 
reducing  the  PABA  intake.  Acidosis  is 
avoided  by  simultaneous  administration  of 
buffering  sodium  bicarbonate  and  con- 
trolled by  parenteral  administration  of  sixth 
molar  sodium  lactate  solution  in  amounts 
sufficient  to  keep  the  urine  neutral  or 
slightly  alkaline.  An  alkaline  urine  should 
avoid  the  possibility  of  crystal  formation  in 
the  kidney  tubules.  If  crystalluria  does  oc- 
cur, the  drug  must  be  discontinued.  Ab- 
dominal distention  and  tympanites  occasion- 
ally accompany  the  giving  of  PABA;  they 
are  not  considered  to  be  of  real  significance. 

Development  of  leukopenia  is  the  chief 


untoward  result  from  para-aminobenzoic 
acid  administration.  Agranulocytosis  has 
not  been  reported.  The  total  number  of 
white  blood  cells  is  decreased  in  the  ma- 
jority of  patients  who  receive  the  drug,  al- 
though definite  leukopenia  does  not  always 
occur.  The  leukocytes  may  drop  as  low  as 
5,000  per  cubic  millimeter  of  blood.  The 
decrease  is  a gradual  one,  occurring  be- 
tween the  fourth  and  sixth  day  of  therapy. 
Mild  reductions  in  the  number  of  white 
blood  cells  are  of  no  significance  since  a 
return  to  normal  is  effected  within  a few 
days  after  therapy  is  discontinued.  If  the 
white  blood  cell  count  drops  to  4,000,  dif- 
ferential counts  are  indicated.  When  the 
granulocyte  count  is  below  25  or  30  and/or 
the  total  white  blood  cell  count  is  under 
3,000,  termination  of  PABA  therapy  is  ad- 
visable. Leukocytosis  which  appears  at 
the  time  para-aminobenzoic  acid  is  being 
taken  must  suspicion  the  development  of 
complications. 

Administration  of  PABA  may  be  followed 
by  elevation  of  the  blood  nonprotein  nitro- 
gen. This  finding  does  not  serve  as  a con- 
traindication for  continued  use  of  the  drug, 
unless  the  nitrogen  retention  becomes  ex- 
cessive. Elevations  of  the  nonprotein  nitro- 
gen may  be  due  to  the  disease  process. 
When  azotemia  is  present  or  develops  in 
patients  receiving  para-aminobenzoic  acid, 
the  blood  concentration  of  the  drug  must 
be  measured  more  than  once  a day  and 
the  two  hour  doses  adjusted  accordingly. 
Delay  in  excretion  may  result  in  unneces- 
sarily high  concentrations,  requiring  careful 
scaling  of  the  dosage  if  difficulty  is  to  be 
avoided. 

The  liver  shares  with  other  organs  in  the 
generalized  capill^y  damage  which  ac- 
companies Rocky  Mountain  spotted  fever. 
The  cephalin  flocculation  test,  as  an  index 
of  liver  dysfunction,  may  range  from  3 to 
4 plus.  There  is  some  question  whether 
marked  cephalin  positivity  is  due  to  PABA 
or  to  the  disease  process,  but  it  is  felt  that 
both  the  infection  and  para-aminobenzoic 
are  capable  of  producing  the  change. 

Although  PABA  can  be  a dangerous  drug, 
administration  is  relatively  safe  if  a thera- 
peutic regimen  is  established  and  adhered 


816 


Rocky  Mountain  Medical  Journal 


to.  Daily  white  blood  cell  and  differential 
counts  must  be  performed.  Para-amino- 
benzoic  acid  levels  must  be  determined 
daily.  Urinalyses  and  blood  nonprotein 
calculations  should  be  made  every  second 
day  and  fluid  intake-output  charts  kept  on 
all  patients.  More  specialized  procedures 
may  be  found  necessary.  Prothrombin 
times,  carbon  dioxide-combining  powers 
and  total  blood  protein  determinations  are 
indicated  before  PABA  is  begun  and  every 
third  day  thereafter.  Therapeutic  pitfalls 
can,  for  the  most  part,  be  avoided  if  a 
standard  procedure  is  adopted  and  followed 
for  every  patient  receiving  para-aminoben- 
zoic  acid  in  the  treatment  of  Rocky  Moun- 
tain spotted  fever. 

The  use  of  antibiotics  has  added  a new 
and  interesting  chapter  in  the  struggle 
against  Rocky  Mountain  spotted  fever. 
Aureomycin  has  created  widespread  inter- 
est as  a systemic  antibiotic  agent.  The  drug 
has  been  found  to  be  highly  effective 
against  most  strains  of  rickettsia  and  re- 
sponse from  its  use  in  Rocky  Mountain 
spotted  fever  has  been  uniformly  grati- 
fying. Like  streptomycin  it  is  produced 
from  a mold  of  the  genus  Actinomyces.  The 
mold  is  Streptomyces  auriofaciens  and  it 
derives  its  name  from  the  golden  yellow 
color  produced  as  the  fungus  grows  in  cul- 
ture. 

Aureomycin  is  readily  absorbed  after  oral 
administration.  When  single  doses  are 
given,  appreciable  amounts  may  be  recov- 
ered from  the  urine  within  short  periods  of 
time.  Maximum  urinary  concentrations  oc- 
cur between  two  and  eight  hours,  although 
excretion  may  continue  for  as  long  as  two 
or  three  days.  Satisfactory  blood  levels 
seem  to  be  established  between  the  fourth 
and  sixth  hour  after  the  drug  is  taken.  Ef- 
fective blood  concentrations  are  apparently 
maintained  when  additional  amounts  of 
aureomycin  are  administered. 

The  optimum  dosage  of  aureomycin  in  the 
treatment  of  Rocky  Mountain  spotted  fever 
has  not  been  determined,  but  it  is  believed 
that  30  to  60  milligrams  per  kilogram  of 
body  weight  a day  is  adequate.  Doses  as 
high  as  100  milligrams  have  been  adminis- 
tered without  untoward  results.  Adults  and 


older  children  can  swallow  50  to  100  milli- 
grams with  a minimum  of  difficulty.  In 
younger  children  the  drug  can  be  given  in 
tap  water  or  incorporated  in  a syrup. 
Aureomycin  is  commercially  available  in 
capsule  form.  The  initial  doses  of  aureo- 
mycin vary,  but  are  usually  2 to  5 milli- 
grams per  kilogram  of  body  weight,  given 
at  hourly  intervals  for  three  doses.  The 
same  amount  is  then  administered  every 
two  hours  for  the  purpose  of  maintenance 
therapy.  The  dosage  schedule  is  increased 
to  four  hour  intervals  after  the  tempera- 
ture has  been  normal  for  forty-eight  hours. 

Aureomycin  is  customarily  administered 
for  from  four  to  eight  days,  the  average 
duration  of  therapy  being  six  days.  The 
temperature  usually  becomes  normal  with- 
in two  days  after  treatment  is  begun  and 
does  not  show  a secondary  rise  after  the 
drug  is  discontinued.  The  eruption  clears 
on  the  third  to  fifth  day.  The  lesions  do 
not  become  petechial  in  patients  on  whom 
aureomycin  therapy  has  been  started  early. 
When  the  drug  is  taken  after  the  disease  is 
well  established,  the  eruption  is  slow  to 
fade  and  petechial  manifestations  persist 
for  a week  or  longer.  Striking  clinical 
improvement,  nevertheless,  takes  place  in 
all  patients  who  receive  aureomycin.  With- 
in twenty-four  to  forty-eight  hours  after 
therapy  is  begun,  they  are  more  active  and 
alert  and  show  a return  of  appetite  and  in- 
creased interest  in  their  surroundings.  No 
complications  have  occurred  nor  have  fa- 
talities been  reported  in  those  who  have 
received  the  drug. 

Aureomycin  appears  to  be  relatively  non- 
toxic. No  allergic  sequelae  have  as  yet 
taken  place.  There  is  a tendency  to  nausea 
when  the  drug  is  started.  Diarrhea  may  oc- 
cur. Vomiting  sometimes  takes  place;  it  is 
usually  transient'  and  does  not  necessitate 
discontinuance  of  therapy.  Simultaneous 
administration  of  0.5  ounce  of  an  aluminum 
hydroxide  preparation  with  each  100  milli- 
grams of  aureomycin  mitigates  the  ten- 
dency toward  nausea  and  vomiting. 

Chloromycetin  is  another  antibiotic  of 
promising  clinical  significance  as  regards 
Rocky  Mountain  spotted  fever.  Like  aure- 
omycin, it  is  derived  from  a mold  of  the 


for  October,  1949 


817 


genus  Actinomyces.  A sample  of  field  soil 
from  Venezuela  yielded  a new  Strep tyomy- 
ces  species  and  a crystalline  substance  hav- 
ing antibiotic  properties  was  prepared  from 
broth  cultures  of  the  Streptomyces  venezue- 
lae.  It  was  given  the  name  Chloromycetin  in 
recognition  of  its  source  and  because  of  the 
high  content  of  nonionic  chlorine  which 
characterizes  its  molecule. 

Efficacy  of  Chloromycetin  in  other  rickett- 
sial infections  led  to  its  use  for  Rocky 
Mountain  spotted  fever.  Although  the  new 
antibiotic  has  been  administered  to  a lim- 
ited number  of  patients  with  the  disease, 
results  from  its  use  have  been  encouraging. 
There  is  little  doubt  but  what  it  offers  con- 
siderable promise  as  an  effective  therapeu- 
tic agent. 

Chloromycetin  is  administered  orally.  The 
drug  is  relatively  insoluble  in  water  but 
is  well  absorbed  from  the  gastrointestinal 
tract.  After  single  doses,  appreciable 
amounts  can  be  demonstrated  in  both  the 
blood  and  urine  within  half  an  hour,  the 
titers  decreasing  to  zero  at  the  end  of  eight 
hours.  Effective  blood  concentrates  can  be 
maintained  with  repeated  doses  of  the  drug. 

The  dosage  of  Chloromycetin  in  Rocky 
Mountain  spotted  fever  is  as  yet  empirical 
and  is  based  on  reports  of  amounts  found 
to  be  effective  in  other  rickettsial  diseases. 
The  initial  dose  is  50  to  75  milligrams  per 
kilogram  of  body  weight,  administered  in 
two  or  three  parts  at  hourly  intervals. 
Chloromycetin  is  then  given  at  three-hour 
intervals  day  and  night.  Arbitrary  amounts 
are  0.25  gram  for  children  under  16  years 
of  age  and  0.5  gram  for  older  children  and 
adults.  In  spite  of  its  bitter  taste,  the  drug 
is  well  tolerated.  In  younger  patients  the 
tablets  may  be  pulverized  and  suspended  in 
water  or  given  in  a dilute'  chocolate  syrup. 
Chloromycetin  is  prepared  commercially  in 
capsule  form. 

Patients  do  not  show  striking  improve- 
ment during  the  first  twenty-four  hours  of 
therapy.  By  the  second  day,  however,  defi- 
nite response  to  use  of  the  drug  is  shown. 
There  is  a clearing  of  headache,  mental 
dullness  and  other  associated  manifesta- 
tions. Patients  are  plainly  convalescent  by 


the  third  day.  Irrespective  of  the  height  of 
the  fever,  a dramatic  fall  takes  place.  The 
temperature  reaches  normal  no  later  than 
three  days  after  the  initial  does  of  Chloro- 
mycetin. The  average  duration  of  fever 
after  therapy  is  begun  is  shortly  more  than 
two  days. 

After  the  temperature  has  reached  nor- 
mal and  remained  there  for  twenty-four 
hours,  a secondary  elevation  does  not  occur. 
Convalescence  is  not  accompanied  by  a re- 
turn of  fever.  Significantly,  the  eruption 
does  not  progress  following  initiation  of 
Chloromycetin  therapy.  By  the  end  of  for- 
ty-eight hours  after  the  drug  is  begun,  it 
demonstrates  evidence  of  recession.  Admin- 
istration of  Chloromycetin  is  continued  un- 
til the  temperature  has  been  normal  forty- 
eight  hours.  Convalescence  proceeds  in  a 
normal  manner;  it  is  proportionate  in  length 
to  the  severity  of  the  infection  and  duration 
of  the  initial  ferbrile  period. 

Administration  of  Chloromycetin  does  not 
appear  to  be  accompanied  by  toxic  mani- 
festations. Vomiting  may  result  from  the 
first  or  second  doses  of  the  drug;  it  is  never 
continued.  The  cause  of  vomiting  from 
Chloromycetin  is  not  known,  but  it  is  be- 
lieved that  the  bitter  taste  or  psychic  fac- 
tors may  be  at  fault.  Diarrhea  and  jaundice 
have  not  been  reported.  The  urine  reveals 
no  significant  albuminuria,  casts  or  crys- 
tals. Blood  counts  taken  during  and  after 
Chloromycetin  therapy  show  no  striking  va- 
riations from  normal. 

Aureomycin  and  Chloromycetin  are  new 
and  potent  antibiotics.  They  appear  to  be 
remarkably  effective  agents  for  the  treat- 
ment of  Rocky  Mountain  spotted  fever.  It 
must  be  cautioned,  however,  that  the  drugs 
to  the  present  time  have  been  given  for 
short  periods  of  not  more  than  a week  or 
two.  Whether  more  prolonged  administra- 
tion will  produce  toxic  symptoms  is  as  yet 
unknown.  The  questions  as  to  the  optimum 
dosage,  the  proper  administration  interval, 
and  the  number  of  days  during  which  aureo- 
mycin and  Chloromycetin  can  be  safely 
given  to  patients  have  not  been  answered. 
More  extensive  use  of  antibiotics  will  be 
required  before  their  potentialities  are  de- 


818 


Rocky  Mountain  Medical  Journal 


termined.  The  mystery  of  the  mechanism 
by  which  aureomycin  and  cloromycetin 
produce  their  effect  in  Rocky  Mountain 
spotted  fever  has  not  been  solved.  It  is  be- 
lieved that  they  have  the  ability  to  pene- 
trate cells  membranes  and  attack  rickett- 
siae  directly,  suppressing  their  growth  and 
reproduction  and  allowing  a lower  level  of 
immunity  to  be  effective  in  lessening  tox- 
icity, reducing  temperature  and  bringing 
about  a clinical  remission  of  the  disease. 

Rocky  Mountain  spotted  fever  is  pre- 
ventable. Vaccine  affords  definite  protec- 
tion. It  has  been  available  for  some  time 
and  was  originally  made  from  phenoliza- 
tion  of  ground  up  tick  viscera.  Tick  tissue 
type  vaccine  was  effective,  but  it  had  the 
disadvantage  of  being  difficult  and  hazard- 
ous to  prepare  and  never  assured  an  ade- 
quate supply.  It  has  since  been  superseded 
by  a vaccine  made  from  infected  yolk  sacs 
of  fertile  hens’  eggs.  Chick  embryo  type 
vaccine  is  equally  potent.  It  is  available 
commercially  in  amounts  sufficient  to  sat- 
isfy the  ever  increasing  demand. 

The  dose  of  chick  embryo  type  vaccine  is 
0.5  cubic  centimeter  for  children  under  12 
years  of  age  and  1 cubic  centimeter  for 
adults  and  older  children.  Vaccine  is  ad- 
ministered subcutaneously  and  three  in- 
jections at  intervals  of  a week  or  ten  days 
are  given.  Booster  immunizations  are  indi- 
cated each  year.  Although  one  injection  is 
considered  ample,  it  is  customary  to  make 
a second  administration  a week  or  ten  days 
later. 

In  the  Rocky  Mountain  areas  vaccine 
must  be  given  as  early  in  the  spring  as  pos- 
sible in  order  to  assure  maximal  response. 
The  precaution  is  less  important  in  other 
sections  of  the  country.  Rocky  Mountain 
spotted  fever  is  most  prevalent  from  March 
to  July  in  the  West;  in  the  East,  Middle 
West  and  South  the  disease  has  the  greatest 
incidence  during  June  and  July.  The  varia- 
tion is  explained  by  differences  in  feeding 
activities  of  the  wood  tick  and  dog  tick 
vectors.  A period  of  a month  or  six  weeks 
is  required  for  a peak  of  immunity  to  be  at- 
tained following  administration  of  vaccine 
and  a sufficient  time  interval  between  the 


procedure  and  possible  exposure  to  in- 
fection must  be  allowed. 

Care  must  be  exercised  in  administration 
of  Rocky  Mountain  spotted  fever  vaccine. 
It  must  not  be  given  intravenously.  The 
usual  contraindications  for  vaccine  in  gen- 
eral, such  as  tuberculosis,  debilitating  dis- 
ease and  other  latent  and  active  infections, 
interdict  its  use.  Patients  who  are  allergic 
to  eggs  or  egg  products,  chicken  or  chicken 
feathers  may  react  unfavorably  to  chick 
embryo  type  vaccine.  Immunization  of  sus- 
ceptible individuals  must  be  performed  un- 
der close  supervision.  The  usual  dose  should 
be  subdivided  or  tick  tissue  type  vaccine 
procured  and  administered  instead. 

The  duration  of  protection  afforded  by 
vaccine  has  a tendency  to  vary,  but  those 
immunized  in  the  spring  of  the  year  are 
usually  well  taken  care  of  for  at  least  the 
remainder  of  the  year.  It  is  probable  that 
a certain  proportion  of  individuals  carry 
some  immunity  into  the  second  year,  but  no 
considerable  degree  is  present  after  that. 
The  protection  appears  to  be  greater  in 
those  who  have  been  vaccinated  for  two 
or  more  successive  years.  It  is  recommend- 
ed, nevertheless,  that  immunization  be  per- 
formed each  year. 

At  the  present,  at  least,  exposure  to  Rocky 
Mountain  spotted  fever  is  not  general 
enough  to  make  vaccination  necessary  ex- 
cept where  hazards  of  residence,  work  or 
occupation  demand.  All  whose  business  or 
pleasure  takes  them  into  localities  where 
ticks  are  encountered  in  appreciable  num- 
bers, or  from  which  cases  of  the  disease 
have  come  in  the  past,  should  be  candidates 
for  vaccination.  This  warning  cannot  be 
emphasized  too  strongly.  One  of  the  most 
serious  phases  of  the  tick  fever  problem  is 
that  new  areas  of  infection  are  being  un- 
covered each  year.  Failure  of  the  disease 
to  appear  in  regions  where  ticks  are  found 
is  no  guarantee  that  the  same  favorable 
situation  will  be  prolonged  indefinitely. 
Physicians  over  the  country  are  aware  of 
the  increasing  regional  incidence  of  Rocky 
Mountain  spotted  fever.  As  a result,  pro- 
phylactic vaccination  is  more  generally 
practiced  than  it  was  a few  years  ago. 


jor  October,  1949 


819 


Vaccination  has  been  popular  in  the 
Rocky  Mountain  area  for  over  two  decades. 
Several  thousand  residents  have  been  pro- 
tected, many  of  them  annually,  for  years. 
It  can  never  be  estimated  how  many  ill- 
nesses have  been  avoided  and  lives  saved  by 
the  procedure.  It  is  unfortunate,  neverthe- 
less, that  some  westerners  avoid  vaccina- 
tion. The  majority  of  victims  of  the  disease 
in  the  Rocky  Mountain  states  are  ranchers 
and  stockmen,  or  others  engaged  in  similar 
rural  pursuits.  Warnings  that  they  should 
be  vaccinated  are  unheeded,  although  these 
individuals  are  engaged  in  work  activities 
during  the  spring  and  early  summer  months 
where  the  greatest  exposure  to  infection 
takes  place.  They  reason  that  it  is  impos- 
sible to  make  long,  exhausting  trips  to  ur- 
ban areas,  often  over  rough  and  muddied 
roads,  to  be  vaccinated.  Calving,  lambing, 
and  shearing  must  of  necessity  be  their  first 
interest,  because  economic  security  for  the 
entire  year  depends  on  a successful  out- 
come. Immunization  during  the  late  winter 
months  has  never  been  attempted,  but  it 
can  be  the  answer  to  their  problem. 

Prevention  of  exposure  to  Rocky  Moun- 
tain spotted  fever  is  assured  only  by  re- 
maining out  of  localities  where  ticks  are 
numerous.  Such  precautions  are  not  al- 
ways possible  or  feasible.  Ticks  resemble 
insects  found  in  the  same  localities.  The 
similarity,  unfortunately,  is  mere  one  of  ap- 
pearance. True  ticks  belong  to  the  spider 
family,  although  they  bear  faint  resem- 
blance to  some  members  of  the  group.  In 
common  with  other  spiders,  however,  ticks 
attack  only  living  prey.  Blood  is  their  sole 
means  of  subsistence.  Ticks  customarily 
seek  warm-blooded  animals,  but  when  hu- 
man beings  are  encountered  several  species 
make  no  distinction. 

Wood  ticks  of  the  Rocky  Mountain  areas 
spend  the  colder  months  of  the  year  buried 
under  fallen  vegetation  or  hidden  in  the 
thick  winter  coats  of  animals.  The  first 
warm  spring  days  release  them  from  their 
dormant  state.  They  crawl  to  a convenient 
bush,  weed  or  clump  of  grass,  there  lying 
in  wait  for  animal  hosts.  Ticks  do  not  jump 
on  those  who  pass  their  vantage  points,  but 


take  a favorable  position  not  over  eighteen 
inches  above  the  ground,  actively  moving 
their  numerous  serrated  legs  with  which 
they  seek  to  cling  to  objects  that  brush  by. 

Detection  of  ticks  on  the  outer  garments 
indicates  that  transfer  has  been  accom- 
plished. Purposeful  attempts  to  find  means 
of  ingress  to  the  body  surfaces  through 
apertures  in  the  clothing  are  masked  by 
what  appears  to  be  aimless  wandering.  Once 
on  the  surface  of  the  body,  ticks  move 
slowly  about  for  variable  periods  of  time, 
seeking  suitable  attachment  sites.  Areas 
chosen  are  those  covered  by  hair  or  pro- 
tected from  rubbing  or  attempts  at  removal. 
The  process  of  attachment  follows.  Ticks 
apply  cutters  from  their  mouth  parts  to 
penetrate  the  skin.  This  accomplished, 
barbs  are  inserted  to  hold  the  head  in  place. 
Finally,  the  proboscis  is  used  when  a source 
of  blood  has  been  reached.  Vectors  of  Rocky 
Mountain  spotted  fever  carry  infection  in 
their  salivary  glands  and  victims  are  inocu- 
lated with  virus  of  the  disease  during  the 
feeding  process. 

Most  tick-borne  infections  may  be  avoided 
by  observance  of  adequate  personal  pre- 
cautions. In  order  to  afford  proper  pro- 
tection, clothing  should  have  a minimum  of 
seams  and  openings  and  be  gathered  snugly 
at  the  wrists  and  ankles  so  as  to  prevent 
ingress  of  ticks  to  the  body  surfaces.  A 
hat  or  cap  should  be  worn  to  discourage  at- 
tachment on  the  scalp.  Smooth  clothing 
prevents  ticks  from  gaining  footholds,  and 
cloth  with  a rough  nap  impedes  their 
progress.  Such  attire  is  ideal  for  avoiding 
tick  attachment,  but  it  is  not  comfortable 
at  the  time  of  year  when  it  is  meant  to  be 
worn.  Exposure  to  infection  usually  takes 
place  during  the  warmer  months  when  gar- 
ments offering  maximum  coolness  and  free- 
dom of  action  are  preferred.  Dry  and  warm 
days  activate  ticks  and  cool  and  rainy  days 
render  them  dormant.  Adequate  clothing 
is  tolerated  when  the  weather  is  bad,  but 
few  ticks  are  feeding  then  and  it  can  be 
dispensed  with  as  far  as  protection  against 
infection  is  concerned. 

Advice  to  the  contrary,  there  is  as  yet 
no  satisfactory  material  which  can  be  placed 
on  the  body  or  .clothing  to  keep  off  ticks. 


820 


Rocky  Mountain  Medical  Journal 


While  in  tick  country  it  is  a good  plan  to 
pass  the  hand  occasionally  over  the  back 
of  the  neck  in  order  to  detect  the  crawling 
pests.  They  tend  to  work  their  way  up- 
ward in  an  attempt  to  gain  access  to  the 
body  surfaces,  particularly  when  difficulty 
is  encountered  in  making  ingress  at  other 
places.  In  localities  known  to  be  tick  in- 
fested or  at  any  other  time  when  ticks  are 
found  crawling  on  the  clothing,  suspicion 
must  be  aroused  that  some  of  them  have 
made  their  way  to  the  body  surfaces.  In  or- 
der to  afford  the  greatest  degree  of  protec- 
tion possible,  all  garments  should  be  re- 
moved at  least  twice  a day  and  a through 
inspection  made  to  detect  the  presence  of 
crawling  or  attached  ticks.  Since  they  hide 
away  in  body  folds,  crevices  or  hairy  por- 
tions free  of  rubbing,  a diligent  search  must 
be  conducted.  The  process  of  attachment,  un- 
fortunately, is  not  noticeable  to  victims,  nor 
are  they  usually  aware  of  crawling  ticks. 
Sources  of  minor  irritations  should  always 
be  carefully  investigated  so  as  not  to  brush 
off  attached  ticks  which  may  be  the  cause 
of  the  disturbance. 

When  detected,  attached  ticks  must  be 
removed  without  delay.  It  is  supposed  that 
vectors  of  the  disease  are  not  actively  in- 
fectious until  several  hours  have  elapsed, 
but  it  is  safest  to  place  little  reliance  in 
this  contention.  Prompt  removal  has  un- 
doubtedly prevented  many  infections  of 
Rocky  Mountain  spotted  fever.  As  a rule 
the  head  of  an  attached  tick  is  embedded 
beneath  the  surface  of  the  skin,  the  body 
remaining  free  and  protruding  at  an  angle 
from  it.  The  head  is  held  firmly  in  place 
by  mouth  parts,  so  that  hasty  or  careless 
plucking  often  removes  the  body  alone, 
leaving  the  remainder  in  place  to  serve  as 
a potential  source  of  infection.  Application 
of  heat  or  chemicals  should  not  be  resorted 
to.  The  process  of  attachment  takes  a con- 
siderable period  of  time  and  securely  fas- 
tened ticks  are  neither  able  or  willing  to  re- 
lease their  holds  in  a matter  of  seconds. 
Strong  agents  serve  only  to  kill  ticks  or  to 
drive  them  deeper.  In  either  event,  nothing 
has  been  accomplished.  It  is  better  to  at- 
tempt removal  by  gentle  traction  applied 


to  the  body  of  the  tick.  The  maneuver  is 
frequently  successful  if  attachment  has 
taken  place  recently.  Close  inspection  then 
reveals  the  tick  to  be  intact,  often  with  a 
small  fragment  of  epidermis  caught  in  the 
mouth  parts.  Failing  in  the  procedure  of 
gentle  traction,  a small  piece  of  skin  in 
which  the  tick’s  head  lies  embedded  may 
be  elevated  with  a fair  of  thumb  forceps 
and  a tent-like  wedge  of  tissue  snipped  with 
a fine  pair  of  scissors.  An  elective  pro- 
cedure is  to  insert  the  point  of  a hypo- 
dermic needle  or  scalpel  through  the  epi- 
dermis adjacent  to  and  beneath  the  head 


Fig.  1.  Rocky  Mountain  spotted  fever.  Distribution 
of  the  disease  throughout  the  United  States. 


of  the  tick  and  effect  removal  by  turning 
the  point  of  the  instrument  sharply  up- 
ward. Either  maneuver  is  accomplished  in 
a matter  of  seconds  and  insures  complete 
removal.  Wounds  from  tick  extraction  must 
always  be  thoroughly  touched  with  an  ef- 
fective germicidal  agent;  this  may  be  intro- 
duced into  attachment  sites  by  means  of  a 
pointed  toothpick.  A light  sterile  dressing 
can  then  be  applied  and  the  wound  left 
alone  unless  it  becomes  infected. 

Extreme  caution  must  be  observed  not  to 
crush  ticks.  When  frankly  engorged  they 
must  be  removed  with  a thumb  forceps  or 
by  gauze  protected  fingers.  If  accidental 
crushing  takes  place,  the  discharged  con- 
tents should  be  thoroughly  washed  from  the 
hands  by  soap  and  water,  care  being  ex- 
ercised not  to  irritate  the  skin.  For  the 
reason  that  virus  is  apt  to  be  highly  in- 
fectious, even  on  unabraded  skin  surfaces, 
precautions  for  its  removal  are  important. 
After  return  from  trips  to  tick  infested 


for  October,  1949 


821 


Fig-.  2.  Rocky  Mountain  spotted  fever.  Adult  male 
of  the  wood  tick  (Dermacentor  andersoni),  vector 
of  the  disease  in  the  Rocky  Mountain  states. 


localities,  clothes  and  bedding  should  be 
carefully  gone  over,  aired  and  then  removed 
to  buildings  not  used  for  human  habitation. 
A tub  bath  should  be  taken  and  a final  in- 
spection made  for  crawling  or  attached 
ticks.  In  spite  of  these  precautions,  crawl- 
ing or  attached  ticks  are  sometimes  detected 


Fig.  3.  Rocky  Mountain  spotted  fever.  Adult  female 
of  the  wood  tick  (Dermacentor  andersoni),  vector 
of  the  disease  in  the  Rocky  Mountain  states. 

at  a later  date;  they  may  be  found  on  the 
individual  who  brought  them  home  or  on 
other  members  of  the  family.  Once  ticks 
have  taken  up  their  abode  in  places  of  hu- 
man occupancy,  eradication  is  apt  to  prove 
most  difficult  and  uncertain;  it  can  take 


months  or  years  to  get  rid  of  the  pests. 
DDT  in  solution  or  incorporated  in  a 
thermol  aerosol  insecticide  fog  may  be  ef- 
fective. A 10  per  cent  DDT  powder  de- 
stroys ticks  which  infest  domestic  pets.  It 
can  be  applied  liberally  and  is  not  danger- 
ous to  animals  in  this  form.  Use  of  insecti- 
cides for  tick  removal  from  animals  is  more 
safe  and  effective  than  the  common  and 
hazardous  practice  of  picking  them  off  with 
bare  hands. 

Enumeration  of  several  cases  of  Rocky 
Mountain  spotted  fever  serves  no  useful 
purpose  as  far  as  discussion  of  prevention 
and  treatment  of  the  disease  is  concerned. 
The  following  patients,  under  care  in  1941, 
1944  and  1947,  are  presented  in  detail;  they 
stand  as  examples  of  changes  which  have 
taken  place  in  the  past  few  years. 

CASE  1 

S.  F.,  aged  55,  a male  white  wool  grower, 
was  seen  in  Casper  on  May  25,  1941.  He  com- 
plained of  generalized  body  aches  and  pains, 
a troublesome  frontal  headache  and  a temper- 
ature of  two  days’  duration.  A dry  hacking  cough 
was  present  and  the  throat  felt  raw  and  irri- 
tated. The  patient  did  not  appear  to  be  par- 
ticularly ill.  Bronchitis  and  pharyngeal  injection 
were  detected  and  a low-grade  temperature  was 
present. 

For  the  reason  that  he  recently  had  been  en- 
gaged in  lambing  activities,  working  for  long 
hours  in  the  rain  and  sleet  and  sleep- 
ing at  night  in  a sheep  wagon  on  the  open  range, 
it  was  believed  that  he  had  contracted  a respira- 
tory infection.  At  the  time  of  examination, 
nevertheless,  several  tender,  elevated,  pin-point 
and  black-tipped  areas  were  seen  on  the  legs 
and  trunk.  The  patient  readily  acknowledged 
that  these  were  sites  of  former  tick  attachment 
and  admitted  that  he  had  previously  plucked 
off  the  pests.  He  did  not  appear  concerned  over 
the  lesions,  stating  that  he  had  found  numerous 
ticks  on  his  person  at  lambing  time  each  spring. 
The  patient  had  never  been  immunized  against 
Rocky  Mountain  spotted  fever.  He  had  ranched 
in  the  same  vicinity  for  forty  years,  and  assumed 
that  he  was  immune  to  the  disease.  Appropriate 
measures,  outlined  for  alleviation  of  a respir- 
atory infection  were  given  and  the  patient  was 
asked  to  report  his  progress. 

Mrs.  F.  called  two  days  later,  stating  that  her 
husband  was  now  quite  ill.  He  had  felt  con- 
siderably better  the  next  day  and  had  planned 
to  return  to  the  ranch.  That  evening,  however, 
he  had  bathed  and  noticed  that  he  was  broken 
out.  He  had  spent  a restless  night  and  slept 
poorly.  A second  residence  call  was  made  on 
May  27.  Findings  noted  at  the  time  of  the  origi- 
nal visit  were  intensified.  In  addition,  the  eyes 
were  injected  and  reddened.  The  patient  now 
complained  of  a continuous  headache,  and  in- 
sisted that  the  room  be  kept  darkened  so  as  to 
obtain  partial  relief.  Inspection  revealed  the 
presence  of  a fine  macular  eruption,  present  on 
the  flexor  surfaces  of  the  wrists  and  on  the 
ankles.  The  lesions  were  rose  red  in  color,  dis- 


822 


Rocky  Mountain  Medical  Journal 


Crete  in  character  and  did  not  blanch  when  pres- 
sure was  applied.  A diagnosis  of  Rocky  Moun- 
tain spotted  fever  was  made  and  the  patient  was 
removed  to  the  Natrona  County  Memorial  Hos- 
pital: 

The  temperature  on  admittance  was  103.4  de- 
grees F.,  the  pulse  96,  and  the  respiratory  rate  22. 
The  blood  count  revealed  5,100,000  red  blood 
cells,  13.25  grams  of  hemoglobin  and  9,600  white 
blood  cells  with  a differential  count  of  78  poly- 
morphs, 18  lymphocytes,  and  4 monocytes.  The 


Fig.  4.  Rocky  Mountain  spotted  fever.  Case  2.  A 
fatal  case  of  the  disease,  showing  the  generalized 
distribution  of  the  lesions. 


urinalysis  was  negative  save  for  a 1 plus  albu- 
min. The  blood  Wasserman  and  Kahn  reactions 
were  negative.  The  Proteus  agglutination  (Weil- 
Felix)  reaction  against  0X19  strains  was  nega- 
tive on  May  29. 

Bed  rest  in  a semi-darkened  room  was  ad- 
vised. A soft  high  carbohydrate  diet  was  pre- 
scribed and  sweetened  fruit  punch  urged.  Mild 
cathartics  and  enemas  were  used  as  necessary 
to  facilitate  elimination.  Because  of  a past  his- 
tory of  chronic  alcoholism,  eggnogs  with  whiskey 
were  given.  Hot  witch  hazel  and  alcohol  rubs 
were  administered  and  oral  mouth  washes  were 
used.  Compound  empirin  10  grains  and  codein 
sulphate  0.5  grains  were  taken  regularly  for  tem- 
perature and  general  discomfort. 

By  May  29  the  eruption  had  spread  over  the 
entire  body  of  the  patient.  It  remained  discrete 
and  was  most  marked  on  the  extremities.  The 
lesions  were  bluish  red  in  color,  circumscribed 
and  sharply  demarcated,  with  intervening  clear 
areas  of  skin.  The  general  condition  of  the  pa- 
tient remained  unchanged,  although  the  head- 
ache and  generalized  aches  and  pains  were  re- 
lieved. He  verged  on  delirium,  perspired  pro- 
fusely and  was  markedly  weakened.  Abdominal 
distress  was  present  and  gastro-intestinal  dis- 
tention was  troublesome. 

By  June  1,  however,  definite  improvement  was 
detected.  The  patient  was  completely  oriented 
and  although  quite  restless,  seemed  to  be  re- 
sponding to  care.  The  temperature  began  to 
recede  by  slow  lysis  and  reached  normal  on 
June  7.  The  Proteus  agglutination  reaction  per- 
formed on  June  8 was  negative,  although  a third 
procedure  made  on  June  19  was  strongly  posi- 
tive. The  patient  developed  pneumonia  on  Jixne 
9.  Right  lower  chest  pain,  exudative  cough  and 
temperature  elevation  appeared.  Diathermy  was 
used  extensively.  Sulfapyradine  15  grains  was 


begun  every  four  hours.  The  patient,  however, 
became  frankly  delirious  and  developed  gastric 
intolerance  and  the  drug  was  discontinued.  By 
June  14,  after  a stormy  course,  improvement 
again  was  detected.  The  temperature  dropped 
to  normal  and  the  patient  felt  stronger  and  took 
more  interest  in  his  surroundings.  The  eruption, 
which  had  shown  evidences  of  rapid  fading 
prior  to  the  occurrence  of  pneumonia,  had  al- 
most disappeared.  Threatened  cardiac  decom- 
pensation, which  was  detected  on  June  15,  neces- 
sitated use  of  digitalis  and  administration  of  oxy- 
gen. Prompt  response  occurred  and  the  patient 
was  sitting  on  the  side  of  his  bed  by  June  19. 
He  had  an  excellent  appetite  and  seem  stronger 
and  more  alert.  By  June  20  he  was  out  of  bed 
the  greater  portion  of  each  day. 

Pneumonia  again  developed  on  June  21. 
Measures  similar  to  those  instituted  on  the  first 
occasion  were  outlined.  Sulfapyradine  was  not 
repeated  because  of  apparent  intolerance  to  the 
drug.  The  patient  again  responded.  The  temper- 
ature became  normal  for  the  first  time  on  June 
24.  The  patient  was  discharged  on  July  3,  thir- 
ty-eight days  after  entering  the  hospital  and 
forty-three  days  after  the  illness  began.  Con- 
valescence took  several  months,  but  a complete 
recovery  followed. 

Discussion:  Rocky  Mountain  spotted  fever  is 
always  serious  in  older  people.  The  individual 
was  an  alcholic  as  well.  History  of  previous  ex- 
posure to  inclement  weather  and  information 
that  he  had  contacted  ticks  with  impunity  for 
several  years  were  confusing.  It  is  fortunate 
that  the  patient  developed  an  intolerance  to  sul- 
fapyradine, in  view  of  the  adverse  effect  of  sul- 
fonamides in  Rocky  Mountain  spotted  fever.  The 
observation  that  they  are  contraindicated  in  the 


Fig.  5.  Rocky  Mountain  spotted  fever.  The  same  pa- 
tient as  in  D.  The  exposed  portions  of  the  body 
are  markedly  tanned  from  over-exposure  to  the 
sun  and  wind.  The  lesions  are  confluent  and  have 
coalesced:  are2Ls  of  necrosis  are  present  on  the 
lateral  chest  wall.  Pupuric  involvement  may  be 
seen  on  the  left  anterior  thigh  region. 

disease  had  not  been  made  in  1941.  Although  the 
patient  was  seriously  ill  for  several  days  and 
convalescence  took  a long  time,  complete  recov- 
ery occurred.  It  is  believed  that  a rugged  con- 
stitution and  energetic  management  with  good 
nursing  care  did  much  to  bring  about  a favorable 
outcome. 

CASE  2 

J.  G.,  a white  male  of  37,  a rancher,  was  first 
seen  in  consultation  with  another  physician  on 


jor  October,  1949 


823 


May  22,  1944.  The  patient  gave  a history  of  hav- 
ing been  ill  for  ten  days.  Prior  to  that  time  he 
had  been  driving  a herd  of  horses  over  several 
miles  of  open  country.  The  drive  lasted  nearly 
a week  and  each  night  found  him  a considerable 
distance  from  human  habitation.  Sleep  in  a bed- 
roll on  the  prairie  was  necessary.  Numerous 
crawling  ticks  were  detected;  a few  of  the  pests 
were  found  attached  on  the  scrotum.  They  were 
carelessly  plucked  off  and  no  further  precau- 
tions were  taken.  The  patient  had  not  been  im- 
munized against  Rocky  Mountain  spotted  fever; 
the  precaution  seemed  unnecessary. 


Fig.  6.  Rocky  Mountain  spotted  fever.  The'  same 
patient  as  in  D and  E.  A more  detailed  view  of 
the  confluent  and  coalescent  lesions.  Necrotic 
areas  of  the  lateral  chest  wall  are  plainly  visible. 

He  commenced  to  feel  ill  within  two  or  three 
days  after  arriving  at  his  ranch.  Generalized 
body  aches  and  pains,  headache  and  a sore  throat 
were  present.  It  was  conceded  that  a respiratory 
infection  had  been  contracted  because  of  ex- 
posure to  the  elements  the  preceding  week. 
Home  remedies  were  applied  and  the  patient 
improved.  Symptoms  recurred  within  a few 
days,  however,  and  the  individual  felt  worse 
than  ever.  On  retiring  the  night  of  May  14,  he 
noticed  that  a rash  was  present.  He  came  to 
Casper  two  days  later  and  reported  for  medical 
care  for  the  first  time.  The  patient  was  ad- 
mitted to  the  Natrona  County  Memorial  Hospital. 
A mascular  eruption  was  present.  The  lesions 
were  chiefly  on  the  wrists  and  ankles,  but  ex- 
tension to  the  lower  arms  and  legs  had  begun. 
They  were  rose  red  in  color  and  discrete  in  dis- 
tribution. The  temperature  was  103.4  degrees  F., 
the  pulse  90,  and  respiratory  rate  22.  The  blood 
count  revealed  4,800,000  red  blood  cells,  with  a 
hemoglobin  of  14.8  grams,  and  a total  white  blood 
cell  count  was  9,200  with  a differential  of  81 
polymorphs  and  19  lymphocytes.  The  urine  had 
a 1 plus  albumin  but  was  otherwise  normal.  The 
blood  Wasserman  and  Kahn  reactions  were  neg- 
ative. A diagnosis  of  Rocky  Mountain  spotted 
fever  was  made  and  care  was  outlined. 

The  patient  was  placed  on  a light  diet  and 
fruit  juices  and  water  were  ordered  to  be  given 
freely.  Mild  cathartics  were  prescribed  and 
enemas  used  as  necessary.  Prescribed  medica- 
tion consisted  of  an  acetadin  capsule  with  codein 
sulfate  0.5  grains  every  three  or  four  hours.  Two 
cubic  centimeters  of  Rocky  Mountain  spotted 
fever  serum  was  administered  intramuscularly 
on  May  17.  The  next  morning,  when  more  serum 
could  be  procured,  18  cubic  centimeters  were 


given;  an  additional  20  cubic  centimeters  were 
given  in  the  afternoon.  The  patient  appeared  im- 
proved the  following  day;  he  perspired  freely 
and  the  temperature,  which  had  been  high, 
dropped  rapidly.  Twenty  cubic  centimeters  of 
serum  were  given  on  May  21.  The  patient 
coughed  frequently  and  complained  of  abdominal 
cramping.  He  became  mentally  confused  toward 
evening.  Barbiturates  were  necessary  to  con- 
trol restlessness.  Digitalis  was  commenced  be- 
cause of  pulse  changes. 

Physical  examination,  performed  on  May  22, 
revealed  a seriously  ill  patient.  He  was  disori- 
ented and  obviously  dehydrated.  The  throat 
was  reddened  and  the  conjunctivae  injected. 
Coarse  bronchial  rales  were  present.  The  blood 
pressure  was  112/80;  the  heart  was  regular  and 
the  tones  of  fair  amplitude  and  intensity.  The 
pulse  was  of  good  volume  and  the  rate  was  88. 
Moderate  abdominal  distention  was  present. 
Generalized  muscular  rigidity  made  palpation 
of  the  liver  and  spleen  impossible,  but  the  pa- 
tient flinched  when  pressure  was  applied  over 
the  splenic  area.  Pain  was  elicited  by  grasping 
the  muscles  of  the  posterior  lower  legs  and  the 
skin  was  sore  and  tender.  A generalized  eruption 
was  present;  the  lesions  were  bluish  red  and  most 
pronounced  on  the  extremities.  They  tended  to 
coalesce  and  areas  of  beginning  purpura  were 
visible  on  the  chest,  abdomen,  and  anterior 
thighs.  The  scrotum  was  black  and  gangrenous 
and  evidenced  early  sloughing.  In  addition  to 
previously  outlined  measures,  5 per  cent  glu- 
cose in  normal  saline  was  begun  parenterally 
and  fluids  were  urged  by  mouth,  in  an  attempt 
to  insure  an  intake  of  3,000  to  4,000  cubic  cen- 
timeters a day.  Continuous  abdominal  stupes 
were  resorted  to  and  repeated  enemas  were 
ordered.  Hot  witch  hazel  and  alcoholic  rubs  were 
given  regularly. 


Fiff  7 Rocky  Mountain  spotted  fever.  The  same 
patient  as  in  D.  E and  F.  Extensive  gangrene  of 
the  external  genitalia  is  present.  The  purpuric 
involvement  of  the  left  anterior  thigh  region  is 
depicted  in  finer  detail. 

The  patient  was  irrational  by  May  23;  admin- 
istration of  morphine  was  necessary  to  quiet 
him.  He  refused  nourishment  and  hiccoughed 
frequently.  The  temperature,  which  had  not 
been  excessively  high,  showed  an  ominous  ele- 
vation. The  pulse  became  rapid  and  thready 
and  a drop  in  blood  pressure  was  recorded.  The 
heart  developed  a gallop  rhythm  and  the  first 
sound  became  muffled  and  indistinct.  The  re- 
spiratory rate  was  increased;  breathing  became 


824 


Rocky  Mouktain  Medical  Journal 


shallow  and  labored.  An  oxygen  tent  was  or- 
dered and  stimulants  were  given.  On  May  25 
the  unfortunate  individual  presented  a pathetic 
appearance.  His  entire  body  was  covered  with 
coalescent  lesions;  large  masses  of  purpura  were 
present  and  localized  areas  of  necrosis  could  be 
made  out.  The  scrotum  was  completely  gan- 
grenous and  had  begun  to  rot  away.  Odor 
emitted  by  the  dying  patient  permeated  the 
room.  He  expired  late  that  evening,  fourteen 
days  after  the  illness  began  and  eight  days  fol- 
lowing admittance  to  the  hospital.  A rectal  tem- 
perature, taken  shortly  before  death  occurred, 
was  108  degrees  F.,  the  pulse  rate  at  that  time 
was  132  and  the  respirations  38. 


Fig.  8.  Rocky  Mountain  spotted  fever.  Case  3.  A 
moderately  severe  recovered  case  of  the  disease, 
showing  the  generalized  distribution  of  the  lesions. 
The  eruption  is  most  marked  on  the  extremities, 
but  is  present  on  other  body  areas  as  well. 

Discussion:  The  patient  died  from  generalized 
toxemia,  but  peripheral  circulatory  failure  was 
a contributory  factor  to  his  demise.  Modern 
supportive  therapy  of  Rocky  Mountain  spotted 
fever,  based  on  an  interpretation  and  correla- 
tion of  the  pathological  alterations  which  accom- 
pany the  disease,  did  not  exist  in  1944.  It  is 
questionable  whether  adequate  serum,  had  it 
been  procurable,  would  have  changed  the  final 
outcome.  Serum  administration  was  not  begun 
until  the  infection  was  well  established  and  ap- 
parently was  without  benefit.  Although  the 
patient  had  an  overwhelming  infection,  a more 
satisfactory  termination  might  have  taken  place 
had  he  reported  for  medical  care  as  soon  as  the 
illness  developed. 

CASE  3 

M.  T.,  aged  42,  a sheep  foreman,  was  seen  in 
Casper  on  May  9,  1947.  He  had  been  ill  four 
days.  Unusual  tire  and  exhaustion  had  been 
followed  by  chilling  sensations  and  development 
of  generalized  headache  and  pains  in  the  larger 
joints.  The  patient  had  been  engaged  in  lamb- 
ing for  three  weeks;  he  had  spent  long  hours 
on  the  open  range,  sleeping  at  night  in  a tent 
pitched  near  the  lambing  grounds.  He  had  been 
unable  to  bathe  or  change  his  clothing  because 
of  strenuous  and  confining  activities.  Numerous 
crawling  and  attached  ticks  were  detected;  the 
pests  were  pulled  off  and  no  further  precautions 
were  taken.  The  patient  had  never  been  immu- 
nized against  Rocky  Mountain  spotted  fever.  He 
had  resided  in  Wyoming  two  months  and  was 
unfamiliar  with  the  procedure. 


The  individual  was  moderately  ill.  He  com- 
plained bitterly  of  headache  and  distress  in  the 
knees  and  lower  back  region.  His  eyes  were 
injected  and  cough  and  bronchial  accentuation 
were  present.  The  exposed  portions  of  the  body 
were  severely  tanned  from  overexposure  to  the 
sun  and  wind.  It  was  believed,  nevertheless,  that 
lesions  could  be  made  out  on  the  wrists  and 
lower  arm  regions.  Inspection  of  the  protected 
areas  of  the  body  revealed  the  presence  of  a 
definite  muscular  eruption.  A diagnosis  of  Rocky 
Mountain  spotted  fever  was  made  and  the  patient 
was  taken  to  the  Natrona  County  Memorial  Hos- 
pital. 

The  clothes  which  had  been  worn  for  several 
days  were  removed  and  burned  in  an  incinera- 
tor. The  patient  was  bathed,  shaved,  and  put  to 
bed.  As  a result  of  the  tub  bath,  the  lesions, 
which  had  previously  been  perceptible  only  to 
close  inspection,  became  clearly  visible.  At- 
tendants who  had  undertaken  the  task  of  mak- 
ing the  patient  presentable  were  warned  to 
watch  for  crawling  ticks.  None  of  the  pests  was 
found,  although  numerous  bite  areas  signifying 
sites  of  former  tick  attachment  were  detected 
on  the  patient’s  body. 

The  temperature  was  103.2  degrees  F.,  the 
pulse  104,  and  the  respiration  26.  A blood  count 
revealed  4,650,000  red  blood  cells,  a hemoglobin 
of  13.25  grams  and  there  were  9,720  white  blood 
cells.  The  differential  count  showed  85  pol 
morphs,  10  lymphocytes,  and  5 monocytes.  The 
urine  showed  no  pathological  alterations.  Blood 
Wasserman  and  Kahn  reactions  were  negative. 
The  Proteus  agglutination  (Weil-Felix)  reaction 
against  0X19  strains  and  the  complement  fix- 
ation reaction  were  negative  on  May  15. 

The  patient  was  placed  on  a soft  high  carbo- 
hydrate and  protein  and  low  fat  diet.  Fluids 
were  urged  in  the  form  of  tap  water  and  strained 


Pig.  9.  Rocky  Mountain  spotted  fever.  The  same  pa- 
tient as  in  G,  showing  detail'  of  the  lesions  on  the 
upper  extremities.  The  eruption  is  discrete  and 
shows  no  evidence  of  coalescence  or  purpuric 
change. 

fruit  punch.  Mild  cathartics  were  prescribed  for 
elimination  and  enemas  ordered  when  necessary. 
An  acetadin  capsule  with  codein  sulfate  grains 
0.5  was  administered  every  four  hours.  An 
initial  dose  of  6 grams  of  para-aminobenzoic  acid 
(PABA)  was  given  along  with  60  grains  of 
sodium  bicarbonate.  Two  grams  of  PABA  and 
20  grains  of  sodium  bicarbonate  were  then  ad- 
ministered every  two  hours  day  and  night.  Dur- 
ing the  time  the  drug  was  given,  daily  white 


for  October,  1949 


825 


blood  cell,  differential  counts  and  urinalyses 
were  performed. 

The  eruption  was  complete  on  the  third  hos- 
pital day.  It  was  maculo-papular  in  character 
and  general  in  distribution.  The  lesions  were 
most  marked  on  the  extremities,  buttocks,  lat- 
eral chest  wall  and  abdomen.  The  eruption  was 
bluish  red  in  color  and  the  lesions  were  discrete. 
One  milligram  of  vitamin  K was  administered 
twice  a day  and  100  milligrams  of  ascorbic  acid 
once  a day  until  the  lesions  commenced  to  fade, 
when  both  preparations  were  gradually  dispensed 
with. 

The  patient  vomited  occasionally.  Vomiting 
was  believed  to  be  attributable  to  mild  intoler- 
ance to  PABA  or  to  the  disease  process,  and  was 
not  particularly  troublesome.  Mild  tympanites 
from  gastrointestinal  distention  occurred;  ene- 
mas relieved  the  condition.  Evidences  of  immi- 
nent peripheral  circulatory  failure  were  watched 
for,  but  were  not  detected.  Generalized  edema 
never  occurred.  The  temperature  had  begun  to 
fall  by  lysis  within  two  days  after  the  patient 
was  hospitalized.  He  was  alert  and  interested 
in  his  surroundings.  The  patient  ate  and  slept 
well  and  appeared  on  the  road  to  recovery. 

On  May  12,  without  permission,  he  commenced 
to  be  up  and  around,  demanding  that  he  be  al- 
lowed to  sit  in  a chair  because  he  could  not 
tolerate  continuous  bed  rest.  The  eruption  was 
complete  by  this  time,  but  showed  evidence  of 
rapid  recession.  It  remained  discrete  and  no  evi- 
dences of  purpuric  change  could  be  detected. 
The  temperature  reached  normal  on  May  24; 
para-aminobenzoic  acid  therapy  was  discontin- 
ued the  same  day.  The  patient  was  discharged 
from  the  hospital  on  May  27,  eighteen  days  after 
entrance  there  and  on  the  twenty-second  day  of 


Fig.  10.  Rocky  Mountain  spotted  fever.  The  same 
patient  as  in  Figs.  7 and  8.  The  lesions  of  the 
buttocks,  thighs  and  lower  leg  regions  are  dis- 
crete, small  in  size  and  situated  in  close  proximity 
to  one  another.  The  eruption  is  maculo-papular 
in  character. 

the  illness.  Proteus  agglutination  and  comple- 
ment fixation  reactions  were  performed  prior 
to  hospital  release.  Agglutination  was  strongly 
positive  against  0X19  strains;  the  serums  gave 
a strong  positive  complement  fixation  with 
spotted  fever  antigen  at  1:256.  The  patient  re- 
turned to  work  following  convalescence  of  a 
month.  Recovery  was  complete;  there  were  no 
sequelae  from  the  infection. 

Discussion:  The  case  demonstrates  satisfac- 
tory response  from  administration  of  para-amino- 


benzoic acid  for  Rocky  Mountain  spotted  fever. 
Early  in  1947  a supply  of  the  drug  in  tablet 
form  had  been  secured.  Although  PABA  had 
by  that  time  been  accepted  as  a valuable  ad- 
junct to  care  for  the  disease,  little  was  known 
regarding  its  toxic  potentialities  save  that  leu- 
kopenia and  acidosis  might  result  from  adminis- 
tration. The  value  of  intravenous  supportive 
therapy  for  Rocky  Mountain  spotted  fever  had 
previously  been  recognized.  Prompt  and  con- 


Fig.  11.  Rocky  Mountain  spotted  fever.  The  same 
patient  as  in  Figs.  7,  8,  and  9.  The  lesions  of  the 
anterior  lower  legs  are  discrete.  The  eruption  is 
maculo-papular  in  character,  bluish  red  in  color 
and  more  extensive  peripherally. 

tinned  administration  of  para-aminobenzoic  acid 
undoubtedly  did  much  to  insure  a favorable  out- 
come and  avoided  necessity  for  administration 
of  electrolytes,  plasma,  and  blood.  It  is  signif- 
icant that  the  patient  refused  to  remain  in  bed 
after  the  third  hospital  day.  In  view  of  the 
present  day  tenet  of  early  ambulation,  self-im- 
posed activity  may  have  been  beneficial.  It  cer- 
tainly did  no  harm,  although  insistence  on  the 
part  of  the  patient  that  he  be  up  and  around  at 
the  height  of  the  infection  was  not  accepted  as 
a wise  decision  at  the  time. 

Summary  and  Conclusions 

Modern  treatment  of  Rocky  Mountain 
spotted  fever  is  based  on  an  interpretation 
and  correlation  of  the  pathological  altera- 
tions which  accompany  the  disease.  Serum 
administration  has  a place  in  treatment,  in 
those  cases  seen  early.  Para-aminobenzoic 
acid  (PABA)  inhibits  the  growth  and  de- 
velopment of  rickettsiae  and  is  a valuable 
adjunct  to  care.  Antibiotic  therapy  appears 
to  be  remarkably  effective  for  Rocky  Moun- 
tain spotted  fever.  Aureomycin  and  Chlor- 
omycetin may  be  specific  agents  for  the 
disease,  but  additional  study  will  be  neces- 
sary before  their  potentialities  can  be  de- 
termined. Rocky  Mountain  spotted  fever 
vaccine  gives  definite  protection  against  the 
disease.  Most  illnesses  of  Rocky  Mountain 


826 


Rocky  Mountain  Medical  Journal 


spotted  fever  can  be  avoided  by  adherence 
to  personal  precautions.  The  present  day 
picture  of  the  disease  is  an  encouraging  one 
and  a source  of  satisfaction  to  physicians 
who  supervised  Rocky  Mountain  spotted 
fever  in  the  past. 


REFEREXCES 

1.  Anigstein,  L.,  and  Bader,  M.  N.;  Para-amino- 
benzoic  Acid,  Effectiveness  in  Spotted  Fever  in 
Guinea  Pigs,  Science  101:591,  1945. 

2.  Baker,  G.  E. : Rocky  Mountain  Spotted  Fever, 
Ann.  Int.  Med.,  17:247,  1942. 

3.  Baker,  G.  E.:  Rocky  Mountain  Spotted  Fever, 
J.A.M.A.,  122:841,  1943. 

4.  Baker,  G.  E. : Rocky  Mountain  Spotted  Fever, 
Med.  Clin.  North  Amer.,  28:752,  1944. 

5.  Baker,  G.  E. : Tice  Practice  of  Medicine,  W.  F. 
Prior  Company,  Hagerstown,  Md.,  W.  F.  Prior  Com- 
pany, Incorporated,  5:49,  1944. 

6.  Duggar,  B.  M. : Introductory  Paper,  in  Confer- 
ence on  Aureomycin — a New  Antibiotic,  New  York 
Academy  of  Science,  Section  of  Biology,  July  21,  1948. 

7.  Editorial:  Progress  in  Treatment  of  Typus  Fever 
and  of  Rocky  Mountain  Spotted  Fever,  J.A.M.A., 
126:964,  1944. 

8.  Ehrlich,  J.,  Bartz,  Q.  R.,  Smith,  R.  M.,  Joslyn, 
D.  A.,  and  Burkholder,  P.  R. : Chloromycetin,  a New 
Antibiotic  from  Soil  Actinomycete,  Science,  106:417, 
1947. 

9.  Flinn,  L.  B.,  Howard,  J.  W.,  Todd,  C.  W.,  and 
Scott,  E.  G. : Para-aminobenzoic  Acid  Treatment  of 
Rocky  Mountain  Spotted  Fever,  J.A.M.A.,  132:911, 

1946. 

10.  Greeley,  D.  M. : Treatment  and  Prevention  of 
Rocky  Mountain  Spotted  Fever  in  Children,  Med. 
Clin.  North  Amer.,  31:647,  1947. 

11.  Harrell,  G.  T.,  Venning,  W.,  and  Wolff,  W.  A.: 
Treatment  of  Rocky  Mountain  Spotted  Fever  with 
Particular  Reference  to  Intravenous  Fluids,  J.A.M.A., 
126:929,  1944. 

12.  Harrell,  G.  T.,  Wolff,  W.  A.,  and  Venning,  W. 

L.  : New  Approach  to  Basic  Supportive  Therapy  in 
Rocky  Mountain  Spotted  Fever,  South.  M.  J.,  38:367, 
1945. 

13.  Kelsey,  W.  M.,  and  Harrell,  G.  T. : Management 
of  Tick  Typus  (Rocky  Mountain  Spotted  Fever)  in 
Children,  J.A.M.A.,  137:1356,  1948. 

14.  Peterson,  J.  C.,  Overall,  J.  C.,  and  Shapiro,  J.  L. : 
Rickettsial  Disease  in  Childhood,  J.  Pediatrics,  30:495, 

1947. 

15.  Pincoffs,  M.  C.,  Guy,  E.  G.,  Lister,  L.  M.,  Wood- 
ward, T.  E.,  and  Smadel,  J.  E. : Treatment  of  Rocky 
Mountain  Spotted  Fever  with  Chloromycetin,  Ann. 
Int.  Med.,  29:656,  1948. 

16.  Ravenel,  S.  F.:  Para-aminobenzoic  Acid  Ther- 
apy of  Rocky  Mountain  Spotted  Fever,  J.A,M.A.,  133, 
989,  1947. 

17.  Ravenel,  S.  F.:  Treatment  of  Rocky  Mountain 
Spotted  Fever  with  Para-Aminobenzoic  Acid,  South. 

M.  J.,  40:801,  1947. 

18.  Rose,  K.  M.,  Duane,  R.  B.,  and  Fischel,  E.  E. : 
Treatment  of  Rocky  Mountain  Spotted  Fever  with 
Para-aminobenzoic  Acid,  J.A.M.A.,  129:1160,  1945. 

19.  Ross,  S.,  Schoenbach,  E.  B.,  Burke,  P.  G., 
Byer,  M.  S.,  Rice,  E.  C.,  and  Washington,  J.  A.:  Au- 
reomycin Therapy  of  Rocky  Mountain  Spotted  Fever, 
J.A.M.A.,  138:1213,  1948. 

20.  Ross,  S,  McLendon,  P.  A.,  and  Davis,  H.  J. : 
Para-aminobenzoic  Acid  in  Treatment  of  Rocky 
Mountain  Spotted  Fever,  Pediatrics,  2:163,  1948. 

21.  Smadel,  J.  E.,  and  Jackson,  E.  B.:  Chloromy- 
cetin, an  Antibiotic  with  Chemotherapeutic  Activity 
in  Experimental  Rickettsial  and  Viral  Infection, 
Science,  106:418,  1947. 

22.  Snyder,  J.  C. : Treatment  of  Rickettsial  Dis- 
eases in  Man,  Symposium  on  Rickettsial  Diseases, 
American  Association  for  the  Advancement  of  Sci- 
ence, 1948. 

23.  Snyder,  J.  C.,  Maier,  J.,  and  Anderson,  C.  R. : 
Report  to  the  Division  of  Medical  Sciences,  National 
Research  Council,  December  26,  1942. 

24.  Topping,  N.  H. : Rocky  Mountain  Spotted  Fever, 
Med.  Clin.  North  Amer.,  27:722,  1943. 

25.  Yeomans,  A.,  and  Snyder,  J.  C. : Treatment  of 
Rickettsial  Diseases,  Med.  Clin.  North  Amer.,  32:1333, 

1948. 


COLORADO 

State  Health  Department 

STANDARD  CERTIFICATES 

Since  the  adoption  January  1,  1949,  of  the  new 
Standard  Certificates  of  Birth,  Death,  and  Still- 
birth by  the  Colorado  State  Board  of  Health, 
the  recording  and  compilation  of  pertinent  facts 
regarding  these  matters  has  been  facilitated. 
These  new  certificates  are  recommended  in  the 
tenth  (1949)  revision  of  the  “Physican’s  Hand- 
book on  Death  and  Birth  Registration.”  Reasons 
for  the  changes  and  directions  for  using  the  new 
forms  are  given  in  the  Handbook,  which  has 
been  sent  to  all  physicians  in  the  state. 

The  changes  do  not  call  for  any  fundamentally 
different  information  than  that  requested  on 
the  certificates  in  use  during  the  decade  of  1939 
to  1948.  The  form  of  the  medical  certification 
on  the  Standard  Death  Certificate  has  been  re- 
designed to  facilitate  reporting  of  the  underly- 
ing cause  of  death  and  to  obtain  the  necessary  in- 
formation on  the  casual  and  chronological  se- 
quence leading  to  death. 

The  new  Standard  Birth  Certificate  has  a sep- 
arate confidential  section  for  medical  and  health 
items.  This  arrangement  facilitates  their  omis- 
sion from  certified  copies  of  the  birth  certificate 
that  are  used  for  ordinary  purposes.  This  prac- 
tice is  intended  to  prevent  unnecessary  embar- 
rassment to  the  child  or  his  parents  when  such 
facts  as  illegitimacy  or  malformations  appear 
on  birth  records. 

Stillbirth  certificates  contain  in  the  medical 
section,  in  addition  to  the  causes  of  stillbirth, 
such  items  of  information  as  length  of  pregnancy, 
and  complications  of  pregnancy  and  labor.  From 
these  facts,  the  magnitude  and  the  underlying 
causes  of  stillbirth  can  eventually  be  determined. 

The  uses  for  the  information  recorded  on  birth 
and  death  certificates  are  almost  endless.  In- 
dividuals use  information  from  death  certificates 
to  claim  life  insurance  and . pensions,  settle  es- 
tates, establish  circumstances  and  place  of  death, 
give  evidence  as  to  age,  sex,  race,  and  place  of 
burial.  Medical  and  health  agencies  determine 
the  incidence  of  specific  diseases  as  causes  of 
death,  establish  the  need  for  special  health  and 
medical  programs,  and  to  measure  the  effective- 
ness of  health  services  in  preventing  and  con- 
trolling disease. 

World  War  II  emphasized  the  importance  of 
the  birth  certificate.  The  importance  of  the  in- 
formation contained  on  birth  certificates  makes 
complete  and  accurate  reporting  essential.  Tak- 
ing time  to  fill  out  a birth  certificate  carefully 
and  fully  saves  the  busy  physician  from  using 
valuable  time  later  in  answering  queries  from 
local  or  state  registrars  regarding  inaccurate 
or  incomplete  entries. 

Occasionally  a physician  files  a birth  or  death 
report  on  the  old  certificate  form.  These  can  no 
longer  be  accepted  and  are  returned  to  the  re- 
porting physician  to  be  re-filed  on  the  new 
certificate. 

Any  physician  who  has  not  received  his  copy 
of  the  1949  edition  of  the  Physician’s  Handbook 
may  obtain  one  by  writing  to  the  Records  and 
Statistics  Section,  State  Department  of  Public 
Health,  403  State  Office  Building,  Denver. 


for  October,  1949 


827 


PRESIDENTIAL  ADDRESS* 

FRED  A.  HUMPHREY,  M.D. 

FORT  COLRINS 


The  Colorado  State  Medical  Society  start- 
ed as  a small  scientific  organization,  meet- 
ing annually  for  the  promulgation  and 
interchange  of  scientific  facts.  Their  first 
meetings  were  primarily  assemblies  of  in- 
dividuals wholly  and  solely  interested  in  as- 
sociating themselves  with  others  who  had  a 
similar  scientific  and  humanitarian  quirk 
in  their  everyday  thinking  and  activity.  As 
a small  boy  grows  &nd  matures,  so  this 
society  has  grown  and  matured,  especially 
during  the  past  few  years,  until  it  now  oc- 
cupies the  prominent  place  it  deserves,  not 
only  in  the  scientific  but  also  in  the  politi- 
cal, social,  and  business  fields,  in  Colorado 
and  the  United  States. 

In  other  words,  the  Colorado  State  Medi- 
cal Society  is  now  “Big  Business.”  As  such, 
it  should  follow  the  custom  of  other  busi- 
ness firms  and  take  inventory  of  its  assets 
and  liabilities,  at  least  once  a year,  to  obtain 
a clear  picture  of  the  events  that  have 
transpired  in  the  past,  so  as  to  have  more 
definite  information  on  which  to  build  its 
future  programs.  Possibly  such  an  inven- 
tory will  indicate  that  some  of  the  activities 
of  the  Society  should  be  curtailed  while 
others  should  be  expanded  and  resolutely 
and  irrevocably  pushed  forward. 

All  will  agree  that  the  greatest  asset  of 
any  organization  such  as  ours  is  the  indi- 
vidual person  or  doctor.  The  adage  that 
“A  chain  is  as  strong  as  its  weakest  link” 
does  not  literally  apply  to  this  organization. 
However,  the  actions  of  the  individual 
members  reflect  either  favorably  or  un- 
favorably, as  the  circumstances  may  dictate, 
in  the  established  relationship  between  the 
medical  profession  as  a whole  and  the  pub- 
lic in  general. 

A few  years  ago,  the  Medical  Society  in- 
stigated a public  opinion  survey  in  Colo- 
rado. This  was  made  by  a public  relations 
firm.  The  purpose  was  to  obtain  accurate 
knowledge  of  the  standing  of  the  medical 
profession  in  the  eyes  of  the  public.  The 

‘Delivered  before  the  7i9th  Annual  Session,  Colorado 
State  Medical  Society,  Denver,  September  23,  1949. 


report  of  this  survey  showed  that  as  indi- 
viduals, the  great  majority  of  the  medical 
profession  stood  very  high  but  that  collec- 
tively, organized  medicine  did  not  rate  so 
well.  Therefore  it  behooves  each  individual 
doctor  to  guard  his  activities,  both  in  rela- 
tion to  other  members  of  the  profession  and 
to  the  public,  so  as  not  to  bring  deleterious 
reactions  against  the  body  politic. 

Using  this  survey  as  a basis,  your  State 
Society  has  launched  a strong  progressive 
program  for  improvement  of  health  and 
medical  care  for  the  people  of  Colorado. 
No  one  will  deny  the  statement  that  the 
Colorado  State  Medical  Society  is  now  con- 
sidered one  of  the  most  active  and  progres- 
sive medical  societies  in  the  United  States. 
By  our  future  actions,  let  us  maintain  this 
enviable  position  and  improve  it  as  oppor- 
tunities present  themselves.  Bather  than 
rescind  any  of  our  past  progressive  activi- 
ties, let  us  move  forward  and  overcome  in 
a constructive  manner  any  new  problems 
which  become  apparent  to  us.  Because  of 
our  past  performances,  many  states  are 
watching  Colorado  for  leadership  in  public 
relations.  A number  of  other  state  societies 
have  copied  almost  word  for  word  our 
“Code  of  Cooperation  With  Newspapers  and 
Radio”  and  the  organization  of  our  “Board 
of  Supervisors.”  These  are  only  two  of  the 
many  activities  which  we  must  support 
wholeheartedly  and  maintain  continuously. 

It  is  common  knowledge  that  the  success 
of  any  organization  such  as  ours  depends  to 
a very  great  extent  on  obtaining  and  hold- 
ing the  interest  of  a large  part  of  the  indi- 
vidual members.  Realizing  this,  I hesitated 
last  summer  before  recommending  to  the 
Board  of  Trustees,  that  this  Society  undergo 
a plan  of  reorganization  whereby  the  num- 
ber of  committees  be  drastically  reduced. 
This  reorganization  will  take  out  of  com- 
mittee work  many  doctors  who  have  done 
exceptionally  good  work  for  their  medical 
society  at  the  willing  sacrifice  of  much  of 
their  valuable  time.  To  all  of  them  we  ex- 
press our  thanks  and  request  that  they 


828 


Rocky  Mountain  Medical  Journal 


continue  their  active  interest  in  the  affairs 
of  the  Society. 

During  the  past  few  years  the  activities 
of  this  Society  have  increased  immeasur- 
ably. Of  necessity,  there  has  developed 
much  over-lapping  in  the  work  of  the  vari- 
ous committees.  As  one  committee  has  ex- 
tended its  work  into  a field  previously 
covered  by  another  committee,  one  or  the 
other  and  sometimes  both  have  failed  in 
the  job  at  hand.  There  is  nothing  which 
kills  the  ambition  of  an  enthusiastic  worker 
in  any  group  more  quickly  than  to  be  placed 
on  a committee  and  then  to  find  that  there 
is  no  present  justification  for  the  existence 
of  that  committee.  For  that  reason  we  have 
outlined  our  conception  of  what  the  activi- 
ties of  each  committee  should  be,  in  an 
attempt  to  further  coordinate  and  corelate 
their  work.  In  so  doing  it  was  found  that 
the  number  of  committees  could  be  reduced. 
Such  a streamlining  of  the  real  working 
part  of  our  organization  should  tend  to  de- 
velop more  active  committees  and  enhance 
our  chances  of  implementing  and  carrying 
to  completion  many  worthwhile  divisions 
of  a progressive  program. 

It  is  expected  that  each  member  of  this 
Society,  who  accepts  membership  on  a com- 
mitteee,  will  devote  the  necessary  time  and 
thought  to  the  problems  of  his  committee 
so  that  the  entire  program  of  the  Society 
will  move  forward  at  a rapid  pace  and  in 
a comprehensive  manner.  From  those  mem- 
bers who  are  not  on  definite  committee 
assignments,  we  will  welcome  constructive 
criticism.  Criticism  from  those  individuals 
who  never  or  seldom  attend  their  county 
medical  society  meetings  cannot  be  con- 
structive as  it  cannot  be  based  on  a knowl- 
edge of  the  program  that  state  and  com- 
ponent societies  are  striving  to  accomplish. 

The  usual  coordination  meeting  of  com- 
mittee chairmen,  where  each  was  supposed 
to  outline  the  activities  of  his  committee 
for  the  year,  will  not  be  held  this  fall.  In- 
stead, it  was  deemed  advisable  to  more  defi- 
nitely outline  the  work  and  program  of 
each  committee  and  then  to  hold  an  accom- 
plishment meeting  later  in  the  year.  At 
that  time  each  of  the  committee  chairmen 
will  report  on  the  various  projects  which 


have  been  started  or  completed  by  his  com- 
mittee. It  is  hoped  that  these  reports  will 
stimulate  greater  activity  on  the  part  of  all 
committee  chairmen  and  members.  If  no 
worthwhile  program  has  been  developed  by 
a committee,  then  that  committee  should 
be  abolished,  if  possible,  under  our  By- 
Laws.  However,  if  the  fault  lies  in  the  per- 
sonnel of  the  committee,  a new  committee 
should  be  formed  to  replace  the  one  which 
has  failed  in  the  purpose  for  which  it  was 
originally  appointed. 

A great  amount  of  the  time  and  energies 
of  the  officers  and  members  of  this  Society 
during  the  following  year  must  be  devoted 
to  the  political  program  of  defeating  the 
Murray,  Wagner,  Dingle  type  of  legislation 
which  also  is  the  short  term  objective  of 
the  American  Medical  Association.  How- 
ever, we  should  not  become  so  engrossed 
in  defeating  such  laws  that  we  forget  to 
neglect  the  positive  long  range  program 
of  organized  medicine  as  embodied  in 
the  more  universal  distribution  of  volun- 
tary prepayment  medical  care  and  hospital 
insurance  to  the  American  public.  The  great 
majority  of  our  fellow  citizens  have  become 
accustomed  to  a higher  type  of  medical  care 
than  can  be  obtained  in  any  other  country 
of  the  world.  Let  us  strive  to  keep  the  bal- 
ance tipped  to  the  side  of  American  medi- 
cine. 

While  speaking  to  a county  medical  so- 
ciety last  winter,  I was  accused  of  being 
an  optimist  after  expressing  an  opinion  that 
Congress  would  not  pass  the  Compulsory 
Health  Bill.  My  answer  to  them  was  and 
my  answer  to  the  same  question  today  is, 
that  it  makes  no  difference  whether  you  are 
an  optimist  or  a pessimist  so  long  as  you  are 
not  so  optimistic  or  so  pessimistic  that  you 
think  the  battle  is  won  or  lost.  Such  per- 
sons, in  either  category,  discontinue  work- 
ing for  the  cause  they  know  is  for  the  pro- 
tection if  not  the  salvation  of  the  health  of 
the  American  people. 

Great  progress  has  been  made  in  the  short 
nine  months  since  the  House  of  Delegates 
of  the  American  Medical  Association,  meet- 
ing in  St.  Louis,  decided  to  embark  on  an 
educational  program  and  enlighten  our  fel- 
low citizens  concerning  the  erroneous  prop- 


for  October,  1949 


829 


aganda  put  out  by  Ewing,  Altmeier,  and 
other  persons,  not  excluding  President  Tru- 
man himself,  who  are  paid  out  of  public 
funds.  The  instigation  of  this  program  by 
the  American  Medical  Association  and  its 
component  state  and  county  societies  was  a 
sharp  departure  from  the  purely  scientific 
activities  of  previous  years.  It  acted  as  a 
sparkplug  to  many  other  strong  national 
organizations  who  believe  in  free  competi- 
tive enterprise  and  are  against  social  “secur- 
ity” in  general  and  against  compulsory 
health  insurance  in  particular.  Such  national 
organizations  as  the  American  Farm  Bureau 
Federation,  the  U.  S.  Chamber  of  Commerce, 
the  American  Bar  Association,  the  American 
Legion  and  many  others  too  numerous  to 
mention  soon  joined  with  us  in  the  promo- 
tion of  our  educational  program. 

I am  fully  cognizant  of  the  tremendous 
amount  of  work  and  energy  put  forth  by 
the  busy  doctors  who  man  the  committees 
of  the  American  Medical  Association  and 
the  various  state  medical  societies.  Never- 
theless, the  proposed  legislation  will  be  de- 
feated, either  easily  or  with  diffculty,  in 
direct  proportion  to  the  amount  of  energy 
expended  by  the  county  societies  and  indi- 
vidual doctors.  First  thoroughly  educate 
yourself  by  studying  the  many  and  varied 
pamphlets  furnished  through  your  county, 
state,  and  national  societies.  Then  read  the 
articles  on  both  sides  of  the  question  and 
on  the  medical  situation  as  it  exists  in  Eng- 
land, which  have  been  and  probably  will 
continue  to  be  published  in  practically 
every  popular  magazine.  After  you  have 
thoroughly  familiarized  yourself  with  all 
the  aspects  of  the  subject,  be  not  afraid 
or  ashamed  to  talk  to  your  patients.  If  they 
did  not  have  a supreme  faith  in  your  knowl- 
edge of  medical  affairs,  they  would  not  be 
your  patients.  A wisely  selected  word  or 
two  from  you  will  do  more  to  influence 
their  thinking  and  reaction  to  socialized 
medicine  than  all  the  impersonal  pamphlets, 
from  sources  unknown  to  them,  which  they 
could  possibly  read. 

Political  medicine  is  a new  term  which 
has  been  forced  upon  us  during  the  past 
few  years.  The  medical  societies,  county, 
state,  and  national,  were  all  organized  for 


the  exchange  of  scientific  information.  For 
generations  they  remained  aloof  and  would 
not  enter  into  any  controversy  which  did 
not  have  a scientific  tinge.  However,  when 
the  attempt  was  made  to  destroy  the  very 
basis  of  good  medical  care  to  the  American 
public — and  even  the  social  planners  admit 
that  the  American  people  have  better  medi- 
cal care  than  those  of  any  other  country — 
it  was  time  to  discard  the  purely  scientific 
mantle  or  rather  to  add  a political  section 
to  an  otherwise  scientific  society.  Whether 
you  like  it  or  not  you  are  in  politics  and  the 
sooner  you  realize  it  and  act  accordingly, 
the  better  it  will  be  for  the  health  and 
welfare  of  your  patients  and  neighbors. 

The  battle  lines  are  drawn  and  we  are 
now  simply  enjoying  an  armistice  waiting 
for  this  Congress  to  adjourn.  The  action 
will  begin  when  Congress  reconvenes  later 
this  year.  Let  us  take  advantage  of  the  re- 
cess between  sessions  to  personally  contact 
our  Congressmen.  Each  of  them  is  inter- 
ested in  knowing  the  reactions  of  his  local 
medical  society  to  the  attempt  of  the  Wash- 
ington Bureaucrats  to  force  compulsory 
health  insurance  and  other  social  revolu- 
tions on  the  American  public.  They  will 
appreciate  hearing  from  you  and  you  will 
be  derelict  in  your  duty  if  you  do  not  seize 
upon  this  opportunity  to  express  your  opin- 
ions to  them  and  at  the  same  time  obtain 
their  reactions. 

The  strategy  of  the  proponents  of  social- 
istic changes  seems  to  be  developing  along 
different  lines  than  have  been  followed  dur- 
ing the  past  few  years.  It  is  conceded  by 
most  political  observers  that  a bill  embody- 
ing complete  compulsory  health  legislation, 
such  as  is  now  in  force  in  England,  will  not 
be  enacted  this  year.  All  of  the  previous 
omnibus  health  bills  were  based  on  the  Eng- 
lish scheme.  While  such  a bill  undoubtedly 
will  be  reintroduced,  a more  concerted  ef- 
fort will  be  made  to  accomplish  the  same 
end  result  by  successive  stages.  The  first 
real  test  of  strength  came  on  August  16 
when  the  President’s  Reorganization  Plan 
No.  1 was  defeated  in  the  Senate.  It  would 
have  increased  the  power  and  scope  of  the 
Social  Security  Administrator  by  giving 
him  a Cabinet  post  in  charge  of  both  health 


830 


Rocky  Mountain  Medical  Journal 


and  welfare.  Scores  of  bills  dealing  with 
health  were  introduced  in  this  session  of 
Congress  and  most  of  them,  along  with  oth- 
ers, will  be  reintroduced  in  the  next.  It 
matters  little  to  the  social  planners  in 
Washington  whether  they  accomplish  their 
goal  in  one  full  swoop  or  by  piece-meal 
tactics.  The  medical  profession  should  im- 
mediately combine  with  all  other  organiza- 
tions who  believe  in  progress  by  individual 
competitive  effort.  Their  combined  forces 
should  then  be  directed  toward  a program 
of  progressive  and  positive  activity  as  well 
as  toward  the  defeat  of  the  trend  toward  so- 
cialistic control  of  American  business.  This 
country  achieved  its  greatness  on  the  princi- 
ple of  free  competition  in  business,  both 
large  and  small,  and  can  maintain  its  su- 
premacy only  by  retaining  the  foundation  on 
which  it  was  built.  We  could  do  no  better 
than  follow  the  tactics  of  a football  coach 
who  believes  that  a good  offense  is  the  best 
defense.  A positive  and  constructive  pro- 
gram is  our  best  defense  against  inroads  on 
the  health  and  medical  care  of  the  American 
public. 

As  medical  societies  were  originally 
organized  for  the  spread  of  scientific  knowl- 
edge so  the  medical  schools  were  established 
for  the  purpose  of  educating  undergraduate 
students  in  the  art  and  science  of  medical 
practice.  Their  activities,  of  necessity,  have 
enlarged  and  expanded  to  keep  pace  with 
the  new  concept  of  teaching  scientific  facts. 
It  is  believed  by  some  doctors  that  their 
interests  have  become  so  diversified  that 
the  basic  reason  for  their  existence  has  been 
relegated  to  a position  of  minor  importance. 
The  premise  on  which  the  above  opinion 
probably,  is  founded,  as  it  applies  to  our 
own  medical  school  at  least,  is  a comparison 
of  the  total  budget  of  the  Colorado  Medical 
School  and  the  number  of  its  students  at 
the  present  time  with  the  same  two  items 
of  a few  years  ago.  For  example,  in  1949 
the  total  cost  of  running  the  Medical  School 
was  $516,575  and  the  number  of  students 
was  250.  In  1939  the  cost  was  $235,368  and 
the  number  of  students  was  207.  Reduced 
to  cost  per  student  per  year  these  figures 
show  that  the  cost  of  medical  education  has 
almost  doubled  during  the  past  ten  years. 


Further  investigation  shows  that  this  in- 
crease is  due  to  the  higher  level  of  salaries 
paid,  the  increased  cost  of  supplies,  and  the 
change  in  policy  in  Colorado  as  in  most 
American  Medical  Schools  whereby  full 
time  instructors  have  replaced  to  a great 
extent  the  former  method  of  teaching  by  a 
voluntary  staff.  A comparison  of  the  1948- 
49  budget  of  the  Colorado  Medical  School 
with  the  budgets  of  forty-nine  other  medi- 
cal schools  shows  that  Colorado  is  below  the 
average.  Actually  it  is  in  thirty-second  place 
among  those  schools  in  total  amount  of 
money  spent.  No  money  from  the  federal 
government  or  from  benevolent  foundations 
is  used  for  operating  the  Medical  'School 
proper,  as  distinguished  from  the  whole 
medical  center.  The  school  itself  receives  its 
money  from  only  three  sources:  a mill  levy, 
a legislative  appropriation,  and  tuition  paid 
by  students. 

Persons  in  a position  to  know  almost  uni- 
versally concede  that  there  is  a shortage 
of  doctors  in  the  United  States,  over  and 
above  the  distributional  problem.  If  the 
University  of  Colorado  School  of  Medicine 
is  to  enroll  and  educate  more  undergrad- 
uate students,  the  appropriations  to  the 
school  by  the  legislature  must  be  increased. 
To  accomplish  this  will  require  the  com- 
bined effort  of  the  Medical  School  authori- 
ties, who  have  the  responsibility  of  train- 
ing the  undergraduate  students,  and  the 
Medical  Society,  whose  individual  members 
have  the  responsibility  of  the  health  and 
medical  care  of  the  people  of  Colorado.  The 
cooperation  between  these  two  bodies  has 
been  gradually  diminishing  during  the  past 
few  years  due  to  a mutual  lack  of  confi- 
dence in  each  other.  That  confidence  must, 
and  probably  can,  be  restored  by  an  open 
discussion  of  the  problems  by  an  impartial 
committee  before  they  develop  into  a situa- 
tion for  which  there  is  no  logical  solution 
satisfactory  to  both  parties. 

At  this  point  I would  like  to  repeat  my 
answer  to  a question  asked  in  the  summer 
of  1948  concerning  my  attitude  toward  the 
Medical  School.  It  was,  “A  strong  medical 
school  would  augment  the  strength  of  the 
medical  society  and  a strong  medical  society 
likewise  would  increase  the  strength  of  the 


for  October,  1949 


831 


medical  school.  The  cooperation  of  the  two 
would  be  of  great  benefit  to  the  health  and 
medical  care  of  the  people  of  Colorado.” 
With  that  idea  in  mind,  and  on  the  theory 
that  most  questions  can  be  solved  before 
they  become  insurmountable  problems,  I 
am  asking  the  Committee  on  Medical  Edu- 
cation and  Hospitals  to  meet  regularly  once 
each  month  as  a clearing  house  for  all  con- 
troverial  questions  dealing  with  the  Medical 
School.  Also,  this  same  committee  should  in- 
vestigate and  recommend  to  the  Society  the 
budgetary  needs  of  the  Medical  School.  The 
State  Medical  Society  should  use  its  influ- 
ence in  helping  to  obtain  an  appropriation 
by  the  legislature  sufficient  for  those  needs. 
The  two  organizations  could  then  offer  a 
united  front  in  opposition  to  Congressional 
legislation  which  throws  the  ultimate  con- 
trol of  medical  schools  into  the  hands  of  the 
Surgeon  General  and  the  Federal  Security 
Administrator.  We  must  keep  our  medical 
schools  free  from  federal  interference.  Those 
who  would  nationlize  medicine  must  con- 
trol the  medical  schools  and  the  production 
of  physicians. 

During  the  past  six  months,  the  Larimer 
County  Hospital  has  had  a resident  physi- 
cian as  a part  of  the  general  practice  resident 
training  program  of  the  Medical  Center. 
To  qualify  for  this  new  activity  the  staff  had 
to  undergo  some  minor  changes  in  order  to 
set  up  a resident  teaching  program.  The  staff 
meets  regularly  once  a month.  On  this 
meeting  day,  the  hospital  is  visited  by  a 
teaching  team  of  two  doctors.  This  team  is 
chosen  by  the  educational  committee  of 'the 
local  staff  and  is  not  limited  to  University 
faculty  membership.  The  morning  is  spent 
in  ward  rounds  with  the  resident  and  those 
local  doctors  who  wish  to  participate.  The 
afternoon  is  devoted  to  clinical  presenta- 
tion and  discussion  of  selected  cases  brought 
in  by  members  of  the  staff.  The  visitors 
then  present  a formal  program  for  the  staff 
at  its  regular  evening  meeting.  The  sub- 
jects to  be  discussed  and  the  specialties  to 
be  represented  on  the  team,  as  well  as  the 
individuals,  are  chosen  by  the  educational 
committee  of  the  hospital  staff.  To  date  this 
program  has  been  eminently  successful  and 


the  hospital  staff,  the  hospital  administra- 
tion, and  I believe,  the  resident  physician, 
all  are  enthusiastic  for  its  continuation. 

Having  used  the  Larimer  County  Hospital 
as  the  guinea  pig,  it  is  now  time  to  branch 
out  and  give  other  small  hospitals  and 
county  medical  societies  the  advantage  of  a 
similar  type  of  program.  It  should  not  be  an 
essential  requirement  that  the  hospital  have 
a resident  in  general  practice  as  such  qual- 
ified residents  are  not  readily  available. 
Through  the  cooperation  of  the  Medical  So- 
ciety and  the  Medical  Center,  a workable 
plan  of  postgraduate  medical  education 
should  be  offered  to  the  small  county  medi- 
cal societies  through  their  local  hospital 
facilities.  This  postgraduate  study  should 
then  be  certified  to  the  American  Academy 
of  General  Practice  to  apply  on  the  amount 
of  postgraduate  work  required  of  its  mem- 
bers each  year. 

In  conclusion  let  me  digress  from  the 
previous  trend  of  this  paper  concerning  the 
Medical  Society’s  problems  and  programs 
and  tell  you  about  a book  which  was  pre- 
sented to  me  by  a patient.  I have  read  it 
many  times  during  the  past  year  and  it  so 
impressed  me  that  I would  recommend  it  to 
every  doctor  as  an  essential  volume  in  his 
library.  Its  title  is  “In  a Chinese  Gar- 
den.” It  was  written  by  Dr.  Frederick  M. 
Loomis  of  California.  It  requires  less  than 
ten  minutes  reading  time.  A Chinese  say- 
ing, which  was  the  inspiration  for  the  story, 
was  reported  to  be  engraved  on  a brass 
plate  imbedded  in  a wall  surrounding  a 
beautiful  garden.  The  Chinese  characters 
translated  into  English  say,  “Enjoy  yourself 
— It  is  later  than  you  think.”  The  influence 
this  book  might  have  on  a physician  in  re- 
lationship to  his  own  health  and  life  ex- 
pectancy if  its  advice  were  heeded,  can  best 
be  expressed  by  reading  a paragraph  of  the 
foreword. 

I quote,  “This  seems  the  time  to  remind 
many  men  and  women  that  they  will  have 
more  years,  and  happier  ones,  to  do  good 
for  others  if  they  start  right  now  to  do 
something  for  themselves;  to  go  places  and 
do  things  which,  without  decision,  they  have 
looked  forward  to  for  years;  to  give  those 
who  love  them  the  happiness  of  seeing  them 


832 


Rocky  Mountain  Medical  Jouknal 


enjoy  some  of  the  rewards  which  they  have 
earned;  to  replace  competition  with  a little 
bit  of  contemplation.”  Unquote.  “Enjoy 
yourself — It  is  later  than  you  think.”  “To 
replace  competition  with  a little  bit  of  con- 
templation.” There  is  a lot  of  philosophy 
wrapped  up  in  those  two  quotations. 

Statistics  show  that  while  the  life  expec- 
tancy of  physicians  is  about  identical  with 
other  walks  of  life,  more  deaths  occur  in 
our  profession  from  coronary  disease  and 
other  circulatory  accidents  than  in  any  other 
group.  During  the  past  few  years,  doctors 
have  been  kept  so  busy  administering  to 
the  needs  of  a sick  population  that  they 
have  had  no  time  to  stop  and  ponder  on  the 
affect  of  such  overactivity  on  their  own  in- 


dividual health.  Every  doctor  of  medicine 
has  at  some  time  in  his  life  carried  on  the 
practice  of  medicine  and  administered  to  a 
sick  child  or  adult  at  a time  and  under  cer- 
tain unfavorable  circumstances  when  he 
should  have  been  the  patient  rather  than 
the  doctor.  In  a similar  situation  he  would 
have  ordered  a patient  of  his  to  surrender 
to  the  laws  of  nature  and  protect  himself 
from  his  own  self-destroying  activities.  If 
each  of  us  would  simply  practice  what  we 
preach,  the  logevity  tables  of  the  insurance 
companies  would  reflect  a very  decided  and 
favorable  trend  in  the  life  expectancy  of  the 
medical  profession. 

May  I close  by  repetition,  “Enjoy  yourself 
— It  is  later  than  you  think.”  “Replace  com- 
petition with  a little  bit  of  contemplation.” 


THE  PSYCHOLOGY  OF  THE  POOR  READER* 

WILLIAM  H.  CRISP,  M.D. 

DENVER 


This  subject  is  in  the  main  pedagogical, 
but  the  ophthalmologist  is  often  consulted 
and  his  knowledge  and  skill  may  be  use- 
fully applied.  Broadly  considered,  the  prob- 
lem has  intimate  association  with  the  psy- 
chology of  vision  as  well  as  with  educa- 
tional method. 

Until  the  present  century  the  approach 
to  acquisition  of  the  writing  and  reading 
skill  was  first  the  teaching  of  the  names 
and  values  of  individual  letters,  then  the 
construction  of  single  syllables,  and  finally 
the  progressive  comprehension  of  words  of 
several  syllables.  This  broadly  repeated  the 
course  of  the  evolution  of  language. 

In  the  modern  educational  trend  toward 
avoidance  of  the  mechanical  in  school 
method,  routine  learning  of  alphabet  and 
spelling  has  been  avoided  and  the  young- 
ster called  upon  to  seize  complete  words  by 
the  so-called  “flash”  method.  It  is  now 
rather  generally  considered  heretical  for  a 
mother  to  teach  her  own  child  the  alphabet 
and  the  rudiments  of  written  speech. 

Types  of  reading  difficulty  with  which 
ophthalmologists  are  most  concerned  do  not 

•Summarized  form  of  a paper  presented  to  the 
American  Opthalmological  Society  at  its  annual 
meeting-,  Hot  Spring's,  Virginia,  June  2 to  4,  1949. 


seem  to  have  a great  deal  of  relation  to  gen- 
eral mental  capacity.  Some  high-grade  im- 
beciles read  with  great  facility  although 
failing  to  grasp  the  sense.  But  many  boys 
and  girls  are  failures  in  reading  although 
showing  a high  intelligence  quotient. 

Defects  in  reading  ability  range  from  ex- 
treme to  moderate.  The  more  necessary 
progress  in  reading  becomes  the  more  ob- 
vious is  the  child’s  retardation.  He  may  go 
along  to  the  high  school  stage  only  to  give 
more  and  more  evidence  that  he  will  not 
be  able  to  satisfy  the  requirements  for  en- 
tering college.  Recognition  of  his  difficulty 
may  be  delayed  by  a retentive  memory  for 
what  he  hears  in  the  class  room.  The  recent 
tendency  to  encourage  silent  reading  helps 
to  disguise  the  defect.  But  the  existence  of 
merely  a moderate  reading  difficulty  may 
thwart  eager  ambitions  and  may  distort  the 
student’s  whole  career.  Such  persons  are 
likely  to  avoid  general  reading,  their  vocab- 
ulary being  thus  greatly  limited. 

Since  the  psychological  environment  of 
the  child  begins  at  least  at  the  cradle  if  not 
earlier,  and  the  impressions,  shocks,  and 
conflicting  influences  of  infancy  go  on  usu- 
ally for  five  or  six  years  before  the  reading: 


for  October,  1949 


833; 


age,  there  are  infinite  possibilities  for  the 
creation  of  inhibitions  or  misdirections  dur- 
ing these  preliminary  years  as  well  as  at 
the  more  or  less  sudden  entry  into  school 
life. 

The  faculty  of  speech  was  developed 
through  a vast  period  of  time,  and  very 
gradual  was  the  supplemental  process  by 
which  reading  and  writing  were  added  to 
the  power  of  speech.  The  necessity  for 
training  in  this  supplemental  skill  is  pre- 
sented to  the  child  as  a fairly  abrupt  transi- 
tion. Failure  of  the  reading  “door”  to  open 
will  often  be  due  to  absence  of  favoring  en- 
vironment influences,  or  to  the  existence  of 
inhibiting  or  obstructing  factors  in  the 
child’s  psychological  experience.  Fear,  anx- 
iety, jealousy,  rivalry,  rebelliousness,  in- 
feriority complexes,  a sense  of  loneliness  in 
effort,  may  play  important  parts.  Once  the 
sense  of  difficulty  or  obstacle  has  been  cre- 
ated, its  mere  presence  has  great  power  to 
interfere  with  progress.  Among  hindrances 
we  must  not  forget  excessive  eagerness  in 
a parent  or  positive  dislike  for  a teacher,  or 
the  contagious  personal  reactions  of  school- 
mates. 

Many  reading-difficulty  cases  are  pretty 
certainly  due  to  poor  educational  method. 
Many  reform  methods  in  human  relations 
have  an  excessive  tendency  to  assume  that 
the  new  is  necessarily  better  than  the  old, 
in  every  respect.  In  education  they  show 
also  a disposition  to  believe  that  new  meth- 
ods are  superior  to  old  regardless  of  the  size 
of  the  group  to  be  taught  or  of  the  training 
and  skill  of  the  teacher.  John  Dewey  some- 
thing like  fifty  years  ago  vigorously  pro- 
mulgated the  thought  that  too  much  im- 
portance had  been  attached  to  reading  as  a 
study  to  be  pursued  for  its  own  sake.  The 
Dewey  school  decried  the  central  impor- 
tance of  reading  in  the  life  of  the  individual. 
Luckily  some  educators  still  frankly  con- 
sider learning  to  read  to  be  the  central 
objective  of  the  first  three  grades  in  school. 

Apparently  one  purpose  of  the  “flash”  or 
“look  and  see”  method  is  the  subsequent 
acquisition  of  greater  speed  and  facility  in 
the  act  of  silent  reading.  But  definite  psy- 
chological advantage  may  be  attributed  to 
the  fixation  upon  detail  associated  with  the 

534 


older  method.  I should  like  to  suggest  also 
that  there  is  psychological  advantage  in  the 
association  between  mother  and  child  in- 
volved in  preliminary  home  teaching. 

Among  those  who  have  made  a special 
study  of  reading  difficulties,  there  is  ac- 
knowledgment that  these  difficulties  are 
more  frequent  among  pupils  who  have  been 
taught  by  the  flash  method  than  among 
those  who  from  the  beginning  have  been 
subjected  to  the  phonetic  method,  in  which 
the  individual  letters  and  the  construction 
of  syllables  are  the  basis  of  learning  to  read. 
These  workers  also  tell  us  that  the  progress 
of  remedial  training  is  much  greater  by  re- 
sort to  the  phonetic  method,  intelligently 
applied,  than  if  the  flash  method  is  per- 
sisted in. 

Orton,  from  his  study  at  the  University 
of  Iowa,  declares  frankly  that  children  who 
had  been  taught  by  the  flash  method 
showed  proportionally  three  times  as  many 
cases  of  reading  difficulty  as  did  those  who 
had  been  taught  by  the  phonetic  method. 
Monroe,  at  the  University  of  Chicago,  says 
the  problem  of  remedial  instruction  in  read- 
ing is  to  find  a possible  method  of  learning 
for  those  children  who  have  never  been 
able  to  learn  to  read  by  methods  adapted 
to  the  majority  group.  She  remarks  it  is 
better  to  be  a slow  reader  than  a non- 
reader; to  read  sentences  word  by  word,  or 
words  sound  by  sound,  than  not  to  read 
them  at  all. 

It  is  commented  by  those  doing  remedial 
training  that  after  development  of  the 
power  to  read  the  general  behavior  of  the 
individual  often  shows  rapid  and  substan- 
tial improvement. 

In  its  larger  sociological  aspects,  the  un- 
successful reader  may  perhaps  be  regarded 
as  the  largest  educational  problem  of  our 
day.  Monroe  declares  that  12  per  cent  of 
the  general  population  may  be  considered 
as  having  reading  defects.  In  many  in- 
stances individual  instruction  is  urgently 
necessary.  In  a number  of  cases,  unfortu- 
nately, the  results  cannot  be  regarded  as 
compensating  for  the  outlay  involved  in  the 
remedial  effort.  The  average  school  teacher 
(as  well  as  the  parents)  is  unsuited  or  will 
require  special  training  for  this  effort.  The 


Rocky  Mountain  Medical  Journal 


subject  appears  to  be  one  for  required 
courses  in  all  institutions  for  teacher  train- 
ing. 

We  are  seeing  occasionally  in  elementary 
schools,  and  in  educational  literature,  some 
reaction  toward  adequate  teaching  of  the 
reading  skill.  A recent  work  by  Gray,  of 
the  University  of  Chicago,  under  the  title 
of  “On  Their  Own  in  Reading,”  presents  an 
excellent  course  in  pedagogical  method. 
Gray  declares  that  the  elaborate  and  exten- 
sive remedial  programs  in  the  intermediate 
and  upper  reading  grades  have  been  finally 
recognized  as  evidence  of  failure  to  provide 
adequate  developmental  reading  programs 
in  the  elementary  grades.  He  points  to  the 
unfortunate  fact  that,  during  the  last  twenty 
years,  teachers  have  had  very  little  prepara- 
tion for  the  teaching  of  word  perception  and 
especially  of  phonetic  analysis. 

Why  has  a teaching  method  that  appears 
so  greatly  to  increase  the  incidence  of  read- 
ing failures  been  so  long  persisted  in?  It 
seems  not  unreasonable  to  suppose  that 
brief  exposure  of  the  pupil’s  eyes  and  brain 
to  a new  word  or  group  of  words  without 
analytical  preparation  would  favor  the  very 
sorts  of  confusion  as  to  spelling  which  are 
encountered  most  frequently  in  the  poor 
reader.  The  emphasis  on  speed  rather  than 
accuracy  must  surely  increase  the  subcon- 
scious sense  of  defeat  and  conflict  in  the 
child’s  mind. 

Many  children  enter  school  eager  for  ac- 
quisition of  the  ability  to  read.  But  they 
are  subjected  to  the  complications  and  in- 
efficiencies of  group  instead  of  individual 
teaching.  Is  there  not  good  ground  to  sup- 
pose that  the  sympathetic  bond  between 
mother  and  child,  and  the  fact  that  the  in- 
struction and  help  afforded  by  the  mother 
are  individual  in  character,  create  more 
favorable  conditions  for  the  first  steps  to- 
ward reading  and  the  comprehension  of  the 
form  of  words? 

I have  never  hesitated  to  encourage  moth- 
ers to  teach  their  children  the  letters  be- 
fore the  usual  primary  school  age,  and  I 
have  never  experienced  any  reaction  which 
seemed  to  speak  against  this  practice.  I 
have  even  wondered  whether  it  might  be 


well,  on  account  of  the  benefit  to  be  de- 
rived from  individual  instruction,  to  form 
classes  in  which  young  mothers  might  learn 
how  to  instruct  the  preschool  child  in  the 
rudiments  of  reading. 

Orton  argues  that  no  child  of  average  in- 
telligence or  better,  if  there  be  tangible  evi- 
dence of  a reading  difficulty,  should  be  al- 
lowed to  continue  into  his  second  year  of 
schooling  without  an  analysis  of  his  condi- 
tion. Last  year,  Rychener  in  discussing  his 
own  paper  before  the  American  Academy  of 
Ophthalmology  and  Otolaryngology,  quot- 
ed the  statement  of  one  third-grade  teacher 
that  his  reading  disability  problems  had 
markedly  decreased  since  the  school  had  re- 
verted to  the  old  phonetic  method  of  train- 
ing in  the  first  few  grades. 

Brilliant  remedial  successes  are  claimed 
by  workers  using  somewhat  different  meth- 
ods of  approach.  The  most  conspicuous 
basis  of  these  successes  appears  to  be  the 
fact  that  they  were  largely  attained  by  in- 
dividual attention  to  the  child.  It  is  desir- 
able to  recognize  the  problem  as  early  and 
fully  as  possible  in  the  life  of  the  individual, 
and  there  is  much  to  be  said  for  reversion 
to  methods  and  principles  which  for  a while 
were  too  readily  discarded  as  old-fashioned, 
mechanical,  and  unscientific. 

The  special  department  of  medicine  in 
which  the  American  Ophthalmological  So- 
ciety has  played  so  important  a part  has  not 
only  the  right  but  the  duty  to  express  itself 
with  regard  to  the  reading  problem.  In  his 
able  discussion  of  Rychener’s  paper  before 
the  Academy,  Kronfeld  called  attention  to 
a special  study  on  this  subject  which  in  1941 
was  presented  by  Angus  MacLean  to  the 
Washington  postgraduate  course.  In  that 
presentation  MacLean  suggested  that  chil- 
dren with  special  reading  disability  would 
gain  if  instead  of  the  usual  “look  and  see” 
method  another  teaching  method  could  be 
made  available  to  them.  Kronfeld  remarks 
that  so  far  as  he  knows  that  recommenda- 
tion has  not  been  followed  by  any  school 
board  in  the  United  States. 

The  following  general  conclusions  seem 
justified: 

1.  Refractive  errors  play  a relatively 


for  October,  1949 


835 


small  part  in  the  problem  of  the  poor  read- 
er, although  they  should  still  be  kept  in 
mind  as  one  basis  for  the  early  inhibitions 
of  childhood. 

2.  Acquirement  of  the  ability  to  read  well 
is  still  the  most  important  purpose  of  the 
first  two  or  three  years  of  school,  and  fail- 
ure to  acquire  this  basic  skill  at  the  proper 
time  is  a cause  of  limitation  and  failure  in 
later  lines  of  endeavor.  It  affects  the  whole 
life  of  the  individual. 

3.  It  is  essential  to  recognize  the  exist- 
ence of  the  reading  problem  within  the  first 
year  or  so  of  schooling  and  to  take  steps 
promptly  toward  its  correction,  by  what- 
ever method  of  group  or  individual  instruc- 
tion may  prove  necessary  or  advisable,  but 


with  special  emphasis  on  ability  to  recog- 
nize at  first  letters  and  their  phonetic  val- 
ues, and  later  the  analytic  details  of  syllable 
and  word  structure. 

4.  As  regards  many  children,  perhaps  the 
great  majority,  it  is  probable  that  an  im- 
portant mistake  has  been  made,  for  the  past 
quarter  century  or  more,  in  too  wide  a de- 
parture from  the  old  more  or  less  mechani- 
cal methods  of  teaching  word  structure  and 
recognition.  The  most  practical  approach  to 
educational  economy  in  acquirement  of  the 
reading  skill  includes  not  merely  an  attempt 
to  correct  failures  already  more  or  less 
firmly  established  but  the  use  of  teaching 
method  which  will  as  far  as  possible  avoid 
creation  and  fixation  of  reading  failures  in 
each  new  school  generation. 


MATERNAL  DEATHS  IN  MONTANA* 

1940  Through  1945 

A PRELIMINARY  REPORT 

Prepared  by  the  Maternal  and  Child  Welfare  Committee  of  the  Montana  State  Medical  Association 
and  the  Maternal  and  Child  Health  Division  of  the  Montana  State  Board  of  Health 


This  study  was  started  in  1938  by  the 
Maternal  and  Child  Health  division  of  the 
Montana  State  Board  of  Health  and  the 
Maternal  and  Child  Welfare  Committee  of 
the  Montana  Medical  Association.  Dr. 
Edythe  B.  Hershey,  the  director  of  the 
M.C.H.  division,  created  a filing  system, 
cataloguing  all  maternal  deaths  and  all 
deaths  associated  with  pregnancy.  She  gave 
the  study  her  enthusiastic  support  until  she 
left  the  division  in  1946. 

A questionnaire  was  sent  to  all  physicians 
reporting  a maternal  death  by  the  Mater- 
nal and  Child  Welfare  Committee.  These 
questionnaires  were  answered  in  most  cases. 
In  1940,  Dr-  T.  J.  Leonard,  an  obstetrician 
on  the  staff  of  the  M.C.H.  division,  at- 
tempted to  interview  as  many  physicians  as 
possible.  This  study  was  curtailed  when 

*Reacl  at  the  interim  session  of  the  Montana  State 
Medical  Association  in  Helena,  Montana,  January  29, 
1949,  by  Dr.  G.  A.  Carmichael. 

Montana  State  Medical  Association  Maternal  and 
Child  Welfare  Subcommittee  on  Obstetrics;  Dr.  F.  L. 
McPhail,  Chairman;  Dr.  G.  A.  Carmichael,  Dr.  Maude 
Gerdes,  Dr.  E.  D.  Hall,  Dr.  R.  Ei  Mattison,  Dr.  D.  S. 
MacKenzie,  Jr.,  Dr.  P.  W.  Paul,  Dr.  A.  E.  Ritt. 

Montana  State  Board  of  Health  Maternal  and  Child 
Health  Division:  Dr.  B.  K.  Kilbourne,  Dr.  R.  E.  Mat- 
tison. 


Dr.  Leonard  left  the  state.  The  filing  sys- 
tem was  maintained,  however.  In  May, 
1946,  Dr.  R.  E.  Mattison  assembled  the  ex- 
isting material  and  continued  the  study. 
Since  90  per  cent  of  the  deliveries  occurred 
in  hospitals.  Dr.  Mattison  reviewed  most  of 
the  hospital  charts  and,  in  addition,  inter- 
viewed the  attending  physician  whenever 
possible. 

A case  history  was  made  of  each  death. 
These  case  histories  were  reviewed  by 
members  of  the  Maternal  and  Child  Welfare 
Committee  of  the  Montana  Medical  Asso- 
ciation. • From  this  review,  the  committee 
attempted  to  assign  responsibility  to  either 
the  patient  or  to  the  attending  physician  or 
both.  Antepartum  care  was  disregarded 
in  placing  responsibility  as  too  little  data 
were  available.  The  standards  outlined  in 
this  report  were  used  in  establishing  this 
responsibility.  In  64  per  cent  responsibility 
was  assigned  in  total  or  in  part  to  the  at- 
tending physician.  In  36  per  cent  the  pa- 
tient was  entirely  or  in  part  responsible  for 
the  outcome.  In  only  18  per  cent,  the  com- 


836 


Rocky  Mountain  Medical  Journal 


mittee  could  assign  no  responsibility.  The 
apparent  discrepancy  in  percentage  is  due 
to  the  fact  that  both  the  patient  and  phy- 
sician were  responsible  in  some  cases  and 
no  attempt  is  made  to  assign  major  re- 
sponsibility. Consultation  was  used  in  only 
22  per  cent  of  the  cases,  and  in  those  con- 
sultation was  not  always  adequate. 

There  were  168  maternal  deaths  during 
the  six  years  from  1940  through  1945,  and 
of  these  18  per  cent  were  a result  of  asso- 
ciated disease.  There  were  66,995  live 
births  in  these  years.  The  reported  causes 
of  death  are  in  some  instances  open  to 
question,  because  so  few  were  confirmed  by 
autopsy.  Adherence  to  a standard  nomen- 
clature in  reporting  cause  of  death  would 
be  of  great  help  in  correctly  interpreting 
our  • problems.  The  number  of  cases  is 
small,  but  the  general  trend  is  noteworthy. 
We  must  find  the  weak  points  in  our  ther- 
apy if  we  are  to  lower  a currently  low  ma- 
ternal mortality  rate.  This  study  uncovers 
some  weak  points  which  will,  unless  we 
close  our  eyes,  point  the  way  for  improve- 
ment in  our  maternal  care  program. 

Antepartum  Care 

From  the  collected  data  we  find  that  only 
20  per  cent  of  the  fatal  cases  are  known  to 
have  had  an  adequate  history  and  physical 
examination,  and  that  only  17  per  cent  had 
the  benefit  of  what  is  considered  adequate 
antepartum  care.  The  first  error  found  in 
the  conduct  of  obstetric  care  then  is  one  of 
omission.  A careful  history,  a complete 
physical  examination,  including  pelvic 
measurements,  serologic  tests  for  syphilis, 
repeated  Wood  counts  and  urinalyses,  is 
necessary.  Rh  determinations  are,  under 
certain  circumstances,  definitely  indicated. 
The  patient  must  be  instructed  regarding 
diet,  particularly  caloric  requirements,  ade- 
quate protein  intake,  and  vitamins  and  min- 
erals. The  routine  use  of  iron  during  preg- 
nancy is  advised.  The  weight  gain  should 
not  exceed  an  average  of  one-half  pound  per 
week.  , The  patient  should  return  to  the 
physician  at  regular  and  frequent  intervals 
for  weight,  urinalysis,  and  blood  pressure 
determination. 

for  October,  1949 


Parity 

Approximately  41  per  cent  of  the  deaths 
occurred  in  the  multiparous  group  as  com- 
pared to  28  per  cent  in  the  primiparous 
group.  The  parity  is  not  known  in  31  per 
cent.  It  is  tempting  to  take  refuge  in  a 
false  sense  of  security  by  assuming  that  a 
woman  is  safe  because  she  has  previously 
gone  through  one  or  more  pregnancies  with- 
out mishap.  “Beware  of  the  dangerous  mul- 
tipara.” 

Hemorrhage 

The  greatest  single  cause  of  death  is 
hemorrhage.  In  this  series  hemorrhage  was 
an  important  cause  of  death  in  sixty-four 
cases,  approximately  39  per  cent.  They  were 
divided  as  follows: 

Antepartum,  partum  and  postpartum 23 


Abortions  33 

Extra  uterine  pregnancy  8 

Total  64 


Although  the  maternal  death  rate  from 
all  causes  has  declined,  the  percentage  due 
to  hemorrhage  has  not  shown  a correspond- 
ing decline.  During  the  antepartum  period, 
the  patient  may  be  prepared  for  blood  loss 
by  careful  and  frequent  hemoglobin  deter- 
minations, and  by  the  routine  use  of  some 
iron  preparation.  The  patient  who  has  a 
high  hemoglobin  and  red  blood  count  at 
the  time  of  labor  will  withstand  blood  loss 
better  at  the  time  of  delivery.  With  im- 
proved technics  and  increased  knowledge  of 
blood  grouping,  blood  transfusion,  and 
blood  storage,  it  is  almost  unbelievable  that 
we  have  not  shown  greater  improvement. 
Happily,  this  is  one  of  the  two  major  causes 
of  death  in  which  we  have  the  greatest  op- 
portunity to  achieve  the  most  improvement. 
Study  of  the  fatal  cases  due  to  hemorrhage 
indicates  that  with  few  exceptions  whole 
blood  is  not  employed,  or  if  employed,  is 
administered  in  amounts  too  small  to  be 
effective  and  that  it  is  given  much  too  late. 
It  cannot  be  too  strongly  nor  too  often  em- 
phasized that  intravenous  fluid,  other  than 
whole  blood,  serves  as  no  more  than  a stop- 
gap to  be  utilized  until  compatible  whole 
blood  is  available.  Review  of  the  hemor- 
rhage group  discloses  evidence,  at  least  pre- 
sumptive, that  some  physicians  are  indif- 

837 


ferent  to  or  are  unacquainted  with  the  signs 
of  impending  shock.  When  in  doubt  we 
should  give  blood.  To  await  the  develop- 
ment of  pallor,  weak  pulse,  hypotension  and 
air  hunger  surely  leads  to  a blind  end, 
namely,  irreversible  cell  damage  and  death. 

Our  hospitals  must  accept  responsibility 
in  providing  blood  plasma,  suitable  intra- 
venous fluids,  and  at  the  very  least  a list 
of  typed  donors.  Should  the  hospital  be  in- 
different to  its  obligations  to  the  patient,  the 
public  and  the  medical  profession  should  be 
aware  of  these  facts.  Each  community  must 
realize  that  the  hospital  is  its  property, 
therefore  its  responsibility.  It  is  hoped  that 
appropriate  and  effective  measures  can  be 
mobilized  to  rectify  any  unsatisfactory  ob- 
stetric environment,  in  every  community. 

Most  deaths  due  to  hemorrhage  would 
appear  to  be  the  fault  of  the  physician,  if 
the  community  provides  the  necessary  fa- 
cilities. Most,  if  not  all,  deaths  due  to  hem- 
orrhage are  preventable.  The  following 
recommendations  for  the  control  of  obstet- 
ric hemorrhage  are  emphasized. 

Management 

Diagnosis  of  the  cause  of  bleeding  should 
be  made.  If  necessary  a careful  vaginal  ex- 
amination should  be  conducted,  using  sterile 
technic.  This  should  never  be  done  until 
all  preparations  have  been  completed  for 
termination  of  the  pregnancy  by  whatever 
means  is  dedicated.  Learn  the  Rh  factor, 
determine  the  blood  group,  cross  match  and 
transfuse  before,  during  and  after  operative 
procedures  if  indicated. 

Almost  all  abortions  were  criminally  in- 
duced. Review  of  these  cases  indicates  that 
these  deaths  are  due  to  severe  anemia  and 
sepsis.  The  most  obvious  and  important  de- 
duction is  that,  with  few  exceptions,  the 
patient  received  too  little  blood  and  in- 
adequate chemotherapy.  When  these  thera- 
peutic measures  were  utilized,  it  was  fre- 
quently noted  that  they  were  neither 
employed  early  enough  nor  were  they  con- 
tinued long  enough  to  offer  a reasonable 
expectancy  of  cure. 

In  all  cases  of  suspected  incomplete  abor- 
tion the  cervix  should  be  visualized  under 
aseptic  conditions.  Many  times  the  prod- 


ucts of  conception  are  found  gripped  in  the 
cervical  canal,  and  if  so  may  be  readily 
and  easily  extracted,  thereby  producing 
hemostasis.  Gentle,  atraumatic  methods 
must  characterize  this  procedure.  For  the 
most  part  no  anesthesia  is  required. 

Generally  curettage  should  never  be  per- 
formed for  infected  threatened  or  infected 
incomplete  abortion.  However,  if  the  bleed- 
ing is  of  sufficient  degree  to  endanger  the 
life  of  the  mother,  the  uterus  should  be  emp- 
tied, preferably  by  the  finger  or  ovum  for- 
ceps. Watch  carefully  for  a developing 
pelvic  abscess  and  institute  drainage  as 
early  as  possible. 

Therapeutic  abortion  by  packing  the  cer- 
vix and  fundus  is  not  a desirable  method. 
It  is  much  better  to  resort  to  dilatation  and 
curettage  or  vaginal  or  abdominal  hysterot- 
omy. 

Ectopic  pregnancy  should  be  kept  in  mind 
in  all  cases  of  irregular  vaginal  bleeding 
whether  or  not  there  is  abdominal  pain. 
The  secret  of  lowering  the  death  rate  from 
hemorrhage  in  ectopic  pregnancy  is  early 
diagnosis  and  prompt  treatment.  If  the  pa- 
tient is  in  shock,  plasma  should  be  started 
at  once.  Blood  typing  and  transfusion 
should  be  instituted  as  rapidly  as  possible, 
while  preparation  for  surgery  is  being  com- 
pleted. Incidental  surgery,,  such  as  appen- 
dectomy, at  the  time  of  operation,  is  con- 
traindicated. The  rule  is  hlood  before,  dur- 
ing and  after  operation  if  indicated. 

Placenta  previa  and  premature  separation 
of  the  placenta  are  responsible  for  a large 
number  of  the  maternal  deaths  due  to 
hemorrhage.  Proper  management  should 
include  blood  replacement,  careful  differ- 
ential diagnosis,  then  appropriate  therapy. 
Great  care  should  be  exercised  in  selecting 
the  most  suitable  type  of  delivery.  If  bleed- 
ing is  not  profuse,  and  if  the  cervix  is  soft 
and  thin,  vaginal  delivery  may  be  the  meth- 
od of  choice.  However,  if  bleeding  is  pro- 
fuse, regardless  of  the  condition  of  the 
cervix,  cesarean  section  should  be  per- 
formed in  the  interest  of  the  mother. 

Prolonged  labor  is  exhausting  and  oc- 
casionally is  a factor  in  uterine  inertia  and 
hemorrhage.  Employment  of  sedatives  in 
amounts  compatible  with  safety  for  the 


838 


Rocky  Mountain  Medical  Journal 


child  and  mother  will  aid  in  preventing  ex- 
haustion. Sedation  should  be  used  to  achieve 
for  the  patient  a period  of  rest,  rather  than 
prolonged  and  extended  unconsciousness. 

In  the  presence  of  hemorrhage,  the  choice 
of  anesthetic  agents  should  be  carefully 
considered.  Because  of  anemia,  pudendal 
block  and  local  infiltration  anesthesia  are 
the  methods  of  choice. 

Ill-advised,  hasty,  and  clumsy  procedures 
during  delivery  may  cause  hemorrhage. 
Complete  dilatation  of  the  cervix  is  essen- 
tial, if  operative  delivery  is  contemplated. 
Inspect  carefully,  completely,  and  gently 
the  birth  passage  for  lacerations  and  if 
tears  are  discovered  they  should  be  re- 
paired. Never  forget  the  possibility  of  a 
ruptured  uterus,  if  blood  loss  is  obvious  but 
not  seen. 

There  is  much  mismanagement  of  the 
third  stage  of  labor  with  consequent  fatali- 
ties. In  the  absence  of  bleeding  always 
wait  for  signs  of  separation  of  the  placenta. 
Forcible  expression  should  not  be  employed. 
The  routine  use  of  posterior  pituitary  ex- 
tract before  the  separation  of  the  placenta 
is  questionable.  Manual  removal  of  the 
placenta  is  indicated  if  bleeding  from  the 
uterus  warrants  such  interference,  but 
should  not  be  done  unless  definitely  indi- 
cated by  bleeding.  The  patient  should  not 
be  removed  from  the  delivery  table  until 
one  hour  following  delivery.  If  the  circum- 
stances are  such  that  it  is  necessary  that  she 
be  removed  to  her  room,  it  is  imperative 
that  there  be  constant  attendance  upon  the 
patient  by  a competent  member  of  the  ob- 
stetric personnel.  The  reviewed  records  re- 
veal that  time  after  time  the  patient  goes 
into  shock  after  she  has  been  returned  to 
her  room  and  after  the  doctor  has  left  the 
hospital  feeling  assured  that  his  patient  has 
come  safely  through  her  delivery. 

In  hemorrhage  from  the  uterus  due  to 
uterine  atony  following  the  third  stage  of 
labor,  never  pack  the  vagina.  This  does  no 
good  and  lulls  the  physician  into  a false 
sense  of  security.  If  uterine  packing  is 
necessary  the  uterus  should  be  packed  as 
tightly  as  possible.  It  should  be  empha- 
sized that  even  though  packed,  the  uterus 
may  continue  to  bleed.  In  that  event  prompt 


consultation,  in  regard  to  possible  hyster- 
ectomy, is  indicated.  Uterine  packing  is 
rarely  necessary  if  oxytocics  are  properly 
used  and  if  the  uterus  is  under  constant 
observation  for  relaxation. 

Late  postpartum  hemorrhage  results  on 
occasion  from  the  retention  of  placental 
fragments.  In  such  event  the  treatment  is 
surgical.  It  is  best  to  separate  the  retained 
fragments  by  the  exploring  finger;  if  un- 
successful, resort  to  the  use  of  placental 
forceps  and  a dull  uterine  curette;  follow 
these  procedures  with  chemotherapeutics, 
antibiotics  and  transfusions  of  whole  blood, 
if  indicated. 

Toxemia  of  Pregnancy 

During  the  six  years  which  this  study 
embraces,  approximately  15  per  cent  of  the 
deaths  are  reported  as  being  due  to  tox- 
emia of  pregnancy.  The  number  of  deaths 
from  toxemia  has  decreased  yearly;  but  the 
relationship  of  toxemia  death  expressed  in 
percentage  of  the  total  number  of  maternal 
deaths  to  other  major  causes  remains  un- 
changed. 

Mortality  from  toxemia  of  pregnancy  will 
be  lowered  only  when  the  early  signs  of 
the  toxemia  are  recognized,  their  signifi- 
cance appreciated,  and  adequate  treatment 
promptly  instituted.  Only  in  this  manner 
will  we  prevent  progression  to  severe  pre- 
eclampsia and  eclampsia.  The  treatment 
should  be  directed  toward  the  maintenance 
of  normal  kidney  function  and  to  the  re- 
versal of  abnormal  fluid  exchange  between 
the  blood  and  body  cells. 

The  toxemia  group  offers  the  most  prom- 
ising hope  of  significant  reduction  in  ma- 
ternal mortality  by  prevention.  The  signs 
and  symptoms  of  toxemia  of  pregnancy 
should  be  engraved  on  the  mind  of  every 
physician  who  accepts  a patient  for  obstetric 
care.  We  do  not  possess  much  knowledge  of 
the  cause  or  causes  of  pre-eclampsia  and 
eclampsia,  but  we  do  know  how  to  recognize 
the  early  signs  and  symptoms  and  we  are 
informed  as  to  the  methods  of  prevention 
and  treatment.  The  key  to  success  in  low- 
ering the  death  rate  in  this  group  is  pre- 
vention. If  we  are  to  lower  the  death  rate 
in  this  group  we  must  prevent  the  patient 


for  October,  1949 


839 


from  progressing  to  the  stage  of  convulsions. 
Once  convulsive  seizures  have  occurred  the 
mortality  rate  of  the  infant  approximates 
100  per  cent  and  the  mortality  rate  of  the 
mother  is  exceedingly  high. 

Management 

A.  Prophylaxis.  Early  examination  of  the 
patient  is  essential.  Any  patient  suspected 
of  having  cardio-vascular-renal  disease 
should  be  watched  most  carefully.  Routine 
instruction  for  all  pregnant  patients  should 
give  the  following  information:  (1)  When 
antepartum  visits  should  be  made;  (2)  im- 
portance of  controlled  weight  gain;  (3)  the 
adequate  intake  of  water  is  to  be  empha- 
sized. The  committee  advises  a minimum 
of  eight  glasses  of  water  daily.  (4)  Sodium 
in  the  form  of  sodium  chloride  is  restricted 
and  sodium  bicarbonate  forbidden.  (5)  Each 
patient  should  be  instructed  to  report  to 
her  physician  immediately  if  edema,  per- 
sistent headache,  epigastric  pain  or  blurred 
vision  develops. 

B.  Non-con vulsive.  The  following  treat- 
ment is  recommended:  (1)  Rest.  Sedation 
may  be  maintained  by  small  amounts  of 
phenobarbital  at  frequent  intervals.  (2) 
Diet.  Neutral  or  slightly  acid  ash,  low  in 
sodium,  with  strict  avoidance  of  sodium 
chloride  and  sodium  bicarbonate  as  well  as 
the  popular  antacids.  The  excretion  of  so- 
dium is  essential  to  the  reduction  of  edema. 
To  rid  the  body  of  sodium,  the  ingestion  of 
sodium  must  be  limited.  Protein  intake 
should  be  60  grams  or  more.  Milk  contains 
considerable  sodium  and  should  be  limited 
in  severe  toxemia.  (3)  A daily  bowel  move- 
ment is  important.  This  may  be  obtained 
by  any  mild  laxative  such  as  milk  of  mag- 
nesia. Dehydrating  purges  are  dangerous. 
(4)  An  adequate  urine  output  is  obtained  by 
an  adequate  intake  of  water.  Juices,  etc., 
contain  sodium  and  should  be  taken  only 
in  small  amounts. 

Frequent  observation  is  important  at  this 
stage.  If  the  blood  pressure  is  rising,  edema 
increasing  and  urine  findings  are  marked, 
the  outlook  for  the  mother  and  baby  is  se- 
rious and  the  thought  of  terminating  the 
pregnancy  must  be  entertained.  Blood  chem- 
istry studies  are  of  great  help  in  observing 


the  progress  of  the  toxemia.  If,  after  a 
reasonable  time  with  active  treatment,  the 
signs  and  symptoms  are  progressing,  cesar- 
ean section  may  be  indicated  to  prevent 
eclampsia.  Local  anesthesia  is  the  choice 
anesthetic  agent. 

C.  Eclampsia.  Sedation:  Control  of  the 
convulsion  is  the  first  step  in  treating 
eclampsia.  No  matter  which  of  the  seda- 
tive or  hypnotic  agents  is  chosen,  the  dos- 
age should  be  adequate  to  control  the 
convulsion.  Oxygen  should  always  be  given. 

Water:  Salt  solution  should  never  be  giv- 
en to  a toxic  patient.  Diuresis  is  essential. 
There  is  still  marked  controversy  over  the 
method  to  be  employed.  Some  believe  in 
utilizing  istonic  solutions,  others  hypertonic. 
Whichever  method  is  employed  the  renal 
output  should  be  at  least  one  to  two  liters 
daily. 

Blood  pressure  readings,  blood  chemistry 
determinations,  and  urinalyses  should  be 
followed  closely.  The  patient  should  be 
carefully  watched  for  any  unusual  findings 
such  as  circulatory  failure,  etc. 

As  soon  as  the  patient  is  under  good  con- 
trol, the  pregnancy  should  be  terminated  by 
the  most  conservative  method.  Radical  ter- 
mination of  pregnancy  by  accouchement 
force  is  mentioned  only  to  be  condemned 
but  was  used  in  some  of  the  fatal  toxemia 
cases  studied. 

Sepsis 

Approximately  20  per  cent  of  the  deaths 
were  due  to  sepsis.  This  is  exclusive  of  the 
deaths  due  to  abortion.  It  is  in  the  “sepsis” 
group  that  the  most  encouraging  reduction 
in  death  rate  has  occurred.  The  decrease  in 
the  mortality  rate  from  this  cause  probably 
results  from  improvement  in  delivery  tech- 
nic and  operative  technic  and  from  the  more 
general  utilization  of  whole  blood  and  sul- 
fonamides. It  is  felt  that  both  antibiotic 
and  sulfonamide  therapy  is  indicated  fol- 
lowing any  vaginal  invasion  of  the  pregnant 
uterus.  Patients  who  have  had  considerable 
blood  loss  are  susceptible  to  infection.  Blood 
loss  should  be  replaced. 

Other  Maternal  Causes 

In  the  six  years  approximately  8 per  cent 
of  the  deaths  were  listed  under  other  causes 


840 


Rocky  Mountain  Medical  Journal 


due  to  pregnancy.  This  includes  anesthetic 
deaths  and  transfusion  reactions.  Three 
deaths  were  said  to  be  caused  by  blood 
transfusion,  and  all  occurred  prior  to  1943. 
No  patient  should  receive  a blood  trans- 
fusion without  careful  cross  matching  and 
determination  of  the  Rh  factor.  In  our  quest 
for  painless  childbirth  we  may  increase  the 
risk  to  the  mothers.  The  choice  of  a safe 
anesthetic  agent  is  important.  Surgical  an- 
esthesia should  never  be  employed  in  a 
patient,  who  has  a full  stomach.  At  least 
two  of  the  deaths  were  anesthetic  deaths. 

Diseases  Associated  With  Pregnancy 

Eighteen  per  cent  of  the  deaths  were  due 
to  diseases  associated  with  pregnancy.  A 
significant  number  of  these  had  rheumatic 
heart  disease.  Proper  evaluation  of  the 
pregnant  woman  with  heart  disease  is  of 
greatest  importance.  She  must  always  be 
considered  as  a grave  risk.  The  increased 
load  of  pregnancy  may  cause  sudden  fail- 
ure and  therefore  these  patients  should  be 
examined  much  more  frequently  during  the 
antepartum  period.  The  patient  should  be 
instructed  to  recognize  and  report  at  once 
the  slightest  symptom  of  failure.  Once  the 
heart  fails  the  patient  must  be  treated  in 
a hospital  or  under  hospital  conditions  un- 
til delivery.  In  the  favorable  group  good 
antepartum  care  almost  wipes  out  the 
greatest  danger  of  death;  that  is  cardiac 
failure. 

Conservative  obstetric  procedures  are 
generally  considered  best  in  handling  the 
cardiac  patient.  Medical  consultation  is  de- 
sirable to  determine  the  exact  status  of  the 
cardiac  patient.  The  obstetrician  should  be 
in  constant  attendance  during  the  labor. 
The  patient  with  a severe  heart  lesion- 
should  not  be  permitted  to  strain  either 
voluntarily  or  involuntarily  during  the  sec- 
ond stage.  Episiotomy  and  judicious  use  of 
low  forceps  will  reduce  most  of  the  effort 
incident  to  the  second  stage.  Cesarean  sec- 
tion is  rarely  indicated,  and  then  only  in 
the  most  severe  cardiac.  It  should  be  under- 
stood that  the  risk  is  greatly  increased  if  a 
patient  is  in  impending  or  actual  failure. 

There  were  three  deaths  from  intestinal 
obstruction.  The  possibility  of  intestinal 


obstruction  during  pregnancy  should  al- 
way  he  considered,  particularly  if  the 
patient  has  had  a previous  laparotomy. 
Early  diagnosis  and  early  treatment  is  es- 
sential if  these  are  to  be  prevented. 

Discussion 

In  1930  Montana’s  maternal  mortality  was 
6.7  per  1,000  live  births.  In  1940  the  rate 
was  3.4,  and  in  1946  it  had  dropped  to  1.3. 
In  this  study  we  have  found  many  prevent- 
able deaths.  It  is  understood,  of  course, 
that  not  all  cases  where  responsibility  was 
assigned  would  have  come  to  a favorable 
outcome  if  proper  treatment  had  been  car- 
ried out.  It  is  reasonable  to  assume  that 
many  of  these  women  would  still  be  alive 
if  treatment  had  been  more  active.  As 
these  records  were  analyzed  it  is  to  be  noted 
that  in  spite  of  the  fact  that  the  mortality 
rate  has  dropped  progressively  over  the 
six  year  period,  the  physician’s  responsi- 
bility has  increased.  In  1940  and  1941  the 
physician  was  considered  responsible  in  56 
per  cent  and  in  1944  and  1945  in  71  per  cent. 

There  were  very  few  autopsies  in  this 
series.  There  were  eleven  deaths  reported 
as  embolism  to  the  heart,  lung,  or  brain. 
Yet  only  one  of  these  was  confirmed  by 
postmortem  examination. 

The  Maternal  and  Child  Welfare  Com- 
mittee of  the  Montana  State  Medical  Asso- 
ciation proposes  to  make  an  annual  audit 
of  all  maternal  deaths.  This  study  will  be 
reported  at  the  annual  meeting  each  year. 
In  addition,  each  year  one  of  the  major 
causes  of  death,  hemorrhage,  sepsis  or  tox- 
emia, will  be  analyzed  in  detail.  The  re- 
sults of  these  studies  will  be  reported  to 
the  Montana  State  Medical  Association.  A 
study  of  deaths  due  to  hemorrhage  will  be 
reported  at  the  interim  meeting  of  the 
Montana  State  Medical  Association  in  1950. 
As  a result  of  the  present  study  the  follow- 
ing recommendations  are  made:  (1)  Strict 
adherence  to  standard  nomenclature  in  re- 
porting cause  of  death  would  make  it  pos- 
sible to  classify  the  cases  studied  more 
intelligently.  (2)  As  far  as  could  be  deter- 
mined consultation  was  rarely  obtained  in 
these  fatal  cases.  Earlier  and  more  frequent 
consultation  is  desirable  in  the  complicated 


for  October,  1949 


841 


obstetrical  case.  (3)  Blood  should  be  given 
earlier  and  in  much  greater  quantity,  when 
indicated.  Preparation  for  transfusion  is 
indicated  in  the  presence  of  severe  anemia. 
This  makes  more  careful  observation  of  the 
blood  picture  during  pregnancy  essential. 
The  committee  recommends  iron  therapy 
as  a routine  during  the  antepartum  period. 
(4)  If  we  are  to  lower  our  toxemia  mor- 
tality, antepartum  examination  must  be 
obtained  more  frequently.  In  the  progres- 
sive toxemia,  termination  of  the  pregnancy 
should  be  considered  if  other  treatment 
proves  inadequate.  (5)  The  sulfonamides 
and  the  antibiotics  and  blood  should  be 
given  early  and  in  adequate  amounts  in 
suspected  infections  if  we  are  to  reduce 
the  death  rate  from  sepsis.  (6)  More  autop- 
sies are  necessary  if  we  are  to  have  the  cor- 
rect diagnosis  of  the  cause  of  death.  (7) 
As  many  of  the  records  studied  indicated 
little  or  no  antepartum  care,  we  must  con- 
tinue to  enlarge  the  scope  of  our  educational 
program  so  that  we  will  have  better  patient 


cooperation.  (8)  Each  community  must  ac- 
cept the  responsibility  for  providing  ade- 
quate laboratory  facilities  so  that  blood 
may  always  be  available  for  obstetric 
emergency.  Public  education  along  this 
line  is  urgent. 

The  declining  maternal  mortality  rate  in 
Montana  is  evidence  of  the  intelligence  of 
the  physicians  and  their  determination  to 
improve  the  quality  for  obstetric  care.  But 
let  us  not  fall  victims  of  complacency, 
smugness,  and  occupational  pride.  Let  us 
not  indulge  ourselves  in  such  phrases  as  the 
“irreducible  minimum,”  which  is,  at  its 
best,  phonetically  pleasant  and  at  its  worst 
a short  cut  to  intellectual  bankruptcy.  There 
is  need  to  reflect,  study,  observe,  compare 
and  thereby  improve  ourselves.  It  then  fol- 
lows that  there  will  be  improvement  in  the 
obstetric  environment  along  the  very 
channels  of  error  revealed  by  such  an  audit 
as  this.  We  must  not,  in  mistaken  vanity, 
view  indifference,  inadequacy,  incompe- 
tence, ignorance  and  neglect  as  pardonable 
imperfection. 


COLLES’  FRACTURE* 

WITH  REPORT  OF  END  RESULTS  IN  56  CASES 
LEWIS  M.  OVERTON,  M.D. 

ALBUQUERQUEi,  N.  M. 


The  saucer-shaped  radio-ulnar  surface  of 
the  wrist  joint  forms  a receptacle  for  the 
ball-shaped  adjacent  surface  of  the  carpal 
bones.  The  complex  mechanism  of  this  ar- 
ticulation allows  motion  in  all  directions. 
In  addition,  the’  radio-ulnar  articulation  al- 
lows rotary  motion  at  the  wrist.  Any  dis- 
turbance in  the  anatomical  relationship  of 
these  articulations  may  result  in  some  im- 
pairment of  function  in  the  wrist  and  hand. 
This  may  not  be  of  much  significance  in  the 
elderly  individual  in  whom  the  wrist  is  not 
likely  to  be  subjected  to  undue  stress  or 
strain,  but  it  will  be  of  extreme  importance 
to  the  skilled  or  common  laborer.  The 
persistence  of  pain  or  the  limitation  of  mo- 
tion may  be  sufficient  to  cause  a change  in 
occupation.  This  is  more  likely  to  be  true 

*From  the  Section  on  Orthopedic  Surgery,  Lovelace 
Clinic. 


if  the  highly  skilled  use  of  the  hand  is  re- 
quired. 

Colles’  fracture,  although  one  of  the  most 
frequently  encountered  fractures,  has  been 
followed  by  results  that  are  not  entirely 
satisfactory.  This  has  not  been  the  direct 
result  of  the  failure  to  secure  complete 
reduction  of  the  bone  fragments  in  all 
cases,  but  rather  to  soft  tissue  injuries  that 
occur  concurrently  with  the  fracture.  Such 
injuries  may  involve  the  interarticular  fi- 
brocartilage,  the  dorsal  radio-ulnar  liga- 
ment, or  the  ventral  radio-ulnar  ligament. 
Damage  to  any  one  of  these  structures  will 
result  in  an  altered  or  disturbed  function  in 
the  radio-ulnar  articulation.  The  impor- 
tance of  this  articulation  has  been  men- 
tioned by  many  authors,  but  it  was  Lipp- 
man  who  forcibly  brought  to  our  attention 


842 


Kocky  Mountain  Medical  Journal 


that  residual  damage  to  this  joint,  even  in 
the  presence  of  complete  anatomical  restora- 
tion of  the  radial  fracture,  would  be  fol- 
lowed by  impaired  function.  This  may  be 
explained  on  the  basis  that  stability  of  this 
articulation  is  necessary  for  normal  func- 
tion of  the  wrist  joint. 

The  anatomy  of  the  radio-ulnar  articula- 
tion makes  it  vulnerable  to  injury  in  any 
fracture  of  the  lower  end  of  the  radius.  The 
interarticular  fibrocartilage  is  firmly  at- 
tached to  the  articular  edge  of  the  lower 
end  of  the  radius,  but  it  is  loosely  attached 
to  the  end  of  the  ulna,  except  for  the  small 
attachment  at  the  base  of  its  styloid  process. 
A fracture  that  results  in  any  material  up- 
ward or  backward  displacement  of  the  low- 
er end  of  the  radius  will  cause  a break  in 
the  continuity  of  this  disc.  Since  the  weak- 
est point  is  at  the  ulna  attachment  it  will 
either  fracture  the  ulnar  styloid  process  or 
separate  the  fibrocartilage  from  it.  The 
radio-ulnar  ligaments  are  less  likely  to  be 
injured  because  they  are  attached  approxi- 
mately half  an  inch  above  the  lower  end 
of  the  radius.  Fractures  below  this  level 
rarely  damage  these  ligaments;  however,  if 
the  fracture  of  the  radius  is  above  the  at- 
tachment, rupture  is  likely  to  occur,  and  this 
most  frequently  involves  the  dorsal  radio- 
ulnar ligament.  It  is  known  that  the  dorsal 
radio-ulnar  ligament  is  tense  when  the  hand 
is  in  pronation  and  that  the  ventral  one  is 
tense  when  the  hand  is  in  supination.  There- 
fore, the  dorsal  ligament  stabilizes  it  in  pro- 
nation and  the  ventral  one  stabilizes  it  in 
supination.  Since  practically  all  Colles’  frac- 
tures occur  with  the  hand  in  pronation,  the 
dorsal  radio-ulnar  ligament  is  the  one  upon 
which  the  strain  is  placed.  If  this  is  suffi- 
cient to  rupture  it,  an  instability  of  the  ulna 
will  result.  In  such  cases  the  lower  end  of 
the  ulna  can  be  pushed  forward  when  the 
hand  is  in  full  pronation,  but  it  will  be  stable 
with  the  hand  in  supination.  The  stability 
in  supination  results  from  a tense  ventral 
radio-ulnar  ligament  when  the  hand  is  in 
this  position. 

The  pathology  of  Colles’  fracture  presup- 
poses that  any  classification,  as  shown  in 
Table  1,  has  been  based  on  such  a premise. 
There  was  one  fracture  of  the  ulnar  styloid 


process  in  the  absence  of  any  displacement 
of  the  radius.  This  can  be  explained  only 
on  the  basis  that  there  must  have  been  some 
compression,  but  that  this  took  place  with- 
out any  collapse  of  the  radius  and  that  the 
normal  relationship  was  restored  as  soon  as 
the  force  was  released,  or  that  there  must 
have  occurred  some  temporary  separation 
of  the  radius  and  ulna.  Only  one  fracture  of 
the  ulnar  styloid  occurred  in  eight  simple 
impacted  fractures,  while  there  were  thir- 
teen in  twenty-seven  displaced  and  im- 
pacted fractures.  Obviously  the  interarticu- 
lar fibrocartilage  must  have  been  detached 
from  the  ulna  in  all  of  the  remaining  dis- 
placed fractures  and  in  some  of  the  simple 
impacted  ones.  The  only  clinical  proof  that 
damage  has  occurred  to  the  fibrocartilage  is 
the  residual  disability  in  such  cases.  There 
were  only  three  cases  of  rupture  of  the 
dorsal  radio-ulnar  ligament  as  evidenced  by 
the  laxity  of  the  ulna  in  complete  pronation. 
This  is  significant  in  that  this  ligament  is 
not  too  vulnerable  to  injury. 


TABLE  I 
CLASSIFICATION 


TYPE  OF  FRACTURE 

COMPLICATIONS  . . . 

TOTAL 

WITHOUT  DISPLACEMENT 

NONE 

FRACTURE  OF  ULNAR 
STYLOID  PROCESS 

RUPTURE  DORSAL 
RADIO-ULNAR  LIGAMENT 

5 

1 

6 

POSTERIOR  TILT  OR 
IMPACTION  ONI  Y 

8 

1 

9 

POSTERIOR  DISPLACEMENT 
AND  IMPACTION 

27 

13 

3 

43 

TOTAL 

40 

IS 

3 

58 

The  successful  treatment  of  these  frac- 
tures implies  that  the  reduction  must  be 
complete.  It  is  not  necessary  to  have  an 
anatomical  restoration  of  the  radius  in  or- 
der to  get  good  function,  but  it  is  necessary 
to  restore  the  displaced  fibrocartilage  and 
approximate  the  radio-ulnar  ligaments  for  a 
good  result.  One  cannot  be  sure  that  this 
has  been  accomplished  unless  the  reduction 
has  been  complete.  The  reduction  should  be 
carried  out  without  further  damaging  these 
structures.  Therefore,  one  should  manipu- 
late the  fractures  with  the  utmost  caution. 
The  old  technic  of  hyperextending  the  wrist 
to  break  up  the  impaction  certainly  is  to  be 
avoided  because  it  increases  the  force  in  the 
same  line  that  produced  the  fracture  and  is 
likely  to  further  damage  the  injured  fibro- 
cartilage and  radio-ulnar  ligaments.  The 
easiest  and  safest  method  of  reduction  is  the 
avoidance  of  any  forceful  manipulation.  The 


for  October,  1949 


843 


impaction  can  be  broken  up  and  the  length 
restored  by  traction,  gentle  but  firm,  with 
fixed  countertraction.  One  can  determine 
when  the  fragments  are  disengaged  by  pal- 
pation. This  maneuver  will  almost  com- 
pletely reduce  the  fracture.  Then  by  gently 
moulding  the  fragments  into  place  a very 
satisfactory  reduction  is  obtained.  The  hand 
should  be  pulled  into  ulnar  deviation  during 
the  procedure.  This  allows  the  end  of  the 
ulna  to  be  used  as  a fulchrum  for  maintain- 
ing the  radius  in  position;  but  more  im- 
portant it  allows  the  reduction  of  the  dis- 
placed fibrocartilage  and  fractured  styloid 
process  of  the  ulna.  There  has  been  consid- 
erable controversy  as  to  whether  the  frac- 
ture should  be  reduced  in  pronation  or 
supination.  Our  experience  has  taught  us 
that  it  is  much  easier  to  reduce  the  fracture 
in  supination  or  mid-supination  than  in  pro- 
nation. The  fracture  that  is  accompanied  by 
a rupture  of  the  dorsal  radio-ulnar  ligament 
must  be  reduced  in  supination  because  this 
position  relaxes  the  ligament  and  allows  its 
edges  to  become  approximated.  At  the  same 
time  the  ventral  radio-ulnar  is  tense  in  this 
position,  thereby  holding  the  ulna  in  its  nor- 
mal position.  The  displaced  fracture  of  the 
ulnar  styloid  will  also  be  reduced  very 
easily  with  the  hand  in  this  position,  but  it 
will  remain  displaced  in  most  instances  of 
reduction  with  the  hand  in  pronation.  The 
fracture  is  dressed  with  the  hand  in  forced 
ulnar  deviation,  very  slight  flexion  and  in 
mid-supination  to  full  supination.  The  el- 
bow is  incorporated  when  a rupture  of  the 
dorsal  radio-ulnar  ligament  exists.  In  such 
cases  the  hand  is  always  placed  in  complete 
supination.  Anterior  and  posterior  splints 
are  applied  directly  to  the  skin  and  ban- 
daged snugly.  They  are  applied  so  as  to 
allow  free  finger  motion.  We  have  found 
that  this  type  of  splint  gives  the  most  satis- 
factory immobilization.  The  plaster  splints 
applied  directly  on  the  skin  produce  the 
best  fixation,  while  at  the  same  time  mak- 
ing it  very  easy  to  release  the  pressure  in 
case  of  swelling.  This  can  be  accomplished 
by  merely  cutting  the  bandage  between  the 
splints.  Active  hand,  elbow,  and  shoulder 
exercises  are  begun  immediately  following 


the  reduction.  This  will  prevent  some  of 
the  swelling  as  well  as  the  embarrassing 
complication  of  stiffness  in  the  uninjured 
joints.  We  have  not  encountered  difficulty 
in  mobilizing  the  wrist  when  function  had 
been  maintained  in  all  adjacent  joints.  It 
is  our  feeling  that  removal  of  the  splints  for 
physical  therapy  during  the  healing  period 
is  too  hazardous  unless  it  can  be  carried  out 
each  time  by  the  physician.  Even  then  there 
is  danger  of  disturbing  the  position  of  the 
fibrocartilage  or  the  dorsal  radio-ulnar  liga- 
ment. This  early  mobility  is  not  necessary 
when  all  components  have  been  adequately 
reduced. 


TABLE  2 

END  RESULTS 


type FRACTURE 

REDUC 

TION 

RESU 

LTS 

WITHOUT  DISPLACEMENT 

COMPLETE 

INCOMPLETE 

EXCELLENl 

GOOD 

FAIR  OR 
POOR 

NO 

FOLLOW 

€ 

3 

3 

POSTERIOR 
TILT  OR 
IMPACTION 

ONLY 

NO 

COMPLICATIONS 

e 

t 

8 

FRACTURE 
ULNAR  STYLOID 
PROCESS 

i 

1 

POSTERIOR 

DISPLACEMENT 

AND 

IMPACTION 

NO 

COMPLICATIONS 

24 

3 

ti 

6 

2 

1 

FRACTURE 
ULNAR  STYLOID 
PROCESS 

1 3 

9 

2 

I 

RUPTURE 
DORSAL 
RADIO-  ULNAR 
LIGAMENT 

3 

1 

2 

total 

3 

4Q__ 

10 

3 

s 

The  fifty-eight  cases  shown  in  Table  2 
have  been  analyzed  in  view  of  the  criteria 
set  up  above.  The  excellent  results  were 
those  cases  that  had  normal  stability  of  the 
wrist,  full  motion,  and  no  discomfort  on 
heavy  work.  Some  of  these  cases  did  not 
have  perfect  anatomical  restoration  of  the 
radial  fracture,  but  there  was  no  residual 
damage  to  the  radio-ulnar  articulation.  The 
good  results  included  those  cases  in  which 
there  was  good  stability,  good  motion,  and 
an  ability  to  perform  their  usual  work. 
However,  these  cases  exhibited  some  dis- 
comfort when  the  wrist  was  subjected  to  ex- 
cessive strain.  It  was  felt  that  these  cases 
had  some  residual  damage  to  the  interartic- 
ular  fibrocartilage  because  the  discomfort 
was  localized  either  over  the  radio-ulnar 
joint  or  about  the  styloid  process  of  the 
ulna.  The  poor  results  included  those  cases 
that  either  had  instability  of  the  radio-ulnar 
articulation  or  limitation  of  motion  with 
pain  sufficient  to  prevent  the  use  of  the 
hand  for  heavy  work.  There  was  both  insta- 


844 


Rocky  Mountain  Medical  Journal 


bility  and  limitation  of  motion  in  all  of  the 
cases  in  this  group. 

Summary  and  Conclusions 

A review  of  the  injuries  encountered  in 
Colles’  fracture  has  been  presented.  The 
importance  of  the  damage  to  the  radio-ulnar 
articulation  has  been  pointed  out.  Lippman 
has  pointed  out  that  rupture  of  the  dorsal 
radio-ulnar  ligament  is  one  of  the  most  im- 
portant factors  in  poor  results.  We  agree 
that  this  is  important  but  feel  that  damage 


to  the  interarticular  fibrocartilage  is  just  as 
important,  and  its  incidence  of  injury  is 
much  higher.  Both  of  these  structures  must 
be  restored  when  injured  if  a good  result 
is  to  follow.  A method  of  treatment  has 
been  presented  showing  the  end  results  in 
fifty-eight  fractures.  These  cases  demon- 
strate the  importance  of  restoring  the  nor- 
mal stability  to  the  joint. 

REFEREilVCE 

iLippmari,  R.  K. : Laxity  of  the  Radio-Ulnar  Joint 
Following-  Colies’  Fracture,  Arch.  Surgery,  35:772-786, 
1937. 


INCIDENCE  OF  HOMOLOGOUS  SERUM  JAUNDICE  IN  RECIPIENTS 
OF  BLOOD  PRODUCTS  FROM  THE  BELLE  BONFILS 
MEMORIAL  BLOOD  BANK* 

ROBERT  S.  LIGGETT,  M.D.,  and  MARION  R.  RYMER,  Ph.D.,  Denver 


The  occurrence  of  homologous  serum 
jaundice  has  attracted  considerable  atten- 
tion with  the  increasing  use  of  blood  and 
blood  products,  and  so  concerned  have  some 
physicians  become  over  this  condition  that 
they  are  reluctant  to  use  blood  and  plasma 
except  in  dire  necessity.  However,  homolo- 
gous serum  jaundice  is  not  a new  entity, 
for  as  early  as  1885  Lurman’^  reported  that 
of  1,289  persons  in  Bremen  vaccinated  with 
vaccine  derived  from  human  lymph,  191  de- 
veloped jaundice.  In  two  other  groups  total- 
ing 587  vaccinated  at  the  same  time  with 
another  batch  of  vaccine,  there  were  no 
cases  of  jaundice.  In  London  in  1937  seven 
recipients  of  a single  batch  of  measles  con- 
valescent serum  developed  jaundice  and 
three  died^  During  World  War  II  interest 
was  focused  on  the  problem  with  the  ap- 
pearance of  homologous  serum  jaundice 
following  yellow  fever  vaccination®  ^ and 
subsequent  to  blood  and  plasma  transfu- 
sions® ® ' ®.  Other  reports®  have  dis- 

cussed in  detail  the  etiology,  incidence,  clin- 
ical picture,  and  mode  of  transmission  of 
homologous  serum  jaundice. 

While  it  is  conceded  that  blood  products 
from  persons  who  have  had  infectious  hep- 
atitis are  usually  the  transmission  media  for 

♦Presented  before  the  Seventy-eighth  Annual  Ses- 
sion of  the  Colorado  State  Medical  Society,  Gllenwood 
Springs,  September  25,  1948.  From  the  Department  of 
Medicine,  University  of  Colorado  School  of  Medicine, 
and  the  Belle  Bonfils  Memorial  Blood  Bank,  Denver. 


homologous  serum  jaundice,  the  two  dis- 
eases show  differences  in  spite  of  their  clini- 
cal similarity.  These  are  as  follows: 

1.  Incubation  period: 

Infectious  hepatitis — one  month  or  less. 
Homologous  serum  jaundice — one  to  six 
months. 

2.  Mode  of  transmission: 

Infectious  hepatitis — parental  or  oral. 
Homologous  serum  jaundice — parental. 

3.  Immunity  conferred: 

No  cross  immunity  is  established  be- 
tween the  two  types  of  jaundice. 

The  incidence  of  homologous  serum  jaun- 
dice following  the  use  of  blood  products  has 
been  reported  as  7.3  per  cent^®,  45  per  cent®, 
4 per.cenH®,  2 per  cent®,  and  0.5  per  cenH*. 
The  incidence  of  this  condition  following 
the  use  of  blood  products  from  any  one 
blood  bank  is  probably  dependent  upon  the 
incidence  of  infectious  hepatitis  in  the  gen- 
eral population  from  which  the  blood  bank 
draws  its  donors.  Little  reliable  informa- 
tion of  this  nature  is  available  in  the  Den- 
ver area,  or,  for  that  matter,  in  the  Rocky 
Mountain  region,  although  the  condition  is 
known  to  be  endemic  here.  Dodge^®  reported 
an  outbreak  of  infectious  hepatitis  in  Koote- 
nai County,  Idaho,  in  1946  which  led  him 
to  believe  that  between  800  and  900  cases 
of  the  disease  occur  in  Idaho  each  year. 

Because  homologous  serum  jaundice  is  of 
special  importance  to  blood  banks  we  in- 


fer October,  1949 


845 


vestigated  its  occurrence  following  the  use 
of  blood  or  plasma  from  this  blood  bank  for 
the  fifty-one  months  period  of  March, 
1943,  through  May,  1948.  To  do  this,  we 
sent  a questionnaire  to  each  recipient  of 
blood  or  plasma  from  this  blood  bahk  who 
was  known  to  be  living  at  the  time  of  his 
discharge  from  the  hospital.  The  extremely 
simple  questionnaire  consisted  of  the  fol- 
lowing items: 

1.  Have  you  had  any  yellow  jaundice  since 

January,  1943? — Yes No 

2.  If  yes,  when? 

3.  If  the  person  to  whom  this  is  addressed  is 
not  living  now,  state  whether  he  or  she  had  yel- 
low jaundice  between  January  1,  1943,  and  his 
or  her  death. 

These  questions  occupied  one-half  of  a 
self-addressed  double  postcard  which  was 
serially  numbered  so  that  no  signature  was 
required  for  identification  of  the  patidnt. 
All  persons  who  did  not  answer  the  first 
questionnaire  within  six  to  eight  weeks  re- 
ceived this  same  questionnaire  card  en- 
closed within  a letter  explaining  in  greater 
detail  the  importance  of  the  survey  and  ask- 
ing the  recipient’s  cooperation. 

Follow-up  inquiry  to  the  patient’s  physi- 
cian was  made  on  all  persons  who  reported 
having  had  jaundice  or  who  gave  indefinite 
answers.  The  administration  of  blood  and 
plasma  from  sources  other  than  the  Belle 
Bonfils  Memorial  Blood  Bank  was  checked 
through  careful  scrutiny  of  the  patient’s 
hospital  chart  and  through  inquiry 'to  his 
doctor. 

In  all,  questionnaires  were  sent  to  3,225 
patients  known  to  be  living  following  their 
hospitalization  when  the  blood  or  plasma 
was  used.  These  patients  had  received  a 
total  of  9,366  whole  blood,  cell  suspensions 
and  plasma  transfusions.  A total  of  2,042 
questionnaires  was  returned  answered.  This 
represented  4,488  transfusions  distributed  as 
follows:  blood  3,603,  plasma  773,  cell  suspen- 
sion 112.  The  responses  received  may  be 
summarized  in  four  categories: 

1.  Answer  definite  negative: 

Patient  answered  questionnaire... .1,821 
Relatives  of  patient  answered 
questionnaire  112 — 1,933 


2.  Answer  affirmative  or  indefinite: 

Had  jaundice — no  other  cause  could 

be  found  1 

Had  jaundice  but  also  had  received 
commercial  or  dried  surplus  plasma  19 
Had  jaundice  or  gave  an  indefinite 
answer;  follow-up  not  possible....  7 
Had  jaundice  or  gave  indefinite  an- 
swer. Follow-up  revealed  jaundice 
unrelated  to  transfusion 82 — 109 

3.  Questionnaire  returned  unanswered: 

Patient  returned  questionnaire  with- 
out answer  8 

Questionnaire  returned  marked  “un- 
claimed”   534 

Questionnaire  returned  marked  “ad- 
dressee deceased” 16 — 558 

4.  Questionnaire  not  returned 625 

From  these  data  we  see  that  a total  of 
1,933  persons  did  not  have  jaundice  during 
the  period  under  consideration.  No  further 
follow-up  was  made  on  these  cases.  The 
remaining  109  returned  questionnaires  were 
either  answered  in  the  affirmative  or  were 
answered  in  an  indefinite  manner.  This 
group  of  109  was  then  subjected  to  careful 
follow-up  scrutiny  and  can  be  divided  into 
four  categories  on  the  basis  of  the  results; 

1.  One  patient  had  had  jaundice  for  which 
no  other  explanation  could  be  found  than 
the  single  blood  transfusion  which  she  re- 
ceived. The  patient  recovered  following  the 
attack. 

2.  Nineteen  patients  had  had  jaundice, 
but  follow-up  inquiry  revealed  that  they 
had  received  either  commercial*  or  surplus 
property  dried  plasma  at  about  the  same 
time  that  they  had  received  the  blood  bank 
blood.  Table  1 presents  data  on  these  pa- 
tients in  greater  detail.  While  the  jaundice 
appeared  within  the  time  limits  allowable, 
it  cannot  be  ascribed  definitely  to  either 
the  blood  from  this  blood  bank  nor  to  the 
plasma  from  outside  sources. 

3.  Seven  patients  reported  having  had 
jaundice  or  gave  indefinite  answers,  but  we 
were  unable  to  obtain  satisfactory  follow-up 
information  on  these.  In  all  cases  except 
one  (number  50268),  this  was  because  no 
physician  could  be  located  who  had  ob- 
served the  patient  following  his  discharge 
from  the  hospital.  Data  on  these  cases  are 
presented  in  Table  2.  It  is  entirely  possible 

•The  commercial  plasma  available  in  the  period 
covered  by  this  study  was  not  irradiated. 


846 


Rocky  Mountain  Medical  Journal 


TABLE  1 


Patient  Reported  Jaundice  but  Also  Received  Plasma  Not  Prepared  by  the 
Belle  Bonfils  Memorial  Blood  Bank 


Date  of  Blood 

Date  of  Plasma 

Number 

Diag^nosis 

Transfusion 

Transfusion 

Date  Jaundiced 

50298 

Carcinoma  of 
sigmoid 

8-(28-29)-46 

Dried  plasma* 

8-28-46 

Nov.,  1946 

50112 

Carcinoma  of 
acetabulum 

7-(6-ll)-46 

Dried  plasma  repeat- 
edly July  ’46 

Oct.  and  Nov., 
1944 

60134 

Third  degree 
burns 

8- 2-47 

9- (5-17)-47 

Dried  plasma 

5-(6-9)-46 

Nov.,  1946 

40329 

Chronic 

salpingitis 

2-6-47 

Commercial  plasma 

2-4-47 

June,  1947 

14011 

Ruptured 
ovarian  cyst 

1-13-47 

Commercial  plasma 
1-13-47 

April,  1947 

10432 

Intestinal 

obstruction 

3-15-47 

Dried  plasma  repeat- 
edly March  ’47 

July,  1947 

11015 

Bronchiect- 

asis 

5-(l-3)-46 

12-6-46 

1- 21-47 

2- (4-17)-47 

Dried  plasma 

11-30-46  and 

2-4-47 

March,  1947 

10787 

Addison’s 

disease 

4-28-47 

Dried  plasma 

12-7-46  and  4-28-47 

July,  1947 

20124 

Lymphosarcoma 
of  stomach 

4-10-46 

Commercial  plasma 
4(ll-21)-46 

June,  1946 

30241 

Giant  cell  tumor 
of  humerus 

4-1-46 

Commercial  plasma 
about  4-1-46 

June,  1946 

30226 

Liomyoma  of 
esophagus 

4-21-46 

Commercial  plasma 
about  4-22-46 

May  and  June 
1947 

303221 

Carcinoma  of 
colon 

2-(6-23)-46 

Dried  plasma 

2-24-46 

June,  1946 

30250 

Sub-diaphrag- 
matic vagot- 
omy— ulcer 

2-3-47 

Dried  plasma 

2-4-47 

May,  1947 

30072 

Obstructing 
bleeding  ulcer 

1-15-47 

Dried  plasma,  5 units 
l-(4-17)-47 

April,  1947 

30108 

Duodenal 

ulcer 

2-26-47 

Dried  plasma 

2-28-47 

Sept,  1947 

30304 

Gall  bladder 
disease 

3-(27-28)-47 

Dried  plasma 

3-27-47 

May,  1947 

40141 

Carcinoma  of 
rectum 

ll-(7-8-10)-46 

Dried  plasma 
ll-(5-8-9-13)-46 

Feb.,  1947 

20286 

Undulent 

fever 

3- 28-46 

4- 2-46 

Commercial  plasma 

about  4-10-46 

Aug.,  1946 

40175 

Carcinoma  of 

stomach 

7- 31-46 

8- 1-46 

Dried  plasma 

7-31-46 

Nov.,  1946 

*Dried 

plasma  is  surplus  property  plasma. 

TABLE  2 

Patient  Reported  Jaundice;  Follow-up  Inquiry  Not  Successful 


Answer  to 


Number 

Diagnosis 

Date  of  Transfusion 

Questionnaire 

10290 

Carcinoma  of 

recto-simoid 

1-17-44 

(1  blood) 

Yes.  No  date  given. 

10863 

Carcinoma  of 

sigmoid 

8-15-46 

(1  blood) 

Not  sure. 

10176 

Carcinoma  of 

caecum 

6-  1-43 

(1  blood) 

Died  1945. 

12004 

Hernia  

3-24-44 

(1  blood) 

May,  1944. 

70104 

? 

10-  1-43 

(1  blood) 

Yes.  Died  12-7-45. 

50268 

9 

4-12-46 

(1  blood) 

Yes.  Three  months  in 

1946. 

20004 

Mesenteric-thrombosis  

6-  2-43 

(1  blood) 

Yes.  July  and  Aug., 

1943. 

for  October,  1949 


847 


that  if  we  had  more  information,  these  pa- 
tients would  be  classified  as  negative,  but 
since  the  follow-up  was  unsuccessful,  they 
must  be  considered  as  those  who  might  have 
had  jaundice.  If  we  add  these  seven  to  the 
nineteen  who  had  jaundice  and  also  re- 
ceived commercial  or  dried  plasma  as  dis- 
cussed above,  we  have  a total  of  twenty-six 
patients  who  might  have  contracted  homolo- 
gous serum  jaundice  following  the  use  of 
blood  products  from  this  bank.  None  of 
these  twenty-six  cases  received  plasma  from 
this  blood  bank. 

4.  Eighty-two  patients  had  had  jaundice, 
but  follow-up  inquiry  to  the  physician  in 
charge  of  the  patient  at  the  time  of  the 
jaundice  attack  revealed  that  the  jaundice 
was  probably  unrelated  to  the  blood  prod- 
ucts received.  Information  on  these  cases  is 
summarized  as  follows: 

Number  of 


Cases  Inquiry  Showed 

1 Cirrhosis  of  the  liver. 

3 Carcinoma  of  head  of  pancreas. 

6  Incubation  period  between  blood  and 

jaundice  too  short,  1-20  days. 

7  Biliary  tract  disease. 

9 Incubation  period  between  blood  and 

jaundice  too  long,  IV2  months*-3  years. 

13 Patient  answered  yes  or  not  sure  but 

physician  who  had  patient  under  care 
during  period  involved  reported  no 
jaundice. 

43 Jaundice  occurred  prior  to  transfusion. 


Discussion 

It  is  evident  that  the  results  of  a survey 
of  this  kind  are  open  to  question  on  the 
basis  of  the  final  sample  obtained.  We  have 
no  way  of  knowing  whether  the  2,042  pa- 
tients who  answered  the  questionnaire  rep- 
resent a reliable  sample  of  the  total  group 
receiving  blood  and  plasma  from  this  bank. 
For  example,  nothing  is  known  about  the 
incidence  of  jaundice  among  the  persons 
who  did  not  answer  the  questionnaire  (but 
probably  received  it  in  most  cases)  and 
among  the  persons  who  did  not  receive  the 
questionnaire  (returned  unclaimed  or  ad- 
dressee deceased).  Moreover,  it  is  possible 
that  blood  from  the  blood  bank  was  the 
transmitting  agent  in  some  of  the  nineteen 

*The  patient  who  developed  jaundice  7%  months 
after  receiving'  whole  blood  probably  had  infectious 
hepatitis  because  a brother  also  developed  this  dis- 
ea.se  a tew  weeks  after  the  patient. 


persons  with  jaundice  who  also  had  concur- 
rently received  commercial  or  surplus  plas- 
ma. On  the  other  hand,  there  is  no  certainty 
that  the  blood  rather  than  an  inadequately 
sterilized  hypodermic  syringe  or  needle  was 
the  causative  factor  in  the  one  patient  who 
clearly  did  develop  jaundice  after  a single 
blood  transfusion. 

In  spite  of  these  facts  and  fully  recogniz- 
ing the  shortcomings  of  the  questionnaire 
method,  some  justifiable  statements  can  be 
made  on  the  basis  of  our  data.  First,  the 
incidence  of  homologous  serum  jaundice 
from  products  of  the  Belle  Bonfils  Memorial 
Blood  Bank  is  low.  Second,  it  appears  that 
the  incidence  of  infectious  hepatitis  in  the 
Denver  area  is  also  low. 


REiF'EREN  CE  S 

iLiirnian,  W.;  Berl.  Klin.  Wohnschr.  2S,  20.  1885. 
Cited  by  Neefe  et  al.  (11). 

2Propert.  S.  A.:  Hepatitis  After  Prophylactic  Ser- 
um, British  Med.  J.  S:6i77,  Sept.,  1938. 

“Sawyer,  W.  A.,  K.  F.  Meyer,  M.  D.  Eaton,  J.  H. 
Bauer,  Peisis  Putnam  and  P.  F.  iShhwentker:  Jaun- 
dice in  Army  Personnel  in  the  Western  Region  of 
the  United  States  and  Its  Relation  to  Vaccination 
Against  Yellow  Fever.  Part  I,  Am.  J.  Hyg.  39:337, 
May,  1944. 

^Sawyer,  W.  A.,  K.  F.  Meyer,  M.  D.  Eaton,  J.  H. 
Bauer,  Persis  Putnam  and  F.  F.  Schwentker:  Jaun- 
dice in  Army  Personnel  in  the  Western  Region  of 
the  United  States  and  Its  Relation  to  Vaccination 
Against  Yellow  Fever.  Parts  II,  III  and  IV,  ibid  40: 
35,  July,  1944. 

“Beeson,  Paul  B.:  Jaundice  Occurring  One  to  Pour 
Months  After  Transfusion  of  Blood  or  Plasma, 
J.A.M.A.  121:1332,  April,  1943. 

“Rappaport,  Emanuel  M.:  Hepatitis  Following 
Blood  or  Plasma  Transfusions.  Observations  in  Thir- 
ty-Three Cases,  ' J.A.M.A.  128:932,  July,  1945. 

’Grossman,  Edward  B.,  Sloan,  G.  Stewart,  and 
Joseph  Stoker:  Post-Transfusion  Hepatitis  in  Battle 
Casualties,  J.A.M.A.  129:991,  Dec.,  1945. 

“Brightman,  I.  Jay,  and  Robert  P.  Korns:  Homolo- 
gous Serum  Jaundice  in  Recipients  of  Pooled  Plasma, 
J.A.M.A.  135:268,  Oct.,  1947. 

^Grossman,  Charles  M.,  and  Ernest  W.  Saward: 
Homologous  Serum  Jaundice  Following  the  Admin- 
istration of  Commercial  Pooled  Plasma.  Report  of 
Eight  Cases  Including  One  Fatality,  New  England 
J.  Med.  234:181,  Feb.,  1946. 

“Committee  on  B'lood  and  Blood  Derivatives  of 
the  Advisory  Board  on  Health  Services  of  the  Amer- 
ican National  Red  Cross:  Report  on  the  Incidence 
of  Homologous  Serum  Jaundice  Following-  the  Use 
of  Surplus  Dried  Plasma,  Am.  Red  Cross,  Aug.  15, 
1947. 

“Neefe,  John  R.,  T.  Grier  Miller  and  Francis  W. 
Chornock:  Homologous  Serum  Jaundice,  A Review 
of  the  Literature  and  Report  of  a Case,  Am.  J.  Med. 

, Sc.  207:626,  Feb.,  1944. 

' “Jaul,  John  R,  W.  P.  Havens,  A.  B.  Savin,  and 
C.  B.  Philip:  Transmission  Experiments  in  Serum 
Jaundice  and  Infectious  Hepatitis,  J.A.M.A.  138:911, 
July,  1945. 

“Havens,  W.  Paul:  The  Etiology  of  Infectious 
Hepatitis,  J.A.M.A.  134:653,  June,  1947. 

“Scheinberg,  I.  Herbert,  Thomas  D.  Kinney  and 
Charles  A.  Janeway;  Homologous  Serum  Jaundice. 
A Problem  in  the  Operation  of  Blood  Banks,  J.A.M.A. 
134:841,  July,  1947. 

“Spurllng,  Nancy,  John  Stone  and  Janet  Vaughan: 
The  Incidence,  Incubation  Period  and  Symptomatol- 
ogy of  Homologous  Serum  Jaundice,  Brit.  M.  J.  1: 
409,  Sept.,  1946. 

“Dodge,  H.  J. : Personal  Communication. 


(The  authors  wish  to  express  their  appreciation 
to  Miss  Betty  Jane  Strickler  for  her  faithful  work 
in  the  collection  of  the  data  presented  in  this 
paper.) 


848 


Rocky  Mountain  Medical  Journal 


DRAMAMINE^ 


(Brand  of  dimenhydrinate) 


has  been  accepted  by  the  Council  on  Pharmacy  and  Chemistry 
of  the  American  Medical  Association  for  the  prophylactic  and 
therapeutic  relief  of  motion  sickness. 

^TRADEMARK  OF  G.  D.  SEARLE  & CO. 


for  October,  1949 


849 


Organization 

National  Affairs  - Proceedings  - Programs  - Society  Notices  - News  - Auxiliary 


COLORADO 

State  Medical  Society 

Ervin  A.  Hinds,  President-Elect 

Ervin  A.  Hinds,  M.D.,  of  Denver,  was  the 
unanimous  choice  of  the  House  of  Delegates  at 
the  recent  annual  session  in  Denver  to  be  Presi- 
dent of  the  Colorado 
State  Medical  Society 
for  the  1950-51  year. 

The  new  President- 
elect will  succeed  Fred 
A.  Humphrey,  M.D.,  of 
Fort  Collins,  who  took 
office  in  September. 
Dr.  Hinds  has  a dis- 
tinguished record  in 
medicine  and  in  medi- 
cal organization  work 
and  is  also  widely 
known  for  his  athletic 
achievements.  For 
many  years  a member 
of  the  Denver  County 
Medical  Society,  he 
served  in  the  House  of  Delegates  as  its  repre- 
sentative. For  the  past  three  years  he  has  been 
a rnember  of  the  Board  of  Trustees  of  the  State 
Society  and  during  the  past  year  was  its  chair- 
man. 

He  is  chief  surgeon  for  the  Denver,  Rio  Grande 
& Western  Railroad.  He  is  a member  of  the 
Denver  Medical  Club,  the  Clinical  and  Path- 
ological Society,  and  is  President-elect  of  the 
Denver  Academy  of  Surgeons.  Dr.  Hinds  is 
a member  of  the  American  College  of  Surgeons, 
a Diplomate  American  Board  of  Surgery,  Con- 
sultant, general  surgery,  Fitzsimons  General 
Hospital  and  a member  of  the  Southwestern 
Surgical  Congress.  He  is  on  the  surgical  staffs 
of  Colorado  General  Hospital,  Denver  General 
Hospital,  Children’s  Hospital  and  St.  Joseph’s 
Hospital.  He  is  a member  of  the  Denver  Coun- 
try Club  and  Gyro  Club. 

Dr.  Hinds  was  born  in  Kansas  March  20,  1899, 
but  has  lived  in  Colorado  since  the  age  of  four 
years.  He  graduated  from  Colorado  A.  & M. 
College  in  1923  and  from  the  University  of  Colo- 
rado School  of  Medicine  in  1934.  He  served 
his  internship  at  Colorado  General  Hospital  and 
a one-year  residency  in  surgery  at  the  same 
institution. 

While  attending  A.  & M.  he  was  President 
of  the  student  body  and  earned  fourteen  letters 
in  football,  basketball,  baseball  and  boxing.  He 
was  Conference  boxing  champion  four  years  and 
an  all-Conference  end  in  football  in  1922.  Fol- 
lowing graduation  from  agricultural  school  he 
coached  at  Eaton  High  School  and  later  was 
director  of  athletics  at  Colorado  School  of  Mines 
for  four  years. 

He  served  in  both  World  Wars,  being  in  World 
War  1 for  two  years  and  overseas  for  eighteen 


months  with  a combat  unit.  He  saw  four  years’ 
service  during  World  War  11  and  was  in  Europe 
two  years  as  a Lieutenant  Colonel,  Chief  of 
Surgery,  154th  General  Hospital. 

He  married  Miss  Pauline  Wright  of  Monte 
Vista  in  June,  1924.  The  couple  has  two  chil- 
dren, Ann,  eleven  years,  and  Ervin,  Jr.,  eight 
years. 


SECOND  ROCKY  MOUNTAIN  ANESTHESIO- 
LOGICAL  CONFERENCE  PROGRAM 

Sponsored  by:  Colorado  Society  of  Anesthe- 
siologists. 

Theme:  Anesthesiology  for  ’Thoracic  Surgery. 
Denver— October  14,  15,  1949.  Headquarters: 
Brown  Palace  Hotel.  No  registration  fee. 

FRIDAY,  OCTOBER  14,  1949 
Morning — ^Brown  Palace  Hotel 
9 : 00 — Registration. 

10:00 — Meeting — C.  Walter  Metz,  M.D.,  Chairman, 
Rocky  Mountain  Section  of  American  Society 
of  Anesthesiologists. 

Election  of  Officers. 

1 2 : 00 — Round-Table  Luncheon. 

Aftemoon—University  of  Colorado  Medical 
Center,  5200  East  Ninth  Avenue 

2:00 — Demonstrations: 

1.  Cardiac  Catheterization.— Henry  Swan, 

M.D.;  George  J.  Maresh,  M.D.;  Philip  A. 
Lief,  M.D. 

2.  Diffusion  Respiration. — Richard  W.  White- 
head,  M.D.;  William  B.  Draper,  M.D. 

3.  Use  of  Procaine  and  Quinidine  to  Control 
Cardiac  Arrhythmias. — Philip  A.  Lief,  M.D., 
and  Staff. 

4.  Bronchospirometry  and  Respiratory  Func- 
tion Tests. — Frank  Princi,  M.D.,  and  Staff. 

4:00 — Case  Presentations  (Clinical  Amphithea- 
tre).— The  anesthetic  management  of  inter- 
esting cases  of  thoracic  surgery  will  be  pre- 
sented and  discussed  by  the  clinicians  and 
residents  in  Denver  and  Denver  hospitals. 

Evening-^-Brown  Palace  Hotel 
6:30 — Dinner. — J.  Lawrence  Campbell,  M.D., 
presiding.  Introduction  of  Members  of  Amer- 
ican Board  of  Anesthesiology.- — C.  Walter 
Metz,  M.D. 

8 :30— Scientific  Session  — Clinical-Pathological 
Panel  on  Surgery  of  Cardiovascular  Disease. 
— Henry  S.  Ruth,  M.D.,  Chairman;  John  B. 
Grow,  M.D.;  Harold  D.  Palmer,  M.D.;  Carl 
J.  Josephson,  M.D.;  Myron  B.  Pedigo,  M.D. 

SATURDAY,  OCTOBER  15,  1949 
Morning — Brown  Palace  Hotel 
9:00— Pre-  and  Postoperative  Care  of  the  Thor- 
acic Surgical  Case. — Colonel  James  H.  Forsee, 
Chairman;  Colonel  Joseph  F.  Peters,  Colonel 
Carl  W.  Tempel. 

10:30 — Pulmonary  Considerations  in  Thoracic 
Surgery. — McKinnie  L.  Phelps,  M.D.,  Chair- 
man; Allan  Hurst,  M.D.;  Sidney  Dressier, 
M.D.;  John  B.  Grow,  M.D. 

12:00 — Round-Table  Luncheon. 


850 


Rocky  Mountain  Medical  Journal 


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only  as  fast  as  the  fertile  lands  below  can  uti- 
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This  gives  the  effect  of  continuous  small  doses. 

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pain  on  injection  and  reduces  side  reactions  to 
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Aftemoon^ — Brown  Palace  Hotel 

1 :30 — Cardiac  and  Circulatory  Considerations  in 
Thoracic  Surgery. — Philip  A.  Lief,  M.D., 
Chairman;  Abe  Ravin,  M.D.;  Edgar  Durbin, 
M.D.;  Robert  K.  Brown,  M.D. 

2:45 — Pulmonary  Resection  in  Tuberculosis  and 
Supportive  Lung  Disease. — J.  Lawrence 
Campbell,  M.D.,  Chairman;  Fred  R.  Harper, 
M.D.;  Harold  M.  Van  Der  Schouw,  M.D.;  Du- 
mont Clark,  M.D. 

4:00 — Anesthesia  in  Thoracic  Surgery. — Scott 
M.  Smith,  M.D.,  Chairman;  W.  Ray  Rumel, 
M.D.;  John  C.  McAfee,  M.D.;  Frederick  P. 
Haugen,  M.D.;'  William  B.  Condon,  M.D. 

Evening — Brown  Palace  Hotel 

6:00 — Cocktail  Hour. 

7:00 — Banquet. 


Obituaries 

JOHN  W.  AMESSE 

Dr.  John  W.  Amesse,  Denver  pediatrician  and 
long  a national  figure  in  medicine  from  both 
the  scientific  and  organization  viewpoints,  died 
at  his  home  August  22,  1949,  at  the  age  of  75. 
He  had  been  ill  for  many  months  from  coronary 
thrombosis. 

Dr.  Amesse  was  born  January  15,  1874,  in 
Eagle  River,  Michigan,  of  French-Canadian  an- 
cestry. He  received  his  medical  degree  from  the 
University  of  Michigan  in  1894,  following  which 
he  did  postgraduate  study  in  pediatrics  and 
public  health  at  Johns  Hopkins  University  in 
Baltimore  and  at  Bellevue  Hospital,  New  York 
City. 

Following  his  formal  training.  Dr.  Amesse 
served  with  the  Marine  Hospital  Corps,  which 
later  became  the  United  States  Public  Health 
Service.  He  served  in  the  Philippine  Islands 
through  the  insurrection  period  following  the 
Spanish-American  War,  and  later  in  the  Ha- 
waiian Islands,  Costa  Rica,  Cuba,  and  New  Or- 
leans. For  a short  time  thereafter  he  prac- 
ticed in  Seattle,  but  moved  permanently  to 
Denver  in  1910  and  entered  the  private  practice 
of  pediatrics.  He  again  entered  government 
service  as  a first  lieutenant  in  the  Army  Medical 
Corps  in  the  first  World  War,  and  was  dis- 
charged at  the  end  of  that  war  as  a Lieutenant 
Colonel.  A member  of  the  original  staff  of  the 
Denver  Children’s  Hospital,  he  also  served  as 
attending  pediatrician  at  Colorado  and  Denver 
General  Hospitals,  and  was  a member  of  the 
faculty  of  the  University  of  Colorado  School  of 
Medicine. 

Dr.  Amesse  was  always  an  enthusiastic  and 
efficient  organizer  of  projects  for  civic  better- 
ment of  his  city  and  state.  He  was  one  of  the 
founders  of  the  Adult  Education  Council  of  Den- 
ver, also  of  the  Rocky  Mountain  Radio  Council, 
two  organizations  which  soon  became  highly  im- 
portant educational  forces.  Likewise  he  helped 
organize  the  Denver  Public  Health  Council  and 
the  Denver  City  Club,  and  had  served  as  presi- 
dent of  both  these  organizations.  For  two  years 
he  was  a member  of  the  Colorado  State  Board 
of  Health. 

In  the  basic  medical  organizations  he  had 
been  a leader  for  many  years.  He  had  served 
as  President  of  the  Medical  Society  of  the  City 
and  County  of  Denver,  and  President  of  the 
Colorado  State  Medical  Society.  In  the  1943-1944 
organizational  year,  he  was  Vice  President  of 
the  American  Medical  Association.  In  every 
year  from  1930  until  his  retirement  a year  ago. 


he  was  active  in  many  committees  of  these 
bodies.  He  served  eight  years  as  one  of  Colo- 
rado’s two  delegates  to  the  American  Medical 
Association  House  of  Delegates.  He  was  a charter 
member  of  the  American  Academy  of  Pediatrics 
and  for  ten  years  was  a director  of  the  Capitol 
Life  Insurance  Company.  Even  those  who  knew 
him  best  continually  marveled  at  his  capacity 
for  work  in  many  and  varied  fields.  Through- 
out the  second  World  War  he  served  as  Chair- 
man for  Colorado  of  the  U.  S.  Procurement  and 
Assignment  Service  for  Physicians  and  Dentists, 
in  addition  to  his  many  other  interests  and  his 
busy  practice. 

As  one  of  the  true  deans  of  pediatrics  in  the 
Rocky  Mountain  West,  Dr.  Amesse’s  passing 
poses  a loss  to  the  medical  profession  that  can- 
not be  measured  in  words.  He  held  a truly 
unique  place  in  the  hearts  and  lives  of  the 
profession  and  the  general  public  alike. 


AUGUSTA  ROTHWELL 

Dr.  Augusth  Rothwell  of  Denver  died  in 
Athens,  Georgia,  on  August  21,  1949,  at  the 
age  of  91. 

Born  in  Acton,  Ontario,  Canada,  on  July  22, 
1858,  Dr.  Rothwell  was  reared  in  Ann  Arbor, 
Michigan.  It  was  there  she  met  her  husband. 
Dr.  Edwin  J.  Rothwell,  while  he  was  a medical 
student  at  the  University  of  Michigan. 

The  Roth  wells  moved  to  Denver  in  1882.  It 
was  in  1901  that  she  graduated  from  an  eastern 
medical  school.  At  the  age  of  65  she  passed 
the  California  State  Medical  Board  and,  after 
reciprocating,  practiced  in  both  Colorado  and 
California  for  a period  of  twenty-three  years. 
Prior  to  her  study  of  medicine.  Dr.  Rothwell 
raised  a family  of  seven  children. 


JOHN  L.  STEVENS 

Dr.  John  L.  Stevens  of  Denver  died  in  a con- 
valescent home  in  Colorado  Springs  on  August 
18,  1949,  at  the  age  of  78.  He  retired  from  the 
practice  of  medicine  three  years  ago  because  of 
ill  health. 

Dr.  Stevens  was  born  in  Montour,  Iowa.  He 
graduated  from  Grinnell  College  and  was  or- 
dained a Congregational  minister  before  decid- 
ing to  enter  the  medical  field. 

Graduating  from  Gross  Medical  School  in  1908, 
Dr.  Stevens  started  practice  in  Denver  the  same 
year.  He  was  a member  of  the  Denver  County 
and  Colorado  State  Medical  Societies. 

During  his  many  years  of  active  practice. 
Dr.  Stevens  became  well  known  throughout  the 
Denver  area.  He  will  be  greatly  missed  by  all 
who  had  come  to  respect  and  admire  his  ability 
as  a physician  and  humanitarian. 


FRANZ  F.  WOHLAUER 

Dr.  Franz  F.  Wohlauer,  formerly  of  Denver 
and  Pueblo,  died  in  Duarte,  California,  on  Au- 
gust 11,  1949,  at  the  age  of  69. 

Dr.  Wohlauer  was  born  in  Breslau,  Germany, 
on  December  13,  1879.  He  received  his  medical 
degree  from  the  University  of  Berlin  in  1903. 

Dr.  Wohlauer  came  to  Denver  in  December, 
1936,  and  practiced  in  the  city  until  April,  1938, 
at  which  time  he  moved  to  Pueblo.  He  con- 
tinued in  active  practice  there  until  his  retire- 
ment in  1947. 

After  nine  years’  active  membership  in  the 
Colorado  State  Medical  Society,  Dr.  Wohlauer 
became  an  associate  non-resident  member  in 
1947. 


852 


Rocky  Mountain  Medical  Journal 


For  the  public  good 


The  health  and  well-being  of  at  least  1 ,000,000  Americans  depends  upon  their  dis- 
covery and  treatment  as  diabetics.  The  American  Diabetes  Association  is  directing 
the  year-round  Diabetes  Detection  Drive  to  find  the  “1,000,000  unknown  diabetics” 
and  guide  them  to  their  own  physicians  for  treatment. 


THE  AMES 


Selftester 

brings  those  with  glycosuria  to  you  for  diagnosis. 


AT  ALL 
DRUGSTORES 


A simple  home  screening  test 
for  urine-sugar,  the  Ames  Self- 
tester*  is  a new  approach  to 
this  detection  problem.  Like  the 
clinical  thermometer,  it  is  sold 
directly  to  the  public  through 
drugstores.  Also  like  the  ther- 
mometer, it  does  not  give  a di- 
agnosis, but  only  a warning. 


_tbe  dirmetions  state: 

1 The  Selftester  does  not  diagnose  diabetes  or  any  other  disease. 

Its  sole  function  is  the  detection  of  sugar  (glucose)  or  sugar-like  substances. 
2.  If  reaction  is  positive,  see  your  doctor  at  once.  Sugar  in  your 
urine  does  not  necessarily  mean  you  have  diabetes  (nor  does  a negative 
result  definitely  exclude  the  presence  of  disease).  But  only  your  doctor,  by 
medical  examination  and  by  additional  laboratory  tests,  can  tell  why  you 
show  sugar. 


THE  AMES  Self  tester  to  detect  ) 

r ) THE  DIABETIC 

C LI  NITEST®  to  control  ( 

Brand  • Reagent  Tablets  ■' 

♦Approved  by  the  Council  of  the  American  Diabetes  Association  and  accepted  for  advertising  in 
publications  of  the  American  Medical  Association. 

AMES  COMPANY,  INC  • ELKHART,  INDIANA 


for  October,  1949 


853 


NEW  MEXICO 

Medical  Society 

ANNUAL  MEETING  OF  THE  HOUSE  OF 
DELEGATES,  NEW  MEXICO 
SOCIETY 

May  5,  1949 


Minutes  of  the  First  Session 


The  meeting  of  the  Sixty-seventh  Session  of 
the  House  of  Delegates  of  the  New  Mexico  Medi- 
cal Society  was  called  to  order  in  the  auditorium 
of  the  Roswell  Woman’s  Club,  in  Roswell,  New 
Mexico,  at  9:00  a.m.  on  May  5,  1949,  by  the 
President,  Philip  L.  Travers,  M.D.  Delegates 
present  were  as  follows; 


Bernalillo  County — Roy  R.  Robertson,  R.  A.  Trom- 
bley, Alternate  for  Charles  K.  Bivings;  J.  W.  Han- 
nett,  Alternate  for  J.  E.  J.  Harris;  W.  O.  Connor, 
Jr.,  L.  M.  Miles,  Sltuart  W.  Adler,  L.  G.  Rice,  Alvin 

R.  Clauser,  C.  M.  Thompson,  M.  K.  Wylder. 

Chaves  County — E.  J.  Hubbard,  E.  L.  Malone. 
Colfax  County — Milton  Ploersheim,  Jr. 
Curry-Roosevelt  County — John  F.  Conway,  H.  A. 

Miller. 

Dona  Ana  County — J.  C.  Sedgwick. 

Eddy  County — Joseph  W.  Hiilsman,  C.  Pardue 
Bunch,  R.  C.  Derbyshire. 

Grant  County — J.  C.  Mitchell,  not  present. 

Lea  County — Coy  S.  Stone. 

Luna  County — D.  B.  Marsh. 

McKinley  County — ^W.  B.  Center. 

Quay  County — 'No  delegate  present. 

Sandoval  County — No  delegate  present. 

San  Miguel  County — E,  HL  Dellinger. 

Santa  Pe  County — LeGrand  Ward,  V.  E.  Berohtold, 

S.  R.  Ziegler,  S.  M.  Gonzalez,  Alternate  for  Howard 
Seitz. 

Sierra  County — W.  B.  Cantrell,  not  present. 
Taos  County — Ashley  Pond. 

E.  H.  Dellinger  moved  in  favor  of  dispensing 
with  the  reading  of  the  minutes  of  the  last 
meeting,  inasmuch  as  they  had  been  published 
in  the  Rocky  Mountain  Medical  Journal  follow- 
ing the  1948  meeting.  J.  W.  Hannett  seconded 
the  motion,  and  the  motion  carried. 

The  following  report  of  Membership  by  Coun- 
ties was  read  by  the  Secretary-Treasurer,  H.  L. 
January: 


MEMBERSHIP  BY  COUNTIES 
County — 

Bernalillo  

Chaves  

Colfax  

Curry  

Dona  Ana  

Eddy  

Grant  

Lea  

Luna  

McKinley  

Quay  

Sandoval  

San  Mi.guel 

Santa  Fe  

Taos  

Members  at  Large 

Honorary  Members  


1948 

1949 

107 

96 

18 

17 

11 

14 

16 

17 

1-0 

9 

22 

26 

17 

11 

7 

13 

3 

3 

10 

11 

5 

6 

8 

10 

12 

14 

41 

42 

4 

4 

21 

18 

1 

1 

313 

318 

The  deaths  of  the  following  members  of  the 
Society  were  reported  to  the  House  of  Delegates: 
T.  R.  Moran,  M.D.,  Albuquerque. 

R.  O.  Brown,  M.D.,  Santa  Fe. 

Dudley  D.  Stetson,  M.D.,  Santa  Fe. 

In  addition,  it  was  reported  that  the  following 
doctors  in  the  state  had  died  during  the  year; 

C.  B'.  Austin,  M.D.,  Lordsburg. 

Karl  Fife,  M.D.,  Lordsburg. 

G.  K.  Maynard,  M.D.,  Clovis. 

Fred  A.  Dillon,  M.D.,  Clovis. 


It  was  unanimously  resolved  by  the  House  of 
Delegates  to  extend  sympathy  to  the  families  of 
the  deceased  and  instruct  the  Secretary  to  strike 
the  names  from  the  roll  of  the  Society  with 
honor  and  regret. 

The  President  called  for  the  following  financial 
report,  which  was  presented  to  the  Society  by 
the  Secretary-Treasurer: 


Financial  Report 

May  3,  1-949 

New  Mexico  Medical  Society 
Balance  on  hand  at  annual  report.  May  15, 

1948  (checking  account) 1 5,894.07 

1948  dues  collected  from  20  members 400.00 

One-half  year  dues-  collected  from  1 member  10.00 

1949  dues-  collected  from  314  members 6,280.00 

Payment  for  membership  list 1.00 

Dividend  on  U.  S.  Treasury  Bond 12.50 

Balance  of  legislative  fund  (Dr.  Brown) 29.30 

A.M.A.  assessments  paid  to  State  Society 

(204  members)  5,100.00 


Total  cash  received --$17,726.87 


Disbursements 

San  Miguel  County  Medical  Society $ 

Secretary’s  Salary,  1948-49  

Clinton  P.  Anderson  for  Treasurer’s  bond — 
Rocky  Mountain  Medical  Journal  (1948  sub- 
scriptions) — 
Rocky  Mountain  Medical  Journal  (1949  sub- 
scriptions) — 

Mountain  States  Tel.  and  Tel.  Co 

Postmaster  

Valliant  Printing  Company 

Linder,  Burk  and  Stephenson  for  audit 

of  books  

Secretarial  work  

Western  Union  

Out-of-state  travel  expenses-  for  repre- 
sentatives of  Society 

Plilton  Hotel  

Conference  of  Presidents 

Railway  Express  

Flowers  for  Dr.  P.  O.  Brown 

American  Heart  Association 

Simms,  Modrall,  Seymour  & Simms 

Secretary  of  State  for  copy  of  Workmen  s 

Compensation  Act — 

A.M.A.  for  assessments  paid  to  State  bo- 
ciety  


500.00 

300.0-0 

5.00 


22.50 


782.50 

49.84 

40.00 

28.62 


81.67 

10.00 

6.00 

579.20 

77.02 

10.00 

1.12 

25.50 

1.50 

1.500.00 

.75 

5.100.00 


Total  disbursements  

Cash  in  bank  (checking  account) 
Cash  in  bank  (savings  account)  — 


9,121.22 

8,605.65 

4,053.55 


Total  cash,  in  bank 


$12,659.20 


Legislative  Fund 

Balance  of  hand.  May  15,  1948 

20  dues  for  1948  at  $15.00 

314  dues  for  1949  at  $15.00 

Balance  from  legeislative  fund  in  First  Na- 
tional Bank,  Santa  Fe 


Expenditures 

Simms,  Modrall,  Seymour,  and  Simms 


BALANCE,  MAY  3,  1949 


4.680.00 
300.00 

4.710.00 

29.30 

9.719.30 

1.500.00 

8.219.30 


It  was  duly  moved  and  seconded  that  the 
financial  report  be  accepted,  and  the  motion 
carried. 

The  following  report  of  the  Council  Meeting 
held  on  May  5,  1949,  at  8:00  a.m.,  was  given 
to  the  Society  by  the  Secretary-Treasurer. 


Council  Report 

The  Council  recommended  that  C.  W.  Gerber 
of  Las  Cruces  and  F.  F.  Doepp  of  Carlsbad  be 
elected  as  honorary  life  members  of  the  New 
Mexico  Medical  Society,  in  tribute  to  their  mariy 
years  of  practice  in  the  state  and  membership 
in  the  Society.  The  Council  further  pointed  out 
that  Z.  E.  Funk  of  Santa  Rosa  was  the  only 
honorary  life  member  at  the  present  time. 

The  Council  asked  John  F.  Conway  to  rep- 
resent the  New  Mexico  Medical  Society  in  the 
Conference  of  County  Medical  Society  Officers, 
which  was  to  be  held  on  June  5,  1949,  in  Atlantic 
City,  inasmuch  as  he  was  also  the  delegate  to 
the  American  Medical  Association  Convention. 


854 


Rocky  Mountain  Medical  Journal 


PUBIIIIUS  SYRUS,  MAXiM  1)9 


For  safe  mooring  in  the  "snug  harbor" 
of  vitamin  adequacy,  the  best 
tv/ln  anchors  are  balanced  diet  and 
vitamin  supplementation. 

In  medicine  as  in  surgery, 
for  prophylaxis  as  for  therapy,  the 
vitamin  forms  and  dosages 
now  available  place  adequate 
vitamin  intake  under  the 

physician's  selective  control. 

• 

Upjohn  prescription  vitamins  are 
prepared  in  potencies  and 
formulas  that  cover  the  varied 
requirements  of  modern  practice. 


Upjohn 

KALAMAZOO  99,  MICHIGAN 


FINE  PHA8MACEUTICAIS  SINCE  1884 


V. 


for  October,  1949 


855 


The  Council  recommended  endorsement  of  the 
National  Sales  Foundation,  which  is  attempting 
to  sell  a type  of  advertising  to  the  druggists 
of  this  state,  which  portrays  the  useful  part 
the  physician  plays  in  the  community. 

The  Council  recommended  that  the  Malprac- 
tice Insurance  Fees  of  the  state  be  investigated 
by  the  State  Society  and  a report  submitted  to 
the  Council  at  a future  meeting. 

The  Council  had  been  advised  by  the  Secre- 
tary-Treasurer that  the  San  Juan  County  Medi- 
cal Society  had  never  organized  after  its  charter 
had  been  granted,  and  that  no  meetings  had 
taken  place,  even  though  two  doctors  in  the 
county  belong  to  the  Society  as  members-at- 
large.  The  charter,  therefore,  was  revoked  by 
the  Council. 

The  Council  discussed  at  great  length  the 
necessity  of  securing  a full-time  Executive  Sec- 
retary. They  felt  that  in  order  to  carry  on  the 
routine  duties  of  the  State  Office  and  to  expand 
its  service  to  the  individual  members  of  the  So- 
ciety, a Secretary  was  needed.  Furthermore,  if 
any  active  public  relations  program  was  to  be 
considered,  a state  office  should  be  established. 
The  Executive  Secretary  would  have  the  addi- 
tional duties  of  being  the  legislative  representa- 
tive of  the  Society  and  also  assist  the  American 
Medical  Association  in  getting  its  educational 
campaign  program  under  way  in  this  state.  It 
was  the  opinion  of  the  Council  that  in  order 
to  accomplish  this,  three  steps  would  be  nec- 
essary. 

First,  motion  by  the  House  of  Delegates  to 
empower  the  Council  to  select  an  Executive 
Secretary;  second,  raising  the  dues  to  $25  or 
$30,  which  would  require  a four-fifths  vote  of 
the  House  of  Delegates;  and  third,  eliminating 
the  legislative  fimd  and  placing  it  back  in  the 
general  fund  for  rimning  the  state  office. 


Leland  S.  Evans  moved  that  C.  W.  Gerber 
be  appointed  an  honorary  life  member  of  the 
Society.  Dr.  Evans  pointed  out  that  Dr.  Gerber 
is  a Past  President  of  the  New  Mexico  Medical 
Society,  was  District  Health  Officer  at  Las 
Cruces  for  many  years,  and  has  done  outstand- 
ing work  in  the  Mesilla  Valley.  M.  K.  Wylder 
seconded  the  motion,  and  the  motion  carried. 

A.  C.  Shuler  moved  that  F.  F.  Doepp  be  made 
an  honorary  life  member  of  the  Society,  stating 
that  Dr.  Doepp  has  been  continuously  chairman 
of  the  State  Board  of  Medical  Examiners  since 
its  inception  in  1912,  and  has  practiced  in  this 
state  since  1896.  R.  C.  Derbyshire  seconded 
the  motion,  and  the  motion  carried. 

The  Secretary-Treasurer  read  a letter  request- 
ing a delegate  from  the  State  Society  to  the 
Conference  of  County  Medical  Society  Officers, 
to  be  held  in  Atlantic  City  immediately  preced- 
ing the  meeting  of  the  A.M.A.  He  also  stated 
it  was  the  decision  of  the  Council  to  place  such 
request  before  the  House  of  Delegates  to  see  if 
anyone  would  volunteer  for  the  post.  C.  H. 
Gellenthian  suggested  that  John  F.  Conway  take 
this  place,  and  Dr.  Conway  stated  that  he  was 
willing  to  do  this.  Dr.  Conway  was  then  duly 
elected  by  the  delegates. 

The  Secretary-Treasurer  presented  a letter 
from  the  National  Sales  Foundation  requesting 
endorsement  by  the  New  Mexico  Medical  So- 
ciety to  the  advertisement  they  desire  to  sell 
to  local  druggists  to  be  published  in  the  daily 
newspapers,  under  the  name  of  the  druggists  who 
paid  for  the  advertisement.  These  advertise- 
ments were  to  improve  the  public  relations  of 


physicians.  The  Secretary  stated  that  other 
Societies  have  endorsed  this  advertisement  and 
that  the  Council  unanimously  endorsed  it  in  its 
report.  M.  K.  Mylder  moved  the  endorsement 
of  the  above  advertisement.  J.  W.  Hannett 
seconded  the  motion,  and  the  motion  carried. 

The  Secretary-Treasurer  then  presented  a let- 
ter from  George  S.  Richardson,  Albuquerque, 
relative  to  obtaining  a lower  fee  for  malpractice 
insurance  than  the  U.S.F.&G.  charges.  The  House 
of  Delegates  approved  the  Councilors’  action  in 
referring  this  matter  to  the  State  Office  for 
investigation. 

A letter  from  Simms,  Modrall,  Seymour  & 
Sims  was  read  by  the  Secretary-Treasurer  to 
the  delegates,  which  stated  they  had  reviewed 
the  National  Social  Security  Laws,  and  that  it 
was  impossible  to  change  the  method  of  paying 
fees  by  the  Department  of  Public  Welfare,  and 
that,  therefore,  when  Federal  funds  were  used, 
the  State  Welfare  Department  had  no  choice  but 
to  give  the  payment  to  the  patient  rather  than 
the  physician. 

V.  E.  Berchtold  then  presented  the  report  of 
Albert  S.  Lathrop,  Chairman  of  the  Legislative 
Committee,  who  was  unable  to  be  present.  The 
report  is  as  follows: 

Legislative  Committee 

The  Legislative  Committee  of  the  New  Mexico 
Medical  Society  was  represented  at  the  State  Legis- 
lature. by  Mr.  McManus,  a junior  member  of  the  law 
firm  which  has  been  caring  for  the  legal  matters 
of  the  New  Mexico.  Medical  Society.  The  only  piece 
of  legislation  sponsored  by  the  Society  was  passed 
by  the  Legislature  and  signed  by  the  Governor. 
This  required  the  Governor  to  name  members  of 
the  Board  of  State  Medical  Examiners  from  a list 
submitted  by  the  Medical  Society,  five  names  to  be 
submitted  for  each  member  of  the  Board  to  be 
appointed. 

The  legislation  in  which  we  were  interested  was 
handled  very  satisfactorily  for  us  by  Mr.  McManus. 
We  gained  the  good-will  of  many  members  of  the 
Legislature  by  suggesting  compromises  which  would 
permit  Dr.  DeVeau  of  Taos  to  practice  medicine 
in  the  State.  A Naturopathy  Bill  was  passed  by  the 
House,  defeated  15  to  8 in  the  Senate.  A bill  was 
introduced  by  the  Representative  of  Sierra  County 
at  the  suggestion  of  the  Sierra  County  Medical 
Society,  abolishing  the  Basic  Science  Board.  This 
was  buried  in  the  committee. 

We  did  nothing  about  the  bill  introduced  by  the 
New  Mexico  Nurses’  Association,  which  would  re- 
quire all  home  nursing  to  be  done  by  registered 
nurses,  making  illegal  the  use  of  practical  nurses 
in  the  home,  which  was  defeated  by  adverse  com- 
mittee action.  Other  legislation  was  watched  for  any 
possible  effect  on  the  practice  of  medicine  in  the 
State. 

Respectfully  submitted, 

/s/  ALBERT  S.  LATHROP. 

The  President  called  for  the  report  from  the 
Basic  Science  Committee,  and  the  Secretary- 
Treasurer  read  the  written  report  of  W.  E.  Nis- 
sen,  as  follows: 

Basic  Science  Committee 

The  Basic  Science  Board  of  the  State  of  New 
Mexico  is  composed  of  five  members:  Ralph  Coombs, 
M.D.;  L.  C.  Boatman,  D.O.;  Dr.  W.  K.  Bottom,  Chiro- 
practor, and  Drs.  Oscar  B.  Muench  and  Fred  W. 
Emerson,  Ph.D. 

The  Secretary  of  the  Board  is  employed  in  a 
Santa  Fe  osteopath’s  office,  and  is  not  in  the  Secre- 
tary of  Stafe’s  office,  as  is  provided  in  the  statute. 

The  applicants  are  examined  in  Anatomy,  Path- 
ology, Bacteriology,  Physiology  and  Chemistry.  It 
is  the  custom  for  each  examiner  to  write  the  ques- 
tions and  correct  the  papers  in  one  subject. 

In  the  year  1948,  111  candidates  of  all  classes 
were  examined  and  17  failed.  The  Secretary  of  the 
Board  informed  us  she  was  not  able  to  make  a 
breakdown. 

The  medical  member  of  the  Board  feels  that  the 
Board  is  functioning  correctly  as  to  statute.  He 
will  be  in  Roswell  and  has  expressed  a willingness 
to  appear  before  the  House  of  Delegates  to  clear 
up  any  misunderstanding  which  may  exist. 

The  committee  has  no  recommendations. 

Respectfully  submitted, 

/s/W.  E.  NISSEN. 


856 


Rocky  Mountain  Medical  Journal 


if  she  is  one  of  your  patients... 

...She  depends  on  your  help  for  a speedy  return  to  gainful  occupation. 
Women  seeking  employment  who  are  nervous,  apprehensive  and  generally 
distressed  by  symptoms  of  the  climacteric,  may  find  it  difficult  to  meet 
competition.  ''"Premarin"  offers  a solution.  Many  thousand  physicians 
prescribe  this  naturally-occurring,  oral  estrogen  because... 

7 . Prompt  symptomatic  improvement  usually  follows  therapy. 

2.  Untoward  side-effects  are  seldom  noted. 

3.  The  sense  of  well-being  so  frequently  reported  tends  to  quickly 
restore  the  patient's  confidence  and  normal  efficiency. 

4.  This  "Plus"  (the  sense  of  well-being  enjoyed  by  the  patient) 
is  conducive  to  a highly  satisfactory  patient-doctor  relationship. 

5.  Four  potencies  provide  flexibility  of  dosage:  2.5  mg.,  1 .25  mg., 
0.625  mg.  and  0.3  mg.  tablets,-  also  in  liquid  form,  0.625  mg. 
in  each  4 cc.  (1  teaspoonful). 

I T\T1T9^ 

While  sodium  estrone  sullale  is  the  principal  estrogen 
in  "Premarin,"  other  equine  estrogens  ...  estradiol, 
equilin,  equilenin,  hippulin  . . . are  probably  also  pres- 
ent in  varying  amounts  as  water-soluble  conjugates. 


ESTROGENIC  SUBSTANCES  (WATER-SOLUBLE) 
also  known  as  CONJUGATED  ESTROGENS  (equine) 


Ayerst,  McKenna  & Harrison  Limited  22  East  40th  Street,  New  York  1 6,  New  York 
for  October,  1949  857 


Following  the  reading  of  this  report,  there  was 
considerable  discussion  concerning  the  Basic 
Science  Law.  It  was  pointed  out  that  the  bill 
which  passed  the  last  Legislature  wherein  the 
Governor  was  to  appoint  doctors  selected  from 
a panel  supplied  by  the  State  Society,  applied 
only  to  the  Medical  Examiners  Board.  Stuart 
W.  Adler  moved  that  this  Society  take  action  to 
change  this,  so  that  wherever  a physician  is 
appointed  to  a Board  by  the  Governor,  he  should 
be  selected  from  a list  of  names  furnished  by 
the  Society.  J.  W.  Hannett  seconded  the  mo- 
tion, and  the  motion  carried. 

The  matter  of  the  Basic  Science  Law  was 
further  discussed,  and  the  opposition  of  the 
Sierra  County  Medical  Society  to  the  law  was 
reported,  as  evidenced  by  their  endorsement  of 
the  bill  presented  to  the  Legislature,  providing 
for  abandonment  of  said  Basic  Science  Law. 
John  Conway  moved  that  the  Basic  Science  Com- 
mittee of  the  New  Mexico  Medical  Society  be 
directed  to  take  the  proper  steps  to  enforce  the 
law  as  it  stands  today  and  to  see  that  the  Secre- 
tary of  the  Basic  Board  is  in  the  State  House, 
as  provided  by  law,  and  that  also  a copy  of  this 
recommendation  be  sent  to  the  Governor.  The 
motion  was  duly  seconded  and  carried. 

The  President  called  on  Stuart  W.  Adler, 
Chairman  of  the  Rural  Medical  Service  Com- 
mittee, to  present  that  committee’s  report,  as 
follows: 

Rural  Medical  Ser'i'ice  Cummittee 

While  no  formal  meeting's  of  this  committee  have 
been  held  since  its  appointment  shortly  after  the 
first  of  the  year,  the  members  individually  and 
collectively  have  been  ’tvorking  in  various  parts  of 
the  iSItate  in  the  interest  of  improving  health  serv- 
ice for  rural  areas. 

Your  chairman  represented  the  State  Medical  So- 
ciety at  the  A.M.A.  Rural  Health  Conference  held  in 
Chicago  in  February  and  has  also  attended  numerous 
meetings  'within  the  State  for  discussion  of  prob- 
lems associated  with  an  attempt  to  meet  some  of 
the  medical  needs  of  people  in  the  rural  portion 
of  the  State. 

The  problems  which  confront  New  MexicO'  are 
similar  to  those  in  many  states  in  the  South  and 
west  of  the  Mississippi,  and  while  having  to  do 
with  shortage  of  professional  personnel  to  give 
service  and  lack  of  appropriate  health  centers  for 
both  the  Public  Health  Program,  as  well  as  private 
medical  care,  those  problems  have  unique  features 
because  of  special  conditions  which  exist  in  our 
State. 

Building  of  hospitals  under  county  bonding  and 
with  assistance  from  Hill-Burton  funds  from  the 
federal  government  will  relieve  the  situation  in 
areas  adjacent  to  small  cities  where  these  hospitals 
are  now  being  erected. 

A pilot  program  in  which  seven  truly  rural  areas 
have  received  assistance  from  this  New  Mexico 
Health  Foundation,  a private  enterprise,  will  give 
further  assistance.  Centers  built  or  being  built  are 
apparently  going  to  be  the  means  of  attracting 
doctors  and  nurses  to  some  of  the  areas  under 
consideration. 

Your  committee  plans  to  continue  its  interest  in 
this  program,  to  assist  in  implementing  the  ap- 
plicable recommendations  of  the  rural  health  con- 
ference and  feels  that  the  program  will  be  strength- 
ened if  a full-time  Executive  Secretary  for  the  State 
Society  can  be  secured. 

Placement  of  physicians,  increasing  nursing  serv- 
ice, and  in  other  ways  augmenting  medical  and 
dental  services  in,  rural  areas  can  be  accomplished 
to  a surprising  degree  with  manifest  interest  and 
a genuine  effort  on  the  part  of  our  profession.  Fur- 
ther efforts  by  the  doctors  of  New  Mexico  toward 
solution  of  this  problem  will  have  much  to  do  with 
forestalling  the  day  when  somebody  else  will  under- 
take that  solution  for  us. 

Respectfully  submitted, 

RURAL.  SERVICE  MEDICAL 
COMMITTEE, 

S.  W.  ADDER,  Chairman, 
W.  B.  CANTRELL, 

A.  T.  GORDON, 

L.  G.  POSTER, 

SAMUEL  ZIEGLER 


Dr.  Adler  further  stated  that  within  the  next 
sixty  days,  three  of  the  areas  will  be  taken  care 
of  by  these  health  centers.  Reserve,  in  Catron 
County,  now  has  a new  building;  Cuba,  House 
and  Mosquero  are  other  centers,  and  assistance 
has  been  given  to  Bernalillo,  Wagon  Mound,  and 
Glenwood. 

The  President  called  on  Murray  M.  Friedman, 
Chairman  of  the  Cancer  Committee,  to  present 
that  committee’s  report,  and  is  as  follows: 

Cancer  Committee 

Your  Cancer  Committee  has  met  on  several  occa- 
sions in  the  past  year  to  deal  with  matters  con- 
cerning a cancer-control  program  for  the  State  of 
New  Mexico.  What  appears  to  be  a workable  pro- 
gram has  been  formulated  and  unanimously  ap- 
proved by  the  Cancer  Committee. 

The  program  to  be  submitted  has  been  made  pos- 
sible by  an  appropriation  of  $15,000  for  cancer 
control  by  the  recent  legislature.  The  Department 
of  Health  has  been  encouraged  to  believe  that  ap- 
proval of  this  program  by  the  State  Medical  Society 
will  materially  aid  in  obtaining  an  equal  or  greater 
amount  from  the  federal  government.  The  Depart- 
ment of  Health  has  worked  closely  with  your 
committee  in  making  this  program,  because  they 
feel  that  the  medical  profession  should  determine 
the  policy  of  such  a program. 

1.  Cancer  Detection  Centers.  The  establishment 
of  Detection  Centers  in  various  communities  has 
been  approved  by  the  Medical  Society.  As  previously 
stated,  these  centers  are  to  be  set  up  only  with  the 
approval  of  the  local  County  Medical  Society.  At 
the  present  time,  there  are  four  Cancer  Detection 
Centers.  They  are  situated  in  Santa  Fe,  Aztec,  Carls- 
bad and  Farmington. 

2.  Follow-up  services  by  Public  Health  Nurses 
have  been  approved  by  the  Medical  Society.  This 
service  is  rendered  only  when  requested  by  the 
attending  physician.  An  enlargement  and  reorgan- 
ization of  this  service  is  planned. 

3.  County  Cancer  Committees.  The  New  Mexico 
Cancer  Society  has  established  Cancer  Committees 
in  a number  of  the  counties  in  this  state..  This 
committee  is  usually  composed  of  laymen  and  their 
principal  function  is  to  plan  the  annual  campaign 
for  fund  raising.  Their  activities  can  be,  enlarged. 
The  Cancer  Committee  suggests  that  the  chairman 
of  each  of  these  committees  be  a member  of  the 
County  Medical  Society. 

4.  Diagnosis.  Funds  will  be  available  for  the 
diagnosis  and  treatment  and  transportation  in  co- 
operation with  the  New  Mexico  Cancer  Society  for 
the  treatment  of  indigent  patients,  who  have  or 
are  suspected  of  having  cancer. 

5.  Tumor  Boards.  The  Cancer  Committee  sug- 
gests the  establishment  of  Tumor  Boards,  composed 
of  a surgeon,  pathologist,  radiologist,  internist  and 
other  representative  of  such  specialties  as  may  be 
desirable.  These  Boards  are  to  be  set  up  by  the 
Cancer  Committee  in  cooperation  with  the  Health 
Department.  Its  function  is  to  meet  at  regular 
intervals,  at  various  centers,  at  which  time  any 
physician  can  present  any  case  of  cancer  or  sus- 
pected cancer  for  consultation,  without  charge  to 
the  patient.  The  purpose  of  this  board  is  to  provide 
specialists'  services  to  physicians  in  non-urban 
communities  which  do  not  have  such  facilities 
available. 

6.  Education.  Medical  Films  are  to  be  made  avail- 
able to  medical  groups  or  County  Medical  Societies 
on  request. 

Subscription  to  the  Texas  Cancer  Bulletin  for 
distribution  to  all  physicians  in  the  state.  Partici- 
pation in  the  annual  refresher  course  given  by  the 
New  Mexico  Cancer  Society  annually. 

7.  Training.  Funds  are  to  be  prpvided  for  train- 
ing of  qualified  physicians,  technicians,  and  nurses 
in  the  field  of  cancer. 

8.  Research.  Depending  on  the  amount  of  funds 
available,  applications  for  funds  to  carry  on  re- 
search in  cancer  can  be  submitted  to  the  Depart- 
ment of  Health. 

9.  Approval  has  been  granted  for  the  distribu- 
tion of  a card  for  laymen,  concerning  cancer  of 
the  breast.  This  card  lists  the  principal  symptoms 
for  which  the  patient  should  be  on  guard,  and 
recommends  that  she  consult  her  physician  with 
the  appearance  of  symptoms. 

10.  Advisory  Committee.  The  Cancer  Committee 
has  offered  to  act  in  an  advisory  capacity  to  the 
New  Mexico  Cancer  Society. 

11.  Information  Centers.  The  Cancer  Committee 
has  had  attention  called  to  the  fact  that  many  pa- 
tients have  no  way  of  finding  where  they  can  go 
for  examination  or  treatment  of  cancer  or  suspected 
cancer.  The  Cancer  Committee  recommends  that  In- 


858 


Rocky  Mountain  Medical  Journal 


# A Duozine  Dulcet  Tablet  is  medicine 
all  right  — two  potent  sulfonamides  — but 
to  the  child  it’s  a pale  orange  cube  that 
tastes  like  tutti-frutti  candy  aU  the  way 
through.  Each  Duozine  Dulcet  Tablet  con- 
tains 0.15  Gm.  sulfadiazine  and  0.15  Gm. 
sulfamerazine — as  stable  and  accurate  as  it 
is  possible  to  compound.  The  antibacterial 
effect  is  the  same  as  0.3  Gm.  of  either  drug. 


but  the  risk  of  crystalluria  is  only  as  great 
asthatof  0.15  Gm.  ofoneofthesulfonamides. 
Indications  and  dosage  are  the  same  as  for 
unflavored  tablets.  Duozine  Dulcet 

Tablets  are  available  on  prescription  through 
your  pharmacy.  Write  for  literature  today. 
Abbott  Laboratories,  North  Chicago,  IlL 


Specify  Abbott's  Sulfadiazine- 
Sulfamerazine  Combination 


IS 


MEDICATED  SUGAR  TABLETS,  ABBOTT 


Duozine 

TRADE  MARK 


dulcet®  tablets 


(Sulfadiazine  0.15  Gm. — Sulfamerazine  0.15  Gm.  Combined,  Abbott) 


for  October,  1949 


859 


I'ormation  Centers  be  set  up  at  strategic  spots  to 
provide  this  information. 

Respectfu'ly  submitted, 

/s/  MURRAY  M.  FRIEDMAN, 
Chairman,  Cancer  Committee. 

M.  K.  Wylder  moved  that  the  Society  endorse 
this  program  as  outlined  by  the  Cancer  Society. 
C.  H.  Gelienthien  seconded  the  motion,  and  the 
motion  carried. 

The  President  then  called  upon  Samuel  J. 
Jelso  to  present  a report  for  the  Venereal  Dis- 
ease Control  Committee.  Dr.  Jelso  reported  a 
letter  from  I.  L.  Peavy,  acting  Director  of  the 
Division  of  Venereal  Disease  Control  of  the  De- 
partment of  Public  Health,  as  follows: 

Venereal  Disease  Control  Committee 

Dept,  of  Public  Health, 
Santa  Fe,  New  Mexico, 
April  28,  1949. 

Samuel  J.  Jelso,  M.D.,  etc. 

Dear  Dr.  Jelso: 

In  reply  to  your  inquiry  of  April  27,  1949,  the  pro- 
posed Private  Physicians’  Perticipation  Program  in 
the  diagnosis  and  treatment  of  syphilis  was  offered 
to  the  physicians  of  the  entire  state,  with  the  ex- 
ception of  Health  Districts  Nos.  1,  6,  and  7.  The 
Program  was  set  up  as  a triad  for  300  cases.  The 
physicians  were  either  contacted  individually  or 
in  County  Medical  Society  meetings  and  the  plan 
of  reporting  and  collecting  for  services  rendered 
was  thoroughly  explained. 

Due  to  the  limited  funds  to  be  expended,  it  was 
my  opinion  that  the  Project  should  be  offered  to 
health  districts  which  do  not  have  adequate  treat- 
ment facilities.  Districts  having  a large  number  of 
practicing  physicians,  part-time  venereal  disease 
clinics  or  full-time  venereal  disease  clinics  as  the 
above-named  which  include  Santa  Fe,  Albuquerque, 
Roswell,  Carlsbad,  and  Hobbs,  will  be  included  in 
the  Special  Project  if  it  is  extended  by  the  Public 
Health  Service  after  June  30,  1949. 

The  cases  which  have  been  reported  to  date  under 
this  plan  are  listed  on  the  enclosed  table.  From 
the  number  treated  and  stages  of  syphilis  reported, 
I do  not  consider  the  Project  to  be  an  outstanding 
success.  However,  a marked  increase  during  the 
months  of  May  and  June  may  justify  a continuation 
of  the  Project  during  the  next  fiscal  year. 

Very  truly  yours, 

/s/  I.  D.  PEAVY, 

Acting  Director, 

Division  of  V.D.  Control. 

Dr.  Jelso  stated  that  under  this  new  program, 
the  physician  would  be  paid  $15  for  making 
a diagnosis  of  syphilis  and  $40  if  he  would  treat 
the  patient;  the  Department  of  Public  Health 
would  give  the  medicine  without  charge,  and 
that  the  project  was  considered  an  outstanding 
success,  but  as  a number  of  these  patients  were 
from  rural  districts,  the  committee  felt  it  would 
be  a wise  thing  to  go  along  with  this  pro^am. 

In  place  of  a report  from  the  Committee  on 
Public  Relations,  the  Secretary-Treasurer  intro- 
duced Mr.  Harvey  Sethman,  Executive  Secre- 
tary of  the  Colorado  State  Medical  Society,  who 
reported  on  the  Public  Relations  Program  of 
the  Colorado  Society. 

C.  H.  Gelienthien  called  on  Carl  Mulky  to 
report  on  the  State  Tuberculosis  Sanitarium. 
Dr.  Mulky  stated; 

Tuberculosis  Committee 

“Much  remodeling  and  construction  has  re- 
cently been  done  to  the  State  Sanitarium:  some 
houses  and  buildings  have  been  secured,  making 
a beautiful  building  for  tuberculosis  treatment, 
and  a very  nice  set-up.  The  present  capacity 
of  the  Sanitarium  is  150  patients,  which  doubles 
former  capacity,  and  there  is  still  room  to  in- 
crease this  number  to  200.  Four  to  ten  are 
being  admitted  each  week,  but  there  is  still  a 
large  waiting  list.  The  present  medical  director. 
Dr.  Alley,  is  changing  on  May  1st,  and  his  suc- 
cessor has  not  yet  been  announced.  The  Sani- 
tarium now  has  a very  fine  surgical  set-up  and 


laboratories.  In  other  words,  for  the  first  time, 
it  has  had  money  enough  to  do  what  they 
wanted  to  do,  and  it  will  be  a first-class  in- 
stitution.” 

C.  H.  Gelienthien  stated  that  the  appropria- 
tion had  been  cut  to  the  point  where  there  was 
neither  personnel  nor  money  to  do  the  job  in- 
tended. At  present  they  have  two  units,  and 
also  an  additional  unit  and  a mobile  unit.  At 
the  recent  meeting  in  Detroit,  Dr.  Gelienthien 
learned  that  an  Ohio  firm  will  furnish  x-rays 
at  65c;  an  appropriation  of  $200,000  has  been 
made  for  research,  but  the  right  drug  has  not 
yet  been  developed,  but  a new  research  project 
has  been  started  at  Duke  University  from  which 
much  is  expected. 

The  President  called  on  E.  W.  Fiske  to  report 
on  the  Committee  on  Insurance  Compensation. 
Dr.  Fiske  was  not  present,  and  no  report  had 
been  sent. 

A.  E.  Reymont  gave  an  oral  report  for  the 
Committee  on  National  Emergency  Service, 
which  outlined  the  plans  in  this  state  to  meet 
emergencies. 

The  President  then  called  for  new  business, 
and  C.  Pardue  Bunch  presented  the  features 
of  the  Colorado  State  Medical  Society,  as  fol- 
lows: 

Features  of  Colorado  State  Medical  Society  Public 
Relations  Program  Recommended  for  Adoption 
by  tbe  New  Mexico  Medical  Society 

1.  Board  of  Supervisors  for  self-discipline. 

2.  Doctors  participation  in  community  affairs  and 
organizations. 

3.  Revision  of  committee  structure. 

4.  Average  fee  schedules. 

5.  Formulation  of  press-radio  code. 

6.  Holding  an  annual  conference  of  Presidents, 
Presidents-elect,  and  Secretaries  of  component 
societies  with  a view  to  strengthening  the  mem- 
ber societies. 

7.  Creation  of  a more  closely  knit  organization  by 
appointing  to  committees  doctors  who  are  per- 
sonally interested  in  the  subjects  with  which 
those  committees  deal. 

8.  Wider  encouragement  of  self-expression  and  par- 
ticipation in  Society  meetings  and  activities  by 
all  members,  especially  younger  physicians. 

9.  Intensifying  the  field  activity  of  selected  officers 
of  the  State  Society. 

10.  Part  or  full-time  lay  Executive  Secretary  and  in- 
crease dues  to  finance  this. 

11.  Arranging  for  part-time  services  of  a publicity 
writer. 

12.  Authorizing-  the  Board  of  Trustese  to  employ  in- 
dependent public  relations  counsel  on  occasion  as 
necessary. 

13.  Appointment  of  component  society  publicity 
chairman  for  every  city  and  town  which  has  a 
newspaper  or  a radio  station. 

14.  Creation  of  a nine-point  publicity  prog-ram,  in- 
cluding such  items  as  a monthly  informal  news 
exchange'  to  the  entire  membership,  increased 
use  of  newspaper  releases,  radio  talks  and  spot 
announcements,  open-house  meetings  of  County 
Societies,  and  others. 

15.  The  Society’s  public  relations  program  should 
emphasize  public  service  and  actions  in  the  pub- 
lic service  and  actions  in  the  public  interest  to 
attract  favorable  publicity  and  other  forms  of 
public  reaction,  rather  than  to  devote  large  sums 
to  advertising  or  paid  propaganda. 

Encourage  each  individual  member  to  participate 
fully  in  community  affairs  and  assume  leadership 
in  chambers  of  commerce,  community  chests, 
service  clubs,  school  boards,  councils  of  social 
agencies,  and  welfare  organizations.  “It  is  a 
mere  rationalization  of  our  lack  of  social  respon- 
sibility to  assert,  as  many  doctors  do,  that  we 
are  too  busy  for  such  leadership.  Other  people 
equally  busy  and  in  most  instances  far  less  quali- 
fied, give  generously  of  their  time  and  energy. 
Surely  we  cannot  afford  to  do  less  for  our  com- 
munity than  our  fellow  citizens!” 

Dr.  Bunch  then  made  a motion  that  the  So- 
ciety endorse  the  principles  of  the  Colorado  Pub- 
lic Relations  Program  and  apply  it  to  this  state, 
so  far  as  practicable.  L.  S.  Evans  seconded 
the  motion,  and  the  motion  carried. 


860 


Rocky  Mountain  Medical  Journal 


Shade!  Sanitarium  has  combined  research*, 
treatment  and  rehabilitation  to  return  thousands 
of  Alcoholics  to  normal  living.  Groundwork 

f' 

for  recovery  is  laid  through  intensive, 
individualized  therapy.  Statistical  evaluation  of 
results  since  1935,  have  shown  that  in  over 
3125  cases  reported*,  40%  remained  abstinent 


SPECIALISTS 


RECOGNIZED  BY  THE 

A.  M.  A. 

MEMBER  OF  THE 

A.  H.  A. 


IN  THERAPY 


for  four  years  or  longer.  Our  object  is  . . . 
Cooperation  with  the  family  physician  in 
mapping  the  road  to  recovery. 


FOR 


1935  TO  1949 

CHRONIC  ALCOHOLISM 


BY  THE  CONDITIONED  REFLEX  AND  ADJUVANT  METHODS 
7106  35th  AVE.  S.  W.  SEATTLE  6,  WASH.,  WEST  7232,  CABLE  ADDRESS:  "REFLEX” 


for  October,  1949 


861 


Dr.  Bunch  then  moved  that  the  Secretary 
authorize  its  Councilors  to  hire  a full-time  Lay 
Executive  Secretary.  W.  O.  Connor  seconded 
the  motion,  and  the  motion  carried. 

Considerable  discussion  ensued  as  to  the  means 
of  putting  the  above  motion  into  effect.  The 
Secretary-Treasurer  stated  the  two  matters  nec- 
essary to  be  passed  by  the  House  of  Delegates 
were:  (1)  Dues  of  the  Society  should  be  in- 
creased to  $25  or  $30  per  member,  in  order  to 
have  a permanent  State  Office;  (2)  The  legis- 
lative fund  should  be  put  into  the  general  fund, 
so  it  can  be  used  for  the  expense  of  maintaining 
the  State  Office. 

R.  C.  Derbyhire  moved  that  the  dues  be  in- 
creased from  $20  per  member  to  $30  per  member 
per  year,  and  that  the  legislative  fund  be  trans- 
ferred to  the  general  fund  to  be  used  to  provide 
for  the  public  relations  program,  as  outlined 
by  Dr.  Bunch,  and  to  pay  the  salary  of  the 
Executive  Secretary,  and  that  the  Executive 
Secretary  be  the  Society’s  legislative  representa- 
tive. S.  W.  Adler  seconded  the  motion,  and 
the  motion  carried,  vote  being  taken  by  raising 
hands,  30  votes  for  and  0 against  motion. 

W.  O.  Connor  then  moved  that  Section  5 of 
Chapter  V of  the  By-Laws,  “thgt  no  member 
of  the  state  nor  federal  government  employee 
can  be  elected  to  office,”  be  rescinded.  M.  K. 
Wylder  seconded  the  motion.  The  Secretary 
announced  that  said  amendment  to  the  By-Laws 
must  be  laid  over  for  twenty-four  hours  before 
voted  upon. 

S.  W.  Adler  then  brought  before  the  House  of 
Delegates  the  matter  of  reimbursing  the  Ber- 
nalillo County  Medical  Society  for  the  $500  at- 
torney fee  paid  by  said  Society  for  interpreting 
a law  that  benefited  the  entire  state,  and  moved 
that  the  State  Society  should  reimburse  the 
Bernalillo  Society  in  the  amount  of  said  $500. 
M.  K.  Wylder  seconded  the  motion,  and  the 
motion  carried. 

V.  E.  Berchtold  then  read  the  following  letter 
from  Harry  Payne,  District  Health  Officer,  ad- 
dressed to  A.  S.  Lathrop,  dated  May  3,  1949. 

Dear  Doctor  Lathrop; 

It  has  come  to  our  attention  that  it  may  be  pos- 
sible to  secure  federal  aid  for  the  Santa  Fe  Cardiac 
Clinic  provided  that  the  clinic  is  open  to  all  chil- 
dren referred  by  physicians  and  that  we  omit  the 
word  indigent.  The  reason  for  omitting  indigent  is 
that  this  would  limit  the  clinic  to  children  of  De- 
partment of  Public  Welfare  families  only  and  would 
not  take  care  of  the  children  who  are  medically  in- 
digent. 

The  clinic  attendance  will  be  controlled  by  the 
private  and  clinic  physicians  because  these  doctors 
will  be  referring  the  patients  to  the  clinic. 

We  would  appreciate  receiving  the  approval  of  the 
State  Medical  Association  for  this  program,  with 
the  understanding  that  any  child  who  is  referred 
by  a physician  may  attend  the  clinic. 

Sincerely  yours, 

/s/  HARRY  PAYNE,  M.D., 

District  Health  Officer. 

S.  W.  Adler  moved  that  such  endorsement  be 
given,  in  the  hope  that  it  will  increase  the  funds 
available.  Coy  S.  Stone  seconded  the  motion, 
and  the  motion  carried. 

S.  W.  Adler  then  moved  that  the  officers  of 
the  Society  prepare  a declaration  of  our  stand 
on  the  whole  matter  of  compulsory  medical  care, 
and  that  said  resolution  be  sent  to  various  or- 
ganizations meeting  in  the  state,  so  they  might 
go  on  record  as  opposed  to  the  public  health 
insurance.  Said  motion  was  duly  seconded  and 
carried. 

D.  B.  Marsh  moved  that  the  Secretary  furnish 
a copy  for  the  use  of  the  Convention  of  Disabled 


American  Veterans  next  month,  which  motion 
was  duly  seconded  and  carried. 

Election  of  officers  was  then  held,  as  follows; 

Earl  L.  Malone  nominated  I.  J.  Marshall  for 
President.  W.  O.  Connor  seconded  the  nomina- 
tion and  moved  that  nominations  be  closed, 
which  motion  being  duly  seconded,  was  carried, 
and  I.  J.  Marshall  was  declared  elected  as  Presi- 
dent. 

C.  Pardue  Bimch  nominated  Leland  S.  Evans 
as  Vice  President;  D.  B.  Marsh  seconded  the 
motion.  W.  O.  Connor  moved  that  nominations 
be  closed;  M.  K.  Wylder  seconded  the  motion, 
the  motion  carried,  and  Leland  S.  Evans  was 
declared  elected  as  Vice  President. 

R.  C.  Derbyshire  nominated  H.  L.  January  as 
Secretary-Treasurer;  Coy  S.  Stone  seconded  the 
motion,  and  moved  that  nominations  be  closed. 
The  motion  was  duly  seconded  and  carried,  and 
H.  L.  January  was  declared  elected  as  Secretary- 
Treasurer. 

The  Councilors  retiring  were  announced  to  be: 
Leland  S.  Evans  of  Dona  Ana  County,  and  Carl 
Mulky  of  Bernalillo  County. 

H.  L.  January  nominated  Carl  Mulky  as  Coun- 
cilor for  the  Bernalillo  District;  M.  K.  Wylder 
seconded  the  motion,  and  the  motion  carried. 
Carl  Mulky  was  declared  elected  as  Councilor 
for  said  Bernalillo  District. 

Leland  S.  Evams  nominated  James  C.  Sedgwick 
as  Councilor  for  the  Las  Cruces  District  (Dona 
Ana  County);  The  motion  was  seconded  by  C.  H. 
Gellenthien  and  carried.  James  O.  Sedgwick 
was  declared  elected  as  Councilor  for  the  Dona 
Ana  County  District. 

V.  E.  Berchtold  then  nominated  A.  S.  Lathrop 
as  Councilor  to  fill  the  unexpired  term  of  R.  O. 
Brown,  deceased.  Said  nomination  was  duly 
seconded  and  carried,  and  A.  S.  Lathrop  was 
declared  elected  as  Councilor  for  said  unexpired 
term. 

M.  K.  Wylder  then  nominated  John  F.  Conway 
as  delegate  to  the  A.M.A.,  which  motion  was 
duly  seconded.  Then  motion  was  made  and 
seconded  that  nominations  be  closed,  which  mo- 
tion carried,  and  John  F.  Conway  was  declared 
elected  as  delegate  to  the  A.M.A.  to  succeed 
himself. 

Carl  Mulky  then  nominated  C.  H.  Gellenthien 
as  alternate  to  the  A.M.A.,  which  motion  was 
duly  seconded;  motion  was  then  made  and  sec- 
onded that  nominations  be  close,  which  motion 
was  carried,  and  C.  H.  Gellenthien  declared 
elected  as  alternate  to  the  A.M.A. 

Announcement  was  made  of  the  expiration  of 
the  terms  of  John  F.  Conway,  A.  H.  Follingstad, 
C.  H.  Gellenthien,  and  G.  S.  Morrison,  as  mem- 
bers of  the  Board  of  Trustees  of  New  Mexico 
Physicians  Service.  J.  W.  Hannett  moved  that 
each  of  said  members  be  elected  to  succeed  him- 
self on  the  Board  of  Trustees  of  said  New  Mexico 
Physicians  Service,  which  motion  was  duly  sec- 
onded and  carried,  and  the  above-named  de- 
clared elected  as  members  of  the  said  Board  of 
Trustees. 

At  this  time  the  retiring  President,  Philip  L. 
Travers,  expressed  his  thanks  to  H.  L.  January 
for  his  work  as  Secretary-Treasurer,  to  the 
Council  for  their  cooperation,  and  to  the  Com- 
mitteemen for  their  services. 

C.  Pardue  Bunch  and  R.  C.  Derbyshire  es- 
corted to  the  chair  J.  W.  Hannett,  the  incoming 
President,  while  the  House  of  Delegates  stood 
in  his  honor.  Dr.  Hannett  expressed  his  thanks 
for  the  honor  and  responsibility  of  being  the 
President,  and  asked  the  assistance  of  the  County 


862 


Rocky  Mountain  Medical  Journal 


The  sound  and  wholesome  nutritious 
diet  is  an  integral  part  of  modern  day 
preventive  and  definitive  therapy.  A 
steady  stream  of  adequate  amounts  of  all 
the  essential  nutritional  elements  is  vital 
for  good  growth,  maintenance  of  tissue 
structure  and  functioning,  healing  after 
trauma,  and  resistance  to  infection.  For 
maintaining  this  daily,  steady  stream  of 
nutrients,  however,  conditions  both  in 
health  and  illness  often  make  imperative 
the  use  of  an  efficient  food  supplement 
along  with  the  diet. 

The  multiple  dietary  food  supplement 
Ovaltine  in  milk  has  wide  usefulness  for 
enhancing  to  full  adequacy  even  nutri- 
tionally poor  diets.  Its  rich  store  of  vita- 


mins and  minerals  includes  vitamins  A 
and  D,  ascorbic  acid,  thiamine,  ribo- 
flavin and  niacin,  and  calcium,  iron  and 
phosphorus.  Its  nutritionally  complete 
protein  has  excellent  biologic  rating. 

Since  these  vital  nutritional  values 
along  with  carbohydrate  and  easily  emul- 
sifiable  milk  fat  are  incorporated  in  liquid 
suspension  or  solution,  Ovaltine  in  milk 
is  also  especially  adapted  to  liquid  diets. 
The  highly  satisfying  flavor  makes  for  its 
ready  acceptability  when  foods  are  often 
distasteful. 

The  important  overall  nutrient  con- 
tribution of  three  glassfuls  of  Ovaltine 
mixed  with  milk  is  presented  in  the 
accompanying  table. 


THE  WANDER  COMPANY,  360  N.  MICHIGAN  AVE.,  CHICAGO  1,  ILL. 


Three  servings  of  Ovaltine,  each  made  of  V^  oz.  of 
Ovaltine  and  8 oz.  of  whole  milk,*  provide; 


CALORIES 

676 

VITAMIN  A 

3000  I.U. 

PROTEIN 

32  Gm. 

VITAMIN  Bl 

FAT 

32  6m. 

RIBOFLAVIN 

CARBOHYDRATE 

65  Gm. 

NIACIN 

CALCIUM 

1.12  Gm. 

VITAMIN  C 

30.0  mg. 

PHOSPHORUS 

0.94  Gm. 

VITAMIN  D 

417  I.U. 

IRON 

COPPER 

*Based  on  average  reported  values  for  milk. 


Two  kinds.  Plain  and  Chocolate  Flavored.  Serving  for 
serving,  they  are  virtually  identical  in  nutritional  content. 


for  October,  1949 


863 


Chairmen  in  naming  members  of  the  committees. 

L.  M.  Miles  moved  this  meeting  adjourn  until 
8:00  a.m.  on  Saturday,  May  6,  1949.  Motion  was 
seconded  and  carried. 


Minutes  of  the  Second  Session 
May  6,  1949 

The  meeting  of  the  House  of  Delegates  was 
resumed  at  8:00  a.m.  on  Friday,  May  6,  1949,  at 
the  same  place,  with  the  newly-elected  Presi- 
dent, J.  W.  Hannett,  presiding. 

Earl  L.  Malone,  on  behalf  of  the  Chaves 
County  Medical  Society,  presented  the  names  of 
W.  W.  Phillips  and  A.  P.  Horwitz,  and  moved 
that  they  be  designated  honorary  life  members 
of  the  Society.  S.  W.  Adler  seconded  the  mo- 
tion, and  the  motion  carried. 

R.  C.  Derbyshire,  on  behalf  of  the  Eddy  County 
Medical  Society,  presented  the  names  of  H.  A. 
Stroup  and  Chester  R.  Russell,  and  moved  that 
they  be  designated  honorary  life  members  of 
the  Society.  C.  Perdue  Bunch  seconded  the  mo- 
tion, and  the  motion  carried. 

L.  M.  Miles,  taking  up  the  amendment  to 
By-Laws  which  was  awaiting  action  from  the 
meeting  on  Thursday,  May  5,  1949,  moved  that 
the  By-Laws  be  amended  as  was  proposed  yes- 
terday, permitting  government  employees  to  be- 
come active  members  and  eligible  for  all  of- 
fices in  the  Society.  Carl  Mulky  seconded  the 
motion,  and  the  motion  carried. 

C.  Pardue  Bunch  then  moved  that  the  By- 
Laws  be  amended  as  follows: 

Section  3,  Chapter  7,  (last  sentence)  be  amended 
to  read : 

“It  shall  hear  and  decide  all  questions  of  disci- 
pline or  right  to  membership  in  this  Society  brought 
before  it  on  appeal  from  the  decision  of  any  compo- 
nent society  or  district  Councilor,  or  brought  be- 
fore it  by  any  special  committee  created  by  the 
House  of  Delegates  tor  this  purpose  and  its  decision 
in  all  such  matters  shall  be  final.” 

Amend  the  By-Laws  by  adding  to  Chapter  VII, 
“Council,”  another  section  to  read  as  follows: 

“Section  7.  The  Council  shall  have  authority  to 
employ  an  Executive  Secretary  for  the  Society,  who 
need  not  be  a physician  or  a member  of  this  Society, 
to  act  as  general  administrative  officer  and  busi- 
ness manager  of  the  Society.  The  Council  shall  have 
authority  to  assign  to  the  Executive  Secretary  such 
of  the  secretarial  duties  of  the  Secretary-Treasurer 
as  the  Council  deems  for  the  best  interest  of  the  So- 
ciety.” 

Amend  the  By-Laws  further  by  repealing  the  last 
paragraph  of  Section  3 of  Chapter  VI,  which  fixes 
an  exact  amount  of  salary  to  be  paid  the  Secretary- 
Treasurer. 

It  was  duly  moved  and  seconded  that  the 
above  amendment  be  made  to  the  By-Laws,  and 
the  motion  carried. 

Amend  the  By-Laws  further  by  adding  the  follow- 
ing: 

“Whereas,  This  House  of  Delegates  has  gone  on 
record  approving  the  principles  of  the  Public  Service 
and  Public  Relations  Program  of  the  Colorado  State 
Medical  Society,  and  has  expressed  the  desire  to 
inaugurate  as  much  of  a similar  program  for  New 
Mexico  as  may  be  practical  at  this  time, 

‘Now,  Therefore,  Be  It  Resolved,  That  the 
President  is  requested  to  appoint  within  the  next 
thirty  days  a special  committee  for  the  ensuing  year 
to  be  known  as  the  Board  of  Supervisors,  to  be  com- 
posed of  eight  active  members  of  this  Society,  no 
two  of  them  from  the  same  component  society;  and, 

“Be  It  Further  Resolved,  That  the  aforesaid  Board 
shall  continually  investigate  the  ethical  deportment 
of  the  medical  profession  of  New  Mexico,  upon  its 
own  motion  or  upon  complaint  or  suggestion  of  any 
person,  shall  advise  the  Society’s  membership  period- 
ically as  to  methods  of  improving  professional  con- 
duct, and  shall  have  the  authority  to  prosecute 
on  behalf  of  the  Society,  charges  against  any  physi- 
cian deemed  by  said  Board  to  be  guilty  of  unprofes- 
sional conduct,  before  the  appropriate  judicial  body 


of  any  component  society  or  before  the  Council  of 
this  Society.” 

The  above  motion  by  Dr.  Bunch  to  adopt  the 
above  resolution  was  duly  seconded  and  carried. 

C.  Pardue  Bunch  then  moved  that  the  Con- 
stitution be  amended  as  follows  (for  final  action 
at  the  next  annual  session): 

Amend  the  Constitution  of  the  Society  by  inserting 
a new  article  to  read  as  follows,  and  by  numbering 
the  remaining  articles  to  conform  thereto: 

“Section  1.  There  shall  be  an  investigative  body 
known  as  the  Board  of  Supervisors,  composed  of 
eight  members  serving  terms  so  arranged  that  the 
terms  of  four  members  of  the  Board  shall  expire 
each  year.  Members  of  the  Board  shall  be  elected 
by  the  House  of  Delegates  in  the  manner  provided 
for  the  election  of  officers,  provided,  that  no  two 
members  of  the  Board  may  be  from  the  same  com- 
ponent society. 

“Section  2.  The  Board  of  Supervisors  shall  contin- 
ually investigate  the  ethical  deportment  of  the  med- 
ical profession  of  the  State,  upon  its  own  motion 
or  upon  complaint  or  suggestion  of  any  person.  It 
shall  advise  the  membership  of  the  Society  period- 
ically as  to  means  of  Improving  professional  con- 
duct. It  shall  be  the  duty  of  the  Board  of  Super- 
visors to  prosecute  on  behalf  of  this  Society,  before 
any  appropriate  judicial  body,  charges  against  any 
physician  deemed  by  the  Board  to  be  guilty  of  un- 
professional conduct. 

“Section  3.  The  Board  of  Supervisors  shall  elect 
such  Board  officers  as  its  purposes  may  require,  and 
may  conduct  its  proceedings  in  executive  or  secret 
session  when  the  Board  deems  this  for  the  best  in- 
terest of  the  Society.  A member  of  the  Board  shall 
be  automatically  disqualified  from  taking  part  In 
proceedings  of  the  Board  affecting  a member  of  his 
own  component  society.  No  member  of  the  Board 
may  hold  any  other  elective  office  in  the  Society 
during  his  term  of  membership  on  the  Board.” 

L.  M.  Miles  moved  that  this  action  for  con- 
sideration of  change  of  the  Constitution  be  acted 
upon  at  the  next  annual  session.  R.  C.  Derby- 
shire seconded  the  motion,  and  the  motion 
carried. 

The  Secretary-Treasurer  stated  that  inasmuch 
as  the  motion  to  amend  Section  3,  Chapter  VII 
of  the  By-Laws  merely  clarifies  the  wording, 
that  the  same  be  held  over  with  the  Amend- 
ment to  the  Constitution  for  action  next  year. 
Said  motion  was  duly  seconded  and  carried. 

R.  C.  Derbyshire  inquired  if  a committee  is 
functioning  in  regard  to  the  Constitution  and 
By-Laws,  and  the  President  announced  that  a 
committee  will  be  appointed  to  revise  this. 

M.  K.  Wylder  then  moved  that  a vote  of  thanks 
be  extended  to  the  ladies  of  Roswell,  the  Ros- 
well Woman’s  Club,  the  Chaves  County  Medical 
Society,  and  the  members  and  speakers  who 
came  long  distances  to  give  papers.  Carl  Mulky 
seconded  the  motion,  and  the  motion  carried. 

John  P.  Conway  then  presented  a report  for 
the  New  Mexico  Physicians  Service,  and  at  its 
conclusion,  answered  various  questions  asked 
about  such  service. 

L.  M.  Miles  then  moved  that  the  Society  have 
confidence  in  the  trustees  of  the  New  Mexico 
Physicians  Service  Plan,  and  that  the  Society 
endorse  the  plan.  R.  C.  Derbyshire  seconded 
the  motion,  and  the  motion  carried. 

M.  K.  Wylder  stated  his  doubts  that  ■ anyone 
present  realized  the  time  and  thought  that  the 
Board  of  Trustees  of  New  Mexico  Physicians 
Service  have  put  in,  and  then  moved  that  the 
Society  extend  to  them  a vote  of  both  confidence 
and  thanks  for  the  good  job  they  have  done. 
Said  motion  was  duly  seconded  and  carried. 

The  House  of  Delegates  was  declared  ad- 
journed. 

H.  L.  JANUARY, 
Secretary-Treasurer. 


864 


Rocky  Mountain  Medical  Journal 


CJ^P  AMTOMICAL  SUPPORTS 

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the  major  part  of  the  bony  pelvis 
as  a base  for  support.  The  unique 
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for  October,  1949 


865 


Obituary 


CHAKLES  W.  GERBER 

Charles  W.  Gerber,  M.D.,  was  born  in  Buffalo, 
New  York,  March  13,  1877.  Dr.  Gerber  received 
his  Degree  in  Medicine  from  the  University  of 
Buffalo  and  did  postgraduate  work  at  the  Uni- 
versity of  Denver  in  1899. 

In  1901  Dr.  Gerber  moved  to  Las  Cruces,  New 
Mexico,  where  he  began  his  practice  of  medicine. 
During  his  early  years  in  Las  Cruces,  Dr.  Gerber 
was  active  in  civic  affairs.  He  was  on  the  first 
Board  of  Directors  of  the  Elephant  Butte  Irriga- 
tion Project.  He  was  a member  of  the  Board 
of  Regents  of  the  New  Mexico  State  College; 
Past  President  of  the  Dona  Ana  County  Medical 
Society;  member  of  the  Kiwanis  Club.  Dr. 
Gerber  served  in  the  capacity  of  Major  in  the 
Medical  Corps  in  the  National  Guard. 

From  1907  to  1923  Dr.  Gerber  was  a part-time 
public  health  officer  and  in  1915  received  a 
Doctor  of  Philosophy  Degree  in  Public  Health 
from  the  University  of  California.  In  1923  Dr. 
Gerber  was  appointed  District  Health  Officer 
and  devoted  full  time  to  these  duties,  until  his 
retirement  from  practice,  due  to  ill  health,  in 
August,  1947. 

Following  his  retirement.  Dr.  Gerber  was  made 
Director  of  Malaria  Control  in  the  District  of 
Las  Cruces. 

Dr.  Gerber  died  on  July  30,  1949,  from  chronic 
myocarditis  and  chronic  pulmonary  bronchiec- 
tasis and  emphyema. 

Dr.  Gerber  was  appointed  to  honorary  life  mem- 
bership of  the  New  Mexico  Medical  Society  by 
the  House  of  Delegates  at  its  Annual  Meeting  in 
Roswell,  May  5,  1949. 

MONTANA 

State  Medical  Association 


COUNCIL  PROCEEDINGS 
1949  Annual  Meeting 

The  Council  of  the  Montana  State  Medical  As- 
sociation was  called  to  order  at  1:00  p.m.,  Sun- 
day, July  31,  1949,  in  the  Finlen  Hotel,  Butte, 
Montana. 

Councilors  present  were:  Drs.  Paul  L.  Eneboe, 
Bozeman;  J.  H.  Garberson,  Miles  City;  Harold  W. 
Gregg,  Butte;  R.  G.  Johnson,  Harlowto.n;  E.  H. 
Lindstrom,  Helena;  Geo.  G.  Sale,  Missoula;  F.  L. 
Unmack,  Deer  Lodge;  and  J.  I.  Wernham,  Bill- 
ings. Present  also  were  Dr.  Thomas  L.  Hawkins, 
President,  and  Dr.  H.  T.  Caraway,  Secretary- 
Treasurer. 

The  duties  of  the  Council  were  discussed.  The 
Council  also  took  cognizance  of  the  number  of 
members  of  the  association  who  have  paid  the 
voluntary  contributions  assessed  by  the  Ameri- 
can Medical  Association  for  their  educational 
campaign  and  the  Council  deplored  the  fact  that 
there  were  some  eighty  or  eighty-five  members 
of  the  Montana  State  Medical  Association  who 
have  failed  to  pay  this  assessment.  The  mem- 
bers of  the  Council  expressed  the  hope  that  in 
the  very  near  future  100  per  cent  of  the  mem- 
bership shall  have  paid  the  assessment. 

Upon  motion  by  Dr.  Harold  W.  Gregg,  second- 
ed by  Dr.  J.  H.  Garberson,  the  Council  recom- 
mended that  the  present  legal  counsel,  Mr.  E.  G. 


Tobmey  of  Helena,  be  retained  for  the  ensuing 
year  at  the  same  retainer  fee.  Motion  carried. 

Dr.  J.  H.  Garberson  was  elected  to  submit  the 
report  of  the  Council  to  the  House  of  Delegates. 

Upon  motion  regularly  made,  duly  seconded 
and  carried,  the  Council  adjourned  at  2:00  p.m. 


PROCEEDINGS,  1949  ANNUAL  MEETING, 
HOUSE  OF  DELEGATES  OF  THE 
MONTANA  STATE  MEDICAL 
ASSOCIATION* 

The  First  Session  of  the  House  of  Delegates 
of  the  Montana  State  Medical  Association  was 
called  to  order  in  the  ballroom  of  the  Finlen 
Hotel,  Butte,  Mont.,  at  2:15  p.m.,  Sunday,  July 
31,  1949,  by  Dr.  Thos.  L.  Hawkins,  President. 

After  roll  call  the  Secretary  announced  that  a 
quorum  was  present  consisting  of  thirty-five 
delegates  representnig  twelve  societies.  The 
I^esident  then  declared  the  House  of  Delegates 
open  and  ready  for  the  transaction  of  business. 

Delegates  present  were  as  follows: 

Cascade  County — ^F.  H.  Crag-o,  Great  Falls:  E.  Hil- 
debrand, Great  Palls;  P.  D.  Hurd,  Great  Falls;  B.  M. 
Larson,  Great  Falls;  C.  P.  Little,  Great  Falls;  P.  L. 
McPhail,  Great  Palls;  Dora  Walker,  Great  Falls. 

Fergus  County — ’Paul  J.  Gans,  Lewistown;  R.  G. 
Johnson,  Karlowtown. 

Flathead  County — R.  A.  Benke,  Kalispell;  T.  L. 
Lockridge,  Whitefish. 

Gallatin  County — ‘Paul  L.  Eneboe,  Bozeman. 

'Hill  County — -A.  W.  Axley,  Havre;  H H.  Leeds, 
Chinook. 

Lewis  & Clark  County — R.  O'.  Lewis,  Helena;  C.  M. 
Mears,  Helena;  R,  W.  Morris,  Helena. 

Mount  Powell— J.  J.  Malee,  Anaconda;  F.  I.  Ter- 
rill, Galen. 

Northeastern  Montana — David  Gregory,  Glasgow. 

Silver  Bow  County — J.  El.  Garvey,  Butte:  D.  L. 
Gillespie,  Butte:  H.  W.  Gregg,  Butte;  H.  H.  James. 
Butte;  R.  F.  Peterson,  Butte;  J.  C.  Shields,  Butte. 

Southeastern  Montana — B.  C.  Farrand,  Jordan;  M. 
A.  Shillington,  Glendive. 

Western  Montana — ^J.  M.  Brooke,  Ronan;  C.  H. 
Frederickson,  Missoula;  W.  P.  Morrison,  Missoula; 
Geo.  G.  Sale,  Missoula. 

Yellowstone  Valley — ^L.  W.  Allard,  Billings;  R.  H. 
Mattison,  Billings;  J.  I.  Wernham,  Billings. 

Reading  of  the  minutes  of  the  previous  session 
was  the  first  order  of  business.  These  minutes 
were  published  in  the  official  journal  of  the 
State  Medical  Association,  The  Rocky  Mountain 
Medical  Journal,  and  it  was  assumed  that  they 
had  been  read  by  all  delegates.  Dr.  E.  M.  Lar- 
son, Great  Falls,  moved  that  the  minutes  of  the 
last  meeting  be  approved  as  published.  Motion 
seconded  by  Dr.  J.  C.  Shields,  Butte,  and  unan- 
imously carried. 

The  Chair  then  call  for  the  report  of  the  Dele- 
gate to  the  American  Medical  Association  House 
of  Delegates,  Dr.  R.  F.  Peterson,  Butte.  Dr. 
Peterson  complimented  Dr.  Hawkins  on  han- 
dling the  meeting  in  the  same  manner  as  done 
by  Dr.  F.  F.  Borzell,  Speaker  of  the  A.M.A. 
House  of  Delegates. 

The  report  of  the  Nominating  Committee  was 
next  called  for.  Dr.  H.  H.  James,  Butte,  Chair- 
man, stated  in  a few  preliminary  remarks  that 
the  wishes  of  the  state  as  a whole  had  been  con- 
sidered in  preparing  their  report.  Each  Society 
in  the  state  was  contacted  and  a reply  received 
from  each.  The  attention  of  the  delegates  was 
called  to  the  fact  that  Dr.  Thos.  F.  Walker,  Presi- 
dent-Elect, was  ill  and  would  probably  not  be 
able  immediately  to  assume  his  duties  as  Presi- 
dent. The  office  of  Vice  President,  therefore, 

* Committee  reports  referred  to  herein  and  consti- 
tuting a part  of  these  proceedings  will  be  published 
in  the  next  issue  of  the  Journal. 


866 


Rocky  Mountain  Medical  Journal 


"Nurse,  I hope  Doctor  will 
prescribe  BAKER’S  MODIFIED 
MILK  for  her  as  he  did  for  my 
little  boy— it’s  so  reliable  and 
easy  to  prepare.’’  / 


POWDER 


LIQUID 


• Individual  requirements  are 
easily  met  with  Baker’s  powder 
or  liquid  form,  since  both  may 
be  fed  interchangeably. 


Are  you  acquainted  with  Baker’s  Modified  Milk? 


Mothers  who  have  brought  one  baby  through  the  bottle-feeding  period 
on  Baker’s  Modified  Milk,  are  happy  when  Baker’s  is  prescribed  for  the 
second  baby.  They  are  thankful  for  the  baby’s  robustness,  regularity  and 
well-being.  Particularly  pleasing  is  the  ease  with  which  Baker’s  is  prepared 
for  feeding — just  dilute  liquid  Baker’s  with  equal  parts  of  boiled  water. 

Many  doctors  have  learned  from  experience  that  Baker’s  Modified  Milk 
meets  their  requirements  in  most  of  their  bottle-feeding  cases,  since 
Baker’s  is  fed  either  complemental  to  or  entirely  in  place  of  mother’s 
milk.  No  formula  change  is  required  as  baby  grows  older — merely  increase 
the  quantity  of  feeding. 

To  prescribe  Baker’s  Milk  at  the  hospital,  just  leave  instructions  with 
the  obstetrical  supervisor. 


for  October,  1949 


867 


would  be  an  important  office  and  the  elected 
Vice  President  would  undoubtedly  have  to  do 
the  work  of  the  President  until  Dr.  Walker  was 
able  to  assume  the  duties  of  the  office.  Taking 
these  things  into  consideration,  the  following 
recommendations  were  made  to  the  House  of 
Delegates  for  state  officers: 

For  President-Elect:  C.  H.  Prederickson,  Missoula: 
F.  D.  Hurd,  Great  Falls. 

For  Vice  Piesident:  E.  S.  Murphy,  Missoula;  F.  L. 
McPhail,  Great  Falls. 

For  Secretary-Treasurer:  H.  T.  Caraway,  Billing's; 
C.  M.  Mears,  Helena. 

The  Chair  asked  for  nominations  from  the 
floor.  It  was  moved  by  Dr.  H.  W.  Gregg,  Butte, 
that  the  two  immediate  Past  Presidents  be  nom- 
inated for  the  vacancies  on  the  Executive  Com- 
mittee. Motion  seconded  by  Dr.  J.  J.  Malee,  Ana- 
conda, and  carried. 

It  was  moved  by  Dr.  Louis  W.  Allard,  Bill- 
ings, seconded  by  Dr.  Malee,  that  the  nomina- 
tions be  closed  for  the  present.  Motion  carried. 

The  report  of  the  Secretary-Treasurer  was 
next  called  for. 

The  Secretary  brought  up  the  subject  of  the 
Committee  for  the  Rocky  Mountain  Medical  Con- 
ference which  had  been  inadvertently  omitted 
when  the  Constitution  and  By-Laws  were  re- 
vised. This  committee  was  authorized  by  the 
House  of  Delegates  at  their  meeting  held  in  Boze- 
man, Mont.,  on  June  18,  1940.  The  Secretary  of- 
fered the  following  amendment  to  the  By-Laws 
for  consideration  at  the  next  meeting  of  the 
House  of  Delegates: 

Add  to  Chapter  VI,  Section  1,  of  the  By-Laws,  the 
following: 

"R.  Committee  on  Rocky  Mountain  Medical  Con- 
ference.” 

Add  to  Chapter  VI,  Section  4,  of  the  By-Laws,  the 
duties  of  this  committee: 

"R.  COMMITTEE  ON  ROCKY  MOUNTAIN  MEDI- 
CAL CONFERENCE.  This  committee  shall  consist 
of  five  (5)  members  serving  terms  so  arranged  that 
the  term  of  one  member  shall  expire  each  year. 
Appointment  to  fill  vacancies  or  expired  terms  shall 
be  made  by  the  President.  The  current  President 
and  Secretary  of  the  Montana  State  Medical  Asso- 
ciation shall  be,  ex-officio,  additional  members  of  the 
committee.  The  duties  of  this  committee  shall  be 
to  represent  the  Montana  State  Medical  Association 
in  all  maters  relating  to  the  Rocky  Mountain  Medi- 
cal Conference,  subject  to  the  By-Laws  of  the  Asso- 
ciation.” 

Dr.  Hawkins  spoke  of  the  revised  State  Board 
of  Health  bill  passed  at  the  last  session  of  the 
State  Legislature  and  called  on  Dr.  E.  S.  Murphy, 
Missoula,  President  of  the  new  State  Board  of 
Health,  for  a few  remarks  on  his  experiences 
up  to  date  on  the  State  Board. 

Dr.  Murphy  stated  that  the  Board  now  con- 
sisted of  seven  members:  three  laymen,  Walter 
E.  Clark,  a pharmacist  from  Havre;  Mary  Mc- 
Nelis,  a teacher  from  Butte,  and  Mrs.  Charlotte 
L.  Holtz,  active  in  health  activities,  from  Great 
Falls;  a dentist.  Dr.  W.  L.  Beale  of  Anaconda; 
and  three  physicians.  Dr.  J.  C.  MacGregor,  Great 
Falls,  Dr.  B.  C.  Farrand,  Jordan,  and  Dr.  E.  S. 
Murphy,  Missoula.  An  organizational  meeting 
had  been  held  and  officers  elected.  Dr.  B.  K. 
Kilbourne,  present  Secretary,  will  soon  retire, 
but  has  agreed  to  stay  on  until  another  secretary 
cani  be  secured;  preferably  a man  under  40, 
trained  in  public  health  work  and  with  a knowl- 
edge of  public  relations,  who  can  sell  good  health 
to  the  people  of  Montana. 

Dr.  M.  A.  Shillington,  Glendive,  offered  a res- 
olution that  the  House  of  Delegates  go  on  record 
that  the  election  of  a physician  as  Vice  Presi- 
dent of  the  State  Association  does  not  eliminate 
him  from  becoming  President  of  the  association 


at  some  future  time;  that  there  is  no  prejudice 
against  a Past  Vice  President  ever  becoming 
President.  The  motion  was  seconded  by  Dr. 
H.  H.  James  and  unanimously  carried. 

The  employment  of  an  Executive  Secretary  of 
the  State  Association  was  brought  up  for  dis- 
cussion by  Dr.  Hawkins.  He  stated  that  this 
was  a serious  matter  about  which  much  discus- 
sion had  been  had  in  the  past,  and  he  felt  that, 
if  possible,  some  decision  should  be  reached  by 
this  body  at  this  time. 

Dr.  J.  C.  Shields,  Butte,  moved  that  the  Execu- 
tive Committee  of  the  Montana  State  Medical 
Association  be  empowered  to  employ  a public 
relations  man  to  work  out  of  the  Secretary’s  of- 
fice. If  satisfactory  he  could  at  some  future 
time  be  considered  for  the  position  of  Executive 
Secretary.  The  motion  .was  seconded  by  Dr. 
Paul  G.  Gans,  Lewistown,  and  after  considerable 
discussion,  was  carried. 

During  the  discussion  on  this  subject,  Mr.  Har- 
vey T.  Sethman,  Executive  Secretary  of  the 
Colorado  State  Medical  Society,  was  called  on 
for  some  remarks'  relative  to  budget  require- 
ments and  the  salary  and  duties  of  a full-time 
Secretary.  Mr.  Sethman  stated  he  thought  the 
Secretary’s  suggestion  a very  sensible  approach 
to  the  problem.  In  his  opinion,  the  duties  of  a 
public  relations  man  would  consist  primarily 
with  the  development  of  the  relationship  of  the 
Montana  State  Medical  Association  as  an  or- 
ganization with  other  organizations,  as  the  in- 
dividual doctors  have  to  develop  their  personal 
relations  with  their  patients  and  confreres.  In 
Colorado,  they  are  aiming  at  making  the  med- 
ical society  the  “family  doctor”  to  the  commu- 
nity, as  much  as  the  individual  doctor  isi  family 
physician  to  his  patients.  This  endeavor  should 
also  develop  good  public  relations  for  the  Mon- 
tana State  Medical  Association. 

Mr.  Sethman  stated  he  hoped  the  terms  “pub- 
lic relations”  and  “publicity”  would  not  be  con- 
fused. Publicity  is  just  one  of  the  many  facets  of 
public  relations,  but  many  people  confuse  the 
terms  and  think  they  are  synonymous.  A public 
relations  man.  can  do  much  for  an  organization, 
but  there  is  also  much  the  members  can  do.  If 
people  are  sick,  they  see  a doctor;  if  they  have 
legal  troubles,  they  see*  their  lawyer.  By  the 
same  token,  an  organization  whose  public  re- 
lations are  not  at  the  best  should  not  try  to  treat 
itself;  a public  relations  expert  should  be  con- 
sulted. The  Colorado  Medical  Society  did  that 
several  years  ago.  The  report  they  received, 
after  much  study  by  a public  relations  counsel, 
was  printed  and  distributed  to  all  members. 

He  stated  he  thought  the  Montana  State  Med- 
ical Association  should  be  able  to  afford  a full- 
time public  relations  man  and  one  or  two  cleri- 
cal assistants,  according  to  his  needs.  Then  in 
a year  or  two,  if  the  Association  wishes  to  do 
so,  he  could  be  employed  on  a more  permanent 
basis  as  an  Executive  Secretary.  At  that  time 
the  Constitution  and  By-Laws  could  be  amended 
to  provide  for  this  office.  He  could  handle  the 
Secretary’s  work  entirely,  and  most  of  the  Treas- 
urer’s work,  with  suitable  supervision  from  the 
doctor  who  might  be  termed  the  Constitutional 
or  Medical  Secretary  as  is  done  in  other  states. 
He  would  act  as  administrative  officer  for  all 
committees,  but  solely  in  an  administrative  ca- 
pacity. Mr.  Sethman  stated  he  felt  that  no  public 
relations  counsel  or  Executive  Secretary  should 
ever  establish  policies  for  the  medical  associa- 
tion. 

In  answer  to  the  question  as  to. salary,  Mr. 
Sethman  expressed  the  opinion  that  the  Montana 


868 


Rocky  Mountain  Medical  Journal 


Luzier 

Gift  Service 


Fine  Cosmetics  and  Perfumes  make  ideal  gifts  for  many  occasions,  including 
Christmas.  While  practically  everything  in  the  Luzier  Service  makes  a suit- 
able gift,  many  of  the  items  are  particularly  appealing  for  this  purpose. 
The  Cosmetic  Consultant  who  distributes  Luzier  preparations  in  your  com- 
munity will  be  pleased  to  show  you  the  complete  Luzier  Gift  Service.  Our 
photograph  shows  just  a few  of  the  many  items  which  may  be  obtained 
for  less  than  five  dollars. 


LUZIER’S  FINE  COSMETICS  AND  PERFUMES 


Are  Distributed  in  Colorado  and  Wyoming  by: 

BURBRIDGE  & BURBRIDGE,  Divisional  Distributors 
519-20  Continental  Bank  Building 
Lincoln,  Nebraska 


Elizabeth  Haskin 

649  Adams 

Denver,  Colo. 


District  Distributors 

Baker  & Baker 

346  Palmer 
Delta,  Colo. 


Cecile  Armstrong 
1352  Jasmine  St. 
Denver,  Colo. 


Catherine  Phelps 

Armstrong  Hotel 
Fort  Collins,  Colo, 


Nellye  Knight 

P.  O.  Box  156 
Casper,  Wyo. 


Local  Distributors 


Irene  K.  Reece 
1337  Madison 
Denver,  Colo. 


Joyce  Kilgore 
250  Collins 
Pueblo,  Colo. 


Funderburk  & Funderburk 
324  So.  7th  St. 
Grand  Junction,  Colo. 


Selma  Sollee 
1426  Grand  Ave. 
Pueblo,  Colo. 


Phil  and  Fern  Pliley 
P.  O.  Box  902 
Laramie,  Wyo. 


Cecelia  Jenkins 

911  San  Pedro 
Trinidad,  Colo. 


for  October,  1949 


869 


state  Medical  Association  should  be  able  to  em- 
ploy a suitable  man  at  a beginning  salary  of 
$5,000  a year,  but  this  would  probably  have  to 
be  raised  in  a few  years  to  perhaps  $7,500.  Most 
of  the  states  employing  an  Executive  Secretary 
have  much  larger  medical  population  than  Mon- 
tana or  Colorado,  and  an  experienced  public 
relations  man  can  command  a larger  salary  in 
the  Eastern  states.  He  stated  that  the  salaries 
ranged  from  about  $4,500  to  $20,000.  Most  men 
in  the  middle  western  states  receive  from  $9,000 
to  $12,000. 

The  amount  of  dues  necessary  to  put  this  ac- 
tion into  effect  was  brought  up  for  discussion. 
Dr.  A.  W.  Axley,  Havre,  moved  that  the  dues 
of  the  State  Medical  Association  be  increased  to 
$60  per  year  and  that  it  is  the  responsibility  of 
each  Society  Secretary  or  Treasurer  to  collect 
the  dues.  Motion  was  seconded  by  Dr.  Dora 
Walker,  Great  Falls. 

After  much  discussion,  an  amendment  was  of- 
fered by  Dr.  H.  W.  Gregg,  Butte,  seconded  by 
Dr.  M.  A.  Shillington,  Glendive,  that  the  motion 
before  the  House  be  amended  to  read  $50  in- 
stead of  $60.  Upon  being  put  to  vote,  the  amend- 
ment was  carried.  The  original  motion  was  then 
put  to  vote  and  carried. 

After  a short  recess,  the  meeting  was  again 
called  to  order  by  Dr.  Hawkins,  who  read  the 
following  announcement: 

We  wish  to  announce  belatedly  that  a Montana 
Uediatric  Society  was  formed  in  Great  Falls  on 
Juim  5,  194'9.  Drs.  D.  L.  Gillespie  and  C.  S.  Meeker 
of  Butte;  Mary  McLaughlin,  A.  L.  Gleason  and  P.  J. 

Great  Falls;  E.  A.  Hagmann  of  Billings 
and  O.  M.  Moore  of  Helena  met  on  this  date  to  form 
a nucleus  for  this  group  which  will  ultimately 
include  other  active  members  who  are  qualified  for 
their  boards  and  associate  members  who  are  inter- 
ested in  pediatric  problems  in  the  state. 

We  v/ould  appreciate  recognition  by  the  state 
association  and  hope  we  may  be  of  definite  aid  in 
the  solution  of  future  problems  of  a pediatric  na- 
ture that  might  arise. 

(Signed)  O.  M.  MOORE. 

The  report  of  the  Auditing  Committee  was 
then  called  for.  The  committee,  consisting  of 
Drs.  E.  H.  Lindstrom,  Helena,  Chairman;  F.  H. 
Crago,  Great  Falls;  R.  G.  Johnson,  Harlowton; 
and  R.  D.  Harper,  Sidney,  reported  that  the  audit 
of  the  books  of  the  Montana  State  Medical  As- 
sociation made  by  Colberg  & Wallin  of  Billings, 
had  been  examined  by  the  committee  and  found 
to  be  in  order.  The  report  of  the  commitee  was 
accepted  in  the  usual  manner. 

Dr.  F.  L.  McPhail,  Great  Falls,  Chairman,  gave 
the  report  for  the  Maternal  and  Child  Welfare 
Committee.  The  report  was  accepted  and  after 
much  discussion  the  recommendations  were  in- 
dividually approved  in  the  usual  manner. 

The  Secretary  brought  up  the  fact  that  the  By- 
Laws  state  no  specific  time  when  the  annual 
dues  should  be  paid  and  when  they  become  de- 
linquent. Dr.  Caraway  moved  that  the  By-Laws 
be  amended  as  follows: 

Add  to  Chapter  I,  Section  1,  of  the  By-Laws: 

“Dues  of  this  association  shall  be  payable  in 

advance  on  or  before  December  31  of  any  year, 

and  shall  be  delinquent  on  January  1 of  the 

year  for  which  the  dues  are  being  paid.” 

The  motion  was  seconded  by  Dr.  H.  W.  Gregg, 
Butte.  After  discussion,  motion  was  made  by 
Dr.  F.  p.  Hurd,  Great  Falls,  seconded  by  Dr.  M. 
A.  Shillington,  Glendive,  that  the  matter  be 
tabled.  Motion  lost. 

Dr.  R.  C.  Monahan,  Butte,  proposed  the  follow- 
ing resolution: 


WHEREAS,  The  Montana  State  Medical  Associa- 
tion, believing  in  state  rights  and  private  owner- 
ship, as  opposed  to  federal  ownership  and  the  usur- 
pation of  state  rights  by  the  federal  government, 
and, 

WHEREAS,  The  said  medical  association  hereby 
specifically  goes  on  record  in  opposition  to  the 
“Welfare”  federal  government  plans  to  infringe  on 
the  state  rights  of  Montana,  and, 

WHEREAS,  The  said  medical  association  con- 
demns the  plans  of  the  federal  government  to  en- 
gage in  any  way  in  the  electric  power  industry 
of  the  said  state;  now  therefore  be  it 

RESOLVED,  That  the  said  medical  association 
shall  vigorously  oppose  any  effort  on  the  part  of 
the  federal  government  to  control  or  regulate  the 
water  of  Montana  or  to  deprive  the  said  state  or 
its  citizens  of  the  complete  use,  enjoyment  and  regu- 
lation thereof. 

The  resolution  was  seconded  by  several  and 
unanimously  carried. 

Upon  motion,  regularly  made,  duly  seconded 
and  unanimously  carried,  the  first  session  of  the 
House  of  Delegates  of  the  Montana  State  Medi- 
cal Association  was  adjourned  at  5:30  p.m. 


The  Second  Session  of  the  House  of  Delegates 
of  the  Montana  State  Medical  Association  was 
called  to  order  at  9:15  a.m.,  Monday,  August  1, 
1949,  in  the  ballroom  of  the  Finlen  Hotel,  Butte, 
by  Dr.  Thos.  L.  Hawkins,  President. 

Dr.  B.  C.  Farrand,  Jordan,  announced  that  a 
charter  had  been  granted  to  the  newly-formed 
Montana  Academy  of  General  Practice  on  July 
14,  1949.  The  Montana  Academy,  consisting  of 
six  members,  is  still  in  an  organizational  stage, 
with  no  elected  officers.  Any  interested  physi- 
cians were  urged  to  contact  Drs,  E.  M.  Farr,  Bill- 
ings; S.  V.  Wilking,  Butte;  J.  R.  Soltero,  Billings; 
R.  H.  Leeds,  Chinook;  J.  A.  Mueller,  Lewistown; 
or  Dr.  B.  C.  Farrand,  Jordan,  for  application 
blanks,  information,  etc. 

Dr.  J.  C.  Shields,  Butte,  Chairman,  stated  no 
meeting  of  the  Economics  Committee  had  been 
held  during  the  year  because  there  were-  no 
questions  of  medical  economics  brought  before 
the  committee,  and  therefore  there  was  no  re- 
port to  be  made  by  this  committee. 

Dr.  L.  W.  Brewer,  Missoula,  Chairman,  gave 
the  report  of  the  Necrology  and  History  of  Medi- 
cine Committee.  The  report  of  the  committee 
was  accepted  in  the  usual  manner  and  the  Chair 
asked  the  House  to  stand  in  silent  tribute  to 
those  Montana  physicians  who  had  passed  on. 
These  were: 

L.  Louis  Elliott,  August  27,  1948. 

Frederick  M.  Poindexter,  August  30,  1948. 

Edwin  M.  Wilson,  January  3,  1949. 

William  S.  Little,  February,  1949. 

Edwin  R.  Fonts,  June  2,  1949. 

The  early  history  of  Montana  medicine  was 
then  brought  up  for  discussion  and  a motion 
made  by  Dr.  H.  W.  Gregg,  Butte,  seconded  by 
Dr.  J.  C.  Shields,  Butte,  that  the  committee  make 
all  necessary  contacts  during  the  coming  year  to 
locate  someone  to  edit  the  material  now  com- 
piled and  get  it  ready  for  publication  in  the  near 
future  if  it  is  financially  possible.  The  motion 
was  unanimously  carried. 

The  report  of  the  Public  Relations  Committee 
was  given  by  Dr.  Harold  W.  Gregg,  Butte,  Chair- 
man, and  accepted  in  the  usual  manner. 

The  report  of  the  Program  Committee  was 
given  by  Dr.  C.  H.  Frederickson,  Missoula,  Chair- 
man, and  accepted,  together  with  the  recommen- 
dations, in  the  usual  manner. 

Dr.  L.  W.  Allard,  Billings,  Chairman,  reported 
for  the  Interprofessional  Relationships  Commit- 
tee. He  stated  that  the  efforts  of  this  committee 


870 


Rocky  Mountain  Medical  Journal 


k ' 


■-/ 


maintaining  nrinarg 
antisepsis  withont 
distressing  the  patient 

Comprehensive  clinical  evidence  establishes  that 
MANDEIAMINE  (methenamine  mandelate)  is  effective  against 
Escherichia  coli.  Staphylococcus  aureus  and  albus,  and 
certain  streptococci.  Comparative  studies  indicate  its 
bacteriostatic  and  bactericidal  effectiveness  to  be  approx- 
imately the  same  as  that  of  the  sulfonamides  or  strepto- 
mycin . 

Because  MANDEIAMINE  therapy  is  exceptionally  well  tolerated, 
patients  willingly  adhere  to  the  prescribed  regimen. 

DOSAGE:  Adequate  dosage  is  important;  for  maximum  effect, 
adults  should  take  3 or  4 tablets  t.i.d.;  children  in 
proportion. 

Complete  literature  and  samples  sent  to  physicians  on 
request. 


outstanding  features 

• Has  wide  antibacterial  range 

• No  supplementary  acidification  required  (except 
when  urea-splitting  organisms  occur) 

• Little  or  no  danger  of  drug-fastness 

• Is  exceptionally  well  tolerated 

• Requires  no  dietary  or  fluid  regulation 

• Simplicity  of  regimen  — 3 or  4 tablets  t.i.d. 


^ I i 


i 


REG.  U.  S.  PAT.  OFF. 

BRAND  OF  METHENAMINE  MANDELATE 

urinary  antiseptic-council  accepted 


NEPERA  CHEMICAL  CO.,  INC. 

YONKERS  2,  N.  Y. 


NEPERA  PARK 


Advertisement 


From  where  1 sit 
Joe  Marsh 


Watch  Out  For 
The  Symptoms! 

Laughed  right  out  loud  when  1 
heard  Hoot  Davis  had  come  down  with 
Chicken  Pox.  A man  of  forty-five 
catching  a kid's  disease! 

I went  to  see  him,  armed  with  jokes 
about  “second  childhood”  but  forgot 
them  fast  when  I got  there.  Hoot 
looked  awful  and  had  quite  a fever. 

While  we  talked,  I thought  of  how 
Chicken  Pox  is  a lot  like  other  “dis- 
eases”— diseases  of  the  character,  such 
as  intolerance,  self-righteousness  or 
just  plain  ignorance.  They're  excus- 
able in  children,  hut  when  they  come 
out  in  adults  they're  ten  times  as  had 
— and  can  he  mighty  “contagious.” 

From  where  I sit,  we  should  all 
watch  out  for  the  “symptoms” — little 
things  like  criticising  a person’s  prefer- 
ence for  a friendly  glass  of  temperate 
beer  or  ale.  We’ve  seen  freedom  wither 
away  in  other  countries,  when  in- 
dividual intolerance  was  allowed  to 
get  out  of  hand  and  become  a nation- 
wide epidemic. 


Copyright,  19 1^9,  United  States  Brewers  Foundation 


had  been  to  hold  together  the  allied  professions. 
During  the  past  year  no  meetings  of  this  group, 
representing  the  various  professions,  were  held, 
but  Dr.  Allard  felt  this  committee  should  be  con- 
tinued and  that  much  could  be  accomplished  in 
the  line*  of  public  relations  by  such  a group. 

The  report  of  the  Cancer  Committee  was  given 
by  Dr.  Mary  Martin,  Billings,  Chairman,  and 
accepted  with  the  recommendations  in  the  regu- 
lar manner. 

Dr.  F.  I.  Terrill,  Galen,  Chairman,  gave  the 
report  of  the  Tuberculosis  Committee,  which  was 
accepted  in  the  usual  manner. 

The  Fracture  and  Orthopedic  Committee  had 
no  report  to  make  at  this  meeting. 

Dr.  B.  C.  Farrand,  Jordan,  Chairman,  gave  the 
report  of  the  Rural  Health  Committee,  which  was 
accepted  in  the  regular  manner. 

No  report  was  given  by  the  Industrial  Wel- 
fare Committee. 

The  Rheumatic  Fever  and  Heart  Committee 
had  no  report  to  make  at  this  time. 

The  report  of  the  Emergency  Medical  Care 
Committee  was  given  by  Dr.  Paul  J.  Gans,  Lewis- 
town,  and  accepted  by  the  House. 

Dr.  Eugene  Hildebrand,  Great  Falls,  Chairman, 
gave  the  report  of  the  Hospital  Relations  Com- 
mittee, which  was  accepted,  together  wth  the 
recommendations,  in  the  usual  manner. 

The  report  of  the  Industrial  Accident  Board 
Fee  Schedule  Committee  was  read  by  Dr.  H.  H. 
James,  Butte,  Chairman,  and  adopted,  together 
with  the  recommendations,  in  the  regular  man- 
ner. 

The  report  of  the  Council  meeting  of  the  Mon- 
tana State  Medical  Association  was  given  by 
Dr.  J.  H.  Garberson,  Miles  City,  duly  elected 
representative,  and  accepted  by  the  House  in  the 
usual  manner. 

At  this  time  the  Chair  declared  the  House  in 
recess'  for  lunch  and  the  delegates  were  re- 
minded to  be  back  at  1:30  p.m.,  when  two  films 
would  be  shown:  “They  Also  Serve,”  produced 
by  the  American  Medical  Association,  and  “The 
Problem  of  Early  Diagnosis,”  produced  by  the 
American  Cancer  Society. 

The  Second  Session  of  the  House  of  Delegates 
was  again  called  to  order  at  2:15  p.m.,  by  Dr. 
Thos.  L.  Hawkins. 

Dr.  Albert  W.  Axley,  Havre,  Secretary  of  the 
Hill  County  Medical  Society,  spoke  about  the 
activities  of  their  society  in  cooperation  with  the 
National  Education  Campaign  of  the  American 
Medical  Association.  He  urged  more  active  par- 
ticipation by  other  component  societies  and  in- 
dividual physicians  in  the  campaign  to  convince 
the  American  people  that  compulsory  health  in- 
surance is  bad  medicine.  He  stated  that  if  com- 
pulsory health  insurance  is  enacted  into  law, 
or  if  the  educational  campaign  fails,  the  physi- 
cians will  have  no  one  to  blame  but  themselves. 
He  also  distributed  packets  of  material  to  dele- 
gates from  each  society  containing  form-  letters, 
resolutions,  and  other  material  being  'used  by 
the  Hill  County  Medical  Society  in  aiding  this 
campaign.  The  use  of  this  material  was  ex- 
plained to  the  delegates. 

The  President’s  Reorganization  Plan  No.  1, 
before  the  United  States  Senate,  which  would 
elevate  the  Federal  Security  Administration  to 
cabinet  status  in  charge  of  welfare,  education, 
health  and  social  security  activities  under  lay 
administration,  was  discussed  and  Dr.  Caraway 
read  the  following  telegram  replying  to  a wire 
from  the  State  Medical  Association  urging  that 
the  plan  be  rejected  and  the  recommendations 
of  the  Hoover  Commission  carried  out: 


872 


Rocky  Mountain  Medical  Journal 


FULFILLING  EVERY 


REQUIREMENT  OF  EFFECTIVENESS 
AND  PATIENT-ACCEPTANCE 


TSAOtMARK  R{0  U S.  PAT.  OFP. 

VAGINAL  JELLY* 

■n  Immobilizes  sperm  in  the 
fastest  time  recognized 
under  the  Brown  and 
Gamble  technique 

Occludes  the  cervix  for  as  long  as 
10  hours — effective  barrier  action 

Nonirritating  and  nontoxic 

— safe  for  continued  use 

B Crystal  clear,  nonstaining,  delicately 
fragrant— esf/iet/cof/y  agreeable 

^ Will  not  liquefy  at  body  tempera- 
ture—nofexcessiVe/y  lubricating 

FOR  ECONOMY  TO  YOUR  PATIENTS 
SPECIFY  THE  URGE  FIVE-OUNCE  SIZE 


gynecological  division 

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423  West  55th  St.,  New  York  19,N.Y. 
quality  first  since  1883 


‘Active  Ingreclients;  Dodecaethyleneglycol 
Monolourqte  5%;  Boric  Acid  t %;  Alcohol  5%. 


for  October,  1949 


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WANTED  LOCUM  TENENS 

ORTHOPEDIC  SURGEON  has  completed  Board  re- 
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31;  would  like  Temporary  Assistantship  or  locum 
tenens  in  Idaho  or  Oregon  from  November  to  April. 
Box  10,  Rocky  Mountain  Medical  Journal. 


WANTED 

PHYSICIAN — ^Desires  Eye  or/and  ENT  association 
or  preceptorship-  under  Board  man;  excellent  ref- 
erences; class  A graduate;  will  complete  one  year 
residency  in  Ophthalmology  July  1,  1950;  Colorado 
license.  Box  9,  Rocky  Mountain  Medical  Journal. 


FOR  SALE 

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scriber two  years.  Dr.  C.  T.  Burnett,  TAbor  5428. 


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OP  ONE  PROFESSIONAL  GROUP  HIGHLY 
DESIRABLE. 

JAMBS  E.  MURRAY. 

Dr.  Hawkins  brought  up  the  need  for  two  meet- 
ings a year  of  the  House  of  Delegates  of  the 
Montana  State  Medical  Association  and  stated 
that  everyone  seemed  to  agree  that  the  Interim 
Session  held  in  Montana  in  January,  1949,  was 
a good  meeting. 

Dr.  C.  H.  Frederickson  moved  that  an  Interim 
Meeting  of  the  House  of  Delegates  be  held  in 
Helena  in  December  or  January,  the  time  to  be 
determined  by  the  Executive  Committee.  He 
added  that  a one-day  scientific  program  be  in- 
cluded in  this  meeting.  The  motion  was  sec- 
onded by  Dr.  J.  C.  Shields  and  carried. 

The  Secretary  then  read  communications  from 
the  Gallatin  County  Medical  Society  and  the 
Chamber  of  Commerce  of  Bozeman,  inviting  the 
Montana  State  Medical  Association  to  hold  their 
1950  Annual  Meeting  in  Bozeman,  Mont.  Upon 
motion  by  Dr.  H.  W.  Gregg,  seconded  by  Dr.  L. 
W.  Brewer,  the  invitation  to  hold  the  1950  An- 
nual Meeting  in  Bozeman  was  accepted  and  the 
motion  unanimously  carried.  It  was  suggested 
that  the  meeting  of  the  Montana  'State  Medical 
Association  be  held  after  the  annual  meeting 
of  the  American  Medical  Association  in  order 
that  the  report  of  the  delegate  to  the  A.M.A.  be 
more  current. 

The  election  of  officers  was  the  next  order 
of  business.  Dr.  F.  D.  Hurd  complimented  the 
committee  on  their  excellent  recommendations 
for  state  officers  and  asked  that  his  name  be 
withdrawn  as  candidate  for  President-Elect.  His 
request  was  granted  and  his  name  removed.  The 
Chair  announced  that  Dr.  E.  S.  Murphy  had  also 
requested  that  his  name  be  removed  as  candidate 
for  Vice  President  and  in  view  of  this  request 
the  name  of  Dr.  Murphy  was  also  removed. 

It  was  moved  by  Dr.  F.  D.  Hurd,  Great  Falls, 
seconded  by  Dr.  W.  E.  Harris,  Livingston,  that 
the  nominations  for  President-Elect  be  closed. 
Motion  carried.  It  was  moved  by  Dr.  M.  A, 
Shillington,  seconded  by  Dr.  J.  C.  Shields,  that 
the  Secretary  cast  a unanimous  ballot  for  Dr. 
C.  H.  Frederickson  as  President-Elect  of  the 
Montana  State  Medical  Association,  and  the  mo- 
tion was  carried. 

Dr.  D.  T.  Berg,  Helena,  was  nominated  for 
Vice  President  by  Dr.  R.  W.  Morris.  The  mo- 
tion was  seconded  by  several  and  carried.  It 
was  moved  by  Dr.  F.  D.  Hurd,  seconded  by  Dr. 
Paul  J.  Gans,  that  the  nominations  for  Vice 
President  be  closed.  Motion  carried. 

Motion  was  made  by  Dr.  B.  C.  Farrand,  sec- 
onded by  Dr.  C.  F.  Little,  Great  Falls,  that  nom- 
inations for  Secretary-Treasurer  be  closed.  Mo- 
tion carried. 

Drs.  L-  W.  Allard  and  Thos.  L.  Hawkins,  im- 
mediate Past  Presidents,  were  nominated  for 
vacancies  on  the  Executive  Committee.  Upon 
motion  by  Dr.  A.  W.  Axley,  seconded  by  Dr. 
J.  C.  Shields,  the  nominations  were  closed  and 
the  Secretary  instructed  to  cast  a unanimous 
ballot  for  Drs.  Allard  and  Hawkins  as  members 
of  the  Executive  Committee. 

The  report  of  the  tellers  appointed  by  the 
Chair  was  received  and  the  following  officers 
declared  elected: 

President-Elect:  C.  H.  Fredrickson,  Missoula. 
Vice  President:  F.  L.  McPhail,  Great  Falls. 


874 


Rocky  Mountain  Medical  Journal 


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Cook  County  Graduate 
School  of  Medicine 

ANNOUNCES  CONTINUOUS  COURSES 

SURGERY — Intensive  course  in  Surgical  Technique, 
Two  Weeks,  starting  October  24,  November  28. 
Surgical  Technique,  Surgical  Anatomy  and  Clinical 
Surgery,  Four  Weeks,  starting  October  10,  Novem- 
ber 7.  Surgery  of  Colon  and  Rectum,  One  Week, 
starting  October  10.  November  28.  Esophageal  Sur- 
gery, One  Week,  starting  October  10.  Breast  and 
Thyroid  Surgery,  One  Week,  starting  October  10. 
Thoracic  Surgery,  One  Week,  starting  October  3. 
Fractures  and  Traumatic  Surgery,  Two  Weeks, 
starting  October  3. 

GYNECOLOGY — Intensive  Course,  Two  Weeks,  start- 
ing October  24.  Vaginal  Approach  to  Pelvic  Sur- 
gery One  Week,  starting  November  7. 

OBSTETRICS — Intensive  Course,  Two  Weeks,  start- 
ing November  7. 

MEDICINE — Intensive  General  Course,  Two  Weeks, 
starting  October  3.  Gastroenterology,  Two  Weeks, 
starting  October  24.  Gastroscopy,  Two  Weeks,  start- 
ing October  24. 

DERMATOLOGY — Formal  Course,  Two  Weeks,  start- 
ing October  24.  Informal  Clinical  Course  every 
two  weeks. 

ROENTGENOLOGY — Diagnostic  and  Lecture  Course 
First  Monday  of  every  month.  Clinical  Course  Third 
Monday  of  every  month.  X-Ray  Therapy  every 
two  weeks. 

CYSTOSCOPY — Ten  Day  Practical  Course  every  two 
weeks. 

GENERAL,  INTENSIVE  AND  SPECIAL  COURSES 
IN  ALL  BRANCHES  OF  MEDICINE,  SURGERY 
AND  THE  SPECIALTIES 

TEACHING  FACULTY— ATTENDING  STAFF  OF 
COOK  COUNTY  HOSPITAL 

Address:  REGISTRAR,  427  SOUTH  HONORE  STREET 
CHICAGO,  ILLINOIS 


Secretary-Treasurer:  H.  T.  Caraway,  Billings. 

Executive  Committee:  L.  W.  Allard,  Billings, 
and  Thos.  L.  Hawkins,  Helena. 

The  Chair  called  on  Dr.  Chapman  for  a few 
words  on  the  progress  of  the  establishment  of 
Red  Cross  Blood  Banks  in  Montana.  Dr.  Chap- 
man stated  that  a center  has  been  established  in 
Great  Falls,  which  is  serving  fifteen  counties 
at  the  present.  In  each  case  the  county  medical 
society  has  a supervisory  committee  and  super- 
vises the  operation  professionally  and  tech- 
nically. Services  are  available  for  localities 
where  there  is  no  such  service,  but  the  approval 
of  the  county  medical  society  must  first  be  ob- 
tained and  such  services  endorsed  by  the  county 
societies.  A mobile  unit  is  also  in  operation.  Dr. 
Chapman  stated  that  to  the  present  time,  2,500 
pints  of  blood  had  been  collected  and  distributed 
in  the  fifteen  counties  served  by  the  Great  Falls 
unit.  He  also  urged  that  doctors  encourage 
friends  and  relatives  of  patients  receiving  blood 
to  donate  blood  to  replace  that  used. 

It  was  moved  by  Dr.  F.  D.  Hurd,  Great  Falls, 
seconded  by  Dr.  Geo.  G.  Sale,  Missoula,  that  a 
telegram  and  flowers  be  sent  to  Dr.  Thos.  F. 
Walker.  Motion  was  unanimously  carried. 

At  this  time  the  meeting  of  the  House  of  Dele- 
gates of  the  Montana  State  Medical  Association 
was  recessed  to  reconvene  immediately  as  the 
Administrative  Body  of  the  Montana  Physicians’ 
Service. 


The  meeting  of  the  House  of  Delegates  was 
again  called  to  order  at  4:30  p.m.  by  Dr.  Thos.  L. 
Hawkins,  President. 

Dr.  S.  V.  Wilking,  Butte,  gave  a brief  report  of 
the  Fifty  Year  Club,  inaugurated  at  the  last  an- 
nual meeting. 

The  Secretary  then  read  the  proposed  amend- 
ments to  the  By-Laws  of  the  Association.  The 
amendment  to  provide  for  the  Committee  on 
Rocky  Mountain  Medical  Conference  was  unani- 
mously adopted.  The  amendment  to  establish  a 
specific  date  for  payment  of  dues  and  a date 
when  dues  are  delinquent  was  also  carried.  Dr. 
A.  W.  Axley,  Havre,  suggested  that  a notice  be 
sent  out  from  the  Secretary’s  office  in  December 
to  all  members  regarding  the  payment  of  dues. 

Dr.  Harold  W.  Gregg  then  introduced  Mr.  Nor- 
man J.  Holter  of  Helena,  who  gave  a brief  talk 
on  research  bemg  conducted  in  Montana  on 
medical  physics.  Slides  were  shown  to  the  dele- 
gates and  telemetering  of  muscle  potential  gen- 
eration of  moving  objects  explained. 

Drs.  L.  W.  Brewer,  Missoula,  and  J.  J.  Malee, 
Anaconda,  introduced  President-Elect  Dr.  C.  H. 
Fredrickson  to  the  assembly.  In  a few  words 
Dr.  Fredrickson  thanked  the  delegates  for  the 
honor  conferred  on  him  and  assured  them  he 
would  do  his  best  to  fulfill  the  duties  involved. 

Dr.  Hawkins  then  turned  the  meeting  over 
to  Dr.  F.  L.  McPhail,  Vice  President,  who  will 
be  acting  President  until  such  time  as  Dr.  Walker 
is  able  to  assume  his  duties.  Dr.  McPhail  ad- 
dressed the  assembled  delegates: 

I am  sorry  to  be  here  today  in  this  capacity.  I 
had  hoped  very  much  to  see  Dr.  Walker  installed 
and  to  see  him  carry  on  the  job  which  I know 
him  to  be  so  capable  of  handling'  and  one  on  which 
he  has  spent  considerable  time  in  preparing  to  take 
over  at  this  time.  1 am  deeply  aware  of  my  inade- 
quacies as  this  is,  of  course,  quite  a surprise  to  me. 
The  situation  is,  therefore,  going  to  require  con- 
siderable sympathy  on  your  part  until  Tom  is  back. 
He  had  many  plans,  particularly  insofar  as  com- 
mittee appointments  are  concerned.  We  had  talked 
on  two  occasions  about  his  plans.  On  these  occa- 
sions Tom  had  discussed  certain  ideas  which  he 
had  planned  to  institute.  One  was  that  all  com- 


876 


Rocky  Mountain  Medical  Journal 


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mittees  would  be  appointed  today  tor  the  ensuing 
year.  That  obviously  cannot  be  done  because  I 
do  not  have  this  information.  All  of  his  plans  will 
be  carried  out  insofar  as  this  is  possible.  Next,  he 
had  planned  that  he  would  require  all  committees 
to  meet  at  least  once  a year  and  preferably  in  Great 
Fa!lls  so  that  he  could  attend  the  meetings  and 
have  a stenographer  present  to  record  committee 
action  and  make  it  possible  to  transmit  their  re- 
ports to  the  secretary  within  a few  days.  It  has 
been  stated  that  it  would  be  an  imposition  to  cer- 
tain people  to  come  to  Great  Falls.  Bear  with  him, 
because  Helena  and  Great  Falls  happen  to  be  cen- 
tral points  in  this  state.  It  isn’t  a question  of  ask- 
ing them  to  come  to  him;  it  is  a question  of  divid- 
ing' travel  distances  for  all  concerned. 

He  also  planned  on  .getting  out  an  occasional 
President’s  Letter  in  which  he  would  try  to  outline 
what  had  happened  in  the  committee  meetings  and 
what  should  be  accomplished  by  the  association. 
One  of  our  greatest  problems  over  the  years  is  in 
not  carrying  on  after  our  very  fine  meetings.  A 
lot  of  things  have  been  discussed.  Individuals  have 
gotten  some  gripes  off  their  chest  and  some  excel- 
lent recommendations  have  been  made.  As  a result, 
we  go  so  far  at  the  meetings  and  then  next  year 
we  will  debate  something  else.  The  action  is  too 
freq'uently  not  noticed  by  the  component  societies. 
The  Maternal  and  Child  Welfare  Committee  made 
some  recommendations  that  will  be  fomvarded  to 
the  societies,  but  will  the  societies  take  it  up  from 
that  point?  The  action  yesterday  regarding  an 
Executive  Secretary  will  help  considerably. 

It  will  be  necessary  that  in  each  society  somebody 
attempt  to  improve  relations  between  the  state  and 
county  societies.  Whether  that  will  be  possible — 
whether  Dr.  Walker  will  be  able  to  return  to  make 
the  trips  he  planned  to  these  societies,  I don’t 
know.  I can  only  say,  I am  completely  unprepared. 
I will  do  my  best  to  fill  his  shoes  until  he  can 
return,  but  with  your  cooperation,  I think  it  can 
be  done. 

Dr.  Hawkins,  retiring  President,  expressed  his 
sincere  thanks  to  Dr.  H.  T.  Caraway  for  the  ex- 
cellent job  he  has  done  as  Secretary-Treasurer 
of  the  State  Association.  He  stated  Dr.  Caraway 
had  done  considerable  traveling,  without  regard 
to  his  own  personal  affairs,  to  Society  meetings 
and  to  National  meetings.  He  felt  Dr.  Caraway 
had  been  a great  Secretary  and  he  thanked  him 
personally  for  all  the  cooperation  he  had  re- 
ceived. The  delegates  concurred  in  this  opinion 
with  a round  of  applause. 

Dr.  T.  L.  Lockridge,  Whiteish,  proposed  a reso- 
lution, seconded  by  several,  thanking  the  retir- 
ing President,  Dr.  Hawkins,  or  a job  well  done. 
This  resolution  was  unanimously  carried. 

Dr.  F.  L.  McPhail  proposed  a resolution,  sec- 
onded by  Dr.  A.  W.  Axley,  thanking  the  Silver 
Bow  County  Society,  the  staff  and  employees 
of  the  Finlen  Hotel,  the  Country  Club  and  others 
who  had  aided  in  making  this  a very  successful 
meeting.  The  motion  was  unanimously  carried. 

Upon  motion,  regularly  made,  duly  seconded 
and  unanimously  carried,  the  meeting  of  the 
House  of  Delegates  of  the  Montana  State  Medi- 
cal Association  was  adjourned  at  5:30  p.m. 


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A completely  rewritten  1948  edition  of  this 
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the  contributed  material  of  nearly  one  hundred 
outstanding  leaders  in  health  education  has  been 
organized  into  a comprehensive,  readable  and 
up-to-date  volume. 


878 


Rocky  Mountain  Medical  Journal 


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Present-day  problems  with  solutions  proved 
effective  by  experience  are  discussed  in  the 
twenty  chapters  under  such  titles  as  Health  Prob- 
lems: Past,  Present  and  Future;  Solving  School 
and  Community  Health  Problems;  Finding  and 
Using  Resources  and  Health  Education  in  Action. 

Although  the  book  is  closely  indexed  for  ready 
reference,  the  clear,  non-technical  presentation 
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as  a textbook  or  for  supplementary  reading 
Modern  typography  and  a liberal  number  of 
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A publication  of  the  Joint  Committee  on 
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Juberculosis  Abstracts 

Issued  Monthly  by  the  National  Tuberculosis 
Association 


Vol.  XXH 


OCTOBER,  1949 


No.  19 


Everyone  concerned  with  tuberculosis  control  depends 
upon  mortality  figures  as  the  mariner  does  upon  the  sun 
and  stars.  They  show  how  far  we  have  come  and 
what  remains  to  be  done  before  tuberculosis  finally  dis- 
appears. The  current  figures  show  progress  but  they 
also  bring  to  our  attention  the  importance  of  more  in- 
tensive work  with  older  groups  in  planning  the  attack 
upon  tuberculosis. 

TUBERCULOSIS  MORTALITY  IN  THE  UNITED 
STATES,  1947 

In  1947,  there  were  48,064  deaths  from  tuberculosis 
in  the  United  States.  The  death  rate  was  33.5  per  100,000 
population,  which  was  8 per  cent  below  the  rate  of  1946. 

This  decrease  in  the  tuberculosis  death  rate  continued 
the  downward  trend  which  has  prevailed  with  few  in- 
terruptions since  1910.  Of  the  total  deaths  from  tuber- 
culosis in  1947,  more  than  90  per  cent  were  attributed 
to  respiratory  tuberculosis.  For  both  respiratory  and 
nonrespiratory  infections,  mortality  was  much  greater 
for  nonwhites  than  for  whites  and  greater  for  males 
than  for  females. 

Death  rates  for  tuberculosis  in  the  white  population 
and  for  nonwhite  males  were  lower  in  the  young 
adult  years  than  in  the  older  age  groups,  while  for 
nonwhite  females  the  highest  rates  occurred  in  the 
young  adult  group.  Among  all  young  adults,  the 
rates  were  higher  for  females  than  for  males;  among 
^der  persons,  the  rates  were  much  higher  for  males. 
The  rates  for  nonwhites  were  far  above  those  for 


W.D.I^ocL 

Ambulance 

Service 


Prompt.  Careful  and  Courteou.s 
Serving  Denver  25  Years 

Approved  by  Physicians  Generally 

18th  Ave.  at  Gilpin  St.,  Phone  EA.  7733 


880 


Rocky  Mountain  Medical  Journal 


Winning  Health 

in  the 

Pikes  Peak  Region 


COLORADO  SPRINGS 


Inquiries  Solicited 


GLOCKNER  PEimOSE  HOSPITAE 

Sisters  of  Charity 

HOME  OF  MODERN  SANATORIA 


WESTERN  ELECTRIC 

HEARING  AIDS 


Engineered  by  Bell  Telephone  Laboratories 


SOME  of  the  exclusive  features  of  this 
new  Vacuum  Tube  Hearing  Aid  are: 
Sealed  Crystal  Microphone — gives  same 
dependable  service  under  all  conditions  of 
temperature  and  humidity.  Stabilized  Feed- 
back — amplification  without  distortion. 
No  sudden  blast  from  loud  sounds  when 
volume  is  turned  up. 

For  other  iniormation  write  or  eoU 

M.  F.  Taylor  Laboratories 

721  Republic  Building 
MAin  1920  Denver,  Colo. 


SERVICE 

QUALITY 

PAUL  WEISS 

PRESCRIPTION 

OPTICIAN 

1620  ARAPAHOE  ST.  DENVER 

MAin  1722 

FAIRFAX  SANITARIUM 

Kirkland,  Wash. 

Situated  one  mile  north  of  Juanita 

TREATING  NERVOUS  AND 
MENTAL  DISEASES 

Beautiful  and  restful  surroundings  affording 
recreational  facilities.  Cottage  plan  for  segre- 
gation of  patients.  Insulin  and  Electro-shock 
Therapy  when  indicated. 

Attending  Physicians 
FREDERICK  LEMERE,  M.D. 

NATHAN  K.  RICKLES,  M.D. 

JAMES  H.  LASATER,  M.D. 

MORTON  E.  BASSAN,  M.D. 

JACK  J.  KLEIN,  M.D. 

Manager:  A.  G.  HUGHES 
Route  2,  Box  365,  Kirkland 
Phone:  Kirkland  2391 


for  October,  1949 


881 


whites  in  ail  age  groups  except  75  years  and  over. 

Death  rates  for  tuberculosis  were  lower  in  1947  than 
in  1939-41  for  almost  all  population  groups.  In  gen- 
eral, greater  gains  were  made  by  females  than  by 
males,  and  by  younger  than  by  older  persons.  The 
only  increases  in  rates  were  for  males  in  the  age 
groups  over  55  years  and  for  nonwhite  females  65-74 
years  of  age.  Tuberculosis  death  rates  in  1947  by 
state  of  residence  ranged  from  11.8  in  Iowa  to  100.0 
for  Arizona. 

Tuberculosis  Mortality  in  the  United  States,  1947, 
Sara  A.  Lewis,  Public  Health  Reports,  April  1,  1949. 

TUBERCULOSIS  MORTALITY  IN  OLDER 
AGE  GROUPS 

Mortality  statistics  compiled  for  1947  show  that 
tuberculosis  death  rates  have  again  declined  in  the 
United  States.  In  1947  the  rate  was  33.5  per  100,000, 
as  compared  to  36.4  in  1946.  These  gratifying  figures 
show  progress  is  still  beng  made  toward  the  goal — the 
disappearance  of  tuberculosis  from  the  United  States. 

An  analysis  of  the  1947  mortality  data  brings  out  a 
fact  which  is  very  significant.  The  proportion  of 
deaths  from  tuberculosis  among  people  over  45  years 
of  age  is  steadily  increasing. 

For  many  years  tuberculosis  was  a disease  primarily 
of  young  adults  between  the  ages  of  15  and  44 — 
people  in  the  prime  of  life,  wage  earners,  parents  of 
small  children,  young  people  just  starting  their  life 
work.  In  1900,  for  example,  almost  two  out  of  three 
of  all  the  reported  tuberculosis  deaths  were  in  this 
age  group.  Only  one  out  of  four  of  those  who  died 
was  45  or  over.  By  1940,  over  half  of  the  tuberculosis 
deaths  reported  still  took  place  among  people  between 
the  ages  of  15  and  44,  but  deaths  of  those  45  and 
older  had  risen  to  42  per  cent  of  the  total. 


An  important  factor  in  this  shift  has  been  the  fact 
that  mortality  rates  have  declined  more  slowly  in  the 
older  age  groups  than  in  the  younger  and  the  greater 
number  of  older  people  in  the  country’s  population 
further  accentuates  the  degree  of  change. 

The  shift  toward  older  ages  at  death  has  great  sig- 
nificance for  tuberculosis  case-finding  activities.  A 
study  of  a recent  mass  x-ray  survey  in  a Georgia 
county  contains  one  of  the  few  available  tabulations 
of  the  ages  of  those  x-rayed.  It  was  disappointing 
to  see  the  small  percentage  of  older  people  who  took 
part  in  that  survey.  Although  62  per  cent  of  the 
population  of  the  county  in  the  age  group  45-54  were 
x-rayed,  the  percentage  fell  rapidly  in  older  groups: 
only  17  per  cent  of  those  75  and  over  participated. 

Obviously  there  are  many  reasons  why  people  do 
not  take  part  in  mass  surveys.  Many  of  the  very  old 
people  could  not  participate  because  of  illness  or  in- 
capacity. Many  others  not  so  old,  however,  failed  to 
be  examined  because  they  think  tuberculosis  is  a dis- 
ease they  have  “outgrown."  They  must  be  cautioned 
that  those  over  45  are  subject  to  tuberculosis  just  as 
younger  people  are. 

Control  workers  should  be  reminded  that  older  people 
form  a major  source  of  infection  in  the  population. 
Special  efforts  are  needed  to  discover  the  disease 
among  those  over  45  for  the  protection  both  of  in- 
dividuals and  of  the  community.  All  men  and  women, 
young  and  old,  should  be  urged  to  have  periodic  x-ray 
examinations  either  in  mass  surveys  or  as  part  of  their 
annual  physical  examination  by  private  physicians. 
Only  by  special  emphasis  and  special  efforts  can  all 
cases  of  tuberculosis  be  discovered,  isolated,  and 
brought  under  treatment. 

T uberculosis  Mortality  in  Older  Age  Groups,  Robert 
J.  Anderson,  M .D.,  Public  Health  Reports,  April  1,  1949. 


LIVERMORE  SANITARIUM 


• The  Hydropathic  Department 
devoted  to  the  treatment  of  gen- 
eral diseases,  excluding  surgical 
and  acute  infectious  cases.  Special 
attention  given  functional  and  or- 
ganic nervous  diseases.  A well 
equipped  clinical  laboratory  and 
modern  X-ray  Department  are  in 
use  for  diagnosis. 


• The  Cottage  Department  (for 
mental  patients)  has  its  own  fa- 
cilities for  hydropathic  and  other 
treatments.  It  consists  of  small 
cottages  with  homelike  surround- 
ings, permitting  the  segregation  of 
patients  in  accordance  with  the 
type  of  psychosis.  Also  bungalows 
for  individual  patients,  offering 
the  highest  class  of  accommoda- 
tions with  privacy  and  comfort. 


GENERAL  FEATURES 

1.  Climatic  advantages  not  excelled  in  United  States.  Beautiful  grounds  and  attractive  surrounding  country. 

2.  Indoor  and  outdoor  gymnastics  under  the  charge  of  an  athletic  director.  An  excellent  Occupational  Department. 

3.  A resident  medical  staff.  A large  and  well-trained  nursing  staff  so  that  each  patient  is  given  careful  individual  attention. 


Information  and  circulars  upon  request. 

Address:  O.  B.  JENSEN,  M.D. 
Superintendent  and  Medical  Director 
Livermore,  California 
Telephone  313 


CITY  OFFICES: 

San  Francisco  Oakland 


450  Sutter  Street 
GArfield  1-5040 


1624  Franklin  Street 
GLencourt  1-5988 


882 


Rocky  Mountain  Medical  Journal 


We 

Qolorado  Springs  ^Psychopathic  Hospital 

A Private  Hospital  for  Nervous  and  Mental  Diseases 

Situated  in  a beautiful  valley  two  miles  south  of  Colorado  Springs,  which  is  nationally  known  as  a health 
center.  New  building  for  mild  cases  of  Functional  Neurosis,  affording  complete  classification  of  patient*. 
Home-like  surroundings,  scientific  medical  treatment  and  nursing  care.  Booklet  and  rates  on  application. 

C.  F.  Rice,  Saperlntendent,  Colorado  Sprlnera,  Colorado 


for  October,  1949 


883 


RELIABLE  DRUGGISTS 

PATRONIZE  DENVER’S  INDEPENDENT  DRUGGISTS 


WE  RECOMMEND 

COUNTRY  CLUB 
PHARMACY 

PRESCRIPTION  SPECIALISTS 

1700  E.  6th  Ave.  EAst  7743 

Denver,  Colorado 

We  Recommend 

Kincaid^s  Pharmacy 

JESS  L.  KINCAID,  Prop. 

Prescriptions,  Biologicals 
and  Fine  Cosmetics 

7024  W.  Colfax  Ave. 

Phone  Lakewood  436 

LAKEWOOD,  COLORADO 

ROBERTS  PHARMACY 

East  23rd  Aye.  at  Onedia  St. 

Phones:  EAst  7783-EAst  7784 

D.  Lyall  Roberts,  Prop. 

East  Denver's  Newest  Neighborhood  Drug  Store 
Takes  Pleasure  to  Fill  the  Needs  of  Your  Pa- 
tients. 

Prompt  Free  Delivery  Service 

Our  Prescription  Stock  Is  Complete 

We  Recommend 

EARNEST  DRUG  COMPANY 

T.  H.  BRAYDEIN,  Prop. 

PRESCRIPTION  SPECIALISTS 
Prompt  Delivery  Service 

1699  Broadway  Phone  KEystone  7237 

Denver,  Colorado 

“Conveniently  Located  tor  the  Doctor" 

HYDE’S  PHARMACY 

ACCURATE  PRESCRIPTIONS 

Chas  W.  Hyde,  Prop. 

Rocky  Mountain  Distributor  for  Sherman 
Biologicals  and  Pharmaceuticals 

Free  Deliveries 

629  16th  St.  (Mack  Bldg.)  KE.  4811 

Doyle's  Pharmacy 

PeiFticuiar 

East  17th  Ave.  at  Grant  KE.  5987 

21  Years  in  the  Heart  of  North  Denver 

GUIDO  SHUMAKE  DRUGS 

(Formerly  Otto  Drug  Co.) 

PRESCRIPTIONS  ACCURATELY 
COMPOUNDED 

Free  Delivery  Service 

West  38th  Ave.  and  Clay  Denver,  Colo. 

Phone  GRand  9934 

We  Recommend 

BONNIE  BRAE 

DRUG  COMPANY 

Alfred  C.  Andersen,  Owner  and  Manager 
Prescriptions  Accurately  Compounded 

Drugs Sundries 

FREE  IMMEDIATE  DELIVERIES 

ON  EMERGENCY  PRESCRIPTIONS 

763  South  University  Boulevard 

Phone  RAce  2874  — Denver,,  Colorado 

WE  RECOMMEND 

Whittaker’s  Pharmacy 

“The  Friendly  Store” 

PRESCRIPTION  SPECIALISTS 

West  32nd  and  Perry,  Denver,  Colo. 

Phone  GLendale  2401 

22  Years  in  North  Denver 

OTTO  DRUG  COMPANY 

TRY  US  FIRST 

Prescriptions  Accurately  Compounded 

Free  Delivery  Service 

(New  Location) 

5070  Federal  Boulevard  Denver,  Colorado 

Phone  GRand  9832 

884 


Rocky  Mountain  Medical  Journal 


RELIABLE  DRUGGISTS 

PATRONIZE  DENVER’S  INDEPENDENT  DRUGGISTS 


WALTERS  DRUG  STORE 
801  COLORADO  BLVD. 
Denver,  Colorado 

'A 

Telephone  FRemont  5391 


lAJi30  to  i^u.^  at 

WEISS  DRUG 

PRESCRIPTION  SPECIALISTS 

☆ 

Colfax  and  Elm  Denver,  Colorado 

Phone  EAst  1814 


We  Recommend 

VAN'S  PHARMACY 

THOS.  A.  VANDERBUR 

Prescrlptlona,  Drags,  Cosmetics,  Magastnes 
Sundries  Excellent  Fountain  Service 

28S9  Umatilla  St.,  Cor.  2tMh  Ave.  at  Umatilla 
GRand  7044  Denver,  Colo. 


Dansberry’s  Pharmacy 
"New  Ultra  Modern  Prescription  Service” 
JAMES  F.  DANSBERRY 
Owner  and  Manager 

Champa  at  14th  Street  Denver,  Colorado 
Phone  KEystone  469 


WE  RECOMMEND 

LAKEWOOD  PHARMACY 

R.  W.  Holtgren,  Prop. 


PRESCRIPTION  SPECIALISTS 


West  Colfax  at  Wadsworth 
Lakewood  Colorado 

Phone  Lakewood  65 


Downing  Street  Pharmacy 

GEORGE  M.  HILL,  Prop. 

PROFESSIONAL  PHARMACIST 

901  Downing  St.  Denver,  Colo. 

Phone  CHerry  2767 

Complete  Merchandise  Line 
Free  Delivery  on  Prescriptions 


East  Denver’s  Prescription  Drug  Store 


DRUG  CO 


Bert  C.  Corgan,  Prop. 

3401  FRANKLIN  STREET 


KEystone  7241 


OVERSTAKE’S  PHARMACY 

Gail  E.  Overstake 
Prescription  Specialists 

DRUGS  — SUNDRIES  — 
COSMETICS  — CANDIES 

We  Deliver 

1000  So.  Gaylord  — RAce  4401 


Harl  Cleveland,  Owner 

CLEVELAND  PHARMACY 

VV.  29th  Ave.  at  Speer  Ph.  GL.  9272 

Modem  Prescription  Department 
Registered  Pharmacist 

Drugs  — Sundries  — Soda  Fountain 
HOURS:  Week  Days.  8 a.m.  to  10  p.m. 

Sundays,  10  am.  to  1 p.m.,  5 p.m.  to  9 p.m. 

Prescriptions  Delivered  Promptly 


PROFESSIONAL  MEN  RECOMMEND 


D.  MALCOLM  CAREY,  Pharmacist 

Phone  AComa  3711 

224  Sixteenth  Street  Denver,  Colorado 


for  October,  1949 


885 


4- 


nijr!§;e!§; 

OFFICIAL 

REGISTRY 

Established  to  Meet  the  Community’s 
Every  Need  for  Nursing  Care 
-K  -It  + 


jf^ifOiluction  .Si 


eruice 


GRADUATE  REGISTERED  NURSES* 

Hourly  Nursing  Service  Positions 
Filled — Information  on  All 
Nursing  Service 

This  registry  is  endorsed  by  the 
Colorado  State  Graduate  Nurses’ 
Association  and  American  Nurses’ 
Association 
-It  -K  -K 

Undergraduates  and  Practical  Nurses 
Furnished  Upon  Request 

KEystone  0168 

ARGONAUT  HOTEL 


ELECTROTYPES 

MATRICES 

STEREOTYPES 

PRINTING 

TYPOGRAPHY 


rn 


Denver  - 
New  York  - 
Chicago  - - 


n 


ewipape^ 


r U 


nion 


- - 1830  Curtis  St. 

- - - 310  East  45th  St. 

- - 210  So.  Desplaines  St. 


And  33  Other  Cities 


+ 


Stodghiirs  Imparial  Pharmacy 

Prescriptions  Exclusively 

For  your  prescriptions  we  stock  a complete  line  of  ALMAY — non-allergic— cosmetics. 

Five  Pharmacists 

319  16th  St.  TAbor  4231  Denver,  Colo. 


COLVm-Medical  Rooks 

Medical  Publications  of  All  Publishers 
Books  Sent  for  Examination  on  Request 
We  Maintain  This  Book  Store  for  Your  Convenience 
Books  Make  Fine  Christmas  Gifts 
Write  or  Come  to 
705-706  MAJESTIC  BUILDING 

Denver  2,  Colorado  Call  MAin  3866 


* Preferred  and  Common  Stocks 

* Industrial  Bonds 

* Public  Utility  Bonds 

* Railroad  Bonds 

* Municipal  Bonds 

* Government  Bonds 

Peters,  Writer  & Christensen  Inc. 

Investment  Bankers 

601-8  U.  S.  National  Bank  Bldg.,  Denver  MAin  6281  ^ 


886 


Rocky  Mountain  Medical  Journal 


Index  to  Advertisers 

Page 

Page 

Page 

Abbott  Laboratories 

859 

Ehret  Engraving  Co. 

804 

Professional  Pharmacv 

.885 

Alba  Dairy 

879 

Fairfax  Sanitarium 

881 

Restaurant  240 

-880 

American  Medical  and  Dental 

Fairhaven  Maternity 

Roberts  Pharmacy 

.884 

Association 

800 

796 

Roche  Ambulance  Service 

.880 

Ames  Company,  Inc. 

853 

Fleet,  C.  B.  Company,  Inc. 

808 

Roedel’s  Prescription  Drug 

.883 

Ayerst,  McKenna  & Harrison_857 

Franklin  Drug  Company 

885 

Sphering  Corporation 

-799 

Baker  Laboratories,  Inc. 

867 

Glockner  Penrose  Hospital 

881 

Schmid,  Julius,  Inc. 

.873 

Blair  X-Ray  Supply 

877 

Hyde’s  Pharmacy 

884 

Searte,  G.  D.  & Co.  _ 

.849 

Bonita  Pharmacy 

883 

Jackson’s  Cut  Rate  Drug 

880 

Shadel  Sanitarium 

.861 

Bonnle-Brae  Drug 

884 

880 

Shadford-Fletcher  Optical  Co. 

.802 

Brown  Schools 

878 

Kendrick-Bellamy  Co. 

794 

Shumake  Drug’,  Guido 

-884 

Burroughs  Wellcome  & 

Co. — 805 

Kincaid’s  Pharmacy 

884 

Smith-Dorsey  Co.,  The.Cover 

III 

Cambridge  Dairy 

796 

Lakewood  Pharmacy 

885 

Squibb,  E.  R.  & Sons 

.807 

Camel  Cigarette 

797 

Lederle  Laboratories 

803 

Stodghill’s  Imperial 

Camp  & Co.,  S.  H. 

865 

Lilly,  Eli  & Co. 

Pharmacy 

.886 

Insert  Between  808- 

809 

Capital  Chevrolet 

876 

Telephone  Answering  Service 

-796 

L/ivermore  Sanitarium 

882 

Cascade  Laundry 

880 

Thornton,  George  R. 

.794 

Luzfer’s,  Inc. 

869 

Children’s  Hospital  Assn 

888 

Tours  Hotel 

.879 

Malone  Drug  Store 

883 

City  Park  Dairy 

802 

United  States  Brewing 

Mead.  Johnson  & Co.  Cover  IV 

Industry 

.872 

Cleveland  Pharmacy 

885 

Medical  Center  Pharmacy 

879 

Upjohn  Company,  Th'e 

-855 

Colburn  Hotel 

880 

Morning'  Milk 

875 

Van’s  Pharmacy 

.885 

Colorado  Springs 

Psychopathic  Hospital 

883 

Nepera  Chemical  Company 

871 

Walter’s  Drug  Store 

.885 

Colvin  Medical  Books 

886 

Newton  Optical  Company 

874 

Wander  Company 

_8’63 

Cook  County  Graduate 

Nurses  Official  Registry 

886 

Wantads 

-874 

School  of  Medicine 

876 

Otto  Drug'  Co. 

884 

Weiss  Drug 

.885 

Country  Club  Pharmacy 

884 

Overstake's  Pharmacy 

885 

Weiss,  Paul 

.881 

Cutter  Laboratories 

851 

Park,  Floral  Company 

804 

Western  Electric 

Dansberry’s  Pharmacy 

885 

Hearing  Aids 

.881 

Parke,  Davis  & Co Cover  II- 

793 

Deep  Rock  Water 

879 

Western  Newspaper  Union 

.886 

Peters,  Writer  & Christensen, 

Denver  Oxygen  Co. 

804 

•Inc. 

886 

Wheatridge  Farm  Dairy 

.874 

Denver  Surgical  Supply 

Co.__874 

Physicians  and  Surgeons 

Whittaker’s  Pharmacy 

.884 

Dorr  Optical  Co. 

806 

Supply 

879 

Wlnthrop-Stearns,  Inc. 

.795 

Downing  Street  Pharmacy 885 

Physicians  and  Surgeons 

Woodcroft  Hospital 

.888 

Doyle’s  Pharmacy 

884 

Telephone  Service  Exch 

874 

Wj^eth,  Incorporated 

.801 

Earnest  Drug  Company 

884 

Physicians  Casualty  Assn 

878 

York  Pharmacy 

.883 

for  October,  1949 


887 


lAJooclci*o^t  J^oApitai—jPueLio^  C^oiorado 

A private  hospital  for  the  scientific  treatment  of  neuro-psychiatric  disorders,  including 
alcoholism  and  drug  addiction.  Beautiful  landscaping  and  home-like  surroundings  afford 
a restful  atmosphere.  Accommodations  vary  from  single  rooms  with  or  without  bath  to 
rooms  en  suite,  allowing  for  segregation  of  guests. 


Detailed  information  furnished  on  request. 


Karl  J.  Waggener,  M.D. 


Wendell  T.  Wingett,  M.D. 


THE  CHILDREN’S  HOSPITAL  ASSOCIATION 

of  DENVER 

NON-SECTARIAN NON-PROFIT 

Providing  medicinal  and  surgical  aid  to  sick  and  crippled  children  of  the  Rocky 
Mountain  Region  from  Birth  to  Maturity 

Every  modern  scientific  aid  available  to  the  physicians  and  surgeons 
of  Colorado  and  Wyoming 

Approved  by  the  American  Medical  Association  and  Full  Three-Ye^r 

the  American  College  of  Surgeons  Nurses’  Training  Course 


888 


Rocky  Mountain  Medical  Journal 


FOLLOWING  a parallel  route  to  a similar 
destination,  the  ethical  pharmaceutical 
maker  necessarily  keeps  the  progress  and 
direction  of  scientific  medicine  constantly 
in  view. 

For  a closer  look  at  medicine’s  progress 
and  full  comprehension  of  its  implications, 
the  Smith-Dorsey  Company  has  expanded 
its  research  facilities,  secured  increased  re- 
search grants  and  added  research  personnel. 


Supplements  the  sun... 
removes  the  shadow 


of  RICKETS 


Rickets  may  be  found  in  apparently  healthy  and  well  nourished  infants 
due  to  an  insufficient  intake  of  vitamin  D plus  inadequate  exposure  to  ultraviolet  rays. 
It  is  now  generally  accepted  that  a vitamin  D supplement  should  be  given  regularly 
not  only  to  infants  but  to  older  children  and  adolescents.  Mead’s  Oleum  Percomorphum 
With  Other  Fish  Liver  Oils  and  Viosterol  is  useful  for  this  purpose. 


Mead’s  Oleum  Percomorphum 

1.  Is  a highly  potentf  source  of  natural  vita- 
mins A and  D. 

2.  May  be  given  in  drop  doses  that  are  easily 
administered  and  well  tolerated,  and  is  sup- 
plied in  capsule  form  also. 

3.  Has  a background  of  sixteen  years  of  suc- 
cessful cUnical  use. 

tPotency:  60,000  U.S.P.  units  of  vitamin  A and  8500 
U.S.P.  units  of  vitamin  D per  gram.  Each  drop  sup- 
plies 1250  units  of  vitamin  A and  180  units  of  vitamin 
D;  each  capsule,  5000  units  of  vitamin  A and  700  units 
of  vitamin  D. 

Supplied  in  10  cc.  and  50  cc.  bottles;  and  in  bottles 
of  SO  and  250  capsules. 


Speculum  Medici — Reginald  Fitz,  M.D.,  Boston. 

Otology  in  General  Practice — Herman  I.  Laff, 
M.D.,  Denver. 

Highlights  of  Public  Health  Progress  in  Colo- 
rado (a  Symposium) — Roy  L.  Cleere,  M.D., 
Denver;  Robert  A.  Dovms,  D.D.S.,  Denver; 
Martin  D.  Baum,  D.V.M.,  Denver;  J.  A.  King, 
Denver;  Roland  H.  Loder,  M.D.,  Greeley. 

Trichomoniasis  in  the  Male — Raymond  L.  Young, 
M.D.,  Santa  Fe. 

Isotopes  and  the  New  Alchemy — Thad  P.  Sears, 
M.D.,  Fort  Logan,  and  Kenneth  D.  A.  Allen, 
M.D.,  Denver. 

Medicolegal  Aspects  of  Radiation  Injury  and 
Biologic  Aspects  of  Atomic  Energy — Shields 
Warren,  M.D.,  Boston. 

Utah  House  of  Delegates — Minutes  of  the  An- 
nual Session. 

{For  Complete  Table  of  Contents, 

Turn  the  First  Page) 


I 


25c  Per  Copy 


$2.50  Per  Year 


A “superior”  compound 
among  the  nearly 
IQOO  antiluetics  studied  by 
Ehrlich,*  an 
antispirochetal  agent 
distinguished  by 


more  than  a decade  of 
clinical  successes, 
the  trivalent  arsenoxide 
MAPHARSEN  is  an  arsenical  of 
choice  in  the 
treatment  of  syphilis. 


MAPHARSEN 


an 

arsenical  of 
choice 

in  the  treatment 
of 

syphilis 


The  antiluetic  structure  of 

MAPHARSEN  symbolizes 

consistently  high  therapeutic  efficacy 

and  consistently  low  relative 

toxicity,  as  attested 

by  more  than  two  hundred  million 

injections  and  extensive 

serological  follow-ups.  mapharsen 

is  valuable,  either  alone  or 

with  penicillin,  in'  syphilotherapy  schedules 

of  all  three  familiar  types— 

intensive,  intermediate,  prolonged. 


MAPHARSEN  ( oxophenarsine  hydrochloride,  P.  D.  & 
is  supplied  in  single  dose  ampoules  of 
0.04  Gm.  and  0.06  Gm.,  boxes  of  10;  and  in 
dose  ampoules  of  0.06  Gm.  in  boxes  of  10. 
’Krantz.  J.  C.,  Jr.,  and  Carr,  C.  J.: 

Pharmacologic  Principles  of  Medical  Practice, 
Williams  & Wilkins  Co., 

^ Baltimore,  1949,  pps.  114-119. 


CO 


N 


ft 


Christmas 

Gift 

Suggestions 


Good  Books  for  Your  Good  Friends, 


And  for  Your  Own  Library — 

“Life  Among  the  Doctors” — 

Paul  De  Kruif  -...$4.75 

“Autobiography  of  Will  Rogers”..  3.50 

“The  Mature  Mind” — 

H.  A Overstreet  2.95 

“Out  of  My  Life  and -Thought” — 

Albert  Schweitzer  3.50 

“The  Conquerors”  (The  Pageant 
of  England)  — 

Thomas  B.  Costain 4.00 

“Mary” — Sholem  Asch  3.50 


Come  in.  Phone  or  Mail  Your  Order; 


Use  Your  Charge  Account 

The  Book  Store  of  Denver 

KEystone  0241 

1641  California  Sf.  Denver  2,  Colorado 


QeO:  d.  ^UoA4tta*i 

Orthopedic  Brace 
and  Appliance  Co. 

1628  Court  Place  MAin  3026 

Write  for  Measuring  Chart 


Table  of  Contents 

VOLUME  46  NUMBER  11 

NOVEMBER,  1949 


Editorials 

I Am  the  State 905 

Ringworm  of  the  Scalp 905 

The  British  National  Health  Service 906 

-f 

Original  Articles 

Speculum  Medici,  Reginald  Fitz,  M.D 908 

Otology  in  General  Practice,  Herman  I. 

Laff,  M.D 914 

Present  Administrative  Organization  and 

New  Programs,  Roy  L.  Cleere,  M.D 918 

Some  Phases  of  the  Program  of  Public 
Health  Dentistry,  Robert  A.  Down,  D.D.S.  921 
Colorado  Veterinary  Public  Health  Pro- 
gram, Martin  D.  Baum,  D.V.M 923 

The  Sanitation  Program  in  Colorado,  J.  A. 

King  924 

Local  Health  Departments  and  the  Physi- 
cian, Roland  H.  Loder,  M.D 926 

Trichomoniasis  in  the  Male,  Raymond  L. 

Young,  M.D 928 

Isotopes  and  the  New  Alchemy,  Thad  P. 
Sears,  M.D.,  and  Kenneth  D.  A.  Allen, 

M.D 931 

Medicolegal  Aspects  of  Radiation  Injury, 

Shields  Warren,  M.D 936 

Biologic  Aspects  of  Atomic  Energy,  Shields 
Warren,  M.D 937 

Case  Report 

Ethylene  Disulfonate  and  Hemolytic  Dis- 
ease of  the  Newborn,  David  R.  Bar  glow, 

M.D 938 

Obstruction  of  the  Bowel  Due  to  Gall- 
stone, N.  L.  Beebe,  M.D 940 

■f 

C or  respondence 

A General  Practitioner  Approves 942 

Requests  Help  in  Twin  Study 942 

Book  Review  Questioned 942 

-f 

Organization 

National  Affairs  944 

Colorado 

Official  Notice  of  Rules  of  the  Board  of 
Supervisors  of  the  Colorado  State  Med- 
ical Society  — - 944 


New  Licenses  Issued  in  October,  1949-...  948 
Policy  in  Regard  to  the  Handling  of 
Cases  of  Acute  and  Late  Effects  of 
Acute  Anterior  Poliomyelitis  in  Colo- 


rado - - 948 

Postgraduate  Course  on  Principles  of 

Inhalation  Anesthesiology  950 

Obituaries  - ■ 950 

Auxiliary,  President’s  Message 952 

New  Mexico 

Board  of  Supervisors 954 

Obituaries  954 

Montana 


Reports  Presented  at  the  Annual  Meeting  954 
Utah 

Minutes  of  the  Fifty-Fifth  Annual  Meet- 


ing   972 

Obituary  986 

Utah  Medical  School  Notes 986 


890 


Rocky  Mountain  Medical  Journal 


ANTACID  MAINTENANCE 


Creamalin,  the  first  aluminum  hydroxide 
gel,  readily  and  safely  produces  sustained 
reduction  in  gastric  acidity.  With  Creamalin 
there  is  no  compensatory  reaction  by  the 
gastric  mucosa,  no  acid  "rebound,"  and  no 
risk  of  alkalosis.  Through  the  formation  of 
a protective  coating  and  a mild  astringent 
effect,  nonabsorbable  Creamalin  soothes 
the  irritated  gastric  mucosa.  Thus  it  rapidly 


relieves  gastric  pain,  speeds  healing  of  pep- 
tic ulcer  and  helps  to  prevent  recurrence. 
Average  dose:  Peptic  ulcer,  2 to  4 tea- 
spoonfuls (or  tablets  or  capsules)  with  a 
little  milk  or  water  every  two  to  four  hours. 
Dyspepsia:  2 teaspoonfuls  (or  tablets  or 
capsules)  one-half  to  one  hour  after  meals. 

WINTHROP-STEARNS  INC. 

New  York  13,  N.  Y.,  Windsor,  Ont. 


Creamalin  liquid  N.N.R.  (peppermint  flavored)  in 
bottles  of  8,  12  and  16  fl.  oz. 

Creamalin  tablets  (not  N.N.R.),  tins  of  12,  bottles 
of  50  and  200.  Creamalin  capsules  (not  N.N.R.), 
bottles  of  24  and  100.  Each  tablet  or  capsule  is 
equivalent  to  1 teaspoonful  of  Creamalin  liquid. 


TIME  TESTED  ALUMINUM  HYDROXIDE  GEL 


Creamalin,  trademark  reg.  U.  S.  & Canado 


ROCKY  MOUNTAIN  MEDICAL  JOURNAL 

Title  Registered,  U.S.  Patent  Office 
Publication  Office: 

835  Republic  Building  (1612  Tremont  Place),  Denver  2,  Colorado 
Telephone  C Kerry  5521. 

EDITORIAL  BOARD 

Colorado:  Douglas  W.  Macomber,  M.D.,  Scientific  Editor,  1820  Gilpin  St.,  Denver;  Lyman  W.  Mason, 
M.D.,  Associate  Editor,  1214  Republic  Bldg.,  Denver,  (Chairman  of  Editorial  Board). 

Montana:  Raymond  F.  Peterson,  M.D.,  Scientific  Editor,  Butte,  Mont.;  Herbert  T.  Caraway,  M.D., 
Associate  Editor,  Billings,  Mont. 

New  Mexico:  Carl  H.  Gellenthein,  M.D.,  Scientific  Editor,  Valmora,  New  Mexico;  Harold  L.  Janu- 
ary, M.D.,  Associate  Editor,  First  National  Bank  Bldg.,  Albuquerque,  New  Mexico. 

Utah:  Richard  P.  Middleton,  M.D.,  Scientific  Editor,  Boston  Bldg.,  Salt  Lake  City;  W.  H.  Tibbals, 
Associate  Editor,  42  South  Fifth  East  St.,  Salt  Lake  City. 

Wyoming:  Earl  Whedon,  M.D.,  Scientific  Editor,  Sheridan;  Arthur  R.  Abbey,  Associate  Editor,  P.O. 
Box  897,  Cheyenne. 


Managing  Editor:  Harvey  T.  Sethman,  835  Republic  Bldg.,  Denver. 
Business  Manager:  Helen  Kearney,  835  Republic  Bldg.,  Denver. 


Ownership  and  Sponsorship:  The  Rocky  Mountain 
Medical  Journal  Is  owned  by  the  Colorado  State 
Medical  Society  and  is  published  monthly  as  a non- 
profit enterprise  for  the  mutual  benefit  of  the  or- 
sranlzatlons  which  jointly  sponsor  it.  It  is  published 
under  the  direction  of  the  Board  of  Trustees  of  the 
Colorado  State  Medical  Society,  assisted  by  an  Edi- 
torial Board  representing-  the  sponsoring  organiza- 
tions. It  Is  the  Official  Journal  of  the  Colorado  State 
Medical  Society,  the  Montana  State  Medical  Associa- 
tion, the  New  Mexico  Medical  Society,  the  Utah 
State  Medical  Association,  the  Wyoming  State  Medi- 
cal Society,  the  Rocky  Mountain  Medical  Conference, 
and  the  Colorado  Hospital  Association. 

Manuscripts:  Scientific  Articles,  Case  Reports,  etc., 
from  any  state  for  which  this  is  the  Official  Journal 
should  be  submitted  to  the  Scientific  Editor  for  that 
state  as  named  in  the  Editorial  Board,  above.  Other 
material  from  any  participating  state  should  be  sub- 
mitted to  the  Associate  Editor  for  that  state  as 
named  above.  Manuscripts  from  outside  the  Rocky 
Mountain  area  should  be  sent  direct  to  the  Journal 
office.  Manuscripts  must  be  typewritten,  double  or 
triple  spaced,  using  only  one  side  of  each  sheet.  It 
is  the  policy  of  this  Journal  to  omit  bibliographies. 


Advertising;  National  representatives:  The  Coop- 
erative Medical  Advertising  Bureau,  535  North  Dear- 
born Street,  Chicago  10,  111.  Local  advertising  from 
firms  in  the  Rocky  Mountain  area  should  be  submit- 
ted to  the  Associate  Editor  of  the  appropriate  state 
or  to  the  Journal  office.  Advertising  forms  close  on 
the  20th  of  the  month  preceding  publication;  allow 
ten  days  additional  to  insure  submitting  proofs  for 
approval. 

Subscription:  |2.50  per  year  in  advance,  postpaid  in 
the  United  States  and  its  possessions;  single  copy, 
25  cents  plus  postage.  Subscription  is  included  in 
medical  society  dues  of  sponsoring  state  medical 
organizations. 

Copyright:  This  Journal  is  copyright,  1949,  by  the 
Colorado  State  Medical  Society.  Requests  for  permis- 
sion to  reproduce  anything  from  the  columns  of  this 
Journal  should  be  addressed  to  the  Journal  office. 

Second  Class  Matter:  Entered  as  second  class  mat- 
ter Jan.  22,  1906,  at  the  Postoffice  at  Denver,  Colo., 
under  the  Act  of  Congress  of  March  3,  1879.  Accepted 
for  mailing  at  special  rates  of  postage  provided  for 
in  (Section  1103,  Act  of  Oct.  3,  1917;  authorized  July 
17,  1918. 


The  Fairhaven  Maternity  Hospital 

Mrs.  H.  E.  Lowther,  Superintendent 

Seclusion  for  the  unwed  mother.  Write  for  descriptive  booklet. 

1349  JOSEPHINE  DExter  1411  DENVER 


Don't  miss  important  telephone  calls 

Let  us  act  as  your  secretary  while  you  are  away,  day  or  night: 
our  kindly  voice  conscientiously  tends  your  telephone  business, 
^ accurately  reports  to  you  when  you  return. 

Telephone  ANSWERING  Service  CALL  ALpine  1414 


Cambridge  Dairy  Grade  “A”  Milk  Is  Produced  and  Processed  at  690  S.  Colo.  Blvd. 

We  do  not  handle  Shipped-in  Milk  produced  Where?  How  and  by  Whom?  Doctors  know  the  difference 
Now  Homogenized  Vitamin  D Milk  is  available  for  baby  feeding  and  family  use. 

We  Invite  Your  Inspection  and  Appreciate  Your  Recommendation. 


THROAT  SPECIALISTS  REPORT  ON  30-DAY  TEST 
OF  CAMEL  SMOKERS- 


Yes,  these  were  the  findings  in  a 
total  of  2,470  weekly  examina- 
tions of  hundreds  of  men  and  women 
from  coast-to-coast  who  smoked  only 
Camels  for  30  consecutive  days!  And 
the  smokers  in  this  test  averaged  one 
to  two  packages  of  Camels  a day! 


R.  J.  Reynolds  Tobacco  Co..  Winston-Salem.  N.  C. 


According  to  a Nationwide  survey; 

MORE  DOCTORS 
SMOKE  CAMELS 

than  any  other  cigarette! 

Doctors  smoke  for  pleasure,  too!  When  three 
leading  independent  research  organizations 
asked  113,597  doctors  what  cigarette  they 
smoked,  the  brand  named  most  was  Camel! 


for  November,  1949 


893 


THE  COLORADO  STATE  MEDICAL  SOCIETY 


Next  Annual  Session:  Broadmoor  Hotel,  Colorado  Springs,  September  20,  21,  22,  23,  1950 


OFFICERS 

Terms  os  Officers  and  Committees  esrpire  at  the  Annual  Session 
in  the  year  indicated.  Where  no  year  is  indicated,  the  term 
is  for  one  year  only  and  expires  at  the  1950.  Annual  Session. 

President;  Fred  A.  Humphrey,  Fort  Collins. 

President-Elect:  Ervin  A.  Hinds,  Denver. 

Vice  President:  A.  B.  Gjellum.  Del  Norte. 

Constitutional  Secretary  (three  years) : George  R.  Buck,  Denver,  1951. 
Treasurer  (three  years) : George  C.  Shivers,  Colorado  Springs,  1950. 

Additional  Trustees  (three  years) ; Samuel  P.  Newman,  Denver,  1950; 

Claude  D.  Bonham,  Boulder,  1951;  Cyrus  W.  And  rson,  Denver,  1952; 

B.  H.  Miinro,  Grand  Junction,  1952. 

(The  above  nine  officers  compose  the  Board  of  Trustees  of  wliich  Dr. 
Samuel  P.  Newman  is  the  1949-1950  Chairman.) 

Board  of  Councilors  (three  years);  District  No.  1;  Clemens  F.  Eakins, 
Brush,  1951;  No,  2:  Ella  A.  Mead,  Greeley,  1951;  No.  3:  L.  G.  Crosby, 
Denver,  1951  (Chairman  of  Board  tor  1949-50);  No.  4:  Banning  E. 
Likes,  Lamar,  1950;  No.  5:  Guy  H.  Hopkins,  Pueblo,  1950;  No.  6:  C.  Rex 
Fuller,  Salida,  1950;  No.  7,  Leo  W.  Lloyd,  Durango,  1952;  No,  8;  Arch 

H.  Gould,  Grand  Junction,  1952;  No.  9:  Marvel  L.  Crawford,  Steamboat 
Springs,  1952. 

Board  of  Supervisors  (two  years):  L.  D.  Buchanan,  Wray,  1950;  W.  F. 
Deal,  Craig,  1950;  G.  C,  Cary,  Grand  Junction^  1950,  Chairman;  W,  A. 
Campbell,  Colorado  Springs,  1950;  Ralph  S,  Johnston,  Sr.,  La  Junta,  1950; 
William  A,  Liggett,  Denver,  1950,  Secretary;  Edgar  A.  Eliff,  Sterling, 

1951;  Keith  F,  Krausnick,  Lamar,  1951;  Charles  L.  Mason,  Durango, 

1951;  Ira  L.  Howell,  Alamosa,  1951;  Howard  H.  Heuston,  Boulder,  1951; 
George  M.  Myers,  Pueblo,  1951. 

Delegates  to  American  Medical  Association  (two  years) : William  H. 
Halley,  Denver,  1950;  (Alternate:  Kenneth  C,  Sawyer,  Denver,  1950); 
George  A.  Unfug,  Pueblo,  1951;  (Alternate:  Herman  C.  Graves,  Grand 
Junction,  1951). 

Foundation  Advocate:  Walter  W.  King,  Denver. 

Executive  Office  Staff:  Mr.  Harvey  T.  Sethman,  Executive  Secretary: 
Miss  Helen  Kearney.  Assistant  Executive  Secretary;  Mr.  Evan  A.  Edwards, 
Public  Relations  Director  and  Field  Secretary,  835  Republic  Building, 
Denver  2.  Colorado,  Telephone  CHerry  5521. 

General  Counsel;  Mr.  J.  Peter  Nordlund,  Attomey-at-Law.  Denver. 


STANDING  COMMITTEES 

Credentials:  George  R.  Buck,  Denver,  Chairman;  others  to  be  appointed. 

Public  Policy:  M.  L.  Phelps,  Denver,  Chairman;  C.  F.  Hegner,  Denver; 

I.  E.  Hendryson,  Denver,  Vice  Chairman;  F.  B.  McGIone,  Denver;  W.  R. 
Lipscomb,  Denver;  T.  M.  Rogers,  Sterling;  Sidney  Anderson,  Alamosa; 
Harvey  M.  Tupper,  Grant  Junction;  C.  S.  Gydesen,  Colorado  Springs;  E.  L. 
Davis,  La  Junta:  R.  T.  Porter,  Greeley;  G.  C.  Milligan,  Englewood:  Francis 
S.  Adams.  Pueblo;  Ex-Officio  Members:  F.  A.  Humphrey,  Fort  Collins,  Presi- 
dent; Ervin  A.  Hinds,  Denver,  President-Elect;  George  R.  Buck,  Denver, 
Constitutional  Secretary. 

Sub-Committee  on  Legislation;  John  B.  Farley,  Pueblo,  Chairman. 

Sabcomniittec  on  Nurses’  Education:  L.  R.  Safarik,  Denver.  Chairman: 
John  R.  Evans,  Co-chairman;  Frank  B.  McGIone,  Denver;  Harry  C.  Bryan, 
Colorado  Springs;  Robert  T.  Porter,  Greeley. 

Subcommittee  on  Planning  for  the  State  Health  Council:  Monroe  Tyler, 
Chairman.  Denver;  V.  V.  Anderson,  Del  Norte;  T.  M.  Rogers,  Sterling: 
James  W.  Lewis,  Colorado  Springs;  Paul  E.  Tramp,  Loveland;  Harold 

E.  Haymond,  Greeley;  Robert  D.  Schilling,  Pueblo;  Paul  B.  Stidham,  Grand 
Junction;  Carl  J.  Gilman,  Boulder;  Fred  A.  Humphrey,  Fort  Collins;  Roger  G. 
Hewlett,  Golden;  James  R.  Blair,  Denver;  Harry  C.  Hughes,  Denver;  Samuel 
P.  Newman,  Denver;  Wm.  R.  Lipscomb,  Denver;  Ward  Darley,  Denver;  Roy 
L.  Cleere,  Denver;  A.  C.  Sudan,  Denver. 

Health  Education  (two  years):  E.  H.  Munro,  Grand  Junction,  1950; 

F.  0.  Robertson,  Denver,  1950;  R.  B.  Bradshaw,  Alamosa,  1950;  James 
A.  Matson,  Denver,  1950.;  Miss  Norma  Johannis,  Denver,  1950;  H.  T. 
Low,  Pueblo,  1950;  J.  D.  Bartholomew,  Boulder,  Chairman,  1951;  A.  C. 
Sudan,  Denver,  1951;  R.  J.  Savage,  Denver,  1951. 

Sub-Committee  on  Weekly  Health  Column:  J.  L.  Campbell,  Denver,  Chair- 
man: F.  C.  Campbell,  Denver;  E.  L.  Binkley,  Denver;  H.  F.  Bramley, 
Denver. 

Scientific  Work:  Terry  J.  Gromer,  Denver,  Chairman;  William  B.  Condon, 
Denver;  Robert  S,  Liggett,  Denver;  E.  L.  Binkley.  Jr.,  Denver;  T.  E.  Best, 
Denver;  James  M.  Perkins,  Denver;  Joseph  H.  Patterson,  Denver, 

Arrangements:  To  be  appointed. 


Medicolegal  (two  years):  R.  W.  Arndt,  Denver,  1950;  George  B.  Packard, 
Denver,  1950;  K.  D.  A.  Allen,  Denver,  1950;  C.  S.  Bluemel,  oDenver, 
Chairman,  1951;  Lyman  W.  Mason,  Denver,  1951;  Atha  Thomas,  Denver, 
1951. 

Medichl  Education  and  Hospitals;  Fred  H.  Hartshorn,  Denver,  Chairman; 
George  F.  Wollgast,  Denver;  Kenneth  C.  Sawyer,  Denver;  James  E.  Hutchison. 
Denver;  Robert  S.  Liggett,  Denver;  Henry  Swan,  Denver;  J.  B.  McNaught, 
Denver.  Ex-Officio  Members:  F.  A.  Humphrey,  Fort  Collins,  President, 

C.S.M.S.;  Ervin  A.  Hinds,  President-Elect,  C.S.M.S.;  Mr.  Hubert  W.  Hughes, 
Denver,  President,  Colo.  Hosp.  Assoc.;  Ward  Darley,  Dir.  of  the  Univ.  of 

Colo.  Medical  Center. 

Library  and  Medical  Literature:  W.  W.  King,  Denver,  Chairman;  A.  J. 
Markley,  Denver;  T.  E.  Beyer,  Denver. 

Medical  Service  Plans:  James  R.  Blair,  Denver,  Chairman;  F.  H.  Good, 
Denver;  Henry  A.  Buchtel,  Denver;  T.  K.  Mahan.  Grand  Junction;  V.  L. 

Bolton,  Colorado  Springs ;Scott  A.  Gale,  Pueblo;  L.  W.  Holden,  Boulder; 

J.  A.  Weaver,  Jr.,  Greeley. 

Necrology:  R.  C.  Chatfield,  Denver.  Chairman. 


PUBLIC  HEALTH  COMMITTEES 

General  Committee  on  Public  Health;  Consists  of  the  chairmen  of  the 
following  eight  public  health  sub-committees,  presided  over  by  James  S. 
Cullyford,  Denver,  as  General  Chairman. 

Cancer  Control:  Stanley  K.  Kurland,  Denver,  Chairman;  J.  C.  Mendenhall, 
Denver:  L.  E.  Likes,  Lamar;  Robert  K.  Brown,  Denver;  James  B.  McNaught, 
Denver. 

Tuberculosis  Control:  John  I.  Zarit,  Denver,  Chairman;  W.  J.  Hinzelman, 
Greeley;  J.  P.  McGraw,  Pueblo. 

Sanitation:  H.  D.  Palmer,  Denver,  Chairman;  G.  W.  Stiles.  Denver; 
S.  W.  Downing,  Denver. 

Rural  Health  and  Health  Units;  Robert  M.  Lee,  Fort  Collins,  Chairman: 
L.  N.  Myers,  Cheyenne  Wells;  M.  E.  Tyler,  Denver. 

Industrial  Health:  R.  F.  Bell,  Louviers,  Chairman:  David  W.  Boyer, 
Pueblo:  Nicholas  S.  Saliba,  Walsenburg;  Frank  Princl,  Denver. 

Maternal  and  Child  Health:  J.  L.  Sadler,  Fort  Collins,  Chairman;  J.  H. 
Amesse,  Denver;  J.  D.  Whitmore,  Denver. 

Rehabilitation  and  Crippled  Children:  H.  C.  Hughes,  Denver,  Chairman: 
Lewis  Barbato,  Denver;  M.  G.  Nims,  Denver;  W.  W.  Haggart,  Denver; 
R.  H.  Mellen,  Colorado  Springs;  John  Nelson,  Denver. 

Mental  Hygiene:  F.  H.  Zimmerman,  Pueblo,  Chairman;  Bradford  Murphey, 
Denver;  J.  M.  Lyon,  Denver. 


SPECIAL  COMMITTEES 

Rocky  Mountain  Medical  Conference  (five  years) : D.  W.  Macomber, 
Denver,  1954;  L.  Clark  Hepp,  Denver,  1953;  G.  P.  Lingenfelter,  Denver, 
Chairman,  1952;  Ward  Darley,  Denver.  1951;  L.  W.  Bortree,  Colorado 
Springs,  1950. 

Advisory  to  Auxiliary:  Ervin  A.  Hinds,  Denver,  Chairman;  Samuel  P. 
Newman,  Denver;  M.  L.  Phelps,  Denver. 

Medidal  Disaster  Commission:  Foster  Matchett,  Denver,  Chairman;  0.  S. 
Philpott,  Denver,  Vice  Chairman;  Karl  F.  Arndt,  Denver,  Secretary;  Harry 
C.  Hughes,  Denver;  R.  J.  McDonald,  Denver;  Karl  F.  Sunderland,  Denver; 
Henry  Swan,  Denver;  Rudolph  E.  Glehm,  Denver;  William  S.  Curtis,  Denver; 
M.  S.  Donovan,  Denver;  T.  P.  Sears,  Fort  Logan.  Others  to  be  appointed. 

Advisory  to  U.M.W.  Welfare  Fund  (Executive  Committtee,  three-year 
terms;  others,  one  year);  Executive:  Ligon  Price,  Hayden,  1952;  J.  H. 
Lamme,  Walsenburg,  1952;  W.  W.  Haggart,  Chairman,  1951;  F.  H.  Good, 
1951;  J.  S.  Bouslog,  1951,  all  of  Denver;  W.  H.  Halley,  1950;  C.  F. 
Hegner,  1950.,  both  of  Denver;  R.  F.  BeU,  1950,  Louviers.  Other  mem- 
bers; D.  W.  McCarty,  Longmont,  1950:  J.  W.  Craighead,  Pueblo,  1950; 
F.  A.  Humphrey,  Fort  Collins,  1950;  Millard  F.  Smith,  Trinidad,  1950. 

A.M.A.  Educational  Campaign:  John  S.  Bouslog,  Chairman;  A.  E.  Lub- 
chenco.  Vice  Chairman;  Ervin  A.  Hinds,  George  R.  Buck,  McKinnie  L. 
Phelps,  William  H.  Halley,  all  of  Denver,  plus  one  member  from  each 
component  society  appointed  by  that  society  (names  to  be  added  here 
next  month). 

Delegate  to  Colorado  Interprofessional  Council  (five  years) : L.  R. 
Safarik,  Denver,  1954;  (Alternate,  J.  R.  Evans,  Denver,  1954). 

Representative  to  Rocky  Mountain  Radio  Council;  I.  E.  Hendryson,  Denver. 

Representatives  to  Adult  Education  Council:  Cyrus  W.  Anderson  and 
Miiliam  E.  Hay,  both  of  Denver. 


894 


Rocky  Mountain  Medical  Journal 


By  intravenous 
injection,  Neo-Iopax* 
provides  not  only  a “bright 
urogram”  that  permits  accurate 
diagnosis,  but  also  significant  free- 
dom from  severe  systemic  reactions. 
Sterile,  crystal  clear  and  containing  no  for- 
eign particles,  Neo-Iopax  has  justly  earned  its 
enviable  record  for  relative  safety  among , uro- 
graphic  agents. 


NEO-IOPAX 

(brand  of  sodium  iodomethamate) 


When  retrograde  pyelography  is  indicated,  Neo-Iopax  will  also  be  chosen 
because  it  is  nonirritating  to  delicate  urinary  tract  membranes. 


CORPORATION  • BLOOMFIELD,  N.  J. 


NEO-IOPAX 


MONTANA  STATE  MEDICAL  ASSOCIATION 

NEXT  ANNUAL  SESSION:  BOZEMAN,  MONTANA,  SUMMER,  1950 


OFFICERS,  1949-1950 

Terms  of  Officers  and  Committees  expire  at  the  Annual  Session 
In  the  year  indicated.  Where  no  year  is  indicated,  the  term 
is  for  one  year  only  and  expires  at  1950  Annual  Session. 

President;  Thomas  F.  Walker,  Great  Falls. 

President-Elect:  C.  H.  Fredrickson,  Missoula. 

Vico  President:  F.  L.  McPhail,  Great  Falls. 

Secretary-Treasurer:  Herbert  T.  Caraway,  Billings. 

Delegate  to  American  Medical  Association:  Raymond  F.  Peterson,  Butte, 
1950;  Alternate,  Thomas  B.  Moore,  KalispeU,  1950, 


Maternal  and  Child  Welfare  Committee:  F.  L.  McPhaU,  Great  Falls, 
Chairman. 

Subcommittee  on  Obstetrics:  E.  L.  Hall,  Great  Falls,  Chairman;  L.  A. 
Barrow,  BilUngs;  L.  W.  Brewer,  Missoula;  H.  B.  CampbeU,  Missoula; 
G.  A.  Carmichael,  Missoula;  Maude  Gerdes,  Billings;  J.  E.  Hynes, 
Billings;  R.  E.  Mattison,  Billings;  C.  W.  Pemberton,  Butte;  S.  N.  Preston, 
Missoula;  A.  E.  Ritt,  Great  Falls. 

Subcommittee  on  Pediatrics:  G.  H.  Barmeyer,  Missoula;  B.  C.  Farrand, 
.Iordan;  F.  J.  Friden,  Great  Falls;  D.  L.  Gillespie,  Butte;  E.  A.  Hagmann, 
Billings;  0.  M.  Moore,  Helena.  "■ 


STANDING  COMMITTEES 
Executive  Committee:  Thos.  F.  Walker,  Great  Falls,  Chairman:  L,  W. 
Allard,  Billings;  H.  T,  Caraway,  Billings;  C.  H.  Fredrickson,  Missoula: 
Thos.  L.  Hawkins,  Helena. 

■ Economic  Committee:  M.  A.  Shlllington,  Glendive.  Cliairman;  W.  E. 
Harris,  Livingston;  W.  E.  Long,  Anaconda:  D.  S.  MacKenzie,  Jr.,  Havre; 
J.  C.  Shields,  Butte;  E.  A.  Welden,  Lewistown. 

Legislative  Committee;  I.  .1.  Bridenstine,  Missoula,  Chairman;  J.  M. 
Fiinn,  Helena:  T.  L.  Hawkins,  Helena;  R.  C.  Monahan,  Butte;  T.  B.  Moore, 
KalispeU;  S.  D.  Whetstone,  Cut  Bank. 

Necrology  and  History  of  Medicine  Committee;  L.  W.  Brewer,  Missoula, 
Chairman;  .A.  A.  Dodge,  KalispeU;  J.  H.  Garberson,  Miles  City;  E.  M. 
Gans,  Harlowton;  J.  P.  Ritchey,  Missoula;  J.  I.  Wernham,  Billings. 

Public  Relations  Committee:  H.  T.  Caraway,  Billings,  Chairman;  A.  W. 
Axley,  Havre:  R-  F.  Peterson,  Butte;  L.  G.  Russell,  Billings;  R.  L. 
Towne,  KalispeU. 

Legal  Affairs  and  Malpractice  Committee:  A.  L.  Gleason,  Great  Falls, 

Chairman;  J.  H.  Bridenbaugh,  BiUii^s;  M.  0.  Burns,  KalispeU;  P.  E. 

Kane,  Butte;  R.  D.  Knapp,  Wolf  Point;  A.  M.  Lueck,  Livingston:  J.  C. 

MacGregor,  Great  Falls;  W.  F.  Morrison,  Missoula:  B.  R,  Tarbox,  Forsyth. 

Program  Committee:  H.  W.  Gregg,  Butte,  Chairman;  R.  L.  Casebeer, 
Butte;  C.  H.  Fredrickson,  Missoula;  J.  A.  Layne,  Great  Falls;  J.  J.  Malee, 
Anaconda. 

Interprofessional  Relationship  Committee:  L.  W.  Allard,  BllUngs,  Chair- 
man: C.  R.  Canty,  Butte;  R.  A.  Benke,  KalispeU;  B.  J.  Heetderks,  Boze- 
man: E.  S.  Murphy,  Jiissoula. 

Nominating  Committee:  J.  H.  Garberson,  Miles  City,  Chairman:  R.  G. 
Johnson,  Harlowton;  J,  P.  Ritchey,  Missouia;  F.  I.  Sabo,  Bozeman; 

S.  V.  Wilking.  Butte. 

Auditing  Committee:  G.  W.  Setzer,  Malta,  Chairman;  C.  P.  Brooke, 
St.  Ignatius;  Robt.  Leeds,  Chinook;  P.  E.  Logan,  Great  Falls;  R.  G. 
Scherer,  Bozeman. 

Cancer  Committee:  Mary  Alartin,  BilUngs,  Chairman;  R.  E,  Benson. 
BilUngs;  W.  F.  Cashmore,  Helena;  Walter  B.  Cox,  Missoula;  D.  C.  Epler, 
Bozeman;  Philip  Pallister,  Boulder;  W.  C.  Robinson,  Shelby. 


Tuberculosis  Committee:  P.  L.  Eneboe,  Bozeman,  Chairman;  G.  A. 
Anderson,  Deer  Lodge;  H.  V.  Gib.soa,  Great  Falls;  A.  R.  Klintner,  Mis- 
.soula;  P.  A.  Smith,  Glasgow;  F.  I.  Terrill,  Galen. 

Fracture  and  Orthopedic  Committee:  W.  H.  Hagen,  Billings,  Chairman; 

L.  W.  .Allard,  Billings;  J.  K.  Colman,  Butte;  S.  L.  Odgers,  Butte;  Geo. 
A.  Sexton,  Great  Falls;  J.  C.  Wolgamot,  Great  Falls. 

Rural  Health  Committee:  B.  C.  Farrand,  Jordan,  Chairman;  P.  S. 
Cannon,  Conrad;  L.  S.  Crary,  Fairfield;  David  Gregory,  Glasgow;  W.  G. 
Tanglin,  Poison. 

Industrial  Welfare  Committee:  J.  M.  Hickes,  Great  Falls,  Chairman; 
K E.  Brogan,  BUlings;  A.  R.  Little,  Helena;  Geo.  G.  Sale,  Missoula; 
R.  E.  Walker,  Livingston;  F.  L.  Unmack,  Deer  Lodge. 

Rheumatic  Fever  and  Heart  Committee:  F.  R.  Schemm,  Great  Falls,  Chair- 
man; R.  L.  Ek;k,  Lewistown;  F.  J.  Friden,  Great  Falls;  D.  L.  GiUespie, 

Butte;  J.  S.  Gilson,  Great  Falls;  H.  W.  Gregg,  Butte;  Elizabeth  Grimm, 
Billings;  T.  F.  Walker,  Jr.,  Great  Falls;  0.  M.  Moore,  Helena. 

Rocky  Mountain  Medical  Conference  Committee;  Thos.  F.  Walker,  Great 
Falls,  1950;  John  E.  Hynes,  BilUngs,  1951;  F.  K.  Waniata,  Great  FaUs, 
1952;  H.  W.  Gregg,  Butte,  1953;  H.  T.  Caraway,  BilUngs,  1954. 

SPECIAL,  COMMITTEES 

Emergency  Medical  Service  Committee:  D.  J.  MacDonald,  BilUngs,  Chair- 
man: Paul  J.  Gans,  Lewistown;  L.  G.  Griffis,  KalispeU;  T.  M.  Keenan, 
Great  Falls;  S.  A.  Olson,  Glendive ; W.  P.  Smith,  Columbia. 

Industrial  Accident  Board  Committee:  Thos.  L.  Hawkins,  Helena,  Chair- 
man; D.  J.  Almas,  Havre;  H.  H.  James.  Butte;  E.  R.  Grigg,  Bozeman; 

E.  L.  Gallivan,  Helena. 

Hospital  Relations  Committee;  E.  Hildebrand,  Great  Falls,  Chairman; 
R.  B.  Beans,  Great  FaUs;  J.  H.  Bridenbaugh,  Billings;  Walter  B.  Cox, 

Missoula;  R.  S.  Leighton,  Great  Falls;  W.  W.  McLaughlin,  Great  Falls; 

Mary  Martin,  BilUngs;  R.  F.  Peterson,  Butte;  G.  P.  Riatt,  Billings; 

P.  T.  Spurck,  Butte. 

Mental  Hygiene  Committeee:  W.  S.  AVilder,  Warm  Springs,  Chairman; 
J.  J.  Bulger,  Great  Falls;  R.  W.  Clapp.  Butte;  M.  A.  Ruona,  Billings; 

M.  A.  Shillington,  Glendive. 


Collection 


of 


t^OUi 


Accounts 


All  reports  show  a trend  toward  slower  and  harder  collections  in  the 
months  ahead. 

At  the  first  sign  of  neglect  you  will  save  money  if  they  are  turned  over 
to  us  for  collection. 

Comparison  of  collection  results,  hacked  by  35  years  of  experience,  proves 
you  obtain  greater  results  at  less  cost,  when  you  list  your  accounts 

with 

The  American  Medical  and  Dental  Association 

Suite  524,  810  14th  St.  TAbor  2331  Denver,  Colorado 


896 


Rocky  Mountain  Medical  Journal 


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897 


NEW  MEXICO  MEDICAL  SOCIETY 


OFFICERS— 1949-1950 

President;  1.  W.  Hannett,  Albuquerque. 

President-Elect:  I.  J.  Marshall,  Boswell. 

Vice  President;  Leland  S.  Erans,  Las  Crucra. 

Secretary-Treasurer:  H.  L.  January,  Albuquerque. 

Executive  Secretary:  Mr.  Ralph  R.  Marshall,  Albuquerque. 

Councilors  (o  years):  Carl  Mulky,  Albuquerque;  J.  C.  Sedgwick,  Las 
Cruces.  (2  years):  W.  D.  Dabbs,  Clovis;  A.  C.  Shuler,  Carlsbad,  (1  year): 
A,  S.  Lathrop,  Santa  Fe;  C.  H,  GeUenthien,  Valmora. 

Delegate  to  A.M.A.:  John  F.  Conway,  Clovis,  1950. 

Alternate  Delegate  to  A.M.A.:  C.  H.  GeUenthien,  Valmora,  1950. 

COMMITTEES— 1949-1950 

Basic  Science:  Raymond  L.  Young,  Santa  Fe,  Chairman;  W.  E.  Nissen, 
Albuquerque;  Walter  A.  Stark,  Las  Vegas. 

Rural  Medical  Service:  Stuart  Adler,  Albuquerque,  Chairman;  Samuel  R. 
Zeigler,  Espanola,  A.  T.  Gordon,  Tucumcari;  L.  G,  Foster,  Reserve;  J,  P, 
Turner,  Carrizozo. 

Cancer:  Murray  Friedman,  Santa  Fe,  Chairman;  Van  A.  Odle,  Roswell; 
J.  R.  Van  Atta,  Albuquerque;  J.  W,  Grossman,  Albuquerque;  R.  C.  Derby- 
shire, Artesia. 


Venereal  Disease  Control:  Sam  Jelso,  Albuquerque,  Chairman;  V.  E.  Ber^- 
told,  Santa  Fe;  L.  M.  Miles,  Albuquerque;  Vincent  Accardi,  Gallup;  F,  C, 
Bohannon,  Carlsbad, 

Legislative  and  Public  Policy:  A.  S.  Lathrop,  Santa  Fe,  Chairman;  H.  T, 
Watson,  Gallup;  C,  B,  Elliott,  Raton;  John  F.  Conway,  Clovis;  H.  M.  Mor- 
timer, Las  Vegas:  G,  S.  Morrison,  Roswell;  D.  B.  Marsh,  Demlng;  R.  A. 
Watts,  Silver  City;  Ashley  Pond,  Taos;  W.  L.  Minear,  Hot  Springs;  L.  S, 
Evans,  Las  Cnioes;  W.  M.  Thaxton,  Tucumcari;  William  C.  White,  Lof 
Alamos;  W,  0.  Connor,  Albuquerque;  C.  S,  Stone,  Hobbs;  A.  C,  Shuler, 
Carlsbad. 

Public  Relations;  C.  P.  Bunch,  Artesia,  Chairman';  Earl  L,  Malone,  Ros- 
well; 0,  S.  Cramer,  Albuquerque;  Eric  P,  Hausn«r,'^anta  Fe, 

Tuberculosis:  C.  H.  Gellentbien,  Valmori^  Chairman;  William  H.  Thearle, 
Albuquerque;  P.  0.  Shields,  Albuqimrque; . Carl  Mulky,  Albuquerque;  H,  S. 
A.  Alexander,  Santa  Fe,  ' '/ 

Advisory  Conmittee  on  Insurance  CompensatiO|n:  L.  M.  Overton,  Albuquer- 
que, Chairman;  R.  E.  Forbis,  Albuquerque ;cEdward  Pamall,  Albuquerque;  H. 
D.  Corbusier,  Santa  Fe.  ) ' '' 

National  Emergency  Medical  Service:  A.  E.  Reymont,  Santa  Fe,  Chair- 
man; L.  G.  Rice,  Albuquerque;  C.  M.  Thompson,  Albuquerque. 

Board  of  Supervisors:  L.  G.  Rice,  Bernalillo  County:  Van  A.  Odle,  Chavei 
County;  Milton  Floersheim,  Colfax  County;  John  F,  Conway,  Curry  County: 
C.  P.  Bunch,  Eddy  County;  Frank  W.  Parker,  Jr.,  McKinley  County; 
LeGrand  Ward,  Santa  Fe  County;  W.  A.  Stark,  San  Miguel  County. 


Oculist  Prescription  Service  Exclusively 

SHADFORD-FLETCH  ER  OPTICAL  CO. 

Dispensing  Opticians 

228  16th  Street,  Denver,  Colo.  AComo  2611 
3705  East  Colfax  (Medical  Center  Building).  FLorido  0202 


These  fine  Dairy  Cattle,  a portion  of  City  Park’s  large  herd  of  Guernsey  and  Holstein 
cows,  are  scientifically  fed  and  cared  for,  continuously  tested  by  competent  veterin- 
arians. Only  through  such  precise  watchfulness  does  City  Park  Milk  receive  Grade 
“A”  designation  which  it  enjoys.  Choose  City  Park’s  regular  Grade  “A”  Pasteurized 
or  Homogenized  milk  today  — notice  the  particularly  clean,  fresh  flavor. 


’Phone 
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Cherry  Creek 
Drive — Denver 


898 


Rocky  Mountain  Medical  Journal 


For  the  past  several 
years,  Lederle  has  conducted  extensive 
research  in  the  production  and 
isolation  of  antibiotics.  Scientific 
competition  in  this  field  has 
been  keen  and  Lederle  leadership  has 
been  achieved  at  the  expense 
of  a heavy  investment  in  personnel, 
materials  and  money.  Two  antibiotics 
are  widely  used  throughout 
the  world — aureomycin  and  penicillin. 
The  former  is  produced  solely 
by  Lederle.  Penicillin  in  many  new 
forms,  both  oral  and  parenteral, 
has  been  pioneered  by  Lederle. 


Lederle  research  never  comes 

to  a standstill,  but  on  the  contrary, 

proceeds  apace;  and  will  in 

due  course  produce  many  additional 

weapons  for  man’s  fight 

against  parasitic  microorganisms. 


LEDERLE  LABORATORIES  DIVISION  G^anamid company  30  Rockefeller  Plaza,  New  York  20,  N.  Y. 


for  November,  1949 


899 


THE  UTAH  STATE  MEDICAL  ASSOCIATION 


OFFICERS,  1949-1950 
President:  Ccnrad  H.  Jenson,  Ogden. 

President-Elect:  V.  P.  White,  Salt  Lake  City. 

Past  President;  0.  A.  Ogllvie,  Salt  Lake  City. 

Honorary  President:  D.  G.  Edmunds,  Salt  Lake  City. 

First  Vice  President:  Sims  E.  Duggins,  Pangnltch. 

Second  Vice  President:  Jules  E.  Trowbridge,  Bountiful. 

Third  Vice  President:  Seth  E.  Smoot,  Provo. 

Secretary;  T.  C.  Weggeland,  Salt  Lake  City. 

Executive  Secretary:  Mr.  W.  H.  Tibbals,  Salt  Lake  City. 

Treasurer:  L.  J.  Paul,  Salt  Lake  City. 

Councilor  First  District:  J.  G.  Olson,  Ogden. 

Councilor  Second  District:  Vincent  L.  Rees,  Salt  Lake  City. 

Councilor  Third  District:  L.  W.  Oaks,  Provo. 

Delegate  to  A.M.A.,  1950  and  1951:  George  Fister,  Ogden. 

Alternate  Delegate  to  A.M.A.,  1950  and  1951:  J.  J.  Weight,  Provo. 
Editor  of  the  Utah  Section  of  the  Rocky  Mountain  Medical  Journal: 
R.  P.  Middleton,  Salt  Lake  City. 

Board  of  Supervisors:  1951,  Clark  Rich,  Ogden:  1952,  Ezra  Cragun, 
Logan;  1953,  Paul  K.  Edmunds,  Cedar  City;  1954,  J.  G.  McQuarrie, 
Richfield;  1953,  J.  C.  Hubbard,  Price. 


STANDING  COMMITTEES 
Rocky  Mountain  Medical  Conference  Continuing  Committee;  1950,  K.  B. 
Castleton,  Chrirraan,  Salt  Lake  City;  1951,  Clark  Rich,  Ogden;  1952, 
Noall  Z.  Tannei,  Layton;  1953,  T.  R.  Seager,  Vernal;  1954,  R.  P. 
Middleton,  Salt  Lake  City. 

Scientific  Program  Committee:  T.  C.  Weggeland,  Chairman,  Salt  Lake 
City;  Vincent  L.  Rees,  Salt  Lake  City. 

Public  Policy  and  Legislation  Committee:  1950,  N.  P.  Hicken,  Chair- 
man, Salt  Lake  City:  1950,  Omar  Budge,  Logan;  1950,  George  A.  Allen, 
Salt  Lake  Citv;  1951.  F.  R.  King,  Price;  1951,  R.  V.  Larson,  Roose- 
velt; 1951,  W.  B.  West,  Ogden;  1952.  Chas.  Ruggeri,  Salt  Lake  City; 
1952,  J.  C.  Hubbard,  Price;  1952,  Wilford  G.  Biesinger,  Springville. 

Medical  Defense  Committee: . 1950,  Homer  Smith,  Salt  Lalie  City; 
1950,  L.  N.  Oasman.  Chairman,  Salt  Lake  City;  1950,  Edwin  D.  Zeman, 
Ogden;  1951,  Charles  W.  Woodruff,  Salt  Lake  City;  1951,  James  West- 
wood,  Provo;  1951,  L.  H.  Merrill,  Hiawatha;  1952,  E.  L.  Hanson, 
Logan;  1952,  Reed  Farnsworth,  Cedar  City;  1952,  H,  A.  Dewey,  Richfield. 

Medical  Education  and  Hospitals  Committee:  1950,  G.  G.  Richards, 
Chairman  Sait  Lake  City:  1950,  Ray  T.  Woolsey,  Salt  Lake  City;  1950, 
T.  E.  Robinson,  Salt  Lake  City;  1951,  John  Bowen,  Provo;  1951,  George 


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Special  attention  given  to  floral  tributes 
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H.  Curtis.  Salt  Labe  City;  1951,  R.  0.  Porter,  Logan;  1952,  Ralph 
Ellis,  Ogden;  1952,  PhUip  Price,  Salt  Lake  City;  1952,  W.  H.  Ander- 
son. Ogden. 

Medical  Economies  Committee;  1950,  W.  T.  Ward,  Salt  Lake  Cit;; 
1951,  W.  R.  Merrill,  Brigham  City;  1951,  Ralph  Pendleton.  Chairman, 
Salt  Lake  City;  1952,  Grant  P.  Kearns,  Ogden;  1952,  Preston  Hughes, 
Spanish  Fork. 

Public  Health  Committee:  1950,  F.  D.  Spencer,  Salt  Lake  City;  1951, 
R.  N.  Hirst,  Ogden;  1952,  Seth  E.  Smoot,  Provo;  1952,  James  Z, 

Davis,  Chairman,  Salt  Lake  City. 

Military  Affairs  and  National  Emergency  Committee:  Charles  Woodruff, 
Chairman,  Salt  Lake  City;  L.  J.  Paul.  Salt  Lake  City;  Mazel  Skolfield, 
Sait  Lake  City;  W.  M.  Gorishek,  Standardville;  L.  K.  CuUimore,  Orem; 
Ray  H.  Barton,  Magna;  D.  T.  Madsen,  Price;  RUey  G.  Clark,  Provo; 
Willis  Hayward,  Logan;  Leo  Benson,  Ogden. 

Tuberculosis  and  Cardiovascular  Diseases  Committee:  Elmer  M.  Kirkpatrick, 
Chairman,  ■'^alt  Lake  City;  Ray  Rumel,  Salt  Lake  City;  W.  C.  Walker, 
Salt  Lake  City;  Donald  M.  Moore,  Ogden;  Don  C.  Merrill,  Provo;  D.  0. 

N.  Lindberg  (Associate  Member),  Ogden.  ' 

Cancer  Committee:  James  P.  Kerby,  Salt 'Lake  City;  E.  A.  Lawrence, 
Salt  Lake  City;  J.  Elmer  Nielson.  Chairman,  Salt  Lake  City;  E.  D.  Zeman, 
Ogden;  James  Westwood,  Provo;  W.  J.  Reichman,  St.  George;  J.  Clare 
Hayward,  Logan;  R.  V.  Lars,en,  Roosevelt;  T.  R.  Gledhill,  Richfield; 
Quinn  A.  Whiting,  Price. 

Fracture  Committee:  A.  M.  Okelberry,  Chairman,  Salt  Lake  City;  Boyd 
G.  Holbrook,  Salt  Lake  City;  Louis  Peery,  Ogden;  Paul  A.  Pemberton, 
Salt  Lake  City. 

Necrology  Committee:  E.  B.  Muir,  Chairman,  Salt  Lake  City;  A.  S. 

Crandall,  Salt  Lake  City. 

Industrial  Health  Committee:  Frank  J.  Winget,  Chairman,  Salt  Lake 
City;  Byron  W.  Daynes,  Salt  Lake  City;  Wayne  Aired,  Orem;  W.  F. 

Loomis,  Ogden;  Sherman  Brinton,  Salt  Lake  Chty. 

Advisory  Committee  to  the  Woman’s  Auxiliary:  SUas  S.  Smith,  Chair- 
man, Salt  Lake  City;  A.  A.  Imus,  Ogden;  J.  R.  Smith,  Provo. 

Public  Relations  Committee:  Ray  T.  Woolsey,  Chairman.  Salt  Lake  City; 
L.  V.  Broadbent,  Cedar  City;  Geo.  H.  Lowe,  Jr.,  Ogden;  0.  P.  Heninger, 

Provo;  R.  .N.  Malouf,  Richfield;  Ray  E.  Spendlove,  Vernal;  Paul  Burgess, 
Hyrum;  J.  Leroy  Kimball,  Salt  Lake  City. 

Mental  Health  Committee:  E.  L.  Weimers,  Provo:  Wm.  D.  O'Gorman, 

Ogden;  L.  G.  Moench,  Salt  Lake  City;  Roy  A.  Darke,  Chairman,  Salt 

Lake  City. 

Rural  Health  Committee:  J.  J.  Weight,  Chairman.  Provo;  Joseph 

Tanner.  Layton;  T.  R.  Aldous,  Tooele;  Harold  E.  Young,  Midvale;  J.  H. 
Rasmussen,  Brigham  City. 

Professional  and  Hospital  Relationships  Committee:  James  P.  Kerby, 
Chairman,  Salt  Lake  (Sty;  V.  P.  White,  Salt  Lake  City;  R.  P.  Middle- 
ton.  Salt  Lake  City;  Lcland  R.  Cowan.  Salt  Lake  City;  V.  L.  Ward, 
Ogden;  J,  Russell  Smith,  Provo;  Hugh  0.  Brown,  Salt  Lake  City. 


^^enuer  Oxuaen  ^o,f 


Corner  10th  and  Lawrence  Sts. 
TAbor  5138 
Medical  Gas  Division 


nc. 


MEDICAL  OXYGEN 
CARBON  DIOXIDE-OXYGEN 
MIXTURES 

AVIATORS’  BREATHING  OXYGEN 
WATER  COMPRESSED  NITROGEN 
WATER  COMPRESSED  AIR 


Twenty-Four  Hour  Service 


COLOR  PROCESS. 

LINE  & HALFTONE 
BEN  DAY  ...... 

ILLUSTRATOR5-DE5IGNERS 


PHOTO 

ENGRAVERS 


900 


Rocky  Mountain  Mkdical  Journal 


M odern  therapy  with  Digoxin  helps  eliminate  the 
hazards  of  digitalization  through  more  precise  and  more 
predictable  action.  A pure  crystalline  drug  of  constant 
potency,  Digoxin  allows  greater  accuracy  of  dosage  and 
greater  ease  of  adjustment  than  do  the  crude  digitalis, 
preparations  assayed  in  biological  units. 

Rapid  digitalization  follows  oral  as  well  as  parenteral 
administration  because  the  drug  is  promptly  and  uni- 
formly absorbed.  Rapid  elimination  assures  short  dura- 
tion of  possible  toxic  side  effects. 

The  average  digitalized  patient  on  a maintenance  dose 
of  one  and  one-half  to  three  grains  of  whole  leaf  digitalis 
per  day  may  be  simply  switched  to  maintenance  with 
Digoxin  with  an  initial  trial  daily  dose  of  0.25  mg.  (1 
‘Tabloid’  Digoxin)  and  adjusted  subsequently  in  accord 
with  his  needs. 


ORAL  PREPARATIONS: 

'Tabloid'  brand  Digoxin,  0.25  mgm. 
(gr.  1/260  approx.) 

Botties  of  25,  100  and  500. 

Solution  of  Digoxin 
(B,  W.  & Co.)  0.5  mgm. 

(gr.  1/130  approx.)  in  I cc. 
(supplied  with  pipette). 

FOR  INTRAVENOUS  USE: 
'Wellcome'*  brand  Digoxin 
Injection  0.5  mgm.  (gr.  1/130 
approx.)  in  I cc.  Boxes  of  10 
ond  100  ampuls. 

*Formerly  known  as  'Hypoloid' 


BURROUGHS  WELLCOME  & CO.  (U.S.A.) 


DIGOXIN 


INC. 


9 & II  EAST  4lsl  STREET,  NEW  YORK 


I 


a crystalline  glycoside  of  digitalis  lanata 


for  November,  1949 


THE  WYOMING  STATE  MEDICAL  SOCIETY 


OFFICBRS 

President:  George  E.  Baker,  Casper. 

President-Elect:  DeWitt  Dominick.  Cody. 

Vice  President:  K.  E.  Krueger,  Rock  Springs. 
Treasurer:  ?.  M.  Schunk,  Sheridan. 

CorrespondJng  Secretary:  George  H.  Phelps,  Cheyenne. 
Delegate  A M.A.;  R.  H.  Reeve,  Casper. 

Alternate  Delegate  A.M.A. : W.  A.  Bunten.  Cheyenne. 
Executive  Secretary:  Mr.  Arthur  Abbey,  Cheyenne. 


COMMlTTEMaS 

Rocky  Mountain  Medical  Conference:  Earl  Whedon,  Chairman,  Sheridan; 
George  N.  Phelps,  Cheyenne;  H.  L.  Harvey,  Casper;  C.  W.  Jeffrey,  Rawlins; 
L.  W.  Storey.  Laramie. 

Syphilis  Committee:  N.  E.  Morad,  Chairman,  Casper;  G.  M.  Groshart. 
Worland;  L.  H.  Wilmoth,  Lander;  L.  G.  Booth.  Sheridan;  F.  H.  Halgler, 
Midwest. 

Cancer  Committee:  Earl  Whedon,  Chairman,  Sheridan;  John  Gramlich, 
Cheyenne;  DeWitt  Dominick,  Cody;  J.  R.  Newman,  Kemmerer;  E.  W.  New- 
man, Cheyenne. 

Medical  Economics  Committee:  C.  L.  Rogere,  Chairman,  Sheridan;  Nels 

A.  Vicklund,  Thermopolis;  R.  A.  Corbett,  Saratoga;  G.  R.  James,  Casper; 
S.  S.  Hellewell,  Evanston. 

Fracture  Committee:  Philip  Teal,  Chairman,  Cheyenne:  Silva  J.  Glovale, 
Cheyenne;  Robert  V.  Batterton.  Rawlins;  Lowell  D.  Kattenhorn,  Powell; 
Joseph  E.  Iloadley,  Gillette. 

Medical  Defense  Committee:  George  Baker,  Chairman,  Casper;  Andrew 
Bunten,  Cheyenne;  E.  W.  DeKay,  Laramie. 

Councillors:  Earl  W’hedon,  Chairman,  Sheridan;  R.  J.  Boesel,  Cheyenne; 

B.  \V.  DeKay.  Laramie;  Geoi^e  Baker,  President,  Casper;  George  Phelps, 
Secretary,  Cheyenne. 

Advisory  to  Woman’s  Auxiliary:  John  R.  Bunch,  Chairman,  Laramie; 
Virgil  L.  Thorpe,  Newcastle;  H.  J.  Aldrich,  Sheridan;  G.  B.  Savory,  Chey- 
enne. 

Advisory  to  Workmen’s  Compensation  Department:  J.  D.  Shingle,  Chair- 
man, Cheyenne;  G.  H.  Phelps,  Cheyenne;  W.  A.  Bunten,  Cheyenne;  R.  H. 
Reeve.  Casper;  Albert  T.  Sudman.  Green  River;  P.  M.  Schunk,  Sheridan. 


Industrial  Health  Committee;  K.  E.  Krueger,  ChalrmaD,  BoA  Sprlagu; 
Willard  Pennoyer,  Cheyenne;  Thomas  B.  Croft,  Lovell:  Bugeiie  Ptlton, 
Laramie. 

Veterans'  Affairs  and  Military  Senriea  Committee;  A.  J.  AUegretU,  Chair- 
man, Cheyenne;  Jack  Rowlett,  Laramie;  Everett  ElUs,  Cheyenne;  Bernard 
Sullivan.  Laramie;  G.  W.  Koford,  Cheyenne;  Bernard  Stack,  Themoimlii; 
J.  W.  Sampson,  Sheridan;  DeWitt  Dominick,  Cody;  Paul  B.  Holts,  Lander; 
George  E.  Baker,  President,  Casper;  George  Phelps,  Seeretaiy,  Cheyenne. 

Blue  Cross  Hospital  Committee:  R.  I.  Williams.  Qialrman,  Cheyenne,  1950; 
W.  A.  Bunten.  Cheyenne,  1949;  E.  W.  DeKay,  Laramie,  1951;  Cedric 
Jones,  Cody,  1952. 

Public  Policy  and  Legislation;  George  Phelps,  Cbalnnan,  Cheyenne; 

Andrew  Bunten,  Cheyenne;  George  Baker,  President,  Casper;  G.  W,  Koford. 
Cheyenne;  E.  W.  DeKay,  Laramie;  G.  W.  Henderson,  Casper. 

National  Physicians  Committee:  George  Phelps,  Chairman.  Cheyenno; 

Andrew  Bunten,  Treasurer,  ChPyenne;  E.  W.  DeKay,  Laramie;  George  Baker, 
Casper. 

Poliomyelitis  Committee;  H.  L.  Harvey,  Chairman,  Casper;  N.  A.  Vicklund, 
Thermopolis;  Leo  Keenan,  Torrington;  DeWitt  Dominick,  Co^;  Philip  Teal, 
Cheyenne;  Franklin  Yoder,  Cheyenne;  F.  A.  Mills,  Rawlins. 

State  Inst^utions  Advisory  Committee:  J.  F.  Whalen,  Chairman,  Evans- 
ton; George  Phelps,  Cheyenne;  C.  W.  Jeffrey,  Rawlins;  Earl  Whedwi,  Sheri- 
dan; G.  M.  Groshart,  Worland;  R.  H,  Kanable,  Basin. 

Necrology  Committee:  Earl  Whedon.  Chairman,  Sheridan;  John  B. 
Krahl,  Torrington;  Franklin  Yoder,  Cheyenne. 

Rural  Health  Committee:  Paul  Uoltz,  Chairman,  Lander;  Andrew  Bun- 
ten, Cheyenne;  Samuel  Worthen,  Afton;  Wm.  K.  Rosene,  Wheatland;  Claude 
Raffl,  Basin. 

Public  Health  Department  Liaison  Committee:  E.  C.  Ridgeway,  Chair- 
man, Cody;  R.  P.  Fitzgerald,  Casper;  R.  V.  Batterton,  Rawlins;  J.  W. 
Sampson,  Sheridan;  R.  C.  Stratton,  Green  River;  WUIard  Pennoyer, 

Cheyenne. 

Child  Health  Committee:  Paul  W.  Emerson,  Chairman,  Cheyenne;  John 
Gramlich,  Cheyenne;  Thomas  Croft,  Lovell;  Bernard  Sullivan,  Laramie; 

Paul  R.  Holtz,  Lander;  Geo.  B.  Baker,  Casper;  A.  B.  Abbey,  Cheyenne. 

Council  on  National  Emergency  Medical  Service:  George  H.  Pbel|», 
Chairman,  Cheyenne;  R.  H.  Reeve,  Casper;  DeWitt  Dominick,  Cody;  E.  W. 
DeKay,  Laramie;  K.  S.  Krueger,  Rock  Springs;  P.  M.  Schunk,  Sheridan. 


COLORADO  HOSPITAL  ASSOCIATION 


OFFICERS 

President:  Hubert  W.  Hughes,  General  Rose  Hospital,  Denver. 
President-E!ect:  Walter  G.  Christie,  Presbyterian  Hospital,  Denver. 

Vice  President:  Sister  M.  Domnina,  St.  Anthony  Hospital,  Denver. 
Treasurer:  M.  A.  Moritz,  Denver  General  Hospital,  Denver. 

Acting  Executive  Secretary:  Roy  R.  Anderson,  Presbyterian  Hospital,  Denver. 
Trustees:  Roy  R.  Prangley,  St.  Luke’s  Hospital,  Denver  (1949);  James 
P.  Dixon,  M.D.  Denver  General  Hospital,  Denver  (1949);  Louis  Liswood, 
National  Jewish  Hospital,  Denver  (1950);  DeMoss  TaHaferro,  Children's 
Hospital,  Denver  (1950);  Roy  R.  Anderson,  Presbyterian  Hospital,  Den- 
ver (1951);  Rev.  Allen  U.  Erb,  Mennonite  Hospital,  La  Junta,  Colo. 
(1951). 

Delegate  to  the  American  Hospital  Association:  Herbert  A.  Black,  M.D., 
Parkview  Hospital,  Pueblo. 

Alternate:  Msgr.  John  R.  Mulroy,  CathoUc  Hospitals,  Denver. 

STANDING  COMMITTEES 
Auditing:  R W.  Pontow,  Chairman  (1949),  Colorado  General  Hospital, 
Denver;  Rev.  E.  J.  Friedrich  (1950),  Lutheran  Sanatorium,  Wheatridge; 
Karl  Mortensen  (1951),  SL  Luke’s  Hospital,  Denver. 

Constitution  and  Rules:  Samuel  S.  Golden,  M.D.,  Chairman,  Beth  Israel 
Hospital,  Denver;  Henry  H.  HiH,  Weld  County  Hospital,  Greeley;  Sister 
M.  Johanna,  Sucred  Heart  Hospital,  Lam-r. 

Legislative:  Msgr.  John  R.  Mulroy.  Chairman,  Catholic  Hospitals,  Den- 
ver; DeMoss  TaHaferro,  ChUdren’s  Hospital,  Denver;  Carl  Ph,  Sebwalb, 
Denver;  Herbert  A.  Black,  M.D.,  Parkview  Hospital,  Pueblo. 

Membership:  Sister  M.  Alphonsus  Chairman,  Mercy  Hospital,  Denver; 
Roy  R.  Prangley,  St  Luke’s  Hospital,  Denver. 

Resolutions:  Walter  G.  Christie,  Chairman.  Presbyterian  Hospital.  Denver; 
Carl  Ph.  Schwalb,  Denver. 

Nominating:  Msgr.  John  R.  Mulroy,  Chairman  (1949),  CathoUc  Hos- 
pitals, Denver;  Herbert  A.  Black,  M.D.  (1950),  Parkview  Hospital,  Pueblo; 

C.  S.  Bluemel,  M.D.  (1951),  Mount  Airy  Sanatorium,  Denver. 

Program:  George  A.  W.  Currie,  M.D.,  Chairman,  University  of  (kilorado 
Medical  Center.  Denver;  Boy  Anderson,  Presbyterian  Hospital,  Denver. 


Nursing:  DeMoss  Taliaferro,  (3iairman,  Children’s  Hospital,  Denver; 
Sister  M.  HugoHna,  St.  Anthony  Hospital,  Denver;  Margaret  E.  Paetznick, 
Director  of  Nurses,  Denver  General  Hospital,  Denver;  Sister  Maria  Gratia, 
B.N.,  Glockaer  Sanatorium,  Colorado  Springs;  S.  Russ  Denzler,  M.D., 
Colorado  Hospital.  Canon  City. 

Public  Education:  Owen  B.  Stubben,  Chairman,  Denver  General  Hospital, 
Denver;  Mr.  Torgersen,  Longmont  Hospital  and  CUnic,  Longmont:  Ward 
Darley,  M.D.,  Director,  University  of  Colorado  Medical  Center,  Denver; 
Chas.  Levine,  J.C.R.S..  Spivak. 

SPECIAL,  COMMITTEES 

Public  Relations:  James  P.  Dixon,  M.D.,  Chairman,  Denver  General 
Hospital,  Denve.*;  Sister  Mary  Lina,  St.  Francis  Hospital,  Colorado  Springs. 

Rates  and  Cliarges:  Roy  Anderson,  Chairman,  Presbyterian  Hospital, 
Denver;  Msgr.  John  R.  Mulroy,  Catholic  Hospitals,  Denver;  Boy  B. 
Prangley,  SL  Luke's  Hospital,  Denver;  Walter  G.  Christie,  Presbyterian 
Hospital  Denver:  DeMoss  Taliaferro,  Children’s  Hospital,  Denver;  Ben 
M.  Blumberg,  General  Rose  Memorial  Hospital,  Denver. 

State  Board  of  Health  Advisory:  Msgr.  John  B.  Mulroy,  Chairman. 
CathoUc  Hospials,  Denver;  DeMoss  TaHaferro,  Children’s  Hospital,  Denver; 
Herbert  A.  Black.  M.D.,  Parkview  Hospital,  Pueblo. 

Committee  on  Hospital  Licensing  Regulations  and  Standards:  Msgr.  John 
R.  Mulroy,  Ciiairman,  Catholic  Hospitals,  Denver:  Roy  R.  Prangley.  SL 
Luke’s  Hospital,  Denver;  Owen  B.  Stubben,  Denver  General  Hospital,  Denver; 
DeMoss  Taliaferro,  Children’s  Hospital,  Denver;  Boy  Anderson,  Presbyterian 
Hospital,  Denver. 

Premature  Infant  Care:  DeMoss  Taliaferro,  Chairman,  Chldlren’s  Hos- 
pital, Denver;  Roy  Anderson,  Presbyterian  Hospital,  Denver. 

Rehabilitation  Center:  James  P.  Dixon,  M.D.,  Denver  General  Hospital, 
Denver;  Msgr.  John  R.  Mulroy,  Catholic  Hospitals,  Denver;  Louis  M. 
Liswood,  National  Jewish  Hospital,  Denver. 

Inter-Professional  Council:  Hubert  W.  Hughes,  St.  Anthony  Hospital, 
Denver. 


A 


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DORR  OPTICAL  COMPANY 


421  16th  Street 


Denver,  Colorado 


KEystone  5511 


902 


Rocky  Mount atn  Medical  Journal 


PROTAMINE  ZINC  INSULIN 

SoyiBB 

SO  units  per  ce. 

.wKitflifc  0^t»grs.»,«nc  100 

C»»^  Jn  « c»W  pl«e«W  fr«i*«»i*g: 


qlobin  insuun 

WtCb  Xlnc 


E K Sopimi  & S<5NS  s New  York 


H»4otftcAi  tJkborsiK 


lOOttStla 


”E.  R.  SQUrOB  * SONH 


pr-t^f  aR»^-5 

iwi»a  a 

la  t’.S.A' 


SQUIBB  INSULIN  PRODUCTS 

...purified. ..potent. ..rigidly  standardized  to 
meet  the  various  requirements  of  diabetics. 

short  action:  peak  effect  within  3 to  4 hours,  waning  rapidly 

INSULIN  SQUIBB 

10-cc.  vials  (40,  80  fb- 100  units  per  cc.) 

INSULIN  MADE  FROM  ZINC-INSULIN 

CRYSTALS  SQUIBB 

10-cc.  vials  (40  <b-  80  units  per  cc.) 

intermediate  action:  peak  effect  in  8 to  12  hours,  with  action  continuing 
sometimes  for  16  or  more  hours. 

GLOBIN  INSULIN  WITH  ZINC  SQUIBB 

10-cc.  vials  (40  ir  80  units  per  cc.) 

prolonged  action:  onset  slow;  peak  effect  in  10  to  12  hours,  with  action 
sometimes  persisting  for  24  or  more  hours. 

PROTAMINE  ZINC  INSULIN  SQUIBB 

10-cc.  vials  (40  ir  80  units  per  cc.) 


Squibb 


MANUFACTURING  CHEMISTS  TO  THE  MEDICAL  PROFESSION  SINCE  1858 


* 


jor  November,  1949 


903 


Outstanding  Value ... 

Outstanding  Nutritional  Benefits 

Whether  the  pocketbook  calls  for  economy  or  permits  satisfaction 
of  that  urge  for  the  fanciest  cuts,  meat  gives  your  patients  full 
value  for  their  money.  Every  cut  and  kind  of  meat  supplies,  in 
abundance,  these  essential  nutrients: 

1.  Biologically  complete  protein  . . . the  kind  which  satisfies 
the  requirements  for  growth  and  which  is  needed  daily  for 
tissue  maintenance,  antibody  formation,  hemoglobin  syn- 
thesis, and  good  physical  condition. 

2.  The  essential  B complex  vitamins,  thiamine,  riboflavin,  and 
niacin. 

3.  Essential  minerals,  including  iron  in  particular. 

In  addition  to  these  tangible  values,  meat  ranks  exceptionally 
high  not  only  in  taste  and  palate  appeal,  but  also  in  satiety  value. 

The  instinctive  choice  of  meat  as  man’s  favorite  protein  food 
has  behind  it  sound  nutritional  justification.* 

*McLester,  J.  S. : Protein  Comes  Into  Its  Own,  J.A.M.A.  J39:897  (Apr.  2,)  1949 

American  Meat  Institute 

Main  Office,  Chicago. ..Members Throughout  the  United  States 


The  Seal  of  Acceptance  denotes  that 
the  nutritional  statements  made  in 
this  advertisement  are  acceptable  to 
the  Council  on  Foods  and  Nutrition 
of  the  American  Medical  Association. 


904 


Rocky  Mountain  Medical  Journal 


rf  /Torn  e/ie  ^ anrf  , 


'^ec-et-f/  c/>ff 


>>fOIANAPOus 


v-jf. 

'^*JENZA 

Vaccine 


Sk.,''*  subcut«n*°‘'*'J 

Well  Before  Usi^ 


•CM  ueiore 

3017-44795S 


Kvjenza  Vl"^* 

Vaccine 

L ‘VpE5  ^ an^ijy 
k,'“*  cc.  subcu***^ 

0]  8-447953 

lNvANDC<<f 


and  coM?*^ 
‘^APOUS,  V.S> 


Accent  on  Prevention 


The  absence  of  effective  drugs  with  which  to  treat 
influenza  leaves  prevention  as  the  physician’s  only 
alternative.  In  a high  percentage  of  cases,  immunity 
results  from  a single  1-cc.  subcutaneous  injection  of  Influenza 
Virus  Vaccine,  Types  A and  B,  Lilly.  To  insure  maximum 
protection,  the  fall  inoculation  should  be  followed  in  three 
or  four  months  by  a second  injection.  For  more  complete 
information,  write  for  a copy  of  Influenza  Virus  Vaccine,  Types 
A and  B (A-1341A). 


ELI  LILLY  AND  COMPANY,  INDIANAPOLIS  6,  INDIANA,  U.S.A. 


A quick,  deft  manipulation  and  the  pledget  of  cotton  is 
securely  in  place,  a foreign  body  is  safely  removed  from  an 
eye,  or  a tonsil  is  adroitly  snared.  Specialists  in  eye,  ear,  nose, 
and  throat  practice  take  for  granted  the  high  degree  of  skill 
acquired  from  day-to-day  experience. 

Behind  the  scenes,  in  the  medical  research  laboratories  of 
the  nation,  groups  of  skilled  scientists  are  at  work  on  the 
doctor’s  problems.  Can  this  sympathomimetic  drug  be  made 
more  effective,  less  toxic?  Will  altering  the  chemical  structure 
of  an  antihistaminic  compound  remove  the  undesirable 
side-effects  without  destroying  its  desirable  qualities? 

Can  this  local  anesthetic  be  improved?  These  are  only  a few 
of  the  day-to-day  concerns  which  challenge  the  skills  of 
the  specialists  representing  all  branches  of  medical  science  at 
the  Lilly  Research  Laboratories.  The  result  of  their  findings  is 
reflected  in  the  continuing  flow  of  new  and  better  preparations 
destined  for  the  patient  via  the  physician’s  prescription. 


EXPERTS  WHO  TREAT  STUFFY  NOSES 


LILLY  SPECIALISTS  SERVE  THE  MEDICAL  PROFESSION 


JRocky 

Colorado 
Montana 
New  Mexico 
Utah 
Wyoming 


NOVEMBER 

1949 


JVLoantain 

y\/ledical  Journal 

Editorial » 


‘7  Am  the  State” 

QUCH  is  the  title  of  an  editorial  which 
^ appeared  in  the  Rocky  Mountain  News. 
Many  of  the  editorials  in  this  daily  paper 
have  carried  a real  “punch”  upon  the  sub- 
ject of  England’s  plight  in  general  and 
socialized  medicine  in  particular.  We  take 
liberty  of  quoting  the  editorial  verbatim: 

Aneurin  Bevan,  Britain’s  minister  of  health, 
has  rubbed  off  the  thin  veneer  which  distin- 
guished the  left  wing  of  British  Socialism  from 
the  Marxism  of  Lenin  and  Stalin. 

In  an  interview  on  the  methods  to  be  em- 
ployed in  imposing  compulsory  universal  health 
insurance — socialized  medicine — on  a nation,  Mr. 
Bevan  said: 

“Great  social  change  cannot  be  done  gradually. 
It  must  be  done  all  at  once  on  a day  selected 
for  the  purpose  . . . The  idea  is  that  the  day 
must  serve  as  a catalytic  agent,  one  to  which 
everyone  in  the  nation  must  react.  Otherwise 
such  a major  change  cannot  be  done.” 

And  why  not?  Because  the  people  might  ob- 
ject. 

“To  do  it  gradually,  piece  by  piece,  would 
create  many  resistances,”  Mr.  Bevan  explains. 
This  would  “make  the  minister  subject  to  every- 
one else  instead  of  having  them  subject  to  him,” 
he  said. 

Mr.  Bevan  does  not  want  any  interference 
from  the  people,  for  it  is  a minister’s  “responsi- 
bility to  make  the  new  system  work,  and  he  can- 
not do  that  if  he  is  not  master,  if  he  does  not 
have  complete  control.” 

t 

This  doctrine  is  a throwback  to  the  old  theory 
of  government  by  divine  right,  with  Mr.  Bevan 
substituting  his  will  for  that  of  the  crown. 

Under  it,  the  state  is  the  master  and  not  the 
servant  of  the  people,  and  Mr.  Bevan  becomes 
the  state  in  his  particular  field. 

That  is  dictatorship,  one-man  government,  to- 
talitarianism. 


Democratic  processes  are  subverted  to  stealth 
and  surprise,  rather  than  force,  but  the  end 
result  is  the  same. 

The  people  get,  not  what  they  want,  but  what 
Mr.  Bevan  wants  because  he,  their  self-appointed 
master,  decides  it  is  what  they  should  have. 

If  they  could  look  at  it  beforehand  they  might 
not  want  it,  and  because  he  does  not  want  his 
judgment  questioned  he  ifisists  upon  “complete 
control.” 

If  England  submits  to  such  arrogant  dictum  it 
is  not  the  England  of  Milton,  Byron,  Pitt  and 
Burke  but  the  England  of  King  John,  James  I 
and  George  III. 

9 

Ringworm  of  the  Scalp 

JpOR  many  years  physicians  in  this  region 
have  had  periodic  small  outbreaks  of 
tinea  capitis  to  treat.  Fortunately  these 
have  been  of  the  animal  type  (microporon 
lanosum)  and  have  been  easily  controlled 
with  the  usual  fungicides.  With  the  advent 
of  the  war  and  the  rapid  movement  of  pop- 
ulation from  area  to  area  the  human  type 
tinea  capitis  (microsporon  auduoini)  has 
become  epidemic  in  the  entire  Rocky  Moun- 
tain area. 

This  fungus  is  entirely  resistant  to  the 
usual  fungicides,  and  until  1944  was  gener- 
ally treated  by  x-ray  or  chemical  epilation 
combined  with  topical  fungicides.  In  1944 
the  salicylanilide  antiseptics  were  investi- 
gated in  the  treatment  of  tinea  capitis  and 
found  to  be  effective.  Treatment  requires 
four  to  six  months  of  vigorous  use  of  these 
aitiseptics,  and  in  stubborn  cases  may  re- 
quire a year;  however,  this  is  no  longer  than 
is  necessary  when  roentgen  epilation  is 
used,  and  medicolegal  sequelae  are  avoided. 
'•  All  infected  children  must  wear  a boilable 
skull  cap  of  cotton  or  silk  (nylon  is  not  ef- 


for  November,  1949 


905 


fective)  while  infected,  and  for  three 
months  after  infection  is  apparently  over, 
for  the  protection  of  their  schoolmates  and 
playmates,  since  this  form  of  the  disease 
is  transmitted  directly  or  indirectly  from 
one  infected  patient  to  his  uninfected  asso- 
ciate. Each  case  must  be  followed  by  pe- 
riodic examination  every  two  or  three 
weeks.  The  older  method  of  direct  exami- 
nation of  hairs  in  sodium  hydroxide  solu- 
tion and  culture  is  effective  but  very  time 
consuming.  For  practical  purposes  the 
newer  method  of  periodic  dark-room  exami- 
nation under  the  Woods  light  is  simpler  and 
effective.  Woods  light  is  any  source  of  ul- 
traviolet light  filtered  through  cobalt  glass. 
An  inexpensive  source  of  this  light  is  the 
commercial  “black  light  bulb”  or  the  “pur- 
ple X 10  bulb.”  Hairs  infected  with  micro- 
sporon  auduoini  are  seen  in  this  light  as 
brilliant  green-yellow  fluorescent  bristles. 
In  daylight  the  patches  are  seen  as  areas 
of  broken  stubble  usually  over  the  occipital 
area. 

In  school  areas  where  cases  are  found,  all 
pre-adolescent  school  children  should  be  pe- 
riodically screened  under  the  Woods  light. 
Infected  children  must  be  required  to  have 
their  hair  clipped  short,  to  wear  a clean 
boiled  skull  cap  daily  and  to  be  under  ade- 
quate treatment.  In  areas  in  which  this  pro- 
gram has  been  vigorously  enforced  it  has 
been  found  that  children  may  continue  in 
school  without  endangering  their  school- 
mates and  that  the  epidemic  will  gradually 
recede. 

A.  D.  WOODBURNE. 

<4  ^ 

The  British  National 
Health  Service 

/^NE  of  the  guest  speakers  at  the  recent 
meeting  of  the  Colorado  State  Medical 
Society  was  William  Alan  Richardson,  Edi- 
tor of  Medical  Economics.  Mr.  Richardson 
has  edited  that  widely  distributed  maga- 
zine since  1934.  His  journal  reaches  every 
American  doctor  in  private  practice.  Some 
months  ago  he  decided  to  go  to  England 
and  study  its  medical  situation  at  first 
hand.  Thus  he  traveled  2,000  miles  in  an 


Austin  (no  mean  accomplishment),  visiting 
England,  Scotland,  Wales,  and  North  Ire- 
land and  making  300  interviews  with  repre- 
sentative citizens,  doctors,  and  Ministers  of 
Health. 

Mr.  Richardson  had  lived  in  England  and 
known  its  people  before  socialism  made  its 
mark  upon  them.  His  study  was  thorough 
and  unbiased.  Thus  we  may  have  confi- 
dence in  his  opinion  of  the  English  medical 
system.  We  must  remember  that  60  per 
cent  of  American  families  have  annual  in- 
comes over  $2,000.00,  but  86  per  cent  of 
English  families  live  on  less  than  $1,000.00. 
It  is  not  surprising  that  about  seven  out  of 
eight  laymen  express  a favorable  reaction 
to  complete  government-subsidized  medical 
service.  However,  they  all  criticize  it  one 
way  or  another — it  may  be  all  right  if  it 
doesn’t  bankrupt  the  country,  all  right  if 
available  when  needed.  Obviously  avail- 
ability of  medical  service  seems  to  be  of 
more  importance  than  quality  to  poor  peo- 
ple. After  all,  what  was  good  quality  worth 
to  those  who  could  not  afford  to  buy! 

The  old  British  panel  system  was  a form 
of  socialization,  but  far  less  inclusive  than 
the  present  scheme  which  covers  95  per 
cent  of  the  population.  England  now  hasn’t 
enough  doctors,  nurses,  hospital  beds  or  ap- 
pliances. She  has  promised  more  than  she 
is  able  to  deliver.  About  one-half  of  the 
British  doctors  do  a bit  of  private  practice, 
but  a mere  5 per  cent  of  populace  spread 
over  a lot  of  doctors  does  not  amount  to 
much.  The  “privilege”  means  most  to  spe- 
cialists with  national  reputations;  it  is  not 
surprising  that  they  get  most  of  the  5 per 
cent.  Furthermore,  what  if  doctors  are  pen- 
sioned at  the  age  of  65  when  the  average 
age  at  death  is  52!  Some  of  the  “blessings” 
on  paper  do  not  work  out  in  fact. 

Most  people  object  to  hours  of  waiting  for 
impersonal  service.  Many  do  not  feel  that 
they  have  a family  doctor.  Doctors  who  are 
over-worked  and  under-paid  have  little  time 
for  the  art  of  medicine;  pride  in  practice  is 
waning;  they  hesitate  to  advise  their  sons  to 
enter  our  profession;  incentive  is  under- 
mined. Thus  quality  of  service  is  bound  to 


906 


Rocky  Mountain  Medical  Journal 


suffer.  One  doctor  said,  “In  ten  years  no  doc- 
tor will  care  what  patients  think  of  him  but 
will  cater  only  to  the  Minister  of  Health.” 
Another  predicts  that  most  doctors  will  fi- 
nally come  to  have  the  “civil  service  men- 
tality— an  expert  at  filling  out  forms,  watch- 
ing the  clock,  passing  the  buck,  and  waiting 
for  their  own  pensions.” 

People’s  morale  is  slipping,  too.  One  Eng- 
lishman expressed  resentment  toward  Mar- 
shall Plan  Aid  which  gave  a false  and  tran- 
sient sense  of  recovery.  He  said  that  without 
material  American  aid,  England  could  have 
achieved  a real  success  in  the  Battle  of 
Britain.  Furthermore,  “I  pray  for  our  own 
sakes,  that  no  more  Marshall  Aid  will  be 
forthcoming.”  Without  American  money,  all 
of  the  British  social  schemes  could  not  pos- 
sibly survive.  Since  all  such  plans  lead  to 
communism,  the  United  States  may  be 
abetting  a cause  to  which  it  is  opposed. 

Returning  to  the  medical  situation,  the 
average  practitioner  has  2,300  patients,  each 
of  whom  is  seen  on  an  average  of  six  times 
per  year.  A busy  doctor  may  see  (and  we 
mean  see)  an  average  of  eighty  patients  a 
day;  there  are  even  queues  on  the  telephone 
to  call  him  and  for  him  to  call  the  hospital. 
Most  prescriptions  are  written  after  little 
or  no  examination  and  doctors  write  for 
large'  quantities  of  medicine,  hoping  they 
will  appease  patients  for  longer  periods  of 
time.  In  addition  to  “seeing”  up  to  190 
patients  a day,  the  doctor  has  to  make  out 
files,  records,  reports,  certificates;  he  must 
give  chits  to  enable  his  patient  to  get  more 
stuff  from  the  chemists  and  petrol  mer- 
chants. He  may  find  himself  responsible  for 
filling  out  300  forms  per  day.  He  is  the  “poor 
man  of  the  show,”  for  many  doctors  have 
less  than  one-half  their  former  incomes. 
They  resent  the  loss  of  professional  dignity 
and  transition  to  the  position  of  civil  serv- 
ant; formerly  he  was  asked  for  service  and 
now  service  is  demanded.  One  of  his  great- 
est burdens  is  his  unavoidable  response  to 
unnecessary  calls  and  frivolous  demands. 
For  example,  the  cost  of  eye  service  is  650 
per  cent  above  that  which  was  estimated 
for  the  medical  budget. 

Among  Mr.  Richardson’s  concluding  re- 


marks was  a plea  that  American  doctors 
fight  socialized  medicine  on  moral  grounds 
only.  Our  British  colleagues  made  the  mis- 
take of  opposing  it  in  terms  of  service  and 
Bevan  diverted  the  doctor’s  position  to  that 
of  a business  and  economic  pawn.  In  other 
words,  the  profession  did  not  keep  its  eye 
on  the  ball  and  was  placed  in  the  light  of 
selfish  people  opposing  the  average  man  to 
protect  their  own  financial  interests.  We 
believe  that  the  American  medical  profes- 
sion is  not  making  the  same  mistake  and 
that  the  public  has  been  conclusively  shown 
that  our  fight  is  on  behalf  of  the  people,  not 
ourselves.  We  have  confidence  that  our 
fight  will  be  won,  that  the  American  pro- 
fession will  continue  to  attract  men  of  high- 
est caliber,  and  that  doctors  will  retain 
pride  in  practice  and  in  seeing  their  own 
sons  enter  the  profession.  However,  we  can- 
not relax  now;  our  work  and  educational 
program  must  continue  until  the  opponents’ 
initiative  subsides  in  face  of  an  enlightened 
American  public. 

^ ^ <4 

Let’s  Go  to 
Washington! 

'^HE  third  annual  Clinical  Session  of  the 
American  Medical  Association  to  be  held 
in  Washington,  D.  C.,  December  6 to  9 
should  attract  a record  attendance  for  mid- 
winter medical  meetings. 

These  sessions  (formerly  called  the  “In- 
terim Meeting”)  have  been  designed  pri- 
marily for  the  benefit  of  the  general  prac- 
titioner, but  every  specialist  as  well  can 
profit  greatly  by  attending.  There  is  no  reg- 
istration fee  at  the  mid-winter  Clinical  Ses- 
sion and  all  members  of  the  A.M.A.  are 
welcome. 

Not  the  least  of  the  many  values  of  next 
month’s  meeting  will  be  the  opportunity 
for  American  medicine  to  demonstrate  its 
progress  and  its  fighting  spirit  for  main- 
tenance of  American  free  enterprise  in  the 
very  center  of  our  national  government. 
Let’s  all  go,  and  let’s  spend  an  extra  day 
getting  better  acquainted  with  our  national 
legislators  and  the  inside  workings  of  Uncle 
Sam. 


for  November,  1949 


907 


Original  Articles 


SPECULUM  MEDICI* 

REGINALD  FITZ,  M.D. 

BOSTON,  MASSACHUSETTS 


Dr.  Sewall’s  personality  and,  as  one  of  his 
most  notable  characteristics,  the  depth  of 
his  medical  wisdom,  will  always  be  remem- 
bered. During  the  years  of  my  acquaintance 
with  him  he  was  an  active  member  of  the 
Association  of  American  Physicians.  He 
attended  its  meetings  with  great  regularity 
and  always  added  a colorful  and  illuminat- 
ing touch  to  any  discussion  in  which  he 
joined.  He  appeared  to  have  an  omnivorous 
curiosity;  he  was  familiar  with  subjects  in- 
volving such  widely  separated  anatomical 
areas  as  the  brain,  at  the  top  of  the  body, 
or  the  rectum,  at  the  bottom,  and  he  was 
willing  to  include  in  his  consideration  any 
phase  of  internal  medicine — heart  disease, 
pulmonary  disease,  gastrointestinal  disease, 
allergy,  diabetes,  infectious  disease,  renal 
disease,  hematology,  and  endocrinology. 
Everyone  felt  that  he  admirably  represented 
a broad-gauged  clinician  who  enjoyed  quiet 
rambles  over  a large  medical  field  with 
rests,  from  time  to  time,  to  study  anything 
that  seemed  noteworthy;  whatever  at- 
tracted his  attention  he  made  exciting  for 
others. 

In  deciding  what  to  make  the  subject  of 
a lecture  named  in  his  memory,  I have  at- 
tempted to  review  an  aspect  of  medicine 
that  might  have  interested  him— admitted- 
ly a difficult  feat  and  one  involving  the 
putting  together  of  a concoction  of  reflec- 
tion mixed  with  a little  history  to  add  fla- 
vor. Anything  in  the  ordinary  sort  of  a 
clinical  presentation  would  have  been  too 
commonplace  to  suit  his  palate. 

It  may  be  that  one  of  the  reasons  why 
Dr.  Sewall  had  such  inclusive  medical 
knowledge  was  because  a strain  of  biologic 
inquisitiveness  came  to  him  through  in- 
heritance. His  grandfather'  was  graduated 

’•'Presented  as  a Henry  Sewall  Memorial  Lecture, 
February  1,  194!).  Denison  Memoiial  Auditorium, 

Denver. 


from  the  Harvard  Medical  School  in  1812 
and  then  moved  to  Washington.  Here,  it 
was  said,  “his  talents  and  acquirements, 
with  an  upright  deportment  and  great  ur- 
banity of  manner,  soon  procured  for  him  the 
respect  and  patronage  of  a large  portion  of 
the  inhabitants.”  Like  his  grandson,  he  was 
a teacher  and  investigator,  writing  and 
speaking  with  firm  conviction,  and  he  was 
generally  regarded  as  a man  of  distin- 
guished ability.  As  I shall  claim  presently, 
the  tendency  to  be  a successful  doctor  often 
seems  to  develop  in  families. 

Twenty-five  years  ago  I was  appointed 
physician  in  charge  of  the  medical  students 
at  Harvard  University.  It  seemed  to  me 
that  to  regard  this  work  as  a perfunctory 
duty  would  make  it  dull  and  uninteresting; 
could  any  sort  of  an  investigation  be  in- 
corporated into  it  that  would  make  it  more 
stimulating?  After  due  reflection  I realized 
that  Harvard  had  offered  me  an  unusual 
opportunity  to  study  doctors.  Hence,  for  a 
quarter  of  a century  I have  been  trying  to 
learn  all  I could  about  them,  regarding 
them  as  a peculiar  race  of  men,  wondering 
how  they  differed  from  other  people  and 
whether  their  profession  exposed  them  to 
any  particular  hazards  to  make  of  it  what 
industrial  physicians  might  term  a danger- 
ous occupation. 

The  Family  History  of  Doctors 

One  of  the  striking  peculiarities  of  the 
doctor — which  almost  follows  the  pattern 
of  a familial  disease — is  his  tendency  to  be- 
get other  doctors.  During  a great  many 
years,  on  the  average,  at  least  fifteen  of 
every  hundred  Harvard  medical  graduates 
have  been  doctors’  sons.  If  our  experience 
is  general,  and  I believe  it  is,  this  means 
that  at  any  large  medical  gathering  one  out 
of  every  seven  of ' those  present  has  been 


908 


Rocky  Mountain  Medical  Journal 


brought  up  in  a doctor’s  family.  Of  course 
the  question  arises  whether  these  particular 
individuals  are  more  effective  in  the  med- 
ical line  than  their  six  neighbors.  This  is 
a baffling  riddle  to  answer  convincingly  for 
there  are  so  few  straws  of  evidence  on 
which  to  seize.  Perhaps  only  one  criterion 
is  really  helpful  and  that  is  the  judgment 
of  others. 

It  occurred  to  me  that  “Who’s  Who  in 
America”  might  afford  one  means  of  de- 
termining something  of  the  family  history 
of  a group  of  doctors  all  of  whom  had  at- 
tained at  least  a certain  degree  of  eminence 
in  the  eyes  of  the  world.  Therefore,  a 
group  of  1,300  physicians  listed  in  a recent 
volume  were  questioned.  Of  these,  48  per 
cent  had  a positive  history  of  medicine  in 
their  families;  21  per  cent  were  sons  of  doc- 
tors; 13  per  cent  were  grandsons  of  doctors, 
and  14  per  cent  were  fathers  of  doctors. 
There  were  individual  representatives  of 
some  splendid  medical  families  which  had 
produced  successful  doctors  for  five,  six, 
and  even  seven  successive  generations.  In 
fact,  13  per  cent  had  a positive  family  his- 
tory of  medicine  in  at  least  three  out  of 
five  successive  generations. 

In  glancing  through  the  biographical 
sketches  of  the  doctors  selected  in  this 
fashion,  it  was  obvious  that  most  of  them 
were  teachers  in  medical  schools  or  were 
well-known  writers.  It  seemed  possible  that 
such  a sampling  of  the  profession  was  un- 
fairly weighted,  laying  undue  emphasis  on 
scholastic  attainment.  To  offset  this,  by  way 
of  control,  figures  were  assembled  from  a 
group  of  136  doctors  selected  on  a more 
democratic  basis.  These  included  members 
of  the  House  of  Delegates  of  the  American 
Medical  Association  who  were  not  in  Who’s 
Who,  and  forty-three  doctors  who  also  had 
not  achieved  this  distinction  but  were  nom- 
inated by  various  county  medical  societies 
as  being  locally  regarded  as  the  most  useful 
members  of  the  profession.  In  these  com- 
bined groups,  47  per  cent  had  a positive  his- 
tory of  medicine  in  their  families;  22  per 
cent  were  sons  of  doctors;  12  per  cent  were 
grandsons  of  doctors,  and  16  per  cent  were 


fathers  of  doctors.  The  results  were  iden- 
tical with  those  in  the  Who’s  Who  group. 

As  a second  control,  134  Harvard  gradu- 
ates were  selected  more  haphazardly;  they 
were  men  who  had  graduated  between 
twenty  and  thirty  years  ago,  who  as  med- 
ical students  made  no  distinctive  records 
and  now,  so  far  as  could  be  judged,  were 
not  teachers  or  investigators  but  as  practi- 
tioners were  near  the  peak  of  whatever 
they  happened  to  have  made  of  their  lives. 
In  this  group,  in  contrast  to  the  other  two 
groups,  the  familial  incidence  of  medicine 
was  a little  less:  29  per  cent  had  a positive 
history  of  medicine  in  their  families;  15 
per  cent  were  sons  of  doctors;  7 per  cent 
were  grandsons  of  doctors,  and  7 per  cent 
were  fathers  of  doctors. 

It  appears,  from  these  figures,  that  a re- 
lationship may  exist  between  achieved  suc- 
cess in  medicine,  on  the  one  hand  and,  on 
the  other,  a familial  tendency  to  enter  the 
profession.  In  the  Who’s  Who  group,  34 
per  cent  had  a positive  history  of  medicine 
in  two  immediately  preceding  generations; 
in  the  House  of  Delegates  group  and  in  the 
group  nominated  by  county  societies  as 
successful  doctors,  34  per  cent  also  had  a 
positive  history  of  medicine  in  two  imme- 
diately preceding  generations;  in  the  group 
comprised  on  the  whole  of  doctors  less  out- 
standing and  less  well  known  as  writers, 
teachers  or  as  active  men  in  their  local  med- 
ical societies,  such  a familial  incidence  of 
medicine  had  fallen  to  22  per  cent. 

Obviously,  no  conclusion  can  be  drawn 
from  observations  of  this  nature.  I believe, 
however,  that  whatever  the  cause,  the  ten- 
dency for  successful  doctors  to  develop  in 
families  is  noteworthy.  It  does  no  harm  for 
a doctor’s  son  to  wish  to  follow  in  his  fath- 
er’s footsteps.  If,  in  these  times  of  rapid 
change,  doctors  will  but  stop  to  realize  that 
the  impulse  which  made  them  enter  and 
enjoy  their  profession  is  perhaps  inher- 
itable, they  will  stand  together,  well  or- 
ganized and  under  good  leadership,  to  see  to 
it  that  their  ideals  are  upheld.  In  this  way, 
only,  can  their  sons  and  grandsons  continue 
to  find  medicine  as  absorbing  an  occupation 


for  November,  1949 


909 


as  it  proved  for  themselves  and  their  for- 
bears. 

The  Physical  Examination  of  Doctors 

Physically,  doctors  have  no  distinctive  at- 
tributes: they  may  be  short  or  tall,  fat  or 
thin,  lively  or  morose,  choleric  or  placid. 
Their  sons,  also,  look  much  like  other  boys; 
they  have  about  the  same  physical  make-up 
as  their  classmates,  the  same  number  of 
brothers  and  sisters,  and  they  enter  their 
professional  training  with  about  the  same 
proportion  of  antecedent  broken  bones  and 
of  tonsils  or  appendices  removed.  Psycho- 
logically, perhaps,  they  have  an  advantage. 
In  a series  of  approximately  300,  data  from 
medical  aptitude  tests  made  before  students 
entered  the  Harvard  Medical  School  were 
compared  with  the  results  of  psychometric 
tests  made  on  the  same  individuals  at  the 
Boston  Psychopathic  Hospital  as  part  of  a 
teaching  exercise  in  the  third  year.  In  this 
series  there  was  a slightly  larger  proportion 
of  doctors’  sons  with  extremely  high  med- 
ical aptitude  tests  and  psychometric  read- 
ings than  in  the  group  of  non-doctors’  sons, 
although  the  proportion  of  ordinarily  good, 
bad  and  indifferent  material  in  the  two 
groups,  as  judged  by  these  tests,  was  es- 
sentially similar.  If  one  has  faith  in  the 
prediction  value  of  medical  aptitude  and 
psychometric  tests,  one  can  conclude  that 
exceptionally  able  candidates  for  medicine 
are  more  likely  to  be  found  among  doctors’ 
sons  than  among  a miscellaneous  group  of 
other  people’s  sons.  Perhaps  this  represents 
the  inheritable  gene  of  success  which  ac- 
counts for  the  figures  I have  related  in  re- 
gard to  the  family  history  of  doctors. 

The  Medical  Histories  of  Doctors 

The  medical  histories  of  doctors  are  much 
like  those  of  their  patients.  In  thinking  of 
this  aspect  of  their  peculiarities  one  does 
well  to  bear  in  mind  an  aphorism  which  Dr. 
Oliver  Wendell  Holmes  propounded  a cen- 
tury ago: 

“If  one  great  truth  defies  the  skeptic’s  scorn 
That  truth  is  this — that  children  must  be 
born; 

If  one  great  maxim  man  dare  not  deny. 

That  maximum  is — that  mortal  man  must 
die.” 


I have  long  imagined  the  practice  of  med- 
icine as  a huge  melting  pot  into  which  each 
year  medical  schools  pour  several  thousand 
young  men  and  from  which  the  Grim  Reap- 
er regularly  takes  out  an  annual  allotment. 
He  keeps  the  pot  stirred  and  mixed  and  not 
over-filled  by  drawing  off  a few  young  men 
each  year,  a larger  number  of  those  in  mid- 
dle age,  and  a great  many  of  the  older  men. 

During  the  years  that  I have  been  inter- 
ested in  this  melting  pot  curious  things 
have  happened  to  the  composition  of  its 
ingredients.  Thirty-five  years  ago,  nearly 
half  of  the  doctors  in  the  Massachusetts 
pot  were  young  men;  a doctor  who  lived  to 
be  much  over  60  was  almost  a rarity,  and 
an  octogenarian  like  Dr.  Holmes  received 
a public  ovation  when  he  survived  his  80th 
birthday.  Now,  while  their  total  number 
is  greater,  the  proportion  of  young  men 
in  circulation  has  become  diluted  because 
one  out  of  every  five  of  our  practitioners 
is  at  least  60,  and  many  who  are  70  and 
even  80  years  old  are  still  going  strong. 
This  phenomenon,  besides  being  of  physical 
interest,  has  economic  implications  which 
I shall  mention  later. 

The  reason  why  the  composition  of  the 
contents  of  the  melting  pot  has  changed  in 
its  age  mixture  is  readily  understandable 
— and  it  is  due  to  increased  medical  knowl- 
edge. The  accompanying  table  illustrates, 
graphically,  what  has  occurred. 


TABLE  I 

The  Common  Cause  of  Death  Among  Young 
Physicians  About  1907  and  Thirty-five 
Years  Later 
(Specific  Death  Rate) 

About  About 

1907  1942 


All  Causes 564  195 

Accidents  119  57 

Pneumonia  85  13 

Tuberculosis  67  6 

Typhoid  Fever  57  0 

Appendicitis  28  1 

Other  Infections  45  14 

Cardio-Vascular-Renal  85  59 


Almost  anyone  in  glancing  backward 
would  say  that  within  the  memory  of  many 
here  the  disappearance  of  typhoid  fever. 


910 


Rocky  Mountain  Medical  Journal 


the  suppression  of  tuberculosis  and  syphilis, 
improvement  in  pre-operative  and  post- 
operative care,  the  development  of  new  sur- 
gical technics,  and  the  discovery  of  chemo- 
therapeutic or  biologic  agents  like  the  sul- 
fonamide drugs,  liver  extract,  insulin  and 
penicillin,  are  among  the  conspicuous  mile- 
stones. As  each  one  has  been  reached,  phy- 
sicians as  well  as  their  patients  have  bene- 
fited. Fifty  years  ago  a great  many  young 
doctors  were  doomed  to  die  each  year.  Now, 
in  that  same  age  group,  only  a handful  are 
lost  and  middle-aged  or  elderly  doctors 
survive  illnesses  which  a few  years  ago  al- 
most certainly  would  have  been  fatal. 

There  has  been  considerable  discussion  as 
to  whether  or  not  doctors  are  unusually 
prone  to  develop  angina  pectoris  and  coro- 
nary occlusion.  P.  D.  White-,  F.  A.  Willius^, 
and  O.  P.  J.  Falk^  have  all  suspected  that 
coronary  disease  among  physicians  was  in- 
creasing, and  more  recently  L.  A.  Dublin® 
has  applied  statistical  methods  to  prove  the 
point.  On  the  other  hand,  Riesman®  and 
Harris,  Chadwick",  and  Haven  Emerson® 
have  reasoned  that  as  the  medical  popula- 
tion grew  older,  inevitably  would  it  de- 
velop more  manifestations  of  vascular  dis- 
ease. My  own  feeling  is  in  agreement  with 
the  opinion  of  the  latter  group;  I believe 
that  the  reason  why  so  many  doctors  are 
afflicted  with  angina  pectoris  is  in  no  way 
related  to  their  profession  but  is  a phenom- 
enon of  age.  One  can  anticipate  that  as  long 
as  the  number  of  elderly  doctors  continues 
to  increase  so  will  the  incidence  among 
them  of  vascular  disease.  Their  health  prob- 
lems in  no  way  differ  from  the  health  prob- 
lems of  people  at  large.  The  practice  of 
medicine  is  not  a dangerous  occupation. 

Economic  Characteristics  of  Doctors 

Doctors,  traditionally,  are  poor  business 
men,  more  concerned  with  taking  care  of 
sick  people  than  they  are  in  attempting  to 
collect  money.  Indeed,  before  1929  scarcely 
any  mention  was  made  of  the  financial  side 
of  medicine.  The  depression  of  that  year, 
however,  stimulated  a new  interest  so  that 
during  the  past  twenty  years  the  literature 


on  medical  economics  has  rapidly  grown  to 
reach  behemothian  stature. 

As  a matter  of  fact,  a variety  of  events 
occurred  long  before  1929  which  insidiously 
began  to  modify  the  basic  character  of  med- 
ical practice.  The  state  of  Rhode  Island 
is  a pleasant  region  for  medical  study; 
it  is  small,  representative,  and  it  has 
kept  reliable  statistical  records  for  many 
years.  Since,  1870,  the  growth  of  popu- 
lation and  the  increase  in  number  of  doc- 
tors there  have  been  strikingly  parallel. 
Seventy  years  ago,  in  contrast,  hospitals 
were  unpopular  and  little  used.  As  house 
owners  gave  way  to  apartment  dwellers 
and  as  hospitals  improved  the  service  they 
offered,  people  grew  to  regard  them  as 
places  in  which  to  be  cured  rather  than  as 
places  in  which  to  die  and  their  use  in- 
creased with  astonishing  rapidity;  this  had 
an  appreciable  effect  on  practice. 

I believe  that  this  sort  of  experience  is 
universal.  I know  of  a town  in  Massachu- 
setts, for  example,  which  used  to  be  proud 
of  its  increasing  birth  rate  and  where,  now, 
for  the  past  three  years  no  children  have 
been  born  at  all — all  expectant  mothers 
electing  to  go  to  the  hospital  in  a nearby 
city  rather  than  to  risk  the  hazards  of  labor 
at  home. 

A generation  ago  young  doctors  were  ac- 
customed to  enter  practice  when  they  had 
completed  an  internship;  they  helped  older 
men  in  laboratory  work,  they  made  night 
calls,  they  served  as  surgical  assistants  to 
busy  itinerant  surgeons  who  operated  all 
over  the  neighboring  countryside,  and  often 
they  camped  out  in  ill  patients’  houses 
when  a doctor  on  night  call  was  needed. 
Under  this  modification  of  the  preceptor 
system  they  began  to  develop  their  own 
practices  with  satisfactory  rapidity  and 
were  soon  well  launched  on  their  careers. 
Now,  in  part  because  of  the  increased  use 
of  hospitals  by  the  community  and  in  part 
because  the  value  of  youthful  energy  has 
become  diluted  by  the  large  number  of 
older  physicians  in  active  competition,  there 
is  much  less  incentive  for  a young  man  to 
start  on  his  own.  He  prefers  a I'ong  hospital 


for  November,  1949 


911 


training  in  an  institution  where  clinical 
experience  is  concentrated  and  where  diag- 
nostic and  therapeutic  facilities  are  close  at 
hand;  operations  on  the  kitchen  table  and 
the  home  care  of  the  seriously  ill  have 
largely  disappeared. 

Admittedly,  too,  the  doctor,  like  anyone 
else,  has  to  pay  for  his  bread  and  butter 
and  for  the  bringing  up  and  education  of 
his  children.  In  the  war  days  of  Procure- 
ment and  Assignment  when  accurate  track 
was  kept  of  what  almost  every  doctor  was 
doing,  I was  struck  by  an  observation  made 
in  Massachusetts,  and  confirmed  in  other 
regions,  that  doctors  were  most  highly  con- 
centrated in  areas  of  dense  population 
where  the  dollar  circulated  quickly,  and 
were  less  happy  and  more  eager  to  leave 
for  the  adventures  of  military  service  from 
regions  where,  as  our  industrial  colleagues 
put  it,  business  was  poor. 

When  I hear  statisticians  claim  that  many 
more  doctors  are  needed  to  meet  the  med- 
ical needs  of  the  country,  I wonder  whether 
they  take  into  consideration  how  much  big- 
ger the  profession  has  become  because  of 
the  work  accomplished  by  elderly  doctors; 
and  how  they  propose  to  create  opportuni- 
ties in  rural  practice  sufficiently  lucrative 
and  attractive  to  draw  young  doctors  away 
from  large  centers.  Certainly,  one  of  the 
immediately  urgent  problems  to  be  solved 
is  not  that  of  increasing  our  total  number 
of  doctors  but  is  that  of  making  best  use  of 
our  present  supply. 

Specialism 

Another  almost  fantastic  trend  has  been 
the  growth  of  specialism.  Its  formalization 
is  only  of  eighteen  years’  duration  for  in 
1931  Dr.  Carl  F.  MolP  of  Michigan  intro- 
duced in  the  House  of  Delegates  of  the 
American  Medical  Association  an  unassum- 
ing resolution  which  led  to  the  formation  of 
our  present  boards.  He  was  conscious  of  the 
growing  desire  for  doctors  to  call  them- 
selves specialists  and  he  regarded  this 
tendency  as  unsound;  therefore,  he  asked 
the  House  to  appoint  a Commission  to  de- 
termine what  a specialist  was  and  how 
many  were  needed. 


Anyone  who  has  been  involved  with  spe- 
cialty boards  has  been  impressed  with  their 
popularity.  One  gets  the  idea  that  almost 
every  young  doctor  hopes  to  become  a spe- 
cialist and  that  very  few  plan  to  offer  any 
community  the  more  general  type  of  med- 
ical advice  so  badly  needed.  Dr.  William  J. 
Mayo  once  suggested  a possible  danger  of 
this  trend  which  may  be  worth  bearing  in 
mind.  In  his  experience,  he  said,  he  was 
continually  impressed  by  the  large  number 
of  people  who  came  to  the  Mayo  Clinic  not 
because  they  knew  or  thought  they  had  any 
disease  but  because  they  wanted  help  and 
advice  about  the  simplest  sort  of  medical 
matters.  His  feeling  was  that  the  modern 
doctor  tended  to  be  over-trained  in  the 
diagnosis  and  treatment  of  advanced  organic 
disease  and  over-fascinated  by  the  array  of 
methods  now  at  his  disposal  for  study.  As  a 
result,  too  many  were  losing  interest  in  the 
less  “scientific”  phases  of  their  work,  were 
getting  far  away  from  old-fashioned  prac- 
tice, so  full  of  human  interest  and  oppor- 
tunity for  service,  and  were  deliberately 
through  indifference  encouraging  countless 
patients  to  patronize  the  various  medical 
cults.  Is  this  what  we  are  hoping  to  ac- 
complish? 

At  the  moment  I feel  in  the  midst  of  an 
ingeniously  constructed  labyrinth  without 
visible  exits.  What  is  needed  are  more  gen- 
eral practitioners.  Yet  each  medical  school 
is  obligated  to  teach  the  highest  type  of 
medicine  it  can,  both  in  pre-clinical  and 
clinical  courses.  This  can  best  be  accom- 
plished through  use  of  the  knowledge  of 
those  most  expert.  In  the  hospital,  the  stu- 
dent is  exposed  to  specialty  practice  and 
sees  its  practical  importance  every  day;  in 
the  laboratory  his  work  is  meticulously 
supervised  by  instructors  who  try  to  in- 
doctrinate him  with  the  scientist’s  love  for 
learning  more  and  more  about  less  and  less; 
and  around  the  school,  at  clinical  meetings, 
at  conferences  or  seminars  and  in  casual 
conversation  with  his  friends,  he  is  more 
occupied  in  surmounting  the  step  imme- 
diately in  front  of  him  than  in  considering 
the  structure  which  made  it  possible  for 
him  to  stand  where  he  now  finds  himself. 


912 


Rocky  Mountain  Medical  Journal 


A problem  almost  as  important  to  solve  as 
the  distribution  of  doctors  in  the  country  is 
the  one  propounded  by  Dr.  Moll.  How  many 
specialists  are  needed?  How  can  their  skills 
be  utilized  to  greatest  advantage? 

My  present  feeling  is  that  medical  schools 
must  discover  the  answer  to  the  questions 
which  now  seem  so  bewildering.  Our  pres- 
ent system  of  medical  education,  while  long 
and  complicated,  produces  impressive  re- 
sults. Our  professional  standards  are  high, 
new  ideas  are  developing,  and  research  goes 
forward.  While  our  system  of  clinical  train- 
ing clearly  lays  great  emphasis  on  special- 
ism yet  how  permanent  an  effect  this  will 
have  on  medical  care  is  less  certain. 

Medical  educators  realize  the  need  for  a 
better  understanding  of  human  nature  and 
are  laying  increasing  emphasis  on  teaching 
how  to  care  for  the  individual  patient.  While 
a new  term  has  been  coined,  psychosomatic 
medicine,  it  merely  emphasizes  an  old  ob- 
servation of  Thomas  Percival’s^"  made  many 
years  ago,  “The  feelings  and  emotions  of 
the  patient,  under  critical  circumstances, 
require  to  be  known  and  to  be  attend  to,  no 
less  than  the  symptoms  of  their  diseases.” 

During  the  war  a survey  made  in  regard 
to  what  young  medical  officers  had  in  mind 
when  they  returned  to  civilian  life  sug- 
gested that  the  majority  hoped  to  aid  in 
developing  a system  whereby  groups  of 
doctors  would  combine  in  different  commu- 
nities to  offer  total  medical  coverage  to 
their  patients  including  every  phase  of  care 
from  home  visits  to  most  complicated  sur- 
gical procedures,  from  the  prevention  of 
disease  to  the  treatnient  of  its  end  stages. 
So  far,  group  practices  have  not  developed 
much  more  rapidly  than  before  the  war; 
isolated  experiments  in  their  establishment 
have  appeared  to  yield  reasonably  success- 
ful results;  possibly  this  is  the  best  road  to 
explore. 

The  fact  remains  that  at  the  moment  too 
few  young  doctors  seem  inspired  by  their 
teachers  to  begin  the  practice  of  medicine, 
not  as  specialists  but  as  plain  physicians, 
trained  to  realize  the  importance  of  special- 
ism but  not  over-attracted  by  its  intellec- 


tual or  commercial  value.  I hope  that  doc- 
tors’ sons  will  continue  to  become  doctors 
and  that  they  will  have  an  increasing  ex- 
pectancy of  long  years  of  productive  work. 
I hope,  too,  that  the  standards  of  medical 
education  will  not  deteriorate  but  will  be 
raised  even  higher  than  they  now  are.  Most 
of  all,  I hope  that  the  practice  of  medicine 
will  never  lose  its  dignity  but  will  always 
remain  a profession,  not  a trade. 

Twenty-three  years  ago.  Dr.  Sewall“  pre- 
sented a paper  before  the  Denver  County 
Medical  Society.  Its  title  was  “Private 
Practice  and  State  Medicine.”  He  foresaw 
the  time  when  our  patients  would  become 
collaborators  in  medical  progress,  giving  us 
their  full  confidence  and  support  when  at 
last  they  came  to  believe  that  their  inter- 
ests outweighed  with  us  our  own.  Not  until 
then,  he  predicted,  would  the  era  of  the 
old-time  family  physician  return  to  its  full 
flowering.  When  it  did,  people  would  see 
us  not  as  doctors  but  as  learned  friends  who 
would  teach  them  how  not  to  need  medical 
advice  and,  as  a result,  they  would  seek  it 
ten  times  for  once  they  did  before. 

Like  almost  all  of  Dr.  Sewall’s  thoughts, 
this  idea  continues  to  be  worthy  of  con- 
templation. 

RJEFEREIVCES 

’Sewall,  T. : His  article  on  “The  Pathology  of 
Drunkenness,  or  the  Physical  Effects  of  Alcoholic 
Drinks,  With  Drawings  of  the  Drunkard’s  Stomach,’’ 
published  in  1841,  was  one  of  his  best-known  ar- 
ticles. 

^White,  P.  D. : The  Physician  Himself.  J.A.M.A., 
115:1495-1499  (Oct.  26),  1940. 

^Willius,  F.  A.:  A Talk  on  Cardiac  Disease  Among 
Physicians.  Proc.  Soc.  Staff  Meet.,  Mayo  Clin.,  16:714- 
716  (Nov.  5).  1941. 

^F'alk,  O.  P.  J. : Coronary  Disease  and  the  Doctor. 
Illinois  M.J.,  80:115-119  (Aug.),  1941. 

i^Dublin,  L.  I.:  Longevity  and  Mortality  of  American 
Physicians.  J.A.M.A.,  134:1211-1215  (Aug.  9),  1947. 

sRiesman,  D.,  and  Harris,  S.  E. : Disease  of  the 
Coronary  Arteries  With  a Consideration  of  Data  on 
the  Increasing  Mortality  of  Heart  Disease.  A.J.M.Sc., 
187:1-15  (Jan.),  1934. 

’Chadwick,  H.  D.:  The  Diseases  of  the  Inhabitants 
of  the  Commonwealth.  New  England  J.  Med.,  216: 
1003-1015  (June  10),  1937. 

^Emerson,  H.,  and  Hughes,  H.  E.:  Death  Rates  of 
Male  White  Physicians  in  the  United  States  by  Age 
and  Cause.  Am.  J.  Pub.  Health,  16:1088-1093  (Nov.), 
1926. 

®Moll,  C.  F. : Resolutions  on  Appointment  of  a Com- 
mission on  Qualifications  for  Specialists.  J.A.il.A., 
96:2114  (June  20),  1931. 

lopercival,  T. : Medical  Ethics;  or  a Code  of  In- 
stitutes and  Precepts  Adapted  to  the  Professional 
Conduct  of  Physicians  and  Surgeons.  London,  1803. 

“Sewall,  H. : Private  Practice  and  State  Medicine. 
Colorado  Med.,  23:230-232  (July),  1926. 


for  November,  1949 


913 


OTOLOGY  IN  GENERAL  PRACTICE* 

HERMAN  I.  LAFF,  M.D. 

DENVER 


Since  we  are  today  witnessing  the  re- 
surgence of  the  general  practitioner,  a re- 
evaluation  of  his  role  and  responsibilities  in 
the  management  of  certain  diseases  of  the 
ear  is  not  out  of  place.  The  newer  concepts 
and  changing  trends  in  otology  of  the  last 
decade  also  require  proper  orientation.  To- 
day, preservation  of  function  and  rehabili- 
tation of  the  handicapped  are  in  the  fore- 
front of  our  thinking  and  social  responsi- 
bility. Therefore,  the  practitioner  must 
join  the  specialist  in  helping  conserve  and 
improve  hearing  function. 

There  are  indications  that  impairment  of 
hearing  from  ear  infections  is  destined  to 
become  more  common  since  the  widespread 
use  of  chemo-  and  bio- therapy.  Our  present 
understanding  of  the  deleterious  effects  of 
hyperplastic  lymphoid  tissue  in  the  naso- 
pharynx, the  advances  in  our  knowledge 
and  management  of  fungus  infections, 
chronic  middle  ear  suppurations,  acoustic 
trauma,  Meniere’s  disease,  and  otosclerosis 
also  deserve  discussion. 

Acute  Otitis  Media  and  Mastoiditis 

Following  the  introduction  of  the  sulfa 
drugs,  perhaps  no  other  field  witneessed 
such  drastic  curtailment  in  the  need  for 
surgical  intervention  as  otology.  With  the 
advent  of  penicillin  and,  more  recently, 
streptomycin,  surgical  drainage  of  acute 
otitis  media  and  mastoiditis  has  almost 
disappeared,  except  in  neglected  cases.  The 
myringotomy  lancet  today  practically  re- 
mains unsheathed  because  most  practition- 
ers appear  to  have  gained  an  implicit  faith 
in  the  routine  ability  of  these  drugs  to  sup- 
plant it.  Too  often  these  agents  are  used 
in  inadequate  doses  and  for  only  a day  or 
two.^  By  then  fever  and  pain  have  either 
improved  or  subsided.  Both  the  physician 
and  patient  are  usually  fearful  of  the  toxic 
potentialities  of  these  drugs  and  are  in- 
clined to  stop  them  prematurely.  The  re- 

*Presented before  the  78th  Annual  Session  of  the 
Colorado  State  Medical  Society  at  Glenwood  Springs, 
Colorado,  September  23,  1948. 


suit  is  that  a few  days  later  symptoms  re- 
cur, the  drug  is  once  more  administered  in 
guarded  amounts,  and  relapse  again  follows. 

On  numerous  occasions  I have  seen  this 
cycle  repeated  over  a period  of  weeks.  In 
the  meantime  the  middle  ear  spaces  and 
their  contents,  lacking  drainage,  are  sub- 
jected to  prolonged  inflammatory  insult. 
Such  recurring  impacts  on  the  ears  of  in- 
fants and  children — who  numerically  are, 
of  course,  the  chief  victims  of  acute  otitis — 
are  prone  insidiously  to  damage  their  hear- 
ing function,  because  children  are  apt  to 
ignore  feelings  of  fullness  and  stuffiness 
and  seldom  complain  unless  they  have  ear- 
ache. 

When  otoscopy  shows  the  presence  of 
purulent  exudate,  the  institution  of  drain- 
age by  myringotomy  is  urgently  required. 
Some  physicians  have  been  heard  to  say 
that  since  the  chemotherapeutic  era  they 
have  seldom  or  never  experienced  the  need 
for  doing  a paracentesis.  Such  blind  faith 
may  lead  to  serious  intracranial  complica- 
tions, not  to  mention  damage  to  hearing. 
It  is  true  that  more  frequently  than  not 
myringotomy  may  be  avoided  if  these  drugs 
are  adequately  employed  and  continued.  It 
must  be  remembered  that  they  are  bacterio- 
static, not  bactericidal,  agents  and  may  in- 
terfere with  natural  immunity.  The  best 
results  are  obtained  when  they  are  ad- 
ministered early.  When  purulent  exudate 
is  already  present,  myringotomy  should  be 
done  first  and  the  drug  then  employed  to 
control  the  infection  and  help  hasten  reso- 
lution. This  simple,  proved  and  trustworthy 
minor  surgical  procedure  should  not  be 
lightly  discarded.  Similarly,  the  simple 
mastoid  operation,  fast  becoming  a rarity, 
also  still  has  its  place  and  should  not  be 
unconditionally  eliminated. 

The  above  is  not  to  be  considered  a con- 
demnation of  the  use  of  these  drugs.  No 
one  who  has  witnessed  their  almost  miracu- 
lous effects  on  numerous  occasions  can 
gainsay  their  great  value.  The  inherent 


914 


Rocky  Mountain  Medical  Journal 


risks  of  solely  relying  on  them  in  all  types 
of  ear  infections  are,  however,  not  to  be  ig- 
nored. 

Hyperplastic  Lymphoid  Tissue  in  the 
Nasopharynx 

It  has  long  been  known  that  enlarged 
adenoids  and  associated  lymphoid  tissue  in 
and  around  the  mouths  of  the  eustachean 
tubes  of  children  predisposed  them  to  at- 
tacks of  catarrhal  and  suppurative  otitis 
media.  Surgical  removal  of  the  main  ade- 
noid mass  frequently  produced  gratifying 
results.  The  aberrant  lymphoid  aggrega- 
tions near  the  mouths  of  the  tubes,  espe- 
cially when  chronically  infected,  were 
known  to  be  a greater  menace,  but  their 
removal  surgically  was  difficult  or  impos- 
sible. Although  roentgen-ray  therapy  had 
been  used  sporadically  to  shrink  this  tissue, 
it  remained  for  Crowe^  ® and  his  associates 
to  place  irradiation  therapy  of  the  naso- 
pharynx on  a firm  footing.  By  devising 
radon  and  radium  applicators  for  this  pur- 
pose they  placed  this  modality  in  the  hands 
of  interested  otologists. 

The  applicator  at  present  in  use  consists 
of  50  mg.  of  radium  enclosed  in  a monel 
metal  capsule  firmly  attached  to  a rod  six 
inches  in  length.  It  is  inserted  along  the 
floor  of  the  nose  until  it  reaches  the  region 
of  the  eustachean  tube  and  is  left  in  place 
for  exactly  twelve  minutes  on  each  side. 
In  the  majority  of  cases,  even  in  children, 
this  can  be  carried  out  as  an  office  pro- 
cedure. Three  such  treatments  at  bi- 
weekly intervals  constitute  a series.  Thus 
used  it  has  proved  harmless  in  thousands 
of  cases. 

Results  have  been  gratifying  and  numer- 
ous reports  from  many  sources  testify  to 
its  value.  It  improves  ventilation  of  the 
tubes  and  helps  eliminate  the  pathways  for 
spread  of  infection  to  the  middle  ear,  thus 
minimizing  damage  to  auditory  function. 
Where  moderate  deafness  already  exists, 
improvement  frequently  results.  Audio- 
metric testing  of  school  children  is  serving 
to  bring  them  to  otologists  for  radium  treat- 


ment before  their  deafness  is  too  far  ad- 
vanced. 

Obviously,  large  adenoid  and  lymphoid 
masses  are  best  removed  surgically.  Too 
frequently  the  practitioner  neglests  to  re- 
move the  adenoids  cleanly.  He  is  prone  to 
be  much  more  thorough  with  the  tonsil- 
lectomy. This,  of  course,  is  due  to  the  fact 
that  surgery  in  the  nasopharynx  is  mostly 
a blind  procedure.  By  use  of  special  intru- 
ments  and  a palate  retractor,  lymphoid 
masses  in  Rosenmuller’s  fossa  and  along  the 
lateral  pharyngeal  walls  can  be  adequately 
removed.  Irradiation  should  be  reserved 
for  shrinking  of  lymphoid  tissue  not  avail- 
able to  surgical  management. 

As  was  the  case  during  the  war,  radium 
treatments  are  presently  also  helping  to 
control  attacks  of  aero-otitis  media  in  pilots 
and  the  flying  public. 

Chronic  Suppurative  Otitis  Media 

After  the  advent  of  chemotherapy  many 
hoped  that  it  would  favorably  control  chron- 
ically discharging  ears.  With  the  passing 
of  time  it  has  become  more  evident  that, 
systemically  employed,  these  drugs  may 
bring  temporary  improvement  but  hardly 
lasting  cures.  Their  local  use  has  been 
somewhat  more  effective.  In  the  so-called 
non-dangerous  types  (with  central  perfora- 
tions of  the  drum,  usually  denoting  absence 
of  bone  necrosis  and  cholesteatoma) , otosmo- 
san  and  otomide  (sulfa  preparations),  pen- 
icillin solutions,  and  glycerite  of  hydrogen 
peroxide  have  proved  of  considerable  value. 
Actually  these  newer  preparations  may 
possess  few  advantages  over  the  time-hon- 
ord  boric-alcohol  drops,  iodobor  powder, 
etc.,  which  also  produced  results  in  many 
cases,  especially  when  swimming  was  in- 
terdicted, proper  ear  hygiene  instituted  and 
attention  directed  to  existing  sinus  and 
nasopharyngeal  pathology. 

It  is  obviously  not  possible  here  to  enter 
into  a detailed  discussion  of  the  etiologic 
and  pathologic  factors  concerned  in  chronic 
ear  suppurations.  Suffice  it  to  say  that  each 
case  must  be  treated  on  an  individual  basis. 
Cleansing  treatment  combined  with  local 


for  November,  1949 


915 


applications  may  prove  effective  in  some. 
Where  granulations  exist,  they  certainly 
must  be  removed  before  suppuration  will 
cease. 

If  the  drum  is  the  site  of  a marginal 
perforation  it  may  be  assumed  that  bone 
necrosis  or  cholesteatoma  are  present.  Be- 
cause both  favor  progression  and  complica- 
tions, they  are  considered  as  the  dangerous 
type  of  chronic  ear  infection.  Here  local 
treatment  alone  is  doomed  to  failure  and 
some  form  of  radical  mastoid  surgery  will 
be  necessary  to  eradicate  the  diseased  areas 
permanently.  Since  in  this  variety  much 
of  the  drum  and  ossicular  chain  are  often 
found  intact,  modifications  of  the  radical 
operation  have  been  sought  in  order  to 
preserve  the  remains  of  these  structures, 
thus  maintaining  the  existing  hearing  while 
at  the  same  time  eliminating  the  causative 
pathology.  As  is  the  practice  in  fenestra- 
tion surgery  for  otosclerosis,  by  using  the 
endaural  instead  of  the  post-auricular  ap- 
proach and  by  adding  a magnifying  loupe 
the  technical  difficulties  of  performing  the 
modified  radical  operation  have  been  large- 
ly overcome.  Results  from  this  surgery  are 
now  so  improved  that  it  may  be  increasing- 
ly recommended. 

It  is  thus  apparent  that,  unlike  acute 
otitis  media,  surgery  in  chronic  ear  sup- 
purations has  not  until  now  and  probably 
never  will  be  replaced  to  the  same  degree 
by  the  “miracle  drugs.” 

Fungus  Infections  of  the  External  Ear 

Experiences  with  another  type  of  trouble- 
some ear  condition  commonly  encountered 
during  the  recent  conflict — mycotic  infec- 
tions of  the  external  ear  canal — have  re- 
warded us  with  improved  methods  for  their 
eradication.  Many  varieties  of  fungi  are 
capable  of  invading  the  skin  lining  the  ex- 
ternal canals,  especially  under  conditions 
of  excessive  moisture  and  warmth.  Treat- 
ment to  be  effective  must  be  prolonged  and 
intelligently  applied.  Although  moisture  is 
best  kept  out  of  the  canals,  cleasing  irriga- 
tions by  the  physician,  followed  imme- 
diately by  complete  drying,  will  do  no  harm 
and  will  remove  products  of  inflammation 


and  fungi  that  no  amount  of  wiping  will 
accomplish. 

It  should  also  be  remembered  that  in 
order  to  destroy  spores,  treatment  must  be 
continued  for  several  weeks  after  apparent 
cure.  Among  the  newer  fungicides,  cresa- 
tin,  isopar  and  dalyde  have  proved  effective. 

^ Acoustic  Trauma 

The  two  recent  world  wars  have  dra- 
matically brought  to  our  attention  the  dis- 
astrous and  progressive  deterioration  of 
hearing  brought  about  by  cannon  and  rifle 
fire,  riveting,  airplane  noise,  etc.  In  many 
civilian  industries  the  auditory  nerves  are 
similarly  damaged.  Once  initiated,  acoustic 
trauma*  is  more  often  progressive  than  not. 
We  know  of  no  remedy  to  stay  the  process. 
Our  efforts  must  therefore  be  directed 
towards  prevention.  “Ear  defenders”  to  be 
inserted  into  the  ear  canals,  of  a type  ca- 
pable of  reducing  the  impact  of  loud  sounds 
on  the  inner  ear  while  at  the  same  time 
permitting  the  individual  to  hear  conversa- 
tion, are  now  available.  The  problem  is  to 
get  people  to  wear  them.  It  appears  that 
much  educational  and  ground  work  will  be 
necessary  on  the  part  of  physicians  in  order 
to  convince  employers  and  the  public  of 
their  prophylactic  value. 

Vertigo  and  Meniere’s  Disease 

When  a physician  sees  a patient  with  the 
troublesome  complaint  of  vertigo  he,  as  a 
rule,  promptly  seeks  the  aid  of  an  otologist. 
A good  history  and  thorough  physical  ex- 
amination should,  however,  come  first. 
Many  conditions  causing  vertigo  are  due  to 
pathology  often  remote  from  the  inner  ear, 
as  in  the  vestibular  pathways,  eyes  and 
cardiovascular  system.  Drug  intoxications, 
focal  infection,  sunstroke,  cerebral  tumors, 
head  injury,  eyestrain  and  vasomotor  dis- 
turbances at  the  time  of  the  menopause 
may  initiate  the  attacks.  The  otologist  is, 
of  course,  more  directly  concerned  when 
local  pathology  in  the  ear  is  present.  Thus 
such  minor  conditions  as  inspissated  ceru- 
men or  obstruction  of  an  eustachean  tube 
may  alter  local  air  pressure  and  affect  the 
labyrinth.  When,  in  the  course  of  a chronic 


916 


Rocky  Mountain  Medical  Journal 


otitis  media,  a cholesteatoma  has  eroded 
into  the  horizontal  semicircular  canal,  pro- 
ducing labyrinthitis,  relief  obviously  de- 
pends on  its  eradication. 

The  tendency  has  been  to  lump  all  forms 
of  vertigo  into  one  category  and  call  them 
Meniere’s  disease.  Recently  it  has  been 
shown  that  in  true  Meniere’s  there  exists 
a distention  of  the  endolymphatic  spaces — 
a hydrops  of  the  labyrinth.®  Hearing,  as  a 
rule,  is  also  reduced.  Some  have  maintained 
that  the  distention  of  the  labyrinthine 
spaces  may  be  the  result  of  salt  retention, 
fluid  retention,  or  allergic  edema. 

Accordingly,  treatment  has  varied,  de- 
pending on  the  point  of  view,  and  has  not 
been  too  satisfactory.  Salt  free  diet  and 
limitations  of  fluid  intake,  together  with  the 
use  of  ammonium  chloride,  have  enjoyed 
varying  degrees  of  popularity.  More  re- 
cently the  use  of  histamine  and  nicotinic 
acid  has  come  into  the  fore  with  consider- 
able success.  They  are  potent  vasodilators 
and  may  so  alter  capillary  permeability  in 
the  labyrinth  as  to  hasten  the  absorption 
of  the  labyrinthine  hydrops.  If  the  dropsy 
is  the  result  of  an  allergy,  histamine  is  val- 
uable by  its  antagonistic  action. 

Medical  management  fails  in  15  to  20  per 
cent  of  patients.  Dandy  practiced  section 
of  the  vestibular  nerve.  At  present  opera- 
tions planned  to  destroy  the  labyrinth  prop- 
er are  simpler  and  safer.  After  fenestrating 
the  bony  horizontal  semicircular  canal  by 
the  usual  mastoid  route  the  membranous 
canal  may  be  destroyed  by  tearing,  coagula- 
tion, or  applying  alcohol. 

Otosclerosis  and  Fenestration  Surgery 

Otosclerosis  is  a fairly  common  cause  of 
deafness  of  unknown  etiology  and  com- 
mences in  young  adults,  attacks  both  ears, 
grows  progressively  worse  and  is  not  de- 
pendent on  any  previous  ear  infection.  The 
pathology  consists  of  a spongification  of  the 
bone  in  the  region  of  the  oval  window, 
causing  ankylosis  of  the  stapes  and  a typi- 
cal conduction  type  of  deafness.  The  ear 
drums  and  eustachean  tubes  are  normal. 
The  window  or  fenestration  operation  of 


Lempert  which  has  been  practiced  during 
the  last  decade  for  relief  of  otosclerosis 
permits  sound  to  reach  the  inner  ear  via 
this  newly  created  pathway.  Results  im- 
mediately following  the  operation  have 
generally  been  satisfactory  in  properly  se- 
lected cases.  Unfortunately  in  many  the 
window  becomes  occluded  five  or  six 
months  later  and  the  hearing  gain  recedes 
to  the  pre-operative  level.  In  a fair  per 
cent  the  window  remains  patent  perma- 
nently and  patients  are  very  grateful,  pre- 
ferring this  to  the  wearing  of  a hearing 
aid.  Technics  to  overcome  this  tendency 
for  closure  are  constantly  being  improved. 
In  my  opinion  the  continuous  irrigation 
technic  and  the  dissecting  microscope,  as 
advocated  by  Shambaugh,  appear  to  be  for- 
ward advances. 

Because  of  the  progressive  character  of 
otosclerosis  the  cochlear  nerve  as  a rule 
becomes  secondarily  involved.  We  are  see- 
ing many  patients  on  whom  the  fenestra- 
tion operation  is  no  longer  feasible,  because 
nerve  degeneration  has  become  so  extensive 
that  a successful  result  is  out  of  the  ques- 
tion. We,  as  physicians,  must  therefore  be 
cognizant  of  this  time  element,  ih  order  to 
be  able  to  advise  correctly  and  guide  our 
patients,  in  case  they  wish  to  consider 
fenestration  surgery. 

Conclusions 

1.  Because  of  the  present  widespread  use 
of  chemotherapy  in  otologic  infections,  the 
recent  advances  in  our  understanding  and 
management  of  certain  ear  diseases  and  the 
emphasis  now  placed  on  conservation  of 
hearing,  the  practitioner  must  today  be 
more  alert  than  ever  if  he  is  to  propertly 
discharge  his  responsibilities  to  his  patients. 

2.  Not  all  cases  of  acute  otitis  media  and 
mastoiditis  are  properly  and  adequately  re- 
lieved by  chemotherapy. 

3.  Most  types  of  chronic  ear  suppurations 
are  not  cured  by  the  systemic  use  of  sulfa 
drugs  and  penicillin. 

4.  Shrinking  of  hyperplastic  lymphoid 
tissue  in  remote  parts  of  the  nasopharynx 


for  November,  1949 


917 


by  the  use  of  50  mg.  radium  applicator  has 
proved  of  distinct  value  in  reducing  and 
controlling  childhood  deafness. 

5.  Our  newer  knowledge  and  improved 
management  of  fungus  infections,  acoustic 
trauma,  Meniere’s  disease  and  otosclerosis, 
will  better  help  the  practitioner  to  cope 
with  these  problems. 


KEFERENCES 

Wan  Alyea,  O.  E.:  Otolaryngology  In  General 
Practice,  New  Orleans  II.  and  S.  Journal,  99:161-165 
(Oct.),  1946. 

Klrowe,  S.  J.,  and  Baylor,  J.  W.:  Prevention  of 
Deafness,  J.A.M.A.  112:252-590  (Feb.  18),  1939. 

^Crowe,  S.  J.,  and  Burnani,  C.  F. : Recognition, 
Treatment  and  Prevention  of  Hearing  Impairment 
in  Children,  Ann.  Oto'l.,  Rhin.  & Laryng.  50:15-31 
(March),  1941. 

■•Taylor,  H.  Marshall:  Traumatic  Deafness;  Prob- 
lems of  Prevention,  Laryngoscope  54:362-373  (Julv), 
1944. 

“Daggett,  W.  I.:  Advances  in  Otolaryngology,  Prac- 
titioner 157:295-302  (Oct.),  1946. 


HIGHLIGHTS  OF  PUBLIC  HEALTH  PROGRESS  IN 
COLORADO:  A SYMPOSIUM 

I.  PRESENT  ADMINISTRATIVE  ORGANIZATION  AND 

NEW  PROGRAMS* 

ROY  L.  CLEERE,  M.D. 

DENVER 


Public  Health  protection  today  implies 
constant  consultation  and  interchange  of 
services  between  the  medical  profession 
and  strong  state  and  local  health  depart- 
ments equipped  and  staffed  to  perform 
a great  variety  of  specialized  functions. 

Thanks  to  the  Sabin  health  bills  and 
the  increased  appropriations  approved  by 
the  Thirty-Sixth  General  Assembly — with 
the  backing  of  practicing  physicians  and 
medical  institutions  — Colorado  today  has 
a strong  State  Department  of  Public 
Health  with  highly  qualified  professional 
and  technical  personnel  in  many  of  the 
hey  positions.  Our  communities  now  can 
look  forward  to  increasingly  effective 
health  protection  at  the  local  level  be- 
cause of  the  strengthened  state  services 
und  also  because  of  the  growing  number 
of  district  health  departments.  At  both 
the  state  and  the  local  levels,  the  medical 
profession  and  the  health  departments 
are  working  together  in  numerous  case- 
finding, disease  control,  public  health  re- 
search, and  training  programs. 

For  my  share  of  this  presentation,  I 
should  like  to  deescribe  briefly  the  organi- 
zation patterns  of  our  state  and  local  health 

^Presented  as  part  of  a symposium  on  “Adminis- 
trative Organization  and  New  Programs’’  of  the 
■Colorado  Department  of  Public  Health  at  the  78th 
Annual  Session  of  the  Colorado  State  Medical  So- 
■ciety,  Glenwood  Springs,  September  25,  1948.  The 
author  is  Executive  Director,  Colorado  State  De- 
tjartment  of  Public  Health. 


departments  and  to  summarize  our  recent 
progress  and  new  activities  for  prevention 
of  disease  and  unnecessary  deaths. 

Organization  at  the  State  Level 

The  functions  of  the  State  Department  of 
Public  Health  now  are  coordinated  under 
four  main  divisions  or  groupings  of  pro- 
grams which,  taken  together,  represent  a 
full  range  of  the  services  requisite  for  pub- 
lic health  preservation  at  modern  standards. 

First:  The  General  Services  Division  em- 
braces the  General  Administration,  Records 
and  Statistics,  Laboratories,  Health  Educa- 
tion, and  Hospital  Facilities  Sections. 

Second;  In  the  Preventive  Medical  Serv- 
ices Division,  we  have  grouped  the  Sections 
of  Epidemiology,  Venereal  Disease  Control, 
Tuberculosis  Control,  Maternal  and  Child 
Health,  and  Crippled  Children;  also  the 
Public  Health  Nursing,  Dentistry,  and  Vet- 
erinary Services;  and  the  Cancer  Control 
and  Mental  Hygiene  programs. 

Third:  The  Sanitation  Division  is  divided 
into  three  major  sections.  They  are  Public 
Health  Engineering,  including  water  and 
sewage  sanitation  activities;  General  Sani- 
tation relating  to  food,  milk,  and  environ- 
mental conditions;  and  Industrial  Hygiene. 

Fourth:  The  Local  Health  Services  Di- 
vision, one  for  which  great  expansion  is 


918 


Rocky  Mountain  Medical  Journal 


foreseen,  completes  the  State  Department’s 
organization  plan. 

It  is  gratifying  also  to  be  able  to  report 
that  vacancies  no  longer  are  a predominant 
note  in  the  professional  personnel  picture 
of  the  Department.  Salary  scales  have  been 
revised  upward,  and  many  of  the  formerly 
vacant  or  newly  created  division  and  sec- 
tion directorships  have  been  filled  on  a 
career  basis. 

Other  new  staff  members,  whose  employ- 
ment was  made  possible  by  the  reorgan- 
ization program  and  increased  funds,  in- 
clude consultants  in  nutrition,  pediatrics, 
physical  therapy,  and  industrial  hygiene. 
Cancer  control  and  Mental  hygiene  pro- 
grams are  being  developed  in  cooperation 
with  the  Medical  Society  and  the  Medical 
School. 

Local  Health  Organization 

Glancing  now  at  the  local  health  depart- 
ments, we  again  find  the  prospect  bright. 
In  the  San  Juan,  the  south  central,  and  the 
northeastern  areas  of  the  state  and  in  the 
tri-county  area  surrounding  Denver,  four 
new  health  districts,  serving  a total  of  fif- 
teen counties,  have  been  organized.  Sep- 
arate county  health  departments  are  main- 
tained in  Otero,  Weld,  and  El  Paso  Counties. 
Medical  directors  are  employed  in  five  of 
these  departments. 

Denver,  too,  has  reorganized  its  health 
services,  obtained  personnel  for  its  public 
health  programs  and,  with  the  stimulating 
presence  of  Dr.  Florence  Sabin  as  Manager 
of  Health  and  Charity,  is  improving 
health  conditions  in  our  capital  city.  In  the 
unorganized  areas  of  the  state,  groundwork 
is  being  laid  for  establishing  additional  dis- 
trict health  departments  when  more  funds 
are  available. 

Progress  on  Many  Fronts 

Under  the  improved  organization  plan 
and  enlarged  professional  staff,  the  State 
Department  of  Public  Health  has  been  able 
to  work  more  closely  with  the  county  of- 
ficials, local  health  departments,  and  prac- 
ticing physicians  as  well  as  with  other  state 


agencies,  professional  societies,  and  non- 
official health  associations.  As  a result, 
public  activities  are  gaining  momentum  on 
many  fronts. 

The  state  sanitary  engineering  staff  deal- 
ing with  water  supply,  sewage  disposal,  and 
stream  pollution  problems  has  been  in- 
creased from  one  to  four,  and  regular  in- 
spections and  reports  on  water  and  sewage 
plants  have  become  possible.  In  addition, 
important  special  surveys  are  on  the  calen- 
dar. A study  of  pollution  of  irrigation 
waters  is  in  progress  in  cooperation  with 
the  University  of  Colorado  Medical  Center; 
plans  have  been  completed  for  a thorough 
survey  of  the  South  Platte  River  by  the 
Denver  and  State  Health  Departments  and 
the  United  States  Public  Health  and  Recla- 
mation Departments.  In  August,  confer- 
ences were  held  by  sanitary  engineers  of 
this  and  nine  other  states  on  inter-state 
pollution  problems  in  the  Missouri  River 
Basin. 

The  Industrial  Hygiene  Section  is  con- 
ducting studies  of  many  types  in  a variety 
of  plants,  as  well  as  on  stream  pollution 
from  industrial  sources.  As  to  statewide 
distribution  of  sanitation  services,  nineteen 
sanitarians  who  are  working  under  in- 
creased supervision  by  the  state  staff  now 
are  employed  in  the  local  areas,  in  contrast 
to  only  six  a year  ago.  Restaurant  sanitation 
has  been  improved  through  intensive  in- 
spection campaigns  prior  to  issuance  of  the 
1948  licenses  and  by  continuous  periodic  in- 
spections. 

Educational  and  inspection  activities  re- 
lated to  milk  sanitation  have  been  increased, 
particularly  regarding  compliance  with  the 
provisions  of  the  Standard  Milk  Ordinance. 
An  encouraging  achievement  in  widened 
food  sanitation  measures  is  the  strengthened 
meat  inspection  program  recently  developed 
by  the  Public  Health  Veterinarian.  The 
drive  to  obtain  effective  control  of  brucello- 
sis will  continue  until  the  desired  goal  is 
met. 

In  communicable  disease  case-finding  and 
control,  progress  is  being  made  by  expand- 
ing established  programs  and  developing 

9ia 


for  November,  1949 


new  ones,  some  of  which  are  joint  projects 
of  the  state  and  local  health  departments 
and  nonofficial  health  organizations,  the 
Medical  Center,  and  other  cooperating 
agencies.  For  example;  A new  mobile 
bacteriological-laboratory  unit  and  an  addi- 
tional mobile  x-ray  unit  for  mass  tubercu- 
losis surveys  are  now  in  operation.  The 
practicing  physicians  and  tuberculosis  in- 
stitutions are  participating  well  in  our  im- 
proved tuberculosis  case  reporting  system 
and  are  helping  to  make  the  Register  a 
more  valuable  tool  for  case  follow-up. 
Through  local  cooperation  with  our  Mater- 
nal and  Child  Health  Section,  more  children 
were  immunized  last  year  than  formerly. 

Control  of  venereal  disease  locally  is  being 
facilitated  by  intensified  case-finding  and 
lay  and  professional  education  programs  of 
the  Veneral  Disease  Control  Section;  also 
by  its  activities  directed  toward  decentral- 
ization of  rapid  treatment  through  adoption 
of  new  penicillin  methods  which  can  be 
performed  by  the  physicians  in  their  offices. 
With  these  ends  in  view,  and  with  the  co- 
operation of  the  San  Luis  Valley  Medical 
Society,  a case-finding  and  educational  pro- 
gram through  mass  blood  testing  went  into 
operation  in  the  Valley  this  summer. 

Other  public  health  research  now  in  prog- 
ress by  the  State  Department  of  Public 
Health,  or  under  its  supervision,  includes 
cancer  case  reporting  and  statistical  studies; 
surveys  on  dental  caries  in  relation  to  fluo- 
rine; and  dietary  and  nutrition  studies  in 
relation  to  physical,  dental,  and  crippling 
conditions. 

Very  important  for  future  health  protec- 
tion and  for  minimizing  disability  and  pre- 
ventable deaths  are  several  new  services 
which  are  designed  to  afford  professional 
training  in  preventive  medical  technics. 
These  projects  are  conducted  with  the  fi- 
nancial aid,  supervision,  and  professional 
participation  of  the  State  Department  of 
Public  Health  in  conjunction  with  other 
state  and  non-official  health  organizations. 
They  include  the  center  for  the  care  of  pre- 


mature infants  at  the  University  of  Colo- 
rado Medical  Center,  a cytological  diag- 
nostic service  for  cancer  at  the  Medical 
Center,  mental  hygiene  demonstrations  in 
local  areas,  and  a statewide  physical  ther- 
apy service  for  post-polio  victims  and  other 
crippled  children. 

Of  great  future  significance,  too,  are  the 
plans  of  the  universities  and  colleges  in 
Colorado  and  of  the  state  and  local  health 
departments  to  provide,  within  our  own 
borders,  the  specialized  education  and 
training  essential  for  the  public  health 
workers  we  shall  require  in  growing  num- 
bers as  local  health  activities  gain  in  sup- 
port and  strength.  In  addition  a compre- 
hensive framework  for  a five-year  public 
health  field-training  program,  with  two 
primary  and  three  secondary  training  areas 
in  the  state,  has  been  drawn  for  proposed 
grants  from  the  Kellogg  Foundation. 

During  the  past  year,  as  you  may  know, 
plans  for  hospital  construction  with  the  aid 
of  federal  funds,  where  the  bed  supply  is 
below  standard,  have  assumed  the  concrete 
form  of  approved  applications  for  nine  hos- 
pitals, to  date.  In  the  meantime,  more 
rigid  inspection  policies  have  been  formu- 
lated; revised  licensing  regulations  for  tu- 
berculosis institutions  went  into  effect  in 
January;  and  the  new  regulations  covering 
general  hospitals  and  allied  institutions 
were  submitted  to  the  State  Board  of 
Health  for  their  approval  last  night. 

Tomorrow’s  Goal 

Reviewing  the  year’s  progress,  we  of  the 
health  and  medical  professions  can  look 
with  satisfaction  upon  the  organizational 
improvements  and  the  program  expansion 
thus  far  achieved  for  public  health  protec- 
tion. Tomorrow,  we  shall  move  forward  to 
bring  preventable  disease,  disability,  and 
mortality  rates  rapidly  down  to  ever  lower 
levels.  Together  with  a health-minded 
public,  we  can  establish  for  Colorado  a 
truly  enviable  record  as  an  outstanding 
health  state. 


920 


Rocky  Mountain  Medical  Journal 


11.  SOME  PHASES  OF  THE  PROGRAM  OF  PUBLIC  HEALTH 

DENTISTRY* 

ROBERT  A.  DOWNS,  D.D.S. 

DENVER 


In  this  limited  space  it  will  only  be  pos- 
sible to  touch  some  of  the  phases  of  the 
dental  program.  Primarily,  of  course,  we 
are  interested  in  programs  that  offer  hope 
for  the  mass  prevention,  or  at  least  con- 
trol, of  dental  caries.  For  approximately 
sixty  years,  ever  since  Dr.  W.  D.  Miller 
expounded  his  chemico-parasitic  theory  of 
the  cause  of  dental  caries,  the  dental  pro- 
fession has  been  seeking  some  method  of 
preventing,  or  at  least  controlling,  the  dis- 
ease. To  date  our  success  has  been  meager. 
Basically  we  know  that  dental  caries  be- 
gins on  the  enamel  surface  and  that  acid 
produced  by  action  of  certain  bacteria  upon 
carbohydrate  foods,  especially  sugar,  ini- 
tiates the  lesion. 

Based  upon  these  facts,  three  methods 
of  control  present  themselves.  The  first 
method  would  be  eliminating  the  acid  pro- 
ducing bacteria  which  we  try  to  do  through 
the  dietary  control  of  dental  caries.  A posi- 
tive way  to  do  this  would  be  to  stop  eat- 
ing, which,  of  course,  isn’t  practical.  An- 
other way  would  be  to  almost  eliminate  the 
foods  from  the  diet  upon  which  the  bac- 
teria thrive.  From  a practical  standpoint 
this  means  drastically  curtailing  sugars. 
This  restricted  diet  means,  for  our  children, 
no  sugar,  candy,  syrup,  soft  drinks,  chewing 
gum,  etc.  This  is  one  of  the  programs  we 
are  using.  Obviously  it  will  never  become 
popular.  The  general  public  will  not  accept 
it,  and  hence,  from  a public  health  stand- 
point, it  has  been  very  disappointing.  In 
spite  of  these  difficulties  many  Colorado 
dentists  and  pediatricians  are  taking  care  of 
a few  of  their  patients  by  this  method  with 
excellent  results.  We  will  continue  the  pro- 
gram. 

The  second  possible  approach  would  be 
aimed  at  preventing  bacteria  in  the  mouth 

*Presented  as  part  of  a symposium  on  “Adminis- 
trative Organization  and  New  Programs”  of  the 
Colorado  Department  of  Public  Health  at  the  78th 
Annual  Session  of  the  Colorado  State  Medical  So- 
ciety, Glenwood  Springs,  .Steptember  25,  1948.  The 
author  is  Director  of  Public  Health  Dentistry  Sec- 
tion. 


from  producing  the  acid,  or  neutralizing  the 
acid  as  fast  as  it  is  produced.  Experimen- 
tally many  substances  are  being  tried,  such 
as  ammonia  liberating  compounds,  naphtha 
quinone,  urea,  streptomycin,  penicillin,  etc. 
Dr.  Fosdick  of  the  Northwestern  University 
is  trying  to  find  a method  to  treat  sugar  so 
that  it  cannot  be  converted,  into  acid.  We 
have  not  tried  any  of  these,  as  they  are 
all  experimental  and,  hence,  to  date  not 
practical  from  a public  health  standpoint. 

The  third  possibility  is  directed  at  mak- 
ing the  enamel  more  resistant  to  the  effect 
of  acids  produced  in  the  mouth.  This  is 
where  the  much  discussed  subject  of  fluor- 
ine comes  in.  Our  principal  efforts  at  the 
present  time  are  along  these  lines.  We  are 
correlating  water  analyses  with  dental  ex- 
aminations, primarily  of  school  pupils.  Re- 
peated investigations  constantly  show  ap- 
proximately 60  per  cent  less  tooth  decay  in 
fluoride  areas.  The  following  two  slides 
from  recent  studies  of  our  department 
graphically  illustrate  this  point:  Montrose 
and  Salida. 

The  Montrose  study  was  interesting  be- 
cause one  of  the  local  dentists  wrote  that 
the  fluorine  theories  were  all  wet  because 
they  had  fluorine  in  their  water  (1.4  ppm) 
and  that  dental  caries  was  rampant;  and, 
as  evidence,  submitted  a chart  of  a child 
who  had  been  in  the  office  that  day — 
exhibiting  fifty-four  cavities.  We  wrote 
that  in  light  of  our  present  knowledge  this 
was  impossible,  and  he  then  sent  over  a 
collection  showing  similar  findings.  Our 
findings  were  as  follows; 

Total  students  checked,  406.  Of  these, 
only  seventy-seven  were  natives,  and  only 
one  of  these  natives  was  free  from  caries. 
Every  one  exhibited  normal  tooth  enamel 
with  no  sign  of  fluorosed  enamel.  As  the 
examination  proceeded,  however,  other  pu- 
pils were  observed  who  presented  typical 
examples  of  dental  fluorosis.  While  many  of 
the  individuals  came  from  various  other 
communities  in  which  fluorosed  enamel  was 


for  November,  1949 


921 


known  to  be  endemic,  a considerable  num- 
ber had  been  born  and  raised  in  an  agri- 
cultural district  adjacent  to  Montrose, 
known  as  Spring  Creek  Mesa.  There  were 
sixty-seven  individuals  who  exhibited  fluor- 
osed  enamel.  Of  these,  twenty-seven  were 
caries  free.  In  contrast  to  the  Montrose 
natives  the  fluorosed  individuals  averaged 
only  1.7  carious  areas  against  10.2  for  Mont- 
rose. In  extracted  teeth  the  fluorosed  aver- 
aged 0.17  against  0.818  for  Montrose. 

We  contrast  condition  found  in  Salida 
among  12-14  year  old  students  where  the 
water  contains  1.2  ppm  against  Madison, 
Wisconsin,  where  the  water  is  fluorine  free. 
Again  we  found  the  same  story.  Salida, 
Colorado,  with  1.2  ppm  of  fluorine  in  their 
water,  53.7  per  cent  of  the  students  of  this 
age  group  caries  free,  while  Madison  with 
no  fluorine  in  their  water  has  only  3.7  per 
cent;  the  average  number  of  decayed, 
missing  or  filled  teeth  being  1.19  for  Salida 
against  7.73  for  Madison. 

The  story  of  fluorine  is  a most  fascinat- 
ing subject  in  the  history  of  dentistry.  In 
all  the  history  of  medicine  I know  of  no 
such  history  of  such  “about  face”  in  em- 
phasis. A few  years  ago  our  only  interest 
was  trying  to  remove  fluorine  from  the 
water,  and  now  many  communities  are  plan- 
ning on  adding  it.  Approximately  twenty 
to  twenty-five  communities  are  conducting 
experiments  along  these  lines  now,  and 
within  four  or  five  years  we  will  know 
if  the  addition  of  sodium  fluoride  to  a com- 
munity water  supply  will  reduce  the  decay 
to  the  level  found  in  fluoride  areas;  namely: 

(1)  Six  times  as  many  children  caries  free; 

(2)  about  60  per  cent  less  tooth  decay;  (3) 
75  per  cent  decrease  in  first  molar  lost;  (4) 
85  per  cent  less  decay  in  proximal  surfaces 
of  upper  incisors.  Through  our  present 
studies  and  examinations  we  hope  to  be  in 
a position  to  properly  advise  local  commu- 
nities. 

Fluorine  water  studies  led  to  investiga- 
tions of  the  possible  use  of  topical  applica- 
tions of  fluoride  solutions  to  the  teeth.  Six 
years  of  experiments  with  painting  of  chil- 
dren’s teeth  with  2 per  cent  solution  of 
sodium  fluoride  have  indicated  possible  re- 


ductions in  carious  teeth  ranging  up  to  40 
per  cent. 

This  fall,  on  a demonstration  basis,  ele- 
mentary school  children  in  four  different 
sections  of  the  state  will  be  given  treat- 
ment, namely:  (1)  Cleasing  of  teeth;  (2) 
isolation  with  cotton  rolls;  (3)  dry  with 
compressed  air;  (4)  wet  crown  with  sodium 
fluoride;  (5)  let  dry  three  minutes  in  the 
air.  The  treatment  is  definitely  not  a “cure 
all.”  It  has  no  effect  on  pyorrhea,  for  ex- 
ample, and  certainly  does  not  hold  any 
hope  for  complete  elimination  of  caries.  In 
conjunction  with  this  demonstration  we  are 
setting  up  a study  to  try  to  determine  the 
effect  on  deciduous  teeth,  and  whether  such 
treatment  will  further  reduce  the  caries 
rate  in  fluoride  areas. 


ANTIBIOTIC  DRUG  GIVES  FAST  RELIEF 
FROM  TYPHOID  FEVER 

Treatment  of  typhoid  fever  with  the  relatively 
new  antibiotic  drug,  Chloromycetin,  is  so  effective 
that  patients  generally  are  clear  of  fever  three 
or  four  days  after  the  drug  is  first  administered, 
according  to  an  article  in  the  current  (Septem- 
ber 10)  Journal  of  the  American  Medical  Asso- 
ciation. 

“Continued  experience  reveals  that  fever  dis- 
appears during  the  first  three  or  four  days  of 
treatment,”  Drs.  Joseph  E.  Smadel  and  Charles 
A.  Bailey  of  the  Army  Medical  Department  Re- 
search and  Graduate  School,  Washington,  D.  C., 
and  Dr.  Theodore  E.  Woodward  of  the  University 
of  Maryland,  Baltimore,  say.  “Our  early  ob- 
servations brought  out  that  relapses  of  typhoid 
were  common  in  treated  patients.  In  order  to 
eliminate  such  occurrences,  we  have  prolonged 
the  course  of  treatment.  Analysis  of  the  results 
obtained  in  forty-four  patients  with  typhoid  who 
received  chloramphenicol  (Chloromycetin)  under 
our  observation  has  indicated  a striking  rela- 
tion between  the  duration  of  chemotherapy  and 
the  incidence  of  relapses. 

“A  clinical  relapse  occurred  in  seven  of  the 
thirteen  patients  whose  initial  course  of  drug 
was  given  for  eight  days  or  less.  None  of  the 
members  of  another  group  of  nineteen  patients 
suffered  relapses;  this  group  was  comparable  to 
the  first  in  essentially  all  respects,  except  that 
treatment  was  continued  for  nine  to  fourteen 
days.  A third  group  consisting  of  twelve  pa- 
tients was  treated  for  fourteen  to  twenty-three 
days;  relapses  did  not  occur  among  these  pa- 
tients. All  patients  in  the  first  group  who  had 
relapses  responded  satisfactorily  when  chloram- 
phenicol treatment  was  again  instituted.  These 
results  warrant  the  following  conclusions; 
Chloramphenicol  should  be  administered  in  ade- 
quate amounts  for  more  than  eight  days  to  pa- 
tients acutely  ill  with  typhoid  if  relapses  of  the 
disease  are  to  be  avoided.  There  appears  to  be 
little  advantage  in  continuing  treatment  for 
more  than  fourteen  days.” 


922 


Rocky  Mountain  Medical  Journal 


III.  COLORADO  VETERINARY  PUBLIC  HEALTH  PROGRAM* 

MARTIN  D.  BAUM,  D.V.M. 

DENVER 


The  ultimate  objective  of  the  Veterinary 
Public  Health  program  is  to  establish,  iden- 
tify, and  study  the  relationship  of  domestic 
and  wild  animals  as  reservoirs  of  human 
disease,  and  make  the  necessary  epidemio- 
logical investigations  in  order  to  trace  the 
origin  of  these  diseases.  In  Colorado,  the 
first  step  in  reaching  this  objective  was 
accomplished  by  requiring  that  animal  dis- 
eases transmissible  to  humans  be  reportable 
to  the  State  Health  Department  by  prac- 
ticing veterinarians  These  reports  are  han- 
dled in  the  same  manner  as  reportable  hu- 
man diseases,  and  are  tabulated  for  statis- 
tical purposes.  This  represents  the  first  at- 
tempt to  catalog  animal  diseases  by  any 
Health  Department  in  the  country. 

The  recent  provisions  for  state  approval 
of  local  meat  slaughtering  establishments 
will  also  furnish  valuable  information  rel- 
ative to  disease  incidence,  by  requiring 
proper  autopsy  of  food  animals  by  profes- 
sionally trained  personnel.  This  program 
has  been  badly  neglected  in  the  past,  and 
it  is  hoped  that  valuable  information  as  to 
pathology  will  be  forthcoming  within  the 
near  future. 

Rabies  vaccination  programs  have  been 
conducted  in  several  counties,  and  work 
will  continue  in  order  to  stimulate  proper 
ordinances  in  other  cities  and  counties. 

Brucellosis  is  an  ever  present  condition 
which  warrants  vigilant  watch  by  both 
medical  and  veterinary  groups  within  the 
state.  Legislation  will  be  presented  at  the 
forthcoming  session  of  the  Legislature,  and 
the  support  of  all  interested  is  essential. 

♦Presented  as  part  of  a synoiposium  on  “Adminis- 
trative Organization  and  New  Programs’’  of  the 
Colorado  Department  of  Public  Health  at  the  78th 
Annual  Session  of  the  Colorado  State  Medical  So- 
ciety, Glenwood  Springs,  September  25,  1948.  The 
author  is  Director  of  Public  Health  Veterinary 
Section. 


At  present,  the  absence  of  such  laws  makes 
adequate  control  impossible.  Pasteuriza- 
tion of  milk  and  dairy  products  is  only  part 
of  the  answer  to  the  brucellosis  problem. 

Equine  encephalomyelitis,  trichinosis, 
teniasis,  salmonellosis  and  Q fever  are  other 
problems  confronting  the  Veterinary  Public 
Health  Section,  and  especially  in  the  case 
of  Q fever,  the  cooperation  of  all  physi- 
cians is  imperative  in  making  a correct 
differential  diagnosis. 

This  newly  created  section  in  the  State 
Health  Department  is  ready  and  willing  to 
work  cooperatively  with  all  the  physicians 
of  the  state. 


INTERNATIONAL  ACADEMY  OF 
PROCTOLOGY 

The  first  business  meeting  and  scientific  ses- 
sion of  the  newly  organized  International  Acade- 
my of  Proctology  was  held  at  the  Marlborough- 
Blenheim  in  Atlantic  City  on  Friday,  June  10, 
1949. 

Officers  elected  for  the  coming  year  are:  Pres- 
ident, Earl  J.  Halligan,  Jersey  City,  N.  J.;  Pres- 
ident-elect, Caesar  Portes,  Chicago,  111.;  First 
Vice  President,  H.  A.  Springer,  Cincinnati,  Ohio; 
Second  Vice  President,  Edgar  M.  Scott,  Jr.,  Bir- 
mingham, Ala.;  Third  Vice  President,  I.  Norman 
Albert,  Johnston  City,  111.;  Secretary,  Alfred  J. 
Cantor,  Flushing,  N.  Y.;  Treasurer,  William  Lie- 
berman,  Brooklyn,  N.  Y.;  Chairman  of  Board 
of  Trustees  (temporary),  Earl  J.  Halligan,  Jer- 
sey City,  N.  J. 

Board  of  Trustees:  William  Lieberman,  Brook- 
lyn, N.  Y.;  Raymond  S.  Johnston,  Kearney,  Nebr.; 
Kenneth  W.  Kressler,  Easton,  Pa.;  Carroll  J. 
Beilis,  Long  Beach,  Calif.;  Donald  C.  Collins, 
Hollywood,  Calif.;  Evan  C.  Reese,  Stroudsburg, 
Pa.;  Francis  S.  Adams,  Pueblo,  Colo.;  I.  Norman 
Albert,  Johnston  City,  111.;  Paul  Lahvis,  Gow- 
anda,  N.  Y.;  H.  A.  Springer,  Cincinnati,  Ohio; 
William  W.  Meissner,  Buffalo,  N.  Y.;  Harry  A. 
Gussin,  Chicago,  111.;  Edgar  M.  Scott,  Jr.,  Bir- 
mingham, Ala.;  Earl  J.  Halligan,  Jersey  City, 
N.  J.;  Caesar  Portes,  Chicago,  111.,  and  Alfred  J. 
Cantor,  Flushing,  N.  Y. 

Dr.  Alfred  J.  Cantor  was  unanimously  ac- 
claimed the  first  President  of  the  Academy  in 
recognition  of  having  organized  and  carried  on 
the  work  of  the  Academy  for  the  first  year 
single-handedly. 

Membership  in  the  Academy  is  open  to  those 
who  are  specializing  in  Proctology  or  allied 
fields.  Further  information  and  application 
blanks  may  be  obtained  by  writing  to  the 
Academy,  43-55  Kissena  Blvd.,  Flushing,  N.  Y. 


for  November,  1949 


923 


IV.  THE  SANITATION  PROGRAM  IN  COLORADO* 

J.  A.  KING 

DENVER 


When  one  defines  sanitation  as  “simple 
cleanliness,”  then  describes  Colorado  as 
being  deficient  in  several  basic  phases  of 
sanitation,  the  average  citizen  wonders 
why  a young  and  progressive  state  per- 
mitted such  a basic  necessity  to  become 
lax.  If  we  review  history,  however,  we 
discover  that  even  though  Colorado  has 
long  been  cognizant  of  basic  sanitation 
problems,  the  rapid  development  of  agri- 
culture and  industry  along  with  the  related 
population  increases  were  m^ore  rapid  than 
the  provision  for  “simple  cleanliness.”  True, 
we  have,  in  comparison  to  other  states,  a 
creditable  number  of  sewage  treatment 
plants  as  well  as  many  safe  municipal  water 
supplies,  food  plants,  and  eating  establish- 
ments which  are  a credit  to  the  munici- 
palities and  industries  involved.  On  the 
other  side  of  the  ledger  are  polluted  streams 
and  municipal  water  supplies,  food  plants 
with  careless  practices  which  endanger 
lives,  cities  with  numerous  rats  inviting 
plague,  dangerous  sv/imming  pools,  camps 
with  inadequate  facilities  and  in  most  of 
these  cases  an  uninformed  citizenry  which 
is  responsible. 

These  conditions  were  pointed  out  to  the 
public  by  press,  radio,  chart,  and  from  the 
platform  during  the  two  preceding  years 
and  received  the  type  of  reaction  which 
an  intelligent  populace  is  expected  to  give. 
Several  good  results  came  to  the  sanitation 
program  as  the  result  of  legislation  passed 
in  August,  1947 — (1)  laws  were  amended 
and  broadened,  (2)  additional  funds  were 
made  available  for  use  both  by  the  state 
and  local  health  departments,  (3)  the  nu- 
merous divisions  of  the  State  Department 
of  Public  Health  responsible  for  sanitation 
were  brought  together  to  form  one  single 
division  under  the  same  leadership,  (4)  sal- 
ary scales  were  amended  to  permit  per- 
sonnel procurement. 

‘Presented  as  part  of  a symposium  on  “Adminis- 
trative Organization  and  New  Programs’’  of  the 
Colorado  Department  of  Public  Health  at  the  78th 
Annual  Session  of  the  Colorado  State  Medical  So- 
ciety, Glenwood  Springs,  September  25,  1948.  The 
author  is  Director  of  General  Sanitation  Section. 


In  shouldering  the  responsibility  for  an 
expanded  postwar  sanitation  division  the 
nucleus  of  approximately  ten  persons  (less 
than  50  per  cent  of  whom  were  trained  or 
experienced)  faced  the  task  of  (1)  develop- 
ing sanitation  standards  for  some  twenty 
phases  of  sanitation,  (2)  developing  an  ef- 
ficient plan  of  organization,  (3)  training  of 
personnel,  (4)  development  of  a sound  over- 
all program  including  all  phases  of  sanita- 
tion, but  designed  to  accomplish  the  most 
public  health  protection  in  the  shortest  .pe- 
riod of  time. 

In  the  face  of  a public  which  is  awake 
and  interested  in  sanitation,  it  has  been 
impossible  to  ask  for  “time-out”  while  two 
dozen  veterans  are  sent  to  a short  course 
in  public  health.  Just  what  have  we  done, 
what  are  we  doing,  and  what  do  we  plan? 
These  are  current  questions  and  deserve  an 
accounting. 

In  the  first  place,  our  vision  is  one  of 
developing  and  establishing  within  strong 
local  health  units,  well  trained  sanitation 
personnel  capable  of  rendering  service  and 
carrying  out  programs  based  on  state  laws 
and  standards.  As  these  programs  become 
established  at  local  levels,  state  personnel 
is  withdrawn,  the  funds  are  channeled  to 
local  units  and  the  nature  of  state  organi- 
zation changes.  From  an  organization 
handicapped  by  size,  attempting  to  render 
service  over  great  distances  at  great  ex- 
pense per  unit  of  service,  the  division  of 
sanitation  becomes  a small  unit  made  up 
of  personnel  technically  trained  in  the  va- 
rious phases  of  sanitation  with  the  duty  of 
service  to  local  units  and  the  responsibility 
for  overall  programs  directed  at  the  proper 
goal.  Several  steps  have  been  made  in  this 
direction  within  the  past  eight  months. 

1.  Four  less  persons  are  employed  di- 
rectly in  our  Denver  office  and  nine  addi- 
tional men  are  located  in  local  units  or 
sanitation  districts  where  their  work  is  con- 
venient. Educational  qualifications  have 
been  raised  and  all  replacements  of  per- 


924 


Rocky  Mountain  Medical  Journal 


sonnel  are  required  to  have  basic  science 
in  their  college  training. 

2.  Well  qualified  personnel  has  been  re- 
cruited to  fill  positions  in  the  fields  of  milk 
sanitation,  food  sanitation,  and  public  health 
engineering  in  the  State  Sanitation  Division. 

3.  Standards  have  been  adopted  and  pro- 
grams are  well  under  way  in  the  fields 
of  food  and  milk  sanitation  as  well  as  in 
several  phases  of  general  sanitation  such  as 
schools  and  insect  and  rodent  control. 

4.  Standards  governing  water  supplies, 
sewage  treatment  and  stream  pollution  are 
under  consideration  and  will  be  adopted 
when  complete. 

5.  A broad  program  designed  to  reduce 
stream  pollution  to  a degree  compatible 
with  public  health,  recreational  interests 
and  industries  of  Colorado  was  initiated  in 
July  with  the  beginning  of  studies  which 
will  take  the  guesswork  out  of  the  degree 
of  treatment  required. 

6.  Policies  governing  the  relationship  be- 
tween local  and  state  health  department 
personnel  have  been  adopted  after  approval 
by  the  local  units. 

7.  New  record  systems  providing  perma- 
nent type  records  of  sanitation  in  dairies, 
food  plants,  and  restaurants  have  been 
placed  in  use. 

8.  Films,  leaflets,  charts  and  other  aids 
have  been  procured  and  are  being  made 
available  to  local  sanitarians  for  use  in 
training  industry  personnel.  Assistance  is 
also  being  rendered  by  guest  lecturers  from 
the  State  Department  of  Public  Health. 

In  the  future  plans  of  the  Sanitation  Di- 
vision, we  must  face  the  challenge  of  any 
service  organization,  realizing  that  service 
is  the  only  basis  of  accomplishing  the  ob- 
jective: 

1.  Of  the  thirty  men  employed  or  bud- 
geted by  the  state  and  local  health  depart- 
ments, exclusive  of  Denver,  approximately 
fifteen  are  in  the  early  stages  of  a career 
in  public  health,  hence  they  require  guid- 
ance and  assistance  as  well  as  additional 


training  as  opportunity  permits.  Training 
schools  and  field  training  centers  are  being 
established  to  provide  such  training. 

2.  The  sanitation  personnel  in  Colorado 
provides  one  person,  including  administra- 
tive personnel,  for  each  36,000  population. 
The  minimum  acceptable  standard  for  ade- 
quate coverage  of  sanitation  problems  is 
one  sanitarian  for  15,000  population.  We 
trust  that  as  trained  personnel  becomes 
available,  additional  local  health  units  will 
permit  a correction  of  the  present  sanita- 
tion load. 

3.  The  scope  of  the  sanitation  program 
will  be  broadened,  as  personnel  and  funds 
permit,  to  include  such  items  as  housing 
which  cannot  now  be  given  attention. 

In  summarizing  the  sanitation  program, 
it  represents  the  judgment,  planning,  and 
vision  of  many  professional  people  experi- 
enced in  sanitation  and  that  the  efforts  put 
forth  by  these  people  are  not  limited  by  the 
salaries  involved  or  the  job  security  offered. 

Though  the  Health  Department  and  its 
personnel  are  of  utmost  importance,  the 
success  of  a sanitation  program  is  depend- 
ent upon  the  good  will  and  cooperation  of 
the  citizenry  served.  This  cooperation  and 
good  will  exists  in  most  communities, 
towns,  and  hamlets  in  proportion  to  the 
influence  of  interested  physicians  who  sup- 
port the  program.  We  know  that  there 
can  be  no  argument  with  “simple  cleanli- 
ness” and  certainly  the  results  to  be  ob- 
tained are  non-controversial.  We  must  agree 
that  the  means  of  accomplishing  improved 
sanitation  are  basically  educational  even 
though  laws  are  essential  and  must  be  used 
as  a standard,  a guide,  and  to  punish  or 
restrain  the  wilful  offender.  You  are  in- 
vited, individually  and  collectively,  to  par- 
ticipate in  the  sanitation  program.  One  note 
of  caution  is  injected  for  the  good  of  the 
program — call  your  local  sanitarian  or  en- 
gineer for  a discussion  of  the  needs  and 
program  of  the  community.  You  are  as- 
sured of  assistance  and  cooperation  and  we 
in  turn  are  appreciative  of  the  assistance 
and  good  will  which  can  result  from  your 
support. 


for  November,  1949 


925 


V.  LOCAL  HEALTH  DEPARTMENTS  AND  THE  PHYSICIAN* 

ROLAND  H.  LODER,  M.D. 

GREEL.ET 


Haven  Emerson,  Emeritus  Professor  of 
Public  Health  at  Columbia  University,  New 
York,  has,  in  collaboration  with  state  and 
territorial  health  officers,  outlined  in  his 
“Local  Health  Units  for  the  Nation”  a .sug- 
gested grouping  of  counties,  cities  and  coun- 
ties, or  cities  or  counties  alone  into  popula- 
tion groups  of  approximately  50,000  popula- 
tion as  a basic  area  for  developing  essential 
public  health  services  in  local  areas  with 
trained  public  health  personnel.  The  Amer- 
ican Medical  Association  has  endorsed  un- 
qualifiedly the  objective  envisioned  in  Dr. 
Emerson’s  publication. 

The  United  States  Public  Health  Service 
and  its  regional  representatives  aid  in  ev- 
ery way  possible  the  achievement  of  this 
gigantic  task  by  working  with  state  and 
local  officers;  and  has  even  suggested  re- 
cruitment and  training  of  physicians  from 
the  rank  and  file  of  practitioners  for  serv- 
ing on  a carefully  planned  and  definitely 
outlined  part-time  service  basis  with  an 
adequate  remuneration  therefor,  aided  by 
a minimum  well  trained  auxiliary  staff  of 
sanitation  and  public  health  nurse  and  ad- 
ditional special  personnel  where  deemed 
necessary,  to  provide  adequate  services  to 
very  sparse  rural  and  village  areas  of  15,000, 
slightly  more  or  less. 

Recent  enacted  national  legislation,  name- 
ly the  National  Hospital  Facilities  Act, 
which  was  unqualifiedly  and  unanimously 
supported  by  the  medical  profession,  hos- 
pital administrators,  public  health  officers 
and  the  auxiliary  professional  workers  in 
each  of  these  groups — as  well  as  by  the 
general  public  who  are  the  recipients  of 
the  services  from  each  group — provide  op- 
portunity for  not  only  improved  hospital 
and  out-patient  service  but  also  the  joint 
action  of  groups  providing  private  medical 
and  hospital  individual  services  with  those 
groups  providing  essential  and  necessary 

’Presented  as'  part  of  a symposium  on  “Adminis- 
trative Organization  and  New  Programs’’  of  the 
Colorado  Department  of  Public  Health  at  the  78th 
Annual  Session  of  the  Colorado  State  Medical  So- 
ciety, Glenwood  Springs,  September  25,  1948.  The 
author  is  Director  of  Weld  County  Health  Depart- 
ment. 


public  health  and  preventive  services  to 
the  entire  community,  thus  enhancing  the 
value  and  efficiency  of  the  services  from 
each  group  to  the  individual  or  the  com- 
munity. 

Public  health  officers  both  of  the  nation 
and  of  Colorado  view  with  encouragement 
the  wholehearted  support  given  by  Colo- 
rado medicine  in  the  1947  legislation  per- 
mitting, under  continued  excellent  former 
leadership,  a stabilized  State  Department  of 
Health  reorganization  and  addition  of  need- 
ed skilled  and  trained  personnel  under  a 
carefully  chosen,  widely  representative 
State  Board  of  Health  freed  from  official 
political  hindrance.  Companion  legislation 
permits  establishment — by  city  officials  or 
county  commissioners  of  local  city,  city- 
county,  single  county  or  multi-county 
health  departments  under  a widely  repre- 
sentative local  board  of  health  — of  a well 
qualified  specialty  staff  in  public  health. 
Public  health  administrative  and  profes- 
sional personnel  in  the  respective  medical, 
dental,  nursing,  sanitation,  laboratory  or 
other  professional  fields  require  just  as 
highly  trained  and  experienced  personnel 
as  do  the  specialties  of  medicine  in  surgery, 
obstetrics,  pediatrics.  In  fact,  many  public 
health  administrators  are  from  the  latter 
two  medical  specialties,  with  additional 
training  in  public  health  administration. 

Activities  of  the  personnel  in  a local 
health  department  cover  a wide  variety  of 
skilled  services  differing  in  requirements 
of  skill,  ingenuity  and  professional  judg- 
ment as  may  be  found  in  the  work  of  a 
general  practitioner  of  medicine  meeting 
the  myriad  and  varied  emergencies  of  a 
rural  practice,  or  of  the  specialist  with  the 
minute  and  intricate  variations  in  require- 
ments of  skill  within  his  specialty.  The 
primary  difference  lies  in  the  public  service 
technics,  or  methods  in  the  public  or  com- 
munity type  of  service  to  all  the  popula- 
tion, as  contrasted  to  the  medical  practi- 
tioner’s individual  or  family  type  of  service. 


926 


Rocky  Mountain  Medical  Journal 


Enumerated,  the  services  cover  the  fields 
of: 

1.  Vital  records  or  “public  health  book- 
keeping.” 

2.  Health  education  or  “developing  com- 
munity understanding.” 

3.  Environmental  sanitation  or  “commu- 
nity housekeeping,”  including  problems  of 
food  and  water  supply,  disposal  of  human 
wastes,  industrial  hygiene,  school  sanitation, 
tourist  camp  sanitation,  garbage  and  refuse 
disposal,  pest  control  and  housing  sanita- 
tion. 

4.  Communicable  and  non-communicable 
disease  preventive  and  control  programs. 

5.  School  services. 

6.  General  community  and  family  health 
services,  including  preventive  medical  and 
dental  health  conferences  and  nursing  con- 
ferences in  mental  health,  maternity  and 
infancy,  school,  tuberculosis,  venereal  dis- 
ease or  ( Others  considered  public  health 
preventive  problems  as  viewed  by  the 
medical  profession,  public  health  workers 
and  the  community  served. 

7.  Public  health  laboratory  services. 

Medical  practitioners,  general  or  special, 
serving  through  individual  or  family  cura- 
tive and  preventive  medical  services,  are  an 
indispensable  and  inseparable  part  of  the 
groups  of  private  and  public  servants  who, 
along  with  the  administrative  and  profes- 
sional public  health  service  personnel,  serve 
through  voluntary  or  official  public  service 
agencies  to  provide  the  optimum  health 
status  and  achieve  the  best  individual  and 
public  practices  in  healthful  being  and 
living. 

History  records  a wide  gap  between  em- 
piric medicine  and  the  scientific  advances 
then  being  made  by  Lister,  Pasteur,  and 
others — much  to  the  dismay  of  the  public 
and  to  harmful  reflection  on  medical  service 
and  the  public's  confidence  therein. 

In  even  greater  degree  today,  our  com- 
plex and  concentrated  modern  society  re- 
quires concerted  effort  of  medical  practi- 
tioner and  public  health  administrator  for 


the  best  accomplishment  in  health  toward 
the  public,  and  a continued  safeguarding 
and  retention  of  public  confidence  in  the 
scientific  health  effectiveness  of  both  of  the 
medical  and  public  health  services. 


THE  ROLE  OF  NUTRITION  IN  ALLERGY 

For  several  years  there  has  been  an  increasing 
interest  in  the  nutrition  of  their  patients  by 
those  physicians  who  specialize  in  the  treatment 
of  persons  with  allergies.  A review  of  the  liter- 
ature has  led  Dr.  Thomas  J.  Adams  of  Rich- 
mond Hill,  New  York,  to  attack  the  problem 
of  managing  his  allergic  patients  from  the  nu- 
tritional point  of  view.  He  has  endeavored  to 
improve  the  nutritional  state  of  his  patients 
so  that  they  would  lose  their  allergies.  He 
reports  the  results  of  his  work  in  the  July- 
August  issue  of  the  Annals  of  Allergy,  the  of- 
ficial publication  of  the  American  College  of 
Allergists.  There  has  been  a general  belief  for 
some  time  that  there  is  something  wrong  with 
the  digestion  and  assimilation  powers  of  the 
victims  of  allergy. 

Dr.  Adams,  therefore,  used  a predigested  mix- 
ture of  all  of  the  essential  building  materials 
for  making  the  patient’s  own  tissues  and  a large 
amount  of  all  of  the  vitamins  necessary  to  the 
remaking  of  the  materials  into  the  living  tissue 
of  the  patient.  The  Richmond  Hill  physician 
has  been  following  carefully  twenty-five  dif- 
ficult cases  for  two  years  now.  For  the  twenty- 
five  patients  whom  Dr.  Adams  has  managed  from 
his  nutritional  viewpoint,  he  reports  that  not  only 
do  they  get  relief  from  their  eczema  or  asthma, 
but  they  seem  to  be  cured.  In  addition,  these 
patients  are  able  to  tolerate  the  foods  and  dusts 
to  which  they  were  previously  allergic  just  like 
persons  who  are  not  allergic. 

The  results  of  improving  the  nutritional  state 
of  his  patients  after  this  plan  has  convinced  Dr. 
Adams  that  the  idea  apparently  has  great  merit. 
He  cautions  that  the  number  of  cases  is  small 
and  many  more  patients  will  have  to  be  studied 
by  him  and  by  many  other  physicians  before 
the  method  can  be  evaluated  realistically. 

In  commenting  upon  this  report,  Dr.  Jonathan 
Forman  of  Columbus,  Ohio,  President  of  the 
American  College  of  Allergists,  said  that  many 
allergists  have  written  about  the  depleted  state 
of  the  allergic  patient  and  have  in  one  way  or 
another  attempted  to  improve  the  nutritional 
state  of  tbeir  patients.  When  these  attempts 
have  been  successful,  the  condition  of  the  pa- 
tient has  almost  invariably  improved.  But  how 
to  develop  a comprehensive  program  for  nu- 
tritional improvement  for  all  patients  has  been 
the  problem.  Dr.  Adams  has  made  use  of  the 
newly  developed  predigested  mixtures  of  pro- 
tein originally  introduced  into  medicine  of  the 
smgical  patient  and  the  badly  depleted  old  per- 
son. He  has  made  a distinct  contribution.  Dr. 
Forman  said,  that  may  well  do  more  for  the 
allergic  patients  of  this  country  than  anything 
that  has  been  developed  in  the  last  twenty  years. 


for  November,  1949 


927 


TRICHOMONIASIS  IN  THE  MALE* 

RAYMOND  L.  YOUNG,  M.D. 

SANTA  FE,  NEW  MEXICO 


Trichomonas  vaginalis  infestation  of  the 
lower  urinary  tract  is  by  no  means  a recent- 
ly recognized  entity,  but  only  in  the  last  few 
years  has  it  attracted  the  attention  it  de- 
serves. In  1868  Salisbury^  reported  the 
presence  of  these  flagellates  in  the  urine 
specimen  of  a woman  which  he  had  exam- 
ined. Since  that  time,  reports  of  similar 
findings  in  both  men  and  women  have  ac- 
cumulated in  the  literature  with  gradually 
increasing  frequency.  The  incidence  of 
“trichomoniasis  urinaria,”  as  such  infesta- 
tions might  well  be  called,  varies  greatly 
in  the  various  reports,  from  1 to  nearly  60 
per  cent,  usually  being  considerably  higher 
in  women  with  trichomonas  vaginalis  vag- 
initis. 

In  the  male,  the  incidence  varies  from 
1 to  10  per  cent  in  most  series,  although 
Allison^  found  that  T 5 per  cent  of  his  male 
urologic  patients  harbored  the  organism  in 
their  urinary  tracts.  Riba  and  Harrison® 
reported  trichomoniasis  in  10  per  cent  of 
their  male  urologic  patients,  while  Liston 
and  Lees^  found  an  overall  incidence  of  4 
per  cent  among  a series  of  male  patients, 
not  all  of  whom  had  urological  complaints. 

Data  and  Methods 

During  the  past  two  years  I have  been 
studying  the  incidence  of  urinary  tract  tri- 
chomoniasis in  association  with  vaginal  tri- 
chomoniasis. This  work,  together  with  the 
results  of  a new  method  of  treatment  for 
the  former,  will  be  reported  in  the  near  fu- 
ture. As  a part  of  this  larger  study,  I have 
been  interested  in  determining  the  inci- 
dence of  trichomoniasis  urinaria  among  a 
group  of  consecutive  male  patients  suffi- 
ciently large  to  have  statistical  significance. 
This  forms  the  basis  of  the  present  report. 

The  fresh,  centrifuged  urinary  sediments 
of  2,500  consecutive  male  patients  admitted 
to  the  Lovelace  Clinic  in  Albuquerque  were 

‘The  present  study,  together  with  the  larger 
studies  on  trichomoniasis  in  women  which  are  men- 
tioned in  this  paper,  was  completed  while  the  author 
was  a member  of  the  Department  of  Obstetrics  and 
Gynecology  at  the  Lovelace  Clinic,  Albuquerque, 
N.  M.  Grateful  acknowledgement  is  made  to  Mr.  W. 
J.  Hadley,  Director  of  Clinical  Laboratories  there, 
for  his  cooperation  in  examining  these  specimens. 


examined.  All  of  these  patients  were  over 
14  years  old.  They  presented  the  variety 
of  complaints  which  would  be  expected 
in  a series  of  this  size.  Many  of  them 
had  none  at  all,  but  were  undergoing  pre- 
employment or  insurance  physical  examina- 
tions. The  admissions  to  the  Urology  De- 
partment of  the  clinic  were  included.  Most 
of  the  urine  specimens  were  uncatheterized. 

In  addition,  300  consecutive  male  urine 
specimens  from  the  Pediatrics  Department 
were  studied,  with  patients  ranging  in  age 
from  newborn  infants  to  15  years  old. 

One  hundred  and  seventy-one  prostatic 
smears  taken  from  the  same  adult  group  and 
151  semen  specimens  were  also  examined 
with  a special  interest  in  identifying  T. 
vaginalis. 

Care  was  taken  to  avoid  mistaking  con- 
taminants, such  as  Bodo  urinaris^  for  tri- 
chomonads.  All  questionable  specimens,  of 
which  there  were  a number,  were  consid- 
ered to  be  negative.  Criteria  used  in  diag- 
nosing trichomoniasis  urinaria  included  not 
only  the  positive  identification  of  the  or- 
ganisms by  their  morphological  character- 
istics but  also  by  the  motility  of  the  flagel- 
lates. Had  less  caution  been  used  in  identi- 
fication, I am  certain  that  the  incidence  of 
positive  findings  in  this  series  would  have 
been  considerably  higher. 

Results 

The  results  of  this  study  are  outlined  in 
Table  1. 


TABLE  1 

The  Incidence  of  T.  Vaginalis  in  the  Urine,  Pros- 
tatic Secretion  and  Semen  of  2,800 
Consecutive  Male  Patients. 

No.  of  No.  with  % with 
Examination  specimens  T.  vaginalis  T.  vaginalis 


Urine  (adult)  .... 

2,500 

53 

2.12 

Urine  (children) 

300 

0 

0 

Prostatic  smears* 

171 

26 

15.2 

Prostatic  smears 
containing  gon- 
ococci   

26 

2 

7.7 

Semen 

151 

1 

0.6 

•There  were  a grand  total  of  65  patients  in  the 
adult  group  of  2,500  who  revealed  the  organisms  in 
either  urine,  prostatic  smear,  or  both,  a total  inci- 
dence of  2.6  per  cent. 


928 


Rocky  Mountain  Medical  Journal 


1.  Trichomonads  in  Adult  Male  Urine 
Specimens:  The  positive  identification  of  T. 
vaginalis  organisms  was  made  in  fifty-three 
of  the  2,500  adult  male  urine  specimens  ex- 
amined (2.12  per  cent).  As  would  be  ex- 
pected, this  incidence  is  considerably  lower 
than  that  found  when  only  patients  with 
urologic  complaints  are  studied  but  is,  I be- 
lieve, representative  of  the  incidence  in  a 
cross-section  of  private  male  patients. 

None  of  the  patients  whose  urine  con- 
tained the  organisms  was  a negro.  Fourteen 
(26.4  per  cent)  of  the  fifty-three  patients 
were  Spanish-American  and  the  rest  were 
Anglo. 

The  mean  pH  of  the  fifty-three  positive 
urine  specimens  was  5.9,  with  a range  of  4.5 
to  8.0.  This  mean  is  practically  identical 
with  that  of  100  consecutive  urine  specimens 
in  which  trichomonads  were  not  found. 

Unfortunately,  only  seventeen  of  the 
wives  of  patients  harboring  trichomonads  in 
their  urinary  tracts  could  be  studied.  On 
single  examination  eleven  of  them  revealed 
the  organisms  in  their  vaginas.  In  a larger 
study  on  female  patients  which  I plan  to  re- 
port later,  additional  data  on  this  problem 
will  be  presented.  It  is  probable  that  if  re- 
peated examinations  of  the  wives  of  the 
male  patients  could  have  been  made,  more 
of  them  would  eventually  have  revealed  the 
presence  of  trichomonads. 

An  additional  finding  of  interest  in  these 
urine  specimens  was  that  two  of  them 
which  were  negative  for  T.  vaginalis  con- 
tained Monilia  albicans*  (0.08  per  cent). 
That  this  fungus  can  occur  in  the  urinary 
tract  has  long  been  known,  although  few 
studies  have  been  made  on  the  problem. 
The  reported  incidence,  as  in  the  present 
series,  is  rare.  Both  of  the  specimens  were 
otherwise  normal.  Neither  of  the  wives  of 
these  two  patients  could  be  studied  for  the 
presence  of  vaginal  moniliasis. 

2.  Trichomonads  in  the  Urine  of  Male  In- 
fants and  Children:  The  study  of  300  con- 
secutive urine  specimens  obtained  from 
male  patients  under  the  age  of  15  failed 
to  reveal  the  presence  of  T.  vaginalis  in- 
festation in  a single  instance.  While  urinary 
trichomoniasis  in  children  is  unquestionably 
rare,  it  has  been  reported  on  several  occa- 


sions, usually  in  girls.  However,  in  1924 
Katsunuma®  described  the  organisms  in  the 
urine  of  a boy  three  years  old.  More  recent- 
ly Strain’’  reported  three  additional  cases  in 
boys  under  6. 

3.  Trichomonads  in  Prostatic  Smears: 
Twenty-six  of  the  171  prostatic  smears 
which  were  examined  for  T.  vaginalis  re- 
vealed them,  an  incidence  of  15.2  per  cent. 
This  agrees  in  general  with  most  of  the 
other  series  which  have  been  reported  and, 
like  a number  of  them,  is  considerably 
higher  than  the  incidence  in  urine. 

All  171  of  the  patients  whose  prostatic 
tained  trichomonads  were  also  positive  for 
gonococci,  the  presence  of  the  latter  being 
confirmed  by  culture.  An  additional  twen- 
smears  were  studied  also  had  urinalyses, 
but  only  fourteen  of  the  twenty-six  patients 
(53.8  per  cent)  who  had  the  flagellates  in 
their  smears  also  had  them  in  their  urine. 

Two  of  the  twenty-six  smears  which  con- 
ty-four  specimens  revealed  gonococci  but 
were  negative  for  trichomonads.  While  tri- 
chomoniasis has  been  reported  in  patients 
with  gonorrhea  on  a number  of  occasions, 
the  association  is  usually  considered  to  be 
an  uncommon  one. 

One  of  the  smears,  which  was  negative 
both  for  gonococci  and  trichomonads,  con- 
tained numerous  M.  albicans  buds,  an  ex- 
tremely uncommon  finding.  The  patient 
had  only  mild  complaints,  suggestive  of  a 
chronic  urethritis.  His  urine,  incidentally, 
was  negative  for  evidence  of  the  fungi  and 
was  sugar-free. 

4.  Trichomonads  In  Semen  Specimens:  In 
view  of  the  frequent  occurrence  of  T.  vagi- 
nalis organisms  in  prostatic  smears,  one 
would  expect  to  find  them  at  least  occa- 
sionally in  semen  specimens.  Of  the  151 
specimens  examined,  however,  only  one 
contained  trichomonads,  an  incidence  of  0.6 
per  cent.  While  it  is  possible  that  their 
presence  might  be  overlooked  in  a hanging 
drop  teeming  with  motile  spermatozoa  — 
though  such  an  error  would  be  hard  to  un- 
derstand— still  their  absence  in  fixed  and 
stained  specimens  would  seem  to  confirm 
their  rarity  in  semen. 


for  November,  1949 


929 


Discussion 

The  significance  of  trichomoniasis  of  the 
male  urinary  tract  is  still  unsettled.  Cer- 
tainly, not  all  of  the  patients  whose  urine 
or  prostatic  secretion  contains  the  organisms 
have  urologic  symptoms.  A number  of  them 
do,  however,  and  in  the  absence  of  concom- 
itant pathologic  conditions,  elimination  of 
the  trichomonads  is  followed  by  the  disap- 
pearance of  the  patient’s  complaints.  This 
seems  to  be  particularly  true  of  men  whose 
complaints  suggest  chronic  prostatitis  or 
urethritis  and  in  'N^hose  prostatic  smears  T. 
vaginalis  are  found.  While  the  question  of 
pathogenicity  of  trichomonads  in  urine 
specimens  is  frequently  doubtful,  laboratory 
examinations  of  prostatic  smears  suggest 
that  at  least  in  these  instances  the  organ- 
isms are  pathogenic.  In  addition  to  the  tri- 
chomonads, such  smears  invariably  contain 
many  pus  cells  and  bacteria,  by  no  means 
normal  smears.  Whether  the  bacteria,  which 
in  this  series  were  most  frequently  Staphy- 
lococcus alhus,  or  the  trichomonads  were 
the  secondary  invader,  the  members  of  the 
Urology  Department  who  have  treated  these 
patients  report  that  once  the  trichomonads 
disappear  from  the  smears  under  treatment, 
the  patients’  complaints  are  relieved. 

Allison^  also  believes  that  the  organisms 
are  frequently  pathogenic  in  the  male  and 
points  out  that  95  per  cent  of  over  200  col- 
ored draftees  whom  he  examined  had 
urethral  strictures  wherever  T.  vaginalis 
was  found. 

Since  the  motility  of  the  trichomonads  is 
usually  lost  in  a relatively  short  time  both 
in  bladder  urine  and  in  urethral  hanging 
drops,  quite  possibly  one  of  the  reasons  that 
the  organisms  were  found  more  frequently 
in  prostatic  smears  than  in  urine  was  be- 
cause the  presence  of  motility  was  employed 
as  one  of  the  criteria  for  the  identification 
of  the  organisms  in  the  urine.  The  com- 
bined incidence  of  T.  vaginalis  found  either 
in  urine  or  in  prostatic  smears  was  2.6  per 
cent. 

TrusselP  has  emphasized  the  importance 
of  examining  male  patients  for  the  presence 
of  trichomonads  in  the  preputial  sac,  calling 
attention  to  the  fact  that  bovine  tricho- 


moniasis is  a venereal  disease  in  which  the 
flagellates  find  a suitable  environment  in 
the  preputial  sacs  of  bulls.  Roth®  has  re- 
ported three  such  cases  in  men,  but  large 
studies  have  apparently  never  been  re- 
ported. 

It  is  generally  agreed  that  the  organisms 
gain  entrance  to  the  male  urinary  tract  fol- 
lowing sexual  contact  with  women  afflicted 
with  trichomonas  vaginitis.  Numerous  re- 
ports of  acute,  non-gonorrheal  urethritis  in 
men  following  such  exposure  have  been 
made.  By  no  means,  of  course,  do  all  male 
patients  whose  urine  reveals  the  flagellates 
have  urinary  complaints,  the  majority  of 
them  apparently  acting  as  carriers.  Such  a 
state  is  obviously  important  as  a focus  for 
the  reinfection  of  gynecologic  patients  who 
have  themselves  been  treated  for  the  dis- 
ease, but  whose  husbands  still  harbor  the 
organisms.  Interest  in  this  possibility  was, 
as  a matter  of  fact,  the  incentive  for  the 
present  study,  and  it  has  been  my  custom 
during  the  past  two  years  to  examine  the 
urine  of  the  husbands  of  all  women  in 
whom  I find  vaginal  trichomoniasis.  A more 
detailed  report  on  this  aspect  of  the  prob- 
lem is  in  preparation. 

In  view  of  the  fact  that  three  of  the  2,500 
men  examined  (0.12  per  cent)  revealed  M. 
albicans  in  either  their  urine  or  prostatic 
smears  suggests  that  the  routine  examina- 
tion of  the  husbands  of  women  infected 
with  this  fungus  might  be  worthwhile,  espe- 
cially in  those  women  whq.iiave  unexplain- 
able recurrences* of  the  infection. 

The  importance  of  protection  at  the  time 
of  intercourse  with  a woman  suffering  from 
trichomoniasis  should  be  obvious.  I rou- 
tinely advise  the  use  of  a condom  by  the 
husbands  of  my  patients  with  this  infection. 
Douching  is  notoriously  inefficient  in  rid- 
ding the  vagina  of  these  organisms  and  the 
lack  of  protection  offered  by  a diaphragm, 
even  when  it  is  used  in  conjunction  with  a 
trichomonacidal  jelly,  should  be  apparent. 

Despite  the  fact  that  sexual  contact  is  the 
common  method  of  infection  in  the  male, 
classifying  trichomoniasis  as  a veneral  dis- 
ease— as  has  been  suggested  in  several  re- 
cent reports — seems  hardly  wise.  In  the 
first  place,  there  are  many  other  possible 


930 


Rocky  Mountain  Medical  Journal 


sources  of  infection  in  women.  In  another 
study  of  vaginal  trichomoniasis  now  in 
preparation,  further  and,  at  least  to  me, 
rather  convincing  evidence  of  the  impor- 
tance of  these  extra-sexual  sources  will  be 
presented.  To  give  the  husbands  of  such 
patients  the  idea  that  they  or  their  wives 
are  suffering  from  a veneral  disease  is  to 
cast  a moral  implication  over  the  problem 
which  in  many  cases  may  be  wholly  unwar- 
ranted. I believe  that  if  time  is  taken  to 
explain  the  infection  to  the  patient  and  her 
husband,  understanding  of  it  can  be  im- 
parted without  the  doubt  and  shame  which 
the  use  of  the  term  “venereal  disease”  usu- 
ally causes. 

Conclusions 

1.  The  records  of  2,500  urine  specimens 
from  consecutive  adult  male  patients  which 
were  examined  for  T.  vaginalis  have  been 
reviewed;  fifty-three  specimens,  or  2.12  per 
cent  of  them,  were  positive. 

2.  Three  hundred  urine  specimens  from 
consecutive  male  pediatric  patients  were 
similarly  examined,  but  no  trichomonads 
were  identified. 


3.  One  hundred  seventy-one  consecutive 
prostatic  smears  were  also  examined;  twen- 
ty-six, or  15.2  per  cent  of  them,  were  posi- 
tive. Only  one  of  the  151  semen  specimens 
examined  revealed  the  organisms. 

4.  The  importance  of  searching  for  tri- 
chomonads in  male  urologic  patients  with 
non-gonorrheal  urethritis  and  other  infec- 
tions of  the  lower  urinary  tract  is  empha- 
sized. Routine  examinations  of  the  hus- 
bands of  women  with  trichomoniasis  is  sug- 
gested. The  labeling  of  trichomoniasis  a 
venereal  disease  is  deplored. 

5.  “Trichomoniasis  urinaria”  is  suggested 
as  a suitable  name  for  urinary  tract  infesta- 
tions with  T.  vaginalis. 

REOPEREIVCES 

^Salisbury,  J.  H.;  Ani.J.M.  Sc.,  55:371,  1868. 

“Allison,  G.  G.:  South.  M.J..  36:821,  1943. 

“Riba,  Jj.  W.,  and  Harrison,  R.  M. : Surg.,  Gynec.  & 
Obst.,  71:369,  1940. 

^Liston,  V/.  G.,  and  Lees,  R.:  Brit.  J.  Ven.  Dis.,  16:34, 
1940. 

“Karnaky,  K.  J. : Urol.  & Cutan.  Rev.,  40:823,  1936. 

“Katsunuma,  S.;  cited  by  Trussell,  R.  E. : Tricho- 
monas' Vaginalis  and  Trichomoniasis,  Springtield, 
C.  C.  Thomas,  1947,  p.  100. 

“Strain,  R.  E.:  J.  Urol.,  54:483,  1945. 

“Trussell,  R.  E.:  op  cit.,  p.  99. 

“Roth,  R.  B.:  Ven.  Dis.  Inform.,  25:163,  1944. 


ISOTOPES  AND  THE  NEW  ALCHEMY* 

THAD  P.  SEARS,  M.D.,  Ft.  Logan,  Colo.,  and  KENNETH  D.  A.  ALLEN,  M.D.,  Denver 


We  may  well  suspect  that  when  chemis- 
try came  into  medicine  it  was  greeted  as 
a youth  who  bore  a banner  with  a strange 
device.  Comes  now  into  our  field  a more 
mature  stranger  on  whose  banner  is  em- 
blazoned the  figure  of  an  alchemist  carry- 
ing, in  his  out-stretched  hand,  an  atomic 
bomb.  This  stranger  within  our  medical 
ranks  has  been  sired  by  a most  distin- 
guished line  of  progenitors — Becquerel,  the 
Curie’s,  Roentgen,  Planck,  Rutherford,  Ein- 
stein, Bohr,  Firmi,  Lawrence,  perhaps  even 
Sir  Isaac  Newton.  We  must  accept  this 
stranger.  It  can  be  anticipated  that  a Chair 
of  Biophysics  will  presently  be  established 
in  every  medical  school.  We  believe  that 
medical  men  cannot  escape  the  need  of  em- 

•From  the  Medical  Service,  Veterans  Administra- 
tion Hospital,  Fort  Lyon,  Colorado.  Read  at  the 
Seventy-eighth  Annual  Session,  Colorado  State  Med- 
ical Society,  Glenwood  Springs,  September,  1948. 


bracing  this  new  approach  to  clinical  medi- 
cine. Diligent  study  needs  to  be  given  to 
the  principles  and  technics  of  the  physics 
laboratory.  This  is  not  an  easy  discipline. 
But  the  adaptation  of  physics  to  biology 
leaves  the  physician  with  no  other  choice. 

The  purpose  of  this  paper  is  to  partially 
enumerate  a few  of  the  present  practical 
applications  of  radioactive  isotopes  to  the 
practice  of  medicine.  The  field  is  rapidly 
advancing  and  new  and  highly  important 
applications  can  be  constantly  anticipated. 

Natural  radioactivity  has  been  known  for 
fifty  years.  It  is  that  quality  found  in  a 
group  of  unstable  elements  of  high  atomic 
weight  whereby  the  element  spontaneously 
simplifies  itself  by  continuously  casting  off 
minute  portions  of  its  substance  in  the  form 
of  radioactive  particles.  In  this  manner  the 
element  acquires  stability  at  a lower  level 


for  November,  1949 


931 


of  atomic  weight.  The  use  of  radioactive 
isotopes  now  has  appeared  somewhat  ex- 
plosively in  medical  science.  This  is  de- 
pendent upon  the  discovery  that  artificial 
radioactivity  can  be  induced  in  almost  any 
element  of  the  Periodic  Table  by  employ- 
ment of  the  cyclotron  or  the  atomic  pile. 

What  is  an  isotope?  To  answer  this,  some 
discussion  of  the  physics  of  an  atom  is  in 
order.  Elements,  in  the  sense  that  they  are 
preordained  and  unchangeable  units,  do  not 
exist.  Rather  than  this  it  is  now  seen  that 
all  elements  are  composed  of  a small  num- 
ber of  basic  particles  which  may  be  enumer- 
ated as  electrons,  protons,  neutrons,  posi- 
trons, neutrinos,  mesotrons.  The  particles 
are  accompanied  by  energies,  which  are  as 
much  a part  and  parcel  of  an  atom  as  is  its 
particulate  mass.  These  energies  are  repre- 
sented by  the  photons  of  gamma  and  x-rays, 
by  the  coulombs  of  electric  repulsion  or  at- 
traction, and  by  what  appears  to  be  a new 
kind  of  force  termed  “nuclear  energy.”  It 
is  also  recognized  that  mass  and  energy  are 
equivalents  and  interchangeable  by  the  for- 
mula that  E=MC^.  This  is  the  Einstein 
equation.  In  its  application,  E=energy  in 
ergs,  M=mass  in  grams,  C=the  velocity  of 
light  expressed  in  centimeters  per  second. 
The  velocity  is  30,000,000,000. 

An  atom  consists  of  an  extremely  small 
spheroid  mass  made  up  of  a central  core 
or  nucleus  around  which  particulate  elec- 
trons revolve  in  orbits  at  very  great  veloci- 
ties. The  electron  carries  one  unit  of  nega- 
tive electric  charge.  It  has  a weight'd  10“^^ 
gram.  The  hydrogen  atom  has  one  electron. 
One  more  electron  is  added,  in  numerical 
order,  for  each  element  of  the  Periodic  Ta- 
ble above  hydrogen.  Uranium,  the  heaviest 
natural  element,  will  therefore  have  ninety- 
two.  The  electrons  are  disposed  in  rings  or 
“shells,”  the  maximum  known  number  of 
which  may  be  seven.  The  rings  are  desig- 
nated by  letters,  beginning  closest  to  the 
nucleus  at  the  K ring  and  progressing  dis- 
tally  and  alphabetically  to  the  Q ring.  The 
outer  orbit  of  any  atom  may  be  spoken  of 
as  the  “valence”  ring,  since  chemical 
bondage  depends  on  the  electron  pattern  in 
this  ring.  Chemical  changes  do  not  affect 
the  nucleus.  The  orbits  are  in  fact  some- 


what nebulous,  representing  levels  of  in- 
creasing energies  as  new  rings  are  added  to 
the  original  K ring. 

Electrons  can  be  knocked  out  of  the 
atomic  rings  by  various  methods.  These 
methods  include  bombardment  of  the  atoms 
composing  the  element  by  protons,  deu- 
terons,  alpha  or  beta  particles  or  neutrons 
which,  being  used  as  artificial  projectiles, 
are  fired  from  a machine  gun.  The  machine 
gun  is  represented  by  a cyclotron,  a beta- 
tron or  an  atomic  pile.  Electrons  can  also 
be  displaced  by  gamma  and  x-rays,  by  pho- 
to-electric phenomena  and  by  thermal  and 
chemical  changes.  The  electron  so  displaced 
is  termed  the  negative  ion.  The  remaining 
part  of  the  atom,  after  separation  from  the 
negative  ion,  is  rendered  relatively  positive 
by  loss  of  the  negative  electric  charge  on 
the  separated  electron.  This  residue  there- 
fore becomes  the  positive  ion.  The  two  ions 
are  called  an  ion  pair. 

The  nucleus  is  the  real  depository  of 
atomic  power.  Its  exact  constitution  is  a 
present  problem  of  physics.  The  nucleus 
contains  protons  and  neutrons.  The  proton 
is  about  1,800  times  heavier  than  an  electron 
and  carries  one  unit  of  positive  electric 
charge.  The  number  of  protons  in  a nucleus 
will  be  equal  to  the  number  of  electrons 
found  in  its  surrounding  orbits. 

The  neutron  is  a trifle  heavier  than  a 
proton  and  is  electrically  neutral.  It  is  a 
very  interesting  particle  for  many  reasons. 
It  is  the  bombarding  particle  of  nuclear  fis- 
sion; it  is  a dangerous  product  of  the  atomic 
bomb  and  it  is  by  the  addition  of  neutrons 
to  a nucleus  that  isotopes  are  created.  The 
neutron  is  also  apparently  identified  with 
a new  force  termed  “nuclear  energy.”  With- 
in the  small  volume  of  the  nucleus,  there 
are  confined  a number  of  positive  proton 
charges.  Since  like  electric  charges  repel, 
these  can  be  expected  to  violently  oppose 
each  other.  But  since  the  repellent  forces 
act  over  only  short  critical  ranges,  they  can 
be  contained  if  the  cohesive  force  of  the 
neutrons  be  interposed  between  the  protons. 
The  neutrons  can  therefore  be  thought  of 
as  the  “glue”  of  the  nucleus.  These  forces 
are  very  great.  Two  pounds  of  uranium^®® 


932 


Rocky  Mountain  Medical  Journal 


when  split  by  nuclear  fission  liberate  the 
equivalent  energy  of  20,000  tons  of  TNT. 

We  next  note  that  the  atomic  number  of 
an  element  is  the  sum  of  the  protons  in  the 
nucleus  of  one  of  its  atoms.  Its  atomic 
weight  is  the  sum  of  the  protons  plus  neu- 
trons. By  adding  neutrons  to  the  nucleus 
we  therefore  increase  the  atomic  weight 
without  increasing  the  atomic  number.  Ele- 
ments which  have  the  same  atomic  number 
but  different  atomic  weights  are  isotopes. 

are  isotopes  of  hydrogen.  (The 
atomic  number  appears  in  the  lower  left- 
hand  corner  and  is  called  the  subscript; 
the  atomic  weight  appears  in  the  upper 
right-hand  corner  and  is  called  the  super- 
script.) gC",  gC^^,  gC^^  gC’^*  are  isotopes  of 
carbon.  igP-®,  15P®®,  i5P^\  isP®^  are  phos- 
phorus isotopes.  Iodine,  with  an  atomic 
number  of  53  has  nine  isotopes  ranging  be- 
tween atomic  weights  of  124  to  137.  The 
one  commonly  used  in  thyroid  study  is  53!^®^. 
Of  ninety-two  naturally  occurring  elements 
there  are  about  450  isotopes. 

The  highly  significant  qualities  in  an  iso- 
tope are  these:  that  (1)  in  all  isotopes, 
except  those  of  hydrogen,  the  chemical  re- 
'actions  of  the  isotope  are  identical  with 
those  of  the  normal  element;  (2)  most  iso- 
topes are  radioactive  and  can  be  detected 
with  great  accuracy  by  instruments  which 
are  sensitive  to  the  presence  of  radioactiv- 
ity; (3)  the  radioactive  isotope  of  an  ele- 
ment, by  reason  of  its  identical  chemistry, 
can  be  substituted  for  the  normal  element 
in  a chemical  compound  and  the  reactions 
and  fate  of  that  compound  can  thereafter 
be  instrumentally  followed;  (4)  the  pure 
isotope  can  be  administered  to  a living  or- 
ganism, either  plant  or  animal.  Its  uptake 
and  fate  in  the  tissues  can  then  be  followed 
by  electroscope,  Geiger  counter  or  autora- 
diograph; (5)  if  the  isotope  is  given  for 
therapeutic  reasons  and  if  it  has  a specific 
uptake  by  some  tissue,  it  will  irradiate  that 
tissue  internally  by  virtue  of  its  beta  and/or 
gamma  emissions.  These  will  disrupt  the 
tissue  by  ionization  of  the  atoms  of  its  con- 
stituent molecules. 

Of  the  many  instruments  of  detection, 
three  types  are  of  particular  interest.  (1) 
The  Lauritsen  Electroscope  is  an  adaptation 


of  the  old  gold-leaf  electroscope.  Because 
the  leaves  are  discharged  in  the  presence 
of  a radioactive  source,  their  movement  can 
be  calibrated  against  an  activity  of  known 
strength,  so  that  the  radioactivity  of  an  un- 
known sample  can  be  read  in  units  of  rapid- 
ity of  discharge  per  minute.  (2)  The  Geiger- 
Muller  counter  is  essentially  a metal  vac- 
uum tube  filled  with  gas.  It  has  a central 
wire  bearing  positive  electric  charge  and  its 
walls,  which  are  insulated  from  the  central 
wire,  carry  negative  charge.  The  tube  and 
wire  are  in  circuit  with  voltages  of  1,200  to 
1,500  volts.  Since  the  central  wire  is  in- 
sulated, no  current  can  flow  until  an  ioniz- 
ing radiation  comes  through  the  “window” 
of  the  tube.  The  radiation  produces  ions  in 
the  gas  of  the  tube.  The  ions  serve  as  car- 
riers for  the  electric  current  and  a tem- 
porary flow  of  current  ensues.  This  causes 
a “pulse”  which  is  recorded  as  the  number 
of  “counts”  per  minute.  The  Geiger  tube  is 
used  in  conjunction  with  some  type  of  re- 
cording instrument,  since  the  counts  come 
in  much  too  fast  to  be  counted  by  ear.  (3) 
Autoradiographs  are  made  by  applying  a 
sensitive  photographic  emulsion  against  a 
tissue  which  has  previously  absorbed  radio- 
active material.  By  this  arrangement  the 
tissue  “takes  its  own  photograph”  and  very 
accurately  visualizes  its  own  histologic 
structure. 

■ In  their  applications  to  medical  science, 
radioisotopes  are  used  for  both  therapy  and 
research  investigations.  At  the  moment,  the 
investigative  use  far  overshadows  the  thera- 
peutic. Whichever  the  use,  the  isotope  owes 
its  utility  to  its  nuclear  unstability.  In  gain- 
ing stability,  the  atom  emits  alpha  or  beta 
particles  or  photons  of  gamma  radiation.  If 
neutrons  are  to  be  used  for  therapeutic  pur- 
poses, they  can  be  driven  out  of  a beryllium 
target  by  bombardment  with  the  deuteron 
beam  from  a cyclotron.  In  tissues,  these 
emissions,  if  of  sufficient  intensity,  can 
change  or  even  destroy  the  cells  by  ioniza- 
tion of  the  atoms  comprising  the  molecules 
forming  the  cell  membranes  and  protoplasm. 

In  investigative  study,  the  radioactive 
emissions  are  the  agents  which  activate  the 
instruments  of  detection.  The  emissions  are 
submicroscopic  particles.  When  they  are  re- 


for  November,  1949 


933 


ferred  to  as  “rays”  it  is  only  in  tribute  to 
the  physical  law  that  any  particle  moving 
with  high  velocity  takes  on  some  of  the 
attributes  of  wave  length.  The  proton 
is  the  nucleus  of  the  hydrogen  atom  from 
which  the  electron  has  been  stripped.  The 
alpha  particle  (oHe^)  is  the  nucleus  of  the 
helium  atom.  The  deuteron  (iff)  is  the 
stripped  nucleus  of  heavy  hydrogen.  The 
beta  particle  is  an  electron.  If  it  carries  a 
negative  charge  it  may  be  called  a negatron. 
If  it  is  positively  charged  it  is  termed  a 
positron.  A beam  of  electrons  constitutes 
either  a negative  or  positive  beta  ray. 

For  therapeutic  use  it  is  necessary  that 
an  isotope  have  a convenient  and  safe  half- 
life.  (Half-life  is  the  time  in  which  one-half 
of  the  radio-active  atoms  of  an  element  dis- 
integrate.) The  isotope  must  have  a specific 
up-take  by  the  tissue  we  desire  to  irradiate. 
The  isotope  itself  must  not  be  poisonous  and 
it  must  not  decay  into  a dangerous  stable 
element.  It  must  be  uncontaminated  by 
other  radio-elements  and  the  dose  must  be 
very  carefully  calculated.  To  date  only  I^®^ 
and  have  had  extensive  therapeutic 
usage.  Strontium®^’  has  been  used  to  a lesser 
extent.  These  isotopes  have  been  applied 
to  thyroid  disease,  neoplasms,  polycythemia 
and  osteogenic  tumors.  The  hope  for  ther- 
apy is  that  still  untried  isotopes  will  be 
found  to  be  efficient.  It  would  be  particu- 
larly useful  if  specific  amino-acids  or  other 
metabolites  of  tumor  cells  could  be  discov- 
ered which,  after  having  radioactive  side 
chains  attached  to  their  molecules,  could  be 
fed  to  neoplasms  for  their  destruction.  That 
neutrons  can  destroy  neoplasms  is  unques- 
tioned. The  problem  here  has  been  the  late 
results  of  injury  to  surrounding  tissues  and 
the  organism  as  a whole.  Patients  have  sur- 
vived the  carcinoma  to  die  of  the  radiation. 
In  general,  the  isotopes  have  not  added 
much  to  the  efficiency  of  therapy. 

In  contrast  to  a somewhat  disappointing 
therapeutic  use,  the  investigative  uses  of 
the  isotopes  have  created  a field  so  vast 
that  it  is  already  out  of  hand.  We  can  only 
list  a few  of  the  clinical  and  biochemical 
applications. 

1.  Phosphorus®^  is  used  to  saturate  a 
known  volume  of  red  blood  cells  isolated 


from  heparinized  blood.  These  are  re-in- 
jected into  the  patient  and  after  a period 
of  time  for  equalization  of  the  cells  in  the 
plasma,  the  degree  of  dilution  can  be  ad- 
judged by  the  effect  on  the  Geiger  count. 
From  this  count  is  calculated  the  total  cir- 
culating blood  volume. 

2.  Phosphorus®^  is  placed  in  the  medium 
in  which  tobacco  plants  are  grown.  The 
virus  of  tobacco  mosaic  is  grown  on  these 
plants.  The  virus  incorporates  the  P®®  and 
becomes  radioactive.  It  is  then  injected  into 
test  animals  and  the  uptake  and  fate  of  the 
virus  is  followed. 

3.  Phosphorus  is  incubated  with  human 
red  blood  cells.  These  red  cells  suspended 
in  saline,  are  perfused  through  normal  hu- 
man hearts  obtained  at  autopsy.  The  red 
cells  are  deposited  along  the  capillary  chan- 
nels and  their  instrumental  identification  in 
the  myocardium  shows  the  course  of  the 
finer  anastamoses  of  the  coronary  vessels. 

4.  Phosphorus®®  is  concentrated  in  rapidly 
growing  tissues.  Where  a nodule  is  found 
in  the  breast,  P®®  can  be  given  to  the  pa- 
tient. Both  breasts  are  then  surveyed  by  a 
Geiger  counter.  If  the  suspected  area  has  a 
count  25  per  cent  above  that  of  the  normal 
breast,  and  if  abscess  can  be  ruled  out,  car- 
cinoma can  be  diagnosed  with  confidence. 
Low-Beer  has  correctly  diagnosed  thirty-six 
out  of  forty-two  early  cases  of  mammary 
carcinoma  by  this  method.  The  technic  can 
also  be  used  to  locate  metastases  and  can  be 
employed  in  mycosis  fungoides,  dermal  car- 
cinoma and  cutaneous  Hodgkins. 

5.  Phosphorus®®  can  be  given  to  a patient 
who  is  taking  stilbestrol  to  obtain  remission 
in  the  degree  of  malignancy  in  a breast 
tumor.  The  effect  of  the  endocrine  is  at- 
tended by  a reduced  uptake  of  P®®.  The  re- 
duction can  be  evaluated  by  serial  Geiger 
counter  recordings.  A lessened  uptake  indi- 
cates a recession  of  malignancy. 

6.  Phosphorus®®  will  not  be  absorbed  by 
multiple  myeloma  nodules.  Since  carcino- 
mata absorb  the  isotope,  this  test  can  be 
used  as  a rapid  differential  diagnosis  of  the 
two  diseases. 

7.  Phosphorus®®  is  used  to  study  the  nor- 
mal bone  metabolism  and  the  changes  pro- 


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Rocky  Mountain  Medical  Journal 


duced  by  rickets,  hyperparathyroidism,  par- 
athormone and  vitamin  D reactions. 

8.  Strontium®®  can  be  substituted  for  cal- 
cium in  bone  deposition.  It  is  therefore  in 
use  in  the  study  of  bone  metabolism  and  in 
the  study  and  treatment  of  malignant  bone 
tumors.  The  substitution  is  made  because 
no  very  useful  calcium  isotope  exists, 

9.  Sodium®^  is  used  to  determine  the  vol- 
ume of  the  total  extracellular  fluid  of  the 
body  and  to  study  water  balance  in  neph- 
rosis. It  is  being  used  in  the  study  of  the 
mechanism  of  shock.  When  incorporated  in 
penicillin  aerosols,  the  depth  and  distribu- 
tion of  the  antibiotic  within  the  lung  can 
be  determined  by  a Geiger  count  survey  of 
the  chest  wall. 

10.  Sodium®^  provides  an  excellent  method 
for  the  determination  of  circulation  time. 
Na®^  is  injected  into  a vein  of  one  extremity. 
A survey  instrument  indicates  the  arrival 
of  radioactivity  at  another  vascular  point. 
This  clocks  the  circulation  time. 

11.  Sodium®^  is  injected  into  an  anticubital 
vein.  A Geiger-Muller  counter  is  placed 
over  the  foot.  The  instrument  records  the 
arrival  of  the  sodium  and  a counting  pat- 
tern can  be  established  for  the  normal.  This 
pattern  is  then  utilized  to  study  occlusive 
vascular  diseases  of  the  periphery  and  even 
a favorable  level  for  amputation  may  be  in- 
dicated. 

12.  lodine^®^  is  used  to  study  hyperthy- 
roidism and  the  mechanism  of  thiocyanate 
and  thiouracil  block.  It  can  be  employed 
in  tests  of  the  degree  of  malignancy  of  thy- 
roid carcinomata.  The  less  primitive  the 
neoplasm  the  more  I’^®^  it  will  take  up.  It  is 
able  to  search  out  aberrant  hyperactive  thy- 
roid tissue  or  malignant  thyroid  metastases. 
Hypothyroid  states  are  not  associated  with 
iodine  uptake.  The  fate  of  thyroxin  can  be 
followed  by  use  of  I^®\tags  in  the  thyroxin 
molecule. 

13.  Hydrogen  of  atomic  weight  3 (H® — 
tritium)  can  be  used  in  man  as  a rapid 
method  of  determining  the  volume  of  total 
body  water.  It  is  another  one  of  the  dilution 
tests. 

14.  Carbon’^^,  C^®  and  are  being  exten- 


sively used  to  advance  the  knowledge  of 
carbon  chemistry.  CO2  interchanges,  uric 
acid  precursors,  tyrosine  and  glycine  meta- 
bolism, the  fate  of  nicotine  acid  are  under 
study.  By  the  use  of  and  O^®,  the  un- 
solved problem  of  photosynthesis  of  starch 
is  being  investigated.  This  is  an  important 
study  in  a world  of  increasing  population 
and  decreasing  water  supply. 

15.  Sulfur®®  is  used  in  the  culture  medium 
for  the  growth  of  the  penicillium  mold.  The 
mold  concentrates  this  isotope  and  the  peni- 
cillin extract  is  tagged  by  becoming  radio- 
active. 

16.  Iron®®  can  be  used  to  tag  red  blood 
cells.  Since  the  tagged  hemoglobin  remains 
in  the  cell  throughout  its  life,  the  life  span 
and  fate  of  the  cell  can  be  followed.  By 
this  method  it  has  been  shown  that  young 
cells  are  more  sensitive  to  hypotonic  solu- 
tions; that  plasmodia  prefer  to  invade  young 
cells;  that  nembutal  drives  red  cells  into  the 
spleen  and  is  dangerous  in  shock;  that 
stored  red  cells  survive  much  longer  in  a 
recipient  if  glucose  has  been  added  in  stor- 
age; that  citrated  red  cells  perish  quickly; 
that  transfused  red  cells  live  three  weeks 
in  the  recipient.  It  has  been  shown  that  iron 
once  admitted  to  the  body  is  not  excreted 
but  is  stored  in  combination  with  a protein. 
Except  in  iron  deficiency  anemia,  it  has 
been  shown  that  iron  is  only  slightly  ab- 
sorbed or  not  at  all.  It  has  been  shown  that 
liver  extract  does  not  improve  hematopoiesis 
in  iron  deficiency  anemia  and  that  the 
anemia  of  infection  is  due  to  inability  of 
the  bone  marrow  to  use  iron. 

17.  Nitrogen^®  is  being  very  widely  used 
as  a tag  for  study  of  the  synthesis  and  cata- 
bolism of  the  proteins.  Deuterium,  S®®  and 

are  also  utilized  as  tags.  N^®  can  be  in- 
troduced into  several  of  the  nitrogen  bonds 
of  the  amino  acids  and  their  fractionation 
can  be  followed.  The  pigmentary  chemistry 
is  under  study  and  the  precursors  of  the 
bile  pigments.  P®®  is  being  employed  in  a 
great  number' of  studies  involving  the  inter- 
mediary metabolism  of  the  carbohydrates, 
the  nucleoproteins  and  the  phospholipids. 

18.  Mention  should  be  made  of  the  tech- 


for  November,  1949 


935 


nic  of  autoradiography  in  the  study  of  his- 
tologic sections  of  plant  and  animal  tissues. 

Enough  has  been  said  to  convince  the 
most  skeptical  that  the  Science  of  Physics 
has  become  entrenched  in  Medicine.  The 
new  stranger  at  our  gates  must  be  made 
welcome  and  embraced.  He  must  be  enter- 
tained and  his  character  studied.  This  adds 
to  our  scholastic  difficulties  but  makes  Med- 
icine the  richer. 


Summary 

There  have  been  reviewed  some  of  the 
practical  applications  of  radio-active  iso- 
topes in  the  practice  of  medicine.  The  list 
is  far  from  complete  but  it  is  thought  that 
a sufficient  number  have  been  noted  to  in- 
dicate the  trend  of  this  new  ;nethod  in  medi- 
cal science.  The  general  principles  and 
nomenclature  of  isotopic  physics  have  also 
been  reviewed.  We  believe  that  physicians 
must  accept  this  new  development  and  give 
it  the  study  it  so  much  deserves. 


MEDICOLEGAL  ASPECTS  OF  RADIATION  INJURY^ 

SHIELDS  WARREN,  M.D. 

BOSTON 


The  essential  difference  between  radia- 
tion injury  and  most  other  types  of  injury 
is  that  radiation  causes  no  sensory  stimula- 
tion and  its  effects  may  be  extremely  de- 
layed, sometimes  not  being  apparent  until 
years  after  the  radiation  had  been  received. 
In  light  of  the  statute  of  limitations  that 
very  properly  applies  to  most  claims  for  re- 
covery of  damages  for  injury,  the  doctor  car- 
ing for  a case  of  acute  radiation  injury 
should  have  in  mind  that  much  greater  harm 
may  become  apparent  at  a later  time  than 
is  obvious  at  the  time  of  his  examination. 

Consequently,  in  appraising  the  extent 
and  seriousness  of  any  radiation  injury, 
every  effort  should  be  made  to  determine 
the  physical  factors  involved  in  the  ex- 
posure— that  is,  the  amount  and  character 
of  the  radiation  received,  the  time  over 
which  it  was  received,  and  so  forth.  With 
this  data  in  mind  plus  the  results  of  his 
physical  findings,  the  doctors  can  calculate 
with  a high  degree  of  probability  what  the 
ultimate  damage  may  be. 

There  are  two  general  types  of  radiation 
hazards  to  be  faced,  external  radiation,  as 
that  from  x-ray,  radium,  neutrons  and  the 
like,  and  internal  radiation,  in  which  radio- 
active material  had  gained  access  to  the 
body  and  hence  is  able  to  irradiate  various 
of  the  body  cells  with  varying  degrees  of 
significance. 

External  radiation  hazards  may  be  sub- 

*Abstract  of  address  presented  at  the  Utah  State 
Medical  Association,  Salt  Lake  City,  September  2, 
1949. 


divided  again  into  acute  and  chronic,  acute 
radiation  injury  usually  resulting  from  a 
single  exposure  of  200  r or  oyer  and  chronic 
injury  from  repeated  exposure  of  a low 
order  of  magnitude  but  considerably  more 
than  the  permissible  dose  of  0.1  r per  day. 
It  is  worth  while  to  have  in  mind  that  radia- 
tion injury  can  be  obviated.  Up  until  the 
outbreak  of  the  war  there  were  about  2V2 
pounds  of  radium  available,  and  about  10 
per  cent  of  the  people  concerned  in  the  re- 
finement and  use  of  this  had  received  vary- 
ing degrees  of  injury  from  it.  In  the  develop- 
ment of  the  Atomic  Energy  Project  there 
have  been  literally  hundreds  of  thousands 
of  man-years  of  exposure  to  radiation  equi- 
valent not  to  pounds  of  radium  but  to  tons 
of  it,  and  only  two  deaths  and  a bare  hand- 
ful of  injuries  have  resulted. 

In  appraising  radiation  injury  it  is  essen- 
tial to  remember  that  the  mere  develop- 
ment of  a reaction,  even  a severe  reaction 
in  normal  tissue  in  the  course  of  or  follow- 
ing therapy  for  a malignant  disease,  does 
not  constitute  evidence  in  itself  of  negli- 
gence or  malpractice. 

It  must  be  recognized  that  just  as  the 
surgeon  cannot  operate  -without  leaving  a 
scar  or  cannot  amputate  without  structural 
loss,  so  the  radiologist  cannot  be  expected 
to  accomplish  his  responsibilities  without 
some  degree  of  reaction. 

In  the  field  of  internal  radiation  we  have 
the  radioactive  isotopes  such  as  iodine  and 
phosphorus  as  extremely  valuable  therapeu- 


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Rocky  Mountain  Medical  Journal 


tic  agents.  On  the  other  hand,  even  very 
minute  amounts  of  some  radioactive  mate- 
rials once  gaining  access  into  the  body  can 
be  stored  there  and  by  the  ionizing  radia- 
tion that  they  give  off  may  do  serious  harm, 
as  in  the  case  of  poisoning  due  to  radium. 

The  evidences  of  radiation  injury,  either 
acute  or  chronic,  appear  as  changes  both  in 
cells  and  in  the  intracellular  substances  de- 
pendent on  those  cells.  The  character  of  the 
injury,  whether  it  be  ulceration,  dense 
fibrosis,  necrosis  of  bone,  development  of 
bone  tumor,  skin  cancer  or  leukemia,  hinges 
on  which  cells  were  injured  and  how  se- 
riously they  were  injured.  In  general,  the 
radiation  changes  may  be  regarded  as  due 
to  the  production  of  ion  pairs  in  the  cells 
irradiated.  The  direct  damage  to  protein 


molecules  and  disruption  of  enzyme  sys- 
tems seem  to  be  important  factors.  In  any 
tissue  a good  deal  of  the  damage  ultimately 
to  develop  and  one  reason  for  the  slow  de- 
velopment of  some  of  the  damage  is  the  fact 
that  injury  may  be  done  to  the  nucleus 
which  will  not  be  apparent  in  any  change 
functionally  or  structurally  in  the  cell  until 
a number  of  cell  divisions  have  taken  place. 
Similarly,  changes  in  the  way  of  hyaliniza- 
tion  of  the  connective  tissue  and  impair- 
ment of  the  vascular  supply  are  very  im- 
portant factors. 

In  attempting  to  determine  whether  in- 
jury is  due  to  radiation,  the  history  is  of 
great  importance,  because,  except  in  the 
most  typical  cases  of  chronic  response,  other 
types  of  injury,  notably  thermal  or  electri- 
cal burns,  may  confuse  the  picture. 


BIOLOGIC  ASPECTS  OF  ATOMIC  ENERGY* 

SHIELDS  WARREN,  M.D. 

BOSTON 


In  the  tremendous  destructive  power  of 
the  atomic  bomb,  it  is  easy  to  lose  sight  of 
the  actual  and  potential  benefits  of  atomic 
energy.  As  physicians,  we  are  primarily  con- 
cerned with  care  of  our  patients,  and  what 
we  can  do  for  them. 

Thus  far,  the  benefits  of  atomic  energy 
immediately  applicable  to  therapy  are  rela- 
tively few:  First,  the  production  of  radio- 
active cobalt  as  a satisfactory  substitute  for 
radium;  second,  the  provision  of  radioactive 
phosphorus  as  a therapeutic  agent  for  cer- 
tain types  of  leukemia  and  for  polycythemia 
vera;  third,  radioactive  iodine  as  a means 
of  treating  inoperable  cases  of  hyperthyroi- 
dism or  thyroid  cancer;  fourth,  radioactive 
colloidal  gold  as  a means  of  treating  certain 
types  of  inoperable  cancer;  fifth,  the  avail- 
ability of  radioactive  substances  for  some 
useful  diagnostic  procedures  such  as  deter- 
mination of  circulation  time  and  determina- 
tion of  blood  volume.  What  further  may 
develop,  time  alone  can  tell. 

In  the  field  of  research,  less  immediately 
but  no  less  surely  applicable  to  human  wel- 
fare, the  advances  are  by  contrast  astound- 

•Abstract  of  address  presented  at  the  Utah  State 
Medical  Association,  Salt  Lake  City,  September  1, 
1949. 


ing.  The  research  tool  provided  by  the 
radioactive  tracer  elements  is  of  as  great 
fundamental  importance  as  was  the  inven- 
tion of  the  microscope.  Any  number  of  pro- 
cedures that  would  have  defied  even  the 
finest  analytical  chemical  methods  may  now 
be  undertaken  with  a fair  assurance  of  suc- 
cess. Any  chemical  laboratory  that  could 
analyze  down  to  a millionth  of  a gram  of 
phosphorus  would  be  properly  proud  of  it. 
Yet  with  appropriate  instrumentation  it  is 
possible  to  detect  a millionth  of  a millionth 
of  a gram  of  radioactive  phosphorus. 

The  unraveling  of  biologic  processes  that 
may  occur  in  the  near  future  is  almost  un- 
believable. Not  only  is  this  true  in  the  field 
of  medicine,  but  that  of  agriculture  and  biol- 
ogy in  its  broadest  sense. 

One  phase  of  the  advent  of  atomic  energy 
to  which  the  medical  profession  must  be 
properly  alert  is  its  implication  for  the  race 
as  a whole.  It  is  a power  that  can  either 
destroy  us  or  impel  us  to  make  startling 
advances.  In  a world  as  unsettled  and  as 
tense  as  that  of  today,  we  would  be  foolish  to 
close  our  eyes  to  the  baleful  possibilities 
that  exist,  and  it  is  important  to  remember 
in  our  considerations  for  the  welfare  of  the 


for  November,  1949 


937 


individual  that  we  may  be  concerned,  with 
the  protection  of  great  masses  of  population. 
The  evolution  of  adequate  civil  defense 
methods  and  participation  in  them  is  a duty 
that  will  devolve  especially  on  the  physician 
as  one  of  the  best  educated  members  of  the 
community,  who  by  training  and  by  inclina- 
tion is  able  to  guide  his  fellow  citizens  in 
scientific  matters. 


Case  Reports 


ETHYLENE  DISULFONATE  AND 
HEMOLYTIC  DISEASE  OF 
THE  NEWBORN 

DAVID  R.  BARGLOW,  M.D. 

TRINIDAD,  COLORADO 

The  treatment  of  hemolytic  disease  in  the 
newborn  baby  is  now  well  established.  With 
multiple  transfusions  or  replacement  trans- 
fusions it  is  now  possible  to  save  the  ma- 
jority of  babies,  provided  they  are  born 
alive  and  have  not  suffered  irreparable 
damage  during  their  intra-uterine  life. 

Shortly  after  isoimmunization  was  recog- 
nized to  be  the  cause  of  hemolytic  disease 
there  appeared  several  reports  on  the  pos- 
sibility of  preventing  this  isoimmunization. 
Burnham^  suggested  the  use  of  Vitamin  C 
on  the  assumption  that  the  lack  of  this  vita- 
min may  be  responsible  for  the  breaking 
down  of  the  placental  barrier,  thus  permit- 
ting a leak  of  fetal  blood  into  the  maternal 
circulation.  Wiener’s  idea  of  “competition 
of  antigens”  as  well  as  other  suggestions  for 
the  prevention  of  hemolytic  disease  are  well 
discussed  by  Potter  in  her  book  on  “Rh.” 
An  editorial  in  J.A.M.A.^  discusses  Horn- 
burger’s  experimental  use  of  sodium  salicy- 
late in  guinea  pigs  and  rabbits.  The  same 
editorial  describes  Day’s  work  on  the  “op- 
position factor”  or  “anti-immunity  sub- 
stance.” 

According  to  a News  report  (General 
Electric  X-ray  News)  Milton  Sacks  of  the 
University  of  Maryland  Medical  School  has 
been  experimenting  with  a red  blood  cell 
extract,  but  to  my  knowledge  the  results  of 
his  experiments  have  not  been  published. 


In  1947  Kariher^  reported  the  use  of  Ethy- 
lene Disulfonate  (E.D.)  in  the  prevention  of 
hemolytic  disease  in  the  newborn.  In  his 
paper  he  discusses  the  theoretical  basis  for 
its  use  and  gives  the  detailed  case  history 
of  mothers  he  expected  to  deliver  babies 
with  hemolytic  disease  and  who  received 
the  E.D. 

Two  infants  were  clinically  normal;  the 
third  had  a mild  form  of  the  disease  and 
survived  following  transfusion.  It  should  be 
stressed  here  that  Kariher  does  not  credit 
his  results  to  E.D.  He  is  rather  inclined  to 
assume  a non-specific  mechanism,  possibly 
caused  by  the  injection  of  “an  unphysiologic 
solution  into  muscle  tissue.”  To  my  knowl- 
edge, there  are  no  other  reports  on  the  use 
of  E.D.  in  the  prophylaxis  of  hemolytic  dis- 
ease of  the  newborn.  The  following  case 
report  might  therefore  be  of  general  inter- 
est. From  the  discussion  of  this  case,  it  v^ill 
be  seen  that  it  is  not  published  as  a claim 
for  any  specific  action  of  E.D. 

CASE  REPORT 

Mrs.  E.  J.  S.,  27-year-old  white  female,  para  II, 
gravida  IV.  She  did  not  have  any  miscarriage 
nor  any  blood  transfusions.  She  married  in  Janu- 
ary, 1941,  and  became  pregnant  at  the  beginning 
of  1942.  The  delivery  was  premature,  about 
fifty  days  before  the  expected  date.  The  infant 
died  twenty-four  hours  postpartum.  Cause  of 
death  was  not  established.  She  was  pregnant 
again  in  1944.  About  seven  weeks  before  the  ex- 
pected date  of  delivery  she  started  to  “hemor- 
rhage.” There  was  induction  of  labor  with  a 
spontaneous  delivery  of  a four-pound  baby  on 
August  4,  1944.  The  mother  was  found  to  be  Eh 
negative,  the  baby  Rh  positive.  It  was  transfused 
with  30  c.c.  Rh  positive  placental  blood.  The 
record  is  incomplete,  because  the  patient  was  un- 
der the  care  of  a Navy  doctor,  who  was  trans- 
ferred at  short  notice  and  could  not  complete 
the  record.  But,  according  to  the  patient,  the 
baby  had  three  additional  transfusions  of  Rh 
positive  blood.  The  baby  was  doing  fairly  well 
for  four  days,  yet  died  on  the  seventh  day. 

The  administrator  of  the  hospital  in  New  Lon- 
don, Conn.,  where  the  baby  was  born  was  kind 
enough  to  send  me  a copy  of  the  autopsy  report: 

“This  is  the  body  of  a 7-day-old  baby  boy  that 
as  far  as  hair  growth  and  development  of  finger 
nails  is  concerned  he  should  be  considered  as 
mature.  The  skin  and  sclerae  are  yellowish  dis- 
colored. Rigor  mortis  is  absent.  Livor  mortis  is 
present  over  the  dependent  portions  of  the  body. 
The  skull  is  covered  with  blond  hair.  Both 
corneae  are  cloudy.  The  pupils  are  round  and 
measure  each  5 millimeters  in  diameter.  There 
is  no  discharge  from  the  mouth,  nares  or  ears. 
The  abdominal  wall  is  1 c.m.  above  the  level  of 
the  chest  plate.  A slight  amount  of  edema  is 
seen  around  the  ankles  and  also  over  the  sacrum. 

“Lungs:  Both  lungs  float  on  water.  The  con- 
sistency of  both  lower  lobes  seems  to  be  slightly 


938 


Rocky  Mountain  Medical  Journal 


increased.  On  cutting,  the  upper  lobes  and  the 
right  middle  lobe  do  not  offer  any  changes  ex- 
cept yellowish  brown  discoloration.  The  cut  sur- 
face of  the  lower  lobes  shows  several  small  gray- 
ish purple  areas  that  are  interpreted  as  focal 
pneumonia.  The  bronchi  are  free  of  exudate. 
The  pleurae  are  smooth  and  glistening. 

“Kidneys:  Both  kidneys  show  fetal  lobulation. 
They  are  markedly  yellowish  discolored  and  the 
surface  is  smooth. 

“The  remainder  of  the  organs  are  normal.” 

At  a later  date  (May,  1945)  the  patient  was 
examined  at  the  Mayo  Clinic.  Their  report  reads 
as  follows: 

“Mrs.  S.  was  Rh  negative  and  there  were  no 
anti-Rh  conglutinins  present.  It  should  be 
pointed  out,  however,  that  she  was  nearly  a year 
postpartum  at  the  time  the  anti-conglutinins 
were  made.” 

Iri  November  of  the  same  year  she  was  exam- 
ined by  a very  competent  hematologist.  He  found 
blocking  antibodies  and  advised  against  another 
pregnancy  At  that  time,  however,  the  patient 
was  already  pregnant. 

She  came  under  my  care  in  January,  1946.  At 
that  time  our  hospital  was  not  equipped  to  do 
antibody  tests.  However,  because  of  the  previous 
loss  of  two  babies,  it  was  thought  advisable  to 
give  75  c.c.  Rh  negative  Type  O blood  through 
the  umbilical  vein.  The  blood  was  given  with 
an  equal  amount  of  physiological  saline  imme- 
diately after  delivery.  Subsequently  the  baby 
was  found  to  be  Rh  negative.  During  the  first 
week  the  infant  showed  marked  icterus  and  had 
one  attack  of  cyanosis  with  dyspnea  when  two 
days  old.  During  the  next  few  days  it  developed 
a purpuric  rash,  which  disappeared  after  24 
hours.  There  were  some  other  minor  complica- 
tions, a report  of  which  will  be  published  else- 
where. The  baby  was  taken  home  after  ten  days’ 
stay  at  the  hospital;  he  is  now  over  2%  years 
old  and  normal  in  every  way.  Since  the  baby 
was  Rh  negative  the  parents  were  told  that  this 
was  sufficient  proof  that  the  father  is  heterozy- 
gous, and  that  theoretically  they  had  a 50  per  cent 
chance  to  have  normal  infants.  The  patient  was 
pregnant  again  in  the  spring  of  1948.  Her  last 
menstrual  period  was  May  -15,  expected  date 
December  22.  Between  April  29  and  May  15  she 
had  moderate  amount  of  bloody  flow  with  blood- 
clots  on  several  occasions. 

A vaginal  examination  showed  the  uterus  to 
correspond  to  a pregnancy  of  about  two  months. 
The  os  cervicis  admitted  easily  the  tip  of  the 
index  finger.  Bleeding  stopped  after  two  weeks 
of  bedrest  and  injections  of  progesterone.  Intra- 
muscular injections  of  2 c.c.  Ethylene  Disulfo- 
nate* were  started  on  May  6 and  continued 
weekly  until  November  20.  A total  of  twenty- 
eight  injections  were  given. 

The  examinations  for  antibodies  were  done  by 
the  dilution  method  up  to  a dilution  of  1:32.  The 
red  blood  cells  used  were  group  O Rh,  Rh^  posi- 
tive. Both  saline  and  albumen  were  used  as  the 
suspending  media.  The  first  test  was  run  May  6, 
the  last  one  October  15.  AR  tests  were  negative. 

On  November  25,  i.e.,  about  four  weeks  before 
the  estimated  date,  a baby  girl  was  delivered, 
weighing  6 pounds.  About  40  c.c.  Rh  negative 
type  O blood  was  given  by  cord  transfusion. 
Examination  of  the  cord  blood  proved  it  to  be 
group  B,  Rh  positive.  It  was  negative  for  anti- 
bodies, both  in  saline  and  albumen,  there  were 
eight  erythpblasts  per  100  WBC.  Icteric  index 
was  38  units.  The  following  day  examination 

*Generously  supplied  by  Spicer-Gerhart  Company, 
Pasadena,  Calif. 


of  finger  blood  showed  139  per  cent  Hb,  6 mil- 
lion RBC,  16,000  WBC  with  a normal  differential 
count  and  two  erythroblasts  per  100  WBC. 

As  a general  supportive  treatment,  liver,  iron 
and  vitamin  K was  given  The  subsequent  counts 
were  all  within  normal  limits  and  there  were 
no  more  erythroblasts.  The  baby  was  kept  in  an 
incubator  for  about  ten  days;  it  showed  a pro- 
nounced icterus  during  the  first  week.  The  baby 
is  now  four  months  old  and  normal  in  every 
respect. 

Discussion 

If  our  present  concept  of  Rh  incompatibil- 
ity is  correct,  we  should  have  expected  the 
mother  to  have  antibodies  and  the  baby  to 
be  born  with  hemolytic  disease  or  to  de- 
velop the  disease  shortly  after  birth.  On 
that  point  there  seems  to  be  no  controversy 
in  the  literature.  Potter*  states: 

“When  a sufficient  degree  of  immuniza- 
tion has  been  established  to  produce  the  dis- 
ease in  one  infant,  the  effect  in  a subsequent 
conception  is  much  more  dramatic  and  the 
chance  of  survival  of  the  infant  is  very 
poor.” 

Yet,  here  we  have  a patient  who  did  not 
develop  antibodies,  and  a baby  that  did  not 
have  any  hemolytic  disease. 

After  the  baby  was  born,  an  inquiry  was 
sent  to  the  hematologist  who  examined  the 
patient  in  June,  1945.  His  answer  by  wire 
was: 

“Mrs.  S.  Group  O Rh  negative.  Mr.  Group 
B Rh  positive.  Mrs.  shows  presence  of 
blocking  antibodies  which  precludes  success- 
ful pregnancy.” 

We  have  to  assume  that  the  antibodies, 
which  were  still  present  in  1945,  had  disap- 
peared at  a later  time.  This,  as  we  know, 
happens  quite  frequently.  Of  course,  no 
new  antibodies  were  formed  with  the  next 
pregnancy  because  the  baby  was  Rh  nega- 
tive. The  question  still  remains  why  was 
there  no  production  of  antibodies  during  the 
last  pregnancy?  One  would  be  inclined  to 
give  credit  to  the  injections  of  E.D.  How- 
ever, according  to  the  report  by  the  Council 
on  Pharmacy  and  Chemistry®,  this  product 
cannot  be  distinguished  from  distilled  water. 
As  a matter  of  fact,  because  of  the  enormous 
dilution,  10“*®,  the  product  cannot  even  be 
analyzed.  Several  authors  report  favorable 
results  from  the  use  of  E.D.  in  allergic  con- 
ditions, but  according  to  the  Council  on 
Pharmacy,  these  reports  are  of  little  value 


for  November,  1949 


939 


because  they  are  “based  on  either  entirely 
uncontrolled  or  poorly  controlled  studies.” 
My  own  experience  is  limited  to  two  pa- 
tients with  bronchial  asthma  and  one  child 
with  infantile  eczema.  None  of  them  showed 
any  improvement  whatever. 

Further,  the  biochemical  theory  as  pub- 
lished in  a number  of  papers,  and  most  re- 
cently by  Ketcham®  appears  doubtful  and, 
to  my  knowledge,  has  not  been  confirmed 
in  the  medical  literature. 

There  is  only  one  way  to  establish  the 
value  of  E.D.  in  the  treatment  of  hemolytic 
disease  of  the  newborn.  That  is  to  treat  a 
fairly  large  group  of  Rh  negative  mothers 
who  delivered  children  with  erythroblas- 
tosis. A control  group  will  have  to  be  treat- 
ed with  injections  of  distilled  water.  The 
possibility  of  a nonspecific  muscle  injury, 
as  assumed  by  the  Council  on  Pharmacy 
and  by  Kariher,  has  to  be  kept  in  mind. 

Since  it  is  difficult  for  anyone  to  collect 
a large  group  of  these  cases,  this  report 
is  published  as  a small  contribution  to  the 
problem  with  the  hope  that  larger  centers 
will  investigate  this  question  on  a large 
scale. 

REFERENCES 

^Burnhan.,  L. : Vitamin  C Deficiency  as  a Possible 
Factor  in  the  Pathogenesis  of  Erythroblastosis  Fe- 
talis. Am.  J.  Obst.  & Gynec.,  44:920,  1942. 

^Editorlai.  J.A.M.A.,  131:525,  1946. 

^Kariher,  D.  H.,  and  Miller,  D.  I.:  Am.  J.  Obst.  & 
Gynec.,  54:1,  1947. 

■•Potter,  E.  L.:  Pediatrics,  2:369,  1948. 

^Ethylene  Disulphonate,  Report  of  the  Council: 
J.A.M.A.,  131:1495,  1946. 

^Ketcham,  M.  W. : Allergy,  J.  Miss.  State  Med.  A., 
Dec.,  1948. 


OBSTRUCTION  OF  THE  BOWEL 
DUE  TO  GALLSTONE 

N.  L.  BEEBE,  M.D. 

FORT  COLLINS,  COLORADO 

Fifty  per  cent  mortality  is  in  itself  suffi- 
cient reason  for  continued  report  and  dis- 
cussion of  any  surgical  condition,  and  this 
is  the  average  mortality  as  shown  by  sta- 
tistics of  the  relatively  few  cases  of  gall- 
stone ileus  reported  to  date.  This  is  the 
per  cent  observed  by  Hinchey^  in  one  of  the 
largest  series  recorded;  Huet®  estimates  it  to 
be  even  60  per  cent. 

The  two  reasons  most  responsible  for  this 
mortality  are  (1)  the  age  of  the  patient,  and 
(2)  the  delay  in  operating  resulting  from  a 


too  late  diagnosis.  Balch^  recognized  these 
two  factors  to  be  of  paramount  importance. 
The  average  age  in  the  series  of  seventeen 
cases  which  he  reported  was  66,  which  is 
the  same  as  that  recorded  by  Hinchey^  in 
his  series  of  thirteeen.  (All  authors  agree 
that  the  incidence  in  female  patients  is  out 
of  proportion  to  the  3:1  ratio  of  occurrence 
of  gallstones  in  women  and  men;  the  ratio 
here  being  about  15:1\)  In  recognition  of 
the  second  factor  mentioned  Hinchey  writes, 
“In  a review  of  a great  many  case  histories, 
the  delay  between  onsent  of  symptoms  and 
surgical  intervention  is  striking.  It  is  tragic 
that  a form  of  obstruction  of  the  bowel  so 
readily  relieved  should  be  manifested  by 
such  indefinite  misleading  symptoms  with 
the  frequent  result  of  delayed  operation.”^ 
He  also  observed  in  the  series  he  studied 
that  “the  average  duration  of  symptoms 
prior  to  hospitalization  was  two  and  a half 
days  in  those  patients  who  survived,  and 
six  and  three-quarters  days  in  those  who 
died.”^  It  is  to  emphasize  what  I believe  to 
be  the  chief  factor  in  the  late  diagnosis 
that  I am  reporting  the  following  case. 

CASE  REPORT 

I first  saw  the  patient,  a widow  lady  78  years 
of  age,  on  August  25,  1941.  Her  immediate  com- 
plaint was  nausea  and  vomiting.  She  stated  that 
she  had  taken  suddenly  sick  at  six  o’clock  the 
evening  before  with  nausea  and  vomiting,  but 
without  abdominal  pain.  She  had  continued  to 
vomit  at  intervals  and  wished  me  to  see  the  last 
vomitus  as  she  felt  that  it  looked  as  if  it  were 
coming  from  her  intestines.  She  gave  the  history 
that  she  had  had  five  or  six  of  these  “bilious 
spells”  in  the  past  six  years,  that  they  always 
came  on  quickly,  and  that  she  was  relieved  as 
soon  as  she  had  vomited. 

The  family  and  past  history  were  irrelevant 
with  the  exception  of  the  history  just  related 
and  the  fact  that  she  had  been  operated  upon 
forty  years  previously  for  a fibroid  tumor.  The 
ovaries  and  appendix  were  removed  at  the  same 
time. 

Physical  examination  revealed  a well  devel- 
oped and  well  preserved  elderly  woman.  Exam- 
ination of  her  head  and  neck  were  grossly  nega- 
tive, as  was  also  her  chest.  The  heart  rate  was 
78  and  regular.  There  were  no  murmurs.  The 
blood  pressure  was  115/70;  the  arteries  were 
soft.  The  adomen  was  relaxed.  There  was  a 
depressed  lower  midline  scar.  No  masses  were 
palpable,  and  there  was  no  special  tenderness 
and  no  evidence  of  gas.  Pelvic  examination 
could  not  be  made  because  of  atresia  of  the 
viginal  canal.  The  rectal  examination  was  nega- 
tive. The  appearance  of  the  vomitus  did  not 
suggest  anything  abnormal  that  could  not  have 
come  from  the  stomach  or  upper  duodenum.  Her 
temperature  was  99.2. 

Because  of  the  persistent  vomiting  and  history 


940 


Rocky  Mountain  Medical  Journal 


of  the  previous  operation,  a tentative  diagnosis 
of  obstruction  of  the  bowel  was  made  and  the 
patient  was  taken  to  the  office  where  a scout 
film  of  the  abdomen  was  secured.  On  the  film, 
which  did  not  show  the  usual  bowel  pattern, 
an  opaque  shadow  was  noted  in  the  left  pelvis 
and  thought  to  be  a calcified  gland.  The  patient 
was  hospitalized  and  given  glucose  solution  in- 
travenously on  the  assumption  that  the  condition 
was  probably  an  acute  gastritis  and  that  the 
patient  would  likely  be  all  right  in  the  morning. 

The  next  day  the  general  condition  of  this  pa- 
tient remained  the  same.  She  continued  to  vomit 
at  intervals,  but  did  not  complain  except  just 
before  vomiting.  She  passed  gas  by  bowel,  and 
the  abdomen  remained  flat.  However,  because 
of  the  persistent  vomiting,  a second  film  was 
taken  than  evening.  The  roentgenoloist’s  report 
on  this  film  was  as  follows: 

“Abdomen:  Roentgen  examination  of  the  ab- 
domen discloses  at  least  one  loop  of  small  intes- 
tine which  seems  to  be  dilated  somewhat  and 
thus  evidence  of  obstruction.  This  does  not  nec- 
essarily indicate  mechanical  obstruction,  though 
it  cannot  be  excluded.  We  believe  there  are  also 
some  loops  of  small  intestines  containing  fluid 
which  appear  to  be  somewhat  dilated. 

“Incidental  findings:  There  appears  to  be  a 
calcified  ovary  in  the  pelvis,  or  else  a calcified 
hematoma. 

“The  cause  of  the  possible  obstruction  in  this 
case  is  not  manifested.” 

Labratory  findings  revealed  a normal  hemo- 
globin and  red  cell  count,  a white  count  of  10,200 
with  81  per  cent  polymorphonuclears.  Urinalysis 
was  negative  except  for  6-10  pus  cells,  and  1-3 
red  cells  per  high  dry  field. 

Before  the  roentgenologist’s  report  came  back, 
it  was  decided  to  explore  the  patient  and  this 
was  done  on  the  morning  of  the  twenty-seventh 
under  spinal  anesthesia,  using  100  mg.  of  novo- 
caine.  When  the  abdomen  was  opened,  the  small 
intestines  were  found  not  to  be  dilated,  but  the 
walls  of  the  lower  ileum  were  thickened  and 
congested.  The  exploring  hand  came  immediately 
upon  a hard  object  in  the  bowel  which  proved 
to  be  a gallstone  impacted  in  the  ileum  seven 
inches  proximal  to  the  ileocecal  valve.  The 
bowel  was  incised,  the  stone  removed,  and  the 
wound  closed  with  one  layer  of  chromic  catgut 
and  one  of  silk.  Exploration  of  the  gallbladder 
revealed  it  to  be  small,  contracted,  and  firm. 
It  was  impossible  by  palpation  to  tell  if  it  was 
adherent  at  the  ampulla  to  the  duodenum.  The 
abdomen  was  closed  in  the  usual  manner.  The 
stone  measured  2.5  cm.  in  diameter. 

The  patient’s  convalescence  was  fairly  smooth 
although  she  was  quite  listless  for  the  first  week, 
and,  on  the  fifth  day,  a rise  of  temperature  to 
102  signalled  the  onset  of  a limited  phlebitis  in 
the  upper  left  thigh.  The  temperature  reached 
normal  again  on  the  eighth  day  and  continued  so. 
She  was  dismissed  from  the  hospital  on  the  six- 
teenth day  and  has  remained  well. 

Discussion 

This  factor  of  intermittent  or  recurring 
obstruction  has  also  been  emphasized  by 
Balch^  and  Hinchey.  The  latter  states  that 
“even  when  the  stone  has  come  to  a final 
halt,  the  resultant  symptoms  are  not  clear 
cut  as  in  other  forms  of  obstruction.  Disten- 


tion is  often  not  pronounced.  Tenderness  is 
not  a common  finding  since  obstruction  is 
purely  mechanical  at  the  onset.^  It. is  gen- 
erally agreed  by  those  who  have  reported 
cases  of  gallstone  ileus  that  the  stone  un- 
doubtedly passes  from  the  gallbladder  into 
the  intestine  directly  through  a spontane- 
ously cholecystoduodenal  fistula®  Due  to 
spasm,  as  well  as  obstruction,  the  stone  hesi- 
tates in  its  passage  down  the  small  intestine, 
producing  typical  symptoms  of  obstruction, 
i.e.,  nausea,  vomiting,  pain.  With  increas- 
ing pressure,  the  stone  is  forced  farther  down 
the  intestinal  tract  with  the  alleviation  of 
all  these  symptoms.  This  clouds  the  picture 
and  causes  a question  as  to  the  first  diag- 
nosis. Just  when  the  attending  physician 
feels  that  he  is  wrong,  the  symptom  complex 
is  repeated,  and  he  again  suspects  obstruc- 
tion, only  to  have  his  confidence  in  the 
diagnosis  shaken  by  the  passage  of  gas  and 
possibly  a stool.^  This  repetition  produces 
a delay  and  hourly  reduces  the  chance  for 
successful  surgery  and  the  patient’s  chance 
for  recovery  and  life. 

The  relatively  infrequency  of  this  condi- 
tion is  such  that  no  one  surgeon  will  see 
many  such  cases,  so  that  the  lesson  learned 
in  the  first  experience  is  likely  to  be  at  the 
expense  of  a 50  per  cent  mortality  since  two 
cases  will  probably  be  as  many  as  he  sees 
in  his  lifetime. 

What,  then,  can  be  done  to  alter  this  situ- 
ation? First,  crystallize  the  diagnostic  fea- 
tures of  gallstone  obstruction;  and  second, 
help  the  medical  profession,  especially  young 
physicians,  to  become  acquainted  with  the 
outstanding  diagnostic  factors  by  increasing 
the  material  in  our  text  books  for  schools, 
and  discussing  it  more  frequently  in  our 
surgical  journals. 

It  seems  to  me  that  the  following  should 
be  considered  as  diagnostic  sign  posts:  (1) 
a female  patient  over  fifty;  (2)  an  acute  on- 
set of  illness  with  symptoms  of  obstruction; 
(3)  a history  of  bilious  attacks  previously 
(this  should  carry  the  same  weight  as  a 
scar  on  the  abdomen  when  thinking  of  in- 
testinal obstruction);  (4)  the  intermittent 
nature  of  the  obstruction  (this  is  probably 
the  key  to  diagnosis) ; and  (5)  an  opaque 


for  November,  1949 


941 


shadow  in  a scout  film,  which,  if  present, 
would  clinch  the  diagnosis. 


RBIi'ERJEaVCES 


>Balch,  Franklin  G.,  Jr.:  Gallstone  Ileus,  The  New 
England  Journal  of  Medicine,  218:457  (March  17), 
1938. 


^Cope,  Zachary:  The  Early  Diagnosis  of  the  Acute 
Abdomen,  7th  Ed.,  Oxford  U.  Press,  New  York,  127- 
130,  1935. 

menendez,  David  Orta:  Report  of  a Case  of  Biliary 
Ileus,  Archives  de  La  Slociedad  de  Estudios  Clinicos 
de  La  Habana,  33:545  (August),  1939. 


■‘Hinchey,  Paul  R. : Gallstone  Ileus,  Archives  of 
Surgery,  45 :«  January),  1943. 


=Huet,  P.:  Biliary  Ileus,  Rev.  Med.  Franc,  18:771 
(December),  1937. 

sKent,  G(-orge  B.,  and  Sawyer,  Kenneth  C. : Acute 
Intestinal  Obstruction.  Rocky  Mountain  Medical 
Journal,  39:283  (April),  1942. 

’Lewis,  Dean:  Complications  of  Gallstones.  Practice 
of  Surgery,  7:2  Pee. 

®Osler,  Sir  William:  The  Principles  and  Practice  of 
Medicine.  8th  Ed.,  D.  Appleton  & Co.,  New  York, 
C.  1918,  P.  874. 

spieczarkorski,  M.:  Acute  Fatal  Intestinal  Occlusion 
Caused  by  Gallstones,  Polska  Gaz.  Lek.  16:556  (July), 
1937. 

’“Ramstedt,  C.:  On  Cholelithic  Ileus,  Rev.  Med.  Ger- 
man.-Iberg-Am.  4:600,  1913. 


nWarbasse,  J.  P.:  Surgical  Treatment,  W.  B.  Saun- 
ders Co.,  Philadelphia,  C.  1923,  Vol.  2,  P.  609. 


Correspondence 


A GENERAL  PRACTITIONER  APPROVES 

To  the  Editor; 

The  August  issue  of  the  Journal  had  such  a 
fine  chain  of  articles  of  interest  to  the  general 
practitioner  that  I cannot  refrain  from  express- 
ing my  appreciation.  Especially:  Differential 
Diagnosis  of  Polio;  Intestinal  Obstruction;  Low 
Back  Pain;  Psychosomatics  in  G.  I.  Disorders,  and 
Treatment  of  Superficial  Ca. 

WILLIAM  A.  HINRICHS,  M.D., 
Douglas,  Wyoming. 

♦ * * 

REQUESTS  HELP  IN  TWIN  STUDY 


BOOK  REVIEW  QUESTIONED 

To  the  Editor: 

In  the  September  edition  of  the  Rocky  Moun- 
tain Medical  Journal,  C.  E.  Stanfield  reviews  a 
book  on  “Contemporary  Religious  Jurispru- 
dence,” hy  I.  H.  Rubenstein,  published  by  The 
Waldain  Press  of  Chicago.  As  this  review  dig- 
nifies and  clothes  with  respectable  authority  a 
book  which  is  full  of  inconsistencies  and  mis- 
taken interpretations,  thereby  giving  your 
readers  a wrong  impression;  I should  appreciate 
your  allowing  space  for  this  letter. 

The  book  “Contemporary  Religious  Juris- 
prudence” is  a rewrite  of  a book  published  by 
Mr.  Rubenstein  about  ten  years  ago.  Like  its 
predecessor,  this  book  has  no  value  as  a legal 
work.  For  example,  anyone  shotdd  recognize 
the  falsity  of  the  statement  on  page  78,  under 
“Divorce,”  where  it  says:  “Surprising  as  it  may 
seem,  a married  person  may  obtain  a divorce 
upon  the  ground  that  his  or  her  spouse  is  a 
Christian  Science  practitioner.”  This,  of  course, 
is  not  true.  Further  reading  of  that  paragraph 
discloses  that  even  in  the  case  cited,  the  charge 
was  cruelty.  This  twisting  of  court  decisions 
to  suit  Mr.  Rubenstein’s  antagonism  runs  through 
the  whole  book. 

In  commenting  on  the  book,  the  Minnesota 
Law  Review  for  February,  1949  (the  journal  of 
the  Minnesota  Bar  Association),  said: 

He  would  not  only  deny  to  Christian  Scientists  re- 
covery of  damages  for  pain  and  suffering  but  also 
disqualify  them  as  jurors  in  personal  injury  cases. 
This  bias,  moreover,  may  be  responsible  for  the  mis- 
interpretation of  such  cases  as  Downsborough  v. 
Huddersfield  Industrial  Society  (1942)  1 ICB.  306, 

from  which  the  author  derives  the  misleading  rule 
that' “A  private  employer  . . . may  discharge  an  adult 
or  minor  employee,  who  registers  as  a conscientious 
objector  and  has  been  classified  as  such  by  the  local 
draft  board  upon  the  ground  that  as  a pacifist  he  is 
an  undesirable  employee.” 

It  is  significant  that  Mr.  Rubenstein,  who  lives 
in  Chicago,  claims  to  be  a member  of  the  Illinois 
Bar,  but  is  not  listed  in  the  Chicago  Legal  Direc- 
tory as  a practicing  attorney.  Neither  is  the 
publisher  of  the  book.  The  Waldain  Press,  listed 
in  the  Chicago  telephone  directory. 


To  the  Editor: 

The  study  of  twins  is  of  great  value  in  pro- 
viding information  concerning  the  respective 
importance  of  hereditary  predisposition  and  en- 
viromental  influences  in  disease  . . . this  method 
has  shown  a hereditary  predisposition  to  tuber- 
culosis, diabetes,  tumor  formation,  and  a high, 
medium  or  low  intelligence  quotient.  There  is 
some  a priori  evidence  showing  an  hereditary 
predisposition  for  peptic  ulcer  . . . 

I should  like  to  ask  physicians  to  cooperate  by 
sending  me  cases  in  which  (1)  one  or  both  twins 
develop  peptic  ulcer,  (2)  the  site  of  the  ulcer, 
(3)  the  age  of  onset  of  ulcer,  (4)  the  type  of 
twins  (monovular  or  diovular),  (5)  the  sex  of 
the  twins,  (6)  the  date  of  birth  of  the  twins,  and 
(7)  the  number  and  age  of  the  brothers  and 
sisters  and  the  absence  or  presence  of  ulcer  in 
each. 

A.  C.  IVY,  M.D., 

Dept,  of  Clinical  Science, 
University  of  Illinois, 
1853  West  Polk  Street, 
Chicago  12,  111. 


The  implication  Mr.  Rubenstein  leaves  with  the 
reader  of  his  book,  that  Christian  Science  seeks 
to  annul  those  law  of  the  land  which  are  designed 
to  protect  the  health  and  safety  of  citizens  in  gen- 
eral, is  not  substantiated  by  fact.  Mary  Baker 
Eddy,  the  Discoverer  and  Founder  of  Christian 
Science,  in  her  book,  “The  First  Church  of 
Christ,  Scientist,  and  Miscellany,”  makes  our 
position  very  clear: 

I have  expressed  my  opinion  publicly  as  to  the  pre- 
cautions against  the  spread  of  so-called  infectious 
and  contagious  diseases  in  the  following  words: 
“Rather  than  quarrel  over  vaccination,  I recommend, 
if  the  law  demand,  that  an  individual  submit  to  this 
process,  that  he  obey  the  law,  and  then  appeal  to  the 
gospel  to  save  him  from  bad  physical  results.  What- 
ever changes  come  to  this  century  or  to  any  epoch, 
we  may  safely  submit  to  the  providence  of  God,  to 
common  justice,  to  the  maintenance  of  individual 
rights  and  to  governmental  usages.  I believe  in 
obeying  the  laws  of  the  land.  I practise  and  teach 
this  obedience,  since  justice  is  the  moral  significa- 
tion of  law.  Injustice  denotes  the  absence  of  law.” 
(pp.  219,  220). 

ARTHUR  P.  WUTH, 

Christian  Science  Committee  on 
Publication  for  Colorado. 


942 


Rocky  Mountain  Medical  Journal 


"Constipation  is  very  frequently  found  in  people  of  climacteric 
age, In  the  vast  majority  of  patients,  constipation  is  prob- 

ably due  to  improper  habits,  diet,  or  gastrointestinal  disorders.”* 

The  soft,  demulcent,  water-retaining,  mucilloid  bulk  provided 
by  Metamucil  gently  initiates  reestablishment  of  reflex  peris- 
talsis and  movement  of  the  intestinal  contents. 

G.  D.  Searle  & Co.,  Chicago  80,  Illinois. 


*Wemer,  A.  A.;  The  Climacteric  in  Women 
and  Men,  Postgrad.  Med.  4:102  (Aug.) 
1948. 


METAMUCIL®  is  the  highly  refined 
mucilloid  of  Plontogo  ovoto  (50%),  a seed 
of  the  psyllium  group,  combined  with 
dextrose  (50%)  os  a dispersing  agent. 


RESEARCH  IN  THE  SERVICE  OF  MEDICINE 


SEARLE 


for  November,  1949 


943 


Organization 

National  Affairs  - Proceedings  - Programs  - Society  Notices  - News  - Auxiliary 


NATIONAL  AFFAIRS 


NATIONAL  CONFERENCE  OF  COUNTY 
ftlEDICAL  SOCIETY  OFFICERS 

Grass  Roots  Conference — The  Sixth  National 
Conference  of  County  Medical  Society  Officers 
will  be  held  Thursday  evening,  December  8,  1949, 
at  the  Hotel  Statler,  Washington,  D.  C. 

Members  will  be  interested  in  hearing  a de- 
scription of  three  or  four  of  the  nation’s  “Out- 
standing Achievements  in  Community  Medical 
Leadership,”  described  by  persons  who  know 
from  experience. 

The  Grass  Roots  Conference  is  sponsored  by 
the  Board  of  Trustees  of  the  A.M.A.  and  is 
carried  on  by  county  medical  society  officers. 


TENTH  ANNUAL  COUNCIL  ON  INDUSTRIAL 
HEALTH 

The  Council  on  Industrial  Health  will  hold  its 
Tenth  Annual  Congress  on  Industrial  Health  at 
the  Roosevelt  Hotel  in  New  York  City,  February 
20  and  21,  1950. 


ANNOUNCEMENT  OF  VAN  METER  PRIZE 
AWARD 

The  American  Goiter  Association  again  offers 
the  Van  Meter  Prize  Award  of  $300  and  two 
honorable  mentions  for  the  best  essays  sub- 
mitted concerning  original  work  on  problems 
related  to  the  thyroid  gland.  The  award  will  be 
made  at  the  annual  meeting  of  the  association, 
which  will  be  held  in  Houston,  Texas,  March  9, 
10  and  11,  1950,  providing  essays  of  sufficient 
merit  are  presented  in  competition.  The  com- 
peting essays  may  cover  either  clinical  or  re- 
search investigations;  should  not  exceed  3,000 
words  in  length;  must  be  presented  in  English; 
and  a typewritten  double  spaced  copy  in  dupli- 
cate sent  to  the  Corresponding  Secretary,  Dr. 
George  C.  Shivers,  100  East  St.  Vrain  Street, 
Colorado  Springs,  Colorado,  not  later  than  Jan- 
uary 15,  1950.  The  committee  who  will  review 
the  manuscripts  is  composed  of  men  well  quali- 
fied to  judge  the  merits  of  the  competing  essays. 


ERRATUM 

Through  circumstances  beyond  our  control, 
some  technical  errors  occurred  in  the  article  en- 
titled “Remote  Recording  of  Physiological  Data 
by  Radio”  by  Holter  and  Generelli,  which  was 
published  in  our  September  issue.  Dr.  Gener- 
elli’s  name  did  not  appear  in  the  cover  Table  of 
Contents.  Figs.  1-a.  and  1-b.  did  not  show  the 
alpha  waves  clearly,  although  they  were  clear 
in  the  large  photographs  from  which  our  cuts 
were  made.  Fig.  4-a.  was  printed  backwards. 


COLORADO 

State  Medical  Society 

OFFICIAL  NOTICE 

To  All  Members  of  the 
Colorado  State  Medical  Society: 

Revised  Rules  of  the  Board  of  Supervisors  of 
the  Colorado  State  Medical  Society,  adopted 
August  27,  1949,  and  approved  by  the  Board  of 
Councilors  of  the  Society,  September  23,  1949, 
are  reproduced  below  for  the  information  of  all 
concerned. 

This  official  publication  is  in  compliance  with 
that  portion  of  Chapter  VII,  Section  11,  of  the 
By-Laws  of  the  Colorado  State  Medical  Society, 
as  amended,  which  reads  as  follows:  “The  Board 
shall  have  power  to  adopt  rules  to  cover  matters 
within  its  jurisdiction,  and  said  rules  after  ap- 
proval by  the  Board  of  Councilors  shall  be  pub- 
lished in  the  official  Journal  of  the  Society  and 
shall  be  binding  upon  all  members  of  the  Society 
ten  days  after  said  publication.” 

BOARD  OF  SUPERVISORS,  By 
WILLIAM  A.  LIGGETT,  M.D.,  Secretary. 

RULES  OF  THE  BOARD  OF  SUPERVISORS  OF 
THE  COLORADO  STATE  MEDICAL  SOCIETY 

1.  Purposes  of  the  Board: 

a.  To  act  as  the  Society’s  “grand  jury”  for 
investigating  complaints  and/or  initiating  in- 
vestigations concerning  professional  conduct  and 
ethical  deportment. 

b.  To  prepare,  for  issuance  to  the  entire  mem- 
bership in  bulletin  form  through  the  executive 
office,  periodic  bulletins  on  ethical  deportment 
containing  definite  educational  advice  to  physi- 
cians in  this  regard. 

c.  To  initiate  and  prosecute,  just  as  would  a 
grand  jury  in  civil  procedures,  charges  against 
any  physician  deemed  by  the  Board  guilty  of  un- 
professional conduct.  'These  charges  may,  in  the 
discretion  and  judgment  of  the  Board,  be  filed 
originally  with  the  Board  of  Censors  of  any  com- 
ponent society,  direct  with  the  Councilor  of  the 
appropriate  district  of  the  State  Society,  direct 
with  the  Board  of  Councilors  of  the  State  Society, 
direct  with  the  State  Board  of  Medical  Exam- 
iners, or  direct  with  any  criminal  court,  accord- 
ing to  the  nature  of  the  charges. 

d.  By  way  of  further  definition  of  purposes, 
it  should  be  understood  that  the  Board  of  Super- 
visors has  no  final  jurisdiction  in  a judicial  way. 
Just  as  would  a grand  jury,  it  will  receive  and 
pass  its  own  judgment  upon  evidence,  but  it 
will  not  assume  authority  to  discipline  any 
physician.  It  may  at  any  time  express  its  ad- 
vice to  a member  of  the  Society  on  any  matter 
pertaining  to  professional  conduct. 

e.  In  pursuance  of  its  function  as  a grand 
jury  within  the  structure  of  the  Society  the 


944 


Rocky  Mountain  Medical  Journal 


What  do  you  demand  in  a toxoid.  Doctor? 

As  an  example,  consider  the  superiority  of  the  new, 
purified  DiP-PeRT-TeT*— for  simultaneous  immunization 
against  diphtheria,  pertussis,  and  tetanus; 

1.  Immunization  routine  is  simplified  with  three  injections  of 
0.5cc  each  at  monthly  intervals. 

2.  Purified  toxoids  assure  virtual  freedom  from  reactions  due 
to  bacterial  protein  components. 

3.  Alhydrox**— exclusive  adsorbing  agent- 
results  in  a more  solid  immunity,  fewer  post-injection  reactions, 
and  less  pain  on  injection. 

When  single  immunizations  are  indicated  or  booster 
shots  are  required,  there  is  a PURIFIED  TOXOID- 
CUTTER— available  in  both  single  and  multiple  dose 
packages.  Your  pharmacist  has  them  in  stock. 

*D1P-PERT-TET-  Cutter*s  diphtheria  and  tetanus  toxoids  and  pertussis 
vaccine  combined  for  simultaneous  immunization  against  diphtheria, 
pertussis,  and  tetanus. 

**Alhyd  rox- Trade  name  for  aluminum  alhydrox  adsorption, 
exclusive  with  CUTTER. 

CUTTER  LABORATORIES  • BERKELEY,  CALIFORNIA 


CUTTER 


small  dosage  volume? 
purity? 

concentrated  potency? 
high  antigenicity? 

Of  course,  doctor,  you  want  the  best  possible 
combination  of  these  advantages. 

Research  and  manufacturing  know-how  of 
CUTTER,  first  producer  of  combined  toxoids, 
have  developed  in  their  new  purified  toxoids 
products  which  meet  all  of  your  demands. 


for  November,  1949 


945 


Board  shall  have  the  power  and  authority  to 
summon  members  of  the  Society  to  appear  before 
it,  either  in  connection  with  complaints  involving 
the  member  summoned  or  as  witnesses  in  cases 
involving  other  members.  In  case  any  member 
shall  fail  to  respond  to  such  summons,  the  Board 
of  Supervisors  shall  cite  the  member  before  the 
Board  of  Councilors  for  contempt  proceedings. 

2.  Standards  of  Conduct: 

The  current  edition  of  the  “Principles  of  Med- 
ical Ethics  of  the  American  Medical  Association,” 
as  interpreted  from  time  to  time  by  the  Board 
of  Councilors  of  the  Colorado  State  Medical 
Society  for  this  state,  shall  be  the  final  standard 
by  which  all  professional  conduct  and  ethical 
deportment  are  determined. 

3.  Organization  of  Board: 

The  Board  annually  elects  a Chairman,  a Vice- 
Chairman,  and  a Secretary  from  among  its  own 
members.  The  By-Laws  of  the  Society  do  not 
permit  any  member  of  the  Board  to  participate 
in  the  deliberation  of  questions  concerning  the 
conduct  of  a physician  residing  in  the  jurisdic- 
tion of  that  Board  member’s  cornponent  society. 
In  view  of  this  fact  the  Vice-Chairman  will  pre- 
side in  all  cases  involving  a member  of  the 
Chairman’s  district,  and  the  Vice-Chairman  will 
serve  as  Secretary  in  all  cases  involving  a mem- 
ber of  the  Secretary’s  district.  Thus,  two  dis- 
interested officers  of  the  Board  will  always  as- 
sume these  functions.  Any  person  against  whom 
an  accusation  is  made  will  be  informed  that  the 
member  of  the  Board  residing  in  his  district 
will  not  be  present  during  the  Board’s  delibera- 
tion of  that  case.  However,  if  the  accused  is 
willing,  the  acting  Chairman  of  the  Board  may, 
on  occasion,  instruct  the  Board  member  in  the 
accused’s  district  to  undertake  preliminary  in- 
vestigation, obtain  information,  and  report  to  the 
Board,  in  order  to  expedite  proceedings  and 
eliminate  unnecessary  travel. 

4.  Professional  and  Technical  Assistance: 

a.  Unless  in  a given  case  the  Board  deter- 
mines that  verbatim  testimony  should  be  taken, 
no  person  other  than  elected  members  of  the 
Board  and  any  witness  then  being  heard  will  be 
admitted  to  any  part  of  its  proceedings  when  a 
complaint  is  being  considered. 

b.  Should  it  become  necessary  in  the  opmion 
of  the  Board  to  take  verbatim  testimony  in  any 
case  the  Board  will  obtain  the  services  of  a 
certified  shorthand  reporter  licensed  by  the 
State  of  Colorado  for  such  purposes.  No  regular 
employee  of  the  Society  will  be  requested  or 
permitted  to  take  notes  or  minutes  on  such 
matters. 

c.  In  the  event  the  Board  reaches  the  point, 
in  any  investigation,  where  the  Board  feels  it 
should  file  and  prosecute  charges  against  a 
physician  before  any  judicial  body,  the  Board 
will,  before  filing  such  charges,  consult  with  the 
regular  retained  attorney  of  the  State  Society 
to  determine  the  sufficiency  of  the  evidence. 

5.  General  Procedure: 

a.  The  Board  will  receive  complaints  either 
verbally  or  in  writing  from  any  person,  whether 
or  not  he  or  she  be  a physician,  a member  of  the 
Society,  an  employee  of  the  Society,  a patient 
of  a physician,  or  any  other  person,  lay  or  pro- 
fessional. 

b.  The  Board  will  respect  the  completely  con- 
fidential nature  of  any  complaint,  provided  that 
any  complainant  unwilling  to  appear  personally 
before  the  Board  will  be  given  to  understand 
that  such  unwillingness  prejudices  against  the 
possibility  of  the  Board  being  able  to  make  a 
com.plete  investigation.  Every  complainant  will 
be  invited  to  appear  before  the  Board  with  the 


assurance  that  even  the  fact  of  his  appearance 
before  the  Board,  as  well  as  the  origin  of  the 
complaint,  will  be  kept  confidential;  provided, 
however,  that  should  any  form  of  prosecution  re- 
sult the  Board  will  of  necessity  reveal  the 
names  of  prospective  witnesses  even  though 
these  names  may  include  that  of  the  complainant. 

c.  The  Secretary  of  the  Board  will  acknowl- 
edge receipt  of  all  complaints,  either  verbally 
or  in  writing,  as  the  circumstances  of  each  case 
indicate  to  be  wiser.  The  Secretary  will  like- 
wise, in  consultation  with  the  Chairman,  arrange 
for  meetings  of  the  Board  with  such  frequency 
as  may  be  necessary  so  that  investigation  of  each 
complaint  is  carried  out  with  reasonable  dis- 
patch, and  will  notify  complainants  and  any 
other  persons  whom  the  Board  wishes  to  in- 
terview concerning  meeting  dates  and  places. 
The  Secretary  will,  at  all  times,  keep  the  Chair- 
man informed  concerning  the  progress  of  in- 
vestigations conducted  otherwise  than  at  meet- 
ings of  the  Board. 

d.  The  Chairman,  on  receipt  of  information 
from  the  Secretary  concerning  each  new  com- 
plaint, shall  determine  whether  first  investiga- 
tion or  action  on  the  complaint  should  be  by 
the  whole  Board  at  a rneeting  or  by  one  or  more 
members  of  the  Board  individually.  In  most 
cases  the  Chairman  will  designate  one  or  two 
members  of  the  Board  who  are  not  residents  of 
the  same  district  as  the  physician  bemg  com- 
plained against  to  undertake  a preliminary  in- 
formal investigation,  bearing  in  mind  the  con- 
fidential nature  of  such  investigations. 

e.  When  an  informal  investigation  like  that 
referred  to  next  above  has  convinced  at  least 
two  members  of  the  Board  (not  including  the 
member  in  whose  district  the  physician  under 
investigation  resides)  that  no  disciplinary  action 
is  indicated  and  that  both  the  complainant  and 
the  physician  involved  are  willing  to  accept  the 
advice  of  the  Board  for  reconciliation  of  the 
complaint,  advice  and  suggestions  of  the  Board 
shall  be  reduced  to  writing  and  supplied  to  both 
complainant  and  the  physician  concerned,  over 
the  signature  of  the  acting  Chairman. 

f.  When  an  informal  investigation  like  that 
referred  to  in  “d”  above  convinces  any  disin- 
terested member  of  the  Board  that  disciplinary 
action  is  indicated,  the  entire  Board  except  the 
member  whose  district  is  involved  shall  con- 
sider the  matter  formally  in  meeting  before 
further  action  is  taken,  and  further  action  shall 
be  determined  by  majority  vote  of  those  present. 

g.  When,  after  investigation  and  attempts  to 
effect  amicable  settlement,  the  Board  is  unable 
to  reconcile  differences  over  fees  charged  by  a 
member  of  the  Society,  the  Board  shall  by  a 
majority  vote  determine  the  fee  which  it  deems 
fair  and  proper.  In  case  the  Society  member 
shall  agree  to  the  amount  so  fixed  and  shall  fail 
to  abide  by  his  agreement,  the  Board  of  Super- 
visors shall  cite  such  member  before  the  Board 
of  Councilors  for  contempt  proceedings.  Failure 
of  the  member  to  agree  to  such  determination 
of  the  Board  of  Supervisors  shall  constitute 
grounds  for  the  preferring  of  charges  of  unpro- 
fessional conduct  under  the  principles  of  ethics. 

h.  Whenever  the  Board  determines  to  file 
charges  against  a member  of  the  Society  with 
either  a Board  of  Censors  or  the  Board  of 
Councilors,  the  charges  shall  be  reduced  to  writ- 
ing and  filed  over  the  signature  of  two  officers 
of  the  Board  and  over  the  typed  signatures  of 
all  other  members  of  the  Board  who  have  taken 
part  in  the  preceedings. 

In  the  event  that,  in  consideration  of  a case 
involving  complaint  against  a physician  who  is 


946 


Rocky  Mountain  Medical  Journal 


A Disability 

Life  Income  Program 

for  Eligible 

Physicians  & Surgeons 

of  your 

State 

Lifetime  Profeefion 
for  both 

Sickness  & Accidents 


A SILiNT  PARTNER  . . , Continental’s  Companion  Policies 


Pays  $ 400 

$ 300 

Pays  $ 600 

Pays  $ 7,500 
Pays  $10,000 
$ 5,000 


Monthly  Benefits  first  2 years  ($200  I $t  mo.)  ond 
Monthly  Benefits  thereafter  for  Life. 

Additionol  Monthly  Benefits 

Rrst  3 Months  for  Hospital  Disability. 

Accidental  Death  Benefits,  $12,500  Double  Indemnity. 

Loss  of  Hands  Feet  or  Eyes,  $ 1 5,000  Double  Indemnity  (or) 
Cash,  & $400  monthly  first  2 years,  $300  monthly  thereafter. 
Adjusted  benefits  for  disabilities  occurring  after  age  60. 


SPECIAL  FEATURES 

No  Cancellation  Clause, — Standard  Provision  16  Non  Pro-Hating, — Standard  Provision  17 

No  Terminating  Age, — Standard  Provision  20  Non-Assessoble, — No  Contingent  liability 

No  Increase  in  Premium, — Once  Policy  is  Issued  Non- Aggregate, — Previous  Claims  Paid 

Grace  Period  I 5 Days  do  not  limit  Company's  liability 


Unusually  Complete  Protection 

'A' Pays  Montlily  Benefits  from  1st  Day  to  Life. 

Pays  Benefits  for  botli  Sicicness  and  Accident. 

'A  Pays  Lifetime  Benefits  for  Time  or  Specific  Losses. 
if-  Pays  Regular  Benefits  for  Commercial  Air  Travel. 

^ Pays  Benefits  for  Non-Disabling  Injuries. 

Pays  Benefits  for  Non-Confining  Sickness. 

Pays  Benefits  for  Septic  Infections. 

Pays  Whether  or  not  Disability  is  Immediate. 

"A’ Waives  Premiums  for  Total  Permanent  Disability. 

Renewal  is  guaranteed  to  individual  active  members,  except 
for  non-payment  of  premium,  so  long  as  the  plan  continues 
in  effect  for  the  members  of  your  designated  organization. 


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For  Ages  59  to  75 


Only  Companion  Policies  GP-1309  and  IP-1308  pay  the  above  benefits. 

IMPORTANT — Permit  no  agent  to  substitute  — IMPORTANT 


Name.... 

Address. 

Age. 


for  November,  1949 


947 


not  a member  of  the  Medical  Society,  it  is  de- 
termined that  disciplinary  charges  should  be 
filed  against  the  doctor  with  a Board  of  Censors 
or  the  Board  of  Councilors  were  he  a member 
of  the  Society,  but  it  is  also  determined  that  the 
evidence  does  not  justify  proceedings  before  the 
State  Board  of  Medical  Examiners  or  a criminal 
court,  the  Board  shall  reduce  its  findings  to 
writing,  and  subject  to  advice  of  legal  counsel, 
shall  notify  the  physician  concerned  of  its  find- 
ings and  shall  file  a copy  of  this  notice  with  the 
executive  office  of  the  State  Society  and  the 
Secretary  of  the  State  Board  of  Medical  Exami- 
ners for  future  reference. 

i.  Both  the  original  complainant  and  the 
physician  against  whom  the  complaint  has  been 
made  will  be  furnished  with  a written  state- 
ment and  explanation  of  the  final  decision  of 
the  Board  as  soon  as  possible  after  the  Board 
has  completed  its  investigation  of  the  case, 
whether  (1)  the  Board  considers  the  case  closed 
or  (2)  decides  to  file  charges  with  a judical 
body. 

j.  Immediately  after  each  meeting  of  the 
whole  Board,  the  officers  of  the  Board  shall 
prepare  and  deliver  to  the  executive  office  of 
the  Society,  a memorandum  suitable  for  inclu- 
sion in  the  monthly  News  Exchange,  concerning 
any  non-secret  actions  taken  or  general  advice 
arrived  at  concerning  the  status  of  ethical  de- 
portment within  the  Society.  In  the  event  it  is 
desired  that  such  material  be  made  the  subject 
of  a special  bulletin  to  the  entire  membership 
of  the  Society,  the  Board  shall  make  this  decision 
known  to  the  Executive  Secretary. 

k.  Whenever  the  Board  determines  that  con- 
templated actions  of  the  Board,  other  than  bulle- 
tin services  indicated  next  above,  will  require 
use  of  certified  shorthand  reporters,  telegraph  or 
long  distance  telephone  service,  travel  expense, 
or  other  matters  involving  State  Society  finances 
aside  from  routine  services  of  the  executive 
office,  the  Board  will  notify  the  Board  of  Trustees 
of  the  Society  through  the  Executive  Secretary, 
and  estimate  the  financial  requirements  of  the 
action  then  contemplated. 

l.  Officers  of  the  Board  shall  keep  appro- 
priate and  sufficient  records  of  all  of  its  final 
actions,  other  than  confidential  matters,  and 
shall  prepare  quarterly  reports  of  progress  to 
the  Board  of  Trustees  and  an  annual  report  and 
recommendations  to  the  House  of  Delegates. 

m.  Until  further  notice,  the  Board  will  meet 
regularly  at  2:00  p.m.,  on  the  last  Saturday  of 
each  calendar  month  in  the  Executive  Office  of 
the  Society,  subject  to  the  privilege  of  the  Chair- 
man to  postpone  any  such  meeting  if  the  date 
is  impractical. 

. . . Done  in  meeting  August  27,  1949. 
Approved  and  confirmed 
by  the  Board  of  Councilors 
September  23,  1949. 


NEW  LICENSES  ISSUED  IN  OCTOBER  1949 

The  following  physicians  were  granted  licenses 
to  practice  medicine  in  this  state  at  the  regular 
quarterly  meeting  of  the  State  Board  of  Medical 
Examiners,  held  October  4,  1949: 

Willis  L.  Bennett,  Univ.  Pensylvania  ’41;  Deep- 
dale  Rd.  Strafford,  Wayne,  Pa. 

Fred  H.  Branan,  Jr.,  Univ.  Georgia  ’42;  1999 
Mohne  St.,  Aurora,  Colo. 

Harold  Henry  Bremers,  Creighton  Univ.  ’48;  2525 
Albion  St.,  Denver. 

Stanley  Crosbie,  Univ.  Minnesota  ’42,  V.A.  Hos- 
pital, Grand  Junction,  Colo. 


Jamesi  Rogers  Fox,  Univ.  Minnesota  ’46;  1325 
Mt.  Curve,  Minneapolis,  Minn. 

Frank  John  Gorishek,  Creighton  Univ.  ’38;  1980 
S.  Williams  St.,  Denver. 

Hodson  Arthur  Hansen,  Univ.  Nebraska  ’42;  4200 
E.  9th  Ave.,  Denver. 

Marshall  Daniel  Hayes,  Rush  Medical  Coll.  ’21; 
8136  S.  Wood  Ave.,  Chicago. 

Erode  Jensen,  Columbia  Univ.  ’37;  1259  Albion 
St.,  Denver. 

Roland  J.  Marasco,  St.  Louis  Univ.  ’47;  902  Colo- 

. rado  Ave.,  Grand  Junction,  Colo. 

Elmer  Perry  Monahan,  Jr.,  Northwestern  Univ. 
’47;  Rangely,  Colo., 

Harry  Albert  Sauberli,  Vanderbilt  Univ.  ’32;  2901 
Forest  St.,  Denver. 

C.  Robert  Schmidt,  Northwestern  Univ.  ’39;  1928 
Midroad,  Colorado  Springs. 

James  Ennis  Sheehan,  Long  Island  Coll.  Med. 
’47;  Climax,  Colo. 

Stanley  John  Sontag,  Univ.  Minnesota  ’48;  1530 
Carr  St.,  Lakewood,  Colo. 

Charles  T.  Streeter,  Univ.  Nebraska  ’45;  Estes 
Park,  Colo. 

Charley  J.  Smyth,  Jefferson  Med.  Coll.  ’35;  4200 
E.  9th  Ave.,  Denver. 

Willard  V.  Thompson,  Univ.  Oklahoma  ’44;  Den- 
ver Gen.  Hospital,  Denver. 

George  W.  Thatcher,  Univ.  Nebraska  ’46;  4200 
E.  9th  Ave.,  Denver. 

Walter  M.  Uhler,  Jefferson  Med.  Coll.  ’43;  3600 
S.  Broadway,  Englewood,  Colo. 

Ronald  Fisher  Kirk,  Univ.  Nebraska  ’33;  6623 
Bdway.,  San  Antonio,  Tex. 

Kathryn  Kirby,  Univ.  Iowa  ’47;  1516  Downing 
St.,  Denver. 

Gerald  W.  Lockwood,  Univ.  Oklahoma  ’48;  3730 
E.  1st  St.,  Tulsa,  Okla. 

Edmond  Forrest  Noel  (Negro),  Meharry  Univ. 
’41;  3515  Cook  St.,  Louis,  Mo. 

Mary  Hoag  Rehm,  Univ.  Colorado  ’40;  617  Co- 
lumbia Rd.,  Colorado  Springs. 

James  Austin  Troian,  Univ.  Colorado  ’33;  Con- 
cord, Calif. 

Orlando  W.  J.  Penner,  Coll.  Medical  Evang.  ’38; 
Dillon,  Colo. 


POLICY  IN  REGARD  TO  THE  HANDLING  OF 
CASES  OF  ACUTE  AND  LATE  EFFECTS 
OF  ACUTE  ANTERIOR  POLIO- 
MYELITIS IN  COLORADO 

Approved  by  the  Colorado  State  Medical  Society 
and  the  State  Department  of  Public  Health 

To  reduce  confusion  and  duplication  in  the 
care  of  polio  cases,  it  was  agreed  that  polio  cases 
would  be  treated  in  local  hospitals  when  possible, 
according  to  the  plan  of  the  Disaster  Committee 
of  the  State  Medical  Society.  During  the  first 
ten  days,  hospital  care  will  be  guaranteed  where 
assistance  is  necessary,  and  medical  care  will  be 
paid  when  need  is  indicated,  by  the  local  chapter 
of  the  N.F.I.P.  During  this  ten-day  period,  the 
case  can  be  evaluated  both  from  a medical  and 
economic  standpoint. 

Further  medical  care  will  depend  on  the  status 
of  the  patient.  If  the  family  is  medically  in- 
digent, the  case  would  be  carried  as  a private 
patient  to  the  local  chapter  of  the  Polio  Foun- 
dation as  long  as  seems  reasonably  possible  and 
then  transferred  entirely  to  the  Crippled  Chil- 
dren Section  of  the  State  Health  Department, 
providing  the  Crippled  Children  Section  has 
funds  available  for  this  purpose.  If  the  family 
of  this  case  can  afford  the  care,  they  will  be 


948 


Rocky  Mountain  Medical  Journal 


from  head  to  toe 


CeREViITI, 

CEREALS+VITAMINS  + MINERALS 

1 . "A  Study  of  Enriched  Cereal  in  Child  Feeding  " Urbach, 

C.;  Mack,  P.  B.,  and  Stokes,  Jr.,  J;  Pediatrics  1:70,  1948. 

•Cerevim  contains  neither  vitamin  A nor  C but  possibly 
exercises  an  A-and-C  sparing  effect  attributed  to  its 
high  content  of  protein  ond  mojor  B vitamins. 


CEREViM-fed  children  showed  greater 
clinical  improvement,  in  the  following 
nutrition-influenced  categories,  than 
children  fed  on  ordinary  unfortified 
cereal  or  no  cereal  at  all:^ 


hair  lustre 
recession  of  corneal  invasion 
retardation  of  cavities 
condition  of  gums 
condition  of  teeth 
skin  color 
skeletal  maturity 
skeletal  mineralization 
*blood  plasma  vitamin  A increase 
*blood  plasma  vitamin  C increase 
subcutaneous  tissues 
dermatologic  state 
urinary  riboflavin  output 
musculature 
plantar  contact 


Here’s  why:  Cerevim  is  not  just  a cereal. 

Much  more:  CEREVIM  provides  8 natural 
foods:  whole  wheat  meal,  oatmeal,  milk 
protein,  wheat  germ,  corn  meal,  barley, 
Brewers’  dried  yeast  and  malt  — PLUS 
added  vitamins  and  minerals. 


M&R  DIETETIC  LABORATORIES,  INC.  • Columbus  16,  Ohio 


for  November,  1949 


949 


encoiaraged  to  pay  for  it,  with  the  assistance  of 
local  chapter  funds  if  necessary.  It  is  imder- 
stood  that  any  of  the  cases  can  be  seen  for 
diagnosis  and  consultation  in  a Crippled  Chil- 
dren’s clinic,  providing  they  are  referred  by  a 
local  physician,  but  they  will  not  be  eligible  for 
treatment  unless  medically  indigent  and  official- 
ly transferred  to  the  Crippled  Children  Section. 
The  full-time  staff  of  the  State  Health  Depart- 
ment will  be  available  at  all  times  for  consul- 
tation regarding  any  of  the  problems  the  local 
physician  or  the  family  may  have. 

The  advantages  of  the  arrangement  are  as 
follows; 

1.  Wherever  possible,  private  physicians  will 
care  for  these  cases  until  they  become  medically 
indigent. 

2.  The  Polio  Foundation  will  be  relieved  of 
some  of  the  financial  responsibility  of  (a)  fam- 
ilies who  can  afford  to  pay  for  this  care,  (b) 
families  who  are  medically  indigent. 

3.  The  Crippled  Children  Section  of  the  State 
Health  Department  will  likewise  be  relieved  of 
that  part  of  the  financial  burden  which  the 
Foundation  carries  through  its  local  chapters. 

4.  There  will  be  a very  sharp  line  of  demarca- 
tion between  cases  who  are  and  those  who  are 
not  being  cared  for  by  the  Crippled  Children 
Section. 

5.  Under  this  arrangement,  children  crippled 
by  polio  will  be  treated  exactly  the  same  as 
children  crippled  from  other  conditions,  as  far 
as  the  Crippled  Children  Section  of  the  State 
Health  Department  is  concerned. 

6.  The  Denver  hospitals  would  be  relieved  of 
some  of  the  acute  case  load  which  was  so  serious 
a problem  in  the  1946  epidemic. 


POSTGRADUATE  COURSE  ON  PRINt 
CIPLES  OF  INHAI.ATION 
ANESTHESIOLOGY 
University  of  Colorado  Medical  Center, 

4200  East  Ninth  Avenue, 

Denver  7,  Colorado 

NOVEMBER  18  AND  19,  1949 

Sponsored  by  Division  of  Anesthesiology, 
University  of  Colorado  School  of  Medicine 

OUTLINE  OF  COURSE 
Friday,  November  18,  1949 
MpRNING  SESSION 
(Clinical  Amphitheater) 

8:00 — Registration — Office  of  Director  of  Grad- 
uate and  Post-Graduate  Education. 

8:45 — Film:  “Advent  of  Anesthesia.” 

9:00 — History  of  Inhalation  Anesthesiology: 

Present  Scope. — C.  Walter  Metz,  M.D. 

9:30— Basic  Definitions:  Significance  of  Records. 
—Philip  A.  Lief  M.D. 

10:00 — Normal  and  Applied  Physiology  and  Anat- 
omy: the  Respiratory  System;  the  Cardio- 
vascular System;  the  Central  and  Autonomic 
Nervous  System. — Robert  W.  Virtue,  Ph.D., 
M.D. 

11:00 — Premedication:  Purposes,  Principles,  Tech- 
nics.— Philip  A.  Lief,  M.D. 

11:30 — Theories  of  Anesthesia. — Philip  A.  Lief, 

M.D. 

AFTERNOON  SESSION 
(Clinical  Amphitheatre) 

1:00 — Classification  and  Evaluation  of  Methods. 
— Carol  Hunter,  M.D. 


1:30 — Stages  and  Signs  of  Anesthesia. — Philip 
A.  Lief,  M.D. 

2:00— Chemistry  and  Pharmacology  of  Volatile 
Agents  and  Anesthetic  Cases. — Robert  W. 
Virtue,  Ph.D.,  M.D. 

3:00 — Anesthetic  Emergencies:  Vomiting,  Con- 
vulsions, Reflexes. — Philip  A.  Lief,  M.D. 

3:30 — Fires  and  Explosions. — J.  Lawrence  Camp- 
bell, M.D. 

4:00 — Soda  Lime  and  Carbon  Dioxide  Absorp- 
tion.— John  C.  McAfee,  M.D. 

4:30— Endotracheal  and  Endobronchial  Tech- 
nics.— John  C.  McAfee,  M.D. 

Saturday,  November  19,  1949 
MORNING  SESSION 

8:00 — Practical  Observations  (Operating  The- 
ter):  The  Use  and  Care  of  Gas  Anesthesia 
Apparatus;  Open  Drop  and  Insufflation  Tech- 
nics; Semi-Closed  and  Closed  Carbon  Dioxide 
Absorption  Technics;  Compensated  and  Con- 
trolled Respiration;  Endotracheal  and  En- 
dobronchial Technics. — Philip  A.  Lief,  M.D.; 
Robert  W.  Virtue,  Ph.D.,  M.D.;  Fred  R. 
Brown,  M.D. 

11:30 — Film  (Clinical  Amphitheatre):  Inhalation 
Anesthesia  for  Short  Medical  and  Dental 
Operative  Procedures. 

Requirements 

This  course  is  open  to  all  doctors  of  medicine 
and  dental  surgery  in  Colorado  and  neighboring 
states  who  are  members'  of  their  constituent 
medical  and  dental  societies.  There  will  be  a 
registration  fee  of  $10.00. 

Clinical  Instruction 

Following  this  course,  a limited  number  of 
students  will  have  the  opportunity  to  receive 
supervised  clinical  training  in  inhalation  anes- 
thesiology. 


Obituaries 

EDWIN  L.  APPERSON 

Dr.  Edwin  L.  Apperson,  widely  known  retired 
Denver  ear,  nose  and  throat  specialist,  died  Sep- 
tember 29,  1949.  He  resided  at  1325  East  Seventh 
Avenue. 

Dr.  Apperson  was  born  in  California,  Mo.  He 
attended  Washington  University  in  St.  Louis 
where  he  received  his  medical  degree.  For  a 
time  he  studied  in  Vienna  and  upon  his  return 
to  St.  Louis  served  his  internship  and  practiced 
for  several  years. 

Dr.  Apperson  came  to  Denver  in  1912  and 
served  on  the  staff  of  Agnes  Memorial  Sanato- 
rium for  six  years.  He  then  entered  private  prac- 
tice, limited  to  ear,  nose  and  throat.  At  this  time 
he  served  on  the  staffs  of  Children’s,  Colorado 
General,  and  National  Jewish  Hospitals  until  his 
retirement  in  1937. 

In  1922,  Dr.  Apperson  was  appointed  local  con- 
sul for  the  Republic  of  Panama,  which  he  held 
until  his  retirement. 

He  was  a member  of  the  American  Medical 
Association,  the  Colorado  and  Denver  Medical 
Societies  and  Nu  Sigma  Nu  medical  fraternity. 


HENRY  S.  CANBY 

Dr.  Henry  S.  Canby,  of  555  Marion  Street, 
Denver,  retired  internist,  died  October  11,  1949, 
at  the  Dorothy  Olssens  Sanatorium  in  Lake- 
wood,  Colorado. 

Dr.  Canby  was  born  March  14,  1876,  in  Port- 


950 


Rocky  Mountain  Medical  Journal 


if  she  is  one  of  your  patients... 


...She  depends  on  your  help  for  a speedy  return  to  gainful  occupation. 
Women  seeking  employment  who  are  nervous,  apprehensive  and  generally 
distressed  by  symptoms  of  the  climacteric,  may  find  it  difficult  to  meet 
competition.  ''Premarin"  offers  a solution.  Many  thousand  physicians 
prescribe  this  naturally-occurring,  oral  estrogen  because... 

1 . Prompt  symptomatic  improvement  usually  follows  therapy. 

2.  Untoward  side-effects  are  seldom  noted. 

3.  The  sense  of  well-being  so  frequently  reported  tends  to  quickly 
restore  the  patient's  confidence  and  normal  efficiency. 

4.  This  "Plus”  (the  sense  of  well-being  enjoyed  by  the  patient) 

is  conducive  to  a highly  satisfactory  patient-doctor  relationship. 

5.  Four  potencies  provide  flexibility  of  dosage-.  2.5  mg.,  1 .25  mg., 
0.625  mg.  and  0.3  mg.  tablets;  also  in  liquid  form,  0.625  mg. 

in  each  4 cc.  (1  teaspoonful). 


1 


While  sodium  estrone  sullale  is  the  principal  estrogen 
in  "Premarin,"  other  equine  estrogens  ...  estradiol, 
equilin,  equilenin,  hippulin  . . . are  probably  also  pres-  ( 
ent  in  varying  amounts  as  water-soluble  conjugates. 


ESTROGENIC  SUBSTANCES  (WATER-SOLUBLE) 
also  known  as  CONJUGATED  ESTROGENS  (equine) 


Ayerst,  McKenna  & Harrison  Limited  22  East  40th  Street,  New  York  1 6,  New  York 
for  November,  1949  951 


land,  Oregon.  He  came  to  Denver  at  an  early 
age  and  attended  East  High  School.  He  took 
his  pre-medical  course  at  the  University  of 
Denver,  where  he  was  a member  of  Sigma  Alpha 
Epsilon  Fraternity. 

In  1901  he  received  his  medical  degree  from 
Bellevue  Hospital  Medical  College  in  New  York. 
From  1901  to  1903  Dr.  Canby  was  with  the 
Harlem  Hospital  in  New  York  and  then  became 
medical  director  for  the  Y.M.C.A.  Tuberculosis 
Health  Farm  until  1909.  This  same  year  Dr. 
Canby  returned  to  Colorado  and  was  on  the 
visiting  staff  of  Denver  General  Hospital  and 
was  consultant  to  the  Swedish  Lutheran  Hos- 
pital. He  was  a member  of  the  Colorado  State 
Medical  Society  until  his  retirement  in  1937. 


CHARLES  A.  ST.  CLAIR 

Dr.  Charles  A.  St.  Clair  of  3815  Federal  Boule- 
vard, widely  known  Denver  physician,  died  of 
a heart  attack  October  3,  1949,  at  the  age  of  69. 
Dr.  St.  Clair  was  born  in  Moccasin,  111,,  and 
moved  to  Effingham,  111.,  where  he  graduated 
from  Austin  College.  He  received  his  medical 
degree  at  Colorado  University.  From  1913 
through  1919  he  practiced  in  Frederick,  a Colo- 
rado coal  mining  town.  He  then  returned  to 
Denver,  where  he  had  been  in  practice  to  the 
present.  Dr.  St.  Clair  was  a member  of  the  Den- 
ver and  Colorado  Medical  Societies,  and  the 
American  Medical  Association. 


Auxiliary 

PRESIDENT'S  MESSAGE 

Greetings  to  all  members  of  the  Woman’s  Aux- 
iliary to  the  Colorado  State  Medical  Society. 

A few  weeks  ago  we  had  the  privilege  of  at- 
tending the  27th  Annual  Meeting  at  Convention 
in  Denver.  Much  was  in  our  favor  — efficient 
planning,  excellent  programs,  pleasant  weather 
and  a large  attendance  of  membership,  with  al- 
most every  county  represented.  We  so  enjoyed 
the  wonderful  hospitality  and  cooperation  of  the 
Denver  County  Auxiliary.  Theirs  was  a real  task 
and  they  did  it  beautifully.  We  all  returned 
home  inspired  by  Congressman  Dr.  Walter  H. 
Judd’s  message,  and  with  a renewed  stimulus  as 
to  the  purposes  and  objectives  of  Auxiliary  work. 

Through  Dr.  Fred  A.  Humphrey,  President  of 
the  Colorado  State  Medical  Society,  and  our  Ad- 
visory Council  we  have  been  solicited  to  continue 
to  cooperate  in  the  State  Society’s  program  of 
Health  Education  and  Public  Relations.  The  fol- 
lowing resolution  was  unanimously  adopted  at 
our  annual  meeting  as  our  first  response: 

WHEREAS,  Under  a system  of  free  enterprise, 
the  American  medical  profession  has  established  the 
world’s  highest  standard  of  scientific  performance, 
treatment,  and  research,  thereby  helping  the  United 
States  to  become  the  healthiest  major  nation  in  the 
world;  and, 

WHEREAS,  The  benefits  of  American  medicine  are 
available  to  the  people  of  this  country  through 
budget-basis  voluntary  health  insurance,  the  best 
health  insurance  which  exists  in  the  world;  and, 

WHEREAS,  The  experience  of  all  countries  where 
government  has  assumed  control  of  medical  services 
has  shown  that  there  has  been  a gradual  erosion  of 
free  enterprise  and  a progressive  deterioration  of 
medical  standards  and  medical  care  to  the  detriment 
of  the  health  of  the  people;  now,  therefore,  be  it 

RESOLVED,  That  the  Woman’s  Auxiliary  to  the 
Colorado  State  Medical  Society  does  hereby  go  on 
record  against  any  form  of  compulsory  health  insur- 
ance or  any  system  of  political  medicine  designed  for 
national  bureaucratic  control; 

That  a copy  of  this  resolution  be  forwarded  to  the 
President  of  the  United  States,  to  each  Senator  and 
Representative  from  the  State  of  Colorado,  and  that 


said  Senators  and  Representatives  be  and  are  hereby 
respectfully  requested  to  use  every  effort  at  their 
command  to  prevent  the  enactment  of  such  legisla- 
tion. 

Let  us  accept  our  work  as  a challenge!  We  can 
and  should  strengthen  our  organization.  We  need 
to  urge  every  doctor’s  wife  to  become  an  active 
Auxiliary  member.  Let  us  be  a closely-knit  group 
ever  cognizant  that  a cooperating,  enthusiastic 
membership  can  so  direct  its  activities  that  we 
will  be  keenly  felt  in  our  communities.  Thus  we 
will  assure  others  of  our  interests  and  concerns 
for  their  health  and  well-being.  As  an  approach 
to  our  goals  for  the  year,  may  I suggest — 

A Prayer  for  EJvcry  Day 

Let  me  not  shut  myself  within  myself 
Nor  dedicate  my  days  to  petty  things. 

Let  there  be  many  windows  in  my  life. 

The  entrance  to  my  heart  a door  that  swings. 
Where  through  I go  and  come  with  eyes  that  smile. 
And  folk  without  as  gladly  come  to  me. 

That,  haply  I may  learn  the  whole  thing  worth  while. 
The  art  of  human  hospitality. 

Save  me  from  self-preferment,  that  would  gain 
Its  cloistered  place  safe  sheltered  from  the  strife. 
But  purposeful  and  calm  and  sweet  and  sane. 

Lord,  keep  me  in  the  Living  Room  of  Life. 

— ^A.  K.  H. 

Best  wishes  for  much  success  as  with  united 
effort  you  plan  for  effective  work  in  your  Coimty 
Auxiliaries.  May  you  have  many  rich  experi- 
ences that  will  bring  accomplishments  and  happi- 
ness to  you  as  well  as  to  the  lives  of  those  about 
you. 

ALICE  HEINZ, 
(Mrs.  Theodore  E.) 

* * ♦ 

Officers  elected  and  chairmen  appointed  to 
serve  for  the  year  1949-1950  are  as  follows: 

President — Mrs.  Theodore  E.  Heinz,  Weld. 
President-Elect — Mrs.  Harry  Gauss,  Denver. 

First  Vice  President — ’Mrs.  Arnold  Minnig,  Denver. 
Second  Vice  President — Mrs.  L.  L.  Ward,  Pueblo. 
Third  Vice-President — Mrs.  K.  H.  Beebe,  Northeast. 
Fourth  Vice  President  — Mrs.  L.  E.  Thompson, 
Boulder. 

Treasurer — Mrs.  J.  C.  Wiedenmann,  Arapahoe. 
Recording  Secretary — Mrs.  F.  I.  Nicks,  El  Paso. 
Corresponding  Secretary — Mrs.  Henry  N.  Russell, 
Weld. 

Auditor — Mrs.  Paul  K.  Dwyer,  Denver. 
Parliamentarian — Mrs.  Lorenz  Frank.  Denver. 
Custodian  of  Files — Mrs.  W.  W.  Webster,  Weld. 
Historian — .Mrs.  G.  E.  Garrison,  Larimer. 

Chairmen  of  Standing  Committees 

Administration  of  Emergency  Benevolent  Fund — 
One  year  term,  Mrs.  George  L.  Pattee,  Denver;  two- 
year  term,  Mrs.  Harley  S.  Rupert,  Weld;  three-year 
term,  Mrs.  H.  H.  Heuston.  Boulder. 

Bulletin — Mrs.  J.  P.  Rigg,  Mesa. 

Health  Education — Mrs.  John  B.  Farley,  Pueblo, 
plus  committee  of  three  immediate  Past  Presidents, 
Mrs.  A.  A.  Wearner,  Denver;  Mrs.  Homer  B.  Catron, 
Arapahoe;  Mrs.  John  S.  Bouslog,  Denver. 

Finance — Mrs.  S.  P.  Esposito,  Arapahoe. 

Hygeia — Mrs.  R.  F.  Courtney,  Eastern. 

Legislative — Mrs.  Fred  A.  Humphrey,  Larimer. 
Organization  (First  Vice  President) — Mrs.  Arnold 
Minnig,  Denver. 

Philanthropic  and  Benevolent — Mrs.  C.  F.  Eakins. 
Morgan. 

Program — Mrs.  J.  S.  Haley,  Boulder 
Public  Relations — Mrs.  Earl  J.  Perkins,  Denver. 
Press  and  Publicity  — Mrs.  Russell  John  Evans, 
Denver;  Co-chairman,  Mrs.  Wilbur  F.  Manly,  Denver. 

Social — Mrs.  J.  W.  Marsh,  Weld;  Co-chairman,  Mrs. 
Sam  E.  Widney,  Weld. 

Yearbook — Mrs.  J.  Leonard  Swigert,  Denver;  Co- 
chairman,  Mrs.  A.  W.  Mayer,  Denver. 

Street  addresses  and  telephone  numbers  are  in  the 
Auxiliary  Yearbook. 

MRS.  RUSSELL  JOHN  EVANS, 

Press  and  Publicity. 


952 


Rocky  Mountain  Medical  Journal 


WORLD  TRAVELER  . 
Dietary  Dub 


Food  customs?  He  can  describe  the  bill  of  fare  in  far 
away  places  some  people  never  heard  of.  His  personal  eating  habits, 
however,  are  those  of  most  men  in  public  life — a feast  when  the 
hectic  schedule  permits,  just  a bite  here  and  there  between  times. 
And  like  innumerable  others  who  will  not  or  cannot  eat 
properly,  these  are  the  half-well,  half-sick  cases  you  recognize  as 
subclinical  vitamin  deficiencies.  Your  first  move 
in  such  cases  is  dietary  reform,  but  when  it  comes  to  the  right 
vitamin  supplement,  remember  the  name  Abbott.  In  the  complete 
Abbott  line  are  single  and  multivitamin  products  ...  in 

hquid,  capsule  and  tablet  form  . . . for  oral  and  parenteral 
use  ...  for  supplemental  and  therapeutic  dosage.  Your  pharmacist 
can  supply  them  in  a variety  of  package  sizes. 

Abbott  Laboratories,  North  Chicago,  Illinois. 


SPECIFY 


ABBOTT  Vitamin  Products 


for  November,  1949 


953 


NEW  MEXICO 

Medical  Society 

BOARD  OF  SUPERVISORS 

The  first  meeting  of  the  Board  of  Supervisors 
of  the  New  Mexico  Medical  Society  was  held  in 
Albuquerque  Sunday,  October  9,  1949,  in  the 
executive  office. 

Officers  elected  were:  Le  Grand  Ward,  M.D., 
Santa  Fe,  Chairman;  L.  G.  Rice,  M.D.,  Albu- 
querque, Vice  Chairman;  and  C.  Pardue  Bunch, 
M.D.,  Artesia,  Secretary. 

The  Outhne  of  Purpose  and  Procedure  of  the 
Board  of  Supervisors  of  the  Colorado  State  Medi- 
cal Society  was  adopted  in  principle  by  the 
board. 

All  complaints  will  be  sent  to  the  executive 
office  and  forwarded  to  the  Secretary. 

Meeting  dates  have  not  been  definitely  estab- 
lished, but  the  board  plans  to  meet  every  six 
weeks  or  upon  call  of  the  Secretary,  in  con- 
sultation with  the  chairman,  at  which  time 
all  complaints  will  be  discussed  and  acted  upon. 

Four  members  of  the  board  will  constitute  a 
quorum.  It  was  emphasized  that  the  board  will 
act  as  a “grand  jury,”  and  not  as  a judicial  body. 

The  fact  that  the  medical  profession  is  trying 
to  govern  its  own  house  through  the  medium 
of  the  Board  of  Supervisors  will  be  publicized 
through  the  local  newspapers. 


Obituaries 

DONALD  BURR  MARSH 

Donald  Burr  Marsh,  M.D.,  Doming,  New  Mex- 
ico, died  September  1,  1949,  at  Physicans  and 
Surgeons  Hospital,  after  an  illness  of  about  two 
months. 

At  the  time  of  his  death.  Dr.  Marsh  was  Sec- 
retary of  the  Luna  County  Medical  Society, 
Post  Commander  of  Bataan  Post  No.  4,  the 
American  Legion,  and  First  Vice  Commander  of 
Department  of  New  Mexico,  DAV.  He  was  a 
member  of  the  Rotary  Club  and  Masonic  Lodge. 

Dr.  Marsh  was  born  at  Galion,  Ohio,  January 
19,  1892.  He  received  his  medical  education  at 
the  University  of  Michigan  and  practiced  medi- 
cine in  Jackson,  Michigan,  before  coming  to  New 
Mexico.  He  had  been  practicing  medicine  in 
Deming  since  1942. 

He  served  as  an  officer  of  the  Army  Medical 
Corps  during  the  First  World  War,  and  held  a 
commission  as  a Captain  in  the  Medical  Reserves. 
He  recently  completed  thirty-four  years  of  serv- 
ice as  a physician.  He  was  a member  of  the 
First  Presbyterian  Church. 


DONAT  F.  MONACO 

Donat  F.  Monaco,  M.D.,  Gallup,  New  Mexico, 
died  September  12,  at  Veterans  Hospital  in  Santa 
Fe,  after  a lengthy  illness. 

Dr.  Monaco  was  born  in  1895,  and  received 
his  Doctor  of  Medicine  Degree  from  Loyola  Uni- 
versity of  Chicago  in  1917.  He  practiced  medi- 
cine in  Gallup  from  1937  to  1949. 

Dr.  Monaco  was  past  State  Commander  of  the 
Veterans  of  Foreign  Wars,  a member  of  the 
Masonic  bodies,  and  Ballut  Abyad  Shrine,  as 
well  as  a member  of  the  New  Mexico  Medical 
Society. 


MONTANA 

State  Medical  Association 

REPORTS  PRESENTED* 

At  the  Annual  Meeting,  Montana  State  Medical 
Association 

HOUSE  OF  DELEGATES 
Delegate  to  the  A.M.A. 

The  first  important  news  of  the  proceedings 
at  the  House  of  Delegates  of  the  American  Medi- 
cal Association,  in  session  in  Atlantic  City  in 
June,  is  the  forthcoming  retirement  of  Dr.  Fish- 
bein.  In  the  meantime,  he  will  continue  as 
editor  of  the  A.M.A.  Journal,  but  he  will  not 
speak  or  write  on  any  controversial  issue.  There 
is  no  question  but  that  Dr.  Fishbein  is  a brilliant 
man,  and  his  excellent  work  in  the  many  years 
past  was  recognized.  Dr.  Austin  Smith,  now  as- 
sistant editor,  will  be  the  new  editor. 

New  principles  of  medical  ethics  were  adopted. 
Every  member  of  the  profession  should  read 
these  new  principles,  which  may  be  obtained 
from  the  American  Medical  Association.  Read 
also  the  editorial  in  the  Journal  of  the  A.M.A., 
July  16,  1949 — page  960. 

The  House  also  determined  that  the  Associated 
Medical  Care  Plan  has  now  grown  to  such  stat- 
ure that  it  should  be  autonomous  and  it  would 
function  better  by  itself  as  an  autonomous  or- 
ganization, also  that  the  Blue  Cross  plan  would 
be  a similar  organization  for  the  voluntary  hos- 
pital care  plans.  A Blue  Shield  national  en- 
rollment agency  was  approved.  The  Council  on 
Medical  Service,  representing  the  A.M.A.,  will 
continue  to  approve  or  disapprove  any  insurance 
plan  setup  according  to  a twenty-point  set  of 
principles  as  recorded  in  the  Journal  of  the 
A.M.A.,  June  25,  1949 — page  686. 

Whitaker  and  Baxter  were  voted  full  confi- 
dence for  their  efforts  in  the  national  education 
campaign.  Both  were  speakers  before  the  House 
of  Delegates. 

Lord  Horder  and  Mr.  Abell,  a distinguished 
surgeon  of  England,  spoke  before  the  House  of 
Delegates  and  gave  convincing  discussions  as  to 
what  government  medicine  is  doing  in  England. 
Impressive  was  a list  of  sixteen  or  more  certifi- 
cates on  display  that  had  to  be  filled  out  by 
doctors  practicing  medicine  there. 

Actions  on  the  following  subjects  were  taken 
by  this  House: 

Fees  for  insurance  examinations — Hospital, is 
and  practice  of  medicine — -Medical  schools — Pos- 
sible assessments  for  all  members  of  the  A.M.A. 
— Possibility  of  establishing  dues  for  all  members 
of  the  A.M.A. — Hearings  on  the  Taft  Bill  and 
the  Hill  Bill. 

For  a resume  of  this  action,  I urge  everyone 
to  read  the  editorial  in  the  Journal  of  the  A.M.A,. 
July  16,  1949,  page  960,  which  is  the  best  and 
most  readable  resume  I have  seen  in  this 
Journal. 

There  was  general  optimism  that  we  are  on 
the  road  to  defeating  compulsory  health  insur- 
ance if  all  doctors  will  do  their  share.  Every 
doctor  should  use  the  pamphlets.  He  should 
use  the  posters. 

Although  Montana  is  above  the  national  aver- 
age in  payment  of  the  $25  assessment,  it  is  not 
near  the  top.  With  slight  effort  within  two  or 
three  local  medical  societies,  Montana  could 

♦Continued  from  last  month. 


954 


Rocky  Mountain  Medical  Journal 


about  the  LARYNX/ 

the  PHARYNX... 
and  CIGARETTES 


Here  is  the  simple  reason  why  many  lead- 
ing nose  and  throat  specialists  suggest 
''Change  to  Philip  Morris."* 

The  sensitive  tissues  of  the  upper  respiratory  tract  are 
often  affected  adversely  by  the  irritants  in  the  smoke  of 
ordinary  cigarettes. 

Philip  Morris,  on  the  other  hand,  are  specifically  processed 
to  minimize  such  irritants  . . . the  only  one  of  all  leading 
cigarettes  to  offer  this  advantage. 

Why  not  give  your  patients  the  benefit  of  this  proved** 
superiority  . . . why  not  suggest  Philip  Morris.  Many  leading 
doctors  make  it  a point  to  say  to  their  patients  who  smoke  . . . 
"Change  to  Philip  Morris  Cigarettes." 


PHILIP 


MORRIS 


Philip  Morris  & Co.,  Ltd.,  Inc. 
119  Fifth  Avenue,  New  York 


ARE  YOU  A PIPE  SMOKER?  . . . We  suggest  an  unusually  fine 
new  blend— Country  Doctor  Pipe  Mixture.  Made  by  the  same 
process  as  used  in  the  manufacture  of  Philip  Morris  Cigarettes. 


*Complefely  c/ocumenfec/  evidence  on  file, 

**Reprinfs  on  request: 

Laryngoscope,  Feb.  1935,  Vol.  XLV,  No.  2,  149-154;  Laryngoscope,  Jan.  1937,  Vol.  XLVIl,  No.  I,  58-60; 
Pifoc.  Soc.  Exp.  Biol,  and  Med.,  1934,  32-241;  N.  Y.  Stale  Journ.  Med.,  Vol.  35,  6-1-25,  No.  II,  590-592. 


for  November,  1949 


Of 


be  near  the  top.  The  $25  is  the  cheapest  price 
that  any  doctor  ever  paid  for  the  education  of 
the  public  about  freedom  in  medicine  and  health 
in  America.  He  should  be  grateful  to  pay  this 
fee.  He  should  be  thankful  for  the  A.M.A.,  any 
critic  of  whom  I advise  to  attend  one  of  the 
House  of  Delegates  session. 

The  scientific  sessions,  from  the  color  tele- 
vision to  the  scientific  exhibits  and  papers,  were 
excellent. 

R.  E.  PETERSON. 

Secretary’s  Report 

During  the  past  year  the  routine  activities  of 
your  Secretary’s  office  have  been  considerably 
augmented  by  our  A.M.A.  national  education 
campaign.  This  was  more  particularly  true  the 
first  three  or  four  months  of  1949.  The  fact  that 
the  Montana  State  Legislature  was  in  session 
also  increased  the  work  load,  both  in  the  Secre- 
tary’s office  and  for  the  other  officers  and  mem- 
bers of  the  Legislative  Committee.  Since  a re- 
port will  be  given  to  you  by  the  Legislative  Com- 
mittee, we  will  not  go  into  details  on  this 
subject;  but  suffice  it  to  say  that  the  State  Board 
of  Health  reorganization  bill  was  passed  and  has 
gone  into  effect.  This  bill  represents  much  time 
and  effort  by  the  officers  and  members  of  the 
medical  association  as  well  as  the  dental  assoc- 
ciation. 

Membership  in  our  state  association  continues 
its  upward  climb.  To  date  dues  have  been  paid 
by  419  members;  thirty-one  have  not  yet  paid, 
but  since  they  have  been  members  in  the  past, 
we  expect  their  dues  will  be  forwarded  before 
too  long.  This  is  a total  of  450’  dues-paying 
members  and  in  addition  we  have  twenty  inactive 
members.  There  are  approximately  550  physi- 
cians registered  as  practicing  in  Montana.  Many 
of  these  would,  no  doubt,  become  members  with 
a little  encouragement  from  the  local  societies. 
Thirty-three  new  physicians  have  joined  the 
association  since  the  first  of  the  year,  and  others 
are  coming  into  the  state  every  month. 

In  accordance  with  instructions  from  this  body 
at  the  mid-winter  meeting,  your  Secretary’s  of- 
fice sent  out  a ballot  form  to  each  member  of 
the  association  in  June.  Four  hundred  forty-one 
were  sent  out  and  211  have  been  returned  to 
date;  a little  over  47  per  cent.  In  answer  to 
the  question:  “Are  you  in  favor  of  employing 
an  Executive  Secretary  for  the  Montana  State 
Medical  Association?  one  hundred  fourteen  an- 
swered “yes”;  eighty-eight,  “no”;  and  nine  did 
not  reply  to  this  question.  In  answer  to  the 
amount  of  dues  they  would  be  willing  to  pay, 
the  rephes  ranged  all  the  way  from:  “The  dues 
are  too  high  now,”  to  “Up  to  $100,  or  whatever 
is  necessary.”  Two  stated  $15;  one,  $25;  ninety-six 
said  $50  or  $60;  and  thirteen,  $75.  Fifty  indicated 
no  amount  and  thirty-two  stated  no  increase. 
Thus  ninety-six,  or  almost  one-half  of  the  ballots 
returned,  favored  dues  increase  to  $50  or  $60  to 
hire  an  Executive  Secretary.  This  represents, 
however,  an  expression  for  increase  of  dues  from 
only  one-fourth  of  our  membership.  The  other 
fourth  did  not  favor  the  hiring  of  a lay  Secre- 
tary and  did  not  favor  increasing  our  dues. 

While  148  had  no  other  suggestions  to  offer, 
the  balance  had  suggestions  that  were  decidedly 
varied;  ranging  from  part-time  Secretary  or 
combining  with  Montana  Physicians’  Service, 
Health  League  or  other  states,  to  those  not  in 
favor  of  any  change.  One  suggested  that  the 
job  should  “not  be  a pension  for  anyone.”  An- 
other advised  waiting  until  November,  1950.  And 
there  were  those  who  asked  to  be  shown  the  need. 


I am  of  the  very  definite  opinion  that  if  this 
body  decides  to  employ  an  Executive  Secretary, 
that  it  not  be  done  in  haste.  A man  might  be 
employed  in  the  Secretary’s  office  as  a public 
relations  person  as  a starter.  His  job  would,  of 
course,  eventually  lead  to  that  of  Executive  Sec- 
retary— but  only  if  he  was  satisfactory;  if  his 
contacts  throughout  the  state  with  individual 
physicians  and  societies  was  favorable  and  he 
proved  that  he  was  the  person  who  could  do  the 
job  for  us  before  lay  groups,  in  the;  legislature, 
in  his  attendance  at  national  meetings,  etc.  To 
jump  in  and  make  some  person  our  lay  Execu- 
tive Secretary  before  a chance  is  had  to  ob- 
serve him,  and  his  actions,  first  hand,  would  be, 
in  my  opinion,  an  unwise  move.  I would  be 
highly  in  favor  of  raising  the  dues  to  $60  or  $75 
at  this  time  and  the  authorizing  of  your  Execu- 
tive Committee  to  hire  a public  relations  man 
to  work  out  of  your  Secretary’s  office,  and  if  he 
turns  out  to  be  what  we  want,  then  make  him 
our  Executive  Secretary.  If  he  is  not  up  to  what 
we  want  and  expect,  then  he  can  easily  be  dis- 
missed and  another  attempt  made.  This  would 
be  much  simpler  and  lead  to  much  less  con- 
fusion than  to  try  to  get  rid  of  an  incompetent 
or  a disappointing  full-time  lay  Executive  Sec- 
retary. This,  I believe,  is  obvious  to  you  and  I 
am  sure  warrants  your  serious  consideration  in 
your  discussion  of  this  important  problem. 

Your  present  Secretary  is  not  trying  to  dump 
the  job  into  the  lap  of  anyone — he  is  perfectly 
willing  to  carry  on  with  the  work  if  it  is  the  wish 
of  this  body.  In  fact,  as  you  probably  know,  I 
thoroughly  enjoy  serving  in  the  capacity  of  your 
Secretary  and,  after  three  years,  I feel  that  I am 
now  at  the  point  where  the  job  is  easiest  for 
me  and  where  I am  of  much  more  service  to  you. 
At  least  a year  is  necessary  in  a job  like  this  be- 
fore one  becomes  acquainted  with  the  many  ram- 
ifications of  the  work  and  becomes  better  able 
to  carry  out  its  functions. 

Letters  going  out  of  the  Secretary’s  office 
average  200  a month.  That  is  in  addition  to  the 
monthly  bulletin.  An  accurate  record  was  kept 
for  the  period  from  June  20  to  July  20'  and  dur- 
ing fhat  time  there  were  192  regular  letters,  18 
airmail,  one  special  delivery,  and  10  over-weight 
letters  such  as  papers  for  publication,  etc.  Dur- 
ing July,  also,  approximately  450  packages  of 
educational  material,  a letter  from  the  President 
to  all  members,  and  the'  ballot  form  were  sent 
out. 

Some  360  members  of  the  association  have  paid 
the  $25  assessment  of  the  A.M.A.,  leaving  ap- 
proximately 90  who  have  not  paid  it,  and  in  this 
number  appear  the  names  of  several  delegates 
sitting  in  this  meeting.  This'  fact  your  Secretary 
does  deplore.  Let’s  hope  that  within  the  very 
near  future  every  member  of  our  association  will 
have  paid  this  small  amount  toward  our  great 
educational  campaign. 

Your  Secretary  attended  the  House  of  Dele- 
gates meeting  of  the  Association  of  American 
Physicians  and  Surgeons  and  is  much  impressed 
by  the  amount  of  work  which  this  organization 
is  able  to  accomplish  on  simply  the  $10  dues 
from  its  members.  Certainly  their  appearances 
before  Congressional  committees,  giving  testi- 
mony and  arguments  against  compulsion  and 
regimentation  have  been  among  the  most  effec- 
tive forces  aligned  against  this  movement.  They 
certainly  are  an  asset  to  the  American  Medical 
Association.  Your  Secretary  also  attended  the 
Interim  Session  of  the  A.M.A.  and  the  Annual 
Session  of  the  A.M.A.  and  is  still  amazed  at  the 
amount  of  work  which  this  body  is  able  to  ac- 


956 


Rocky  Mountain  Medical  Journal 


During  Pregnancy ••• 


VITAMIN  REQUIREMENTS 
ARE  INCREASED 


Vitamin  deficiency  may  occur  as  a result  of 
increased  requirements  during  pregnancy,  febrile 
conditions,  hyperthyroidism,  or  other  conditions 
in  which  the  metabolism  is  greatly  augmented. 

The  vitamin  deficiencies  most  commonly  seen 
are  those  of  the  B complex.  Since  deficiency  of 
only  a single  vitamin  of  this  group  rarely  occurs, 
and  since  many  of  the  metabolic  functions  of 


members  of  the  vitamin  B complex  are  closely 
related,  best  results  are  obtained  in  most  cases 
by  administering  all  of  the  B complex  vitamins 
known  to  be  of  importance  in  human  nutrition. 
This  can  be  done  most  conveniently  by  prescrib- 
ing a sufficiently  potent  preparation  containing 
these  vitamins  combined  in  properly  balanced 
proportion. 


MERCK 

VITAMINS 


MERCK  & CO.,  Inc.  iy^anu^actanin^  RAHWAY,  N.  J. 


for  November,  1949 


957 


complish.  I would  like  to  put  in  at  this  time  a 
big  “plug”  for  our  delegate  to  the  American 
Medical  Association,  Dr.  Peterson.  He  has  cut 
out  for  himself  an  enviable  place  in  this  organ- 
ization. He  is  a member  of  the  important  Cre- 
dentials Committee  of  the  A.M.A.  and  it  is  heart- 
ening to  see  the  other  delegates  of  the  A.M.A. 
consult  him  on  frequent  occasions  and  ask  his 
advice.  Montana  is  certainly  well  represented 
in  our  national  association. 

Your  Secretary  has  been  greatly  heartened 
and  encouraged  by  the  excellent  campaign  which 
has  been  put  on  by  Whitaker  and  Baxter  for  the 
American  Medical  Association  in  its  educational 
work  relative  to  compulsory  health  insurance. 
We  have  the  assurance  that  within  another  year 
there  won’t  be  any  American  who  doesn’t  know 
that  he  can  buy  medical  care  for  his  family 
on  a budget  basis,  and  there  also  will  not  be 
any  state  in  the  Union  without  a vigorous  pro- 
motion campaign  for  voluntary  health  insurance. 
It’s  like  a great  tidal  wave  which  has  engulfed 
this  entire  country,  in  which  doctors  are  quickly 
learning  to  practice  on  the  body  politic  and  are 
becoming  proficient  in  the  art  of  political  per- 
suasion. They  tell  us  that  thousands  upon  thou- 
sands of  doctors  have  enlisted  in  this  fight  to  save 
their  profession,  and  we  know  personally  that 
many  of  our  Montana  doctors  have  been  active 
in  this  conflict.  We  marvel  at  times  about  some 
of  our  fellow  colleagues  who  seldom  attend  their 
medical  society  meetings  and  also  about  the 
doctors  who  are  apparently  completely  absorbed 
in  their  practices  and  their  academic  and  scien- 
tific pursuits.  We  wonder,  many  times,  whether 
they  will  ever  respond,  now  that  this  decisive 
battle  is  nearing.  Our  national  campaign  people 
tell  us  that,  apparently,  there  are  still  thousands 
of  doctors  who  don’t  know  that  their  house  is  on 
fire.  But  it  is  heartening  that  every  day  a few 
more  smell  the  smoke  and  join  the  fire  depart- 
ment. 

We  hope  that  every  practicing  physician  in 
Montana  has  the  poster  of  the  Fildes  painting, 
“The  Doctor,”  with  the  caption,  “Keep  Politics 
Out  of  This  Picture,”  hanging  in  a prominent 
place  in  his  office.  Whitaker  and  Baxter  have 
stated  that  it  may  take  six  months  or  even  a 
year  to  get  100,000  doctors’  offices  in  America 
displaying  the  Fildes  poster.  Your  Secretary  sin- 
cerely hopes  that  it  will  take  no  such  length  of 
time  for  it  to  be  displayed  in  every  Montana 
physician’s  office. 

The  $25  which  the  doctor  gives,  in  most  in- 
stances, will  be  the  smallest  part  of  his  contri- 
bution. The  time  he  should  give,  away  from  his 
practice — the  evenings  he  spends  away  from  his 
family,  addressing  meetings— the  hours  invested 
in  molding  public  opinion  for  his  profession — 
these  will  be  his  costly  contributions.  But 
whatever  the  cost  in  money  and  energy,  in  frus- 
trations and  irritations,  and  even  in  damage  to 
health,  the  cost  will  still  be  just  a fraction  of 
the  terrific  price  we  would  pay  if  this  fight  is 
lost! 

We  have  fought  two  wqrld  wars  in  defense  of 
our  liberty,  so  we  have  no  illusions  about  the 
cost  of  freedom.  The  price  of  liberty  comes  high, 
but  the  loss  of  liberty;  that’s  the  price  none  of 
us  can  afford  to  pay!  Whitaker  and  Baxter  have 
given  us  this  strong  personal  assurance:  This 
fight  can  be  won!  It  will  be  won!  It  simply  must 
be  won!  And  in  the  winning  of  it,  Montana  doc- 
tors who  get  into  the  battle  will  contribute  to 
the  well-being  of  this  nation  in  greater  measure 
than  you  have  ever  had  opportunity  to  do  before. 


This  is  the  greatest  challenge  any  of  us  has  ever 
met.  With  the  socializers  on  the  march  all  over 
the  world,  we  have  been  given  the  task  of  re- 
versing that  trend.  That’s  the  stupendous  re- 
sponsibility— the  wonderful  opportunity  — • that 
has  been  given  to  us,  as  doctors.  It  is  an  oppor- 
tunity to  change  the  course  of  history;  to  defend 
our  good  way  of  life;  and  to  leave  a priceless 
heritage  to  generations  yet  unborn. 

H.  T.  CARAWAY. 

Maternal  and  Child  Welfare  Committee 

The  Maternal  and  Child  Welfare  Committee 
has  held  two  meetings  during  the  year  1948-49. 
Subcommittee  meetings  have  also  been  held. 

Maternal  Mortality  in  Montana.  On  January 
29,  1949,  a report  was  read  at  the  interim  meet- 
ing of  the  Montana  State  Medical  Association, 
giving  statistical  information  on  maternal  deaths 
during  the  years  1940  through  1945.  An  effort 
was  made  to  determine  the  responsibilty  for  each 
death.  Recommendations  for  the  further  reduc- 
tion of  maternal  deaths  were  made. 

To  date  in  1949,  there  has  been  an  alarming  in- 
crease in  maternal  deaths  in  Montana.  In  an  ef- 
fort to  reduce  this  increase,,  recommendations 
were  made  in  a recent  issue  of  the  Secretary’s 
Bulletin.  In  addition,  your  committee  voted  to 
continue  a strong  program  to  the  doctors  in  the 
state  during  the  coming  year.  An  annual  audit 
of  maternal  deaths  is  to  be  made,  and  these 
case  studies  are  to  be  discussed  at  an  open  meet- 
ing during  the  annual  meeting  of  the  associa- 
tion. The  first  of  these  meetings  will  be  a joint 
meeting  with  the  Montana  Obstetrical  and  Gyn- 
ecological Society,  Monday  night,  August  1,  1949, 
at  the  Finlen  Hotel.  Is  is  the  purpose  of  the  com- 
mittee to  present  a case  study  of  each  death  oc- 
curing  in  the  preceding  year.  After  free  discus- 
sion, responsibility  for  the  death  will  be  placed 
and  recommendations  for  future  care  of  these 
complications  will  be  made. 

In  addition,  a study  of  one  of  the  major  causes 
of  death  will  be  made  each  year.  When  this  is 
undertaken,  all  cases  dating  back  to  1940  will  be 
included.  The  result  of  this  study  and  recom- 
mendations will  be  reported  at  the  interim  meet- 
ing each  year. 

Your  committe  recommends  that  the  following 
suggestions  be  put  into  operation  immediately  if 
we  are  to  control  a serious  situation  which  has 
developed  this  year: 

1.  Earlier  and  more  frequent  consultations  should 
be  obtained  in  the  complicated  obstetrical  case. 

2.  Blood'  should  be  given  earlier , and  In  much 
greater  quantity,  when  indicated.  Preparation  should 
be  made  for  transfusion  in  the  presence  of  severe 
anemia. 

3.  To  lower  our  incidence  of  toxemias,  earlier  and 
better  ante  partum  care  must  be  instituted.  In  the 
progressive  toxemia  termination  of  the  pregnancy 
must  be  considered  promptly. 

4.  Sulfonamides,  antibiotics  and  blood  must  be 
given  early  and  in  adequate  dosage  if  we  are  to  com- 
bat sepsis. 

5.  More  autopsies  should  be  performed  if  we  are 
to  know  the  real  cause  of  death. 

6.  We  must  continue  to  enlarge  the  scope  of  our 
educational  program  if  we  are  to  have  full  coopera- 
tion from  the  individual  patient. 

7.  Our  separate  communities  must  be  made  aware 
of  the  community  responsibility  in  providing  ade- 
quate laboratory  facilities  so  that  blood  may  always 
be  available  for  obstetric  emergency. 

Infant  Mortality  in  Montana.  A subcommittee 
was  appointed  to  begin  a study  of  infant  deaths 
which  will  parallel  the  maternal  mortality  study. 
Because  the  greatest  number  of  infant  deaths 
occur  in  the  neonatal  period  a joint  study  of 
the  problem  from  the  obstetric  and  pediatric 


958 


Rocky  Mountain  Medical  Journal 


WHEi\  OBESITY 


t 

S.  H.  CAMP  and  COMPANY  f 

JACKSON,  MICHIGAN 

World’s  Largest  Manufacturers  j, 

of  Scientific  Supports  'i 


IS  A PROBLEM 

Clinicians  have  long  noted 
that  the  forward  bulk  of  the 
heavy  abdomen  with  its  fat- 
laden wall  moves  the  center 
of  gravity  forward.  As  the  ; 
patient  tries  to  balance  the 
load,  the  lumbar  and  cervical 
curves  of  the  spine  are  in- 
creased, the  head  is  carried 
forward  and  the  shoulders  j 
become  rounded.  Often  there  ^ 
is  associated  visceroptosis.  | 
Camp  Supports  have  a long  j 
history  among  clinicians  for  | 
their  efficacy  in  supporting  I 
the  pendulous  abdomen.  The  I 
highly  specialized  designs  and 
the  unique  Camp  system  of 
controlled  adjustment  help  ^ 
steady  the  pelvis  and  hold  the  *■ 
viscera  upward  and  backward.  * 
There  is  no  constriction  of  i 
the  abdomen,  and  effective 
support  is  given  to  the  spine. 
Physicians  may  rely  on 
the  Camp- trained  fitter  for 
precise  execution  of  all  in- 
structions. { 

If  you  do  not  have  a copy  of  l 
the  Camp  “Reference  Book 
for  Physicians  and  Surgeons’  ’ , 
it  will  be  sent  on  request. 


Scientific 


K 


Offices  in  New  York  • Chicago 
Windsor,  Ontario  • London,  England 


THIS  EMBLEM  is  displayed  only  by  reliable  merchants  | 
in  yoor  community.  Camp  Scientific  Supports  are  never 
sold  by  door-to-door  canvassers.  Prices  are  based  on 
intrinsic  value.  Regular  technical  and  ethical  training  of 
Comp  fitters  insures  precise  and  conscientious  attention 
to  your  recommendations. 


for  November,  1949 


standpoint  will  be  carried  on.  This  study  is  being 
made  possible  through  the  expressed  interest  by 
the  newly  formed  Montana  Pediatric  Society. 

Postgraduate  Education.  A subcommittee  was 
appointed  to  arrange  for  speakers  both  in  Obstet- 
rics and  Pediatrics.  It  is  hoped  to  have  at  least 
two  speakers  in  the  coming  year.  This  subcom- 
mittee expects  to  correlate  the  subjects  under  dis- 
cussion with  the  study  being  carried  on  by  the 
subcommittee  on  Maternal  and  Infant  Mortality. 
These  lectures  will  be  made  possible  by  the 
Maternal  and  Child  Health  Division  of  the  State 
Board  of  Health. 

RH  Factor.  The  entire  committee  approved  a 
suggestion  that  we  attempt  to  obtain  one  of  the 
leading  authorities  on  the  rh  factor  and  have 
either  three  or  four  talks  given  throughout  the 
state  in  key  cities,  the  objective  being  to  make 
a speaker  available  to  every  doctor  in  the  state. 

The  committee  approved  a suggestion  that  the 
Montana  Pathology  Association  be  consulted  in 
regard  to  recommendation  or  approval  of  sera  for 
rh  determinations.  It  is  felt  that  there  are  still 
many  errors  in  these  tests  and,  due  to  the  fact 
that  blood  is  being  used  more  frequently,  it  is 
necessary  that  we  avoid  every  possible  error  in 
technic. 

Nursing  Manual.  Subject  to  final  approval  by 
a subcommittee,  the  nursing  manual  entitled 
“Maternal  Nursing  Manual,”  prepared  by  the 
State  Board  of  Health,  was  approved  by  the  com- 
mittee as  a whole.  This  manual  will  be  distrib- 
uted to  all  hospitals  accepting  obstetrical  cases. 
The  American  Academy  of  Pediatrics  Bulletin 
on  newborn  care  is  to  be  purchased  by  the  State 
Board  of  Health  and  distributed  to  the  hospitals 
at  the  same  time. 

Newborn  Nursery  Care.  The  committee  rec- 
ommends that  the  House  of  Delegates  approve 
and  request  similar  action  from  each  component 
medical  society  to  the  effect  that  each  hospital 
so  organize  its  staff  that  a committee  be  ap- 
pointed to  make  recommendations  and  supervise 
newborn  nursery  care.  It  is  useless  to  make  mor- 
tality studies  and  recommendations  if  the  staff 
of  the  hospital  does  not  follow  the  recommenda- 
tions. Certainly  there  is  great  room  for  im- 
provement in  so  far  as  newborn  care  is  con- 
cerned. 

Prenatal  Letters.  The  committee  recommends 
to  the  House  of  Delegates  that  they  approve  a 
change  in  the  Wasserman  request  form  supplied 
by  the  State  Board  of  Health.  In  order  to  carry 
on  a more  effective  educational  program  in  re- 
gard to  antepartum  care  the  committee  would 
like  to  see  more  effective  use  made  of  the  pre- 
natal letters.  It  is  suggested  that  the  following 
statement  be  placed  on  the  Wasserman  request 
forms:  “Prenatal  Literature  is  requested.  Yes 

No ” It  is  to  be  understood  that 

in  tlj.e  event  the  doctor  indicates  no  choice  that 
the  literature  will  be  sent. 

Health  Nursing  Service.  The  committee  ap- 
proved for  a second  time  the  instructions  issued 
by  the  State  Board  of  Health  to  the  Public  Health 
Nurses  and  recommends  to  the  doctors  that  we 
use  the  Public  Health  Nurse  as  much  as  possible 
in  our  effort  to  improve  maternal  and  infant 
care  in  the  state. 

School  Health  Service  Demonstration.  The 
committee  discussed  recommendations  from  a 
subcommittee  which  had  studied  in  detail  a 
school  health  demonstration  service.  The  pur- 
pose of  the  recommendation  was  to  determine 
and  demonstrate  the  type  of  school  health  serv- 
ice best  suited  for  rural  Montana.  In  addition, 


it  was  felt  that  such  a program  would  comple- 
ment training  in  health  education;  demonstrate 
the  feasibility  of  district  nursing  supervision; 
demonstrate  more  efficient  cooperation  between 
the  health  department  services  and  the  U.  S.  In- 
dian Service;  and,  secure  for  every  child  dental 
service  and  education. 

The  committee  as  a whole  approved  the  prin- 
ciple of  a school  health  demonstration  service 
and  approved  sponsoring  this  demonstration  in 
any  area  where  it  is  desirable  and  where  both 
the  community  and  the  doctors  desire  such  a 
service.  Dr.  Brewer  reported  that  the  doctors  in 
Lake  County  did  not  desire  such  a service.  A 
letter  from  Dr.  J.  M.  Brooke  of  Ronan  registered 
complete  opposition  to  the  plan,  on  the  basis  that 
it  was  a form  of  socialized  medicine.  Because 
of  the  action  taken  by  the  flouse  of  Delegates 
at  the  interim  meeting,  letters  were  sent  to  all 
members  of  the  Montana  State  Medical  Associa- 
tion residing  in  Lake  County,  inviting  them  to 
attend  this  meeting.  None  attended. 

We  are  attempting  to  render  better  medical 
care  to  the  rural  areas  of  this  state.  Your  com- 
mittee feels  that  the  cooperation  of  the  doctor 
with  local  committees  in  improving  health  con- 
ditions is  imperative.  The  committee  requests 
that  the  House  of  Delegates  also  approve  the 
school  health  service  demonstration,  in  principle. 

Vital  Statistics.  The  maternal  mortality  study 
presents  many  problems  in  interpreting  infor- 
mation on  death  certificates.  For  this  reason  the 
committee  recommends  to  the  House  of  Dele- 
gates that  a committee  be  appointed  to  work  in 
cooperation  with  the  division  of  Vital  Statistics 
of  the  State  Board  of  Health  to  the  end  that  bet- 
ter diagnoses  be  placed  on  death  certificates. 

The  following  motion  was  made  at  the  request 
of  the  Maternal  and  Child  Welfare  Committee: 

1.  It  is  moved  that  each  hospital  organize  its  staff 
so  that  a committee  is  appointed  to  make  recOm- » 
mendations  and  supervise  newborn  nursery  care; 
and  that,  if  passed,  official  notice  be  sent  to  each 
component  society  requesting  similar  action  at 
county  society  level. 

2.  It  is  moved,  in  order  that  we  may  carry  on  a 
more  effective  educational  program  in  regard  to 
antepartum  care,  that  the  Montana  State  Medical 
Association  through  the  House  of  Delegates  request 
the  State  Board  of  Health  to  add  the  following  state- 
ment to  the  Wasserman  request  forms:  “Prenatal 

literature  is  requested.  Tes No ” Passage 

of  this  motion  accepts  the  understanding  that  in 
the  event  the  doctor  indicates  no  choice,  literature 
will  be  sent. 

3.  It  is  moved,  in  order  that  we  may  take  some 
positive  action  in  improving  Public  Health  stand- 
ards in  Montana,  that  the  school  health  service,  in 
principle,  be  approved;  and  that  we  encourage  the 
component  medical  societies  to  study  and  develop 
these  services  at  the  local  level. 

4.  It  is  moved,  in  order  that  we  may,  as  doctors, 
give  more  adequate  information  on  death  certifi- 
cates, that  this  association  appoint  a committee  to 
work  in  cooperation  with  the  division  of  Vital  Sta- 
tistics of  the  State  Board  of  Health.  The  duties  of  the 
committee  are  to  be  largely  educational,  so  that 
standard  nomeclature  may  be  more  universally  em- 
ployed. 

F.  L.  McPhail, 

Chairman, 

L.  W.  BREWER, 

P.  L.  ENEBOE, 

MAUDE  M.  GERDES, 

D.  L.  GILLESPIE, 

A.  L.  GLEASON, 

E.  L.  HALL, 

Necrology  and  History  of  Medicine  Committee 

Since  the  last  annual  meeting  our  society  has 
suffered  the  loss,  by  death,  of  the  following 
physicians: 

William  S.  Little.  Dr  Little  practiced  in  Kalispell 
from  1910  until  his  retirement  in  1938,  and  sub- 
sequently, after  a period  of  residence  in  California, 
returned  to  Kalispell  where  he  was  health  officer 


D.  S.  MacKENZIE,  JR, 

R.  E.  MATTISON, 

O.  M.  MOORE, 

P.  W.  PAUL, 

C.  W.  PEMBENTON, 

S.  N.  PRESTON, 

A.  E.  RITT. 


960 


Rocky  Mountain  Medical  Journal 


^ POWDER  OR 
^ LIQUID 


Ask  your  secretary  to  write  for  a copy  of 
this  informotive  folder  which  fully  de- 
scribes Baker’s  Modified  Mtik<~Powder  ond 
1 Liquid — with  complete  feeding  directions. 

L-.. 

BAKER’S  HAS  7 
DIETARY  ESSENTIALS: 

1 . High  protein  content — ample 
amino  acid  supply  for  growth. 

2.  An  adjusted  fat — butterfat  replaced. 

3.  Two  added  sugars — lactose  and  dextrose. 

4.  Full  requirements  of  Vitamins  A and  Bi. 

5.  Not  less  than  800  units  of  Vitamin  D per  quart. 

6.  Added  iron. 

7.  Zero  cm'd  tension. 


BAKER’S  MODIFIED  MILK 

THE  BAKER  UBORATORIES  INC.,  Cleveland,  OMo 


for  November,  1949 


961 


at  the  time  of  his  death  in  February,  1941),  at  the 
age  of  67.  He  w-as  a native  of  Kentucky,  graduated 
in  medicine  from  the  University  of  Houisville  1906, 
and  served  internships  in  London,  England,  and  at 
the  Cook  County  Hospital  in  Chicago.  He  served 
as  Captain  in  the  first  World  War  and  with  the 
National  Guard  on  the  Mexican  border.  He  made 
a hobby  of  gardening  and  raising  cherries  and  was 
a licensed  bird-bander  for  the  Federal  Wildlife 
Service,  a hobby  in  which  he  took  great  interest, 

Li.  Louis  Elliott.  Dr.  Elliott  was  born  on  Novem- 
ber 28,  1887,  at  Binghamton,  New  York,  and  re- 
ceived his  M.D.  in  1910  from  the  George  Washington 
University,  Washington,  D.  C.  He  practiced  in 
New  York,  New  Mexico  and  Minnesota  before^  coming 
to  Montana  in  1941,  locating  at  Cut  Bank.'  Early 
in  1948  he  left  Montana  for  California,  where  he 
opened  offices  in  Paso  Robles  on  January  13th.  He 
died  suddenly  of  a heart  condition  on  August  27,  1948. 

Edn-ln  M.  Wilson.  Dr.  Wilson  was  born  on  No- 
V e m b e r 16,  1869,  in  Illinois,  where  he  re- 

ceived his  education.  He  received  his  M.D.  degree 
trom  the  University  of  Nebraska  College  of  Medi- 
cine in  1895  and  interned  at  the  Douglas  County 
Hospital  in  Omaha.  He  came  to  Montana  shortly 
after  receiving  his  degree  and  spent  more  than 
fifty  years  practicing  medicine,  with  most  of  his 
service  at  Twin  Bridges,  Montana.  He  died  on 
January  3,  1949,  at  the  MacDonald  Rest  Home  in 
Alder,  where  he  had  been  a patient  for  several 
months. 

Frederick  M.  Poinde.xter.  Dr.  Poindexter  was  a 
resident  of  Dillon  for  well  over  sixty  years.  Born 
January  5,  1875,  at  Canyon  City,  Oregon,  he  came 
to  Dillon  in  1881,  with  his  parents  and  four  brothers. 
Pie  was  a member  of  the  first  graduating  class  of 
the  old  Dillon  High  School  and  graduated  from 
Northwestern  University  in  1902,  returning  to  Dillon 
to  begin  a long  and  useful  career  which  extended 
to  the  hospitals  of  England  during  the  first  Woi'ld 
War,  then  to  study  and  research  in  the  most  noted 
clinics  of  Vienna.  He  succumbed  on  August  30, 
1948,  to  infirmities  which  had  kept  him  a patient 
at  the  Barrett  Hospital  for  over  a year.  He  was 
active  in  civic  and  fraternal  organizations  and  will 
be  greatly  missed  by  his  community. 

Edwin  R.  Fonts.  Dr.  Fouts  was  born  April  20, 
1873,  in  Illinois,  and  received  his  M.D.  degree  from 
Beaumont  College,  now  known  as  St.  Louis  Medical 
School,  in  St.  Louis,  in  1892.  After  graduation 
from  medical  school  he  practiced  at  Central  City, 
Colorado,  until  1909,  when  he  came  to  Montana  and 
practiced  at  White  Sulphur  Springy  During  World 
War  I he  was  the  doctor  for  Great  Palls  smelter. 
He  moved  to  Ryegate  in  1932,  where  he  died  on 
June  2,  1949,  of  a cerebral  hemorrhage.  He  had 
been  ill  for  about  ten  days.  He  was  a charter 
member  of  the  Fifty-Year  Club  and  a member  of 
the  Masonic  Lodge  at  Nevada,  Colorado. 

The  passing  of  these  physicians  is  a real  loss 
to  our  society,  and  is  mourned  not  only  by 
their  professional  brothers  but  by  a host  of 
friends  and  patients  in  the  communities  they 
served.  It  is  fitting  that  a memorial  expressing 
the  sympathy  and  respects  of  our  society  be 
prepared  by  our  Secretary  and  sent  to  the  fam- 
ilies of  these  physicians,  as  well  as  recorded  in 
our  permanent  records.  The  committee  so  rec- 
ommends. 

With  reference  to  the  History  of  Medicine, 
your  committee  has  the  following  summary  to 
present.  In  1932  a group  of  our  members  be- 
came interested  in  the  possibility  of  accumulat- 
ing material  for  a Medical  History  of  Montana 
and  in  having  such  a book  published.  The  min- 
utes of  the  1932  Annual  Session  show  that  a 
report  was  received  from  a committee  of  which 
Dr.  E.  D.  Hitchcock  was  chairman,  and  that 
$500  was  appropriated  from  the  association  funds 
for  use  of  the  committee.  Over  the  last  seven- 
teen years  various  sums  have  been  appropriated 
from  year  toi  year,  totaling  just  over  $4,000. 
Most  of  this  was  prior  to  the  war. 

In  the  last  year  Dr.  Hitchcock  has  asked  to 
be  relieved  of  the  chairmanship  of  the  com- 
mittee; Dr.  J.  C.  Irwin  has  moved  from  the  state; 
and  Dr.  Thomas  F.  Walker  has  found  it  neces- 
sary to  resign  because  of  the  many  other  duties 
connected  with  his  work  as  President-elect. 

The  main  responsibility  of  writing  and  editing 
the  accumulated  material  has  been  in  the  hands 
of  Judge  L.  L.  Callaway  of  Helena,  formerly 


of  the  Montana  Supreme  Court,  a pioneer  lawyer 
of  wide  acquaintance  and  eminent  esteem.  Fail- 
ing health  has  forced  Judge  Callaway  to  hus- 
band his  efforts  in  the  last  decade  and  finally, 
this  year,  to  withdraw  from  the  project.  Your 
chairman  has  had  the  privilege  of  visiting  with 
Judge  Callaway,  to  learn  his  suggestions  for 
further  progress,  and  to  express  the  apprecia- 
tion of  the  association  for  the  sincere  effort 
represented  in  the  present  manuscript. 

This  manuscript  has  been  submitted  to  Charles 
Thomas,  publishers,  and  these  gentlemen  feel 
that  in  its  present  form  it  is  not  of  sufficiently 
general  interest  to  warrant  the  expense  of 
publishing  it.  They  have  suggested  a smaller 
firm  which  might  be  interested  in  rearranging 
and  publishing.  The  essence  of  the  matter  seems 
to  be  that  sonieone  with  background  and  talent 
as  a historian  is  needed  to  organize  the  material 
and  these  talents  need  supplementing  by  the 
ornament  of  effective  narration. 

Your  committe  has  not  met  to  try  to  make 
specific  recommendations  to  the  association.  We 
feel  that  the  society  as  a whole  needs  to  express 
itself  on  the  basis  of  the  foregoing  summary,  as 
to  whether  further  efforts  should  be  directed 
into  this  project.  It  is  apparent  that  while  some 
$4,000  already  has  been  spent,  the  actual  editing 
and  printing  will  entail  considerably  more  ex- 
pense. It  is  also  apparent  that  the  chief  market 
for  the  publication  will  be  our  own  member- 
ship. My  personal  conviction  is  that  the  ma- 
terial so  far  collected  and  sketched  has  many 
episodes  of  genuine  interest,  and  much  detail 
of  the  lives  and  professional  environment  of  our 
medical  predecessors  worth  permanent  recording. 
But  certainly  much  is  yet  to  be  done  before  this 
work  can  be  published. 

Dr.  Walker  has  suggested  that  Mrs.  Esther 
Ingraham  of  Marblehead,  Massachusetts  (who 
wrote  for  the  State  Board  of  Entomology  the 
publication  on  Spotted  Fever  History)  would  be 
competend  and  perhaps  available  to  take  on  the 
job.  There  are,  also,  persons  connected  with 
units  of  the  State  University  who  might  be  ap- 
proached for  help;  and  private  citizens  active 
in  the  Montana  Pioneers’  organization  might 
take  an  active  interest  if  the  problem  were  made 
known  to  them.  If  it  please  the  society,  an 
effort  to  assess  the  possibilities,  financial  and 
editorial,  by  every  suitable  inquiry,  might  be 
made  during  the  coming  year,  with  no  definite 
committments  for  financial  outlay,  and  a report 
given  at  the  next  interim  or  annual  meeting. 
However,  your  committee  wishes  instruction 
from  the  society  before  making  any  compre- 
hensive fresh  start  on  the  problem,  involving 
considerable  correspondence  and  numerous  per- 
sonal contacts. 

L.  W.  BREWER,  Chairman, 

I.  J.  BRIDENSTINE, 

C M.  MEERS, 

J P.  RICHEY, 

S.  V.  WILKING. 

Public  Relations  Committee 

Your  committee  has  been  unable  to  meet  since 
January  23,  1949.  However,  I have  written  to 
every  member  of  the  committee  asking  for  sug- 
gestions to  incorporate  into  this  report.  We 
have  also  tried  to  get  suggestions  and  ideas  from 
many  men  and  women  in  the  state  who  are 
interested  in  public  relations,  including  repre- 
sentatives of  business,  the  legal  profession  and 
labor. 

Your  committee  wishes  to  re-emphasize  the 
point  which  we  m_ade  in  our  last  report,  e.g.,  that 
public  relations  should  place  first  emphasis  on 


962 


Rocky  Mountain  Medical  Journal 


PHYSICIANS  AND  HOSPITALS  SUPPLY  CO.,  Inc. 

MINNEAPOLIS  MINNESOTA 


Your  Most  Complete  Drug  Source 


A Representative  Croup  of  Ulmer  Pharmacal  Specialties 

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cals. The  items  offered  xmder  the  Ulmer  label  represent  ethical  development  of  the 
ideas  of  medical  men  and  are  produced  in  cooperation  with  physicians,  clinics,  and 
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development  and  refinement  of  new  ideas  as  the  need  develops.  Full  information 
on  the  Ulmer  Line  appears  in  our  medical  catalog.  Refer  to  it  and  be  sure  to  include 
the  name  ULMER  in  your  next  drug  order. 

Distributed  by 


for  November,  1949 


963 


public  and  patient  welfare  and  not  on  the  wel- 
fare of  our  profession.  We  would  emphasize 
also  that  public  relations  do  begin  in  the  doctor’s 
office  and  that  every  individual  doctor  who  prac- 
tices medicine  honestly,  decently,  and  with  the 
welfare  of  his  patients  always  uppermost  in  his 
mind  is  the  best  public  relations  agent  that  our 
profession  can  possibly  have. 

We  feel  that  our  “house  is  still  on  fire.”  We 
also  feel  that  the  executive  branch  of  our  gov- 
ernment in  its  attempt  to  do  some  of  the  things 
which  certain  segments  of  our  people  are  de- 
manding is  going  to  make  every  effort  to  get 
in  a wedge  as  to  regimented  medicine  during 
the  forthcoming  year. 

Mr.  Ewing  and  his  cohorts  know  that  the 
campaign  of  education  which  is  being  carried 
on  by  the  American  Medical  Association  is  bear- 
ing fruit,  perhaps  much  more  fruit  than  we  or 
Mr.  Ewing  can  now  reahze,  and  the  agencies 
which  hope  to  have  American  medicine  socialized 
in  one  fell  swoop  are  bending  every  effort  to 
force  legislation  through  at  the  earliest  possible 
moment,  before  the  full  impact  of  this  program 
is  felt  and  the  results  of  the  British  experiment 
are  fully  appreciated  by  our  people. 

The  response  to  the  request  for  payment  of  the 
$25  assessment  to  the  American  Medical  Asso- 
ciation for  the  educational  campaign  has  been 
very  gratifying.  We  hope  that  the  men  in  Mon- 
tana who  have  not  paid  this  assessment  will  do 
so  soon. 

We  feel  still  that  the  medical  profession  must 
bend  every  effort  to  help  in  full  utilization  of 
the  Blue  Cross  and  Blue  Shield. 

A further  point  in  public  relations  might  bear 
emphasis  at  this  time  and  our  committee  feels 
that  it  should  be  definitely  considered.  Our 
organization — that  is,  organized  medicine  in  Mon- 
tana— must  bend  every  effort  to  align  with 
groups  who  have  similar  ideas  regarding  so- 
cialization and  we  must  work  at  the  job  of  get- 
ting along  with  these  groups.  1 believe  that 
our  committee  is  thoroughly  opposed  to  undue 
meddling  of  the  Federal  or  State  governments 
in  business  and  in  other  professions  than  medi- 
cine. The  Social  Security  group  seems  to  have 
picked  the  medical  profession  as  their  easiest 
prey.  The  believers  in  socialism  apparently 
sense  that  the  utilities  are  the  next  easiest  prey. 
They  have  thus  far  made  more  progress  in  this 
field  than  in  our  profession,  where  our  fight 
has  been  more  effective.  We  feel  that  the 
medical  profession  must  in  some  way  find  a 
means  of  cooperating  with  other  groups  who  do 
not  want  American  life  completely  regimented. 
While  we  realize  that  governments  must  do 
much  more  for  their  people  than  was  formerly 
demanded  of  them,  we  are  unalterably  opposed 
to  unnecessary  and  pernicious  interference  with 
the  individual  liberty  and  living  of  any  man 
or  woman  in  this  country. 

We  still  feel  that  the  profession  must  make 
every  effort  to  eliminate  the  few  gougers  whom 
we  have  in  our  own  ranks.  Also,  that  most 
of  the  active  jobs  of  the  state  associations  should 
be  conducted  by  comparatively  young  men. 

It  is  my  impression,  although  I am  not  sure 
it  is  shared  by  other  members  of  the  committee, 
that  we  need  expert  help  in  carrying  on  our 
public  relations  and  that  one  of  the  ways  we 
might  obtain  expert  help  is  through  the  employ- 
ment of  a competent  lay  Executive  Secretary. 

Another  point  which  has  been  brought  up  by 
some  of  the  members  of  the  committee  is  the 
difficulty  which  patients  have  in  getting  doctors 


for  house  calls,  night  calls,  emergency  calls  and 
holiday  calls. 

It  is  our  impression  that  either  the  state  or 
county  medical  societies  should  make  some  de- 
ternrined  effort  to  solve  this  problem  of  people 
getting  emergency  medical  care  when  needed. 
We  all  realize  that  many  so-called  emergencies 
are  not  emergencies  and  that  many  night  calls 
are  entirely  unnecessary,  and  yet  we  should 
fully  realize  that  when  a real  emergency  does 
exist  and  a doctor  cannot  be  obtained,  our 
public  relations  get  a distinct  “kick  in  the  rear.” 

We  further  feel  that  as  far  as  consistent  with 
good  scientific  work  and  thorough  examination 
by  specialists,  the  nearer  the  family  physician- 
patient  relationship  can  be  maintained,  the  bet- 
ter it  will  be  for  public  relations.  The  day  of 
the  family  physician  is  not  done,  in  spite  of 
our  modern  clinics  and  all  of  our  contract  prac- 
tice, and  we  do  not  believe  that  it  will  add  any- 
thing to  public  relations  if  and  when  the  passing 
of  the  family  physician  takes  place. 

H.  W.  GREGG,  Chairman, 
DORA  WALKER, 

W.  L.  DuBOIS, 

R.  V.  MORLEDGE, 

W.  H.  STEPHAN. 

(Concurred  in  by  Dr.  Walker  who  was  the  only 
member  of  the  committee  present  at  the  House  of 
Delegates  meeting.) 

Program  Committee 

The  House  of  Delegates  of  the  Montana  State 
Medical  Association,  meeting  in  Billings,  June 
17-19,  1948,  authorized  an  interim  session  for 
the  following  winter  to  cover  two  days,  the  first 
devoted  to  a meeting  of  the  House  of  Delegates 
and  the  Administrative  Members  of  the  Montana 
Physicians’  Service,  and  the  other  to  the  pres- 
entation of  a scientific  program. 

On  instructions  of  the  President,  the  Program 
Committee  arranged  a program  of  papers  to  be 
presented  by  members  of  the  association,  and 
on  subjects  considered  of  interest  and  with  prac- 
tical apphcation  to  the  general  practitioners, 
who  comprise  the  large  majority  of  the  associa- 
tion membership.  The  subjects  chosen  were 
based  upon  recommendations  of  the  chairmen 
of  the  clinical  committees  of  the  association. 

The  interim  session  was  held  at  the  Placer 
Hotel,  Helena,  on  January  28-29,  1949,  concurrent 
with  the  Montana  Legislative  session.  The  first 
day  of  the  meeting  consisted  of  business  of  the 
association  and  the  Montana  Physicians’  Service, 
followed  in  the  evening  by  a dinner  meeting 
at  the  Montana  Club.  The  Honorable  John  Bon- 
ner, Governor  of  Montana,  appeared  as  guest 
and  speaker,  and  Mr.  Ed  G.  Toomey,  legal  coun- 
sel for  the  association,  gave  the  principal  address. 

The  scientific  portion  of  the  interim  session 
was  held  on  the  morning  and  afternoon  of 
Saturday,  January  29.  Five  papers  were  pre- 
sented by  members  of  the  association.  The  sub- 
jects were  well  chosen,  interesting  and  practical, 
and  the  discussion  they  aroused  gave  ample 
proof  of  the  excellence  of  preparation  of  the 
papers  and  the  abilities  of  the  essayists.  The 
splendid  reception  of  these  papers  and  com- 
ments by  members  in  attendance  indicate  the 
advisability  of  providing  scientific  programs 
from  the  association  membership  at  future  win- 
ter sessions  of  the  association. 

Inasmuch  as  the  1949  annual  meeting  of  the 
association  is  held  jointly  with  the  Rocky  Moun- 
tain Medical  Conference,  the  Program  Committee 
was  relieved  from  further  duties  this  year. 

The  committee  recommends  that  for  subse- 
quent interim  sessions  of  the  association,  that  a 


964 


Rocky  Mountain  Medical  Journal 


FOLLOWING  a parallel  route  to  a similar 
destination,  the  ethical  pharmaceutical 
maker  necessarily  keeps  the  progress  and 
direction  of  scientific  medicine  constantly 
in  view. 

For  a closer  look  at  medicine’s  progress 
and  full  comprehension  of  its  implications, 
the  Smith-Dorsey  Company  has  expanded 
its  research  facilities,  secured  increased  re- 
search grants  and  added  research  personnel. 


THi  SMITH-DORSEY  COMPANY  . lincoln,  Nebraska 

BRANCHES  AT  LOS  ANGELES  AND 


DALLA? 


for  November,  1949 


965 


day  be  set  aside  for  the  presentation  of  clinical 
papers  and  discussion,  for  which  the  majority 
of  papers  should  be  provided  by  members  of 
this  association. 

C.  H.  FREDRICKSON,  Chairman, 

H.  T.  CARAWAY, 

H.  W.  GREGG, 

J.  J.  McCABE, 

E.  S.  MURPHY. 

Cancer  Committee 

As  has  been  the  procedure  in  the  past,  the 
Cancer  Committee  has  worked  closely  with  tbe 
Montana  Division  of  the  American  Cancer  So- 
ciety. The  members  of  the  committee  are  mem- 
bers of  the  Executive  Committee  of  the  Mon- 
tana Division  of  the  American  Cancer  Society 
and  meet  five  times  a year  with  this  group. 
During  the  past  year  the  committee  mec  sep- 
arately on  one  occasion.  New  projects  and  de- 
velopments only  will  be  included  in  this  report. 

Education:  Supplementary  material  has  been 
added  to  the  school  kit  distributed  throughout 
the  state.  Medical  brochures  are  being  sent  to 
physicians  of  the  state.  The  first  of  the  series, 
“Early  Diagnosis  of  Cancer,”  was  sent  to  all 
physicians  in  Montana  with  a card  asking  each 
to  indicate  whether  he  wished  to  continue  receiv- 
ing the  series.  About  one-third  responded,  indi- 
cating their  interest.  Future  issues  of  the  series 
will  be  sent  to  these  physicians. 

The  State  Board  of  Health,  the  Cancer  Com- 
mittee and  the  American  Cancer  Society  co- 
operated to  bring  two  speakers  to  Montana. 
The  first  of  these  was  Dr.  Bernard  G.  Sarnat, 
Professor  of  Maxillofacial  Surgery,  University  of 
Illinois,  who  appeared  before  four  medical  so- 
cieties. He  spoke  at  Glendice,  November  30, 
1948;  Billings,  December  1,  1948;  Bozeman,  De- 
cember 2,  1948;  and  Butte,  December  3,  1948. 
Members  of  the  Montana  State  Dental  Associa- 
tion as  well  as  physicians  attended  in  good 
numbers.  The  second  lecturer  touring  Montana 
was  Dr.  Hicken  of  Salt  Lake  City,  who  spoke 
in  February  in  Anaconda,  Great  Falls,  Havre, 
and  Wolf  Point,  on  “Inaccessible  Cancer.”  The 
State  Board  of  Health  has  budgeted  for  three 
such  speakers  to  tour  chief  spots  in  Montana 
during  the  next  year. 

Exhibits  are  planned  for  county  fairs  and 
meetings.  One  such  exhibit  will  be  on  display 
at  the  meeting  of  the  Rocky  Mountain  Medical 
Conference.  This  exhibit  is  provided  by  the 
American  Cancer  Society. 

In  the  field  of  lay  education,  County  Training 
Schools  for  education  of  lay  people  in  the  field 
of  cancer  control  are  a new  innovation.  Thirty- 
five  of  the  fifty-six  counties  report  holding  such 
schools,  with  an  average  attendance  of  thirty. 
Response  to  this  effort  has  been  excellent. 

Research:  The  reporting  program  has  been 
continued  during  the  year  and  reporting  of  can- 
cer cases  has  increased,  but  is  far  from  ideal. 
In  1947,  311  physicians  reported  cancer  cases. 
In  1948,  338  physicians  reported.  There  were 
1,348  cases  reported  in  1948. 

Service:  A grant  was  given  through  the  Great 
Falls  unit  of  the  American  Cancer  Society  to 
aid  in  the  project  of  the  Tuberculosis  Associa- 
tion to  install  units  in  both  hospitals  in  Great 
Falls  for  routine  chest  x-rays.  It  was  the 
consensus  of  the  committee  that  cancer  of  the 
lung  was  among  the  lesions  which  might  be  de- 
tected by  such  a procedure.  There  is  no  charge 
to  the  patient  for  this  service. 

Support  of  the  diagnostic  Tumor  Clinic  of  St. 
Vincent’s  Hospital  in  Billings  was  continued. 


This  financial  aid  supplies  secretarial  service, 
consumable  supplies,  records,  and  through  a 
grant  furnishes  and  equips  the  clinic.  The  Tumor 
Clinic  is  organized  along  lines  approved  by  the 
American  College  of  Surgeons  and  meets  week- 
ly. It  is  a joint  project  of  the  Yellowstone  Val- 
ley Medical  Society,  the  administrators  of  St. 
Vincent’s  Hospital  and  the  American  Cancer  So- 
ciety. Professional  support  of  this  diagnostic 
clinic,  which  extends  its  facilities  to  patients  of 
both  local  hospitals  and  physicians  of  the  out- 
lying communities,  has  been  enthusiastic. 

A grant  was  made  through  the  Helena  unit 
of  the  American  Cancer  Society  for  assistance 
for  placing  new  x-ray  equipment  in  St.  Peter’s 
Hospital  in  Helena. 

The  program  of  cooperation  with  the  Montana 
State  Dental  Association  was  further  developed. 

An  expenditure  was  authorized  for  the  pur- 
pose of  supplying  drugs,  for  medically  indignent 
patients  upon  application  of  the  attending  phy- 
sician. 

The  free  biopsy  service  for  indigent  patients 
has  been  continued.  To  improve  diagnostic  fa- 
cilities available  to  physicians  o^f  the  state  the 
Cancer  Society  _continued  its  financial  support 
of  technicians’  training  in  the  Papanicoloau 
method.  Five  in  all  have  been  so  trained;  one 
during  the  past  year. 

In  an  effort  to  expand  the  service  program 
of  the  American  Cancer  Society  a service  com- 
mittee to  suggest,  evaluate,  and  develop  further 
projects  has  been  appointed.  This  committee  is 
composed  of  district  medical  advisors. 

Recommendation:  It  is  recommended  that: 

1.  The  Cancer  Committee  cooperate  as  in  the  past 
with  the  Montana  Division  of  the  American  Ca.ncer 
Society. 

2.  That  the  Cancer  Committee  working'  with  the 
County  Committees  develop  functions  independent 
of  the  Montana  Division  of . the  American  Cancer 
Society. 

3.  That  the  reporting  of  cancer  cases  be  continued 
and  improved.  Stimulation  of  such  reporting  might 
be  conducted  through  the  Cancer  Committee  of 
the  county  societies. 

4.  That  statistical  evaluation  of  the  cases  reported 
be  undertaken  since  the  data  now  obtained  would 
seem  to  be  sufficient  for  analyses. 

5.  Inasmuch  as  the  program  of  direct  service  to 
indigent  cancer  patients  has  been  discontinued  by 
the  Montana  Division  of  the  American  Cancer  So- 
ciety, that  the  Cancer  Committee  investigate  what 
funds  are  available  on.  a County,  State,  and  Federal 
level  for  such  aid. 

6.  That  the  Montana  Division  of  the  American 
Cancer  Society  and  the  State  Board  of  Health  be 
requested  to  continue  to  present  authoritative  lee- 
turers  on  cancer. 

7.  That  the  refresher  courses  be  continued. 

8.  That  support  of  diagnosis  tumor  clinics  in 
medical  centers  In  the  state  be  approved. 

MARY  E,  MARTIN,  Chairman, 

R.  F.  PETERSON, 

W.  F.  CASHMORE, 

C.  H.  FREDRICKSON, 

W.  C.  ROBINSON. 

Tuberculosis  Committee 

During  the  past  few  years  there  has  been  an 
extensive  case-finding  survey  carried  out 
throughout  the  entire  state.  This  survey  has 
been  made  under  the  direction  of  the  State 
Board  of  Health,  with  the  cooperation  of  the 
Montana  Tuberculosis  Association.  The  chest 
x-rays  were  taken  by  mobile  and  portable  x-ray 
units.  Altogether,  approximately  71,000  films 
• were  taken  during  the  year  of  1948.  In  addition 
to  many  active  cases  of  tuberculosis,  there  were 
discovered  many  other  pathological  conditions  of 
the  chest,  including  a fair  number  of  lung  can- 
cers. 


966 


Rocky  Mountain  Medical  Journal 


BLAIR  X-RAY  SUPPLY 

20  East  9th  Avenue 
Denver,  Colorado 


Ansco  Solutions 
We  Mix  Em 


X-RAY  MACHINES 
We  Fix  Em 


for  November,  1949 


967 


In  addition  to  the  case-finding  program  car- 
ried out  by  the  mobile  units,  micro  film  equip- 
ment for  routine  chest  examination  of  hospital 
admissions  was  installed  in  four  hospitals,  and 
microfilm  installation  was  made  at  the  State 
College  at  Bozeman.  There  is  also  a microfilm 
installation  in  the  courthouse  in  Butte,  and  the 
program  conducted  there  by  the  Silver  Bow 
County  Tuberculosis  Association  has  completed 
more  than  6,000  chest  film  exposures. 

It  is  felt  by  the  committee  that  the  entire 
program  has  been  a very  worthwhile  one,  the 
only  criticism  being  that  there  is  insufficient 
medical  supervision  by  the  State  Board  of  Health. 
It  is  suggested  that,  if  necessary,  a full  time 
Tuberculosis  Control  Officer  be  made  available 
for  this  supervision. 

The  committee  urges  that  all  physicians  re- 
spond 100  per  cent  to  cases  referred  them  by 
the  mobile  and  portable  units.  Of  1,489  cases 
brought  to  the  attention  of  physicians,  there 
was  a failure  to>  complete  the  examination  of 
the  patient  by  the  physician  in  approximately 
20  per  cent  of  cases. 

At  the  State  Meeting  in  Missoula  in  1947  a 
state  chapter  of  the  American  Trudeau  Society 
was  formed  with  the  idea  of  promoting  interest 
in  tuberculosis  work.  This  society  had  two  very 
interesting  meetings,  the  first  of  which  was  at 
Galan  where  the  program  consisted  of  the  pres- 
entation of  cases.  The  second  meeting  was  in 
Great  Falls  where  a most  interesting  scientific 
program  was  given.  At  both  meetings  it  was 
gratifying  to  see  the  interest  exhibited  in  the 
tuberculosis  problem. 

The  Congress  of  the  United  States  has.  appro- 
priated IV2  milhon  dollars  for  building  and  im- 
provements at  the  State  Sanitarium  at  Galen, 
with  the  understanding  that  100  beds  will  be 
made  available  for  the  care  of  tuberculosis  In- 
dians in  the  state.  To  match  this  federal  grant, 
the  last  State  Legislature  appropriated  $600,000. 
Previous  to  this,  out  of  Postwar  Construction 
Funds,  the  state  of  Montana  had  assigned  $400,- 
000  for  a new  wing  at  the  institution. 

In  addition  to  these  amoimts,  the  last  Legis- 
lature also  appropriated  $350,000  for  a new 
kitchen  and  dining-rooms;  $110,000  for  an  apart- 
ment house;  $84,000  for  furnishing  the  hospital 
wing;  and  $90,000  for  a sewage  disposal  plant 
and  fire  lines.  Altogether,  this  will  make  over 
three  million  dollars  for  buildings  and  improve- 
ments. With  these  additions  to  the  State  Sani- 
tarium, we  should  have  one  of  the  most  modern 
institutions  in  the  country. 

F.  I.  TERRIIjLi,  Chairman, 

C.  B.  CRAFT, 

E.  A.  DOLAN, 

A.  N.  KINTNER. 

J.  A.  LATNE. 

Rural  Health  Committee 

The  activities  of  the  committee  have  been  lim- 
ited to  the  attending  of  the  National  Health 
Conference  in  Chicago,  which  was  attended  by 
Dr.  W.  G.  Tanglin  and  myself  in  February,  1949, 
and  a special  meeting  at  Kansas  City  which  was 
held  the  day  before  the  Chicago  meeting,  at  the 
invitation  of  the  Kansas  Medical  Society  and  its 
Rural  Health  Committee. 

Both  of  these  meetings  were  interesting  and 
instructive.  The  Kansas  City  meeting  was  at- 
tended only  by  physicians,  who  met  to  hear  and 
discuss  the  activities  of  the  Kansas  Society  and 
hear  the  results  of  these  activities  as  related  to 
the  general  public.  The  one  thing  that  it  dem- 
onstrated was  that  the  people,  be  they  rural  or 


urban,  are  very  interested  in  health  and  medical 
care,  and  are  anxious  to  cooperate  with  the  medi- 
cal profession  in  any  way  that  they  can  help  im- 
prove and  extend  this  care. 

I will  not  attempt  to  give  any  detailed  account 
of  the  Chicago  meeting,  but  will  give  the  eleven 
points  that  were  adopted  by  the  Conference  as 
the  aims  for  the  committee  work  during  the 
coming  year. 

1.  state  and  Public  Health  services  for  general 
community  hygiene  and  communicable  disease  con- 
trol, public  health  nursing,  well-child  conferences 
and  clinics. 

2.  The  Hill-Burton  Construction  Act  operating 
where  the  people  of  a community  demonstrate  suf- 
ficient desire  for  such  facilities. 

3.  Scholarships  provided  by  medical  associations, 
farm  organizations  and  through  legislative  appro- 
priations to  be  given  to  deserving  boys  and  girls, 
without  discrimination,  for  medical  education  where 
the  recipient  agrees  to  practice  for  a time  in  rural 
areas,  and  for  nurses,  particularly  from  rural  areas. 

4.  Agricultural  School  extension  services  where 
they  utilize  theli'  home  demonstration  courses;  4-H 
Clubs;  health  specialists  whose  duty  it  is  to  organize 
health  councils  in  counties  for  the  purpose  of  health 
education  and  where  appropriate  to  apply  for  Hill- 
Burton  facilities;  the  teaching  of  better  farm  meth- 
ods, better  soil  conservation  and  soil  practices,  better 
grain  and  productive  livestock  methods  such  as  calf 
and  pig  clubs,  five-acre  club  lots,  better  cost  ac- 
counting and  business  methods. 

5.  Parent  teacher  associations  where  they  encour- 
age examination  of  school  children  for  hearing, 
sight,  heart,  hernia,  immunization,  school  hygiene, 
as  well  as  physical  education. 

6.  Voluntary  health  agencies  such  as  tuberculosis, 
polio,  cancer,  heart,  etc.,  which  do  considerable  edu- 
cation within  narrow  limits. 

7.  Application  of  voluntary  prepaid  medical  and 
hospital  care  plans  in  rural  areas,  taking  into  con- 
sideration that  several  of  the  large  farm  groups 
have  their  own  indemnity  prepaid  medical  and  hos- 
pital plans. 

8.  Promotion  of  state  and  county  health  councils, 
the  medical  profession  acting  cooperatively  with 
organized  farm  groups  and  other  civic,  church  and 
school  organizations  and  special  health  groups  for 
the  puipose  of  health  activities  of  a local  character. 

9.  Creation  of  a plan  to  bring  the  medical  in- 
digent, or  low  income  farmer,  into  voluntary  pre- 
paid medical  plans. 

10.  Use  of  health  education  programs  for  rural 
groups. 

11.  Encouragement  of  civilian  population  to  help 
itself. 

In  the  states  where  the  Rural  Health  Com- 
mittee has  the  active  backing  of  the  State  Medi- 
cal Association,  they  are  doing  a worthwhile  job. 
California,  Michigan  and  Colorado,  as  well  as 
Kansas  and  several  other  states,  have  held  state 
rural  health  meetings  and  sponsored  and  assisted 
in  the  establishment  of  local  health  councils,  and 
they  are  getting  the  wholehearted  support  and 
help  of  the  lay  population  and  are  doing  a very 
good  job  of  public  relations  and  changing  the 
minds  of  the  people  concerning  any  form  of 
Federal  interference.  The  people  are  being  sold 
on  voluntary  health  insurance  and  encouraged 
to  work  with  the  physicians  in  finding  some  way 
to  spread  the  cost  of  medical  care  so  it  will 
not  be  a burden  on  each  individual.  They  are 
learning  why  medical  care  is  so  expensive  now 
and  are  not  just  blaming  the  medical  profession 
and  letting  it  go  at  that. 

In  Montana  we  have  the  Health  Planning 
Committee  as  well  as  several  other  agencies  that 
are  interested  in  health,  health  planning  and 
medical  costs.  They  are  all  doing  a good  job 
but  feel  that  the  medical  profession  should,  as 
a group,  take  an  active  part  in  this.  These  other 
groups  all  have  medical  representation,  but  they 
are  not  definitely  sponsored  by  the  medical  pro- 
fession. We  are  allowing  people  who  are  hon- 
estly interested  in  health  problems,  but  are  not 
physicians,  do  a job  that  we  should  be  doing, 
or  at  least  guiding.  The  people  must  be  made 


968 


Rocky  Mountain  Medical  Journal 


The  Complete 

RENTAL  SERVICE 

Cooler  — Water  — Cups 
Modernize  Your  Office  With 

PURE  DEEP  ROCK 

Artesian  Water 

COLD  STORAGE  SPACE 

For  Biological  Supplies 

ICE  CUBES 

A Generous  Supply 

ELEC.  WATER  COOLERS 

All  Types  and  Makes 

FOR  RENT  OR  FOR  SALE 
DEEP  ROCK  WATER  CO. 

614  27th  St.  TAbor  5121 


No  Test  Tubes  • No  Measuring  • No  Boiling 

Diabetics  welcome  “Spot  Tests”  (ready  to  use  dry 
reagents),  because  of  the  ease  and  simplicity  in  using. 

No  test  tubes,  no  boiling,  no  measuring;  just  a little 
powder,  a little  urine — color  reaction  occurs  at  once 
if  sugar  or  acetone  is  present. 

(denco) 

FOR  DETECTION  OF  FOR  DETECTION  OF 

SUGAR  IN  THE  URINE  ACETONE  IN  THE  URINE 


SAME  SIMPLE 
TECHNIQUE  FOR  BOTH 


1.  A iiniE  POWDER 


2.  A LITTLE  URINE 


COLOR  REACTION  IMMEDIATELY 


A carrying  case  containing  cne 
vial  of  Acetone  Test  (Denco) 
and  one  vial  of  Galatest  is  now 
available.  This  is  very  conven- 
ient for  the  medical  bag  or  for 
the  diabetic  patient.  The  case 
also  contains  a medicine  dropper 
and  a Galatest  color  chart.  This 
handy  kit  or  refills  of  Acetone 
Test  (Denco)  and  Galatest  are 
obtainable  at  all  prescription 
pharmacies  and  surgical  supply 
houses. 


Accepted  tor  advertising  in  the  Journal  of  the  A.M.A. 
WRITE  FOR  DESCRIPTIVE  LITERATURE 


(denco)  , . ♦ 

The  Denver  Dhemicai  Maanfacturmf  Go.,  Inc. 

, i '.,.  163  Vartek  Street,  New  York  13,  N.  Y. 


NURSES 

OFFICIAL 

REGISTRY 

Established  to  Meet  the  Community’s 
Every  Need  for  Nursing  Care 

-k  -K  -K 

GRADUATE  REGISTERED  NURSES 

Hourly  Nursing  Service  Positions 
Filled — Information  on  All 
Nursing  Service 

This  registry  is  endorsed  by  the 
Colorado  State  Graduate  Nurses’ 
Association  and  American  Nurses’ 
Association 

-k  -k  -K 

Undergraduates  and  Practical  Nurses 
Furnished  Upon  Request 

KEystone  0168 

ARGONAUT  HOTEL 


for  November,  1949 


969 


to  feel  that  the  doctors,  as  a group,  have  a 
very  definite  interest  in  their  medical  problems, 
aside  from  merely  collecting  a fee  for  their  care. 
I am  not  sure  but  that  we  have  lost  control  of 
this  health  planning  and  guiding  already,  be- 
cause if  we  should  start  now  to  try  to  set  up 
another  health  group  in  the  state  we  might  be 
cluttering  up  the  picture  with  too  many  groups 
of  the  same  kind.  But  we  very  definitely  should 
do  something  about  it. 

The  only  good  that  your  Rural  Health  Com- 
mittee has  done  or  can  do  in  the  future,  if  it 
is  allowed  to  go  on  as  it  has,  is  to  attend  the  na- 
tional meeting  and  report  back  some  of  the 
activities  of  groups  in  other  states.  I think  if 
you  continue  a Rural  Health  Committee  in  the 
state  association  that  you  should  make  arrange- 
ments for  at  least  two  of  the  committee  and 
at  least  one  of  the  officers  of  the  state  associa- 
tion to  attend  the  national  meeting.  Other  in- 
terested states  send  several  men  to  these  meet- 
ings and  I see  no  good  reason  why  Montana 
cannot  do  the  same.  It  is  very  hard  to  have 
your  state  committee  meet  as  a committee  dur- 
ing the  year  because  they  do  not  have  anything 
to  meet  about. 

We  think  that  you  should  either  discontinue 
the  state  Rural  Health  Committee  or  that  the 
association  as  a whole  should  take  a more  active 
part  and  give  more  support  to  this  committee. 
I personally  think  that  this  committee  can  do 
a lot  of  good  for  the  profession  if  properly  sup- 
ported. 

B.  C.  FARRAND,  Chairman. 

Emergency  Medical  Care  Committee 

The  Committee  on  Emergency  Medical  Care 
wishes  to  report  progress  and  re-emphasize  the 
principles  laid  down  in  the  report  of  January, 
1949,  to  the  interim  session. 

The  acknowledged  shortage  of  medical  per- 
sonnel in  the  armed  forces  still  continues  and 
Montana  is  expected  to  do  its  share  in  alleviating 
this  situation.  With  that  in  mind,  this  com- 
mittee wishes  to  submit  to  this  House  the  prin- 
ciples of  the  same  resolution  passed  by  the 
House  of  Delegates  of  the  American  Medical 
Association  as  follows: 

RESOLVED,  That  if  and  when  it  becomes  clear 
to  the  Council  on  National  Emerg-ency  Medical 
Service  that  essential  requirements  of  the  armed 
forces  cannot  be  met  in  any  other  way,  it  be 
authorized  to  develop  a method  of  equitable  selec- 
tion from  among  V-12  and  A.S.T.P.  trained  physicians 
and  those  deferred  from  military  service  to  complete 
their  medical  education,  and  that  the  method  pro- 
posed be  submitted  to  the  House  of  Delegates  for 
its  approval,  except  in  an  emergency,  when  the 
Board  of  Trustees  shall  act  on  the  proposal. 

PAUL  J.  CANS, 

J.  J.  McCABE, 

S.  A.  OLSEN, 

L.  G.  RUSSELL, 

R.  F.  PETERSON. 

Hospital  Relations  Committee 

The  committee  met  and  continued  its  delibera- 
tions regarding  the  practice  of  Pathology  Radi- 
ology, Anesthesiology,  and  Physical  Therapeutics, 
begun  last  year.  During  the  course  of  these 
deliberations,  it  became  apparent  that  recom- 
mendations of  the  committee  should  be  made  to 
both  the  House  of  Delegates  and  the  Montana 
Physicians’  Service.  The  following  are  the  rec- 
ommendations to  the  House  of  Delegates: 

1.  It  is  recommended  that  the  Montana  State  Medi- 
cal Association  cause  hospitals  to  cease  the  practice 
of  medicine  with  special  reference  to  the  practice 
of  Pathology,  Radiology,  Anesthesiology,  and  Physical 
Therapeutics,  which  are  the  practice  of  medicine.  It 
is  further  recommended  in  this  regard  that  hospitals 
be  requested  to  set  up  departments  of  Pathology, 


Radiology,  Anesthesiology,  and  Physical  Therapeutics 
under  medical  supervision. 

2.  It  is  recommended  that  the  Montana  State  Medi- 
cal Association  request  hospitals  to  separate  costs 
of  hospital  care  from  costs  of  medical  care  and  that 
these  charges  appear  thus  separated  on  the  bill  of 
the  patient.  It  is  further  recommended  that  bills 
for  medical  service  be  rendeied  in  the  name  of  the 
physician  in  question. 

3.  It  is  recommended  that  the  Montana  State  Medi- 
cal Association  urge  that  hospitals  establish  the 
basic  principle  that  each  department  of  the  hospital 
be  self-supporting.  This  principle  should  be  so 
applied  that  neither  the  hospital  nor  the  physician 
rendering  the  service  shall  exploit  the  patient  or 
each  other. 

These  recommendations  are  fundamental  to 
the  practice  of  Pathology,  Radiology,  Anesthe- 
siology and  Physical  Therapeutics.  Similar  rec- 
ommendations have  been  adopted  by  the  House 
of  Delegates  of  the  American  Medical  Associa- 
tion at  the  recent  Atlantic  City  meeting. 

These  motions  are  not  meant  to  be  antagonistic 
to  hospitals,  but  are  meant  to  stimulate  discus- 
sions on  this  general  subject  and  to  further  con- 
ferences by  the  doctors  and  hospitals  so  that  this 
situation  can  be  remedied  to  the  satisfaction  of 
all  parties  concerned. 

EUGENE  HILDEBRAND,  Chairman, 
ROBERT  BEANS', 

EDWARD  GIBBS, 

H.  W.  GREGG. 

DORA  WALKER. 

Lab.  Fee  Schedule  Committee 

The  committee  met  at  the  offices  of  Drs. 
Hawkins  and  Lindstrom  in  Helena,  June  21.  The 
following  members  were  present:  Drs.  H.  H. 
James,  E.  H.  Lindstrom,  J.  J.  Malee,  and  F.  K. 
Waniata.  Dr.  D.  S.  MacKenzie  was  absent.  The 
committee  went  over  the  entire  fee  schedule  of 
the  Montana  Industrial  Accident  Board.  Later 
the  committee  met  with  Mr.  W.  P.  Coombs, 
Chairman  of  the  Industrial  Accident  Board,  at 
his  offices  in  the  Public  Health  Building  in  Hel- 
ena. Fees  were  discussed  and  certain  raises 
were  recommended. 

On  Thursday,  July  28,  not  having  heard  from 
Mr.  Combs,  I contacted  him  by  telephone,  at 
which  time  he  informed  me  that  the  board  had 
held  several  meetings  regarding  the  fee  sched- 
ule and  that  he  would  forward  their  decision 
on  the  proposed  increases  in  the  medical  fee 
schedule.  He  stated  that  the  changed  advocated 
were  arrived  at  after  discussions  with  representa- 
tives of  Plans  One  and  Two.  He  stated  that  the 
board  has  sought  to-  arrive  at  just  and  equitable 
fees  which  will  be  satisfactory  to  the  medical 
profession,  to  insurance  carriers.  Plan  One  op- 
erators and  the  state  compensation  fund.  The 
changes  which  have  been  approved  by  the  Board 
are  as  follows: 

General  Items 

First  visit,  including  dressing  and  report $ 4.00 

First  visit  as  above,  night  (10:00  p.m.  to  7:00 

a.m.)  7.00 

Subsequent  visits  at  office,  including  dressings  2.00 
Subsequent  visits  at  hospital,  including  dress- 
ings   2.00 

Subsequent  visits  at  house,  including  dressings  4.00 
(Payment  will  not  be  made  for  house  calls 
after  patients  become  ambulatory  and  able 
to  go  to  the  physicians’  office  for  treatment 
or  dressings.) 

General  Surgery No  Change 

Genito-Urinary 

Catherization  or  urethra  or  passing  of  sounds-?  4.00 

Nephrotomy,  nephrectomy  or  nephropexy 150.00 

Ear,  Eye,  Nose  and  Throat 
Removal  of  foreign  bodies  from  cornea  or  con- 
junctiva   - . — - 4.00 

R '^inv'  i of  foreign  bodies  from  ear,  nose  or 

throat  4.00 

Minor  operation.  First  Visit 6.00 

Subsequent  Visit  5.00 


970 


Rocky  Mountain  Medical  Journal 


KE  4271  Burnoce  Hadley 

OUT  PATIENT  HOTEL  SERVICE 


for 

CONVALESCENTS 


offered  by 


TOURS  HOTEL 

East  Colfax  at  Lincoln 
Denver,  Colorado 

60  Rooms  Free  Parking 

36  Baths  Nurse  Escort 


Surgical  Supports  Expertly  Fitted. 

Miss  Mabel  P.  Cliff,  Authorized  Fitter 


^^enver  ^uraicai Suppiu 


ur^ical  K^ompan^ 


“For  better  service  to  the  profession” 

1438-40  Tremont  Place  CHerry  4458 

Denver  2,  Colorado 


MEDICAL  CENTER 
PHARMACY 

yilba  Dairy 

Located  in  the  New  Medical  Building 

3701  East  Colfax  DExter  5467 

Properly  Pasteurized  Milk 

DENVER,  COLO. 

Prescriptions  and  Medical  Supplies 

Ice  Cream — Butter— Buttermilk 

Wm.  K.  VAN  SANT,  Mgr. 

Free  Delivery 

Phone  1101  Boulder,  Colo 

Metrazol,  pentamethylentetrazol 
Ampules,  I cc.  and  3 cc. 

Sterile  Solution,  30  cc.  vials 
Tablets  and  Powder 


lUetrazol 

COUNCIL  ACCEPTED 

A DEPENDABLE,  QUICK -ACTING 
CEREBRAL  AND  MEDULLARY 
STIMULANT 


Metrazol  is  indicated  for  narcotic  depression, 
for  instance,  in  poisoning  with  barbiturates 
or  opiates,  in  acute  alcoholism  and  during  the 
operation  and  postoperatively  when  respiration 
becomes  inadequate  because  of  medullary  de- 
pression due  to  the  anesthetic. 

Inject  3 cc.  Metrazol  intravenously,  repeat  if 
necessary,  and  continue  with  I or  2 cc.  intra- 
muscularly as  required. 


for  November,  1949 


971 


Fractures 

Vertebra,  compressed  body : 100.00 

Compound  fracture  or  open  reduction:  An  ad- 
ditional charge  of  50  per  cent  may  be  added 

in  cases  of  compound  fractures  or  open  re- 
duction. 

X-ray No  Change 

Although  some  of  the  fees  at  the  present  time 
are  far  from  ideal,  the  committee  feels  that  this 
advance  is  a definite  step  in  the  proper  direction 
and  will  open  the  door  for  future  negotiations. 
It  was  called  to  the  attention  of  the  committee 
by  the  chairman  of  the  board  that  in  some  cases 
where  dispute  over  payment  of  a case  has  arisen, 
the  attending  physician  was  at  fault  by  not  in- 
cluding with  the  bill  a letter  of  sufficient  ex- 
planation, especially  where  some  unusual  service 
had  been  performed. 

It  was  also  suggested  by  the  chairman  of  the 
board  and  unanimously  concurred  in  by  the 
com.mittee  that  our  State  President  appoint  a 
committee  of  three  doctors,  one  to  be  replaced 
each  year,  to  act  as  a Board  of  Arbitration,  which 
board  may  be  called  in  by  the  chairman  of  the 
Industrial  Accident  Board  to  settle  disputed  cases 
when  necessary. 

From  our  talk  with  Mr.  Coombs,  the  com- 
mittee feels  that  his  attitude  is  one  of  fairness 
and  that  much  may  be  gained  for  both  parties 
by  discussing  the  problems  fairly  as  they  arise. 

H.  H.  JAMES,  Chairman, 

E.  H.  LINDSTROM, 

D.  S.  MacKENZIE, 

J.  J.  MALEE, 

F.  K.  WANIATA. 

UTAH 

State  Medical  Association 

FIFTY-FIFTH  ANNUAL  MEETING 

HOUSE  OF  DELEGATES  OF  THE  UTAH 
STATE  MEDICAL  ASSOCIATION 

Salt  Lake  City,  September  1,  2,  3,  1949 

President  O.  A.  Ogilvie  called  the  House  of 
Delegates  to  order  in  the  Union  Building,  Uni- 
versity of  Utah,  at  3:00  p.m.  September  1,  1949. 

The  roll  was  called,  showing  seventy  five  mem- 
bers, alternates  and  ex-officio  members  of  the 
House  of  Delegates  present.  Dr.  Charles  Wood- 
ruff, chairman  of  the  Credentials  Committee, 
on  call  from  the  President,  reported  that  all 
were  duly  accredited. 

Upon  motion  of  Dr.  Ray  T.  Woolsey,  duly 
seconded,  the  minutes  of  the  Fifty-Fourth  An- 
nual Session  were  approved  as  published  in  the 
Rocky  Mountain  Medical  Journal. 

The  next  order  of  business  was  the  address  of 
the  President  which,  due  to  recent  illness  of  the 
President,  was  read  for  him  by  Mr.  Allen  H. 
Tibbals  as  follows: 

President’s  Report 

“It  has  been  one  of  the  great  privileges  of  my 
life  to  serve  as  President  of  the  Utah  State  Med- 
ical Association  during  the  past  year.  I am  deep- 
ly grateful  for  the  honor  that  has  been  conferred 
upon  me;  however,  the  position  has  not  been 
without  its  cares  and  responsibilities,  and  the 
year  has  been  for  me  one  of  strenuous  activity. 
Some  of  the  anxieties,  I feel,  are  due  to  the 
trends  of  the  times  in  which  we  live — trends 
which  are  creating  conditions  that  are  strange 
to  our  accepted  ways  of  thinking  and  acting, 
in  which  the  so-called  laws  of  economics  are 
ceasing  to  be  laws,  which  indicate  that  society 


has  grown  weary  of  convention  and  is  avidly 
seeking  change  whether  it  be  good  or  bad.  It 
may  seem  trite  to  repeat  these  somewhat  obvious 
facts,  but  I believe  their  significance  makes  the 
repetition  well  worthwhile. 

“The  record  of  the  past  year  contains  the  ac- 
count of  many  achievements  wrought  by  the 
members  of  our  society.  Of  these  we  are  proud, 
for  they  point  the  way  to  advances  which  are 
constantly  broadening  the  horizon  of  medical 
practice  and  enabling  the  practicing  physician 
to  increase  the  measure  of  his  effectiveness  in 
alleviating  human  ills.  But  standing  as  a hin- 
drance athwart  the  path  of  scientific  advances 
in  the  field  of  medicine  is  the  cost  of  bringing 
these  advances  to  the  patients  who  need  them. 
In  other  words,  in  the  economics  of  medical 
practice  is  found  the  challenge  to  our  future 
progress  and  security.  Dr.  Paul  R.  Hawley,  in  a 
recent  letter  published  in  the  Michigan  Medical 
Society  Journal,  clearly  set  forth  the  position  of 
the  practicing  physician  in  these  words:  ‘The 
time  is  past,  if  indeed  it  ever  existed,  when  the 
responsibility  of  the  physician  is  limited  to  pro- 
viding medical  care.  He  must  now  offer  a solu- 
tion for  the  economic  problems  of  medical  care. 
He  alone  can  do  this  without  revolutionizing  the 
pattern  of  medical  practice,  which  has  brought 
the  world  capital  of  medicine  to  the  United 
States.’ 

“And  the  need  for  effective  action  in  this 
battle  of  economics  is  pressing  indeed.  How 
pressing  is  demonstrated  by  the  urgency  with 
which  the  Government  bureaucrats  and  socializ- 
ers,  with  their  ever-present  promises  of  some- 
thing for  nothing,  are  injecting  themselves  into 
the  medical  field.  Unfortunately,  on  the  sub- 
ject of  medical  care,  the  Government  Bureau- 
crats and  socializers  do  have  something  to  talk 
about.  For  it  cannot  be  denied  that  the  cost  of 
the  finest  medical  care  today  exceeds  the  ability 
of  the  average  person  to  pay  for  it.  The  prob- 
lem posed  is  dramatic,  vital,  and  is  one  that 
must  be  solved.  It  is  no  answer  to  the  plight 
of  the  man  of  average  means,  whose  wife  or 
child  is  afflicted  with  a deadly  disease,  resulting 
in  almost  certain  death  unless  expensive  medical 
or  surgical  care  is  made  available  at  once,  to  tell 
him  that  the  cost  is  prohibitive  for  a person  of 
his  means  and  that  the  inevitable  result  is  the 
loss  of  his  loved  one.  Such  an  answer  satisfies 
neither  the  patient  nor  the  physician.  And  to 
whom,  let  me  ask  you,  are  the  unfortunate  to 
turn,  if  the  medical  profession  does  not  supply 
the  answer?  Without  doubt,  to  the  government! 

“Of  what  significance  is  this  to  the  medical 
profession?  Of  what  importance  is  it  to  medicine 
whether  the  Government  does  or  does  not  enter 
the  field  of  medical  care?  Primarily  this!  It 
injects  into  the  time-honored  confidential  re- 
lationship which  has  existed  between  the  prac- 
ticing physician  and  his  patient  a third  party — 
a party  who  controls  the  purse  strings  and  over 
whom  the  doctor  can  exercise  no  control,  yet 
from  whom  the  doctor  can  only  take  orders.  To 
any  thinking  member  of  the  profession,  such  a 
situation  would  be  intolerable!  It  would  in- 
evitably mark  the  descent  of  the  medical  doctor 
from  the  respected  position  he  has  always  held 
as  a member  of  an  honored  profession  to  that 
of  a salaried  employee  of  the  Government.  It 
is  frequently  argued  that  Government  medicine 
would  not  necessarily  mean  loss  of  professional 
integrity  by  the  medical  profession.  It  would 
be  true,  I am  sure,  that  those  of  us  who  have 
practiced  under  the  present  regime  would  for 
a time  be  able  to  preserve  a few  of  the  traditions 
of  the  profession.  ■ For,  of  course,  the  transition 


972 


Rocky  Mountain  Medical  Journal 


DOROTHY 


S 

A 

N 

A 

T 

0 
R 

1 

U 

M 


1625  Simms  Street 
Denver  14,  Colo. 


OLSSEN’S 


DEAR  DOCTOR: 

We  know  that  you  want  the  best  for  your  aged  patients.  We 
sincerely  believe  we  have  the  most  Beautiful  Convalescent  Home 
in  the  Rocky  Mountain  Region.  Beautifully  decorated  rooms, 
with  new  and  modern  equipment,  and  the  most  modern  and 
sanitary  kitchen. 

Your  patients  will  get  excellent  care  under  the  best  of  condi- 
tions. We  have  had  years  of  experience  in  this  field  and  invite 
your  inspection  at  any  time.  We  are  proud  of  our  institution  and 
the  individual  care  given  our  patients.  Truly  an  exclusive  home 
for  the  aged  and  infirm.  No  Contagious  or  MENTAL  Cases. 


Phone 

Lakewood 

1922 


Nurses  on  duty  24  hours  daily.  Moderate  rates. 

Very  sincerely, 
Dorothy  B.  Olssen 


GYNERGEN..  . ergotamine  tartrate 

For  the  Effective  Treatment  of 

MIGRAINE 

Accepted  by  American  Medical  Association 
Council  on  Pharmacy  and  Chemistry 

DOSAGE:  0.5  cc.  intramuscularly  as  early  as  possible. 

In  resistant  cases  the  dosage  may  be  increased  to  1 cc. 

In  mild  attacks  2 to  6 tablets  preferably  sublingually-— 
often  prove  effective. 

LITERATURE  ON  REQUEST  • 

SANDOZ  PHARMACEUTICALS 

West  Coast  Office — 450  Sutter  Street  San  Francisco  8,  California 


for  November,  1949 


973 


would  not  be  immediate.  But  what  of  the 
younger  men — men  who  enter  the  field  of  medi- 
cine under  Government  control  and  never  know 
anything  but  that  type  of  practice?  What  tradi- 
tions can  they  know?  Around  what  conception 
of  medical  practice  will  their  ideals  and  atti- 
tudes be  built?  Those  of  Government  interven- 
tion and  control,  without  doubt!  And  once 
medicine  has  been  established  in  the  minds  of 
future  practitioners  as  a salaried  job,  professional 
standing  would  be  forever  lost. 

“The  history  of  socialized  medicine  as  practiced 
in  New  Zealand,  Great  Britain,  Germany  and 
France  have  certain  qualities  in  common  and 
represent  a matter  of  vital  concern.  In  these 
countries  medical  standards  are  low.  Little 
money  is  voted  for  medical  research.  Physicians 
have  practically  no  time  for  study.  They  have 
to  see  too  many  patients  in  the  course  of  one 
day — as  many  as  fifty  and  one  hundred.  Ade- 
quate care  under  this  system  is  more  lacking 
than  under  our  own.  Pressure  is  applied  for 
the  doctor  to  use  cheap  remedies  even  when 
more  expensive  treatment  is  necessary. 

“The  United  States  is  the  only  country  in  the 
world  which  spends  adequate  amounts  on  medi- 
cal research.  The  medical  profession  in  America 
has  substantial  funds  supporting  research  in 
heart  disease,  cancer,  infantile  paralysis  and 
other  scourges,  and  much  that  is  helpful  has  been 
accomplished,  while  little  of  importance  has 
come  from  the  socialized  and  communistic  coun- 
tries. 

“The  socializers  in  our  own  country,  sensing 
an  opportunity  for  the  exploitation  which  will 
result  in  great  benefits  to  themselves,  ignore 
the  facts  that  argue  for  the  superiority  of  our 
present  regime,  and  falsely  stress  the  statistics 
of  rejections  of  the  last  war,  emphasizing  the 
deplorable  state  of  the  nation’s  health,  contend- 
ing that  adequate  medical  care  is  possible  only 
under  a compulsory  system. 

“Much  has  been  said  in  defense  of  the  pro- 
fession and  indeed  much  more  can  be  said.  But 
we  must  not  overlook  the  shortcomings  within 
our  ranks!  And,  while  there  is  the  matter  of  the 
legitimate  increases  in  the  cost  of  medical  care 
today,  what  is  even  more  important  to  the  future 
well-being  of  our  profession  is  the  ever-present 
problem  of  exorbitant  fees  charged  by  certain 
of  our  mmbers.  More  than  ever  before,  it  is  now 
imperative  that  we  keep  before  us  the  important 
fact  that  we  undertake  the  practice  of  medicine 
to  serve  humanity  and  alleviate  its  suffering,  and 
that  the  members  of  the  profession  are  not  to 
use  their  practice  primarily  as  a means  for  the 
acquisition  of  wealth.  The  step — from  the  con- 
cept of  the  medical  practitioner  as  an  angel  of 
mercy  alleviating  the  pains  and  sickness  of  man- 
kind to  the  concept  of  the  practitioner  as  a vul- 
ture preying  upon  the  ills  of  humanity  and  grow- 
ing wealthy  and  fat  in  the  process — is  a short 
one.  And  it  is  up  to  the  profession  to  see  to  it 
that  the  conduct  of  its  practicing  members  is 
such  that  society  will  never  adopt  the  second 
concept.  Too  many  of  our  members  have  for- 
gotten that  the  era  of  specialization  which  has 
brought  about  the  virtual  disappearance  of  the 
family  physician  has  deprived  the  profession  of 
much  that  endeared  it  to  the  heart  of  the  people. 

“Through  its  official  organizations  and  its  pre- 
paid medical  care  plans,  the  profession  is  doing 
a great  deal  to  meet  the  problems  presented  on 
the  economic  side  of  medicine.  Vastly  more  re- 
mains to  be  done.  And  an  alert  and  conscien- 
tious doctor  can  help  immeasurably  in  achieving 
these  vital  goals.  Each  and  every  medical  doc- 
tor can  see  to  it  that  the  efforts  of  our  profes- 


sional organizations  are  not  rendered  valueless 
by  constantly  keeping  in  mind  that  a satisfied 
patient — one  who  feels  that  his  needs  have  been 
administered  to  well  and  at  a fee  that  he  can 
afford  to  pay — is  a friend  of  the  profession.  On 
the  other  hand,  we  must  never  forget  that  a 
patient  who  feels  that  he  has  been  subjected 
to  an  inferior  quality  of  medical  care  is  an 
enemy  of  the  profession,  and  a dangerous  one. 
For  it  is  he  that  lends  solid  support  to  the 
schemes  of  the  socializers.  Multiply  him  in  suf- 
ficient number  and  our  profession  will  be  robbed 
of  its  independence  and  professional  standing. 
A compulsory  system  will  be  the  price  we  pay 
for  ignoring  the  fundamental  priciple  of  un- 
selfish, devoted  service — a basic  law  of  public 
relations.  If  all  of  our  members  could  be  de- 
pended upon  to  make  every  patient  feel  that  he 
had  been  well  taken  care  of,  the  threat  of  Gov- 
ernment medicine  would  disappear  overnight. 

“As  I pass  the  responsibilities  of  my  office  on 
to  another,  I call  upon  each  and  every  one  of 
you  to  support  your  professional  organizations, 
to  be  loyal  to  your  voluntary  pre-payment  plan 
and,  above  all,  to  remember  that  the  economic 
problem  posed  to  the  average  individual  by  ill- 
ness is  a real  one.  Make  certain  that  you  do 
nothing  to  add  unnecessarily  to  this  burden,  and 
then  take  one  additional  step — do  something  to 
lighten  it!  By  doing  this  we  may  yet  preserve 
our  right  to  practice  medicine  as  free  profes- 
sional men  answerable  only  to  God  and  con- 
science— and  not  to  a Government  Bureau- 
cracy.” 

Treasurers’  Report 

The  Treasurer’s  report  was  read  by  Treasurer 
White.  An  epitome  of  the  statement  follows  to- 
gether with  the  general  statement  of  the  Audi- 
tors, Goddard-Abbey  Company. 

ANNUAL  STATEMENT  1949 
RECEIPTS 

1948  dues  . $ 237.50 

1949  dues 26,700.00 

1948  Convention  

1949  Convention  Sale  Exhibit 

space  

Miscellaneous 


TOTAL  RECEIPTS  $30,100.95 

Cash  Balance  August  15,  1948  — 35,357.78 


$26,937.50 

729.55 

2,410.00 

23.90 


Total  Receipts  and  Cash 

Balances  

DISBURSEMENTS 


Salaries  $ 8,746.17 

Less  reimbursement  S.L.  Co. 

Med.  So. $ 4.800.03 

Less  reimbursement 

Med.  Serv.  Bur. 1,200.00  4,800.03 

Expenses  exclusive  of  salaries 

Rent  $ 960.00 

Postage 159.26 

Phone  and  Telegraph 310.79 

Supplies  and  Stationery 493.13 

Unemployment  tax 44.20 

F.O.A.B.  Tax  54.41 

Premiums  on  Bonds 27.50 

Audit  1948  133.50 


$65,458.73 


$ 3,946.14 


2,182.79 


Subscriptions  Rocky  Mtn.  Med. 

Journal  1,312.50 

Subscriptions  A.M.A.  Journal  12.00 

Dues.  United  Pub.  Health 

League  $ 1,078.00 

Dues.  Inter  Mtn.  Radio  Council  5.00 

Dues.  1 9 4 9 Conference  of 

Presidents  10.00 

Dues.  Executive  Assn. 5.00  1,098.00 


Woman’s  Auxiliary  contribu- 


tion   1,551.00 

Traveling  exp.  Del.  J.  P. 

Kerby  $ 550.88 

Traveling  exp.  J.  J. 

Weight 209.82 

Traveling  exp.  Sec- 
retary   202.64  $ 963.34 

Council  travel  959.25  1,922.59 


974 


Rocky  Mountain  Medical  Journal 


THANKSGIVING 

Lord  Cod.  we  give  Thee  thanks  this  day. 

Humbly,  in  our  simple  way, 

For  all  the  gracious  gifts  which  Thou 
Hast  deigned  so  richly  to  endow — 

For  life — for  every  passing  minute — 

For  this.  Thy  world,  and  all  things  in  it! 


PUBLIC  SERVICE  COMPANY  OF  COLORADO 


LIVERMORE  SANITARIUM 


• The  Hydropathic  Department 
devoted  to  the  treatment  of  gen- 
eral diseases,  excluding  surgical 
and  acute  infectious  cases.  Special 
attention  given  functional  and  or- 
ganic nervous  diseases.  A well 
equipped  clinical  laboratory  and 
modern  X-ray  Department  are  in 
use  for  diagnosis. 


• The  Cottage  Department  (for 
mental  patients)  has  its  own  fa- 
cilities for  hydropathic  and  other 
treatments.  It  consists  of  small 
cottages  with  homelike  surround- 
ings, permitting  the  segregation  of 
patients  in  accordance  with  the 
type  of  psychosis.  Also  bungalows 
for  individual  patients,  offering 
the  highest  class  of  accommoda- 
tions with  privacy  and  comfort. 


GENERAL  FEATURES 

1.  Climatic  advantages  not  excelled  in  United  States.  Beautiful  grounds  and  attractive  surrounding  country. 

2.  Indoor  and  outdoor  gymnastics  under  the  charge  of  an  athletic  director.  An  excellent  Occupational  Department. 

3.  A resident  medical  staff.  A large  and  well-trained  nursing  staff  so  that  each  patient  is  given  careful  individual  attention. 

Information  and  circulars  upon  request.  CITY  OFFICES : 

Address;  O.  B.  JENSEN,  M.D. 

Superintendent  and  Medical  Direaor  San  FRANCISCO  Oakland 

Livermore,  California  450  Sutter  Street  1624  Franklin  Street 

Telephone  313  GArfield  1-5040  GLencourt  1-5988 


for  November,  1949 


975 


Reporting^  expense  263.30 

Convention  Expense,  1948  and 

1949  3,052.81 

Essay  Contest  prizes 50.00 

Donation  United  Pub.  Health 

League  f 5,000.00 

Donation  Nat’l  So.  Med.  Re- 
search   100.00 

Donation  U.  of  U.  Library 2,000.00 


Office  Furniture 855.89 

Sundry  Expenses  200.02 


TOTAL  EXPENSES $23,547.04 

Cash  Balance  on  Hand 

8-17-49  41,911.69 


$65,458.73 

Collected  and  sent  to  A.M.A.  $13,275.00 


Upon  motion  of  Dr.  Reichman,  seconded  by 
Dr.  Olson,  the  Treasurer’s  report  was  accepted. 

Each  officer  and  Councilman  having  been 
asked  as  to  whether  he  had  anything  to  add  to 
his  written  report,  with  no  affirmative  answers, 
upon  motion  of  Dr.  Thomas  Robinson,  duly  sec- 
onded, it  was  ordered  that  these  reports  be  ac- 
cepted. Motion  was  carried. 

Dr.  J.  G.  Olson  of  Ogden  presented  to  the 
House  a matter  having  to  do  with  the  desirability 
of  establishing  some  means  of  providing  for  re- 
tirement of  employees  that  have  been  with  the 
Association  for  a period  of  years.  This  was  dis- 
cussed by  Dr.  Reichman  and  Edmunds  and  final- 
ly a motion  was  made  by  Dr.  James  P.  Kerby 
that  the  Council  be  empowered  to  investigate 
this  matter  and  take  such  action  as  it  sees  fit. 
Motion  was  seconded  by  Dr.  Edmunds.  During 
the  discussion  which  followed.  Dr.  Kerby  am- 
plified or  explained  his  motion  as  follows: 

“I  would  like  to  state  that  I took  it  for  granted 
the  matter  they  were  going  to  investigate  was 
the  question  of  some  program  for  providing  the 
old-age  security  for  the  permanent  employees 
of  the  Association.  I don’t  mean  to  imply  that 
this  should  necessarily  be  social  security.  Any 
form  of  insurance  that  the  Council  believes  is 
the  best  is  what  I have  in  mind.” 

Dr.  Edmunds,  as  seconder  of  Dr.  Kerby’s  mo- 
tion, accepted  this  amplification  and  as  the  ques- 
tion was  called  for  Dr.  Ogilvie  called  for  the 
vote  and  the  motion  was  carried. 

Budget 

In  line  with  a suggestion  by  Dr.  Reichman,  Dr. 
Oaks  moved  that  the  Treasurer,  assisted  by  such 
committee  as  might  be  appointed  by  the  Council, 
make  a study  of  the  finances  of  the  Association 
and  determine  the  financial  program  and  pre- 
sent a budget  to  the  Society.  Upon  motion  by 
Dr.  Skolfield  this  motion  was  amended  to  make 
this  committee  a standing  committee  to  report 
to  the  Annual  Meeting  of  the  House  of  Dele- 
gates. 

The  amendment  to  the  motion  was  accepted 
by  Dr.  Oaks  and  his  seconder.  Dr.  Paul.  Dr. 
Ogilvie  called  for  a vote  and  the  motion  was 
unanimously  carried. 

Dr.  Oaks  presented  a resolution  as  to  the  re- 
lationship between  the  medical  profession  and 
other  practitioners  of  the  healing  arts,  which 
was  ordered  referred  to  the  Legislative  and  Pub- 
lic Relations  Committee,  and  also  a resolution  as 
to  referral  of  emergency  cases  from  outlying 
areas,  which  was  again  referred  to  the  Legisla- 
tive and  Public  Relations  Committee. 

Dr.  I.  B.  McQuarrie  presented  a resolution 
favoring  a contribution  to  the  Medical  Library 
of  the  State  University,  which  resolution  was 
referred  to  the  Committee  on  Medical  Economics. 

Mr.  Tibbals  at  the  request  of  the  Executive 
Committee  of  the  Salt  Lake  County  Medical 
Society,  presented  a resolution  concerning  exam- 


ining fees  paid  by  insurance  companies.  This 
resolution  was  also  referred  to  the  Reference 
Committee  on  Medical  Economics. 

At  this  time  President  Ogilvie  called  upon 
Mr.  Harvey  Sethman  to  address  the  House. 

Mr.  Sethman  brought  cordial  greetings  from 
the  President  and  Trustees  of  the  Colorado  State 
Medical  Society  and  expressed  the  hope  that  an 
official  representation  from  the  Utah  State  Medi- 
cal Association  could  attend  the  meeting  in  Den- 
ver on  September  20th  to  23rd.  He  explained 
the  operations  of  the  joint  sponsorship  of  the 
Rocky  Mountain  Medical  Journal.  He  expressed 
gratification  of  the  fact  that  Utah  had  used  its 
proper  proportion  of  space  available  and  urged 
continuance,  especially  emphasizing  the  interest 
in  case  reports,  stating  that  the  Journal  would 
like  to  have  at  least  three  such  reports  to  pub- 
lish in  each  issue.  He  stated  that  the  Journal 
is  in  sound  financial  condition. 

AMA  Assessment  , 

Mr.  Tibbals  stated  that  in  addition  to  the  reg- 
ular dues  of  the  Association,  his  office,  through 
Component  Societies,  had  collected  $13,275.00  on 
the  $25.00  assessment  for  the  A.M.A.  and  same 
had  been  remitted  to  them.  That  Dr.  George 
Lull,  the  A.M.A.  Secretary,  in  acknowledging 
the  remittances,  had  advised  that  Utah  had  re- 
mitted for  84  per  cent  of  its  membership  and 
stood  second  among  the  associations  in  the 
country. 

There  being  nothing  further  to  come  before 
the  First  Session  of  the  House  of  Delegates, 
same  was  adjourned  at  6:00  p.m. 

SECOND  SESSION 

The  Second  Session  of  the  House  of  Delegates 
convened  in  the  Little  Theatre  of  the  Union 
Building  at  4:00  p.m.  September  2,  President 
Ogilvie  presiding. 

Sixty-six  delegates  and  alternates  answered 
the  roll  call. 

The  first  order  of  business  was  consideration 
of  the  Reference  Report  of  the  Committee  on 
Constitution  and  By-Laws,  the  report  being  pre- 
sented by  Chairman  Kerby. 

Create  Board  of  Supervisors 

The  first  matter  which  the  Reference  Com- 
mittee had  to  consider  was  the  resolution  passed 
by  the  House  of  Delegates  of  the  Association  at 
its  meeting  in  Cedar  City,  September  3,  1948,  pro- 
viding for  the  establishment  of  a Board  of  Super- 
visors. As  this  resolution  called  for  changes  in 
the  Constitution  and  By-Laws  of  the  Association, 
it  had  to  lie  over  for  one  year  and  therefore  was 
now  up  for  final  consideration.  Dr.  Kerby 
stated  that  the  committee  had  carefully  gone 
over  the  original  resolution  and  had  found  it 
necessary  to  make  several  changes  which  he 
would  like  to  present.  He  then  read  the  revised 
form  of  the  resolution,  as  follows: 

RESOLVED,  That  this  House  of  Delegates  of  the 
Utah  State  Medical  Association  proposes  the  follow- 
ing changes  in  the  present  Constitution  and  By-Laws 
of  the  Utah  State  Medical  Association: 

That  Article  IX  of  the  Constitution  be  amended  by 
adding  a new  Section  3,  as  follows: 

"A  Board  of  Supervisors  shall  be  established  con- 
sisting of  five  members  to  serve  without  compensa- 
tion except  for  reimbursement  for  necessary  ex- 
penses as  may  be  provided  in  the  By-Laws,  nominated 
and  elected  by  the  House  of  Delegates  of  the  State 
Society  for  staggered  terms  of  five  years  and  eligi- 
ble for  no  other  State  or  Component  Society  office 
except  membership  in  the  House  of  Delegates  during 
their  services  on  this  Board,  provided  that  at  the 
first  election  after  the  approval  of  this  Section  that 
one  member  of  the  Board  of  Supervisors  be  elected 
for  one  year,  one  for  two  years,  one  for  three  years, 
one  for  four  years  and  one  for  five  years  and  there-  j 
after  one  member  be  elected  each  year  to  serve  for 
a term  of  five  years.  Each  member  of  the  Board 


976 


Rocky  Mountain  Medical  Journal 


Winning  Health 

in  the 

Pikes  Peak  Regian 


COLORADO  SPRINGS 


Inquiries  Solicited 


GLOCKIVER  PEXROSE  HOSPITAE 

Sisters  of  Charity 

HOME  OF  MODERN  SANATORIA 


SOME  of  the  exclusive  features  of  this 
new  Vacuum  Tube  Hearing  Aid  are: 
Sealed  Crystal  Microphone — gives  same 
dependable  service  under  all  conditions  of 
temperature  and  humidity.  Stabilized  Feed- 
back — amplification  without  distortion. 
No  sudden  blast  from  loud  sounds  when 
volume  is  turned  up. 

For  other  inionaation  write  or  coll 

M.  F.  Taylor  Laboratories 

721  Republic  Building 
MAin  1920  Denver,  Colo. 


SERVICE 

QUALITY 

PAUL  WEISS 

PRESCRIPTION 

OPTICIAN 

1620  ARAPAHOE  ST.  DENVER 

MAin  1722 

FAIRFAX  SANITARIUM 

Kirkland,  Wash. 

Situated  one  mile  north  of  Juanita 

TREATING  NERVOUS  AND 
MENTAL  DISEASES 

Beautiful  and  restful  surroundings  affording 
recreational  facilities.  Cottage  plan  for  segre- 
gation of  patients.  Insulin  and  Electro-shock 
Therapy  when  indicated. 

Attending  Physicians 
FREDERICK  LEMERE,  M.D. 

NATHAN  K.  RICKLES,  M.D. 

JAMES  H.  LASATER,  M.D. 

MORTON  E.  BASSAN,  M.D. 

JACK  J.  KLEIN,  M.D. 

Manager:  A.  G.  HUGHES 
Route  2,  Box  365,  Kirkland 
Phone:  Kirkland  2391 


WESTERN  ELECTRIC 

HEARING  AIDS 

Engineered  by  Bell  Telephone  Laboratories 


for  November,  1949 


977 


of  Supervisors  shall  serve  until  his  successor  is 
elected  and  installed.  No  member,shall  serve  for  more 
than  tvro  consecutive  terms.  Under  no  circumstances 
shall  more  than  one  member  of  the  Board  of  Super- 
visors be  elected  from  the  membership  of  any  single 
Component  Society  so  that  at  least  five  Component 
Societies  shall  be  represented  in  its  membership. 
This  Board  shall  elect  a chairman  annually  and  he 
shall  serve  one  year;  he  may  be  re-elected  at  the 
discretion  of  the  Board.” 

Amendment  to  the  By-Baws,  Chapter  VI,  Sec- 
tion 3: 

In  paragraph  2,  delete  the  third  sentence  entirely 
beginning,  “All  questions  of  an  ethical  nature.”  In 
the  fourth  sentence  delete  the  last  four  words  (of 
an  individual  councilor)  and  substitute  therefor, 
“of  the  (Component  County  Society,”  thus  changing 
the  paragraph  to  read  as  follows: 

"By-Laws,  Chapter  VI,  Sec  3,  Paragraph  2. — The 
Council  shall  be  the  Board  of  Censors  of  the  State 
Association.  It  shall  consider  all  questions  involv- 
ing the  rights  and  standing  of  members  either  in 
relation  to  other  members,  the  Component  Societies 
or  to  this  Association.  It  shall  hear  and  decide  all 
questions  of  discipline  affecting  the  conduct  of  mem- 
bers or  Component  Societies  on  which  an  appeal  is 
taken  from  the  decision  of  the  Component  Society." 

Make  a new  Chapter  VII  as  follows: 

“1.  The  duties  and  responsibilities  of  the  Board 
of  Supervises  of  the  Utah  State  Medical  Association 
shall  be  as  follows:  to  meet  at  the  call  of  the  Board 
or  its  Secretary  at  such  times  and  places  as  may 
be  required  for  the  effective  discharge  of  its  duties. 

“2  It  shall  be  the  duty  of  the  Board  of  Supervisors 
to  entertain  and  consider  all  reported  violations  of 
medical  ethics  or  personal  misconduct  on  the  part 
of  any  member  of  the  Association,  when  such  report 
shall  be  brought  to  the  attention  of  the  Secretary 
or  any  member  of  the  Board  or  any  of  the  duly 
elected  officers  of  any  Component  Society  or  any 
member  of  the  Council  of  the  Utah  State  Medical 
Association  by  any  member  of  the  Association  or  any 
citizen. 

"3.  Any  complaint  of  misconduct  on  the  part  of 
any  member  of  the  Association  received  by  any  duly 
elected  officer  of  any  Component  Society,  or  by  the 
Council  of  the  Utah  State  Medical  Association,  shall 
be  referred  to  the  Board  of  Supervisors  for  con- 
sideration and  action. 

“4.  The  said  Board  shall  be  and  hereby  is  em- 
powered to  summon  before  it  to  answer  charges 
made  against  him  or  her,  or  them,  any  member  or 
members  of  the  Utah  State  Medical  Association,  who 
shall  be  accused  of  violation  of  the  code  of  medical 
ethics  or  of  personal  misconduct.  Any  member  or 
members  of  the  Association  so  summoned,  who  may 
fail  to  appear  after  due  notice  in  writing,  and  with- 
out plausible  excuse  acceptable  to  a majority  of  the 
Board,  shall  be  cited  to  the  Council  of  the  Associa- 
tion for  appropriate  action.  The  said  Board  of  Super- 
visors shall  further  be  and  hereby  is  empowered  to 
invite  witnesses  or  peisons,  including  members  of 
the  profession  or  the  public  at  large,  who  may,  in 
its  majority  opinion,  possess  information  of  value 
to  the  Board  in  any  inquiry  or  investigation  which 
it  may  be  conducting  in  any  given  case,  to  appear 
before  it  and  to  furnish  such  information  volun- 
tarily. 

“5.  After  adjudication  of  charges  made,  the  Board 
of  Supervisors  shall  have  the  power  to  dismiss  the 
charges  without  further  action,  or  to  direct  the 
Board  of  Censors  or  the  Executive  Officers  of  the 
Component  Society  to  which  the  accused  member 
belongs,  as  to  specific  disciplinary  action  to  be  taken 
against  such  member,  and  it  shall  be  the  function  of 
the  Board  of  Supervisors  to  seei  that  the  directives 
are  enforced.  Provided,  however,  that  the  accused 
may  appeal  any  findings  of  the  Board  of  Supervisors 
to  the  Council  of  the  Utah  State  Medical  Association 
and  the  decision  of  the  majority  of  the  Council  shall 
be  final. 

“6.  The  Executive  Secretary  of  the  Utah  State 
Medical  Association  shall,  ex-officio,  act  as  secretary 
to  the  Board  of  Supervisors  and  shall  be  responsible 
for  the  keeping  of  its  minutes,  the  record  of  its  ac- 
tions, conducting  its  correspondence  and  the  preser- 
vation of  its  records. 

“7.  The  records  of  the  Board  of  Supervisors  shall 
be  stored  in  the  offices  of  the  Utah  State  Medical 
Association  and  shall  not  be  accessible  to  anyone  ex- 
cept the  Board  itself  or  its  secretary,  except  that 
such  records  shall  be  accessible  to  the  Council  of 
the  Utah  State  Medical  Association,  in  any  given 
case. 

“8.  No  disclosure  of  the  nature  or  content  of  any 
of  the  discussions,  actions  or  records  of  the  Board 
shall  be  made  by  any  member  of  the  Board  or  of  the 
Council  of  the  Utah  State  Medical  Association  or  by 
its  secretary,  except  by  a majority  action  of  the 
Board  or  of  the  Council,  and  then  only  through  the 
Executive  Secretary  of  the  Utah  State  Medical  As- 
sociation, who  shall  make  such  disclosures  only  in 


writing  as  directed  by  the  Board,  retaining  a copy 
to  be  filed  with  the  records  of  the  Board.  Violation 
of  this  rule  shall,  upon  due  proof  submitted  to  the 
Council  of  the  Utah  State  Medical  Association,  be 
held  to  constitute  a major  violation  of  medical 
ethics. 

“9.  In  case  of  the  death  of  any  member  of  the 
Board  of  Supervisors  during  the  period  of  his  in- 
cumbency, the  then  President  of  the  Utah  State 
Medical  Association  shall  appoint  a member  from 
the  Component  Society  from  which  such  member  was 
elected  by  the  House  of  Delegates,  within  thirty 
days  after  the  date  of  such  death  to  complete  the 
unexpired  term  of  such  deceased  member. 

“10.  The  Treasurer  of  the  Utah  State  Medical  As- 
sociation shall  be  and  hereby  is  empowered  to  reim- 
burse each  member  of  the  said  Board  annually  upon 
his  submission  of  an  itemized  bill  for  necessary 
travel  and  maintenance  expense  incurred  in  con- 
nection with  official  meetings  or  official  business 
of  the  Board.  In  any  case  of  controversy,  the  Council 
of  the  Utah  State  Medical  Association  shall  be  the 
final  arbiter  in  deciding  upon  the  fairness  and 
correctness  of  such  bill,  and  shall  have  the  power 
to  decide  upon  its  payment  or  non-payment.” 

Change  the  Chapter  numbers  beginning  with  the 
present  Chapter  VII  by  advancing  them  one  num- 
ber, the  present  Chapter  VII  becoming  Chapter  VIII 
Chapter- VIII  becoming  Chapter  IX,  Chapter  IX  be- 
coming Chapter  X,  Chapter  X becoming  Chapter  XI, 
Chapter  XI  becoming  Chapter  XII  and  Chapter  XII 
becoming  Chapter  XIII.” 

Following  the  reading  of  the  resolution,  Chair- 
man Kerby  moved  its  adoption  which  was  duly 
seconded. 

There  followed  a lengthy  discussion  partici- 
pated in  by  many  members  of  the  House  of 
Delegates.  Dr.  Matthei  moved  an  amendment 
to  Dr.  Kerby ’s  original  motion  as  follows:  That 
there  be  made  a paragraph  7 A,  stipulating  that 
the  only  records  of  the  Board  of  Supervisors  be 
a record  of  their  decisions,  and,  that  should  be 
accessible  to  the  accused.  The  motion  was  duly 
seconded.  President  Ogilvie  put  the  amendment 
to  vote  and  upon  a standing  vote  it  was  found 
that  the  amendment  had  been  defeated. 

President  Ogilvie  then  put  the  original  motion 
to  vote  and  it  was  unanimously  adopted. 

Reprint  By-Laws 

Chairman  Kerby  then  called  attention  of  the 
House  to  the  fact  that  the  Constitution  and  By- 
Laws  of  the  State  Association  had  not  been  re- 
printed for  many  years  and  that  there  were 
many  amendments  that  the  members  were  not 
properly  appraised  of.  He  moved  that  the  House 
instruct  the  Council  to  prepare  a revised  copy 
of  the  Constitution  and  By-Laws  of  the  Utah 
State  Medical  Association  in  which  this  action 
today  will  be  incorporated.  Motion  was  sec- 
onded by  Dr.  T.  E.  Robinson.  There  being  no 
discussion.  President  Ogilvie  put  the  motion  to 
vote  and  it  was  unanimously  carried. 

This  Reference  Committee  also  gave  considera- 
tion to  a request  from  numerous  sources  that 
some  better  plan  of  lightening  the  expenses  of 
membership  for  those  just  entering  practice  be 
provided.  To  accomplish  this  end  the  commit- 
tee recommends  that  in  the  previous  action  taken 
by  the  House  September  11,  1947,  as  recorded 
on  page  58  of  the  official  minutes,  the  following 
changes  be  made: 

In  the  first  line  of  the  first  paragraph,  delete  the 
word  “associate”  and  substitute  the  word  “active” 
and  following  the  word  “Association”  in  the  second 
line  insert,  “for  doctors  just  entering  the  practice 
of  medicine.”  Delete  the  third  and  fourth  sentences 
of  this  same  paragraph  and  substitute  “such  reduced 
dues  to  continue  for  a period  not  longer  than  three 
years  in  any  case  and  provided  further  that  the 
following  requirements  have  been  met: 

"First:  Recommendation  by  his  County  Society  is 
necessary;  that  is,  anyone  wishing  this  low  fee  due 
must  be  recommended  by  the  officers  of  his  County 
Society. 

"Second:  It  must  then  be  forwarded  to  the  State 
Association  and  passed  by  the  Council  of  the  Utah 
State  Medical  Association.” 

Strike  all  of  present  Sections  3 and  4 and  make  a 
new  Section  3,  as  follows: 


978 


Rocky  Mountain  Medical  Journal 


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Home-like  surroundings,  scientific  medical  treatment  and  nursing  care.  Booklet  and  rates  on  application. 

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jor  November,  1949 


979 


"It  is  suggested  that  the  Component  Societies  con- 
sider an  active  membership  for  doctors  just  entering 
the  practice  of  medicine  on  a like  basis.” 

Dr.  Kerby  then  moved  that  the  report  of  the 
Reference  Committee  on  Constitution  and  By- 
Laws  as  a whole  be  accepted. 

Motion  was  seconded  by  Dr.  Olsen  and  upon 
being  put  was  unanimously  carried. 

At  this  point  President  Ogilvie  called  attention 
to  the  fact  that  through  oversight  there  had  been 
no  approval  of  the  minutes  of  the  special  meet- 
ing of  the  House  of  Delegates  held  March  5,  1949. 

Dr.  Bryner  moved  that  the  minutes  of  March  5, 
1949,  as  published  be  approved  and  the  motion 
was  seconded 'by  Dr.  Robinson  and  upon  being 
put  before  the  House  by  Dr.  Ogilvie  was  unan- 
imously carried. 

President  Ogilvie  then  called  for  the  report  of 
the  Reference  Committee  on  Membership  and 
Medical  Economics  which  was  presented  by 
Chairman  Belden. 

Chairman  Belden  stated  that  the  first  report 
that  his  committee  had  considered  was  that  of 
the  Secretary  and  he  moved  that  this  report  be 
accepted  with  the  additional  comment  that  a 
copy  of  the  Code  of  Ethics  be  given  to  each  mem- 
ber as  he  enters  the  County  Society  and  that  he 
be  held  responsible  for  living  up  to  this  Code. 
Motion  was  seconded  by  Dr.  T.  E.  Robinson. 
President  Ogilvie  put  the  motion  to  vote  and  it 
was  unanimously  carried. 

Dr.  Belden  then  moved  the  acceptance  of  the 
report  of  the  Councilor  from  the  Third  District. 
Motion  was  seconded  by  Dr.  Belnap.  Upon  being 
put  to  vote  by  President  Ogilvie,  motion  was 
carried  unanimously. 

Dr.  Belden  moved  the  acceptance  of  the  report 
of  the  Delegate  to  the  A.M.A.  Upon  being  duly 
seconded,  motion  was  put  and  unanimously 
carried. 

Dr.  Belden  moved  that  the  House  of  Delegates 
accept  the  report  of  the  Fee  Schedule  Committee. 
Dr.  Ruggeri  seconded  the  motion  and  upon  be- 
ing put  by  the  President  same  was  carried  unan- 
imously. 

Chairman  Belden  then  moved  that  the  House 
of  Delegates  accept  the  report  of  the  special 
Committee  on  the  Study  of  Dues.  Motion  was 
seconded  by  Dr.  Trowbridge. 

There  followed  considerable  discussion  during 
which  Dr.  Seager  moved  that  recommendation 
No.  1 in  the  report  of  the  Special  Committee 
to  study  dues  be  deleted.  This  motion  was 
seconded  by  Dr.  Olson.  The  matter  was  thrown 
open  for  discussion,  following  which  upon  be- 
ing put  the  motion  was  lost.  Following  further 
discussion.  Dr.  Woolsey  made  an  amendment 
to  the  original  motion  to  the  effect  that  the 
Treasurer’s  books  be  closed  at  such  time  as  will 
be  determined  by  the  Executive  Secretary  and 
Treasurer  to  permit  the  publication  of  the  Audi- 
tor’s Report  to  the  membership.  This  motion 
was  seconded  by  Dr.  Bryner.  There  was  a brief 
discussion  following  which  the  motion  on  the 
amendment  was  put  by  President  Ogilvie  and 
unanimously  carried.  The  question  on  the  origi- 
nal motion  was  then  called  for  and  upon  being 
put  by  Dr.  Ogilvie,  was  again  unanimously 
carried. 

The  next  report  considered  by  the  Reference 
Committee  was  that  of  the  Committee  on  Medi- 
cal Defense.  On  motion  of  Dr.  Belden,  duly 
seconded,  this  report  was  accepted  by  the  House 
of  Delegates. 

In  like  manner  the  report  of  the  Military  Af- 
fairs Committee  was  accepted. 


Resolutions 

Chairman  Belden  then  turned  his  attention 
to  the  resolutions  which  had  been  referred  to 
his  committee,  the  first  one  being  that  one 
having  to  do  with  requesting  life  insurance  com- 
panies to  increase  the  fee  for  life  insurance 
examinations  as  follows: 

WHEREAS,  Many  of  our  members  have  requested 
that  negotiations  be  entered  into  with  life  insurance 
companies  for  the  purpose  of  securing  an  increase 
of  the  standard  medical  fees  for  life  insurance 
examinations  and  to  increase  other  similar  medical 
fees  in  like  proportion,  and 

WHEREAS,  These  fees  have  not  been  changed  for 
a great  many  years  and  should  be  adjusted  in  recog- 
nition of  changing  economic  conditions  and  ad- 
vancing standards  of  medical  practice,  and 

WHEREAS,  This  is  a matter  which  will  have  to 
be  taken  up  with  each  individual  company;  there- 
fore, 

BE  IT  RESOLVED,  That  the  House  of  Delegates 
of  the  Utah  State  Medical  Association  authorize  the 
appointment  of  a special  committee  on  the  subject 
of  Insurance  Examination  Fees  with  full  authority 
to  contact  all  life  insurance  companies  doing  busi- 
ness in  this  area  in  the  effort  to  secure  proper  in- 
crease in  fees.  Further,  that  copies  of  the  action 
of  this  House  of  Delegates  be  sent  to  all  State  Medi- 
cal Associations  and  to  the  American  Medical  As- 
sociation urging  similar  action. 

Chairman  Belden  moved  the  acceptance  of  this 
resolution,  seconded  by  Dr.  Kerby  and  unan- 
imously adopted. 

The  resolution  presented  by  Dr.  L.  J.  Paul  in 
regard  to  the  use  of  medical  officers  in  the  1st 
eschelon  units  of  the  Army  as  follows  was  then 
presented  to  the  House: 

WHEREAS,  The  Medical  Reserve  Corps  is  very 
much  in  need  of  medical  officers,  yet  in  the  re- 
organization of  the  armed  forces  no  apparent  effort 
is  being  made  to  reduce  the  number  of  medical 
officers  attached  to  1st  eschelon  units,  and 

WHEREAS,  It  was  shown  in  the  last  war  that 
only  first  aid  and  emergency  care  should  be  given 
in  the  field  where  sterile  technique  is  impossible, 
relief  of  pain  and  shock  with  quick  transportation 
to  hospital  units  being  the  proper  procedure,  and 
WHEREAS,  First  aid  teams  and  litter  bearer 
squads  can  quickly  be  trained  composed  of  the  En- 
listed Medical  Corps  personnel  to  perform  emer- 
gency treatment  for  shock  and  pain,  etc.,  and  not  be 
tempted  as  doctors  frequently  are  to  perfoim  major 
operations,  amputations  chest  aspirations,  cleansing 
of  brain  injuries,  etc.,  in  the  field,  and 

WHEREAS,  Field  service  in  the  Armed  Forces  1st 
eschelon  units  requires  young  men,  while  doctors 
now  spend  nine  to  fifteen  years  in  schools  and  hos- 
pitals so  are  too  old  and  usually  too  specialized  to 
adapt  themselves  to  field  medical  service,  though 
being  excellent  when  assigned  to  hospital  units,  and 
WHEREAS,  We  feel  certain  that  young  doctors 
will  enthusiastically  do  their  part  in  the  Medical 
Reserve  Program  if  they  are  assured  assignments 
where  their  skills  and  medical  training  can  be 
utilized  in  hospital  organizations  in  place  of  such 
gieat  numbers  being  assigned  to  1st  eschelon  forces 
to  perform  first  aid,  shock  treatment,  latrine  inspec- 
tion and  administrative  work  which  enlisted  men 
and  Medical  Service  Corps  officers  can  be  better 
trained  to  perform;  therefore, 

BE  IT  RESOLVED,  First,  that  the  Secretary  of 
Defense,  Mr.  Louis  Johnson,  and  the  various  Surgeon 
Generals  of  the  combined  forces  be  urged  to  reduce 
by  at  least  50  per  cent  the  number  of  medical  offi- 
cers in  the  Tables  of  Organization  and  Equipment 
of  Medical  units  attached  to  serve  with  1st  eschelon 
forces,  and 

Second,  that  plans  and  efforts  be  made  to  train  ' 
Medical  Corps  enlisted  men  and  Medical  Service  Corps 
officers  to  replace  doctors  in  the  Tables  of  Organiza- 
tion and  Equipment  of  all  1st  eschelon  units,  and 
Third,  that  the  Delegate  from  the  Utah  State  Medi- 
cal Association  be  instiucted  to  present  this  resolu- 
tion to  the  House  of  Delegates  of  the  A.M.A.  at 
Washington,  D.  C.,  in  December,  1949,  for  appropriate 
action. 

Dr.  Belden  moved  that  this  resolution  be 
adopted,  seconded  by  Dr.  Paul  and  unanimously 
carried. 

Dr.  Belden  then  presented  the  resolution  which 
had  been  read  by  Dr.  Charles  Ruggeri,  having 
to  do  with  the  control  of  State  Institutions  as 
follows: 


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for  November,  1949 


981 


WHEREAS,  There  has  in  the  last  few  years  been 
much  public  criticism  of  the  conduct  of  the  Utah 
State  Hospital  at  Provo,  the  Training  School  at 
American  Fork,  the  Utah  State  Tuberculosis  Sana- 
torium, the  School  for  the  Deaf  and  the  State  In- 
dustrial School  at  Ogden,  and 

WHEREAS,  The  proper  management  of  these.j.,ia 
stitutions  is  of-=^>4tal  import  to  the  reputation  aT  the 
State  and  to  the  peace  of  mind  of  large  numbers  of 
the  population,  and 

WHEREAS,  The  five  named  institutions  are  pri- 
marily concerned  with  the  care  of  individuals  suffer- 
ing from  psychiatric  and  medical  conditions  re- 
quiring the  attention  of  competently  trained  per- 
sonnel, and  further  that  these  problems  are  not 
solely  those  of  indigency,  and 

“VSHIEREAS,  It  appears  that  considerable  of  the 
criticism  directed  against  these  institutions  arises 
from  the  fact  that  they  are  under  the  supervision 
and  conrol  of  a political  body  in  this  State,  the 
Department  of  Public  Welfare,  and  as  such  the 
policies  and  employees  have  been  subject  to  change 
to  meet  political  requirements,  and 

WHEREAS,  Under  a political  regime  it  has  been 
proved  that  it  is  impossible  to  attract  the  calibre  of 
personnel  necessary  to  establish  continuity  of  stand- 
ards of  treatment  of  a sufficiently  high  level  to 
accomplish  the  civic  purpose  for  which  these  in- 
stitutions are  designed  and  intended,  and 

WHEREAS,  In  our  opinion  the  over-all  control 
and  management  of  these  institutions  should  be  non- 
political and  of  such  nature  as  to  assure  continuity 
of  policies  in  administration  and  management,  en- 
abling these  institutions  to  develop  standards  of  care 
which  will  entitle  them  to  accreditation  by  repre- 
sentative national  institutions  of  like  character  and 
which  standards  will  redound  to  the  benefit  of  those 
coming  under  their  care  and  of  the  community  at 
large  due  to  increased  rehabilitation  of  beneficiaries 
and  the  accessibility  of  the  best  treatment  to  the 
people  of  our  State;  now,  therefore, 

BE  TT  RESOLVED,  That  the  Utah  State  Medical 
Association  through  its  House  of  Delegates  urge  the 
passage  of  necessary  legislation  and  such  other  ac- 
tion as  will  remove  these  institutions  from  political 
control  and  provide  for  the  establishment  of  a non- 
paid  non-partisan  Board  made  up  of  civic  minded 
citizens  for  the  control  of  these  institutions  with 
full  power  of  direction  and  right  to  appoint,  for  the 
carrying  out  of  these  functions,  the  respective  super- 
intendents. That  the  Boards  shall  have  full  power 
to  make  appointments  and  to  stabilize  tenure  of  of- 
fice free  of  political  influence,  and  further  that 
copies  of  these  resolutions  be  sent  to  the  Governor, 
the  Legislative  Council,  and  to  the  officers  of  all 
service  clubs  and  the  press. 

Dr.  Belden  moved  that  this  resolution  be 
adopted,  seconded  by  Dr.  Ruggeri  and  unan- 
imously carried. 

Dr.  Belden  then  presented  the  following  reso- 
lution concerning  the  Medical  Library: 

WHEREAS,  There  is  need  to  build  up  and  main- 
tain in  this  State  and  in  this  region  an  excellent 
Medical  Library  available  for  services  to  all  practi- 
tioners, and 

WHEREAS,  With  substantial  University  support 
and  grants-in-aid  from  organizations  and  private 
individuals,  the  University  of  Utah  Medical  Library 
is  beginning  to  compare  favorably  with  libraries  in 
other  medical  centers;  now  therefore, 

BE  IT  RESOLVED,  that  the  grant  of  Two  Thou- 
sand Dollars,  ($2,000)  to  the  Library  made  last  year 
by  the  State  Medical  Association  be  renewed  and 
continued  during  the  present  year. 

Dr.  Belden  stated  that  his  committee  had  con- 
sidered this  matter  at  some  length  and  was  re- 
porting unfavorably.  He  therefore  moved  that 
this  resolution  be  not  favored.  Motion  was  sec- 
onded by  Dr.  Kahn. 

There  followed  considerable  discussion  and  a 
secret  ballot  was  called  for.  However,  before 
the  ballot  was  passed,  Dr.  Matthei,  as  a member 
of  the  Reference  Committee  on  Membership  and 
Medical  Economics  presented  a minority  report 
favoring  the  grant.  The  President  then  called 
for  the  ballot  and  upon  tallying  of  the  vote, 
found  that  thirty-two  opposed  making  the  grant 
and  twenty-five  favored  it.  The  resolution  was 
therefore  declared  lost. 

The  committee  then  considered  a resolution 
presented  by  Dr.  Kerby  as  follows;  and  Dr.  Bel- 
den moved  its  acceptance.  The  motion  was  sec- 
onded and  upon  being  put  was  carried. 

WHEREAS,  There  is  a well  recognized  growing 


tendency  on  the  part  of  administrators  of  many 
hospitals  to  encourage  private  ambulatory  patients 
to  enter  the  radiological,  pathological  and  physical 
therapy  departments  of  their  Institutions  for  the 
purpose  of  examination  and  treatment;  and 

WHEREAS,  This  practice  tends  to  put  such  hos- 
pitals into  competition  with  physicians  who  are  en- 
gaged in  the  private  practice  of  their  specialties; 
therefore, 

BE  IT  RESOLVED,  That  the  House  of  Delegates 
of  the  Utah  State  Medical  Association  go  on  record 
as  disapproving  the  proselyting  of  private  ambula- 
tory patients  by  hospitals  for  thejpurpose  of  making 
studies  or  giving  treatments  in  various  departments 
of  such  hospitals;  and 

BE  IT  FURTHER  RESOLVED,  That  a copy  of  this 
resolution  be  sent  to  the  administrators  of  the  va- 
rious hospitals  in  the  State  of  Utah;  and 

BE  IT  FURTHER  RESOLVED,  That  the  delegate 
of  the  Utah  State  Medical  Association  to  the  Ameri- 
can Medical  Association  be  Instructed  to  introduce 
in  the  House  of  Delegates  of  the  American  Medical 
Association  an  appropriate  resolution  covering  this 
situation. 

Dr.  Belden  read  the  following  resolution  based 
upon  similar  action  taken  by  the  House  of  Dele- 
gates of  the  A.M.A.: 

WHEREAS,  At  the  recent  Atlantic  City  Meeting 
of  the  A.M.A.  the  final  accepted  report  of  the 
Reference  Committee  on  the  Report  of  the  Hess 
Committee  on  the  Practice  of  Medicine  by  Hospital 
states  that  voluntary  Medical  Insurance  Programs 
and  Hospital  Service  Plans  shall  provide  payment 
for  Hospital  Service  only.  The  report  also  states 
that  Medical  Service  Plans  should  supply  payments 
for  all  of  the  medical  services  offered  to  subscribers, 
including  Pathological,  Roentgenological,  Anesthesio- 
logical  and  Physio-Therapeutic  Services.  The  re- 
port also  states  that  the  licensed  physician  is  the 
only  person  legally  and  professionally  qualified  to 
render  any  individual  medical  services,  and 

WHEREAS,  Certain  medical  services,  such  as  x-ray 
examinations,  are  now  furnished  to  subscribers  by 
the  Blue  Cross  Plan  of  Utah;  therefore, 

BE  IT  RESOLVED,  That  the  House  of  Delegates 
of  the  Utah  State  Medical  Association  urge  that  the 
Blue  Cross  Plan  of  Utah  delete  from  its  policies  all 
provisions  for  medical  services  and  that  the  Medi- 
cal Service  Plan  of  the  Utah  State  Medical  Associa- 
tion incorporate  within  its  benefits  such  amounts  of 
Roentgenological,  Pathological  and  Anesthesiological 
Services  as  may  be  furnished  on  a sound  actuarial 
basis. 

Dr.  Belden  moved  the  adoption  of  this  resolu- 
tion, seconded  and  carried. 

Dr.  Belden  then  moved  that  his  committee  re- 
port be  accepted  as  a whole.  Motion  was  carried. 

At  this  point  Dr.  Kahn  moved  that  the  news- 
papers be  given  information  as  to  the  revision 
of  the  Fee  Schedule,  particularly  as  to  a few 
basic  items,  such  as  day  visits,  night  visits,  etc. 
The  motion  was  seconded  by  Dr.  Kerby.  Follow- 
ing discussion  the  motion  was  put  and  defeated. 
On  motion  of  Dr.  Hatch,  duly  seconded,  the 
House  of  Delegates  adjourned  until  8 a.m.,  Sep- 
tember 3. 

Third  Session 

The  House  of  Delegates  reconvened  at  8:00 
a.m.,  September  3 in  the  Little  Theatre  of  the 
Union  Building. 

President  Ogilvie  first  called  for  the  report  of 
the  Reference  Committee  on  Medical  Education 
and  Hospitals.  Due  to  the  absence  of  Dr.  Wen- 
dell Thomson,  chairman  of  the  committee,  this 
report  was  presented  by  Dr.  D.  E.  Ostler.  He 
moved  the  acceptance  of  the  written  report  of 
the  Councilor  of  the  First  District;  seconded  by 
Dr.  Kerby  and  carried.  In  like  manner.  Dr.  Ost- 
ler moved  the  acceptance  of  the  report  on  Medi- 
cal Education  and  Hospitals;  seconded  by  Dr. 
Bryner  and  carried.  ■ Dr.  Ostler  then  asked  for 
the  approval  of  the  report  of  the  committee  as 
a whole  which  was  seconded  and  carried. 

Dr.  J.  C.  Hubbard  gave  the  report  of  the 
Reference  Committee  on  Legislation  and  Public 
Relations. 

Dr.  Hubbard  moved  that  the  report  of  the 
Executive  Secretary  as  published  be  accepted; 
seconded  by  Dr.  Robinson  and  carried. 


982 


Rocky  Mountain  Medical  Journal 


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The  Committee  on  Public  Relations  was  then 
considered.  Dr.  Hubbard  suggested  that  this 
committee  in  the  future  meet  with  the  Council 
at  the  earliest  possible  date  in  order  that  an 
adequate  program  of  activities  might  be  mapped 
out.  With  this  suggestion  he  moved  that  the 
report  of  the  Committee  on  Public  Relations  be 
accepted.  The  motion  was  seconded  by  Dr. 
Kerby  and  carried. 

Chairman  Hubbard  then  read  the  report  of 
the  Committee  on  Rural  Health  and  moved  that 
it  be  accepted;  seconded  by  Dr.  Robinson  and 
carried. 

Chairman  Hubbard  then  read  the  report  of 
the  Committee  on  Public  Health  in  part. 

The  following  are  a few  suggested  projects  al- 
ready within  scope  of  existing  agencies  with  little 
additional  financial  outlay: 

1.  Statewide  pulmonary  tuberculosis  survey  and 
routine  low  cost  chest  x-ray  on  hospital  admissions. 

2.  Statewide  blood  sampling  for  group,  Rh  factor, 
syphilis  and  other  agglutination  tests,  by  clinics  or 
on  patients. 

3.  Statewide  school  health  programs  including  a 
“Health  day”  and  interval  examinations  of  all  stu- 
dents, preferably  by  a family  doctor. 

4.  Widespread  pie-natal  and  pre-school  clinics  for 
all  who  do  not  visit  a family  doctor.  This  could  be 
real  preventive  medicine. 

In  accordance  with  current  trends  and  the  sug- 
gestions of  the  American  Public  Health  Association, 
it  is  recommended  by  this  committee: 

1.  That  laws  of  Utah,  Title  35,  Chapter  1,  Para- 
graph I'.ll  be  amended  to  conform  to  the  principle 
that  the  State  Health  Department  shall  consist  of 
two  sections  or  branches: 

(a)  The  State  Board  of  Health,  which  shall  act  as 
the  consultive,  advisory,  and  policy  forming 
branch  with  emergency  administrative  power. 

(b)  The  State  Health  Officer  and  his  staff  which 
shall  act  as  the  executive  branch  with  ad- 
ministrative power. 

2.  That  Chapter  1,  Paragraph  1.14  of  the  same  be 
reviewed  to  correct  limitations  on  the  salary  of  the 
State  Health  Commissioner. 

3.  That  fewer  and  larger  local  health  districts 
encourage  local  health  departments  with  local  con- 
trol, either  on  a county-wide  basis,  on  a multiple 
county  basis  or  on  the  basis  of  combining  the  larger 
cities  of  the  state  with  the  counties  in  which  they 
are  situated. 

4.  That  local  health  councils  be  encouraged,  ac- 
tivated or  established  to  the  end  that  public  health 
problems  be  illuminated,  understood  and  effectively 
met  on  the  local  level  with  capable  help  from  region 
or  state  if  requested. 

5.  That  finally,  this  committee  reports,  and  in 
principle  commends,  the  recent  action  of  the  State 
Board  of  Health  approved  by  the  Governor  in  secur- 
ing the  advice  of  a competent,  impartial  authority 
in  the  field  of  public  health.  It  is  reported  that  Dr. 
Ira  Hiscock,  Professor  of  Public  Health  at  Yale 
Univei'sity  Medical  School,  is  now  here  studying 
public  health  organization  and  administration  in 
Utah  with  a view  to  making  recommendations  for 
improvement. 

In  conclusion,  it  is  realized  that  well-considered 
expenditures  for  public  health  may  be  among  the 
most  profitable  in  every  way,  yielding  a very  high 
return  as  measured  in  dollars  as  well  as  in  human 
values  and  that  by  proper  and  efficient  utilization 
of  voluntary  and  non-official  health  organizations  in 
the  “grass  roots”  with  professional  assistance  of 
high  caliber,  Utah  could  leave  the  rest  of  the  country 
far  behind  in  public  health. 

Before  Dr.  Hiscock  was  invited  to  do  that  we  got 
him  to  make  a few  recommendations. 

Now  this  is: 

“WHEREAS,  In  the  opinion  of  Consultant  Dr.  Ira 
V.  Hiscock,  Professor  of  Public  Health  of  Yale 
Uriiversity  Medical  School,  and  many  members  of 
this  Association  familiar  with  the  situation,  an  acute 
emergency  now  exists  in  the  Utah  State  Health  De- 
partment, and 

“WHEREAS,  The  most  critical  factor  in  this  situa- 
tion is  the  lack  of  an  experienced,  well  qualified 
State  Health  Commissioner  on  a permanent  basis, 
and 

“WHEREAS,  It  is  unlikely  that  such  person  can  be 
secured  for  less  than  twice  the  present  stipulated 
salary  of  Five  Thousand  Dollars  ($5,000)  per  year, 
and 

WHEREAS,  Funds  for  such  an  increased  salary 
are  now  available  within  the  resources  of  the  State 
Board  of  Health  without  request  for  any  deficit 
appropriation;  now,  therefore, 

“BE  IT  RESOLVED,  That  in  the  face  of  this  emer- 
gency the  Utah  State  Medical  Association  recom- 


mends that  the  administration  of  the  State  of  Utah 
allow  the  Board  of  Health  to  make  a salary  adjust- 
ment sufficient  to  secure  a well  qualified  Public 
Health  executive  without  delay.” 

Chairman  Hubbard  moved  that  the  report  of 
the  Committee  on  Public  Health  be  accepted. 
His  motion  was  seconded  by  Dr.  Skolfield  and 
carried  unanimously. 

Chairman  Hubbard  called  attention  to  the  re- 
port of  the  Committee  on  Public  Policy  and 
Legislation  and  moved  its  acceptance.  The  motion 
was  seconded  by  Dr.  Robinson  and  following 
discussion  an  amendment  was  made  by  Dr.  Rob- 
inson as  follows:  “That  we  empower  the  Council 
to  proceed  as  they  feel  it  wise  in  regard  to  the 
appropriation  of  any  monies  to  further  sponsor 
the  cause  of  obtaining  a Basic  Science  Law  in 
Utah.”  The  motion  was  seconded.  A lengthy 
discussion  followed  and  finally  the  motion  was 
called  for  and  President  Ogilvie  called  for  a 
vote  upon  the  amendment  which  was  unanimous- 
ly carried.  Question  on  the  original  motion  was 
then  asked  for  and  in  like  manner  that  motion 
was  carried. 

Dr.  Hubbard  then  called  attention  to  the  re- 
port of  the  Councilor  from  the  Third  District 
wherein  he  advocated  greater  use  of  present 
day  methods  of  transportation  in  bringing  the 
specialist  to  the  patient  rather  than  vice  versa 
and  to  the  resolution  introduced  by  Dr.  Oaks  as 
follows: 

WHEREAS,  Airplane  tiansportation,  chartered  or 
private,  now  makes  it  feasible  to  reach  any  region 
of  our  State  in  the  space  of  two  hours,  to  do  surgery 
in  coovieration  with  the  family  physician  in  the  local 
hospital,  or  to  make  such  after  calls  as  may  be 
quite  necessary,  and 

WHEREAS,  Such  a plan,  even  where  reasonable 
mileage  or  expense  for  time  involved  is  paid  the 
surgeon,  will  still  result  in  a great  saving  to  patients, 
in  a better  chance  of  survival  of  many  who  stand 
poorly  the  exigencies  of  transportation  over  long 
distances,  in  stimulating  more  enthusiastic  support 
of  the  people  for  their  community  hospitals  and 
physicians;  therefore, 

BE  IT  RESOLVED,  That  a commission  of  repre- 
sentatives from  the  various  specialties  be  appointed 
by  the  Council  to  investigate  the  feasibility  of  such 
a service  being  undertaken  by  members  of  the 
specialties  who  are  interested  in  doing  so,  to  suggest 
mileage  rates  or  time-compensation  rates,  fee  ar- 
rangements between  consulting  surgeon  and  family 
physician,  as  well  as  such  other  details  as  may  seem 
to  need  guidance,  and  to  report  to  the  Council  at 
the  end  of  three  months,  and  be  it 

FURTHER  RESOLVED,  That  this  report,  or  a 
notice  of  its  content  be  mailed  to  all  members  of 
the  Association. 

Dr.  Lowe  moved  that  this  resolution  be  re- 
jected, seconded  by  Dr.  Matthei.  Following 
further  discussion  vote  was  called  for  upon  Dr. 
Lowe’s  motion  and  on  a standing  vote  the  motion 
was  lost. 

Dr.  Tom  Robinson  moved  that  the  resolution 
be  amended  to  include  at  least  two  men  in  gen- 
eral practice  on  the  investigating  committee,  and 
that  with  this  amendment,  the  resolution  be  ac- 
cepted. Motion  was  accepted  by  Dr.  Kerby  and 
upon  being  put  to  vote  by  Dr.  Ogilvie  was  unan- 
imously carried. 

Chairman  Hubbard  moved  that  the  report  of 
tthe  Committee  on  Cancer  be  accepted  as  filed; 
seconded  and  carried.  In  like  manner  the  report 
of  the  Committee  on  Tuberculosis  and  Cardiovas- 
cular Diseases  was  accepted  unanimously.  Dr. 
Hubbard  called  attention  to  the  splendid  work 
done  by  the  Woman’s  Auxiliary  and  its  Advisory 
Committee  and  moved  the  acceptance  of  this 
report.  Upon  being  seconded  the  motion  was 
put  and  unanimously  carried. 

This  concluding  the  report  of  the  Reference 
Committee,  Chairman  Hubbard  moved  the  ac- 
ceptance of  the  report  as  a whole.  This  was 
unanimously  done. 

President  Ogilvie  then  called  for  the  election 


984 


Rocky  Mountain  Medical  Journal 


of  officers,  resulting  in  the  nominating  and  elect- 
ing of  the  following: 

President-Elect:  V.  P.  White,  Salt  Lake  City. 

Honorary  President:  D.  G.  Edmunds,  Salt  Lake 
City. 

1st  Vice  President:  Sims  E.  Duggins,  Pan- 
guitch. 

2nd  Vice  President:  Jules  E.  Trowbridge, 
Bountiful. 

3rd  Vice  President:  Seth  E.  Smoot,  Provo. 

Secretary:  T.  C.  Weggeland,  Salt  Lake  City. 

Treasurer:  L.  J.  Paul,  Salt  Lake  City. 

Councilor,  3rd  District:  L.  W.  Oaks,  Provo. 

Delegate  to  A.M.A.,  1950  and  1951:  George  Fis- 
ter,  Ogden. 

Alternate  Delegate  to  A.M.A.,  1950  and  1951: 
J.  J.  Weight,  Provo. 

The  next  order  of  business  was  the  election 
of  the  five  members  to  serve  on  the  Board  of 
Supervisors.  Nominations  werp  made  and  ballots 
passed.  Tabulation  of  ballots  showed  the  follow- 
ing to  be  elected: 

1951:  Clark  Rich,  Ogden. 

1952:  Ezra  Cragun,  Logan. 

1953:  Paul  K.  Edmunds,  Cedar  City. 

1954:  J.  G.  McQuarrie,  Richfield. 

1955:  J.  C.  Hubbard,  Price. 

Following  the  election  the  names  of  the  candi- 
dates were  written  upon  a slip  of  paper  and 
placed  in  a box  from  which  they  were  drawn 
one  at  a time  and  in  this  fashion  the  terms  that 
each  was  to  serve  was  determined,  namely  from 
one  to  five  years. 

During  the  balloting  for  members  of  the  Board 
of  Supervisors,  President  Ogilvie  requested  the 
members  to  stand  while  the  Secretary  read  the 
names  of  members  of  the  association  who  had 
passed  away  during  the  year  as  recorded  by  the 
Necrology  Committee,  as  follows:  Michael  Fran- 
cis Maloney,  F.  M.  McHugh,  L.  D.  Stewart,  W.  R. 
Wherritt,  Louise  E.  Boutelle,  Ezra  C.  Rich, 
Howard  P.  Kirtley,  William  T.  Cannon,  M.  J. 
Seidner  and  Frank  B.  Steele. 

President  Ogilvie  asked  Dr.  Oaks  to  escort 
President-Elect  Jenson  to  the  chair  and  turned 
over  to  him  the  gavel  amidst  applause. 

President  Jenson  requested  that  a motion  be 
made  thanking  the  Cancer  Fund  of  the  State 
Department  of  Health  and  the  Polio  Fund  for 
their  contribution  in  paying  expenses  of  speakers 
for  the  Scientific  Assembly.  Dr.  Tom  Robinson 
made  the  motion,  duly  seconded,  and  upon  being 
put  to  the  House  by  Dr.  Jenson,  the  motion  was 
carried. 

Dr.  Jenson  then  made  a few  brief  remarks  as 
follows : 

“I  want  to  congratulate  the  officers  this  last 
year  on  the  splendid  work  they  have  done.  I 
think  our  program  has  been  outstanding;  Dr. 
Ray  Woolsey  has  been  chairman  of  the  Pro- 
gram Committee.  I think  thanks  and  gratitude 
should  go  out  to  them. 

“As  to  the  part  we  should  play  in  the  next 
year,  we  beg  to  be  your  humble  servant  and  wish 
to  hear  from  any  and  ail  of  you  upon  any  work 
or  projects  which  you  might  wish  us  to  enter- 
tain. Please  feel  free  always  to  contact  us  for 
any  of  your  desires.” 

Dr.  Robinson  moved  that  the  House  of  Dele- 
gates go  on  record  as  thanking  the  retiring  offi- 
cers and  especially  President  Ogilvie  and  Secre- 
tary Ray  T.  Woolsey  for  their  many  hours  of 
service  to  the  organization.  The  motion  was 
seconded  and  carried. 

Dr.  Woolsey  moved  that  the  next  Annual  Meet- 
ing be  held  at  Ogden,  the  date  to  be  determined 
by  action  of  the  Council.  Motion  was  seconded 
by  Dr.  Kerby. 


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From  where  I sit 
Joe  Marsh 


Now  Hospitals  Are 


At  the  request  of  President  Jenson,  Dr.  Belnap, 
from  Ogden,  elaborated  upon  the  proposal  to 
hold  the  meeting  in  Ogden  as  follows: 

“It  is  customary  to  have  the  Annual  Meeting 
in  the  vicinity  or  district  of  the  President.  Inas- 
much as  Conrad  Jenson,  the  President  next  year, 
is  from  Weber  County,  the  Ogden  Surgical  Socie- 
ty invites  the  Utah  State  Medical  Association 
to  be  our  guests  at  our  Annual  Meeting  of  the 
Ogden  Surgical  Society,  the  Ogden  Surgical 
Society  sponsoring  the  scientific  program.” 

The  motion  having  been  made  that  the  State 
Association  accept  the  invitation  to  hold  its 
meeting  in  Ogden,  the  motion  was  put  and 
unanimously  accepted. 

There  being  no  further  business,  the  House 
adjourned  at  9:50  a.m.,  September  3. 


^^Banks/^  Too! 


Obituary 

JOHN  WALDO  HAGAN 


Doc  Simpson  was  saying,  “Hospi- 
tals are  building  up  'bone  banks’  that 
work  just  like  blood  banks.  When  bone 
is  needed,  the  surgeon  takes  one  from 
a refrigerator,  cuts  it  to  the  right  shape 
and  simply  splices  it  in.” 

“You  doctors  are  sure  making  prog- 
ress,” I says,  “but  tell  me,  are  any  of 
the  patients  fussy  about  whose  bone 
they’re  getting?” 

“No  sir!”  replies  Doc.  “No  more 
than  they  worry  about  whose  blood 
they  get.  No  one  yet  asked  for  a bone 
from  a man  who  went  to  the  same  \ 
school  or  church  he  did.” 

From  where  I sit,  it  would  be  a bet- 
ter world  if  we  were  half  as  wUling  to 
accept  other  people’s  ideas  and  tastes, 
as  we  seem  to  be  wUling  to  accept  their 
bone  and  blood.  There’ll  always  be 
differences.  Some  like  buttermilk, 
others  would  rather  have  a sparkling 
glass  of  temperate  beer.  But  under- 
neath we’re  pretty  much  the  same — 

* 

deserving  each  other’s  respect  and 
tolerance! 


Copyright,  19 ltd.  United  States  Brewers  Foundation 


Dr.  John  Waldo  Hagan,  65,  prominent  Utah 
County  physician,  died  October  2,  1949,  in  the 
Utah  Valley  Hospital  at  Provo  after  a week’s  ill- 
ness. 

He  was  born  December  13,  1883,  in  Hedrick, 
Iowa,  a son  of  Joseph  Marion  and  Ellen  E.  Barnes 
Hagan.  He  received  his  early  education  at  Ot- 
tumwa, Iowa,  and  later  moved  to  Keokuk,  Iowa, 
where  he  finished  his  pre-medical  training. 

Dr.  Hagan  was  graduated  from  the  School  of 
Medicine  of  the  University  of  St.  Louis.  He  first 
began  practicing  at  Elsinore,  Utah.  On  July  6, 
1905,  he  was  married  to  Tina  Jensen.  They  moved 
to  Fairview,  Utah,  and  in  1907  moved  to  Spanish 
Fork,  Utah,  where  he  practiced  for  forty-two 
years. 

He  was  a member  of  the  American  Medical  As- 
sociation, Utah  County  Medical  Association, 
chapter  member  of  the  Spanish  Fork  Rotary 
Club,  and  a member  of  the  Knife  and  Fork  Club 
in  Utah  County. 

Dr.  Hagan  is  suvived  by  his  wife  and  four 
children. 


UTAH 

Medicai  School  Notes 


Dr.  H.  L.  Marshall,  Professor  and  Head  of  the 
Department  of  Public  Health  and  Preventive 
Medicine,  has  been  named  Acting  Dean  of  the 
University  of  Utah  College  of  Medicine.  Dr. 
Richard  H.  Young  left  recently  to  assume  his 
new  duties  as  Dean  of  Northwestern  University 
School  of  Medicine. 

Dr.  James  F.  Bosma,  formerly  Assistant  Pro- 
fessor of  Pediatrics  at  the  University  of  Minne- 
sota, hasi  been  appointed  to  fill  the  vacancy  left 
by  the  resignation  of  Dr.  John  A.  Anderson  as 
Professor  and  Head  of  the  Department  of 
Pediatrics. 


Advertisers  in  our  journal  are  carefully  se- 
lected. Only  those  meeting  our  advertising 
standards  may  use  the  facilities'  of  our  pages. 
No  advertisement  will  be  accepted  which,  either 
by  intent  or  inference,  would  result  in  mislead- 
ing the  reader.  May  we  suggest  that  you  review 
the  ads  in  each  issue  of  our  journal  and  when 
occasion  arises  to  prescribe  products  featured 
or  use  the  facilities  offered,  tell  them'  you  saw 
their  ad  in  the  November  Journal. 


986 


Rocky  Mountain  Medical  Journal 


THE  FRIEND  OF  FRIENDS* 

By  Ora  Kehn 

A friend  to  us  all  through  many  long  years, 

He  shared  in  our  joys  as  he  shared  in  our  tears. 
He  came  when  we  called  him,  in  snowstorm  or 
rain 

And  he  never  refused  us  when  we  were  in  pain. 
With  never  a thought  for  himself  through  it  all. 
He  always  responded  to  our  every  call. 

He  never  once  asked  us,  “How  much  can  you 

pay,” 

But  he  gave  us  far  more  than  we  e’er  can  repay. 
And,  somehow,  I know  when  his  last  call  is  made 
All  his  debts  will  be  cancelled  and  marked  over- 
paid! 

‘Dedicated  to  W.  W.  K.,  whose  76th  birthday  falls 
on  October  22,  1949;  reprinted,  by  permission,  from 
Candor  Magazine. 


AMERICAN  RADIUM  SOCIETY  SELECTS 
PRESIDENT-ELECT  FOR  1949 

Dr.  Leland  R.  Cowan  of  Salt  Lake  City  was 
the  unanimous  choice  of  the  American  Radium 
Society  for  President-elect  for  1949.  Dr.  Cowan 
is  a member  of  the  Radiological  Society  of  North 
America,  a diplomate  of  the  American  Board  of 
Radiology  and  was  Treasurer  of  the  American 
Radium  Society  from  1942  to  1947,  Second  Vice 
President,  1947  and  First  Vice  President,  1948. 


DRUGS  CUT  DEATH  RATE  OF  RARE 
MUSCLE  DISEASE 

Modern  methods  of  treatment  have  reduced 
the  mortality  rate  of  myasthenia  gravis  to  about 
10  per  cent,  according  to  two  doctors  from  the 
University  of  Texas  School  of  Medicine,  Gal- 
veston. In  this  rare  disease,  the  cause  of  which 
baffles  doctors,  the  victim’s  muscles  progres- 
sively become  weaker.  The  muscles  most  fre- 
quently affected  are  those  concerned  with  move- 
ments near  the  eyes,  with  resulting  .squinting 
and  “seeing  double.”  Generalized  muscular  weak- 
ness also  occurs. 

Untreated,  the  disease  runs  a fatal  course  in 
50  to  75  per  cent  of  cases  in  a few  years,  Drs. 
Charles  T.  Stone  and  J.  Alfred  Rider  write  in 
the  current  (September  10)  Journal  of  the  Amer- 
ican Medical  Association.  Drugs,  principally 
neostigmine  and  tetraethylpyrophosphate,  give 
complete  relief  in  some  cases  and  have  greatly 
reduced  the  mortality  rate  of  the  disease,  which 
IS  now  probably  about  10  per  cent,  they  say. 


W.D.I^ocL 

Ambulance 
Service 

Prompt,  Careful  and  Courteous 
Serving  Denver  25  Years 

Approved  by  Physicians  Generally 

18th  Ave.  at  Gilpin  St.,  Phone  EA.  7733 


We  Recommend 

KARC’S  PAINT  CO. 

Lowe  Bros.  Paints  Kem-Tone 

Wall  Paper  Painters’  Supplies 

Art  Supplies 

FREE  DELIVERY  

Phone  CHerry  3779 

620  Santa  Fe  Drive  Denver 


Denver’s  Fireproof 

COLBURN  HOTEL 

D.  B.  Cerise  is  the  genial  Host  and  Manager 

• COKVENIENT  — Located  only  a ten-minute  walk 
from  the  heart  of  the  city. 

• PLEASANT  — Away  from  — above  the  noise  and 
rush  of  downtown  Denver. 

• EXCELLENT  FOOD  — Dining  that  has  satisfied  the 
demanding  tastes  of  all  patrons. 

• Visit  Our  New  Cocktail  Lounge. 

TENTH  AVE.  at  GRANT  ST. 

Phone  MAin  6261  Denver,  Colo. 


RESTAURANT  240 

MISS  M.  E.  GABRIEL,  Prop. 

SERVING  TRADITIONALLY  GOOD 
FOOD  AT  MODERATE  PRICES 

HOURS:  11:00  A.M.— 2:00  P.M.  4:30—7:30  P.M. 
SUNDAYS:  12  Noon  to  7:00  P.M. 

Closod  Wodnosdays 

240  Broadway  Denver,  Colo. 

SPruce  2182 


We  Cater  to  the  Medical  Profession 

CASCADE  LAUNDRY 

10  Per  Cent  Discount  If  You  Bring  Your 
Laundry  in 

HAND  DRY  CLEANING 
“Deserving  of  Your  Patronage” 

1621  Tremont  Denver  TAbor  6379 
Charge  Accounts  Invited 


We  Recommend 

Jackson’s  Cat  Rate  Drugs 

LIQUORS— SUNDRIES 
PRESCRIPTIONS 

Call  SP.  3445 

DOWNING  and  ALAMEDA 


for  November,  1949 


987 


RELIABLE  DRUGGISTS 

PATRONIZE  DENVER’S  INDEPENDENT  DRUGGISTS 


WE  RECOMMEND 

COnVTRY  CLUB 
PHARMACY 

PRESCRIPTION  SPECIALISTS 

☆ ' 

1700  E.  6th  Ave.  EAst  7743 

Denver,  Colorado 

We  Recommend 

Kincaid’s  Pharmacy 

JESS  L.  KINCAID,  Prop. 

Prescriptions,  Biologicals 
and  Fine  Cosmetics 

7024  W.  Colfax  Ave. 

Phone  Lakewood  436 
LAKEWOOD,  COLORADO 

ROBERTS  PHARMACY 

East  23rd  Ave.  at  Onedia  St. 

Phones:  EAst  7783-EAst  7784 

D.  Lyall  Roberts,  Prop. 

East  Denver's  Newest  Neighborhood  Drug  Store 
Takes  Pleasure  to  Fill  the  Needs  of  Your  Pa- 
tients. 

Prompt  Free  Delivery  Service 

Our  Prescription  Stock  Is  Complete 

We  Recommend 

EARNEST  DRUG  COMPAIVY 

T.  H.  BRAYD'EIN.  Prop. 

PRESCRIPTION  SPECIALISTS 
Prompt  Delivery  Service 

1699  Broadway  Phone  KEystone  7237 

Denver,  Colorado 

"Conveniently  Located  ior  the  Doctor" 

HYDE’S  PHARMACY 

ACCURATE  PRESCRIPTIONS 

Chas  W.  Hyde,  Prop. 

Rocky  Mountain  Distributor  for  Sherman 
Biologicals  and  Pharmaceuticals 

Free  Deliveries 

629  16th  St.  (Mack  Bldg.)  KE.  4811 

Doyle's  Pharmacy 

!f74#  jP articular  ^^ru^^Ut** 

East  17th  Ave.  at  Grant  KE.  5987 

21  Years  in  the  Heart  of  North  Denver 

GUIDO  SHUMAKE  DRUGS 

(Formerly  Otto  Drug  Co.) 

PRESCRIPTIONS  ACCURATELY 
COMPOUNDED 

Free  Delivery  Service 

West  38th  Ave.  and  Clay  Denver,  Colo. 

Phone  GRand  9934 

We  Recommend 

BONNIE  BRAE 

DRUG  COMPANY 

Alfred  C.  Andersen,  Owner  and  Manager 
Prescriptions  Accurately  Compounded 

Drugs Sundries 

FREE  IMMEDIATE  DELIVERIES 

ON  EMERGENCY  PRESCRIPTIONS 

763  South  University  Boulevard 

Phone  RAce  2874  — Denver,  Colorado 

WE  RECOMMEND 

Whittaker’s  Pharmacy 

“The  Friendly  Store” 

PRESCRIPTION  SPECIALISTS 

West  32nd  and  Perry,  Denver,  Colo. 
Phone  GLendale  2401 

22  Years  in  North  Denver 

OTTO  DRUG  COMPANY 

TRY  US  FIRST 

Prescriptions  Accurately  Compounded 

Free  Delivery  Service 
(New  Location) 

5070  Federal  Baulevard  Denver,  Colorado 

Phone  GRand  9832 

9 

988 


Rocky  Mountain  Medical  Journal 


RELIABLE  DRUGGISTS 

PATRONIZE  DENVER’S  INDEPENDENT  DRUGGISTS 


WALTERS  RRVG  STORE 
801  COLORADO  BLVD. 
Denver,  Colorado 

☆ 

Telephone  FRemont  5391 


14JiS0  to  at 

WEISS  DRUG 

PRESCRIPTION  SPECIALISTS 

☆ 

Colfax  and  Elm  Denver,  Colorado 

Phone  EAst  1814 


We  Recommend 

VAN'S  PHARMACY 

THOS.  A.  VANDERBUR 

Prescriptions,  Drngrs,  Cosmetics,  Magazines 
Sundries  Excellent  Fonntain  Service 

2859  Umatilla  St.,  Cor.  29th  Are.  at  UmatlMa 
GRand  7944  Denver,  Colo. 


Dansberry’s  Pharmacy 

“New  Ultra  Modern  Prescription  Service” 
JAMES  F.  DANSBERRY 
Owner  and  Manager 

Champa  at  14th  Street  Denver,  Colorado 
Phone  KEystone  469 


’ Harl  Cleveland,  Owner 

CLEVELAND  PHARMACY 

W.  29th  Ave.  at  Speer  Ph,  GL.  9272 

Modem  Prescription  Department 
Registered  Pharmacist 

Drugs  — Sundries  — Soda  Fonntain 
HOURS:  Week  Days,  8 a.m.  to  10  p.m. 

Sundays,  10  am.  to  1 p.m.,  5 p.m.  to  9 p.m> 

Prescriptions  Delivered  Promptly 


WE  RECOMMEND 

S.AKEWGGD  PHARMACY 

R.  W.  Holtgren,  Prop. 
PRESCRIPTION  SPECIALISTS 


West  Colfax  at  Wadsworth 
Lakewood  Colorado 

Phone  Lakewood  65 


Downing  Street  Pharmacy 

GEORGE  M.  HILL,  Prop. 

PROFESSIONAL  PHARMACIST 

901  Downing  St.  Denver,  Colo. 

Phone  CHerry  2767 

Complete  Merchandise  Line 
Free  Delivery  on  Prescriptions 


East  Denver’s  Prescription  Drug  Store 


FR/INKLIf^J 


UGCO 


Bert  C.  Corgan,  Prop. 

3401  FRANKLIN  STREET 
KEystone  7241 


OVERSTAKE’S  PHARMACY 

Gail  E.  Overstake 
Prescription  Specialists 

DRUGS  — SUNDRIES  — 
COSMETICS  — CANDIES 

We  Deliver 

1000  So.  Gaylord  — RAce  4401 


D.  MALCOLM  CAREY,  Pharmacist 

Phone  AComa  3711 

224  Sixteenth  Street  Denver,  Colorado 


for  November,  1949 


989 


Cook  Countv  Graduate 
School  of  Medicine 

ANNOUNCES  CONTINUOUS  COURSES 

SURGERY — Intensive  Course  in  Surgical  Technique,  Two 
Weeks,  starting  November  28,  January  23,  February 
20.  Surgical  Technique,  Surgical  Anatomy  and  Clini- 
cal Surgery,  Four  Weeks,  starting  November  7,  Febru- 
ary 6,  March  6.  Surgery  of  Colon  and  Rectum,  One 
Week,  starting  November  28,  March  6.  Esophageal 
Surgery,  One  Week,  starting  April  17.  Breast  and 
Thyroid  Surgery,  One  Week,  starting  June  19.  Tho- 
racic Surgery,  One  Week,  starting  June  12.  Fractures 
and  Traumatic  Surgery,  Two  Weeks,  starting  April  17. 

GYNECOLOGY^ — Intensive  Course,  Two  Weeks,  starting 
February  20.  Vaginal  Approach  to  Pelvic  Surgery, 
One  Week,  starting  November  7,  March  6. 

OBSTETRICS — Intensive  Course,  Two  Weeks,  starting 
November  7,  March  6. 

PEDIATRICS — Intensive  Course,  Two  Weeks,  starting 
April  3. 

MEDICINE — Intensive  General  Course,  Two  Weeks, 
starting  April  3.  Gastroscopy,  Two  Weeks,  starting 
March  6. 

DERMATOLOGY — Formal  Course,  Two  Weeks,  starting 
May  1.  Informal  Clinical  Course  every  two  weeks. 

ROENTGENOLOGY — Diagnostic  and  Lecture  Course  First 
Monday  of  every  month.  Clinical  Course  Third  Mon- 
day of  every  month.  X-Ray  Therapy  every  two  weeks. 

UROLOGY — Intensive  Course,  Two  Weeks,  starting 
April  17.  Cystoscopy,  Ten  Day  Practical  Course, 
every  two  weeks. 

GENERAL,  INTENSIVE  AND  SPECIAL  COURSES  IN  ALL 
BRANCHES  OF  MEDICINE,  SURGERY  AND 
THE  SPECIALTIES 

TEACHING  FACULTY — ATTENDING  STAFF  OF 
COOK  COUNTY  HOSPITAL 

ADDRESS:  REGISTRAR,  427  South  Honore  St., 
Chicago  12,  Illinois 


ACCIDENT  - HOSPITAL  - SICKNESS 

INSURANCE 

For 

Physicians,  Surgeons,  Dentists  Exclusively 


PREMIUMS 

COME  FROM 


$5,000.00  accidental  death  $8.00 

$25.00  weekly  iBdeonltr,  aoeldent  and  slckneaa  Quarterly 

$10,000.00  accidental  death  $16.00 

$50.00  weekly  Indemnity,  acddent  and  eleknesi  Quarterly 

$15,000.00  accidental  death  $24.00 

$75.00  weekly  Indemnity,  aeddent  and  deknesi  Quarterly 

$20,000.00  accidental  death  $32.00 

$100.00  weekly  Indemnity,  accident  and  slcknesa  Quarterly 


Cost  has  never  exceeded  amounts  shown. 

ALSO  HOSPITAL  EXPENSE  FOR  MEMBERS,  WIVES  & CHILDREN 


8Sc  out  of  each  $1.00  gross  income  used  for 
members’  benefit 

$3,700,000.00  $15,700,000.00 

INVESTED  ASSETS  PAID  FOR  CLAIMS 

$200,000.00  deposited  with  State  of  Nebraska  for  protection  of  our  members. 

Disability  need  not  be  incurred  in  line  of  duty- 
benefits  from  the  beginning  day  of  disability 

PHYSICIANS  CASUALTY  ASSOCIATION 
PHYSICIANS  HEALTH  ASSOCIATION 

47  years  under  the  same  management 
400  F*ir«r  IVationnI  Bstnfe  Bniltling,  Omaha  S.  Nebraaisn 


DL 

BROWN  SCHOOLS 

For  Exceptional  Children 

Four  distinct  units.  Tiny  Tots  through 
the  Teens.  Ranch  for  older  boys.  Spe- 
cial attention  given  to  educational  and 
emotional  difficulties.  Speech,  Music, 
Arts  and  Crafts.  Full  time  Psychologist. 
Under  the  daily  supervision  of  a Certi- 
fied Psychiatrist.  Registered  Nurses. 
Private  swimming  pool,  fireproof 
building.  View  Booh*  Summer  Camp. 
Approved  by  State  Division  of  Special 
Education. 

BERT  P.  BROWN 

President 

Paul  L.  White,  M.D.,  F.A.P.A., 
Medical  Director 

P.  0.  Box  4008,  Austin,  Texas 


990 


Rocky  Mountain  Medical  Journal 


Index  to  Advertisers 


Pag-e 


Abbott  Laboratories  953 

Alba  Dairy  971 

American  Ambulance  Co 981 

American  Meat  Institute 904 

American  Medical  and  Dental 

Association  896 

Ayerst,  McKenna  & Harrison  951 

Baker  Laboratories.  Inc 961 

Beatrice  Distributors  983 

Bilhuber-Knoll  Corp.  971 

Blair  X-Ray  Supply 967 

Bonita  Pharmacy  979 

Bonnie-Brae  Drug-  988 

Brecht  Candy  Co 981 

Bro-w-n  Schools  990 

Burroughs  Wellcome  & Co — 901 


Cambridge  Dairy 
Camel  Cigarette 


Camp,  S.  H.  & Co 959 

Capital  Chevrolet  990 

Cascade  Laundry  98'7 

Children’s  Hospital  Assn 992 

City  Park  Dairy 898 

Cleveland  Pharmacy  989 

Coca-Cola  Co.  981 

Colburn  Hotel  987 

Colorado  Springs 

Psychopathic  Hospital  979 

Colvin  Medical  Books 983 

Continental  Casualty  Co 947 

Cook  County  Graduate 

School  of  Medicine 990 

Country  Club  Pharmacy 988 

Cutter  Laboratories  945 

Dansberry’s  Pharmacy  989 

Deep  Rock  Water 969 

Denver  Chemical  Mfg.  Co., 

Inc.,  The  969 

Denver  Oxygen  Co 900 

Denver  Surgical  Supply^  Co._971 
Dorothy  Olssen’s  Sanatorium  973 

Dorr  Optical  Co 902 

Downing  Street  Pharmacy 989 


Page 

Doyle’s  Pharmacy  988 

Dryer  & Astler  Printing  Co. ^985 

Earnest  Drug  Company 988 

Ehret  Engraving  Co 900 

Fairfax  Sanitarium  977 

Fairhaven  Maternity 

Hospital  892 

Franklin  Drug  Company 989 

Glockner  Penrose  Hospital 977 

Holland-Rantos  Company 897 

Hyde’s  Pharmacy  988 

Jackson’s  Cut  Rate  Drug- 987 

Karg-  Paint  Co 987 

Kendrick-Bellamy  Co. 890 

Kincaid’s  Pharmacy 988 

Lakewood  Pharmacy  989 

Lederle  Laboratories  899 

Lilly,  Eli  & Co. 

Insert  Between 904-905 

Livermore  Sanitarium  975 

M & R Dietetic  Laboratories  949 

Malone  Drug  Store 979 

Mead,  Johnson  & Co Cover  IV 

Medical  Center  Pharmacy 971 

Merck  & Co.,  Inc 957 

Newton  Optical  Company 985 

Nurses  Official  Registry 969 

Otto  Drug-  Company 988 

Overstake’s  Pharmacy 989 

Park  Floral  Compan.v 900 

Parke,  Davis  & Co Cover  H-889 

Peters,  Writer  & Christensen, 

Inc.  983 

Philip  Morris  & Co 955 

Physicians  and  Hospitals 

Supply  Co.,  Inc 963 


Page 


Physicians  and  Surgeons' 

Supply  983 

Physicians  and  Surgeons 

Telephone  Service  Exch.  985 

Physicians  Casualty  Assn 990 

Professional  Pharmacy 989 

Public  Service  Company 975 

Restaurant  240  987 

Roberts  Pharmacy  988 

Roche  Ambulance  Service 987 

Roedel’s  Prescription  Drug._979 

Sandoz  Pharmaceuticals  973 

Schering-  Corporation  895 

Searle,  G.  D.  & Co 943 

Shadel  Sanitarium Cover  III 

Shadford-Fletcher  Optical  Co._898 

Shumake  Drug,  Guido 988 

Smith-Dorsey  Co.,  The 965 

Squibb,  E.  R.  & Sons 903 

Stodghill’s  Imperial 

Pharmacy  983 

Telephone  Answering  Siervice_892 

Thornton,  Georg-e  R 890 

Tours  Hotel 971 

United  States  Brewing- 

Industry  986 

Van's  Pharmacy 989 

Walter's  Drug  Store 989 

Wantads  985 

Weiss  Drug  989 

Weiss,  Paul  977 

Western  Electric 

Hearing-  Aids  977 

Western  Newspaper  Union 983 

Wheatridge  Farm  Dairy 985 

Whittaker’s  Pharmacy 988 

Winthrop-Stearns,  Inc.  891 

Woodcroft  Hospital  992 

York  Pharmacy  979 


for  November,  1949 


991 


A private  hospital  for  the  scientific  treatment  of  neuro-psychiatric  disorders,  including 
alcoholism  and  drug  addiction.  Beautiful  landscaping  and  home-like  surroundings  afford 
a restful  atmosphere.  Accommodations  vary  from  single  rooms  with  or  without  bath  to 
rooms  en  suite,  allowing  for  segregation  of  guests. 


Detailed  information  furnished  on  request. 

Karl  J.  Waggener,  M.D.  Wendell  T.  Wingett,  M.D. 


THE  CHILDREN’S  HOSPITAL  ASSOCIATION 

of  DENVER 

NON-SECTARIAN NON-PROFIT 

Providing  medicinal  and  surgical  aid  to  sick  and  crippled  children  of  the  Rocky 
Mountain  Region  from  Birth  to  Maturity 

Every  modern  scientific  aid  available  to  the  physicians  and  surgeons 
of  Colorado  and  Wyoming 

Approved  by  the  American  Medical  Association  and  Full  Three-Year 

the  American  College  of  Surgeons  Nurses’  Training  Course 


992 


Rocky  Mountain  Medical  Journal 


L 


Sy7A//r///?/l/A1 


RECOGNIZED  BY  THE 

A.  M.  A. 

MEMBER  OF  THE 

A.  H.  A. 


Shadel  Sanitarium  has  combined  research, 
treatment  and  rehabilitation  to  return  thousands 
of  Alcoholics  to  normal  living.  Groundwork 
for  recovery  is  laid  through  intensive, 
individualized  therapy.  Rehabilitation  follows 
with  the  family  doctor  supervising  the 
patient’s  physical  needs  and  the  Sanitarium’s 
Field  Rehabilitation  staff  assisting  with  his 
alcoholic  problems.  Our  object  is  . . . 
cooperation  with  the  family  physieian  in 
mapping  the  road  to  recovery. 


1935  TO  1949 

SPECIALISTS  IN  THERAPY  FOR  CHRONIC  ALCOHOLISM 


BY  THE  CONDITIONED  REFLEX  AND  ADJUVANT  METHODS 
7106  35th  AVE.  S.  W.  SEATTLE  6,  WASH.,  WEST  7232,  CABLE  ADDRESS;  "REFLEX” 


While  careful  supervision  is 

^ commonly  maintained  over 

the  feeding  of  infants,  in  too  many  cases  the 
nutrition  of  older  children  escapes  the  doc- 
tor’s supervision.  Dietary  surveys  of  older 
children  have  shown  a high  incidence  of 
malnutrition. 

Mead’s  Oleum  Percomorphum  With 
Other  Fish  Liver  Oils  and  Viosterol  is  a re- 
liable, convenient  product  for  providing 
vitamin  D in  addition  to  vitamin  A.  The 
vitamin  D exercises  a favorable  influence  on 


calcium  and  phosphorus  metabolism,  plays 
an  important  role  in  tooth  formation,  and, 
in  some  instances,  aids  in  preventing  and 
arresting  dental  caries. 

With  the  possible  exception  of  the  middle 
of  the  first  year,  the  need  for  vitamin  D is 
probably  greater  during  adolescence  than 
at  any  other  time. 


OLEUM  PERCOMORPHUM 


DROPPER  BOTTLES— 10  cc.  and  50  cc.  (60,000  units 
vitamin  A and  8,500  units  vitamin  D per  gram). 

CAPSULES — Bottles  of  50  and  250  capsules  (5,000 
units  vitamin  A ; 700  units  vitamin  D per  capsule). 


-'^rOELPl^A^ 


Volume  46 


Number  1 2 


Anokexia  Nekvosa — Douglas  D.  Bund,  M.D.,  Cleve- 
land. 

Recent  Advances  in  the  Care  of  the  Deafened — 
J.  Mackenzie  Brown.  M.D..  Los  Angeles. 

Surgical  Treatment  of  Hermaphroditism— 
Claude  L.  Shields,  M.D.,  C.  B.  Freudenberger, 
M.D..  and  Orin  Ogilvie.  M.D.,  Salt  Lake  City. 

Review  of  Management  of  Persistent  Occiput 
Posterior  Positions — Harold  W.  Fuller,  M.D., 
Earl  L.  Hall,  M.D..  and  Frank  L.  McPhail,  M.D., 
Great  Falls. 

Surgical  Significance  of  the  Non-P''unctioning 
Gall  Bladder — E.  J.  Lowell,  Jr.,  M.D.,  Denver. 

Colorado  House  of  Delegates — Minutes  of  the 
Seventy-ninth  Annual  Session. 


(Fur  Complete  Table  of  Contents, 

turn  the  first  page)  ^ ' 

tliWAHY  OF  THE 

eatllQE  OF>HfSlClANS 


©f  f KlUUDEliPHlA 


25c  Per  Copy 


$2.50  Per  Year 


f 


Effective 


Indispensable 


in  medical  and  surgical  practice, 
ADRENALIN  — the  pure,  crystalline 
hormone  of  the  adrenal  medulla  — was 
isolated  and  its  formula  determined  at  the 
Parke-Davis  Research  Laboratories  in  1901. 


Available 


as  ADRENALIN  CHLORIDE  SOLUTION  1:1000; 
ADRENALIN  CHLORIDE  SOLUTION  1:100; 

ADRENALIN  IN  OIL  1:500. 


New  and  Nonofficial  Remedies,  Philadelphia, 

J.  B.  Lippincott,  1949,  p.  234, 


OF  THE 

COLIEGE  OF  f-HYSlCIAt!« 


W'T’T  TiUT  R 


in  relaxing  bronchial  muscles  and  in 
markedly  increasing  vital  capacity, 
ADRENALIN  (epinephrine,  Parke-Davis) 
is  “most  valuable  for  treating  a severe 
acute  attack  of  asthma.”*  One  of  the 
truly  basic  drugs,  it  is  also  used 
extensively  in  the  treatment  of  such 
I conditions  as  urticaria,  angioneurotic 
i edema,  anaphylaxis,  serum  sickness  and 
nitritoid  reactions. 


Adrenalin 

plays  a prominent  life-saving  role 
in  the  Adams-Stokes  syndrome, 
anesthesia  accidents  and  other  emergencies. 
Combined  with  anesthetics  it  minimizes 
bleeding  and  prolongs  anesthesia  by  localizing 
the  site  of  action.  Topically  applied 
to  mucous  membranes  it  relieves  catarrhal 
and  congestive  conditions. 


Men  feel  very  much  at  home 
here  in  selecting 

☆ Gifts  for  Women 

* Fountain  Pens  and  Sets 

* Crane’s  Writing  Papers 

* Writing  Portfolios 

* Framed  Pictures 
Books;  Guest  Books 

^ Date  Books  & Diaries 


“Life  Among  the  Doctors” 
tells  of  the  revolutionary 
changes  in  medicine  dur- 
ing the  past  ten  years,  in 
language  everyone  can  un- 
derstand. $4.75. 


Come  In.  Phone  KE.  0241  or  Mail  Your 
Orders.  Use  Your  Charge  Account. 


J{£/nckie^ 


The  Book  Store  of  Denver 

KEystone  0241 
1641  California  St.  Denver  2,  Colorado 


Qeo-.  R,. 

Orthopedic  Brace 
and  Appliance  Co. 

1628  Court  Place  MAin  3026 

Write  for  Measuring  Chart 


Table  of  Contents 


VOLUME  46 


NUMBER  12 


DECEMBER,  1949 


Editorials 

It’s  Time  to  Buy  Christmas  Seals 1009 

Sudden  Social  Change — A National  Ca- 
tastrophe   1009 

Perverted  Emotional  Outlets 1011 


-f 


Original  Articles 

Anorexia  Nervosa,  Douglas  D.  Bond,  M.D...1012 

Recent  Advances  in  the  Care  of  the  Deaf- 
ened, J.  Mackenzie  Brown,  M.D 1020 

Surgical  Treatment  of  Hermaphroditism, 
Claude  L.  Shields,  M.D.,  C.  B.  Freuden- 
berger,  M.  D.,  and  Orin  Ogilvie,  M.D 1024 

Review  of  Management  of  Persistent  Oc- 
ciput Posterior  Positions,  Harold  W.  Full- 
er, M.D.,  Earl  L.  Hall,  M.D.,  and  Frank 
L.  McPhail,  M.D 1027 

Surgical  Significance  of  the  Non-Function- 
ing Gall  Bladder,  E.  J.  Lowell,  Jr.,  M.D. ..1033 


Organization 

Colorado 

Minutes,  House  of  Delegates  of  the  Colo- 
rado State  Medical  Society,  Seventy- 


ninth  Annual  Session 1036 

Obituaries  1054 

Utah 

Obituary  1056 

Colorado  State  Health  Department 1056 

Book  Comer  1058 

Tuberculosis  Abstracts  1066 


994 


Rocky  Mountain  Medical  Journal 


4^;*^#.  *'-  V'” 

-T  . - 


promotes 


T 


Iteration  . . . free  droino^ 

|’;c<.'  -jn  colds 


sinusitis 


V-  f* 


m.4 


mm 


JNasal  engorgement  and  hypersecretion 
accompanying  the  common  cold  and  sinusitis  are 
quickly  relieved  by  the  vasoconstrictive  action  of 


Nasal  membrane  showing  increased 
leukocytes  with  denudation  of  cilia. 


Normal  appearing  nasal  epithelium. 


niEO- SVNEPH  BlI  NE® 

HYDROCHLORIDE 
Brand  of  Phenylephrine  Hydrochloride 


The  decongestive  action  of  several  drops  in  each 
nostril  usually  extends  over  two  to  four  hours.  The 
effect  is  undiminished  after  repeated  use. 

Relatively  nonirritating  . . . Virtually  no  central 
stimulation. 

Supplied  in  V4%  solution  (plain  and  aromatic), 
1 oz.  bottles.  Also  1%  solution  (when  greater  con- 
centration is  required),  1 oz.  bottles,  and  ’/2% 
water  soluble  jelly,  ¥b  oz.  tubes. 


Heo-Synephrlae,  trademark  reg,  U.  S.  & Canada 


ROCKY  MOUNTAIN  MEDICAL  JOURNAL 

Title  Registered,  U.S.  Patent  Office 
Publication  Office: 

835  Republic  Building  (1612  Tremont  Place),  Denver  2,  Colorado 
Telephone  CHerry  5521. 

EDITORIAL  BOARD 

Colorado:  Douglas  W.  Macomber,  M.D.,  Scientific  Editor,  1820  Gilpin  St.,  Denver;  Lyman  W.  Mason, 
M.D.,  Associate  Editor,  1214  Republic  Bldg.,  Denver,  (Chairman  of  Editorial  Board). 

Montana:  Raymond  F.  Peterson,  M.D.,  Scientific  Editor,  Butte,  Mont.;  Herbert  T.  Caraway,  M.D., 
Associate  Editor,  Billings,  Mont. 

New  Mexico:  Carl  H.  Gellenthein,  M.D.,  Scientific  Editor,  Valmora,  New  Mexico;  Harold  L.  Janu- 
ary, M.D.,  Associate  Editor,  First  National  Bank  Bldg.,  Albuquerque,  New  Mexico. 

Utah:  Richard  P.  Middleton,  M.D.,  Scientific  Editor.  Boston  Bldg..  Salt  Lake  City;  W.  H.  Tibbals, 
Associate  Editor,  42  South  Fifth  East  St.,  Salt  Lake  City. 

Wyoming:  Earl  Whedon,  M.D.,  Scientific  Editor,  Sheridan;  Arthur  R.  Abbey,  Associate  Editor,  P.O. 
Box  897,  Cheyenne. 


Managing  Editor:  Harvey  T.  Sethman,  835  Republic  Bldg.,  Denver. 
Business  Manager:  Helen  Kearney,  835  Republic  Bldg.,  Denver. 


Ownership  and  Sponsorship:  The  Rocky  Mountain 
Medical  Journal  Is  owned  by  the  Colorado  State 
Medical  Society  and  is  published  monthly  as  a non- 
profit enterprise  for  the  mutual  benefit  of  the  or- 
ganizations which  jointly  sponsor  it.  It  is  published 
under  the  direction  of  the  Board  of  Trustees  of  the 
Colorado  State  Medical  Society,  assisted  by  an  Edi- 
torial Board  representing  the  sponsoring  organiza- 
tions. It  is  the  Official  Journal  of  the  Colorado  State 
Medical  Society,  the  Montana  State  Medical  Associa- 
tion, the  New  Mexico  Medical  Society,  the  Utah 
State  Medical  Association,  the  Wyoming  State  Medi- 
cal Society,  the  Rocky  Mountain  Medical  Conference, 
and  the  Colorado  Hospital  Association. 

Mannscrlpts : Scientific  Articles,  Case  Reports,  etc., 
from  any  state  for  which  this  is  the  Official  Journal 
should  be  submitted  to  the  Scientific  Editor  for  that 
state  as  named  in  the  Editorial  Board,  above.  Other 
material  from  any  participating  state  should  be  sub- 
mitted to  the  Associate  Editor  for  that  state  as 
named  above.  Manuscripts  from  outside  the  Rocky 
Mountain  area  should  be  sent  direct  to  the  Journal 
office.  Manuscripts  must  be  typewritten,  double  or 
triple  spaced,  using  only  one  side  of  each  sheet.  It 
is  the  policy  of  this  Journal  to  omit  bibliographies. 


Advertising:  National  representatives:  The  Coop- 
erative Medical  Advertising  Bureau,  536  North  Dear- 
born Street,  Chicago  10,  111.  Local  advertising  from 
firms  in  the  Rocky  Mountain  area  should  be  submit- 
ted to  the  Associate  Editor  of  the  appropriate  state 
or  to  the  Journal  office.  Advertising  forms  close  on 
the  20th  of  the  month  preceding  publication;  allow 
ten  days  additional  to  insure  submitting  proofs  for 
approval. 

Subscription:  $2.50  per  year  in  advance,  postpaid  in 
the  United  States  and  its  possessions;  single  copy, 
25  cents  plus  postage.  Subscription  is  included  in 
medical  society  dues  of  sponsoring  state  medical 
organizations. 

Copyright:  This  Journal  is  copyright,  1949,  by  the 
Colorado  State  Medical  Society.  Requests  for  permis- 
sion to  reproduce  anything  from  the  columns  of  this 
Journal  should  be  addressed  to  the  Journal  office. 

Second  Class  Matter:  Entered  as  second  class  mat- 
ter Jan.  22,  1906,  at  the  Postoffice  at  Denver,  Colo., 
under  the  Act  of  Congress  of  March  3,  1879.  Accepted 
for  mailing  at  special  rates  of  postage  provided  for 
in  Section  1103,  Act  of  Oct.  3,  1917;  autnorised  July 
17,  1918. 


The  Fairhaven  Maternity  Hospital 

Mrs.  H.  E.  Lowther,  Superintendent 

Seclusion  for  the  unwed  mother.  Write  for  descriptive  booklet. 

1349  JOSEPHINE  DExter  1411  DENVER 


Don't  miss  important  telephone  calls 

Let  us  act  as  your  secretary  while  you  are  away,  day  or  night: 
^ ^ kindly  voice  conscientiously  tends  your  telephone  business. 


accurately  reports  to  you  when  you  return. 


Telephone  ANSWERING  Service  call  ALpine  i4i4 


Cambridge  Dairy  Grade  “A”  Milk  Is  Produced  and  Processed  at  690  S.  Colo.  Blvd. 

We  do  not  handle  Shipped-in  Milk  produced  Where?  How  and  by  Whom?  Doctors  know  the  difference 
Now  Homogenized  Vitamin  D Milk  is  available  for  baby  feeding  and  family  use. 

We  Invite  Your  Inspection  and  Appreciate  Your  Recommendation. 


Throat  Specialists 
report  on 
30-Day  Test  of 
Camel  smokers— 


dn'b)  smokm  CtUHtlis 


• Yes,  these  were  the  findings 
in  a total  of  2,470  weekly  ex- 
aminations of  hundreds  of 
men  and  women  from  coast 
to  coast  who  smoked  only 
Camels  for  30  consecutive 
days!  And  the  smokers  in  this 
test  averaged  one  to  two  pack- 
ages of  Camels  a day! 


EoJ.  Re7no!d§ 
Tobacco  Co., 
Winston-Salem, 
N.C. 


According  to  a Nationwide  survey: 


than  any  other  cigarette! 


Doctors  smoke  for  pleasure,  too!  When  three  leading  independent  research  organizations 
asked  113,597  doctors  what  cigarette  they  smoked,  the  brand  named  most  was  Camel! 


for  December,  1949 


997 


THE  COLORADO  STATE  MEDICAL  SOCIETY 

Next  Annual  Session:  Broadmoor  Hotel,  Colorado  Springs,  September  20,  21,  22,  23,  1950 


OFFICERS 

Terms  oi  Officers  and  Committees  expire  at  the  Annual  Session 
in  the  year  indicated.  Where  no  year  is  indicated,  the  term 
is  tor  one  year  only  and  expires  at  the  1950.  Annual  Session. 

President:  Fred  A.  Humphrey,  Fort  Collins. 

President-Elect:  Eryin  A.  Hinds,  Denver. 

Vice  President:  A.  B.  Giellam,  Del  Norte. 

Constitutional  Secretary  (three  years) : George  R.  Buck,  Denver,  1951. 
Treasurer  (three  years) : George  C.  Shivers,  Colorado  Springs,  1950. 

Additional  Trustees  (three  years):  Samuel  P.  Newman,  Denver,  1950; 
Claude  D.  Bonham,  Boulder,  1951;  Cyrus  W.  And'rson,  Denver,  1952; 
E.  H.  Munro,  Grand  Junction,  1952. 

(The  above  nine  officers  compose  the  Board  of  Trustees  of  which  Dr. 
Samuel  P.  .Newman  is  the  1949-1950  Chairman.) 

Board  of  Councilors  (three  years):  District  No.  1:  Clemens  F.  Eakins, 
Brush,  1951;  No.  2:  Ella  A.  Mead,  Greeley,  1951;  No.  3:  L.  G.  Crosby, 
Denver,  1951  (Chairman  of  Board  for  1949-50);  No.'  4;  Canning  E. 
Likes,  Lamar,  1950;  No.  5:  Guy  H.  Hopkins,  Pueblo,  1950;  No.  6:  C.  Rex 
Fuller,  Salida,  1950;  No.  7,  Leo  W,  Lloyd,  Durango,  1952;  No.  8:  Arch 

H.  Gould,  Grand  Junction,  1952;  No.  9:  Marvel  L.  Crawford,  Steamboat 
Springs,  1952. 

Board  of  Supervisors  (two  years):  L.  D.  Buchanan,  Wray,  1950;  W.  F. 
Deal,  Craig,  1950;  G.  C.  Cary,  Grand  Junction,  1950,  Chairman;  W.  A. 
Campbell,  Colorado  Springs,  1950;  Ralph  S.  Johnston,  Sr.,  La  Junta,  1950; 
William  A.  Liggett,  Denver,  1950,  Secretary;  Edgar  A.  Eliff,  Sterling, 
1951;  Keith  P.  Krausnick,  Lamar,  1951;  Charles  L.  Mason,  Durango, 


Delegates  to  American  Medical  Association  (ftPo  years) : WiUiain.  H. 
Halley,  Denver,  1950;  (Alternate;  Kenneth  C.  Sawyer,  Denver,  lS§®) ; 
George  A.  Unfug,  Pueblo,  1951;  (Alternate:  Herman  C.  Graves,  Grand 
Junction,  1951), 

Foundation  Advocate:  Walter  W.  King,  Denver. 

Executive  Office  Staff:  Mr.  Harvey  T.  Sethman,  Executive  Secretary; 
Miss  Helen  Kearney,  Assistant  Executive  Secretary;  Mr.  Evan  A.  Edwards, 
Public  Relations  Director  and  Piel(T  Secretary,  835  Republic  Building, 
Denver  2,  Colorado,  Telephone  CHerry  5521. 

General  Counsel:  Mr.  J.  Peter  Nordlund,  Attorney-at-Law,  Denver. 


STANDING  COMMITTEES 

Credentials:  George  R.  Buck,  Denver,  Chairman;  others  to  be  appointed. 

Public  Policy:  M.  L.  Phelps,  Denver,  Chairman:  C.  F.  Hegner.  Denver; 

I.  E.  Hendryson,  Denver,  Vice  Chairman;  F.  B.  McGlone,  Denver;  W.  R. 
Lipscomb,  Denver;  T.  M.  Rogers,  Sterling;  Sidney  Anderson,  Alamosa; 
Harvey  M,  Tupper,  Grant  Junction;  C.  S.  Gydesen,  Colorado  Springs;  R.  L. 
Davis,  La  Junta:  R.  T.  Porter,  Greeley;  G.  C.  Milligan,  Englewood;  Francis 
S.  Adams.  Pueblo;  Ex-Officio  Members;  F.  A.  Humphrey,  Fort  Collins,  Presi- 
dent; Ervin  A,  Hinrts,  Denver,  President-Elect;  George  R.  Buck,  Denver, 
Constitutional  Secretary. 

Sub-Committee  on  Legislation;  John  B.  Farley,  Pueblo,  Chairman. 

Subcommittee  on  Nurses’  Education:  L.  R.  Safarik,  Denver,  Chairman; 
John  R.  Evans,  Co-chairman;  Frank  B.  McGlone,  Denver;  Harry  C.  Bryan, 
Colorado  Springs;  Robert  T.  Porter,  Greeley. 

Health  Education  (two  years):  E.  H.  Munro,  Grand  Junction,  1950; 
F.  0.  Robertson,  Denver.  1950;  R.  B.  Bradshaw,  Alamosa,  1950;  James 
A.  Matson,  Denver,  1950.;  Miss  Norma  Johannis,  Denver,  1950;  H.  T. 
Low,  Pueblo,  1950;  J.  D.  Bartholomew,  Boulder,  Chairman,  1951;  A.  C. 
Sudan,  Denver,  1951;  R.  J.  Savage,  Denver,  1951. 

Sub-Committee  on  Weekly  Health  Column:  J.  L.  Campbell,  Denver,  Chair- 
man: F.  C.  Campbell,  Denver;  E.  L.  Binkley,  Denver;  H.  F.  Bramley, 
Denver. 

Scientific  Work:  Terry  J.  Gromer,  Denver,  Chairman;  William  B.  Condon, 
Denver;  Robert  S.  Liggett,  Denver;  E.  L.  Binkley,  Jr.,  Denver;  T.  E.  Best, 
Denver:  James  M.  Perkins,  Denver;  Joseph  H.  Patterson,  Denver. 

Arrangements;  To  be  appointed. 

Medicolegal  (two  years)  ; R.  W.  Arndt.  Denver,  1950;  George  B,  Packard, 
Denver,  1950;  K.  D.  A.  Allen,  Denver,  1950:  C,  S.  Bluemel,  Denver. 
Chairman,  1951:  Lymaiv  W.  Mason.  Denver,  1951:  Atha  Thomas,  Denver. 
1951. 


Medical  Education  and  Hospitals;  Fred  H.  Hartshorn,  Denver,  Chairman: 
George  F.  Wollgast,  Denver;  Kenneth  C.  Sawyer,  Denver;  James  E.  Hutchison, 
Denver;  Robert  S.  Liggett.  Denver;  Henry  Swan,  Denver;  J.  B.  McNaught, 
Denver.  Ex-Officio  Members:  P.  A.  Humphrey,  Fort  Collins,  President, 
C.S.M.S. : Ervin  A.  Hinds,  President-Elect,  C.S.M.S. ; Mr.  Hubert  W.  Hughes. 
Denver,  President,  Colo.  Hosp.  Assoc.;  Ward  Darley,  Dir.  of  the  Univ.  of 
Colo.  Medical  Center. 

Library  and  Medical  Literature:  W.  W.  King,  Denver,  Chairman;  A.  J. 
Markley,  Denver;  T.  E.  Beyer,  Denver. 

Medical  Service  Plans:  James  R.  Blair,  Denver,  Chairman;  F.  H.  Good. 
Denver:  Henry  A.  Buchtel,  Denver;  T.  K.  Mahan,  Grand  Junction;  V.  L. 
Bolton,  Colorado  Springs :Scott  A.  Gale,  Pueblo;  L.  W.  Holden,  Boulder; 

J.  A.  Weaver,  Jr.,  Greeley. 

Necrology:  R.  C.  Chatfield.  Denver,  Chairman. 


PUBLIC  HEALTH  COMMITTEES 

General  Commij|4ee  on  Public  Health:  Consists  of  the  chairmen  of  the 
following  eight  gubUc  health  sub-committees,  presided  over  by  James  S. 
Cullyford,  Denv^,  as  General  Chairman. 

Cancer  Control :‘  Stanley  K.  Kurland,  Denver,  Chairman;  J.  C.  Mendenhall, 
Denver;  L.  E.  Likes,  Lamar;  Robert  K.  Brown,  Denver;  James  B.  McNaught, 
Denver. 

Tuberculosis  Control:  John  I.  Zarit,  Denver,  Chairman;  W.  J.  Hinzelman, 
Greeley;  J.  P.  McGraw,  Pueblo. 

Sanitation:  H.  D.  Palmer,  Denver,  Chairman;  G.  W.  Stiles,  Denver: 
S.  W.  Downing',  Denver. 

Rural  Health  and  Health  Units:  Robert  M.  Lee,  Fort  Collins,  Chairman. 
L.  N.  Myers,  Cheyenne  Wells;  M.  R.  Tyler,  Denver. 

Industrial  Health;  R.  F.  Bell,  Louviers,  Chairman;  David  W.  Boyer, 
Pueblo;  Nicholas  S.  Saliba,  Walsenburg;  Frank  Princi,  Denver. 

Maternal  and  Child  Health:  J.  L.  Sadler,  Fort  Collins,  Chairman;  J.  H. 
Amesse,  Denver;  J.  D.  Whitmore,  Denver. 

Rehabilitation  and  Crippled  Children:  H.  C.  Hughes,  Denver,  Chairman; 
Lewis  Barbate,  Denver;  M.  G.  Nims,  Denver;'  W.  W.  Haggart,  Denver: 
R.  H.  Mellen,  Colorado  Springs;  John  Nelson,  Denver. 

Mental  Hygiene:  F.  H.  Zimmerman,  Pueblo,  Chairman;  Bradford  Murphey, 
Denver;  J.  M.  Lyon,  Denver. 


SPECIAL  COMMITTEES 

Rocky  Mountain  Medical  Conference  (five  years):  D.  W.  Macomber, 
Denver,  1954;  L.  Clark  Hepp,  Denver,  1953;  G.  P.  Lingenfelter,  Denver, 
Chairman,  1952;  Ward  Darley,  Denver,  1951;  L.  W.  Bortree,  Colorado 
Springs,  1950. 

Advisory  to  Auxiliary:  Ervin  A'.  Hinds,  Denver,  Chairman;  Samuel  P. 
Newman,  Denver;  M.  L.  Phelps,  Denver. 

Medical  Disaster  Commission:  Foster  Matchett,  Denver.  Chairman;  0.  S. 
Philpott,  Denver,  Vice  Chairman;  Karl  P.  Arndt,  Denver,  Secretary;  Harry 
C.  Hughes,  Denver;  R.  J.  McDonald,  Denver;  Karl  F.  Sunderland,  Denver: 
Henry  Swan,  Denver;  Rudolph  E.  Glehm,  Denver;  William  S.  Curtis,  Denver; 
M.  S.  Donovan,  Denver;  T.  P.  Sears,  Fort  Logan.  Others  to  be  appointed. 

Advisory  to  U.M.W.  Welfare  Fund  (Executive  Committtee,  three-year 
terms;  others,  one  year);  Executive:  Ligon  Price,  Hayden,  1952;  J.  H. 
Lamme,  Walsenburg,  1952;  W.  W.  Haggart,  Chairman,  1951;  F.  H.  Good, 
1951;  J.  S.  Bouslog,  1951,  all  of  Denver;  W.  H.  Halley,  1950;  C.  F. 
Hegner,  1950.,  both  of  Denver;  R.  F.  Bell,  1950,  Louviers.  Other  mem- 
bers: D.  W.  McCarty,  Longmont,  1950:  J.  W.  Craighead.  Pueblo,  1950; 
F.  A.  Humphrey,  Fort  ColUns,  1950;  Millard  F.  Smith,  Trinidad,  1950. 

A.M.A.  Educational  Campaign:  John  S.  Bouslog,  Chairman;  A.  B.  Lub- 
ch.cnco.  Vice  Chairman;  Ervin  A.  Hinds,  George  R.  Buck,  McKinnie  L. 
Phelps,  William  H.  Halley,  all  of  Denver,  plus  one  member  from  each 
component  society  appointed  by  that  society  (names  to  be  added  here 
ra:xt  month). 

Delegate  to  Colorado  Interprofessional  Council  (five  years):  L.  R. 
Safarik,  Denver,  1954;  (Alternate,  J.  R.  Evans,  Denver,  1954). 

Representative  to  Rocky  Mountain  Radio  Council:  I.  E.  Hendryson,  Denver. 

Repr  sentatives  to  Adult  Education  Council:  Cyrus  W.  Anderson  and 
Dilliam  E.  Hay,  both  of  Denver. 


998 


Rocky  Mountain  Medical  Journal 


much 

to 

recommend 

it 


SOLGANAL 


(aurothioglucose) 


Schering’s  aurothioglucose  has  much  to  recommend 
it  for  the  treatment  of  active  rheumatoid  arthritis. 
Water  soluble,  but  suspended  in  oil  to  provide  pro- 
longed absorption,  it  is  effective  in  small  dosage, 
frequently  inducing  remissions  in  early  acute  phases 
of  the  disorder. 

in  active  rheumatoid  arthritis 

Marked  improvement  has  been  reported  in  “50  to  60 
per  cent  of  patients,  moderate  improvement  in  20  to 
25  per  cent.  . . Among  1000  patients  treated  re- 
cently with  SoLGANAL,  there  were  no  fatalities  and 
few  instances  of  severe  toxicity.^ 

1.  Rawls,  W.  B.;  New  York  Med.  (no.  15)  3:19,  1947.. 


CORPORATION  BLOOMFIELD,  N.  J. 


SOLGANAL 


MONTANA  STATE  MEDICAL  ASSOCIATION 

NEXT  ANNUAL  SESSION:  BOZEMAN,  MONTANA,  SUMMER,  1950 


OFFICERS,  194»-1»50 

Terms  of  Officers  and  Committees  expire  at  the  Annual  Session 
in  the  year  indicated.  Where  no  year  is  indicated,  the  term 
is  for  oin  year  only  and  expires  at  1950  Annual  Session. 

President:  Thomas  F.  Walker.  Great  Falls. 

President-Elect:  C.  H.  Fredrickson,  Missoula. 

Vice  President:  F.  L.  MiPhail,  Great  Falls. 

Secretary- Treasurer:  Herbert  T.  Caraway.  Billings. 

Delegate  to  American  Medical  Association:  Raymond  F.  Peterson,  Butte, 
‘950;  Alternate,  Thomas  B,  Moore,  Kalispell,  1950. 

STANDING  COMMITTEES 
Executive  Committee:  Thos.  P.  Walker,  Great  Palls,  Chairman;  L.  W. 
Allard,  Billings;  H.  T.  Caraway,  Billings;  C.  H.  Fredrickson,  Missoula; 

Thos.  L.  Hawkins,  Helena. 

Economic  Committee:  M.  A.  Shillington,  Glendive,  Chairman;  W.  E. 
Harris,  Livingston;  W.  E.  Long,  Anaconda;  D.  S.  MacKehzie,  Jr.,  Havre; 
J.  C.  Shields,  Butte:  E.  A.  Welden,  Lewistown. 

Legislative  Committee;  I.  J.  Bridenstine,  Missoula,  Chairman;  J.  M. 
Flinn.  Helena:  T.  L.  Hawkins,  Helena;  R,  C.  Monahan,  Butte;  T.  B.  Moore, 
Kalispell;  S.  D.  Whetstone.  Cut  Bank. 

Necrology  and  History  of  Medicine  Committee:  L.  W.  Brewer,  Missoula, 

Chalrm,an;  .\.  A.  Dodge,  Kalispell;  J.  H.  Garherson,  Miles  City;  E.  M. 
Gans,  Harlowtou;  J.  P.  Ritchey,  Missoula;  J.  I.  Wernham,.  Billings. 

Public  Relations  Committee:  H.  T.  Caraway,  Billings,  Chairman;  A.  W. 
Axley,  Havre;  R.  F.  Peterson,  Butte;  L.  G.  Russell,  Billings;  R.  L. 
Towne,  Kalispell. 

Legal  Affairs  and  Malpractice  Committee:  A.  L.  Gleason,  Great  Falls, 
Chairman;  J.  H,  Bridenbaugh.  Billings;  M.  0.  Burns,  Kalispell;  P.  E. 

Kane.  Butte;  li.  1).  Knapp,  Wolf  Point;  A.  M.  Lueck,  Livingston;  J.  C. 

MacGregor,  Great  Falls;  W.  F.  Morrison,  Missoula;  B.  R.  Tarbox,  Forsyth. 

Program  Committee:  H.  W.  Gregg.  Butte,  Chairman;  R.  L.  Casebeer, 
Butte:  C.  II.  Fredrickson,  Missoula;  J.  A.  Layne,  Great  Falls;  J.  J.  Malee, 
Anaconda. 

interprofessional  Relationship  Committee:  L.  W.  Allard,  Billings,  Chair- 
man: C.  R..ICanty,  Butte;  R.  A.  Benke,  Kalispell;  B.  J.  Heetderks,  Boze- 
man : E.  S.  Murphy,  Missoula. 

Nominating  Committee:  J.  H.  Garberson,  Miles  City,  Chairman:  R.  G, 
Johnson,  Harlowton;  J.  P.  Ritchey,  Missoula;  F.  I.  Sabo,  Bozeman: 

S.  V.  Wilking.  Butte. 

Auditing  Committe;:  G.  W.  Setzer,  Malta,  Chairman;  C.  P.  Brooke, 
St.  Ignatius;  Robt.  Leeds,  Chinook;  P,  E.  Logan,  Great  Falls;  R.  G. 

Scherer,  Bozeman. 

Cancer  Committee:  Mary  Martin,  Billings,  Chairm.an;  R.  E.  Benson. 
Billings:  W.  F.  Cashmore,  Helena;  Walter  B.  Cox,  Missoula;  D.  C.  Epler, 
Bozeman;  Philip  PallistCr,  Boulder;  W.  C.  Robinson,  Shelby. 


Maternal  and  Child  Welfare  Committee:  F.  L.  McPhail,  Great  rails. 
Chairman. 

Subcommittee  on  Obstetrics:  E.  L.  Hall,  Great  Falls,  Chairman;  L.  A. 
Barrow,  Billings;  L.  W.  Brewer,  Missoula;  H.  B.  Campbell,  Missoula; 
G.  A.  Carmichael,  Missoula;  Maude  Gerdes,  Billings;  J.  E.  Hynes, 
Billings;  R.  E Mattison,  Billings;  C.  W.  Pemberton,,  Butte;  S.  N.  Preston, 
Missoula;  .A.  E.  Ritt,  Great  Falls. 

Subcommittee  on  Pediatrics:  G.  H.  Barmeyer,  Missoula;  B.  C.  Farrand, 
Jordan;  F.  J.  Friden,  Great  Falls;  D.  L.  Gillespie,  Butte;  E.  A.  Hagmann, 
Billings;  0.  M.  Moore,  Helena. 

Tuberculosis  Committee;  P.  L.  Eneboe,  Bozeman,  Chairman;  G.  A. 
Anderson,  Deer  Lodge;  H.  V.  Gibson,  Great  Falls;  A.  R.  Klintner,  Mis- 
soula; P.  A.  Smith,  Glasgow:  F.  I.  Terrill,  Galen. 

Fracture  and  Orthopedic  Committee:  W.  H.  Hagen,  Billings,  Chairman; 

L.  W,  Allard.  Billings;  J.  K.  Colman,  Butte;  S.  L.  Odgers,  Butte;  Geo. 
A.  Sexton,  Great  Falls;  J.  C.  Wolgamot,  Great  Falls. 

Rural  Health  Committee:  B.  C.  Farrand,  Jordan,  Chairman;  P.  S. 
Cannon,  Conrad;  L.  S.  Crary,  Fairfield;  David  Gregory,  Glasgow;  W.  G. 
Tanglin,  Poison. 

Industrial  Welfare  Committee:  J.  M.  Hickes,  Great  Falls,  Chairman; 
R E.  Brogan,  Billings;  A.  R.  Little,  Helena;  Geo.  G.  Sale,  Missoula; 
It.  E.  Walker,  Livingston;  F.  L.  Dnmack,  Deer  Lodge. 

Rheumatic  Fever  and  Heart  Committee:  F.  R.  Schemm,  Great  Falls,  Chair- 
man; R.  L.  Eck,  Lewistown:  F.  J.  Friden,  Great  Falls;  D,  L,  Gillespie, 

Butte;  J.  3.  Gilson.  Great  Falls;  H.  W.  Gregg,  Butte;  Elizabeth  Grimm, 
Billings;  T.  F.  Walker,  Jr.,  Great  Falls;  0.  M.  Moore,  Helena. 

Rocky  Mountain  Medical  Conference  Committee;  Thos.  F.  Walker,  Great 
Falls,  1950;  John  E.  Hynes,  Billings,  1951;  F.  K.  Waniata,  Great  Falls, 
1952;  H.  W.  Gregg,  Butte,  1953;  H.  T.  Caraway,  Billings,  1954. 

SPECIAL  COMMITTEES 

Emergency  Medical  Service  Committee:  D.  J.  MacDonald,  Billings,  Chair- 
man; Paul  J.  Gans,  Lewistown;  L.  G.  Griffis,  Kalispell;  T.  M.  Keenan, 

Great  Falls;  S.  A.  Olson.  Glendive;  W.  P.  Smith,  Columbia, 

Industrial  Accident  Board  Committee:  Thos.  L.  Hawkins.  Helena,  Chair- 
man; D.  J.  Almas,  Havre;  H.  H.  James,  Butte;  E.  R.  Grigg,  Bozeman; 

E.  L.  Gallivan,  Helena. 

Hospital  Relations  Committee:  E.  HUdebrand,  Great  Falls,  Chairman; 
R.  B.  Beans,  Great  Falls;  J.  H.  Bridenbaugh,  Billings;  Walter  B.  Cox, 

Missoula;  R.  S.  Leighton,  Great  Palis;  W.  W.  McLaughlin,  Great  Fails; 

Mary  iMartin,  Billings;  R.  F,  Peterson,  Butte;  G.  P.  Riatt,  BHlings; 
P.  T,  Spurck,  Butte. 

Mental  Hygiene  Committeee:  W.  S.  Wilder,  Warm  Springs,  Chairman; 
J.  J.  Bulger,  Great  Falls;  R.  W.  Clapp,  Butte;  M.  A.  Ruona,  Billings; 

M.  A.  Shillington.  Glendive. 


Collection 

Accounts 

All  rcporls  sliow  a trend  toward  slower  and  harder  collections  in  the 
months  idiead. 

■At  the  first  sign  of  neglect  you  will  save  money  if  they  are  turned  over 
to  us  for  collection. 

Comparison  of  collection  results,  hacked  by  35  years  of  experience,  proves 
yon  olitain  greater  results  at  less  cost,  when  you  list  your  accounts 

with 

The  American  Medical  and  De 

Suite  524,  810  14th  St.  TAbor  2331 

mtal  Association 

Denver,  Colorado 

1000 


Rocky  Mountain  Medical  Journal 


the  stuhhornest 
epistaxis 
with  Gelfoam 


And  in  many  other  situations  the  physician  and  J 

surgeon  can  rely  on  the  notable  hemostatic  powers  of 
Gelfoam,*  an  absorbable  gelatin  sponge.  Its  biochemical 
clotting  action  rapidly  controls  trickling  from 
. small  \ein;-.  oozing  surfaces,  hemorrhages  following 
J ic-'-cx  lion  and  capillary  bleeding.  Readily  cut  W’ 

jl  or  molded  lo  any  needed  shape,  easily  applied  ' 

(with  or  without  thrombin), 

■'  I Gelfoam  may  be  left  in 

the  wound  with  minimum 


Kit 


'A: 


>-:V 


ii; 


- y 


'.C'’-  \ t >• 


it  --. 

s*  ’ 'wA-ir ' .'i 


likelihood  of  tissue  reaction. 

•Trademark,  Reg.  U.S.  Pat.  OfF. 

Upjohn 

Fine  pharmaceuticals  since  1886 


for  December,  1949 


1001 


NEW  MEXICO  MEDICAL  SOCIETY 


OFFICERS— 1949-1950 

President:  W.  Hannett,  Albuquerque. 

President-Elect:  1.  J.  Marshall,  Roswell. 

Vice  President:  Leland  S.  Evans,  Las  Cruces. 

Secretary-Treasurer:  H.  L.  January,  Albuquerque. 

Executive  Secretary:  Mr.  Ralph  R.  Marshall,  Albuquerque. 

Councilors  (3  years):  Carl  Mulky,  Albuquerque;  J.  C.  Sedgwick,  Las 
Cruces.  (2  years):  W.  D.  Dabbs,  Clovis;  A.  C.  Shuler,  Carlsbad.  (1  year): 
A.  S.  Lathrop,  Santa  Fe;  C.  H.  Gellenthien,  Valmora. 

Delegate  to  A.M.A.:  John  F.  Conway,  Clovis,  1950. 

Alternate  Delegate  to  A.M.A.:  C.  H.  Gellenthien,  Valmora,  1950. 

COMMITTEES— 1949-1950 

Basic  Science:  Raymond  L.  Young,  Santa  Fe,  Chairman;  W.  E.  Nissen, 
Albuquerque:  Walter  A.  Stark,  Las  Vegas. 

Rural  Medical  Service:  Stuart  Adler,  Albuquerque,  Chairman;  Samuel  R. 
Zelgler,  Espanola,  A.  T. .Gordon,  Tucumcari;  L.  G.  Foster,  Reserve;  J.  P. 
Turner,  Carrizozo. 

Cancer:  Murray  Friedman,  Santa  Fe,  Chairman;  Van  A.  Odle,  Roswell; 
J.  R.  Van  Atta,  Albuquerque;  J.  W.  Grossman,  Albuquerque;  R.  C.  Derby- 
shire, Artesia. 


Venereal  Disease  Control:  Sam  Jelso,  Albuquerque,  Chairman;  V.  E.  Berch- 
told,  Santa  Fe;  L.  M.  Miles,  Albuquerque;  Vincent  Accardi,  Gallup;  F.  C. 
Bohannon,  Carlsl'ad. 

Legislative  and  Public  Policy:  A.  S.  Lathrop,  Santa  Fe,  Chairman;  H.  T. 
Watson,  Gallup;  C.  B.  Elliott,  Raton;  John  F.  Conway,  Clovis;  H.  M.  Mor- 
timer, Las  Vegas;  G.  S.  Morrison,  Roswell;  R.  A.  Watts,  Silver  City: 

Ashley  Pond,  Taos:  W.  L.  Minear,  Hot  Springs;  L.  S.  Evans,  Las  Cruces; 
W.  JI.  Thaxton,  Tucumcari  William  C.  White,  Los  Alamos:  W.  0.  Connor, 
■Albuquerque,  C.  S.  Stone,  Hobbs;  A.  C.  Shuler,  Carlsbad:  E.  A.  Heffner, 

Hobbs. 

Public  Relations:  C.  P.  Bunch,  Artesia,  Chairman;  Earl  L.  Malone,  Ros- 
well: 0.  S.  Cramer,  Albuquerque;  Eric  P.  Hausner,  Santa  Fe;  E.  A. 
Heffner,  Hobbs. 

Tuberculosis:  C.  H.  Gellenthien,  Valmora,  Chairman;  William  H.  Thearle, 
Albuquerque;  P.  0.  Shields,  Albuquerque:  Carl  Mulky,  Albuquerque;  H.  S. 

A.  Alexander,  Santa  Fe. 

Advisory  Conmittee  on  Insurance  Compensation:  L.  M.  Overton,  Albuquer- 
que. Chairman;  R.  E.  Forbis,  Albuquerque;  Edward  Pamall.  Albuquerque;  H. 
D.  Corbusier.  Santa  Fe. 

National  Emergency  Medical  Service:  A.  E.  Reymont,  Santa  Fe,  Chair- 
man: L.  G.  Rice,  Albuquerque;  C.  M.  Thompson,  Albuquerque. 

Board  of  Supervisors:  L.  G.  Rice,  Bernalillo  County:  Van  A.  Odle,  Chaves 
County;  Milton  Floersheim,  Colfax  County;  John  F.  Conway,  Curry  County; 
C.  P.  Bunch.  Eddy  County;  Prank  W.  Parker,  Jr.,  McKinley  County; 
LeGrand  Ward,  Santa  Fe  County:  W.  A.  Stark,  San  Miguel  County. 


Oculist  Prescription  Service  Exclusively 

SHADFORD-FLETCHER  OPTICAL 

Dispensing  Opticians 

228  16th  Street,  Denver,  Colo.  AComo  2611 
3705  East  Colfax  (Medical  Center  Building).  FLorido  0202 


CO 


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1 

1 

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ill 

These  fine  Dairy  Cattle,  a portion  of  City  Park’s  large  herd  of  Guernsey  and  Holstein 
cows,  are  scientifically  fed  and  cared  for,  continuously  tested  by  competent  veterin- 
arians. Only  through  such  precise  watchfulness  does  City  Park  Milk  receive  Grade 
"A"  designation  which  it  enjoys.  Choose  City  Park’s  regular  Grade  “A”  Pasteurized 
or  Homogenized  milk  today  — notice  the  particularly  clean,  fresh  flavor. 


’Phone 

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Cherry  Creek 
Drive — Denver 


1002 


Rocky  Mountain  Medical  Journal 


Folic  acid,  in  either  free  or  conjugated  form, 
is  a normal  constituent  of  the  tissues  of  the  body 
and  is  usually  present  in  the  gastrointestinal 
tract.  Not  only  are  the  glossitis  and  enteritis  of 
sprue  dramatically  relieved  by  folic  acid  but 
the  blood  picture  is  also  simultaneously  improved. 
Lederle  has  been  extremely  active  in  conducting 
research  in  the  field  of  nutrition,  both  in  animals 
and  man,  and  it  is  anticipated  that  the 
orientation  of  folic  acid  with  respect  to  a number 
of  other  nutritional  factors  — including  the 
anti-pernicious  anemia  factor  and  the  animal  protein 
factor  — will  soon  be  made  clear. 


LEDERLE  LABORATORIES  DIVISION  am ert. Gmmunid company  30  Rockefeller  Plaza,  New  York  20,  N . Y. 


for  December,  1949 


1003 


THE  UTAH  STATE  MEDICAL  ASSOCIATION 


OFFICKRS,  1949-1950 

President:  Ccurad  H.  Jenson,  Ogden. 

President-Elect.  V.  P.  Wliite,  Salt  Lake  City. 

Past  President.  0.  A.  Ogileie,  Salt  Lake  City. 

Honorary  President:  D.  G.  Edmunds,  Salt  Lake  City. 

First  Vice  President:  Sims  E.  Duggins,  Panguitcli. 

Second  Vice  President:  Jules  E.  Trowbridge,  Bountiful. 

Third  Vice  President:  Seth  E.  Smoot,  Provo. 

Secretary:  T.  C.  Weggeland,  Salt  Lake  City. 

Executive  Secretary:  Mr.  W.  H.  Tibbals,  Salt  Lake  City. 

Treasurer:  L J.  Paul,  Salt  Lake  City. 

Councilor  First  District:  J.  G.  Olson,  Ogden. 

Councilor  Second  District:  Vincent  L.  Bees,  Salt  Lake  City. 

Councilor  Third  District:  L.  W.  Oaks,  Provo. 

Delegate  to  A.M.A.,  1950  and  1951:  George  Fister,  Ogden. 

Alternate  Delegate  to  A.M.A.,  1950  and  1951:  J.  J.  Weight,  Provo. 
Editor  of  the  Utah  Section  of  the  Rocky  Mountain  Medical  Journal: 
R.  P.  Middleton,  Salt  Lake  City. 

Board  of  Supervisors:  1951,  Clark  Rich,  Ogden:  1952,  Ezra  Cragun, 
Logan;  1953,  Paul  K.  Edmunds,  Cedar  City;  1954,  J.  G.  McQuarrie, 
Richfield;  1955,  J.  C.  Hubbard,  Price. 

STANDING  COMMITTEES 
Rocky  Mountain  Medical  Conference  Continuing  Committee:  1950,  K.  B. 
Castleton,  Chrirman,  Salt  Lake  City;  1951,  Clark  Rich,  Ogden;  1952, 
Noall  Z.  Tannei,  Layton;  1953,  T.  R.  Seager,  Vernal;  1954,  R.  P. 
Middleton,  Salt  Lake  City. 

Scientific  Program  Committee:  T.  C.  Weggeland,  Chairman,  Salt  Lake 
City;  Vincent  L Rees,  Salt  Lake  City. 

Public  Policy  and  Legislation  Committee:  1950,  N.  F.  Hicken,  Chair- 
man, Salt  Lake  City;  1950,  Omar  Budge,  Logan;  1950,  George  A.  Allen, 
Salt  Lake  City:  1951,  F.  R,  King,  Price:  1951,  R.  V.  Larson,  Roose- 
velt; 1951,  W.  B.  West,  Ogden;  1952,  Chas.  Ruggeii,  Salt  Lake  City; 
1952,  J.  C.  Hubbard,  Price;  1952,  Wilford  G.  Biesinger,  Springville. 

Medical  Defense  Committee:  1950,  Homer  Smith,  Salt  Lake  City; 
1950,  L.  N.  Ossman,  Chairman,  Salt  Lake  City;  1950.  Edwin  P.  Zeman, 
Ogden;  1951,  Charles  W.  Woodruff,  Salt  Lake  City:  1951,  James  West- 
wood,  Provo;  1951,  L.  H.  Merrill,  Hiawatha:  1952,  E.  L.  Hanson, 
Logan;  1952.  Reed  Farnsworth,  Cedar  City;  1952,  H.  A.  Dewey,  Riclifield. 

Medical  Education  and  Hospitals  Committee:  1950,  G.  G.  Richards, 
Chairman,  Sait  Lake  City;  1950,  Ray  T!  Woolsey,  Salt  Lake  City;  1950, 
T.  E.  Robinson,  Salt  Lake  City;  1951,  John  Bowen,  Provo;  1951,  George 


d^etter  at  P. 


rices 


'Orders  Delivered  to  Any  City  by 
Guaranteed  Service” 


Special  attention  given  to  floral  tributes 
Also  Hospital  Flowers 

CaU  KEystone  5106 

Vark  3loral  Co.  Store 

1643  Broadway  Denver,  Colo. 


H.  Curtis,  Salt  Lake  City;  1951,  R.  0.  Porter,  Logan;  1952,  Ralph 
Ellis,  Ogden;  1952,  Philip  Price,  Salt  Lake  City;  1952,  W.  H.  Ander- 
son, Ogden. 

Medical  Economics  Committee;  1950.  W.  T.  Ward,  Salt  Lake  City; 
1951,  W.  li.  Merrill,  Brigham  City;  1951,  Ralph  Pendleton,  Chairman, 

Salt  Lake  City;  1952,  Grant  F.  Kearns,  Ogden;  1952,  Preston  Hughes, 
Spanish  Fork. 

Public  Health  Committee:  1950,  F.  D.  Spencer,  Salt  Lake  City;  1951, 
R.  N.  Hirst,  Ogden;  1952,  Seth  E,  Smoot,  Provo;  1952,  James  Z. 
Davis,  Chairman,  Salt  Lake  City. 

Military  Affairs  and  National  Emergency  Committee:  Charles  Woodruff, 
Chairman,  Salt  Lake  City;  L.  J.  Paul,  Salt  Lake  City;  Mazel  Skolfield, 

Salt  Lake  City;  W.  M.  Gorishek,  Standardville;  L.  K.  CuUimore,  Orem; 

Ray  H.  Barton.  Magna;  D.  T.  Madsen,  Price;  Riley  G.  Clark,  Provo; 
Willis  Hayward,  Logan;  Leo  Benson,  Ogden. 

Tuberculosis  and  Cardiovascular  Diseases  Committee:  Elmer  M.  Kirkpatrick, 
Chairman,  Salt  Lake  City:  Ray  Rumel,  Salt  Lake  City;  W.  C.  Walker, 

Salt  Lake  City;  Donald  M.  Moore,  Ogden;  Don  C.  Merrill,  Provo;  D.  0. 
N.  Lindberg  (Associate  Member),  Ogden. 

Cancer  Committee:  James  P.  Kerby.  Salt  Lake  City;  E.  A.  Lawrence, 
Salt  Lake  City;  J.  Elmer  Nielson,  Chairman,  Salt  Lake  City;  E.  D.  Zeman, 
Ogden;  James  Westwood,  Provo;  W.  J.  Reichman,  St.  George;  J.  Clare 
Hajwvard,  Logan;  R.  V.  Larsen,  Roosevelt;  T.  R.  Gledhill,  Richfield; 
Quinn  A.  Whiting,  Price. 

Fracture  Committee:  A.  M.  Okelberry,  Chairman,  Salt  Lake  City;  Boyd 
G.  Holbrook,  Salt  Lake  City;  Louis  Peery,  Ogden;  Paul  A.  Pemberton, 

Salt  Lake  City. 

Necrology  Committee:  E.  B.  Muir,  Chairman,  Salt  Lake  City;  A.  S. 

Crandall,  Salt  Lake  City. 

Industrial  Health  Committee:  Frank  J.  Winget,  Chairman,  Salt  Lake 
City;  Byron  W.  Daynes,  Salt  Lake  City;  Wayne  Aired,  Orem;  W.  F. 
Loomis,  Ogden;  Sherman  Brinton,  Salt  Lake  City. 

Advisory  Committee  to  the  Woman’s  Auxiliary;  Silas  S.  Smith,  Chair- 

man, Salt  Lake  City;  A.  A.  Imus,  Ogden;  J.  R.  Smith,  Provo. 

Public  Relations  Committee:  Ray  T.  Woolsey,  Chairman,  Salt  Lake  City; 
L.  V.  Broadbent,  Cedar  City;  Geo.  H.  Lowe,  Jr.,  Ogden;  0.  P.  Heninger, 

Provo;  R.  N.  Malouf,  Richfield;  Ray  E.  Spendlove,  Vernal;  Paul  Burgess, 
Hyrum;  J.  Leroy  Kimball,  Salt  Lake  City. 

Mental  Health  Committee:  E.  L.  Weimers,  Provo;  Wm.  D.  O'Gorman, 

Ogden;  L.  G.  Moench,  Salt  Lake  City;  Roy  A.  Darke,  Chairman,  Salt 
Lake  City. 

Rural  Health  Committee:  J.  J.  Weight,  Chairman,  Provo;  Joseph 
Tanner,  Layton;  T.  R.  Aldous.  Tooele;  Harold  E.  Young,  Midvale;  J.  H. 
Rasmusson,  Brigham  City. 

Professional  and  Hospital  Relationships  Committee:  James  P.  Kerby, 
Chairman,  Salt  Lake  City;  V.  P.  White,  Salt  Lake  City;  R.  P.  Middle- 
ton,  Salt  Lake  City:  Leland  R.  Cowan,  Salt  Lake  City;  V.  L.  Ward, 

Ogden;  J.  Rustsell  Smith,  Provo;  Hugh  0.  Brown,  Salt  Lake  City. 


(^xuaen 


Corner  10th  and  Lawrence  Sts. 
TAbor  5138 


nc. 


Medical  Gas  Division 

MEDICAL  OXYGEN 

CARBON  DIOXIDE-OXYGEN  MIXTURES 
AVIATORS'  BREATHING  OXYGEN 
WATER  COMPRESSED  NITROGEN 
WATER  COMPRESSED  AIR 

NITROUS  OXIDE  ETHYLENE  CYCLOPROPANE 
HELIUM  OXYGEN  MIXTURE  PURE  HELIUM  100% 

Twenty-Four  Hour  Service 


COLOR  PROCESS. 

LINE  & HALFTONE 

BEN  DAY 

ILLUSTRATORS-DESIGNERS 


PHOTO 

ENGRAVERS 


1004 


Rocky  Mountain  Medical  Journal 


. . . was  developed  to  fill  the 
“need  for  an  insulin  with 
activity  intermediate  betiveen 
that  of  regular  insulin  and  that 
of  protamine  zinc  insulin.”^ 


IN  1939,  Reiner,  Searle  and  Lang  described  a new 
“intermediate  acting”  insulin. 


IN  1943,  after  successful  clinical  testing,  the  new  sub- 
stance was  released  to  the  profession  as  ‘Wellcome’ 
brand  Globin  Insulin  with  Zinc  ‘B.W  & Co.’ 


TODAY,  according  to  Rohr  and  Colwell,  “Fully  80% 
of  all  severe  diabetics  can  be  balanced  satisfactorily”^ 
with  Globin  Insulin  ‘B.W.  & Co.’— or  with  a 2:1  mixture 
of  regular  insulin : protamine  zinc  insulin.  Ready-to-use 
Globin  Insulin  ‘B.W.  & Co.’  provides  the  desired  inter- 
mediate action  without  preliminary  mixing  in  vial  or 
syringe. 

In  10  cc.  vials,  U-40  and  U-80. 


1.  Rohr,  J.H.,  and  Colwell,  A.R.:  Arch.  Int. 
Med.  82:54,  1948. 

2.  ibid  Proc.  Am.  Diabetes  Assn.  8:37,  1948. 


‘B.W.&CO.’— a mark  to  remember 


BURROUGHS  WELLCOME  & C0.(U.S.A.)  INC.  Tuckahoer.Newvork 


for  December,  1949 


1005 


THE  WYOMING  STATE  MEDICAL  SOCIETY 


OFFICERS 

President:  DeWitt  Dominick,  Cody. 

President-Elect:  Karl  Krueger.  Rock  Springs. 

Vice  President:  Paul  Holtz,  Lander. 

Treasurer:  P.  M.  Schunk.  Sheridan. 

Secretary:  G.  H.  Phelps,  Cheyenne. 

Delegate  A.M.A  : Roscoe  Reeve,  Casper. 

Alternate  Delegate  A.M.A. : W.  A.  Bunten,  Cheyenne. 

Executive  Secretary:  Mr.  Arthur  R.  Abbey,  Cheyenne. 

COMMITTEES 

Rocky  Mountain  Medical  Conference:  Earl  Whedon,  Chairman,  Sheridan; 
George  H.  Phelps.  Cheyenne:  H.  L.  Harvey,  Casper;  C.  W.  Jeffrey. 
Rawlins;  L.  W.  Storey,  Laramie. 

Syphilis  Committee:  L.  H.  Wilmoth,  Chairman,  Lander;  F.  H.  Haigler, 
Ca.sper:  N.  E.  Morad,  Casper;  C.  L.  Rogers,  Sheridan;  B.  Gitlitz,  Ther- 
mopolis. 

Cancer  Committee:  John  Gramlich,  Chairman,  Cheyenne;  M.  C.  Henrich, 
Casper;  Thomas  B.  Croft,  Lowell;  J.  R.  Newnara.  Cheyenne;  Franklin 
Yoder,  Cheyeime. 

Medical  Economics  Committee:  C.  L.  Rogers,  Chairman,  Sheridan:  Nels 
A.  Vicklund,  Thermopolis;  H.  L.  Harvey,  Casper;  J.  S.  Hellewell,  Evans- 
ton; H.  E.  Stuckenhoff,  Casper. 

Fracture  Committee  and  Industrial  Health:  W.  K.  Mylar,  Chairman, 
Cheyenne;  Gordon  ^^^^iston.  Casper;  K.  E.  Krueger,  Rock  Springs;  Eugene 
Pelton,  Laramie;  Lowell  D.  Kattenhoni,  Powell;  J.  E.  Hoadley,  Gillette; 
Philip  Teal.  Cheyenne. 

Medical  Defense  Committee:  George  E.  Baker,  Chairman,  Casper;  W.  A. 
Bunten,  Cheyenne;  E.  W.  DeKay,  Laramie. 

Councillors:  Earl  Whedon,  Chairman,  Sheridan;  George  E.  Baker,  Casper; 
E.  W.  DeKay.  Laramie;  DeWitt  Dominick,  President,  Cody;  George  H. 

Phelps,  Secretar>’,  Cheyenne. 

Advisory  to  Women’s  Auxiliary:  Thomas  B.  Croft.  Chairman,  Lovell; 
John  R.  Bunch,  Laramie;  W.  A.  Bunten,  Cheyenne;  J.  C.  Jones,  Cody. 

Veterans  Affairs  and  Military  Service  Committee:  G.  W.  Koford,  Chair- 
man, Cheyenne;  Jack  Rowlett.  Laramie;  L.  B.  Moi^aii,  Torrington;  R.  C. 

Stratton,  Green  River;  Bernard  Sullivan,  Laramie;  G.  W.  Henderson. 


Casper;  G.  .M.  Knapp.  Casper;  A.  J.  Allegretti,  Chej’enne;  E.  J.  Guilfoyle. 
Newcastle;  DeWitt  Dominick.  President,  Cody;  George  H.  Phelps.  Secretary, 
Cheyenne. 

Blue  Cross  Hospital  Committee:  R.  I.  Williams,  Chairman,  Cheyenne, 
i9.50;  E.  W.  DeKay,  Laramie,  1951;  J.  Cedric  Jones,  Cody,  1952;  J.  W. 
Sampson,  Sheridan,  1953. 

Public  Policy  and  Legislation:  George  H.  Phelps,  Chairman.  Cheyenne; 

George  E.  Baker.  Casper:  W.  A.  Bunten,  Cheyenne;  E.  W.  DeKay,  Laramie; 
C.  W.  Jeffrey,  Rawlins;  G.  W.  Koford,  Cheyenne;  K.  E.  Krueger,  Rock 
Springs;  R.  H.  Reeve,  Casper. 

Poliomyelitis  Committee:  E.  W.  Gardner,  Chairman.  Douglas;  E.  C. 
Ridgway.  Cody:  Franklin  Yoder,  Cheyenne;  Bernard  Stack.  Thermopolis; 

Philip  Teal,  Cheyenne;  G.  0.  Beach,  Casper;  B.  J.  Sullivan,  Laramie. 

State  Institutions  Advisory  Committee:  R.  H.  Kanable,  Chairman.  Basin: 
George  H.  Phelps,  Cheyenne;  Franklin  Yoder,  Cheyenne;  George  R.  James. 
Casper;  C.  D.  Anton.  Sheridan;  J.  S.  Hellewell,  Evanston. 

Necrology  Committee:  Earl  Whedon.  Chairman,  Sheridan;  C.  H.  Platz. 
Casper;  Franklin  Yoder,  Cheyenne. 

Public  Health  Department  Liaison  Committee:  E.  C.  Ridgway.  Chairman, 

Cody;  R.  P.  Fitzgerald.  Casper;  J.'  W.  Sampson,  Sheridan;  R.  C.  Stratton. 
Green  River;  0.  K.  Scott,  Casper;  E.  G.  Johnson.  Douglas. 

Rural  Health  Committee:  Paul  Holtz.  Chairman.  Lander;  William  K. 

Roseue,  Wheatland;  Andrew  Bunten,  Cheyenne;  G.  M.  Knapp.  Casper; 
R.  N.  Bridenbaugh.  Powell. 

Child  Health  Committee:  0.  K.  Scott.  Chairman,  Casper;  Paul  Emerson. 
Cheyenne;  John  Gramlich,  Cheyenne;  J.  T.  Murphy,  Casper;  E.  C.  Ridgway, 
Cedy. ; David  M.  Flett,  Cheyenne;  A.  R.  Abbey,  Cheyenne. 

Council  on  National  Emergency  Medical  Service:  George  H.  Phelps,  Chair- 
man, Cheyenne;  R.  H.  Reeve.  Casper:  E.  W.  DeKay,  Laramie;  P.  M. 
Schunk.  Sheridan;  K.  S.  Krueger,  Rock  Springs;  Albert  T.  Sudman, 
Green  River. 

Judicial  and  Advisory  Committee:  District  7,  George  E.  Baker,  Chairman, 
Casper;  District  1,  George  H.  Phelps,  Cheyenne;  District  1,  R.  I.  Williams, 
Cheyenne;  District  1,  J.  D.  Shingle.  Cheyenne;  District  2.  C.  W.  Jeffrey. 
Rawlins;  District  3.  J.  S.  Hellewell,  Evanston;  District  4,  P.  M.  Schunk. 
Sheridan;  District  5,  J.  Cedric  .Jones,  Cody;  Di.strict  6,  E.  J.  Guilfoyle. 
Newcastle. 


COLORADO  HOSPITAL  ASSOCIATION 


OFFICERS 

Presid:tit:  James  P.  Dixon,  Denver  General  Hospital,  Denver.  , 

President-Elect;  Helen  Pixley,  Park  View  Episcopal  Hospital,  Pueblo. 
Vice  President:  Sr.  M.  Johanna,  Sacred  Heart  Hospital,  Lamar. 

Treasurer;  M.  A.  Moritz,  Denver  General  Hospital,  Denver. 

Executive  Secretary;  R.  A.  Pontow,  Colorado  General  Hospital.  Denver. 
Trustets:  Louis  Liswood,  National  Jewish  Hospital,  Denver  (1950): 

DtMoss  Taliaferro,  Children’s  Hospital,  Denver  (1950);  Roy  R.  Anderson, 
Presbyterian  Hospital,  Denver  (1950):  Rev.  Allen  H.  Erb,  Meniionite 
Hospital  and  Sanitarii’m,  La  Junta  (19511;  Roy  R.  Prangley,  St.  Luke’s 
Hospital,  Denver  (1952);  Hubert  IT.  Hughes.  General-Rose  Slemorial 
hospital,  Denver  (1952). 

Delegate  to  the  American  Hospital  Association:  Msgr.  John  R.  Mulroy, 

Catholic  Hospitals,  Denver. 

Alternate:  Herbert  A.  Black,  M.D.,  Parkview  Hospital,  Pueblo. 

STANDING  COMMITTEES 
Auditing:  R W.  Pontow,  Chairman  (1949),  Colorado  General  Hospital, 

Denver: 'Rev.  E.  J.  Friedrich  (1950),  Lutheran  Sanatorium,  Wheatrldge; 
Karl  Mortensen  (1951),  St  Luke’s  Hospital,  Denver. 

Constitution  and  Rules:  Samuel  S.  Golden,  M.D..  Chairman,  Beth  Israel 
Hospital,  Denver;  Henry  H.  Hill,  Weld  County  Hospital,  Greeley;  Sister 
M.  Johanna,  Sacred  Heart  Hospital.  Lam  r. 

Legislative:  Msgr.  John  R.  Mulroy,  Chairman,  Catholic  Hospitals,  Den- 
ver; DeMoss  TaUaferro,  Children’s  Hospital,  Denver;  Carl  Pt  Schwalb, 
Denver;  Herbert  A.  Black,  M.D.,  Parkview  Hospital,  Pueblo. 

Membership:  Sister  M.  Alphonsus  Chairman,  Mercy  Hospital,  Denver; 
Coy  R.  Prangley,  St.  Luke’s  Hospital,  Denver. 

Resolutions:  Walter  G.  Christie,  Chairman,  Presbyterian  Hospital,  Denver; 
■Carl  Ph.  Schwalb,  Denver. 

Nominating:  Msgr.  John  E.  Mulroy,  Chairman  (1949),  CathoUc  Hos- 
■pltals,  Denver;  Herbert  A.  Black,  M.D.  (1950),  Parkview  Hospital,  Pueblo; 
'C.  S.  Bluemel,  M.D.  (1951),  Mount  Airy  Sanatorium,  Denver. 

Program:  Grorge  A.  W.  Currie,  M.D.,  Chairman,  Dnlversity  of  Ciolorado 
■Medical  Center.  Denver;  Boy  Anderson.  Presbyterian  Hospital,  Denver. 


Nursing:  DcMoss  TaUaferro,  Chairman,  Children’s  Hospital,  Denver; 
Sister  M.  Hugnlina,  St,  Anthony  Hospital,  Denver:  Margaret  E.  Paetznlck, 
Director  of  Nurses,  Denver  General  Hospital,  Denver;  Sister  Maria  Gratia, 
R.N.,  Glockner  Sanatorium,  Colorado  Springs;  S.  Buss  Denzler,  M.D., 
Colorado  Hospital.  Canon  City. 

Public  Education;  Owen  B.  Stubben,  Chairman.  Denver  General  Hospital, 
Denver;  Mr.  Torgersen.  Longmont  Hospital  and  CUnic,  Longmont:  Ward 
Darley,  M.D.,  Director,  University  of  Colorado  Medical  Center,  Denver; 
Chas.  Levine,  J.C.R.S.,  Spivak. 

SPECIAL,  COMMITTEES 

Public  Relations:  James  P.  Dixon,  M.D.,  Chairman.  Denver  General 
Hospital,  Denve.*;  Sister  Mary  Lina,  St.  Francis  Hospital,  Colorado  Springs. 

Rates  and  Charges:  Boy  Anderson,  Chairman,  Presbyterian  Hospital, 
Denver:  Msgr.  John  R.  Mulroy,  Catholic  Hospitals,  Denver:  Boy  B. 
Prangley,  SL  Luke’s  Hospital,  Denver;  Walter  G.  Christie,  Presbyterian 
Hospital  Denver.  DeMoss  Taliaferro,  Children’s  Hospital,  Denver;  Ben 
M.  Blumberg,  General  Rose  Memorial  Hospital,  Denver. 

State  Board  of  Health  Advisory:  Msgr.  John  R.  Mulroy,  Chairman, 
CathoUc  Ilospials,  Denver;  DeMoss  TaUaferro,  ChUdren’s  Bos^tal,  Denver: 
Herbert  A.  Black.  M.D.,  Parkview  Hospital.  Pueblo. 

Committee  on  Hospital  Licensing  Regulations  and  Standards:  Msgr.  J(^ 
R.  Mulroy,  Ch.alrman,  CathoUc  Hospitals,  Denver;  Boy  B.  Prangley,  SL 
Luke’s  Hospital,  Denver;  Owen  B.  Stubben,  Denver  General  Hospital,  Denver; 
DeMoss  Taliaferro,  Children’s  Hospital,  Denver;  Roy  Anderson,  Prisbyterian 
Hospital.  Denver. 

Premature  Infant  Care:  DeMoss  TaUaferro,  Chairman,  Cbldlron’s  Hos- 
pital, Denver;  Roy  Anderson,  Presbyterian  Hospital,  Denver. 

Rehabilitation  Center;  James  P.  Dixon,  M.D.,  Denver  General  Hospital. 
Denver;  Msgr.  John  B.  Mulroy,  Catholic  Hospitals,  Denver;  Louis  M. 
Liswood,  National  Jewish  Hospital,  Denver. 

Inter-Professional  Connell:  Hubert  W.  Hughes,  St.  Anthony  Hospital. 
Denver. 


A 


ccuracij  an 


J ^j^eed  in  j^redcription  S. 


eruice 


DORR  OPTICAL  COMPANY 

421  16th  Street  Denver,  Colorado  KEystone  5511 


1.006 


Rocky  Mountain  Medical  Journal 


CHECK 

LIST 

for  choice  of 
a laxative 

Phospho-  type  of 
Soda  action 

^ Prompt  action 
^ Thorough  action 
^ Gentle  action 


SIDE 

EFFECTS 

^ Free  from 

Mucosal  Irritation 

^ Absence  of  Con- 
stipation Rebound 

^ No  Development 
of  Tolerance 

^ Safe  from  Excessive 
Dehydration 

No  Disturbance  of 
Absorption  of 
Nutritive  Elements 

^ Causes  no 

Pelvic  Congestion 

^ No  Patient 
Discomfort 

^ Nonhabituating 

^ Free  from 

Cumulative  Effects 


Judicious  Laxation 

...through  freedom  from 
undesirable  side  effects 

The  clinical  preference  for  Pbospho-Soda  (Fleet)* 
stems  in  large  part  from  its  freedom  from  unde- 
sirabte  side  effects.  This  desidet'otum,  together 
with  its  controlled  action  and  ease  of  adminis- 
tration, assure  safe,  effective  anticostive  therapy 
from  every  prescription  of  this  "tried  and  true" 
laxative  agent.  Clinical  samples  on  request. 

C.  B.  FLEET  CO.,  INC.  • LYNCHBURG,  VIRGINIA 

•'PHOSPHO-SODA'  ond  'FLEET' 
ore  registered  trade-marks  of  C.  6.  Fleet  Co.,  Inc, 


adminis- 

tration 

^ Flexible  Dosage 
^ Uniform  Potency 
^ Pieasont  Taste 


PHOSPHO-SOUA 

(FIEEI) 


Phospho-Sodo  (Fieet)  is  0 so- 
lution containing  in  each  IQO 
cc.  sodium  biphosphdte  48  Om. 
and  sodium  phosphate  18  Gm. 


ACCEPTED  FOR  ADVERTISING  BY  THE  JOURNAL  OF  THE  AMERICAN  MEDICAL  ASSOCIATION 


for  December,  1949 


1007 


A sure  step  to  dietary  adequacy 


The  aim  of  the  dietary  at  all 
times  and  under  all  conditions  is  to  provide  ample 
amounts — not  just  minimum  amounts — of  all  nutrient 
essentials.  Only  when  the  daily  nutrient  intake  is  fully 
adequate,  based  on  the  most  authoritative  nutritional 
criteria,  can  the  possibility  of  adequate  nutrition  be 
assured.  It  is  for  this  reason  that  a food  supplement 
assumes  great  importance  in  daily  practice.  It  should 
be  rich  in  those  nutrients  most  likely  deficient  in  pre- 
vailing diets  or  in  restricted  diets  during  illness  and 
convalescence. 

The  multiple  nutrient  dietary  food  suppletnent,  Ovaltine 
in  milk,  is  especially  suited  for  transforming  even 
poor  diets  to  full  nutritional  adequacy.  This  is  clearly 
shown  by  the  data  in  the  table  above. 

Note  in  particular  the  high  percentages  of  the 
dietary  allowances  for  nutrients  and  the  relatively  low 
percentage  of  the  total  calories  furnished  by  the  serv- 
ings of  Ovaltine  in  milk.  Thus,  without  unduly  in- 
creasing the  caloric  intake,  Ovaltine  in  milk  greatly 
increases  the  contribution  of  nutrient  essentials.  En- 
ticing flavor  and  easy  digestibility  are  other  important 
features  of  this  dietary  supplement. 


Two  kinds,  Plain  and  Sweet  Chocolate  Flavored* 
Serving  for  serving,  they  ore  virtually 
identical  in  nutritional  content. 


THE  WANDER  COMPANY,  360  N.  MICHIGAN  AVE.,  CHICAGO  1,  ILL. 


1008 


Rocky  Mountain  Medical  Journal 


Liver  Plus  Stomach  = Red  Blood  Cells 


Liver-stomach  concentrate  was  discovered  and 
evaluated  in  the  Lilly  Research  Laboratories.  It  was  given 
the  trade-mark  name  ‘Extralin’  (Liver-Stomach 
Concentrate,  Lilly).  To  this  date  it  stands  out  as  a most 
effective  oral  treatment  for  pernicious  anemia.  Twelve 
Pulvules  ‘Extralin’  per  day  will  produce  a standard 
reticulocyte  response  in  previously  untreated  cases  in 
relapse.  The  same  dose  will  maintain  the  blood  picture  of  the 
average  uncomplicated  case  at  normal  levels.  Neurological 
involvement  is  prevented.  When  neural  symptoms  are 
present,  progression  is  promptly  arrested.  For  cases  in  which 
oral  antipernicious-anemia  therapy  is  indicated,  specify 
Pulvules  ‘Extralin.’  ‘Extralin’  may  be  prescribed  alone  or 
as  a supplement  to  injectable  liver  extract. 


'CCt/ 


ELI  LILLY  AND  COMPANY,  INDIANAPOLIS  6,  INDIANA,  U.S.A. 


coll 


(^■p-rUlADELPHlA 


Increasing  longevity  is  prima-facie  evidence  of  medical 
progress.  However,  as  more  people  grow  older,  physicians 
are  confronted  with  an  ever-increasing  number  of 
clinical  problems  which  arise  out  of  the  aging  process. 

It  is  no  longer  fantastic  to  assume  that  geriatrics  will 
someday  take  its  place  at  the  opposite  pole  from  pediatrics 
as  a full-fledged  specialty  practice. 

Diseases  of  the  heart,  kidney,  and  blood  vessels,  pernicious 
anemia,  diabetes  mellitus,  cancer,  and  other  conditions 
which  strike  most  frequently  after  middle  age  have  engaged 
a large  share  of  the  time  and  thought  of  Lilly  research  workers. 
Crystalline  digitoxin,  liver  extract,  liver-stomach  concentrate, 
and  Insulin  are  but  a few  of  the  important  contributions  in 
which  Eli  Lilly  and  Company  has  shared.  Perfecting  existing 
preparations,  as  well  as  searching  for  answers  to  unsolved 
problems,  keeps  teams  of  scientists  busy  at  the  Lilly  Research 
Laboratories.  Practical  developments  are  made  available  to 
the  medical  profession  wherever  ethical  pharmaceutical  and 
biological  products  are  sold. 


COMING:  THE  GERIATRICIAN 


A 75"  X 72"  reproduction  of  this  illustration 
by  Harold  Anderson  is  available  upon  request 


LILLY  SPECIALISTS  SERVE  THE  MEDICAL  PROFESSION 


SRocky 

Colorado 
Montana 
New  Mexico 
Utah 
Wyomin^r 


♦ 


DECEMBER 

1949 


yi/lountain 

y^edical  Journal 

E-ditorial » 


Ifs  Time  to  Buy 
Christmas  Seals 

PACH  year  about  this  time  we  begin  to 
see  in  store  windows  and  other  promi- 
nent places  rather  highly-colored  and  at- 
tractive posters  reminding  us  that  a group 
of  American  citizens  are  deeply  interested 
in  the  eradication  of  tuberculosis.  The  words 
“American  citizens”  are  used  because  these 
people  can  be  given  no  less  broad  definition. 
They  are  made  up  of  doctors,  nurses,  law- 
yers, ministers,  school  teachers,  business 
men,  laborers,  farmers — everyone.  They  are 
our  patients  as  well  as  ourselves.  As  “isms” 
have  taken  over  country  after  country, 
America  is  about  the  only  nation  left  today 
where  people  can  direct  their  efforts  vol- 
untarily to  encourage  eradication  of  a dis- 
ease. 

Tuberculosis  is  no  different  today  than  it 
was  one  hundred  years  ago,  except  that  the 
death  rate  is  falling.  Control  of  the  disease 
is  still  dependent  upon  the  isolation  of  ac- 
tive cases.  The  Tuberculosis  Associations 
throughout  the  United  States  originated  the 
idea  of  finding  tuberculosis  by  the  technic 
of  mass  x-raying.  Such  a program  was  re- 
cently carried  to  a successful  completion  in 
the  Denver  metropolitan  area  and  much 
of  its  success  was  due  to  the  efforts  of  the 
Tuberculosis  Associations  which  contributed 
heavily  financially  and  with  personnel,  both 
trained  and  untrained.  Yet  the  Tuberculosis 
Associations  received  almost  no  publicity 
or  public  credit  for  their  efforts  in  this 
and  similar  x-ray  surveys — official  agencies 
grabbed  the  headlines. 

Tuberculosis  Associations  receive  their 
support  from  their  annual  Christmas  Seal 
Sale.  The  cheerful  little  seals  that  appear 
on  so  many  of  the  envelopes  we  receive  in 


our  offices  in  December,  and  on  so  many 
of  the  Christmas  greeting  cards  at  our 
homes,  help  fight  tuberculosis  in  the  truly 
American,  voluntary  way. 

At  their  last  meeting,  the  Directors  of 
the  National  Tuberculosis  Association 
pledged  $200,000  a year  for  research  toward 
eradication  of  the  disease.  Each  state  as- 
sociation contributes  substantially  to  the 
support  of  research  programs.  These  are 
voluntary  American  dollars.  It  all  fits  in 
perfectly  with  our  construction  of  a great 
educational  campaign  for  the  maintenance 
of  the  American  way  of  life.  So  let  us  con- 
tribute generously  of  our  time,  our  energy, 
and  our  own  finances  to  support  of  our  local 
and  state  tuberculosis  associations.  Our 
patients  do;  let’s  join  them. 

R.  S.  LIGGETT,  M.D. 

^ <4  '4 

Sudden  Social  Change — 

A National  Catastrophe 

'^HE  annual  conference  of  State  Medical 
Association  Secretaries  and  Editors  at  the 
American  Medical  Association  Headquar- 
ters for  1949,  was  held  in  Chicago  last 
month.  One  of  the  most  inspiring  addresses 
during  this  important  meeting  was  by  J ohn 
W.  McPherrin,  New  York,  Editor  of  The 
American  Druggist. 

Mr.  McPherrin  had  made  a tour  of  Eng- 
land and  recorded  many  personal  observa- 
tions upon  the  British  National  Service  and 
its  results  to  date.  In  his  opinion  socialism 
is  merely  a polite  word  for  communism  and 
he  stated  that,  at  the  risk  of  being  sacrile- 
gious, the  people  come  to  adopt  as  their 
proverb  “The  State  is  my  shepherd;  I shall 
not  want.”  He  found  that  many  people,  a 
majority  of  men  on  the  street  and  in  the 


for  December,  1949 


1009 


pubs,  do  not  realize  that  78  per  cent  of  the 
cost  of  British  Health  scheme  comes  out  of 
general  taxation.  They  have  been  led  to 
believe  that  the  four  shillings  sixpence, 
more  or  less,  taken  from  the  pay  check 
covers  the  cost.  They  are  not  aware  of  its 
fabulous  and  unpredictable  cost.  For  ex- 
ample, cost  of  eye  glasses  alone  has  exceeded 
the  pre-scheme  estimate  by  650  per  cent. 
The  average  man  is  amazed  when  he  hears 
the  truth. 

There  are  apparently  three  classes  of  in- 
dividuals, when  classed  according  to  their 
resignation  to,  or  acceptance  of,  the  scheme. 
There  were  the  abusers,  out  to  get  every- 
thing they  can.  They  demand  a prescription 
for  everything  regardless  of  what  it  con- 
tains; they  want  glasses,  wigs,  or  teeth 
whether  they  need  them  or  not.  Then  there 
are  those  who  believe  that  the  scheme  can- 
not last  and  the  individual  should  get  all 
he  can  out  of  it  while  it  lasts.  Finally,  there 
are  the  objectors  who  demand  everything 
and  are  satisfied  with  nothing.  Each  of 
these  groups  constitutes  roughly  one-third 
of  the  populace.  There  are  relatively  fev/ 
who  aver  that  they  really  like  the  scheme. 
A bit  of  questioning  or  investigation  invari- 
ably discloses  that  these  are  the  individuals 
who,  for  one  reason  or  another,  are  better 
off  financially  than  during  pre-schem«. 
years.  (In  America,  many  people  during 
the  past  decade  or  two  have  been  better  off 
financially  than  ever  before.  Thus  they 
“like”  the  present  administration.)  There 
may  be  a pleasant  association  in  the  minds 
of  human  beings  between  their  personal 
welfare  and  that  of  the  State.  They  are  less 
apt  to  be  disturbed  about  the  state  of  na- 
tional affairs  when  their  private  larder  is 
comparatively  full.  Any  national  upheaval 
begets  a crop  of  individuals  who  profit  by 
the  new  situation.  Such  is  true  in  war  and 
in  peace.  The  small  minority  may  scream 
more  loudly  for  or  against  something  than 
the  combined  voices  of  all  who  suffer.  Hu- 
man selfishness  becomes  manifest  in  strange 
ways. 

What  about  the  reactions  of  doctors  them- 
selves? The  mediocre  practitioners  are  the 
ones  who  like  the  system.  They  find  them- 


selves “in  business  again”  through  no  spe- 
cial efforts  of  their  own.  Thus  the  “cash 
motif”  comes  out  and  human  selfishness  is 
the  basic  factor.  The  doctors  who  find  them- 
selves better  off  than  before  with  assured 
and  predictable  incomes  say,  “It’s  a great 
thing  for  humanity!”  Unfortunately  the 
outstanding,  scientific,  ambitious  and  pro- 
gressive doctors  are  always  outnumbered 
by  the  mediocre.  There  may  always  be  room 
for  our  leaders  at  the  top — if  there  is  a top. 
But  with  the  government  at  the  helm,  the 
top  would  be  hard  to  define,  and  if  there  is 
one  it  is  very  flat  indeed. 

England’s  Minister  of  Health,  Bevan  (not 
Bevin)  has  said  that  a great  social  change 
cannot  be  wrought  gradually.  It  must  come 
about  at  once,  on  a certain  day,  like  “D” 
day.  He  states  further  that  to  bring  it 
about  gradually  creates  resistances.  In  other 
words,  many  people  would  then  have  time  to 
come  to  their  senses  and  some  would  make 
their  voices  heard.  It  must  be  quick,  a vic- 
tim yielding  before  he  realizes  what  has 
been  done  to  him  (not  for  him) . When  one 
is  robbed,  as  in  a crooked  night  club,  it 
is  too  late  after  he  is  faced  with  the  bill. 
(Yes,  we  speak  from  experience!). 

Bevan  told  Mr.  McPherrin  that  the  Minis- 
ter must  have  complete  control  and  be  the 
‘■'master”  to  make  it  work.  We  might  ask  the 
master,  “Do  you  call  this  Democracy?” 

Oscar  Ewing,  America’s  Federal  Security 
Administrator,  has  said  that  it  would  be  a 
step  down  if  Truman’s  health  scheme  should 
interfere  with  private  enterprise.  On  the 
contrary,  Bevan  of  England  says  it  won’t 
work  without  complete  governmental  con- 
trol! Let  us  hope  that  an  enlightened  Amer- 
ica will  listen  to  the  man  and  the  country 
who  have  found  out  what  they  know  the 
hard  and  undemocratic  way.  As  we  have 
said  before  in  this  column,  the  important 
thing  is  what  happens  to  the  people  of 
America,  not  what  any  small  group  of  peo- 
ple want  or  how  much  money  they  make. 
We  speak  for  our  people  primarily,  for  doc- 
tors only  incidentally. 

Be  it  socialism  dr  communism,  they  both 
end  in  the  corner  stone  of  a welfare  state. 
Their  destiny  is  the  same — a destruction  of 


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the  faith  of  people  in  themselves.  We  and 
the  British  attest  that  we  like  Democracy 
but,  like  the  coffee  in  our  respective  lands, 
it  might  be  a different  blend.  We  believe 
that  the  solution  of  medical  care  problems 
in  a land  as  large  as  America  is  to  be  found 
at  the  local  level.  The  “blend”  need  not  be 
exactly  the  same  for  different  countries  or 
for  different  parts  of  the  same  country.  We 
believe  that  existing  and  rapidly  growing 
non-profit  plans  are  destined  to  succeed, 
that  they  will  provide  America’s  answer  to 
the  challenge  and  threat  of  those  who 
would  destroy  our  freedom. 

Perverted  Emotional 
Outlets 

TJROM  momentous  national  and  interna- 
tional  affairs,  let  us  descend  to  a most 
mundane  consideration  — thumb  sucking. 
No,  not  what  Fiddle  and  Faddle  or  the 
other  boys  do  in  Washington,  but  rather 
the  original  manifestation  of  immaturity 
and  frustration. 

We  are  prompted  by  another  medical  ar- 
ticle in  the  daily  paper,  this  one  entitled 
“Let  Your  Baby  Suck  His  Thumb.”  It  was 
written  by  an  Associated  Press  Science  Re- 
porter. Obviously  he  didn’t  know  what  he 
was  talking  about  any  more  than  did  a pro- 
fessor of  pediatrics  whom  the  writer  quoted. 

Some  of  our  colleagues  apparently  make 
a bid  for  favor  of  grandmothers  and  moth- 
ers by  sanctioning  a so-called  “natural”  per- 
version. They  talk  of  the  emotional  care 
of  babies  as  though  its  minor  aspects  have 
repercussions  half  a century  later.  If  the 
doctor  was  quoted  correctly,  he  had  told 
his  fellow  academy  members  that  thumb 
sucking  brings  satisfaction,  like  chewing 
gum  or  smoking  does  in  later  life.  He  did 
not  quote  the  average  age  of  infants  who 
told  him  so  He  went  on  to  say  that  it 
doesn’t  distort  the  shape  of  the  jaws  and 
is  only  a minor  factor  in  distorting  teeth. 

Before  making  such  a misstatement,  the 
doctor  should  have  broadened  his  narrow 
perspective  by  talking  to  any  surgeon  who 
deals  with  harelips  and  cleft  palates,  and 


with  a representative  number  of  ortho- 
dontists. These  men  see  the  upper  incisor 
teeth  pulled  forward,  the  lower  ones  pushed 
back,  and  occlusion  spoiled.  Any  doctor 
occasionally  sees  blisters  and  warts  on  the 
thumb  and  chronic  cysts  in  the  lip  second- 
ary to  the  habit.  When  these  conditions  are 
corrected  surgically,  the  correction  lasts  if 
the  habit  of  thumb  sucking  is  broken;  other- 
wise the  abnormalities  return.  The  spokes- 
man said  that  if  the  child  does  not  quit  the 
habit  by  the  time  he  gets  his  permanent 
teeth,  “the  distortion  can  be  easily  cor- 
rected.” Can  he  actually  believe  that  months 
or  years  of  braces  and  a few  hundred  dol- 
lars’ expense  fits  into  the  usual  meaning  of 
“easily  corrected”? 

Anyone  will  agree  that  the  longer  the 
habit  is  established  the  more  difficult  it  is 
to  correct.  Some  doctors  believe  that  a 
child  who  becomes  the  victim  of  one  bodily 
sensation  or  so-called  “emotional  outlet” 
will  also  give  way  to  others,  such  as  mas- 
turbation. Orthopedists  have  described 
cases  of  spinal  curvative  that  they  believe 
are  secondary  to  the  physical  stance  of 
thumb  sucking. 

Parents  occasionally  become  tired  of  see- 
ing the  child  indulge  in  the  filthy  habit  and 
are  not  proud  of  incidental  sights  and 
sounds  which  accompany  it.  They  try  the 
usual  bitter  potions  and  wire  cages  without 
avail.  A few  feel  that  elbow  cuffs  or  splints 
are  cruel;  however,  they  are  apt  to  change 
their  minds  when  the  baby  holds  up  his 
arms  for  their  replacement  after  his  bath, 
and  when  he  obviously  enjoys  his  toys  at 
arms  length  as  well  as  in  his  mouth.  Thus 
the  habit  may  be  broken  within  three 
weeks,  but  always  broken. 

A few  doctors  will  disagree  that  the 
habit  should  be  broken.  Occasionally  one 
will  confess  that  he,  himself,  sucked  his 
thumb  in  infancy.  This,  we  find  no  reason 
to  doubt!  But  let  us  admit  that  there  are 
many  factors  pertaining  to  malevolution  of 
human  personality  and  physical  attributes 
more  tangible  than  alleged  fractured  emo- 
tional constitution  secondary  to  denial  of 
digital  abuse. 


for  December,  1949 


1011 


Original  Articles 

ANOREXIA  NERVOSA* 

DOUGLAS  D.  BOND,  M.D. 

CLEVEI^ND,  OHIO 


We  have  had  at  the  University  Hospitals 
of  Cleveland  a group  of  severe  cases  of 
anorexia  nervosa  in  the  short  time  we  have 
been  there.  As  these  cases  are  so  severe 
and  as  we  have  had  ample  opportunity  to 
study  them,  our  most  outstanding  findings 
will  be  of  interest  to  you.  I will  omit 
anything  but  brief  mention  of  the  literature 
on  this  disease  or  upon  its  aspects  which 
are  common  knowledge.  The  illness  occurs 
pincipally  in  young  women  during  ado- 
lescence, although  it  is  known  in  later  years 
and  is  also  seen  in  men.  The  syndrome  is 
characterized  principally  by  an  intense 
aversion  to  food  with  feelings  of  disgust 
about  eating.  As  the  illness  progresses,  the 
most  evident  symptom  is  emaciation  with  a 
concurrent  cessation  of  menses.  The  pa- 
tient’s behavior  is  characterized  by  a re- 
markable activity  and  display  of  strength 
which  strikes  one  immediately  as  being 
most  inconsistent  in  light  of  the  physical 
condition.  Vomiting  often  accompanies  the 
intake  of  food  and  may  complicate  the  pic- 
ture. Blood  pressure  may  be  low;  there  is  no 
consistent  finding  with  the  BMR,  but  com- 
monly it  is  low  normal.  The  patient  is  apt 
to  seem  withdrawn,  a symptom  which  has 
led  to  the  diagnosis  of  schizophrenia.  Cou- 
pled with  a food  addiction,  as  one  of  our 
cases  shows,  is  added  the  addict’s  devotion 
to  food  or  special  kinds  of  it,  and  his  typ- 
ical resentment  and  clever  deception  when 
attempt  is  made  to  control  diet.  Of  interest 
is  the  feeling  about  special  foods  and  in  our 
cases  a devotion  to  highly  seasoned  and 
unusual  foods.  Attention  has  long  been 
paid  to  the  differential  diagnosis  from  Sim- 
mond’s  disease.  The  most  practical  criterion 
is  the  activity  displayed  by  patients  with 

•Second  Annual  Psychosomatic  Lectureship,  De- 
partment of  Psychiatry,  University  of  Colorado  Med- 
ical School,  February  10,  1949.  From  the  Division  of 
Psychiatry,  Western  Reserve  University,  and  Uni- 
versity Hospitals  of  Cleveland,  Ohio. 


anorexia  nervosa  which  is  so  different 
from  the  lethargy  of  Simmond’s.  There  are, 
of  course,  other  discriminating  points.  Sim- 
mond’s disease  has  been  over-emphasized, 
for  cachexia  is  not  a consistent  finding  in 
patients  who  have  deterioration  of  the  an- 
terior pituitary,  and  perhaps  such  diseases 
as  terminal  ileitis  are  under-estimated  as 
posing  diagnostic  dilemmas.  A strange  and 
perhaps  late  finding  that  has  been  noticed 
is  generalized  hirsutism.  Two  of  our  pa- 
tients had  evidence  of  atrophy  of  the  heart 
and  the  first  one,  who  died,  on  autopsy 
showed  atrophy  of  this  organ.  Two  patients 
showed  disturbances  of  the  gastrointes- 
tinal tracts — the  first,  gastric  retention  after 
four  hours  with  absence  of  peristalsis  down 
to  the  third  portion  of  the  duodenum  with 
dilatation  and  functional  obstruction  of  the 
upper  part  of  the  ileum;  the  second  patient 
showed  atony  of  stomach  and  duodenum 
with  pylorus  extending  into  the  anatomical 
pelvis  and  giving  the  appearance  of  a vagot- 
omized  part.  Both  of  these  conditions 
proved  reversible  but  in  both  probably  ac- 
counted for  severe  difficulties  met  in  forced 
feeding. 

The  first  patient  was  a 16-year-old  girl 
admitted  in  March,  1946.  The  patient  was 
so  uncommunicative  that  the  history  had 
to  be  obtained  from  the  mother.  Three 
years  previously,  during  a mild  epidemic 
in  which  the  patient’s  friends  developed 
nausea  and  vomiting,  the  patient  developed 
a phobia  for  vomiting.  Following  this,  while 
attending  a movie,  she  became  nauseated 
and  vomited.  This  marked  the  onset  of  her 
illness,  for  from  then  forward  she  began  to 
restrict  her  diet,  first  cutting  out  meat,  then 
carbohydrates,  then  almost  all  foods.  For 
two  years  her  diet  consisted  of  the  follow- 
ing: In  the  late  morning  a small  glass  of 
orange  juice,  a tablespoon  of  oatmeal  and 


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Rocky  Mountain  Medical  Journal 


a quarter  cup  of  milk;  in  the  afternoon  a 
teaspoon  of  vegetable  and  at  night  an  egg- 
nog made  with  a quarter  cup  of  milk.  The 
patient  began  rapidly  to  lose  weight  so 
that  on  admission,  although  she  was  161.5 
cm.  in  height,  she  weighed  60  pounds.  She 
showed  extreme  emaciation  as  the  first  photo 
shows.  Prior  to  the  present  illness  she  had 
been  a well  adjusted  girl,  having  many 
friends  and  achieving  good  adjustment 
both  with  them  and  in  school.  Her  grades 
were  superior  and  she  demonstrated  con- 
siderable artistic  talent.  She  had,  however, 
never  menstruated.  Throughout  her  hos- 
pital stay  she  showed  extreme  regression, 
lying  curled  up  in  bed,  crying  for  her 
mother  or  saying  that  she  wanted  to  go 
home.  About  the  only  other  communica- 
tion made  was  whimpering  and  a series  of 
complaints  about  feeling  too  full.  Her  de- 
pression was  obvious,  a mood  that  was 
never  broken.  She  refused  almost  all  food 
and  on  measurements  of  her  spontaneous 
intake  the  total  calories  were  as  low  as  85 
in  twenty-four  hours.  She  resisted  force- 
feeding  which  was  continued  sporadically 
because  of  her  protests.  Because  no  success- 
ful relationship  with  the  patient  was  es- 
tablished, she  was  allowed  to  go  home  in 
May,  unimproved,  her  weight  being  61.16 
pounds.  She  was  readmitted  in  exhaustion 
on  June  15,  following  a fall.  Her  EKG 
showed  inversion  of  the  T waves  in  leads 
II,  HI,  VI,  v-V  and  V-HI  and  AVF.  She 
collapsed  during  a tube  feeding  and  died. 
Autopsy  findings  were  notable  only  for 
atrophy  of  the  soft  tissues  of  the  skeletal 
system  and  of  the  heart.  The  heart  weighed 
99  gm.  There  were  minor  petechial  hem- 
orrhages in  the  frontal  areas  and  a diffuse 
subarachnoid  collection  over  the  brain.  The 
latter  were  of  small  amount  and  could  not 
have  been  the  cause  of  death.  As  a matter 
of  fact,  no  such  cause  was  found.  At  the 
time  of  this  terminal  admission  the  patient 
weighed  4914  pounds.  There  was  never  any 
indication  of  schizophrenia  other  than  the 
withdrawal  and  regression.  She  met  the 
fate  of  many  such  difficult  problems  in  that 
she  was  seen  by  many  physicians  yet  real- 
ly treated  by  none.  Many  consultants  from 


various  services  saw  her — four  internists, 
four  psychiatrists,  and  five  interns.  She  was 
in  a four-bed  ward  and  each  took  a crack  at 
so-called  psychotherapy.  It  was  this  pa- 
tient’s fate  which  put  us  in  readiness  for 
the  second  patient,  who  was  admitted  six 
months  later,  in  January,  1947. 


Fig.  1.  Photograph  of  the  first  patient  taken  short- 
ly before  death.  At  this  time  she  weighed  55 
pounds. 


Fig.  2.  Weight  chart  of  Ruth,  covering  hospital  stay 
and  eleven  months  following  discharge.  The  solid 
line  indicates  weight  in  kilograms.  The  most  strik- 
ing physical  findings  are  listed  above  the  line  and 
above  them  are  the  most  striking  psychological 
points. 

The  second  patient  was  admitted  January 
26,  1947,  a sallow,  'withdrawn,  thin  girl  who 
weighed  67  pounds.  Two  months  prior  to 
admission  while  studying  in  her  intent  and 
frantic  manner,  she  was  unable  to  absorb 
her  work.  She  became  upset,  anxious,  and 
tearful.  Since  then  she  had  remained  agi- 
tated and  depressed,  given  over  at  times 
to  mild  panic.  A physician  gave  her  a sed- 
ative, following  which  she  went  into  a 


for  December,  1949 


1013 


trance,  responding  only  feebly  to  her  name. 
She  was  brought  into  the  hospital  dazed 
and  bemused.  She  refused  food.  By  morn- 
ing she  was  cheerful,  talkative,  and  seemed 
interested  in  her  surroundings.  She  ate 
almost  nothing.  She  was  16  years  old,  the 
eldest  of  three  children,  one  a sister  four 
years  younger,  and  a brother  eight  years 
younger.  The  mother  gave  the  history 
which  the  patient  corroborated. 

She  had  no  desire  to  eat  and  a feeling  of 
fullness  for  years  had  increased  in  the  past 
three  years.  The  patient  had  since  birth 
been  a feeding  problem  and  during  most  of 
her  life  had  been  underweight  and  mal- 
nourished. During  the  past  three  years  she 
had  excluded  more  and  more  items  from 
her  diet  so  that  for  the  year  preceding  she 
had  confined  her  intake  to  spice  cake,  high- 
ly seasoned  sauces,  salt  and  pepper,  cookies 
and  water.  She  skipped  as  many  as  two 
days  without  eating  anything,  or  a glass  of 
milk,  a small  piece  of  lean  meat  and  two 
cookies  throughout  a twenty-four  hour 
period.  Coincident  with  her  starvation,  she 
experienced  an  increase  in  thirst  and  in- 
creased frequency  of  ten  to  twelve  times  a 
day  with  nocturia  one  to  three  times  a 
night.  In  recent  months  she  had  voided  one 
or  two  times  a day.  There  had  been  bouts 
of  constipation  and  she  often  went  four  or 
five  days  between  movements. 

Development  of  symptoms  was  accom- 
panied by  change  in  personality  so  that  she 
withdrew  more  and  more  from  her  friends 
and  applied  herself  with  increasing  effort 
to  her  studies,  working  with  intent  and  con- 
siderable result  as  she  usually  led  her  class. 
However,  during  later  months,  she  was  un- 
able to  absorb  what  she  read  despite  the 
fact  that  she  applied  herself  more  intently 
and  zealously.  She  developed  an  unusually 
strong  attachment  to  her  mother  which  she 
showed  by  always  wanting  to  be  near  her 
and  by  becoming  upset  if  her  mother  did 
anything  which  favored  the  sister  or 
brother.  She  would  have  frequent  temper 
tantrums  in  which  she  behaved  like  a 
younger  child.  She  decided  she  was  going 
to  become  a doctor  after  listening  to  a radio 
program  which  impressed  her  that  doctors 


could  help  other  people.  It  appealed  to  her 
also  that  it  is  a difficult  profession  wherein 
she  could  prove  herself.  She  had  ambitions 
to  get  nothing  but  A’s  in  her  work,  threw 
herself  into  biographies  of  great  women, 
and  had  the  ideal  of  becoming  a career 
woman  and  never  marrying.  Hyperactive 
during  this  time,  she  was  busy  with  many 
activities  of  an  intellectual  sort,  trying  ob- 
sessively to  cram  every  bit  of  knowledge 
she  could  find.  Sleep  became  disturbed  by 
nightmares;  she  felt  that  sleep  was  an  un- 
necessary interruption  to  learning,  so  she 
cut  it  to  around  five  hours.  The  symptom 
which  worried  her  most  upon  admission 
was  inability  to  realize  her  intellectual 
goals. 

The  father  was  described  as  a 40-year-old 
plasterer  who  was  fond  of  his  daughter. 
He  had  suffered  from  stomach  trouble  for 
years.  It  was  later  discovered  that  he  was 
a severe  alcoholic  who  had  gastric  neurosis  . 
accompanied  by  pain’  for  which  over  five 
years  he  had  taken,  on  physician’s  pre- 
scription, three-quarters  grain  of  morphine 
up  to  six  times  a week;  furthermore,  he 
used  his  gastric  symptoms  to  control  his 
family;  he  frequently  vomited  at  the  sup- 
per table;  his  alcoholism  had  caused  diffi- 
culties within  the  family.  These  facts  were 
not  learned  until  the  patient  had  been  in 
treatment  four  or  five  months.  The  mother 
was  a 38-year-old  woman  of  intelligence 
and  insight,  but  was  a passive  person  caught 
between  husband  and  children;  she  could 
never  make  a firm  decision.  She  was  over- 
whelmed by  the  situation  and  was  defen- 
sive at  first,  particularly  about  her  husband. 
She  had  enjoyed  good  health  until  four  or 
five  years  previously  when  she  had  an  oper- 
ation for  bilateral  nephroptosis  and  low  ab- 
dominal pain.  Since  then  she  had  been  in 
an  undramatic  state  of  ill-health,  tired  and 
worn  out  most  of  the  time.  She  was  a pleas- 
ant woman  who  gave  the  impression  of  do- 
ing her  best  in  difficult  circumstances. 

The  patient’s  past  history  was  significant 
only  in  that  her  eating  problems  consisted 
of  vomiting  frequently  as  an  infant  and 
showing  a poor  appetite.  At  the  age  of  4 
or  5 these  symptoms  increased  and  she  de- 


1014 


Rocky  Mountain  Medical  Journal 


veloped  car-sickness.  She  was  supposedly 
allergic  to  milk  and  unable  to  drink  it  until 
she  was  11.  She  had  convulsions  between 
the  ages  of  2 and  3.  Her  toilet  training  was 
accomplished  with  ease  and  complete  at 
three.  Menstrual  periods  began  at  13,  ac- 
companied by  a violent  emotional  storm. 
Five  months  following  her  first  period  she 
had  a second,  then  had  two  more  in  the 
succeeding  year  and  a half  until  menses 
ceased  thirteen  months  prior  to  admission. 
Maximum  weight  had  been  85  pounds  at 
14  and  in  the  past  two  years  she  had  lost 
eighteen  pounds.  Physical  examination  re- 
vealed an  emaciated  girl  below  average 
height  for  age;  pulse,  52;  blood  pressure, 
90/60.  There  was  a loss  of  normal  elasticity 
of  the  skin;  it  was  pale  and  dry.  There  were 
no  other  abnormal  findings.  There  was  a 
normal  distribution  of  the  secondary  sex 
characteristics  and  there  was  active  peris- 
talsis. There  was  slight  edema  of  lower  ex- 
tremities. The  patient  was  hospitalized 
for  a period  of  five  months.  During  the 
early  period  her  behavior  was  characterized 
by  childish  cheerfulness,  exaggerated  in- 
terest in  what  went  on  around  her,  and  im- 
mediate dependence  upon  one  of  the  in- 
terns. This  was  interspersed  with  days  of 
moodiness,  tearfulness,  and  retirement.  She 
seemed  fearful  at  times,  was  hyperactive, 
complaining  of  lack  of  things  to  do  although 
reading  four  or  five  books  simultaneously, 
helping  the  nurses  with  charts  and  begin- 
ning to  do  handicrafts.  She  was  not  kept 
in  bed  but  given  the  run  of  the  floor. 

I saw  her  five  days  after  admission  at 
which  time  she  was  polite  and  guarded  and, 
although  she  told  me  nothing  and  almost 
no  questions  were  asked  her,  she  curled  up 
on  the  bed,  head  near  her  knees,  sobbing 
for  three  hours  until  her  mother  came.  The 
patient  took  an  immediate  violent  opposi- 
tion to  me  and  dreaded  further  meetings. 
She  asked  to  go  home  during  the  first  few 
weeks  and  cried  for  her  mother.  Two  weeks 
after  admission  she  was  seen  cradled  in 
her  mother’s  lap  where  she  remained  for 
about  an  hour. 

For  the  first  three  weeks  she  was  handled 
by  an  internist  who  gave  her  vitamin  B in- 


travenously and  started  tube  feeding,  as 
her  spontaneous  caloric  intake  varied  be- 
tween 300  and  700  calories  a day.  When  I 
say  spontaneous,  I mean  with  all  the  ca- 
jolery that  dietitians  and  nurses  used.  When 
tube  feeding  was  begun,  she  had  gastric 
retention  at  the  end  of  three  hours,  retain- 
ing as  much  as  one-half  the  500  c.c.  feed- 
ing. She  was  given  atropine  as  she  was  suf- 
fering from  pyloric  spasm.  X-ray  of  her 
gastrointestinal  tract  after  atropine  had 
been  discontinued  for  four  days  showed  a 
long  J-shaped  stomach  hanging  down  into 
the  anatomical  pelvis  innocent  of  peristalsis. 
There  was  25  per  cent  retention  of  barium  at 
four  hours  and  there  was  atony  of  upper 
duodenum  and  pylorus.  The  pylorus  was 
patent  and  barium  could  be  easily  mas- 
saged through  it.  Her  stomach  had  the  ap- 
pearance of  one  that  had  been  vagotomized. 
Tube  feedings  were  divided  to  get  around 
the  retention  but  retention  increased  so  that 
five  hours  after  the  last  750  c.c.  feeding 
there  was  500  c.c.  residual.  No  vomiting 
occurred  during  this  period  Prostigmine 
was  then  given  three  times  a day;  1 c.c.  of 
1-4,000  solution  resulted  in  mild  discomfort. 
This  was  terminated  after  two  weeks  as  its 
effectiveness  was  felt  to  be  nil.  Insulin  in 
five-unit  doses  one-half  hour  before  meals 
was  also  tried,  but  the  patient  had  insulin 
reactions  without  any  im-provement  in  her 
appetite.  After  a two-week  trial  it  was 
terminated.  As  the  patient  had  been  hos- 
pitalized for  three  weeks  and  not  gained  or 
improved,  attempt  was  made  to  double  the 
tube  feedings.  She  was  given  500  c.c  at  7 
o’clock  in  the  morning,  another  500  c.c.  at 
9 o’clock  and  at  noon  had  a residual  of 
1,020  c.c  The  patient  was  quite  edematous 
despite  her  serum  protein  maintaining  nor- 
mal ratio  and  value.  Feedings  were  cut  in 
amount  and  gradually  better  absorption  oc- 
curred. 

During  March  the  patient  showed  a de- 
cline. In  the  second  week  she  developed 
edema  of  lower  extremities,  face  and  hands, 
and  large  subcutaneous  hemorrhages  meas- 
suring  up  to  six  inches  in  diameter  ap- 
peared over  the  trunk  and  extremities.  X- 
ray  of  the  gastrointestinal  tract  showed  a 


for  December,  1949 


1015 


relaxed  stomach  with  sluggish  peristalsis 
in  it  and  in  the  first  part  of  the  duodenum. 
Emptying  time  was  improved,  with  rapid 
motility  through  the  small  bowel.  Bleed- 
ing and  clotting  time  gave  normal  values. 
Prothrombin  was  100  per  cent.  There  was 
now  less  difficulty  in  absorption.  This 
alarming  turn  of  events  followed  upon  the 
patient’s  transfer  to  a medical  ward  and 
was  accompanied  by  increasing  insomnia, 
restlessness,  and  depression. 

By  this  time  I had  been  seeing  her  six 
hours  a week  for  three  months.  Interviews 
had  been  characterized  by  twenty-minute 
periods  of  silence,  a defense  in  keeping  with 
the  oral  inhibitions  of  anorexia.  I had  thus 
learned  little  about  her  except  that  she  had 
fears  about  safety  of  her  parents,  particu- 
larly of  her  mother  to  whom  she  imagined 
accidents  happening.  I showed  her  that  her 
frantic  busyness  was  a way  of  avoiding 
such  unhappy  thoughts,  and  to  this  she  gave 
grudging  consent.  It  was  to  assure  herself 
about  the  safety  of  her  mother  that  she  in- 
sisted upon  seeing  her  frequently  and  going 
home.  She  had  always  been  polite  and  shy 
with  me  and  sat  in  a characteristic  manner 
with  her  knees  and  toes  touching,  like  a 
younger  child.  Her  hostile  feeling  toward 
me  changed  as  she  showed  by  a fantasy  of 
my  wife  and  me  at  a dance.  My  wife  was  a 
heavier  edition  of  the  patient,  a meaning 
which  she  spontaneously  recognized  with 
embarrassment.  This  was  followed  by  con- 
fession of  a series  of  dreams,  the  first  of 
which  I will  repeat  because  it  has  a charm- 
ing child-like  quality  and  is  transparent  in 
the  reference  it  bears  to  her  view  of  her 
father  and  mother.  In  this  dream  she  was 
transported  to  the  sky.  The  moon  was  dis- 
tinguished-looking and  became  angry  at 
her  for  being  in  the  sky  when  she  was  only 
a human  being,  and  he  immediately  began 
to  criticize  her  for  trespassing.  He  was  sup- 
posedly very  wise.  He  then  began,,  an  ar- 
gument with  her,  why  that  when  you  were 
counting,  four  came  before  two.  The  pa- 
tient was  frustrated  and  upset  by  this  and 
said  she  knew  that  two  came  before  four. 
She  cried  when  her  argument  was  fruitless. 
A cloud  became  upset  and  protective,  say- 

1016 


ing  that  the  moon  was  rude  and  she  would 
cover  him  up  for  being  so  rude.  She  then 
did  this.  The  stars  came  and  pulled  her  in 
a blue  cart  all  over  the  sky,  laughing  and 
joking  with  her. 

When  she  was  totally  unproductive  which 
was  often,  I would  tell  her  that  she  must 
hate  me  to  keep  me  there  without  saying 
anything,  and  that  she  was  afraid  to  say 
so.  To  this  she  responded  with  denials 
and  tears.  At  the  end  of  three  weeks 
she  was  transferred  to  the  medical  ward 
and  her  symptoms  increased.  Incidentally, 
some  unknown  person  cut  her  caloric  intake 
by  1,000  calories. 

It  was  several  days  before  this  was  cor- 
rected; she  slept  hardly  at  all  and  her 
anxiety  become  intense.  She  came  to  my 
office  one  day  with  the  demand  that  she  go 
home  that  night  for  supper.  I told  her  she 
could  go  home  when  she  was  well.  She 
pleaded,  kicked  her  shoes  off  at  me,  and 
left  in  a towering  rage.  The  next  day  she 
was  relieved  when  I saw  her  as  usual.  I 
told  her  that  increase  in  her  anxiety  and 
demands  to  go  home  showed  an  increase  in 
number  and  intensity  of  worries  over  her 
parents’  safety.  She  said  she  was  obsessed 
with  pictures  of  the  bodies  of  her  mother 
and  father  mangled  in  a train  wreck  (why 
a train  wreck?)  “going  to  Florida  with 
money  they  saved  on  me  by  transferring 
me  to  the  ward.”  It  was  not  difficult  for 
her  to  see  her  bitter  resentment  expressed 
in  fantasies.  This  began  to  pour  out  and 
she  began  to  have  less  difficulty  in  sleeping 
and  eating.  Her  demands  for  going  home 
diminished  and  she  began  to  take  interest  in 
dietetics,  helping  set  up  and  weigh  special 
diets,  an  interest  she  sustained  throughout 
hospitalization.  Concurrently,  edema  began 
to  recede,  subcutaneous  hemorrhages 
cleared,  and  she  began  to  gain  weight.  Guilt 
over  aggressive  thoughts  was  revealed  as  a 
prominent  underlying  motive  and  many 
suicidal  and  self-punishing  thoughts  were 
acted  out  in  maltreatment  of  her  body.  Her 
attitude  toward  her  dangerous  physical 
state  was  characteristic  of  her  and  of  the 
other  two  patients  I know  well.  It  was 
bland  denial  of  any  physical  danger  with 

Rocky  Mountain  Medical  Journal 


an  assumption  of  physical  invulnerability. 
I finally  had  to  approach  this  directly  by 
telling  her  that  she  might  die.  Only  after 
analysis  of  the  way  she  dissociated  her  mo- 
tives one  from  another  and  from  their  ef- 
fects, was  her  guilt  made  conscious  to  her 
and  was  she  able  to  see  how  effective  this 
guilt  had  been  in  punishing  her.  This  guilt 
was  at  first  not  at  all  conscious,  instead  only 
its  end  products;  namely,  that  she  was  not 
loved  by  her  parents  and  that  she  wanted 
them  to  reverse  this  attitude  and,  of  course, 
the  pitiful  state  of  her  body.  At  the  same 
time,  too,  she  was  hurting  her  parents  by 
hurting  herself. 

The  attitude  of  the  patient’s  father  was  of 
importance  and  complicated  the  situation. 
He  had  entered  a competition  with  his 
daughter,  who  had  reproached  him  for 
drinking,  by  stating  that  he  would  stop 
drinking  when  she  started  eating.  She  had 
told  him  she  would  start  eating  when  he 
stopped  drinking.  Obviously  one  had  to 
lose  in  this  contest  and  finally  Ruth  gave 
in  after  the  aggressive  motives  of  her  anor- 
exia had  become  clear.  A great  deal  was 
learned  about  the  father  at  this  time  and 
confirmed  by  the  mother.  But  it  seemed 
every  new  disclosure  had  to  be  preceded 
by  a period  of  stubborn  silence,  anger  at 
me,  then  anger  at  her  father.  The  father 
had  done  his  best  to  make  his  daughter’s 
life  hard.  As  a child  she  had  been  his 
favorite,  but  as  she  entered  puberty  he 
commenced  an  intolerably  jealous  attitude. 
He  nagged  her  to  get  good  marks  and  as 
soon  as  she  got  them  he  called  her  a book- 
worm who  would  get  nowhere.  He  taunted 
her  with  the  accusation  that  she  probably 
thought  she  was  smart  now  that  she  got 
such  good  marks  but  in  reality  they  meant 
nothing,  or  that  she  was  so  dumb  in  other 
ways.  He  bragged  about  her  marks  to 
others.  He  chided  her  for  not  going  out 
with  boys,  then  scoffed  so  long  and  bitterly 
at  the  few  attempts  she  made  or  the  part- 
ners she  had  chosen  that  she  gave  up  in 
confusion.  Her  sincere  and  devoted  attempts 
to  please  her  father,  however,  were  clear. 

Upon  the  accession  of  her  menstrual 
periods  she  experienced  a violent  reaction. 


sobbing  intermittently  for  days  and  express- 
ing her  revulsion  at  their  coming.  She  was 
frightened  by  them,  as  well,  and  felt 
ashamed,  wishing  that  she  could  have  been 
a boy.  This  was  surprising  as  her  mother 
had  prepared  her  for  them.  At  this  time  a 
senile  neighbor  of  70  had  invited  Ruth  to 
his  house  and  made  sexual  advances  to  her. 
The  nature  of  his  advance  was  never  clear 
but  Ruth  felt  that  it  involved  her  mouth  and 
his  genital.  She  ran  home  in  panic  to  her 
mother  and  gave  partial  confession.  At  this 
time,  her  anorexia  began.  It  gradually  be- 
came apparent  how  she  had  chosen  her  diet. 
She  started  by  ruling  out  all  foods  which 
reminded  her  of  sexual  things,  using  shape, 
color,  texture  and  smell  as  criteria.  While 
only  a few  foods  took  on  this  sexual  mean- 
ing for  her  at  first,  specificity  broke  down 
and  left  her  practically  nothing.  In  her  con- 
fusion and  anguish  she  became  more  with- 
drawn, preoccupation  became  more  fixed, 
and  personal  appearance  deteriorated  rapid- 
ly. She  became  secondarily  depressed  by 
outspoken  failures,  but  as  she  lost  weight 
and  became  more  unattractive,  she  expe- 
rienced a certain  relief.  Suppression  of 
menses  and  melting  away  of  her  breast 
tissues  was  welcomed  for  they  spared  her 
any  sexual  advance  and  were  evidence  that 
she  was  not  a sexually  maturing  girl.  She 
had  a loathing  for  the  sight  of  a pregnant 
woman  and  around  this  disclosure  came  a 
whole  set  of  fantasies  about  conception,  its 
relation  to  the  stomach  and  finally  to  food. 
She  recalled  running  home  from  a picnic 
at  the  age  of  four  frightened  that  her  cousin 
was  going  to  die.  She  had  swallowed  a 
watermelon  seed  and  Ruth  imagined  that 
her  cousin  would  have  a baby  and  die  de- 
livering it.  It  was  prior  to  this  that  Ruth’s 
youngest  sister  was  born  and  Ruth  woke  at 
night  to  find  her  mother  gone  with  no  ex- 
planation forthcoming  from  the  woman 
who  came  to  stay  with  her. 

This  was  the  end  of  treatment,  a period 
of  less  than  six  months.  She  had  gained 
only  slightly  in  weight  but  as  food  lost  its 
spurious  sexual  meaning  for  her  she  had 
mastered  her  anorexia,  eating  everything 
with  pleasure  but  not  gorging  and  delight- 


Jor  December,  1949 


1017 


ing  in  foods  no  longer  barred.  Her  person- 
ality had  undergone  a profound  change. 
She  became  the  most  popular  patient  in 
many  sections  of  the  hospital;  she  was  ap- 
pallingly acute  in  observance  of  others.  She 
developed  an  interest  in  her  appearance,  a 
femininity,  and  found  a new  interest  in 
boys.  She  was  quite  outgoing. 

In  about  three  months  she  had  almost 
doubled  her  admission  weight  and  had 
found  she  was  able  to  manage  her  father 
more  easily.  She  went  to  high  school  away 
from  home,  led  her  class  of  three  hundred 
scholastically,  became  president  of  the 
dramatic  club  and  secretary  of  her  class. 
She  had  changed  so  much  in  physical  ap- 
pearance that  I failed  to  recognize  her.  She 
looked  and  dressed  like  a normal  girl  of  17, 
unashamed  of  her  sex.  I told  her  that  her 
periods  would  return  in  one  year  from  the 
time  of  treatment  and  they  beat  my  pre- 
diction by  six  weeks.  They  have  been  reg- 
ular since.  During  this  year  she  gained  at 
first  and  then  leveled  off. 

This  is  only  a summary  of  a complicated 
problem,  and  I will  omit  many  theoretical 
and  technical  points,  and  emphasize  several 
that  concern  hospital  management  of  such 
severely  hysterical  patients.  When  life  is 
so  threatened,  management  outside  a hos- 
pital is  ill-advised.  Particularly  is  this  so 
when  meticulous  attention  to  detail  is  nec- 
essary if  the  patient’s  life  is  to  be  saved. 
Other  illnesses  best  handled  in  this  way 
are  those  in  which  the  patient  acts  out  his 
difficulties  as  in  many  addictions,  in  those 
in  which  the  patient  makes  other  people 
suffer  acutely  with  his  anxiety,  and  in  other 
illnesses  such  as  ulcerative  colitis  or  severe 
asthma.  The  difficulty  in  many  of  these  ill- 
nesses is  that  the  patient  derives  a per- 
verted form  of  pleasure  from  his  symptoms 
sufficient  to  offset  desire  for  treatment  or 
for  relinquishment  of  pleasure-feelings  that 
half  loaves  are  better  than  none.  It  is  only 
when  someone  breaks  up  this  pattern  for- 
eibly  that  the  comfort  of  the  patient  gives 
way  to  anxiety.  Such  a step  leads  to  great 
anger  on  the  patient’s  part.  None  of  the 
four  patients  in  our  group  wanted  treat- 
ment and  all  did  their  utmost  to  prevent  it. 


We  are  wont  to  make  conscious  desire  for 
treatment  a prerequisite  to  success,  but  in 
many  instances  this  is  unnecessary  and  of 
small  importance.  This  is  because  if  con- 
ditions are  favorable  the  patient  forms  a 
strong  attachment  to  the  physician  and  this 
can  be  of  sufficient  strength  to  overcome 
many  obstacles.  This  attachment  then  al- 
lows the  grudging  release  of  unconscious 
ideas  and  symptoms  themselves.  The  sicker 
the  patient  the  more  time  such  an  attach- 
ment takes  in  forming. 

It  is  of  importance  in  the  early  phases  of 
treatment  that  premature  interpretations 
not  be  made  and  that  the  patient’s  own 
disgust  with  her  thoughts  and  feelings  be 
properly  appreciated.  Otherwise  the  at- 
tachment of  patient  to  doctor  will  be  pre- 
vented or  distorted  and  the  bridge  over 
which  disclosures  come  is  closed. 

Perhaps  the  most  important  preparation 
for  treatment  is  recognition  of  the  size  of 
the  task  ahead.  If  this  is  done  the  authority 
in  management  and  treatment  will  be  cen- 
tralized. The  psychiatrist  should  be  di- 
vorced in  the  patient’s  mind  from  hospital 
management;  otherwise  he  will  get  the  full 
force  of  anger  incidental  to  forced  feedings, 
restriction  of  visitors,  etc.  This  anger  may 
be  enough  to  prevent  establishment  of  a 
proper  attachment.  Likewise  it  discour- 
ages the  patient  from  making  spurious  gains 
to  prevent  uncovering  the  underlying  dif- 
ficulty, like  a heroic  effort  to  eat  simply 
to  get  out  of  the  hospital.  It  avoids  end- 
less contentions  and  bargaining  about  real 
issues  which  are  used  by  the  patient  in  re- 
sistance to  disclosures  of  hidden  thoughts. 
But  the  psychiatrist  must  have  a behind- 
the-scenes  hand  in  management;  otherwise 
the  patient’s  handling  may  defeat  every 
other  effort.  The  serious  physical  problems 
demand  all  the  skill  of  a well  trained  in- 
ternist. These  physicians  must  be  in  the 
closest  contact  and  no  radical  or  minor 
change  in  management  should  be  made 
without  full  knowledge  of  both.  Ruth  was 
treated  on  the  medical  ward  and  private 
medical  service.  Nurses,  interns,  dietitians, 
visiting  men  and  residents  change.  Every- 
one has  his  ideas  about  management.  Dieti- 


1018 


Rocky  Mountain  Medical  Journal 


tians  love  these  problems,  at  first  anyway, 
and  many  creep  into  the  picture,  often  in- 
venting a new  diet  or  changing  an  old  one 
and  forgetting  to  mention  it.  Hormones, 
vitamins,  laxatives,  restrictions,  compli- 
cated studies,  lenient  and ' punishing  atti- 
tudes all  come  up  for  consideration  by  each 
and  unless  there  is  one  man  to  hold  firm 
in  control  of  the  patient  the  most  amazing 
inconsistencies  arise  in  study  and  treat- 
ment. There  is  on  the  part  of  nurses  and 
dietitians  particularly,  although  doctors  are 
not  excluded,  a tendency  to  mother  and  pro- 
tect so  pitiful  an  object  as  the  severely 
starved  patient.  As  the  patient’s  insatiable 
demands  become  more  apparent  and  illness 
refuses  to  change,  this  protective  attitude 
may  give  way  to  hostility  and  partial  neg- 
lect. This  unforunately  is  often  timed 
wrong.  At  first  the  patient  is  so  ill  and  pre- 
occupied that  early  attention  does  little, 
while  shortly  thereafter  when  she  is  mak- 
ing an  attempt  to  come  out  she  may  be  re- 
buffed. When  these  patients  give  one  so 
little  margin  because  of  the  narrow  hold 
they  have  on  life,  minor  attitudes  and 
events  can  spell  disaster. 

Another  patient  now  in  treatment  has 
brought  out  these  difficulties  sharply.  Be- 
cause her  behavior  is  so  impulsive  we  have 
had  to  enlarge  the  number  of  people  tak- 
ing direct  responsibility  for  her.  She  has 
been  kept  on  a closed  ward  because  of  her 
inability  to  control  her  impulsive  desires. 
A psychiatrist  is  responsible  for  the  man- 
agement of  her  and  the  control  of  her  be- 
havior. The  internist  interested  in  meta- 
bolism, who  managed  Ruth,  looks  after  her 
physical  condition  and  disclaims  all  other 
authority  to  her.  I am  treating  her  analyt- 
ically. We  three  with  the  head  nurse  and 
one  responsible  dietitian  meet  weekly  to 
discuss  her  progress  or  lack  of  it  and  to 
review  any  intended  move.  The  patient  is 
a 27-year-old  intelligent  and  unusually  tal- 
ented German  girl  who  spent  the  war  in 
Germany.  Her  illness  started  nine  years 
ago  with  anorexia  following  the  discovery 
that  humans  had  intercourse.  This  anor- 
exia has  taken  on  a perverse  aspect  in  that 
it  alternates  with  food  indulgence  of  ex- 


traordinary character.  She  had  impoverished 
her  family  by  periodic  eating  sprees  in 
which  she  eats  $20  worth  of  food  a day, 
vomiting  it  all  within  an  hour  of  eating. 
This  resulted  in  her  collapse  at  a time  when 
she  weighed  61  pounds.  This  craving  for 
food  led  her  to  minor  thefts  and  all  kinds 
of  unfortunate  behavior.  She  is  a magician 
at  playing  one  person  against  another,  dis- 
torting one  doctor’s  “promise”  against  an- 
other, wheedling  all  kinds  of  extras.  She 
steals  food  from  everyone  else’s  tray,  may 
eat  soap  or  paper  and  in  general  does  not 
endear  herself  to  the  personnel  handling 
her.  She  has  escaped  four  times  by  steal- 
ing keys  or  by  extremely  clever  subterfuge. 
She  always  waits  until  the  nurses  are  busy 
before  she  makes  insistent  demands  on  their 
time.  Proper  restriction  of  her  diet  is  of 
utmost  importance  for  if  she  eats  more  than 
a certain  amount,  she  feels  full,  “pregnant”’ 
as  she  puts  it,  and  vomits.  She  suffers 
anxiety  approaching  panic  if  she  is  unable 
to  vomit.  She  is  an  authority  on  foods  easy 
and  hard  to  get  rid  of  in  this  way.  Yet  if  she 
is  allowed  to  continue  this  acting  out  of 
her  troubles  she  will  never  relinquish  them. 
She  meets  every  restriction  at  first  either 
with  an  undisguised  temper  tantrum  or 
with  sullen  stubbornness.  Only  as  the  dis- 
tinction of  me  from  the  others  has  become 
clear  to  her  has  she  begun  to  make  prog- 
ress. As  with  Ruth,  it  was  necessary  to 
forbid  parental  visits  of  more  than  one  per 
week  so  that  anxiety  about  parents’  wel- 
fare could  be  brought  to  light  and  the  hos- 
tile Wishes  underlying  this  anxiety  re- 
vealed. 

In  analyzing  some  of  the  difficulties  in- 
volved in  treatment  and  management  and  in 
clarifying  the  most  important  precaution- 
ary measures,  my  hope  is  that  some  severe 
cases  which  ordinarily  go  untreated  may 
find  a better  fate  in  the  cooperation  be- 
tween internists  and  psychiatrists. 


The  responsibility  for  planning  and  providing 
adequate  hospital  facilities  for  the  tuberculous 
is  a public,  not  a private  obligation. — A.  W. 
Fiske,  (Ohio  State  Representative),  Ohio  Pub. 
Health,  Sept.,  1948. 


for  December,  1949 


1019 


RECENT  ADVANCES  IN  THE  CARE  OF  THE  DEAFENED* 

J.  MACKENZIE  BROWN,  M.D. 

LOS  ANGELBS,  CALIF. 


Approximately  10  per  cent  of  our  pop- 
ulation, representing  some  fourteen  mil- 
lion persons,  have  some  type  of  hearing 
impairment.  The  medical  profession  as  a 
whole  has  not  been  aware  of  the  role  of 
the  physician  in  the  care  of  these  unfor- 
tunate individuals.  Great  strides  have  been 
made  in  recent  years  in  this  phase  of  otol- 
ogy, and  it -is  my  purpose  to  discuss  these 
advances. 

A patient  with  impaired  hearing  has  one 
of  three  types  of  deafness,  namely,  conduc- 
tion or  middle  ear  deafness,  perception  or 
nerve  deafness,  or  otosclerosis,  which  is  a 
combination  of  both  middle  ear  and  nerve 
involvement.  Deafness  due  to  hysteria  or 
to  malingering  is  not  a true  pathological 
entity  and,  therefore,  will  not  be  included 
in  this  presentation. 

Conduction  Deafness 

Etiology:  Any  pathology  that  interferes 
with  the  transmission  of  sound  vibrations 
to  the  inner  ear  produces  a conduction  or 
middle  ear  deafness.  This  pathology  may 
be  in  the  external  ear  canal,  the  middle 
ear,  or  the  eustachian  tube.  External  ear 
canal  obstruction  may  be  due  to  cerumen, 
furunculosis,  foreign  bodies,  bony  exostosis 
and  congenital  malformation.  The  normal 
vibration  of  the  ear  drum  may  be  inter- 
fered with  by  a perforation,  edema,  or  by 
fibrous  tissue.  Sound  transmission  through 
the  middle  ear  may  be  impaired  due  to 
ossicular  chain  pathology,  such  as  disloca- 
tion, articular  disease,  necrosis,  or  by  the 
presence  of  fluid,  either  serous  or  purulent. 
Eustachian  tube  obstruction  results  in  pres- 
sure changes  within  the  middle  ear  and 
likewise  interferes  with  sound  transmission. 
Tubal  obstruction  may  be  due  to  altitude 
changes,  inflammatory  or  allergic  edema, 
or  adenoids. 

Symptoms  and  Findings : The  patient  with 
conductive  deafness  usually  has  a soft 
spoken  voice  because  external  noise  inter- 
ference has  been  diminished  and  he,  there- 

*Read before  the  Annual  Meeting  of  the  New 
Mexico  Medical  Society,  Roswell,  May  5,  1949. 


fore,  hears  his  own  voice  very  loudly.  He 
will  also  state  that  crunchy  foods,  such  as 
toast  or  crackers,  sound  very  loud.  Like- 
wise, because  low  tones  are  not  heard,  the 
patient  with  conductive  deafness  will  state 
he  hears  better  in  a noisy  environment. 
This  occurs  because  people  with  normal 
hearing  to  whom  he  is  talking  are  conscious 
of  the  noisy  environment  and  speak  with 
more  intensity.  The  objective  findings  in 
this  type  of  hearing  impairment  may  re- 
veal external  ear,  ear  drum,  middle  ear, 
or  eustachian  tube  pathology.  A 512  tuning 
fork  placed  in  the  center  of  the  forehead  of 
a conductive  deaf  individual  will  be  re- 
ferred to  the  ear  with  greater  impairment 
due  to  greater  exclusion  of  extrinsic  sounds 
in  that  ear.  (Weber  test).  A 512  fork  no 
longer  heard  when  held  one  inch  from  the 
external  ear  is  heard  when  placed  in  con- 
tact with  the  mastoid  bone.  (Rinne  test). 
A reading  taken  with  the  audiometer  will 
reveal  a loss  of  air-borne  tones,  whereas  the 
bone  conduction  curve  will  remain  essen- 
tially normal. 

Treatment:  Treatment  of  the  patient 

with  conduction  deafness  depends  on  cor- 
rection of  the  underlying  pathology  or  in 
furnishing  adequate  substitutions  as  the  in- 
dividual case  requires.  If  due  to  external 
ear  canal  pathology,  this  must  be  corrected. 
Ear  drum  pathology,  such  as  an  old  perfor- 
ation, may  occasionally  be  successfully 
closed.  This  procedure  is  workable  only  in 
dry  central  perforations.  It  is  accomplished 
by  freshening  the  edges  of  the  perforation 
with  a caustic,  and  placing  a membrane, 
such  as  an  egg  membrane,  over  the  open- 
ing, thus  allowing  epithelization  to  occur. 
Marginal  perforations,  unfortunately,  can- 
not be  closed  in  this  manner.  Conduction 
deafness,  due  to  active  middle  ear  disease, 
necessitates  our  every  effort  in  an  attempt 
to  stop  further  destruction  to  the  hearing 
mechanism.  If  drainage  persists  in  acute 
otitis  media  in  spite  of  adequate  treatment, 
for  a period  of  six  weeks,  it  is  strongly 
suggestive  of  bone  necrosis  in  the  mastoid 


1020 


Rocky  Mountain  Medical  Journal 


cells.  In  this  instance,  a prophylactic  sim- 
ple mastoidectomy  should  be  performed  in 
order  to  prevent  a chronic  discharging  ear 
from  occurring.  If  the  acute  ear  is  allowed 
to  become  a chronic  discharging  ear,  a 
permanent  conduction  deafness  will  result. 

Altitude  changes  and  upper  respiratory 
infections  frequently  result  in  temporary 
obstruction  of  the  eustachian  tube,  due  to 
edema  or  accumulated  mucoid  material.  If 
the  eustachian  tube  does  not  open  sponta- 
neously, an  inflation  or  tv.m  will  usually 
clear  the  lumen. 

In  allergic  edema  of  the  tube  the  hearing 
tends  to  fluctuate  considerably  and  there 
usually  is  an  associated  allergic  rhinitis.  The 
deafness  may  be  temporarily  relieved  by 
inflation  and  by  the  subcutaneous  injection 
of  adrenalin,  as  can  be  illustrated  by  audio- 
grams  taken  before  and  after  its  administra- 
tion. If  antihistamine  drugs  fail  to  control 
these  cases  a complete  allergic  study,  fol- 
lowed by  adequate  desensitization,  is  indi- 
cated. 

Lymphoid  hyperplasia  in  the  nasopharynx 
is  the  most  common  cause  of  conduction 
deafness  in  children.  Fortunately,  through 
group  testing  in  our  schools  these  children 
are  diagnosed  early  and  a thorough  adenoi- 
dectomy,  followed  by  adequate  radiation  of 
the  nasopharynx,  either  by  x-ray  or  ra- 
dium, will  usually  restore  their  hearing  to 
the  serviceable  level.  I have  seen  cases  in 
this  classification  obtain  a 30  decibel  im- 
provement bilaterally  after  such  treatment. 

If  the  hearing  loss  is  bilateral  and  cannot 
be  improved  by  medical  or  surgical  treat- 
ment, and  is  sufficient  to  produce  difficulty 
in  conversation,  then  a substitute  such  as 
the  artificial  ear  drum  or  the  electrical  hear- 
ing aid  is  prescribed.  Artificial  ear  drums 
can  occasionally  be  used  in  cases  of  bilateral 
conduction  deafness  due  to  chronic  ear  dis- 
eases in  which  partial  or  total  destruction 
of  the  ear  drum  and  ossicles  has  occurred. 
In  these  occasional  cases  the  results  ob- 
tained are  most  gratifying  in  that  the  neces- 
sity for  an  electrical  aid  is  eliminated  and 
the  transmission  of  normal  tone  sounds  is 
made  possible. 

All  persons  with  conduction  deafness,  in- 


asmuch as  they  have  a normal  hearing 
nerve,  can  hear  with  the  amplification  of 
sound  made  possible  by  the  electric  aid. 
When  other  means  fail,  the  electric  aid 
serves  the  conductive  deaf  patient  very  well. 
Tremendous  strides  have  been  made  in  the 
hearing  aid  field.  The  instruments  are 
much  more  efficient  and  considerably  more 
compact  than  their  predecessors  of  a few 
years  ago.  Their  disadvantages,  however, 
such  as  the  cosmetic  effect  with  the  result- 
ant psychological  manifestations,  battery 
nuisance,  telephone  type  of  transmitted 
tones,  and  difficulty  with  volume  control, 
are  well  known. 

Nerve  Deafness 

Etiology:  Any  pathology  which  interferes 
with  the  function  of  the  auditory  nerve  re- 
sults in  a perception  or  nerve  type  of  deaf- 
ness. These  include  allergy  (edema  of  the 
cochlea) , infection  (labyrinthitis) , toxemias, 
mumps,  drugs  (alcohol,  quinine,  nicotine), 
etc.  Nervous  system  disease  such  as  mul- 
tiple sclerosis,  syphilis,  and  eighth  nerve 
tumors,  hemorrhage,  industrial  trauma  (ex- 
posure to  a continuous  noise  level),  and 
skull  fractures  which  involve  the  temporal 
bone  also  result  in  nerve  loss.  Vascular 
changes  of  the  aged,  and  congenital  malfor- 
mation of  the  nerve  in  the  newborn  are 
likewise  not  uncommon  causes  of  nerve 
deafness. 

Symptoms  and  Findings:  In  contrast  to 
the  conductive  deaf  individual,  the  percep- 
tive deaf  patient  speaks  loudly  because  he 
does  not  hear  his  own  voice.  Noisy  environ- 
ments markedly  interfere  with  the  patient’s 
ability  to  hear  and  he  frequently  states  he 
is  confused  under  these  conditions.  An  ex- 
amination often  fails  to  reveal  any  evidence 
of  ear  pathology.  A 512  tuning  fork  placed 
in  the  center  of  the  forehead  is  referred  to 
the  ear  of  lesser  impairment.  This  same 
fork  no  longer  heard  when  held  one  inch 
from  the  external  ear  will  likewise  not  be 
heard  when  held  in  contact  with  the  mas- 
toid bone.  Readings  taken  with  the  audio- 
meter will  reveal  loss  of  both  air  and  bone- 
borne  tones  in  approximately  the  same  de- 
gree. 

Treatment:  Once  the  hearing  nerve  is 


for  December,  1949 


1021 


damaged  from  any  cause,  with  the  possible 
exception  of  allergy,  it  shows  little  inclina- 
tion to  regenerate.  Therefore,  treatment  in 
these  cases  is  directed  primarily  toward  pre- 
venting further  nerve  loss  rather  than  at- 
tempting to  improve  the  already  damaged 
nerve.  A complete  history  and  a thorough 
physical  examination  are  indicated  in  all 
cases  to  eliminate  every  possible  under- 
lying cause.  The  use  of  massive  doses  of 
amino  acids  and  thiamine  chloride  in  these 
cases  has  been  advocated  by  some,  but  in 
my  experience  the  results  have  been  very 
discouraging.  The  hearing  aid  is  of  marked 
benefit  unless  the  nerve  function  has  been 
destroyed  beyond  the  point  of  serviceable 
hearing.  In  these  instances,  it  is  of  value, 
but  must  be  correlated  with  a planned  pro- 
gram of  aural  rehabilitation.  The  patient 
must  be  taught  to  adjust  himself  to  the 
hearing  aid  and  to  learn  to  properly  wear 
the  instrument.  He  must  develop  his  ability 
to  lip  read  and  often  requires  guidance  re- 
garding his  speech.  If  the  nerve  loss  is 
congenital  in  origin,  proper  lip  reading  and 
speech  training,  beginning  in  the  pre-school 
child,  is  absolutely  imperative.  In  these 
cases  the  parent  education  program,  such 
as  advocated  by  Mrs.  Spencer  Tracy  of  the 
John  Tracy  Clinic,  is  the  overall  program 
of  choice  in  the  care  of  the  congenitally 
deaf  child.  In  these  unfortunate  cases,  if 
the  proper  educational  program  is  carried 
out  and  the  child  is  started  early  enough 
on  his  career  of  learning,  he  can  grow  up 
to  attend  a university  and  take  his  place 
in  the  complex,  highly  competitive  economic 
and  social  world  of  today. 

Otosclerosis 

The  pathology  of  clinical  otosclerosis  con- 
sists of  a developmental  proliferation  of 
bone  involving  the  area  about  the  footplate 
of  the  stapes  and  the  oval  window  in  the 
middle  ear.  The  exact  cause  of  this  pro- 
liferation is  not  known  other  than  it  is 
hereditary  in  nature. 

The  incidence  of  otosclerotic  changes  in 
the  labyrinthine  capsule  is  very  high  and 
is  often  found  in  autopsy  in  persons  never 
known  to  be  deaf.  How  many  persons  go 
through  life  with  otosclerosis  which  never 


manifests  itself  by  involving  the  stapes  foot- 
plate is  not  known,  but  it  is  estimated  that 
otosclerosis  accounts  for  more  than  50  per 
cent  of  all  deafness  in  this  country. 

The  diagnosis  of  otosclerosis  is  character- 
ized by  a progressive  bilateral  loss  of  hear- 
ing involving  first  the  conductive  and  later 
the  perceptive  mechanism.  It  usually  be- 
comes apparent  in  early  adult  life  and  is 
frequently  associated  with  tinnitus.  There 
may  or  may  not  be  a positive  family  his- 
tory of  deafness.  Frequently  the  patient 
has  some  reason  for  his  deafness,  such  as 
trauma,  childhood  disease,  or  a recent  upper 
respiratory  infection.  This,  unfortunately, 
may  simply  cause  the  examining  doctor  to 
err  in  the  diagnosis  of  otosclerosis. 

A very  thorough  examination  of  the  en- 
tire ear  mechanism  will  fail  to  elicit  any 
cause  whatsoever  for  the  patient’s  impair- 
ment. The  eustachian  tubes  inflate  readily, 
the  ear  drums  appear  normal. 

By  the  time  the  patient  seeks  aid  the 
audiogram  will  reveal  a bilateral  conduc- 
tion loss  of  25  to  50  decibels,  with  or  with- 
out evidence  of  nerve  deterioration. 

Any  progressive  bilateral  hearing  impair- 
ment occurring  in  early  or  middle  adult  hfe, 
which  does  not  present  evidence  of  ear 
pathology,  very  strongly  suggests  oto- 
sclerosis. This,  coupled  with  a co-existent 
tinnitus  and  a family  history  of  deafness, 
is  almost  diagnostic  of  the  disease. 

Perhaps  no  other  group  of  individuals  has 
been  subjected  to  more  treatment  without 
benefit  than  the  patient  with  otosclerosis. 
Repeated  eustachian  tube  inflations,  nose 
treatments,  nose  and  throat  surgery,  ear 
drum  massage,  various  diets,  endocrines, 
vitamins,  and  minerals  have  all  been  put 
through  their  paces  without  improvement. 
When  benefit  has  been  derived  from  these 
treatments  one  must  believe  the  diagnosis  of 
otosclerosis  was  in  error. 

Some  seventy  years  ago  an  otologist  by 
the  name  of  Kessel  had  a patient  suffering 
with  otosclerosis.  The  patient  subsequently 
heard  normally  in  one  ear  following  a skull 
fracture  which  involved  the  temporal  bone. 
Years  later  an  autopsy  revealed  an  open 


1022 


Rocky  Mountain  Medical  Journal 


fracture  in  the  bone  over  the  patient’s  in- 
tact membranous  labyrinth. 

This  led  to  considerable  experimental 
work  in  creating  surgically  an  opening  in 
the  osseous  labyrinth.  It  was  noted  the  oto- 
sclerotics  heard  well  as  soon  as  this  open- 
ing was  made,  providing  the  nerve  function 
was  capable  of  transmitting  the  sound  to 
the  brain.  Likewise,  as  soon  as  the  bony 
opening  closed  the  hearing  dropped  back 
to  its  original  level. 

Pasco,  Jenkins,  Barony,  Holmgren  and 
Sourdille  are  prominent  names  in  the  his- 
tory of  otosclerotic  surgery  and  each  made 
his  contribution.  Some  ten  years  ago  Dr. 
Julius  Lempert  developed  the  first  satis- 
factory surgical  technic  which  could  be  em- 
ployed routinely  in  these  cases.  Since  then 
he  and  others  have  modified  the  procedure 
on  several  occasions  until  now  a patient 
with  otosclerosis,  who  has  good  hearing 
nerve  function,  has  approximately  two  out 
of  three  chances  of  obtaining  permanent 
practical  hearing  by  means  of  the  fenestra- 
tion or  window  operation. 

Surgery  of  this  type  is  very  delicate  and 
exacting.  Fortunately,  the  incidence  of  se- 
rious complications  seems  to  be  less  than 
2 per  cent.  These  complications  include 
labyrinthine  damage  from  injury  or  infec- 
tion, facial  paralysis,  meningitis,  etc.  To 
my  knowledge  there  have  been  no  deaths 
directly  attributable  to  the  operation. 

Today  the  patient  with  otosclerosis  has 
but  one  of  two  choices  when  the  hearing 
loss  becomes  pronounced.  One  is  the  hear- 
ing aid  and  the  other  is  the  fenestration 
operation.  The  hearing  aid  will  give  very 
satisfactory  results  in  early  otosclerosis.  Ul- 
timately, if  the  otosclerotic  process  advances 
to  involve  the  nerve  beyond  the  conversa- 
tional range,  even  a hearing  aid  is  of  little 
value  and  the  patient  must  turn  to  aural 
rehabilitation  just  as  in  the  case  of  advanced 
nerve  deafness. 

The  fenestration  operation  is  indicated 
in  any  case  of  otosclerosis  in  which  the  ear 
drum  is  intact  and  the  nerve  function  is 
capable  of  transmitting  the  normal  ranges 
of  conversation  to  the  brain.  The  degree 


of  nerve  function  present  is  determined  by 
careful  tuning  fork  and  audiometric  tests. 

Conclusion 

From  this  brief  review  of  the  problems 
of  the  hard-of-hearing,  you  can  readily 
realize  that  many  advances  have  been  made 
in  the  care  of  these  unfortunate  individuals. 
It  is  the  obligation  of  the  physician  to  ac- 
quaint the  general  public  with  the  fact  that 
much  can  now  be  done  for  the  hard-of- 
hearing.  If  future  advances  keep  pace  with 
those  of  the  past  decade,  the  impaired  in- 
dividual will  have  little  to  fear. 


PENICILLIN  CURES  CONGENITAL  SYPHILIS 

Babies  born  with  syphilis  can  be  cured  in 
almost  all  cases  in  which  treatment  with  peni- 
cillin is  begun  before  the  age  of  three  months, 
a study  made  by  three  Philadelphia  doctors 
shows.  The  doctors — Elizabeth  Kirk  Rose,  Paul 
Gyorgy,  and  Norman  R.  Ingraham,  Jr. — report 
their  findings  in  the  American  Journal  of  Dis- 
eases of  Children,  published  by  the  American 
Medical  Association.  The  study  was  made  under 
a grant  from  the  National  Institute  of  Health. 
Sixty  children  were  studied  over  a period  of 
two  years.  Seven  infants  died  during  the  study, 
two  of  causes  other  than  syphilis.  The  remain- 
ing five  who  died  were  small,  unusually  weak 
infants  and  their  deaths  were  not  thought  to 
be  related  to  penicillin  therapy,  the  doctors 
say. 

Of  the  forty-eight  babies  treated  with  peni- 
cillin by  injections  into  the  muscles,  thirty- 
seven  apparently  were  cured  and  ten  were  free 
of  symptoms  although  blood  tests  remained  posi- 
tive for  the  disease.  Results  in  one  case  could 
not  be  evaluated  because  the  child  was  not 
available  for  study.  Five  children  were  treated 
with  penicillin  given  by  mouth.  Four  infants 
responded  “satisfactorily”  and  one  child  two 
and  a half  years  of  age  responded  “well”  al- 
though his  blood  test  remained  positive.  “The 
age  of  the  patient  at  the  onset  of  treatment, 
rather  than  the  dosage,  type,  or  means  of  ad- 
ministration of  penicillin,  seemed  to  be  the  chief 
factor  in  determining  satisfactory  response,”  the 
doctors  point  out.  “Cures  approached  100  per 
cent  when  treatment  was  commenced  before 
the  third  month  of  life.” 


The  responsibility  of  the  doctor  in  enabling  the 
patient  to  gain  psychological  acceptance  of  the 
diagnosis  cannot  be  too  strongly  emphasized. 
There  is  much  that  auxiliary  medical  personnel 
can  do,  but  all  that  they  do  cannot  equal  what 
the  doctor  himself  can  accomplish  in  helping  the 
patient  develop  a constructive  attitude  toward 
his  illness.  The  patient  “can  take  it”  from  the 
doctor  to  a degree  that  no  one  else  can  match. 
The  understanding  and  assurance  the  patient 
receives  from  the  doctor  have  far  more  effect 
in  creating  a frame  of  mind  conducive  to  suc- 
cessful hospitalization  than  any  help  the  patient 
receives  from  others. — William  B.  Tollen,  Ph.D., 
VA  Pamphlet  10-27,  Oct.,  1948. 


jor  December,  1949 


1023 


SURGICAL  TREATMENT  OF  HERMAPHRODITISM 

CLAUDE  L.  SHIELDS,  M.D.,  C.  B.  FREUDENBERGER,  M.D.,  and  ORIN  OGILVIE,  M.D. 

SALT  LAKE  CITY 


Our  interest  in  this  subject  was  initiated 
a number  of  years  ago  by  an  article  by  a 
Swedish  surgeon  who  described  his  discov- 
ery and  removal  of  uterus,  ovaries,  fallopian 
tubes,  and  vagina,  in  three  cases  while  do- 
ing a routine  repair  of  inguinal  hernia  in  a 
male.  It  was  fortunate  that  we  had  ab- 
sorbed this  surgeon’s  theories  of  using  sur- 
gery in  attempting  to  make  all  hermaphrod- 
itism predominantly  one  sex  or  the  other 
and  avoiding  when  possible  the  production 
of  a eunuch. 

We  encountered  female  organs  while  do- 
ing a routine  herniotomy  on  a male  patient 
who  had  never  been  suspected  of  being  a 
hermaphrodite.  It  was  quite  unnerving  to 
pull  from  an  opening  made  for  the  repair  of 
an  indirect  inguinal  hernia  a tube  and 
ovary.  A description  of  this  case  is  as  fol- 
lows: 

Mr.  T.  B.,  Holy  Cross  Hospital;  admitted  Au- 
gust 28,  1944;  aged  29.  He  had  been  refused  Army 
enlistment  at  Fort  Douglas  because  of  an  in- 
guinal hernia  and  undescended  testicle.  Exami- 
nation disclosed  a frail  type  of  man  with  a high- 
pitched  voice,  light  hair  on  his  head,  with  no 
facial  hair  except  down  on  the  upper  lip.  He 
did  not  shave.  The  skin  was  pale  and  of  a soft 
texture.  Blood  pressure  was  118/78.  The  heart, 
lungs,  and  abdomen  were  normal.  Blood  and 
urine  analysis,  not  remarkable.  The  rectum  was 
normal.  A very  small  tender  prostate  could  be 
palpated.  The  penis  was  small,  about  Vs  the 
average  size,  but  he  stated  that  he  .had  good 
erections  and  emissions.  A large  left  indirect 
inguinal  hernia  with  cough  impulse  was  present. 
No  testicles  could  be  palpated  in  the  scrotum, 
but  on  this  side  a small  mass  was  found  in  the 
inguinal  canal  which  was  presumed  to  be  an  un- 
descended testicle. 


Fig.  1.  Gross  structure. 


He  stated  that  he  had  had  a hernia  since  the 
age  of  6,  but  that  it  had  not  bothered  him  until 
18  months  ago,  when  he  lifted  a heavy  bale  of 
muslin.  Since  then  he  had  noticed  bulging  and 
pain  in  this  region.  By  pressure  he  could  force 
the  testicle  into  the  scrotum. 

His  sexual  life  was  normal  from  his  point  of 
view.  He  had  good  erections  and  emissions.  His 
wife  was  sterile  and  had  had  three  surgical  pro- 
cedures performed  in  attempts  to  get  pregnant. 
Because  of  this  history,  and  because  we  contem- 
plated transplanting  the  testicles  into  the  scro- 
tum, one  of  us.  Dr.  C.  B.  Freudenberger,  did 
numerous  checks  to  find  spermatazoa,  but  no 
spermatozoa  were  ever  identified. 

The  operation  was  performed  under  spinal  an- 
esthesia August  29,  1944.  Incision  was  made 
parallel  to  Poupart’s  ligament  over  the  left 
spermatic  cord;  but  when  pulled  out  this  proved 
to  be  fallopian  tubes.  The  incision  was  now  en- 
larged and  the  following  organs  were  delivered 
and  identified  — right  fallopian  tube,  left  fal- 
lopian tube,  uterus,  cervix  and  small  tube  at- 
tached to  the  bladder  which  was  later  identified 
as  the  vagina.  The  left  testicle  was  under  the 
tube  and  adherent  to  the  broad  ligament  and  to 
the  uterus.  Because  of  its  position  in  approxi- 
mately the  normal  position  for  an  ovary,  a 
biopsy  specimen  was  removed  and  sent  to  the 
pathologist  for  a frozen  section.  The  report  was 
testicular  tissue,  so  it  was  dissected  from  the 
uterus,  tube  and  broad  ligament  and  transplanted 
into  the  scrotum.  This  testicle  was  normal  size, 
with  vas  and  epididymis  apparently  normal.  The 
cord  contained  very  few  blood  vessels. 

Biopsy  specimens  were  taken  from  a smaller 
fatty  mass  on  the  right  side,  under  the  fibriated 
end  of  the  tube.  No  ovaries  or  testicles  were 
found  in  this  specimen  by  frozen  section. 

This  tube  and  small  fatty  mass  with  the  uterus 
and  left  tube  were  now  dissected  free  from  the 
bladder,  leaving  a small  tube  attached  to  the 
bladder  because  it  had  the  appearance  of  a blad- 
der diverticulum.  After  this  was  opened  it  was 
found  to  have  no  connection  with  the  interior 
of  the  bladder  so  it  was  opened  widely  and  su- 
tured flat  onto  the  bladder  wall.  The  incision 
was  now  enlarged  so  that  the  right  side  could 
be  explored.  A testicle  one-half  as  large  as  the 
left,  with  attached  epididymis  and  vas  deferens 
was  located  on  the  right  posterior  peritoneal 
surface.  It  was  firmly  attached  to  all  surround- 
ing tissues,  so  it  was  not  disturbed.  The  hernia 
was  then  repaired  and  the  abdomen  closed  in  the 
usual  manner. 

The  following  is  the  pathological  report  by  Dr. 
Orrin  A.  Ogilvie:  “Specimen  consists  of  a rudi- 
mentary uterus  with  attached  fallopian  tubes. 
Broad  and  round  ligaments.  A slight  asymmetry 
exists  as  the  uterine  wall  on  the  left  side  is 
somewhat  thicker  than  the  wall  on  the  right 
side.  The  left  tube  is  definitely  longer  than  its 
fellow  on  the  right  side.  The  uterus  is  3 cm.  in 
length,  1 cm.  across  the  cervical  end,  and  2x1  cm. 
on  the  fundal  extremity.  The  fallopian  tubes 
course  along  the  upper  borders  of  the  broad  liga- 
ments. On  the  left  side  the  tube  is  71/2  cm.  long 
and  2 mm.  in  diameter  at  the  isthmus,  but  is 
expanded  to  2y2x6  cm.  at  the  fimbriated  end. 
The  latter  is  pale  and  rounded  off  and  the  tubal 
lumen  is  closed.  The  right  tube  is  a duplicate 
of  its  fellow  except  that  it  is  only  dVz  cm.  in 


1024 


Rocky  Mountain  Medical  Journal 


length.  All  structures  are  serosa-covered.  The 
round  ligaments  are  small  in  proportion  and  fade 
out  in  the  broad  ligaments.  The  broad  ligament 
is  from  1 to  3 mm.  in  thickness,  and  from  1 to  1 % 
cm.  in  width  on  the  right  side,  and  from  1 to  3 
mm.  in  thickness  and  1 to  21/2  cm.  in  width  on 
the  left  side.  There  are  several  small  but  very 
thick-walled  tortuous  blood  vessels  running 
through  the  broad  ligaments.  Some  of  these  ves- 
sels appear  completely  obliterated;  some  have 
blood  in  their  lumina.  Biopsy  of  testis:  Speci- 
men consists  of  a piece  of  tissue  1 cm.  in  di- 
ameter and  from  Vz  to  Vz  cm.  in  thickness.  It 
looks  like  testis.  Microscopic  study  shows  it  to 
be  slightly  atrophic,  non-functioning  (as  to 
spermatozoa  production),  mildly  edematous  testis. 
The  interstitial  cells  of  Lydig  are  intact. 

“Microscopic:  1.  Uterus  a.  the  corpus  and  the 
cervix  uteri  exhibit  the  usual  layers,  serosa, 
muscularis,  and  mucosa,  endometrium  and/or 
endocervix.  The  myometrium  is  edematous  and 
many  of  the  larger  vessels  have  unusually  thick 
fibrotic  walls.  The  cervix  closely  resembles  the 
myometrium,  and  the  endometrium  and  endo- 
cervix are  identical.  These  show  a scanty  stroma 
of  loose  connective  tissue  which  supports  rela- 
tively simple  compound  tubular  glands.  These 
surfaces  are  covered  by  a low-columnar  type  of 
epithelium. 

“Broad  Ligaments:  These  are  composed  of 
loose  or  edematous  connective  tissue  which  is 
well  supplied  with  hyperemic  blood  vessels  of  the 
expected  caliber.  In  addition,  there  are  some 
very  thick-walled  fibrotic  vessels,  some  with 
narrow  lumina  filled  with  blood,  others  that  are 
cord  - like  and  lumenless.  The  fallopian  tubes 
exhibit  the  usual  architecture  of  the  atrophic 
isthmi  of  such  organs.  The  right  and  left  broad 
ligaments  and  tubes  are  identical. 

“Ovarian  Tissue:  None  could  be  demonstrated.” 

Dr.  Freudenberger  later  made  serial  sec- 
tions of  the  remaining  mass  of  tissue  on 
and  under  the  right  tube  and  demonstrated 
ovarian  cells  in  several  areas.  Beneath  the 
yellow  fatty  mass  on  the  right  side,  de- 
scribed above  by  Dr.  Ogilvie,  serial  sections 
were  made  by  Dr.  Freudenberger.  These 
revealed  a nodule  containing  ovarian  tissue 
and,  attached  to  it,  a very  small  hardened 
nodule  of  testicular  cells.  Beneath  this,  but 
not  attached  to  it,  was  the  head  of  an  epid- 
idymis and  a short  tortuous  vas  which 
ended  blindly  in  the  broad  ligament. 

Since  the  study  on  the  above  case  I have 
had  the  opportunity  of  examining  two  more 
specimens  of  female  organs  removed  from 
herniotomy  wounds  of  male  patients.  These 
specimens  were  sent  to  the  pathologic  lab- 
oratory of  the  University  of  Utah  Medical 
School  by  doctors  in  the  neighboring  states. 
The  first  specimen  contained  vagina,  uterus, 
Fallopian  tubes,  and  testicles  on  each  side. 

I discussed  this  case  with  the  operating 
surgeon  who  stated  that  the  testicles  were 
in  the  exact  position  of  the  ovaries  and  had 

for  December,  1949 


the  appearance  of  normal  ovaries,  so  he  re- 
moved the  entire  mass  and  did  not  know 
that  he  had  removed  both  testicles  until  the 
pathologist’s  report.  By  so  doing,  he  un- 
fortunately made  a castrate  of  his  patient. 


Pig.  2.  Female  organs  removed  from  herniotomy 
wound  of  male  patient. 


The  second  specimen  contained  a small 
atrophic  uterus,  two  well-developed  tubes 
with  an  ovary  on  the  left  side  and  testicle 
on  the  right  side  of  the  uterus  (Fig.  3) . The 
surgeon  in  this  case  did  not  examine  the 
other  side  of  the  abdomen  for  ovary  or  un- 
descended testicle,  but  it  is  evident  that  this 
hermaphrodite  would  have  been  better  with 
only  the  removal  of  the  ovary  or  testicle — 
not  both. 


Fig.  3’.  Another  specimen  containing  an  atrophic 
uterus. 


Hermaphrodites  are  the  most  unfortunate 
outcasts  of  our  society.  In  their  contact 
with  males  they  are  the  subject  of  fun  and 
jokes  and  they  are  avoided  and  ridiculed 
by  females.  They  cannot  be  segregated  like 
lepers  or  victims  of  tuberculosis. 

I had  the  opportunity  of  witnessing  the 

1025 


y.  the 
:>HYS1CIANS 


pleasure  and  happiness  that  can'  come  to  an 
individual  who  was  transferred  from  mas- 
querading as  a girl  into  his  proper  sexual 
sphere.  Although  this  patient  was  not  a 
hermaphrodite  he  illustrates  what  can  be 
done  with  surgery  on  some  of  mixed  sex 
cases. 

The  patient  was  a child  of  13  under  the 
care  of  Dr.  E.  F.  Root,  and  had  previously 
been  operated  on  in  Colorado  for  a tumor 
in  the  inguinal  region  which  was  removed 
and  diagnosed  as  ovarian  tissue.  Dr.  Root 
always  thought  that  a mistake  had  occurred 
and  that  an  undescended  testicle  had  been 
removed. 

The  child  had  become  incorrigible.  Os- 
tensibly a girl,  he  would  stay  out  nights 
with  boys  and  play  boys’  games.  He  would 
hang  by  the  feet  from  trees  showing  dainty 
underwear.  In  short,  the  child  had  become 
a hardened  tough  at  an  early  age.  When 
first  seen  in  the  Holy  Cross  Hospital  the 
child  had  all  the  appearance  of  a beautiful 
girl  with  long  dark  curls  and  was  dressed 
in  very  nice  feminine  attire. 

Dr.  Root  recognized  the  fact  that  he  was 
dealing  with  an  individual  more  male  than 
female  and  proceeded  to  reconstruct  a de- 
formed rudimentary  penis  with  hypospa- 
dias, and  bring  the  undescended  testicle 
down  into  the  scrotum.  After  recovering 
from  his  operation,  the  long  hair  was  cut 
off  and  he  was  dressed  in  boys’  clothes. 
The  new  boy  was  the  happiest  kid  in  town. 
The  mental  and  physical  improvement  was 
so  astounding  that  his  parents  could  scarce- 
ly believe  such  a great  change  could  occur. 

When  I was  a medical  student,  hermapro- 
dites  were  offered  no  hope  of  improvement 
by  medicine  or  surgery,  but  many  of  them 
wandered  from  one  medical  school  to  an- 
other, where  groups  of  students  got  to- 
gether and  would  pay  50  cents  apiece  to 
examine  the  freaks  of  nature. 

In  the  last  few  years,  since  the  introduc- 
tion of  refined  and  potent  male  and  female 
hormones,  there  has  been  considerable  work 
done  with  these  preparations  for  the  relief 
of  some  of  the  agonizing  symptoms  of  her- 
maphrodites. In  my  opinion,  hormones  are 
of  greater  value  in  those  cases  where  sur- 
gery has  removed  some  of  the  organs  pro- 


ducing an  antagonistic  hormone.  This  is 
substantiated  by  some  of  the  following  lit- 
erature: F.  Gudernatsch  expresses  the  opin- 
ion of  all  modern  students  — “That  it  is 
gratifying  to  learn  from  the  reports  of  the 
last  decade  that  it  is  possible,  in  some  cases 
at  least,  through  either  surgery  or  hormone 
treatment  or  with  a combination  of  both 
measures,  to  bring  medical  aid  to  these 
individuals  by  shifting  their  anatomical, 
physiological,  and  psychological  unbalance 
from  the  state  of  bisexuality  to  a somewhat 
more  determined  state  of  either  male  or 
female  sexuality.”  The  social  significance 
of  such  corrective  measures  cannot  be  over- 
estimated. 

Hinman  makes  the  following  classifica- 
tion for  true  hermaphroditism: 

1.  Bilateral — testis  and  ovary  on  either 
side  separate  or  united. 

2.  Unilateral — testis  and  ovary  either  sep- 
arated or  united  on  one  side  with  either 
testis  or  ovary  on  other. 

3.  Lateral  or  alternating — testis  on  one 
side,  ovary  on  other. 

The  treatment  of  pseudo-hermaphrodit- 
ism, intersexuality,  and  virilism  brings  to 
the  surgeon  a very  much  larger  group  of 
patients  in  which  operations  on  the  adrenal 
and  pituitary  glands  may  supplement  those 
on  the  gonads.  Eighty-nine  such  cases  are 
reported  by  English  physicians  in  the  book, 
The  Adrenal  Cortex  and  Intersexuality.  Von 
Neugebauer  presented  the  records  of  2,072 
intersexual  charges. 

In  1937,  Dr.  Hugh  Young  in  his  reference 
work  on  genital  abnormalities  and  related 
adrenal  disease  listed  a total  of  twenty  cases 
of  hermaphroditism  verus  reported  in  the 
entire  medical  literature.  In  1944,  F.  Guder- 
natsch corrected  the  total  figure  of  authen- 
ticated cases  of  true  hermaphroditis  to  thir- 
ty-five. These  cases  are  those  that  have  been 
operated  on  or  came  to  the  postmortem 
table,  so  the  actual  number  of  cases  now 
hiding  their  condition  from  the  public  view 
must  be  very  large.  To  illustrate  how 
easily  or  frequently  a hermaphrodite  can  be 
overlooked  by  a surgeon,  McKinna  and 
Kiefer  reported  in  1944  two  cases  of  true 
hermaphroditism  referred  to  them  for  treat- 
ment of  hypospadias.  The  surgeons  had 


1026 


Rocky  Mountain  Medical  Journal 


never  suspected  that  each  patient  had  also 
vagina,  uterus,  fallopian  tubes  and  ovary. 

In  reviewing  the  literature  it  was  very 
surprising  to  find  a large  number  of  re- 
ported cases  in  which  the  gonads  and  the 
sex  organs  were  found  during  herniotomy 
operations.  The  following  are  such  cases  (of 
which  most  were  pseudo-hermaphrodites): 

1.  Smith,  Mack  and  Muney — left  inguinal 
herniotomy. 

2.  Kell,  Mathews,  and  Backman — left  her- 
niotomy. 


3.  Hugins,  Cohne,  and  Harden — herniot- 
omy. 

4.  Reinberger  and  Simpkins  — bilateral 
herniotomy. 

5.  Young  (seven  tabulated  cases)  — left 
scrotal  hernia. 

6.  Malgias  and  Gricouroff  — right  herni- 
otomy. 

7.  Stirling-1 — right  herniotomy. 

8.  Green — left  herniotomy. 

9.  Joseph  McFarland — herniotomy. 

10.  Warten  and  Williams — herniotomy. 

11.  Kozoll — herniotomy. 


REVIEW  OF  MANAGEMENT  OF  PERSISTENT  OCCIPUT 
POSTERIOR  POSITIONS* 

HAROLD  W.  FULLER,  M.D.,  EARL  L.  HALL,  M.D.,  and  FRANK  L.  McPHAIL,  M.D. 

GREAT  FARES,  MONTANA 


In  adding  this  report  to  the  many  already 
published  on  the  management  of  the  persist- 
ent occiput  posterior,  we  wish  to  make  a 
strong  appeal  for  individual  consideration  of 
each  patient.  Frequently  only  one  method  of 
delivery  is  advocated.  Some  mention  deliv- 
ery as  a posterior  only  to  condemn  it;  others 
permit  it  only  when  all  else  fails.  The  ma- 
jority of  the  reports  reviewed  advocate  some 
method  of  anterior  rotation,  either  manual 
or  by  standard  or  specialized  forceps  maneu- 
vers for  every  occiput  posterior.  We  have 
attempted  to  choose  the  easiest  method  of 
delivery.  If  anterior  rotation  is  difficult  and 
requires  force,  we  have  elected  to  deliver 
the  baby  in  the  occipito-sacral  position.  In 
our  experience  this  method  has  permitted 
a reasonably  low  uncorrected  fetal  mortal- 
ity, and  has  not  increased  maternal  morbid- 
ity. 

This  report  is  concerned  with  the  occiput 
posterior  positions  encountered  in  the  ob- 
stetrical service  of  the  Great  Falls  Clinic 
from  August  1,  1931,  through  December  31, 
1948.  There  are  538  patients  in  this  series. 
Fourteen  sets  of  twins  occurred  in  this  group 
and  of  those  there  were  two  sets  in  which 
both  babies  were  occiput  posterior  positions, 
making  the  total  number  of  babies  to  be 

•Read  before  the  Annual  Winter  Meeting-  of  the 
Montana  Obstetrical  and  Gynecological  Society, 
Butte,  Montana,  February  12,  1949.  From  the  Great 
Falls  Clinic. 


considered  540.  During  this  same  period  the 
total  number  of  deliveries  was  8,331,  an  in- 
cidence of  occiput  posterior  positions  of 
6.46  per  cent.  For  the  purpose  of  this  study 
only  deliveries  in  which  the  baby  weighed 
over  1,000  grams  were  considered.  We  have 
included  in  the  group  of  occiput  posterior 
positions  only  those  patients  who  had  an 
occiput  posterior  at  the  time  they  were  pre- 
pared and  draped  for  delivery  and  not  those 
in  whom  spontaneous  rotation  of  a posterior 
may  have  occurred  some  time  during  labor. 
This  explains  why  our  incidence  differs 
from  that  of  many  authors  who  may  state 
the  incidence  of  posterior  positions  to  be  as 
high  as  12  to  50  per  cent.  Therefore,  this 
series  represents  a study  of  persistent  occi- 
put posterior  positions. 

Parity,  Age  Groups,  and  Duration 
of  Pregnancy 

Of  the  538  patients  275  were  primigravidae 
and  263  were  multigravidae.  The  age  inci- 
dence is  not  of  significance,  the  largest  group 
falling  between  twenty  and  thirty  regard- 
less of  parity.  We  have  considered  patients 
whose  period  of  gestation  was  between  thir- 
ty-eight and  forty-two  weeks  to  be  at  term, 
and  of  the  total  number  508  fall  in  this  cate- 
gory. There  were  thirteen  primigravidae  and 
nine  multigravidae  who  delivered  before 
thirty-eight  weeks.  According  to  the  above 


for  December,  1949 


1027 


criterion  there  were  only  eight  patients,  four 
primigravidae  and  four  multigravidae,  clas- 
sified as  post  mature. 


TABLE  1 

Primigravidae  Multigravidae 


Age  Groups 

(275) 

(263) 

Under  20  

. 37 

4 

29-29  

. 200 

168 

30-39  

. 38 

79 

40  and  Over 

0 

12 

Infant 

Infant 

Duration  of  Pregnancy 

Deaths 

Deaths 

Less  Than  38  Wks.... 

. 13 

1 

9 

2 

38-42  Wks 

. 258 

3 

250 

4 

Over  42  Wks 

...  4 

0 

4 

0 

Onset  of  Labor  and  Rupture  of  Membranes 

The  onset  of  labor  was  spontaneous  in  481 
patients,  254  prim^igravidae  and  227  multi- 
gravidae. There  were  seven  medical  induc- 
tions and  fourteen  surgical  inductions  in  the 
primigravidae  as  compared  with  nineteen 
medical  inductions  and  seventeen  surgical 
inductions  in  the  multigravidae.  The  surgi- 
cal inductions  all  consisted  of  rupture  of  the 
membranes  except  one,  a multigravida, 
which  was  a bag  induction,  done  in  the 
early  nineteen  thirties.  The  time  and  method 
of  the  rupture  of  the  membranes  is  shown 
in  Table  2.  To  summarize,  the  membranes 
ruptured  spontaneously  in  318  cases  and 
were  ruptured  artificially  in  185  cases.  In 
both  groups  the  membranes  ruptured  spon- 
taneously during  the  first  stage  in  the  larg- 
est number  of  patients. 

TABLE  2 

Primigravidae  Multigravidae 
Infant  Infant 

Onset  of  Labor  Deaths  Deaths 


Spontaneous  

254 

3 

227 

6 

Medical  Induction  .. 

7 

0 

19 

0 

Surgical  Induction.. 

14 

1 

17(lbg)0 

Time  and  Method 

of  Rupture 
of  Membranes  B.O. 

1st 

2nd 

B.O. 

1st 

2nd 

Spontaneously....  43 

87 

46 

51 

48 

43 

Artificially 14 

30 

42 

16 

40 

43 

No  Record 

13 

22 

Duration  of  Labor 

Inasmuch  as  labor  is  generally  said  to  be 
prolonged  in  posterior  positions  it  is  worthy 
of  note  that  in  48  per  cent  of  the  primi- 
gravidae the  first  stage  was  less  than  twelve 
hours,  in  28  per  cent  it  was  between  twelve 


and  twenty  hours,  and  in  only  20  per  cent 
was  the  duration  of  the  first  stage  over 
twenty  hours.  Four  per  cent  were  unre- 
corded. In  the  second  stage,  40  per  cent 
were  under  one  hour,  35  per  cent  were  be- 
tween one  and  two  hours,  and  21  per  cent 
were  over  two  hours  with  4 per  cent  unre- 
corded. Among  the  multigravidae  69  per 
cent  had  first  stages  of  labor  less  than  eight 
hours,  22  per  cent  between  eight  and  six- 
teen hours  and  only  6 per  cent  over  sixteen 
hours  with  3 per  cent  unrecorded.  The  sec- 
ond stage  was  less  than  one  hour  in  88  per 
cent,  between  one  and  two  hours  in  .8  per 
cent,  and  over  two  hours  in  1 per  cent  and 
3 per  cent  were  unrecorded.  Thus  in  the 
primigravidae  the  first  and  second  stages 
were  both  prolonged  in  about  20  per  cent 
(first  stage  over  twenty  hours  and  second 
stage  over  two  hours) ; in  the  multigravidae 
the  first  stage  was  prolonged  in  6 per  cent 
(over  sixteen  hours)  and  the  second  stage 
was  prolonged  in  9 per  cent  (over  one  hour). 

Weights  of  Babies 

The  weights  of  the  babies  were  compared 
with  the  742  babies  delivered  in  the  Mon- 
tana Deaconess  Hospital  in  1948  and  the  dif- 
ference was  hardly  great  enough  to  be  of 
statistical  significance.  However,  when 
placed  in  group  intervals  of  100  grams  the 
largest  group  of  babies  in  the  normal  series 
fell  in  the  3,400  to  3,500  gram  group  while 
the  largest  number  of  babies  in  the  posterior 
group  were  in  the  interval  between  3,600 
and  3,700  grams. 

Analgesia 

One  hundred  ninety  of  the  primigravidae 
received  analgesia  during  labor  while 
eighty-five  had  none.  Seventy-nine  of  the 
multigravidae  received  analgesia;  184  had 
none.  Types  of  analgesia  varied.  In  the 
early  part  of  the  study  it  was  most  often 
scopolamine  alone,  in  the  later  ninteen  thir- 
ties nembutal  and  scopolamine,  in  the  nine- 
teen forties  seconal  or  sodium  amytal  and 
scopolamine,  demeral  and  scopolamine,  or 
papaverine  and  scopolamine.  Of  the  total 
series  exactly  50  per  cent  had  no  analgesia. 
For  anesthesia  all  received  nitrous  oxide 
and  oxygen  with  or  without  ether  vapor 


1028 


Rocky  Mountain  Medical  Journal 


TABLE  3 
Duration  of  Labor 


0-12 

First  Stage 

No 

12-20  20 — Record 

0-1 

Second  Stage 

No 

1-2  2 — Record 

Primigravidae 

132 

48% 

78 

28% 

54  11 

20%  4% 

109 

40% 

97 

35% 

58 

21% 

11 

4% 

0-8 

8-16 

No 

16 — Record 

Multigravidae.- 

182 

69% 

57 

22% 

16  3 

6%  3% 

231 

88% 

21 

8% 

3 

1% 

8 

3% 

during  delivery  and  in  most  cases  local  an- 
esthesia in  the  form  of  pudendal  block  was 
used.  Since  1933  surgical  anesthesia  has 
rarely  been  employed. 

Methods  of  Delivery 

The  purpose  of  this  study  is  a critical  an- 
alysis of  the  many  methods  of  delivery  in 
the  occiput  posterior  positions,  and  they  are 
tabulated  in  Table  4.  Calculations  of  per- 
centages from  the  figures  shown  in  this  slide 
give  the  following  results;  24.6  per  cent  of 
the  occiput  posterior  positions  rotated  an- 
teriorly spontaneously,  low  forceps  and  an- 
terior rotation  by  the  Scanzoni  or  key-in- 
lock  method  was  done  in  26.1  per  cent  of 
cases,  mid  forceps  with  anterior  rotation  by 
the  Scanzoni  or  key-in-lock  method  was  em- 
ployed in  5.9  per  cent,  manual  rotation  was 
accomplished  in  3.5  per  cent,  delivery  was 
spontaneous  as  an  occiput  posterior  in  17.6 
per  cent,  low  or  mid  forceps  were  used  to 


effect  delivery  in  the  occiput  posterior  posi- 
tion in  20.8  per  cent  of  cases,  rotation  to  an 
anterior  position  with  one  forcep  blade  was 
done  in  0.9  per  cent  and  0.6  per  cent  of  the 
cases  were  delivered  by  either  version  and 
extraction  of  low  cesarean  section.  Durssen’s 
incisions  were  performed  on  ten  patients  in 
the  series.  In  the  entire  series  some  type  of 
operative  delivery,  exclusive  of  episiotomies, 
was  employed  to  deliver  324  of  the  babies, 
making  the  incidence  of  operative  deliver- 
ies 60  per  cent. 

The  teaching  in  medical  schools  over 
many  years  has  been  that  some  form  of  an- 
terior rotation  must  be  done.  Little^  made 
this  statement  in  1930:  “For  fifteen  years 
we  have  taught  that  the  proper  time  to 
deliver  these  patients  is  when  the  cervix  is 
fully  dilated  and  the  head  is  still  movable; 
then  one  can  go  ahead  with  certainty.  Ap- 
ply the  forceps  and  make  traction,  and  in 
90  per  cent  of  the  cases  the  head  will  rotate 


TABLE  4 

Methods  of  Delivery 


Spontaneous  Rotation  and  Delivery  as  OA 

Spontaneous  Rotation  Followed  by  Low  Forceps  Extraction. 

Low  Forceps,  Scanzoni  Rotation  to  OA  and  Extraction 

Low  Forceps,  Key  in  Lock  Rotation  to  OA  and  Extraction 

Low  Forceps,  Key  in  Lock  Rotation  to  OA  and  Spontaneous  Delivery.... 

Mid  Forceps,  Scanzoni  Rotation  to  OA  and  Extraction 

Mid  Forceps,  Key  in  Lock  Rotation  to  OA  and  Extraction 

Mid  Forceps,  Key  in  Lock  Rotation  to  OA  and  Spontaneous  Delivery.... 

Manual  Rotation  to  OA  and  Spontaneous  Delivery 

Manual  Rotation  to  OA  and  Low  Forceps  Extraction 

Spontaneous  Rotation  and  Delivery  as  OP 

Low  Forceps  Rotation  to  OP  and  Extraction 

Low  Forceps  Rotation  to  OP  and  Spontaneous  Delivery  as  OP 

Mid  Forceps  Rotation  to  OP  and  Extraction 

Mid  Forceps  Rotation  to  OP  and  Spontaneous  Delivery  as  OP 

Duhrssen’s  Incisions,  Manual  Rotation  and  Mid  Forceps 

Duhrssen’s  Incisions  Followed  by  Version  and  Extraction 

One  Blade  Rotation  to  OA  and  Spontaneous  Delivery 

Low  Cesarean  Section 

D = Duhvssen’s  Incisions.  Totals 


Prim. 

Mult. 

Total 

33 

88 

121 

10 

2 

12 

15 

10 

25 

25 

8 

33 

58(1D)* 

25 

83 

16(1D) 

9 

25 

6(2D) 

0 

6 

1 

0 

1 

3 

6 

9 

4(1D) 

3 

7 

22 

73 

95 

42 

24 

66 

29 

7 

36 

4(1D) 

5 

9 

1 

0 

1 

3 

0 

3 

1 

0 

1 

3 

2 

5 

1 

1 

2 

277 

263 

540 

for  December,  1949 


1029 


forward.  After  this  rotation,  the  forceps 
is  removed  and  reapplied  for  extraction. 
Should  rotation  result  in  a directly  posterior 
position  of  the  occiput,  extraction  ‘O.P.’  fol- 
lows as  a matter  of  course.”  Only  recently 
GreenhilP  ends  the  discussion  of  persistent 
occiput  posterior  positions  in  his  text  with 
the  following  short  statement:  “Occipito- 
sacral  positions  often  require  assistance.  If 
the  head  is  descending  in  flexion  the  per- 
ineum is  not  endangered  as  much  as  when 
the  brow  comes  down.  In  either  case  a deep 
episotomy  is  indicated  unless  the  patient  is 
a multipara.  If  the  head  is  on  the  perineum 
forceps  may  be  applied  without  rotating  the 
occiput.  However,  because  the  danger  of 
perineal  lacerations  is  much  greater  than 
in  cases  of  occiput  anterior,  a deep  episot- 
omy should  be  performed.” 

In  our  series  of  540  babies,  207  or  approxi- 
mately 38  per  cent,  were  delivered  in  the 
occipito-sacral  position,  either  spontane- 
ously or  with  the  aid  of  forceps.  We  do  not 
believe  that  delivery  as  an  occiput  posterior 
should  ever  be  forcible.  Our  method  of  pro- 
cedure is  always  to  try  anterior  rotation 
first,  either  manually  or  with  forceps.  If, 
however,  such  rotation  cannot  be  easily  ac- 
complished and  the  head  does  rotate  easily 
to  an  occipito-sacral  position  it  is  permitted 
to  do  so.  Forceps  extraction  of  an  occiput 
posterior  is  done  gently  and  slowly;  usually 
slight  or  moderate  traction  is  applied  only 
with  the  pains.  A large  left  medio-lateral 
episotomy  is  almost  always  done  except  in 
multiparae  with  a marked  relaxation  of  the 
pelvic  floor.  It  seems  to  be  logical  that  if 
the  head  fits  the  pelvic  outlet  better  in  the 
posterior  position  it  should  be  permitted  to 
deliver  in  that  position.  This  is  especially 
true  in  the  primigravida  who  has  had  a long 
labor  with  considerable  molding  of  the 
head.  In  these  patients  the  difference  be- 
tween the  suboccipital  bregmatic  and  oc- 
cipito-frontal  diameters  of  the  head  is  cer- 
tainly not  as  great  as  it  is  in  a fetal  head 
which  has  not  been  subjected  to  this  long 
period  of  molding  in  the  occiput  posterior 
position.  As  to  permitting  the  head  to  ro- 
tate the  way  it  wants  to  go  we  would  like 
to  quote  from  the  delivery  notes  of  two 


patients  in  this  series.  The  first  patient  was 
a gravida  II,  para  I.  With  cervix  completely 
dilated  after  a 6-hour  and  55-minute  first 
stage  the  head  below  the  spines  low  forceps 
were  applied  to  the  head  in  the  O.R.P.  posi- 
tion. The  operator  then  states,  “While  at- 
tempting rotation  to  an  anterior  position 
the  patient  had  a strong  pain.  With  this, 
spontaneous  rotation  to  an  O.P.  and  spon- 
taneous delivery  as  an  O.P.  occurred  with 
the  forceps  in  place,  producing  a second- 
degree  laceration.”  This  baby  weighed  6 
pounds  and  15  ounces.  The  second  patient 
was  also  a gravida  II,  para  I.  Her  first  stage 
lasted  5 hours  and  10  minutes.  The  deliv- 
ery notes  state,  “Low  forceps  were  applied 
in  a cephalic  application  to  an  O.L.P.  and 
the  head  was  rotated  to  an  O.L.A.  by  a 
Scanzoni  maneuver.  The  forceps  were  re- 
moved for  reapplication  and  following  their 
removal  the  patient  had  a contraction  with 
which  the  head  rotated  spontaneously  to  an 
occiput  posterior  and  delivered  spontane- 
ously as  an  O.P.  with  no  laceration.”  This 
baby  weighed  7 pounds  and  4 ounces. 

D’Esopo®  states  that  the  oblique  occipito- 
posterior  arrests  may  be  seriously  mis- 
handled by  attempting  to  pull  the  head 
down  in  the  posterior  position.  Regarding 
the  O.P.  arrest  low  in  the  pelvis,  he  states 
that  this  type  of  arrest  is  usually  handled 
quite  easily  by  manual  rotation  to  an  O.A., 
for  the  head  is  low  and  flexed  so  that  rota- 
tion is  usually  easy.  He  then  adds  that 
whether  the  sacrum  encroaches  or  not,  it 
does  not  seem  justifiable  to  deliver  direct 
O.P.  arrests  face  to  pubes,  except  in  the 
very  occasional  case  in  which  there  is  more 
room  in  the  posterior  sagittal  diameter  than 
the  average.  With  these  statements  we 
would  differ  to  some  extent.  It  has  not  been 
our  experience  that  posterior  arrests  deep 
in  the  pelvis  all  rotate  easily  to  an  O.A., 
either  manually  or  with  forceps.  Many  of 
them  do,  many  others  must  be  pushed  high 
in  the  pelvis  and  there  is  a considerable 
number  that,  even  then,  do  not.  We  do  not 
believe  the  danger  to  the  baby  or  to  the 
mother  from  delivery  as  an  occiput  posterior 
is  as  great  as  it  has  been  made  to  seem. 
There  were  more  cervical  lacerations  in  the 


1030 


Rocky  Mountain  Medical  Journal 


group  which  were  rotated  anteriorly  than 
in  those  which  were  delivered  posteriorly. 
No  third  degree  lacerations  occurred  in 
those  delivered  posteriorly,  nor  was  the  ma- 
ternal morbidity  increased. 

Infant  Mortality 

In  support  of  our  contention,  we  believe 
that  our  infant  mortality  in  this  series  will 
compare  favorably  with  that  of  other  re- 
ports in  which  a high  percentage  has  been 
rotated  anteriorly.  In  the  entire  series  of 
540  babies  there  were  ten  infant  deaths, 
including  stillborns,  prematures  and  neo- 
natal deaths,  making  a gross  uncorrected 
fetal  mortality  of  1.85  per  cent.  Of  these 
ten  deaths  six  were  stillborn,  three  were 
premature  babies,  and  one  had  multiple  con- 
genital anomalies.  Of  the  stillborns  one  was 
a macerated  stillborn  with  a true,  tight  knot 
in  the  cord  and  four  of  the  others  were  in- 
trapartum deaths.  One  of  those  was  due  to 
a prolapsed  cord,  one  to  intrauterine  as- 
phyxia (exact  cause  undetermined)  of  a 
small  second  baby  in  twins,  and  two  are 
charged  to  intrapartum  cerebral  injury.  The 
other  stillborn  was  also  a premature  weigh- 
ing 4 pounds  and  1 ounce  and  the  cause 
of  death  was  undetermined,  the  only  posi- 
tive finding  being  an  unusually  small  pla- 
centa. Two  of  the  prematures  were  one  of 
a set  of  twins.  The  mother  of  one  of  the 
babies  which  died  on  the  fourth  day,  had 
a severe  pre-eclampsia.  One  baby  died  on 
the  third  day  with  a clinical  diagnosis  of  a 
cerebral  hemorrhage.  The  methods  of  de- 
livery of  the  babies  that  died  or  were  still- 
born were  as  follows:  Four  delivered  spon- 


taneously as  occiput  anteriors  after  spon- 
taneous rotation,  one  was  delivered  by  low 
forceps  with  a key-in-lock  rotation  to  O.A. 
and  extraction,  three  delivered  spontane- 
ously as  occiput  posteriors,  one  was  deliv- 
ered by  low  forceps  extraction  of  an  occiput 
posterior,  and  one  by  low  cesarean  section. 

Fetal  Morbidity 

Of  the  540  babies,  forty-four  showed  some 
degree  of  apnea,  varying  from  mild  to  se- 
vere. Eight  had  cephalomatomas.  One  was 
diagnosed  as  purpura  of  the  newborn,  but 
this  baby  was  discharged  in  good  condition. 
One  baby  had  a one-sided  facial  paralysis 
which  cleared  in  two  days. 

Complications  in  Previous  Pregnancies 

Inasmuch  as  the  history  a patient  gives 
of  previous  deliveries  is  usually  difficult  to 
evaluate,  accurate  statistics  on  this  subject 
are  difficult  to  present.  For  that  reason  we 
will  mention  only  the  complications  in 
previous  deliveries  on  which  we  have  the 
record  either  in  our  own  files  or  through 
the  record  of  the  physician  who  did  care 
for  the  patient.  These  figures,  however,  do 
not  give  a true  picture  of  previous  compli- 
cations as  the  data  are  incomplete.  Sixteen 
of  the  patients  in  this  series  were  known 
to  have  had  occiput  posterior  positions  in 
previous  pregnancies.  Twenty-four  were 
known  to  have  had  previous  long  labors 
and  difficult  operative  deliveries.  Three 
had  previous  breech  presentations. 

Discussion 

During  the  seventeen  years  covered  by 
this  study  there  were  two  intervals,  one 


TABLE  5 
Infant  Mortality 

Date  Died  Method  of  Delivery  Weight  Parity  Diagnosis 


1936 

1936 

1936 

1938 

1940 

1941 

1942 

1943 

1943 

1944 


12  Hr. 

3 Day 
S.  B. 

S.  B. 

10  Day 
S.  B. 

S.  B. 
(MAC.) 

4 Day 

S.  B. 

S.  B. 


Spont.  OP  7 lbs.  3 oz. 

Spont.  Rot.  and  Del.  OA  8 lbs.  2 oz. 

Spont.  Rot.  and  Del.  OA  4 lbs.  1 oz. 

Spont.  OP  (B  Twin)  4 lbs.  11  oz. 

Spont.  Rot.  and  Del.  OA  (B  Twin)3  lbs.  14  oz. 
Spont.  Rot.  and  Del.  OA  9 lbs.  4 oz. 

Spont.  OP  6 lbs.  10  oz. 


Low  For.  K.I.L.  Rot.  to  7 lbs.  9 oz. 
OA  and  Extraction 

Low  Cesarean  Section  9 lbs.  12  oz. 

Low  For.  Ext.  ASOP  6 lbs.  2 oz. 


G.3  P.2  Mult.  Cong.  Anomalies 
G.l  P.O.  Cerebral  Hemorrhage 
G.2P.1  Undet.  (Small  Placenta) 

G.3  P.2  I.U.  Asphyxia  (Cause?) 

G.l  P.O.  Prematurity,  Atelectasis 
G.4  P.3  Cerebral  Hemorrhage 
G.7  P.6  I.U.  Asphyxia  (Knot  in  Cord) 

G.l  P.O.  Severe  Pre-Eclampsia 

G.4  P.2  Prolap.  Cord,  Hemorrhage 
G.l  P.O.  Cerebral  Hemorrhage 


for  December,  1949 


1031 


from  August,  1931,  to  July,  1940,  and  the 
other,  during  the  war  years,  from  Novem- 
ber, 1942,  to  October,  1945,  when  there  was 
only  one  obstetrician  on  duty.  As  a result 
frequent  observations  during  the  first  stage 
of  labor  were  not  always  possible.  For  that 
reason  it  is  impossible  to  correctly  record 
the  number  of  posterior  positions  in  this 
series  found  at  the  onset  of  labor.  DeLee* 
reports  12.1  per  cent  in  35,179  deliveries. 
Harper®  states  that  the  primary  position  of 
the  occiput  is  posterior  in  approximately  50 
per  cent  of  all  cases.  This  large  group  does 
not,  however,  represent  a problem.  We  are 
concerned  with  the  treatment  of  the  per- 
sistent occiput  posterior,  and  find  that  6.5 
per  cent  of  our  cases  fall  in  this  group. 

We  are  not  convinced  that  maternal  pos- 
ture plays  an  important  role  in  the  produc- 
tion of  a posterior.  Variation  in  the  pelvis 
and  pelvic  soft  tissue  influence  flexion  and 
deflexion  to  a much  greater  extent.  If  the 
head  enters  the  pelvis  in  partial  deflexion, 
molding  and  caput  formation  begin  at  the 
same  time.  The  head  then  tends  to  elongate 
and  adapt  itself  to  the  pelvis.  As  a result 
the  time  arrives  when  the  head  is  so  elon- 
gated that  rotation  from  the  posterior  to 
the  anterior  position  can  only  be  accom- 
plished by  using  force  or  by  pushing  the 
head  out  of  the  pelvis  and  then  rotating  it 
anteriorly.  This  implies  bringing  the  head 
back  through  the  pelvis  with  the  suboc- 
cipital  bregmatic  diameter  increased  by  the 
previous  molding  and  caput  formation.  This 
method,  if  used  routinely,  must  produce 
more  fetal  damage  than  if  previous  molding 
is  recognized  and  delivery  accomplished  by 
the  least  physical  effort. 

Because  we  have  desired  to  be  gentle,  the 
occiput  posterior  has  been  treated  by  watch- 
ful expectancy  and  the  method  of  delivery 
offering  least  resistance  has  been  chosen. 
The  incidence  of  operative  deliveries  in  oc- 
ciput posterior  positions  will  always  be 
high;  in  our  series  it  was  60  per  cent.  Only 
21  per  cent  of  the  primigravidae  had  a sec- 
ond stage  over  2 hours,  and  9 per  cent  of 
the  multigravidae  over  1 hour.  As  natural 
progress  ceases,  it  is  considered  wise  to  as- 
sist in  the  delivery  of  the  baby.  The  easiest 

1032 


method  then  available  is  adopted.  Anterior 
rotation  has  nearly  always  been  attempted, 
but  if  resistance  is  encountered  it  is  dis- 
continued. As  a result  38  per  cent  were  de- 
livered as  posteriors.  The  gross  uncorrected 
fetal  mortality  of  1.85  per  cent  compares 
favorably  with  other  reported  series.  There 
were  no  maternal  deaths  and  no  third  de- 
gree lacerations. 

Summary 

A statistical  study  of  538  patients  "having 
540  occiput  posterior  positions  has  been  pre- 
sented, an  incidence  of  6.46  per  cent  in  8,331 
deliveries. 

In  this  group  the  second  stage  of  labor 
was  prolonged  mainly  in  the  primigravidae, 
of  whom  56  per  cent  had  a second  stage 
longer  than  1 hour  and  21  per  cent  had  a 
second  stage  longer  than  2 hours. 

The  weights  of  the  babies  were  slightly 
greater  in  the  posterior  group  as  compared 
with  a normal  series,  but  not  enough  to  be 
of  statistical  significance. 

Exactly  one-half  of  the  entire  series  had 
no  analgesia  during  labor. 

Two  hundred  and  seven  babies,  38  per 
cent  of  the  series,  were  delivered  in  the 
occiput  posterior  position.  We  feel  that  the 
dangers  of  delivery  in  this  position,  both 
for  the  mother  and  the  baby,  are  not  as 
great  as  the  literature  would  lead  us  to  be- 
lieve. 

The  gross  uncorrected  fetal  mortality  in 
this  series  was  1.85  per  cent.  There  were 
no  maternal  deaths.  There  were  no  third 
degree  lacerations. 

REFERENCES 

^Little,  Herbert  M. : Discussion  of  Paper  of  Vaux, 
Norris  W.,  American  Journal  of  Obstetrics  and  Gyn- 
ecology, 20:782-790,  1930. 

:^DeLee,  Joseph  B.,  and  Greenhill,  J.  P. : Principles 
and  Practice  of  Obstetrics,  ed.  9,  Philadelphia,  1947. 
W.  B.  Saunders  Co. 

^D’Esopo,  D.  Anthony;  American  Journal  of  Ob- 
stetrics and  Gynecology,  42:937-957,  1941. 

■•DeLee,  Joseph  B.:  Statistical  Report  of  the  Obstet- 
ric and  Gynecologic  Work  Done  at  the  Chicago  Ly- 
ing-in Hospital  and  Dispensary,  1918-1931. 

'Harper,  Paul  T. : Clinical  Obstetrics,  ed.  1,  Phila- 
delphia, 1930.  P.  A.  Davis  Company. 

The  cause  of  the  high  prevalence  of  tubercu- 
losis in  mental  hospitals  is  failure  to  recognize 
or  seek  out  cases  of  tuberculosis  among  incom- 
ing patients  who  then  transmit  the  disease  to 
other  patients  during  residence  in  the  hospital. 
The  situation  can  be  improved  only  by  segre- 
gating and  treating  the  tuberculous  patients  dis- 
covered by  survey. — Waldo  R.  Oechsli,  M.D., 
Pub.  Health  Rep.,  January  7,  1949. 

Rocky  Mountain  Medical  Journal 


SURGICAL  SIGNIFICANCE  OF  THE  ‘‘NON-FUNCTIONING” 

GALL  BLADDER 

E.  J.  LOWELL,  JR. 

DENVER 


In  a study,  of  sixty-five  cases  in  which  the 
pre-operative  x-ray  diagnosis  of  “non-func- 
tioning” gall  bladder  was  made,*  patho- 
logic changes  of  the  bile  tract  were  demon- 
strated in  96.9  per  cent  of  patients  under- 
going surgery. 

The  various  pathologic  changes  found  are 
indicated  in  the  accompanying  Tables  I and 
II.  According  to  these  figures,  the  com- 
monest cause  of  the  non-functioning  gall 
bladder  is  cholelithiasis  in  87.7  per  cent  of 
the  cases.  No  demonstrable  bile  tract 
pathology  was  found  in  3.1  per  cent  of  these 
patients,  although  two  instances  are  noted 
where  there  was  associated  hepatic  disease. 

These  results  were  obtained  by  confining 
the  analysis  to  those  cases  satisying  three 
criteria:  (1)  absolute  failure  to  visualize 
any  evidence  of  stone  and  gall  bladder 
shadow  after  Priodax,  (2)  symptoms  justify- 
ing surgical  intervention,  and  (3)  patients 
actually  undergoing  surgical  exploration. 
Admipiitration  of  Priodax  (twelve  .5  Gm. 
tablets) .^^d^the  preparation  of  patients  for 
cholecystography  were  made  in  accordance 
with  sta'ndard  radiographic  procedures. 

Results  of  this  particular  analysis  com- 
pare favorably  with  results  of  other  recent 
studies  in  this  field.  Sosman  found  that  90 
per  cent  of  non-functioning  gall  bladders 
contain  stones;  others  reported  88  and  85 
per  cent.  In  this  connection,  it  may  be  re- 
called that  10  per  cent  of  gallstones  may  be 
visualized  on  a flat  plate  of  the  abdomen 
without  the  aid  of  dye. 

In  comparing  accuracy  of  the  non-func- 
tioning gall  bladder  report  to  accuracy  of 
the  poorly  functioning  gall  bladder  re- 
port, the  literature  reveals  that  gallstones 
are  found  in  from  39  to  around  60  per  cent 
of  poorly  functioning  gall  bladders.  While 
less  significant  than  non-functioning  gall 
bladder,  this  indicates  that  report  of  poorly 
functioning  gall  bladder  is  helpful  to  the 
surgeon  in  a high  percentage  of  instances. 

*Analysis  of  65  cases  at  St.  Joseph’s  Hospital, 
Denver,  Colorado. 


TABLE  I 

Showing  Various  Pathologic  Diagnoses  (Six- 
teen Different  Categories)  as  Encountered 
in  Analysis  of  65  Cases 


Cholelithiasis 

Not 

Present  Present 


Cholecystitis 

Acute  0 1 

Acute  Suppurative  2 0 

Acute  Suppurative  with  necro- 
sis and  vascular  thrombosis 

(cystic  artery)  0 1 

Hydrops  1 0 

Empyema 2 0 

Subacute  9 1 

C^hronic 36  3 

Ulcerative  3 0 

Fibrotic 

With  choledocholithiasis 
and  cholecystoduodenal 

fistula  1 0 

With  gall  bladder  divertic- 
ulum   1 0 

With  associated  hepatitis 
and  cholecystocolic  fis- 
tula   1 0 

Carcinoma  of  the  Hepatic  Duct, 
proximal;  with  choledocholith- 
iasis, unclassified 1 0 

Gall  Bladder  with  pathologic 

change  not  found - 0 1 

Associated  with  nodular  icteric 

cirrhosis  0 1 

Subtotal  57  8 

Total  of  Cases  surveyed  65 


The  present  study  indirectly  bears  out 
the  work  of  Robertson  and  Wollesen  who 
have  established  the  syndrome  of  the 
“silent  gallstones,”  in  that  many  patients 
going  through  a gall  bladder  series  in  our 
x-ray  department  never  arrived  at  surgery 
because  their  symptoms  did  not  justify 
cholecystectomy.  It  was  a striking  obser- 
vation in  reviewing  several  hundred  hospi- 
tal charts  that  fully  half  of  the  patients  in 
whom  x-ray  diagnosis  of  non-functioning 
gall  bladder  was  made  required  no  surgery. 
It  is  now  recognized  that  50  per  cent  of  all 
individuals  carrying  gallstones  are  asympto- 
matic throughout  their  life  span  as  evi- 
denced by  autopsy  study.  In  this  con- 
nection many  workers  have  implicated 
cholelithiasis,  either  silent  or  symptomatic. 


for  December,  1949 


1033 


in  carcinoma  of  the  bile  tract,  stating  that 
from  4 to  5 per  cent  of  all  cholelithiasis  is 
carcinogenic. 


TABLE  II 

Showing  the  Correlation  of  the 
Functioning  Gall  Bladder  to 
Surgical  Pathology 

Non- 

N on-Functioning 

Gall  Bladder 

No.  of 

Per 

Cases 

Cent 

Patients  with  demonstrable 

Bile  Duct  System  Pathology 

With  or  Without  Associated 
Cholelithiasis  63 

96.9% 

With  Associated  Cholelith- 
iasis   57 

87.7% 

Without  Associated  Chole- 
hthiasis  6 

9.2% 

Patients  without  demonstrable 

Bile  Duct  System  Pathology  2 

3.1% 

With  Associated  Liver  Dis- 
turbance   1 

1.5% 

Without  Associated  Liver 
Disturbance  1 

1.5% 

In  attempting  to  correlate  x-ray  findings 
with  pathologic  change,  it  is  of  interest  to 
the  surgeon  that  a moderate  amount  of 
acute  or  chronic  cholecystitis  may  give  an 
x-ray  picture  of  normally  functioning  gall 
bladders.  It  is  even  reported  that  stones 
are  found  in  from  5 to  10  per  cent  of  all  gall 
bladders  reported  as  normally  functioning. 

While  cholelithiasis  exists  in  the  highest 
percentage  of  non-functioning  gall  bladders 
(86  to  90  per  cent),  other  conditions  are 
found  to  be  responsible  in  9.2  per  cent  of 
cases  in  the  series  presented.  These  are: 
cholecystitis,  acute,  subacute  or  chronic; 
acute  suppurative  cholecystitis  with  or  with- 
out cystic  artery  thrombosis;  choledocholi- 
thiasis;  carcinoma  of  the  gall  bladder  or 
adjacent  bile  passages;  various  types  of  liver 
disturbance  such  as  hepatitis  and  cirrhosis. 
Jaundice  interferes  with  gall  bladder  vis- 
ualization. Some  mention  should  be  made 
of  other  causes  of  a non-functioning  gall 
bladder:  congenital  absence,  previous 
cholecystectomy,  failure  to  absorb  Priodax 
in  pyloric  obstruction  and  possibly  in  short- 
circuiting  enterostomies  with  dumping  syn- 
drome. Very  rarely  situs  inversus  may 
cause  failure  of  visualization  of  gall  bladder 
in  the  customary  RUQ  position,  but  atten- 


t'on  to  the  opposite  side  may  reveal  the  gall 
b''adder  to  be  present.  One  case  was  found 
in  our  series  in  which  lupus  erythematosus 
disseminata  was  associated  with  biliary 
disease.  Further  it  has  been  noted  that  32 
per  cent  of  patients  with  pernicious  anemia 
were  found  at  autopsy  to  have  cholecystitis 
with  or  without  lithiasis  or  to  have  war- 
ranted a previous  cholecystectomy.  This 
suggests  that  damage  of  the  biliary  duct 
system  occurs  in  anemias  in  connection  with 
increased  excretion  of  biliary  pigments. 
Achlorhydrias  have  been  in  the  past  thought 
to  interfere  with  gall  bladder  visualization 
but  it  is  now  believed  that  free  gastric  acid 
is  not  an  essential  factor  in  obtaining  an 
accurate  cholecystogram. 

In  summary,  it  is  concluded  that  patho- 
logic changes  are  present  in  96.9  per  cent  of 
all  patients  coming  to  surgery  with  the 
x-ray  diagnosis  of  non-functioning  gall 
bladder. 

Acknowledgment  made  to  Gerald  Maresh,  M.D., 
Department  of  Radiology,  St.  Joseph’s  Hospital,  for 
his  cooperation. 

1; 

ALLERGIC  ARTHRITIS 

For  the  last  forty  years,  according  to  Dr.  Jona- 
than Forman,  President  of  the  American  College 
of  Allergists,  physicians  throughout  the  world 
have  from  time  to  time  found  persons,  whose 
joints  became  swollen,  hot,  and  painful  following 
the  eating  of  certain  foods  or  taking  certain 
drugs.  While  the  number  of  these  cases  is  by 
no  means  large,  they  are  significant,  Dr.  Forman 
said. 

He  stresses  the  importance  of  the  observations 
of  Dr.  Jerome  Miller,  Philadelphia,  Pennsylvania, 
in  the  July- August  issue  of  the  Annals  of  Al- 
lergy, the  official  publication  of  the  American 
College  of  Allergists.  Dr.  Miller  in  his  article 
has  collected  the  various  reports  on  allergic 
arthritis  which  have  appeared  and  added  three 
new  cases  of  his  own. 

Today  many  physicians  are  in  agreement  with 
Dr.  Miller  that  at  least  certain  types  of  arthritis 
are  caused  by  an  allergy  to  foods  and  that  a 
certain  number  of  patients  with  inflamed,  pain- 
ful joints  give  a history  that  they  themselves 
or  members  of  their  family  have  had  other  al- 
lergies such  as  hay  fever,  sinus  trouble,  asthma, 
hives,  eczema,  or  migraine  headaches.  Patients 
with  any  of  these  allergies  who  suffer  from 
arthritis  should  suspect  that  the  latter  may  be 
allergic  in  origin.  Dr.  Miller  indicates  the  many 
laboratory  tests  which  help  to  exclude  causes 
other  than  allergy,  as  well  as  a few  that  help 
to  identify  the  nature  of  the  arthritis.  When 
all  this  evidence  has  been  correlated  and  suf- 
ficient proof  is  lacking  that  the  arthritis  is  caused 
by  some  other  factor,  one  is  justified  in  using 
special  elimination  diets  for  identif3dng  the  of- 
fending food. 


1034 


Rocky  Mountain  Medical  Journal 


Radiopaque  diagnostic  medium . . . 

Original  development  of  Searle  research 

now 


lodochlorol®  ZZtL 


Clear  visualization  of  body  cavities — for  the  roentgen  investigation  of 
pathologic  disorders  involving  sinuses  . . . bronchial  tree  . . . uterus  . . . 
fallopian  tubes  . . . fistulas  . . . soft  tissue  sinuses  . . . genitourinary  tract 
. . . empyemic  cavities. 

lodochlorol  is  notably  free  from  irritation,  free-flowing,  highly  stable 
and  has  pronounced  radiopaque  quahties.  It  contains  the  two  halogens, 
iodine,  27  per  cent,  and  chlorine,  7.5  per  cent,  organically  combined 
with  a highly  refined  peanut  oil. 

lodochlorol  is  available  in  bottles  containing  20  cc.  of  the  radiopaque 
medium;  each  one  is  packed  in  an  individual  carton.  G.  D.  Searle  & 
Co.,  Chicago  80,  Illinois. 

Searle 

RESEARCH  IN  THE  SERVICE  OF  MEDICINE 


for  December,  1949 


1035. 


Organization 

National  Affairs  - Proceedings  - Programs  - Society  Notices  - News  - Auxiliary 


COLORADO 

State  Medical  Society 

MINUTES* 

HOUSE  OF  DELEGATES  OF  THE  COLO- 
RADO STATE  MEDICAL  SOCIETY 

79th  Annual  Session,  September  20,  21,  22, 
23,  1949;  Shirley-Savoy  Hotel,  Denver 

FIRST  MEETING— September  20,  1949 

Vice  and  Acting  President  L.  L.  Ward,  Pueblo, 
called  the  House  to  order  at  10:00  a.m.  Dr. 
George  R.  Buck,  Chairman,  presented  the  report, 
■of  the  Credentials  Committee  (Pages  3 and  4 of 
the  Handbook)  and  supplemented  the  report  as 
follows: 

El  Paso  County  has  elected  Dr.  R.  A.  Beadles 
as  alternate  for  Delegate  F.  I.  Nicies.  Otero 
Coimty  has  elected  Dr.  J.  A.  Shand  as  delegate 
to  succeed  Dr.  B.  B.  Blotz,  and  has  elected  Dr. 
R.  T.  Shima  as  alternate  to  replace  Dr.  T.  J. 
Cooper. 

Your  Credentials  Committee  recommends  that 
Section  2 of  Chapter  IV  of  the  By-Laws  be 
amended  by  striking  the  first  sentence  thereof 
and  substituting  therefor  the  following: 

Membeis  of  the  House  of  Delegates  shall  be 
elected  for  terms  of  two  years  and  shall  assume 
office  on  April  1 of  the  year  next  succeeding  their 
election,  provided  that  incumbent  delegates  at  the 
date  of  adoption  of  this  provision  shall  serve  until 
the  expiration  of  their  term  and  until  their  successors 
are  elected  and  assume  office;  elections  to  fill 
vacancies  shall  be  for  the  unexpired  term. 

The  Secretary  of  the  House,  Mr.  H.  T.  Seth- 
man,  called  the  roll  and  announced  that  57  dele- 
gates accredited  by  the  Credentials  Committee 
were  present,  constituting  a quorum  (A  quorum 
for  this  annual  session  would  be  23  accredited 
delegates). 

The  Credentials  Committee  report  was  adopted 
except  that  part  recommending  an  amendment 
of  the  By-Laws,  which  was  referred  to  the  Ref- 
erence Committee  on  Constitution  and  By-Laws. 

Dr.  George  F.  Lull,  Chicago,  Secretary  and 
General  Manager  of  the  American  Medical  As- 
sociation, was  introduced  and  brought  greetings 
from  the  national  body. 

Minutes  of  the  78th  Annual  Session  were  ap- 
proved as  published  in  the  December,  1948,  issue 
of  the  Rocky  Mountain  Medical  Journal. 


♦Condensed  from  the  transcript  of  H.  E.  Dennis, 
Certified  Court  Reporter.  Reports  referred  to  but 
not  reproduced  herein  were  distributed  to  all  mem- 
bers of  the  House  of  Delegates  in  advance  of  the 
Annual  Session  in  the  printed  “House  of  Delegates 
Handbook”  or  were  distributed  to  members  of  the 
House  in  mimeographed  form  at  the  opening  of  the 
meeting.  Copies  of  all  such  reports,  corrected  to 
Indicate  any  amendments  or  rejections  by  action 
of  the  House,  are  on  file  with  the  Secretary  of  each 
Component  Society  and  are  there  available  for  study 
by  any  member  of  the  Society. 


Acting  President  Ward  announced  that  all  re- 
ports of  officers,  boards,  and  committees  would 
be  referred  to  reference  committees  as  indicated 
in  the  Handbook,  subject  to  discussion  and  the 
wishes  of  the  House. 

Reports  of  the  Board  of  Trustees 

Dr.  Ervin  A.  Hinds,  Chairman,  presented  the 
printed  report  of  the  Board  of  Trustees  and  one 
suppleniental  mimeographed  report.  The  follow- 
ing additional  supplemental  reports  of  the  Board 
of  Trustes  were  read: 

September  20,  1949 

Since  preparing  the  Annual  Report  of  the  Board 
of  Trustees  for  publication  in  the  Handbook  the 
Board  has  taken  the  following  actions  of  interest 
to  the  House; 

On  September  10  your  Board  received  the  annual 
audit  of  the  Society’s  books  for  the  fiscal  year 
ended  August  31.  As  has  been  the  case  for  the 
past  several  years  the  audit  was  made  by  the  firm 
of  Collins,  Peabody  and  Schmitz,  Certified  Public 
Accountants.  The  Board  studied,  the  audit  in  detail 
together  with  a member  of  the  C.P.A.  firm,  and 
approved  it.  Mimeographed  copies  of  its  essential 
pages  will  be  distributed  to  the  Delegates  this 
morning.  Although  the  audit  shows  that  expendi- 
tures for  the  year  exceeded  income  by  a total  of 
$1,528.43,  the  year  was  in  the  opinion  of  your 
Board  a highly  successful  one  financially.  As 
indicated  in  our  Annual  Report  in  the  Handbook, 
several  large  expenditures  were  made  this  year 
which  need  never  be  repeated,  being  incident  to 
(1)  original  organization  of  the  National  Education 
campaign;  (2)  inauguration  of  the  Employees’  Re- 
tirement Fund  Plan  as  ordered  by  last  year’s 
House  of  Delegates,  and  (3>  conduct  of  the  Na- 
tional Conference  on  Medical  Service,  the  expense 
of  which  will  not  again  fall  upon  this  particular 
state. 

From  several  sources  has  come  the  suggestion 
that  in  addition  to  the  pocket-sized  membership 
card  sent  to  each  member  of  the  Society  upon  pay- 
ment of  his  annual  dues  a small  certificate  certi- 
fying to  his  membership  for  that  particular  year 
be  supplied  for  display  in  each  member’s  office. 
A number  of  other  State  Medical  Societies  fO'llow 
this  procedure  and  find  that  it  is  considered  highly 
worthwhile  by  the  vast  majority  of  their  members. 
Your  Board  of  Trustees  favors  this  proposal  and 
has  had  the  Secretary  design  a sample  which  will 
be  passed  around  this  morning  for  your  inspection. 
However,  the  Board  did  not  desire  to  make  final 
decision  upon  this  without  a vote  of  the  House. 

BOARD  OF  TRUSTEES,  By 
ERVIN  A.  HINDS,  M.D.,  Chairman. 

Nomination 

Mr.  President  and  members  of  the  House;  Under 
the  Standing  Rules  of  your  Society  the  Board  of 
Trustees  is  authorized  to  nominate  to  the  House  of 
Delegates  annually,  one  or  more  names  of  persons, 
other  than  the  President  of  this  Society,  whose 
outstanding  contribution  to  the  purposes  of  the  So- 
ciety during  the  year  then  closing  entitle  him  or 
them  to  special  recognition  by  the  Colorado  State 
Medical  Society  through  such  certificates. 

Your  Board  wishes  to  nominate  William  W.  Hag- 
gart,  M.D.,  Denver,  for  the  Society’s  Certificate  of 
Service  to  a member  who  has  done  most  in  service 
to  the  Society  during  the  year  just  closed. 

With  the  inauguration  of  the  United  Mine  Work- 
ers Welfare  and  Retirement  Fund  medical  care  pro- 
gram for  miners  in  the  Rocky  Mountain  area,  it 
was  decided  that  such  medical  care  would  be  pro- 
vided by  private  practicing  physicians.  Fees  for 
service  would  be  comparable  to  those  charged  in 
similar  income  brackets.  It  was  incumbent  upon 
the  Society  to  insure  that  this  program  was  set 
up  and  conducted  to  the  mutual  satisfaction  of  all 
concerned,  since  so  much  of  the  future  private 
practice  of  medicine  was  involved.  It  also  rested 
principally  on  the  Colorado  State  Medical  Society 
to  take  the  lead  in  the  establishment  and  successful 
operation  of  the  program  in  the  other  Rocky  Moun- 
tain states. 


1036 


Rocky  Mountain  Medical  Journal. 


What  do  you  demand  in  a toxoid.  Doctor? 


small  dosage  volume? 
purity? 

concentrated  potency? 
high  antigenicity? 

Of  course,  doctor,  you  want  the  best  possible 
combination  of  these  advantages. 

Research  and  manufacturing  know-how  of 
CUTTER,  first  producer  of  combined  toxoids, 
have  developed  in  their  new  purified  toxoids 
products  which  meet  all  of  your  demands. 


As  an  example,  consider  the  superiority  of  the  new, 
purified  DiP-PeRT-TeT*— for  simultaneous  immunization 
against  diphtheria,  pertussis,  and  tetanus: 

1.  Immunization  routine  is  simplified  with  three  injections  of 
0.5cc  each  at  monthly  intervals. 

2.  Purified  toxoids  assure  virtual  freedom  from  reactions  due 
to  bacterial  protein  components. 

3.  Alhydrox"^*— exclusive  adsorbing  agent- 
results  in  a more  solid  immunity,  fewer  post-injection  reactions, 
and  less  pain  on  injection. 

When  single  immunizations  are  indicated  or  booster 
shots  are  required,  there  is  a PURIFIED  TOXOID- 
CUTTER— available  in  both  single  and  multiple  dose 
packages.  Your  pharmacist  has  them  in  stock. 


*DIP-PERT-TET-  Cutter’s  diphtheria  and  tetanus  toxoids  and  pertussis 
vaccine  combined  for  simultaneous  immunization  against  diphtheria, 
pertussis,  and  tetanus. 

**Alhyd  rOX-Trade  n ame  for  aluminum  alhydrox  adsorption, 
exclusive  with  CUTTER. 


CUTTER 


CUTTER  LABORATORIES  • BERKELEY,  CALIFORNIA 


for  December,  1949 


1037 


Dr.  Haggart  was  selected  by  your  President  as 
Chairman  of  the  Medical  Advisory  Committee  and 
to  act  as  liaison  between  our  profession  and  the 
Fund.  At  great  self-sacrifice  he  has  worked  ex- 
cessively long  hours  to  make  available  to  the  miners 
the  services  of  private  physicians  and  to  provide 
for  them  the  best  medical  care  that  could  be  ob- 
tained. It  has  not  been  an  easy  task.  The  time  of 
inauguration  of  any  new  program  is  always  a dif- 
ficult one,  but  with  so  much  at  stake  here  it  must 
not  fail.  With  the  establishment  of  a roster  of 
physicians,  a list  of  consultants,  and  an  agreed- 
upon  initial  consultation  fee,  the  preliminaries  nec- 
essary to  get  the  program  under  way  have  been 
fixed. 

Always  working  to  insure  that  the  highest  stand- 
ards of  medical  care  are  maintained  and  fighting 
exhaustingly  to  keep  the  private  practice  of  medi- 
cine free  of  restraint  in  order  to  preserve  indi- 
vidual initiative.  Dr.  Haggart  has  performed  this 
exacting  task  well. 

When  the  Rocky  Mountain  Cancer  Conference, 
which  brings  men  of  outstanding  national  reputa- 
tion in  the  field  to  our  state  for  an  annual  series 
of  meetings  was  founded,  it  was  Dr.  Haggart’s  wise 
counseling,  his  guiding  hand,  his  selfless  service 
that  made  the  conference  its  national  reputation. 

Additionally,  his  negotiations  concerning  a pro- 
posed Rehabilitation  Center  in  this  area  have  been 
lessons  in  patience  and  diplomacy. 

If  any  credit  is  to  ensue  to  the  medical  profes- 
sion for  successful  performance,  much  of  it  will  be 
due  to  Dr.  Haggart’s  firm,  considerate  and  tactful 
direction. 

With  the  thought  of  recognition  of  at  least  a part 
of  its  obligation,  the  Board  of  Trustees  respectfully 
nominates  Dr.  William  W.  Haggart  for  this  House 
of  delegates’  1949  Certificate  of  Service  to  his 
profession. 

Citation 

Your  Board  of  Trustees  deems  it  eminently  proper 
this  year  to  direct  the  attention  of  the  House  of 
Delegates  to  the  public  service  achievements  of  one 
of  our  component  societies. 

This  society  deferred  all  scientific  sessions  for 
one  year  in  order  to  devote  its  meetings  to  the 
national  educational  campaign,  community  health 
and  public  relations 

It  not  only  established  a Speakers’  Bureau  of 
Physicians  who  could  talk  on  the  vital  compulsory 
health  taxation  issue,  but  made  these  speakers 
available  to  any  group  desiring  talks  on  medical 
subjects. 

It  took  active  part  in  a city  election  in  which 
one  of  the  issues  was  authorization  of  a city-county 
health  unit  under  the  newly  enacted  Senate  Bill  83. 
Physicians  of  this  society  in  this  election  supported 
a mayor  and  some  council  candidates  as  well  as 
the  health  unit  amendment. 

When  the  city  in  which  this  society  is  located 
proposed  to  close  the  nursing  school  at  its  Memorial 
Hospital  the  county  medical  society  vigorously  and 
actively  opposed  such  a move  and  the  outcome  was 
most  successful.  The  school  is  still  operating. 

The  society  planned  and  conducted  the  first  com- 
munity individual  enrollment  campaign  for  Blue 
Cross-Blue  Shield  in  this  state  with  results  so 
outstandingly  successful  as  to  more  than  compare 
■with  any  professionally-conducted  promotion  cam- 
paign anywhere. 

And  recently  when  a hospital  in  the  community 
was  to  be  turned  over  to  private  interests  the  so- 
ciety as  a body  stepped  into  the  picture  to  insist 
that  the  maintenance  of  the  hospital  was  a com- 
munity responsibility.  The  physicians,  individually 
and  collectively,  supported  a special  election  to 
vote  on  a bond  issue  for  expansion  of  the  hospital 
and  its  continued  operation  by  the  city. 

This  gioup  of  doctors  has  done  much  to  allay  the 
oft-heard  charge  “doctors  first — citizens  second.” 

Your  Board  of  Trustees,  therefore,  cites  the  El 
Paso  County  Medical  Society  as  outstanding  “doctor- 
citizens.” 

Further,  we  recommend  that  this  citation  be  spread 
upon  the  permanent  records  of  this  House,  and  that 
a suitable  copy  be  presented  to  the  President  of  the 
El  Paso  County  Medical  Society. 

Dr.  George  Buck,  Constitutional  Secretary, 
presented  another  supplemental  report  for  the 
Board  of  Trustees  as  follows: 

At  the  request  of  a number  of  Delegates,  the 
Board  of  Trustees  this  morning  agreed  to  bring 
before  you,  formally  a suggestion  for  changing  a 
long-established  custom  of  this  House  with  regard 
to  elections. 

Since  1922 — twenty-seven  years  ago — it  has  been 
the  recognized  custom  to  elect  two  Presidents  in  a 


row  from  Denver,  then  two  in  a row  from  cities 
other  than  Denver,  then  two  in  a row  again  from 
Denver,  and  so  on,  alternating  the  Presidency  bi- 
ennially between  Denver  and  the  remainder  of  the 
state. 

The  fairness  of  this  custom  has  never  been  ques- 
tioned, since  the  Denver  membership  is  approxi- 
mately half  that  of  the  whole  State  Society,  and 
has  maintained  the  same  proportions  for  more  than 
a quarter  of  a century. 

The  change  that  has  been  suggested  is  simply 
that  the  Presidency  be  alternated  between  Denver 
and  the  rest  of  the  state  annually  instead  of  bi- 
ennially. 

Several  reasons  have  been  put  forth  in  favor  of  the 
suggested  change.  If  the  change  were  made,  there 
never  would  be  a time  when  both  the  President- 
elect and  the  President  are  Denver  men;  neither 
would  there  ever  be  a time  when  both  these  of- 
ficers were  outside  of  Denver.  This  would  make 
for  closer  liaison  between  the  concentrated  medi- 
cal population  of  Denver  and  the  more  scattered 
physicians  outside  the  capital  city.  Under  the  pro- 
posed change,  one  of  the  two  highest  elective 
officers  would  always  be  available  for  personal 
consultation  by  members  of  the  Executive  Office 
Staff.  The  heavy  travel  requirements  of  visits  to 
component  societies  would  be  easier  to  coordinate 
between  the  two  officers.  Other  reasons  have  also 
been  suggested,  but  the  above  appear  to  your 
Trustees  as  the  most  important  ones. 

Should  the  House  of  Delegates  desire  to  make  the 
suggested  change  in  the  established  custom,  either 
this  year  or  in  the  near  future,  no  amendment  of 
either  Constitution  or  By-Laws  would  be  needed. 
The  custom  of  biennial  alternation  which  has  been 
followed  so  long  is  just  a custom,  nothing  else. 

Your  Trustees  bring  this  formally  to  your  atten- 
tion because  it  has  been  the  subject  of  wide  dis- 
cussion among  Delegates,  and  we  know  that  sev- 
eral wish  it  discussed.  We  suggest  that  it  be  dis- 
cussed at  this  time  so  that  those  of  you  who 
serve  on  the  Nominating  Committee  this  year  can 
be  informed  as  to  the  wishes  of  the  House,  either 
to  change  the  custom  or  to  retain  it. 

The  above  supplemental  report  was  discussed 
at  length,  favorably,  by  a number  of  delegates 
and  was  then  referred  to  the  Nominating  Com- 
mittee, without  action. 

Motions  were  carried  unanimously  confirming 
the  nomination  of  Dr.  W.  W.  Haggart  for  the 
Society’s  annual  Certificate  of  Service  and  the 
nomination  of  the  El  Paso  County  Society  for  a 
special  citation. 

The  annual  report  of  the  Board  of  Councilors 
was  received  as  printed  in  the  Handbook. 

The  printed  report  of  the  Board  of  Supervisors 
was  supplemented  by'  Dr.  William  A.  Liggett, 
Secretary  of  the  Board,  which  proposed  a re- 
vision of  its  rules  of  procedure.  Both  reports 
were  referred  to  the  Reference  Committee  on 
Public  Relations  for  recommendation,  it  being 
understood  that  the  Board  of  Councilors  would 
finally  pass  upon  any  revision  of  rules  adopted 
by  the  Board  of  Supervisors.  The  Supervisors 
also  proposed  an  amendment  to  the  By-Laws  of 
the  Society  to  clarify  the  legality  of  its  pro- 
ceedings, as  follows: 

Amend  Chapter  VH,  Section  11,  as  the  same  op- 
pears  on  Page  20  of  the  1948  publication  of  the  Con- 
stitution and  By-Laws  by  striking  the  last  sentence 
of  the  section  and  inserting  in  lieu  thereof  the 
following; 

The  Board  shall  have  power  to  adopt  rules  to 
govern  matters  within  its  jurisdiction,  and  said 
rules  after  approval  by  the  Board  of  Councilors 
shall  be  published  in  the  official  Journal  of  the 
Society  and  shall  be  binding  upon  all  members 
of  the  Society  ten  days  after  said  publication. 

These  proposals  were  discussed  at  length  by 
several  delegates,  after  which  the  proposed  By- 
law amendment  was  referred  to  the  Reference 
Committee  on  Constitution  and  By-Laws. 

In  the  enforced  absence  of  President  C.  F. 
Hegner,  due  to  illness.  Dr.  George  R.  Buck  read 
the  following  message  sent  to  the  House  by 
Dr.  Hegner: 


1038 


Rocky  Mountain  Medical  Journal 


SUCCESSFUL  IN 
INFANT  NUTRITION 

The  advantages  of  these 
Nestle  products  in  the 
feeding  of  infants  have 
been  confirmed  by  long 
and  widespread  usage. 


; SPRAY  DRIED 

LACTOGEN 

# 

: HOMOGENIZED 

I WHOLE  COW’S  MILK 

I Modified  with 

MILK  FAT 
LACTOSE 


EVAPORATED 


ACIDIFIED  • SPRAY  DRIED 


DEXTROGEN 

HOMOGENIZED 
WHOLE  COW’S  MILK 

Modified  with 

DEXTRINS  * MALTOSE 


PELARGON 

HOMOGENIZED 
WHOLE  COW’S  MILK 

Modified  with 

GLUCOSE • SUCROSE 


DEXTROSE 


STARCH 


Reinforced  with  IRON 


Reinforced  with  IRON 


Reinforced  with 


IRON 
VITAMINS 
A B C & D 


n 

THE  NESTLE'  COMPANY,  INC. 


Report  of  the  Presiilent 

Reviewing  the  history  and  progress  of  the  Colo- 
rado State  Medical  Society  from  the  days  of  our 
early  rugged  medical  pioneers  to  its  present  position 
among  all  state  societies,  discloses  a record  of 
which  the  members  and  all  other  citizens  of  the 
state  may  well  be  proud. 

That  there  were  many  of  our  members,  who  in 
their  day  were  numbered  among  the  medical  giants, 
is  attested  by  the  fact  that  they  established  na- 
tional and  international  reputations  in  the  medical 
world.  They  gave  luster  to  our  Society  which 
time  cannot  dim.  Then  as  now  the  prime  purpose 
of  our  Society  was  and  will  ever  be  the  best 
possible  medical  service  and  health  care  to  all  the 
people  of  the  state. 

Times  have  changed.  Today  and  henceforth  to 
give  competent  medical  service  it  will  not  be  suf- 
ficient to  be  good  doctors.  Though  this  is  para- 
mount, it  is  equally  urgent  now  as  never  before 
that  to  guard  the  well-being  of  our  people  we 
zealously  defend  and  aggressively  strengthen  the 
citadel  of  medical  freedom.  It  is  imperative  that 
from  this  time  forward  everyone  take  an  active 
part  in  local  civic  affairs,  that  we  keep  well  in- 
formed on  the  implications  and  trend  of  local, 
county,  state  and  national  politics  in  order  to 
thwart  the  inception  of  adverse  legislation. 

The  past  year  has  been  the  busiest  in  the  State 
Society's  long  and  honorable  history.  Its  activities 
and  accomplishments  have  been  epoch  making  in 
medical  annals  and  organization. 

The  Colorado  State  Medical  Society  is  not  merely 
another  local  society,  though  the  roots  from  which 
it  draws  sustenance  and  froi^fcw|iich  it  develops 
strength  are  in  the  heart  of  eacl^one  of  you.  Hp^- 
ever  humble  your  practice  or  however  isolated  3^^r 
sphere  of  action,  the  fruits  of  your  deliberations^ 
here  enriches  all  of  your  sister  societies.  If  j^s^ 
sectional  only  in  the  unity  and  cooperation  of  i^ 
numerical  strength.  In  all  other  respects  it  is* 
national  in  scope.  Your  activities  have  justly  earned' 
the  high  regard  of  our  members  and  have  engendered 
very  commendable  reactions  on  a national  sc^e. 
Moreover;  they  have  forcefully  stimulated  aggres- 
sive, constructive  activities  of  our  parent  organiza- 
tion and  through  it  has  favorably  influenced  medi- 
cal service  and  health  care  for  all  the  people  of 
the  nation. 

The  Colorado  State  Medical  Society  has  come  a 
long  way.  It  has  made  great  strides  forward.  You 
cannot  relax.  There  is  still  much  to  do  to  con- 
solidate the,. 'gains  and  more,  much  more  to  im- 
pregnably  entlench  the  honorable  heritage  of  Ameri- 
can medicine."  This  heritage  bequeathed  to  us  is 
ours  to  uphold  and  enhance  for  the  benefit  of  future 
generations.  We  cannot,  we  must  not  let  it  be 
defamed  or  degraded  either  from  without  or  from 
within  the  profession. 

Never  before  in  the  history  of  our  Nation  have 
so  many  powerful,  so  sinister  forces  outside  the 
medical  profession  been  more  persistently  and  ag- 
gressively active  in  their  endeavors  to  prostitute 
the  merited  honor,  the  sacred  traditions  of  the 
medical  piofession  and  to  degrade  the  world’s  most 
efficient,  highly  personalized  medical  service.  These 
antagonists  know  little  of  medicine  and  care  less  for 
the  continuing  conscientious  efforts  to  ever  improve 
and  ever  more  widely  disseminate  its  service.  They 
do  know  and  appreciate  the  power  of  the  medical  pro- 
fession. They  covet  the  confidence  and  dependence  it 
enjoys  in  the  hearts  and  minds  of  the  people.  This 
confidence  and  dependence  has  long  been  merited  and 
justly  earned  by  years  of  self-sacrificing  service. 

The  notorious  extra-medical  traducers  must  and 
can  be  more  successfully  combated  than  can  the 
more  perverse  and  pernicious — though  happily  less 
numerous — elements  within  our  ranks.  They  should 
and  do  know  better.  They  are  the  more  formidable 
enemies,  because  they  ply  their  pratices  while  mas- 
querading under  the  guise  of  medical  honesty,  honor 
and  respectability.  They  impose  upon  their  col- 
leagues. They  defile  the  profession.  This  is  not 
a pretty  picture  in  whatever  light  one  views  it. 
These  are  our  paramount  problems.  We  must  fact 
facts. 

May  you  be  granted  wisdom  in  your  deliberations 
to  cope  with  the  extra-medical  challenges  and  to 
correct  the  internal  abuses.  May  you  be  given 
courage  to  go  forward  in  the  discharge  of  the  trust 
imposed  upon  you  and  develop  an  unwavering  deter- 
mination to  uphold  and  strengthen  your  elected 
and  executive  officers  in  carrying  out  your  mandates. 

I profoundly  appreciate  the  honor  of  being  Presi- 
dent of  the  Colorado  State  Medical  Society.  None 
will  ever  know  my  disappointment  in  not  being  of 
greater  service,  in  my  inability  to  show  my  grati- 
tude for  your  generosity  and  cooperation  during  my 
term  of  office,  and  lastly  to  be  denied  the  privilege 
of  presiding  during  this  meeting  which  promises  to 

be  the  best  in  the  history  of  the  Society. 


My  disappointment  is  mitigated  by  knowing  that 
our  very  able  Vice  President,  Dr.  Lester  Ward,  who 
has  so  competently  functioned  during  by  absence, 
will  more  ably  than  I fulfill  this  pleasant  duty. 

I cannot  forgo  this  opportunity  to  highly  praise 
Dr.  John  Bouslog  for  the  wonderful  service  he  has 
rendered  the  Society  for  so  many  years,  which  service 
during  the  current  year  has  been  the  most  arduous 
time-  and  energy-consuming  of  all.  I would  be 
woefully  remiss  if  I failed  to  express  my  admiration 
and  sincere  thanks  for  the  other  officers,  and  the 
many  committees  for  their  efficient  work.  Finally 
I most  heartily  praise  our  Executive  Secretary, 
Harvey  Sethman,  and  his  splendid  office  force  for 
the  excellent  job  which  he  so  well  knows  how  to 
perform  and  which  has  been  acclaimed  the  best  of 
all  state  societies. 

May  good  fortune  ever  attend  each  one  of  you, 
and  all  of  you  collectively. 

C.  F.  HEGNER,  President. 

A motion  of  appreciation  to  Dr.  Hegner  for 
his  niessage  and  regret  at  his  inability  to  preside 
at  this  meeting  was  adopted  unanimously.  Acting 
President  Ward  appointed  Drs.  W.  R.  Lipscomb, 
Denver;  E.  R.  Phillips,  Delta;  and  L.  D.  Bu- 
chanan, Wray,  as  a committee  to  call  personally 
upon  Dr.  Hegner  and  express  the  sentiments  of 
the  House.  Dr.  Ward  then  addressed  the  House 
as  follows; 

Report  of  the  Acting  President 

I wish  at  this  time  to  express,  through  the  House 
of  Delegates,  my  sincerej.thanks  and  appreciation  to 
all  members  of  the  Society  whose  active  work  and 
cooperation  has  made  possible  this  year’s  attain- 
j^ients  of  your  State  Society. 

^^In  February  of  this  year  it  was  necessary  for- 
me to  assume  an  unexpected  responsibility  as  your 
Acting  President,  due  to  the  sudden  unfortunate 
'"Illness  of  Dr.  Hegner.  This  was  a position  for 
which  I had  no  previous  preparation,  but  I was 
hurtibly  cognizant  of  what  it  entailed.  Your  State 
Society  had  an  extensive  program  which  was  re- 
quiring the  energies  of  all  its  officials.  Since  that 
time  we  have  labored  diligently  to  continue  this 
program.  Numerous  urgent  problems  have  con- 
fronted our  profession  and  we  have  all  given  our 
best  to  properly  fulfill  our  obligations  to  our  state 
and  national  organizations. 

Any  success  that  our  state  organization  has  at- 
tained this  year  has  been  primarily  due  to  the  full- 
hearted  cooperation  and  unstinted  work  on  the  part 
of  the  elected  boards,  the  regular  and  special  state 
cornmittees,  the  Component  Societies,  and  the  state 
office  personnel.  Many  of  the  members  of  these 
state  committees  are  also  members  of  your  House 
of  Delegates,  and  to  you  and  to  those  numerous  other 
members  of  our  Society  I extend  my  personal  thanks 
for  all  you  have  done.  Our  goal  is  yet  in  the  dis- 
tance; we  cannot  deviate  or  falter  in  our  campaign. 
The  challenge  to  our  American  form  of  medicine, 
the  best  in  the  world,  requires  the  unification  of 
our  members  to  save  the  American  people  from  a 
socialistic  state.  I feel  assured  that  you  will  con- 
tinue to  keep  up  the  good  work  by  full  cooperation 
and  help  to  your  incoming  President,  Dr.  Humphrey. 

Constitutional  Secretary  Buck  assumed  the 
chair  to  recognize  Dr.  Herman  C.  Graves,  who 
moved  a vote  of  thanks  and  appreciation  to  Vice 
President  Ward  for  the  time  and  effort  he  had 
put  forth  in  assuming  the  Acting  Presidency  for 
the  last  six  months.  The  motion  was  passed 
unanimously.  Dr.  Fred  A.  Humphrey  then  ad- 
dressed the  House  as  follows: 

Report  of  the  President-elect 

Mr.  President,  Dr.  Graves  has  just  taken  away  my 
individual  report  in  presenting  the  motion  just 
passed.  To  be  President  of  this  organization  is  no 
longer  an  honorary  position.  It  is  a job.  To  take 
on  this  job  on  a minute’s  notice  without  any 
preparation  makes  it  doubly  difficult.  This  House 
of  Delegates  was  very  wise  in  its  selection  of  a 
Vice  President  last  year.  I think  we  owe  Dr.  Ward 
a double  vote  of  thanks  for  getting  hold  of  the 
ball  and  carrying  it  as  he'  has  done  since  February 
of  this  year.  Y'ou  have  already  passed  a motion 
so  I am  not  going  to  repeat  the  motion  I intended 
to  make,  as  Dr.  Graves  beat  me  to  it. 

The  printed  report  of  the  A.M.A.  Delegates 
was  supplemented  by  Dr.  W.  H.  Halley  as  follows: 


1040 


Rocky  Mountain  Medical  Journal 


maintaining  nrinarg 
antisensis  withoat 
distressing  the  patient 

Comprehensive  clinical  evidence  establishes  that 
MANOELAMINE  (methenamine  mandelate)  is  effective  against 
Escherichia  coli.  Staphylococcus  aureus  and  albus,  and 
certain  streptococci.  Comparative  studies  indicate  its 
bacteriostatic  and  bactericidal  effectiveness  to  be  approx- 
imately the  same  as  that  of  the  sulfonamides  or  strepto- 
mycin . 

Because  MANOELAMINE  therapy  is  exceptionally  well  tolerated, 
patients  willingly  adhere  to  the  prescribed  regimen. 

DOSAGE:  Adequate  dosage  is  important;  for  maximum  effect, 
adults  should  take  3 or  4 tablets  t.i.d.;  children  in 
proportion. 

Complete  literature  and  samples  sent  to  physicians  on 
request. 


6 


outstanding  features  / 


• Has  wide  antibacterial  range 

• No  supplementary  acidification  required  (except 
when  urea-splitting  organisms  occur)  j 

• Little  or  no  danger  of  drug-fa§fness'v 

• Is  exceptionally  well  tolerated 

• Requires  no  dietary  or  fluid  regulation 

• Simplicity  of  regimen  — 3 or  4 tablets  t.i.d. 


MANOELAMINE 

’ REG  U.  S.  RAT  OFF. 

BRAND  OF  METHENAMINE  MANDELATE 

urinary  antlseptie-eounetl  accepted 


4 


N E P E R A CHEMICAL  CO.,  INC. 

NEPERA  PARK  YONKERS  2,  N.  Y. 


for  December,  1949 


1041 


There  was  one  omission  from  the  report  which 
I believe  should  be  brought  up  here.  Colorado  and 
Denver  have  received  a very  high  honor  in  our 
opinion  in  that  the  American  Medical  Association 
has  decided  to  hold  its  Interim  or  Clinical  Session 
for  1950  in  Denver,  from  November  28  to  December 
1,  1950.  There  has  not  been  a meeting  of  the  na- 
tional body  in  Colorado  for  a half  century,  and  we 
can  never  again  conduct  its  regular  Annual  Session 
because  we  have  not  the  facilities  to  handle  such 
a large  meeting.  We  can  handle  the  winter  interim 
meeting,  and  therefore  your  officers  feel  highly 
honored  that  we  were  selected  by  the  A.M.A.  Board 
of  Trustees  and  the  national  House  of  Delegates. 

But  this  involves  some  thinking  and  a great  deal 
of  arranging.  Some  of  the  entertainment  will 
involve  a rather  large'  expense,  probably  several 
thousand  dollars,  and  it  is  hardly  to  be  expected 
that  our  treasury  should  stand  such  expense.  So, 
without  making  a specific  suggestion,  we  would 
like  to  have  this  matter  considered  by  the  appro- 
priate committee. 

Following  discussion,  the  supplemental  as  well 
as  the  printed  report  was  referred  to  the  Ref- 
erence Committee  on  Professional  Relations. 

The  report  of  the  Foundation  Advocate,  not 
previously  distributed,  was  presented  by  Dr.  W. 
W.  King  as  follows: 

Report  of  Foundation  Advocate 

The  tax  exemption  situation  of  our  Foundation  is 
stili  recognized  as  far  as  the  state  is  concerned, 
but  the  Federal  authorities  have  changed  their  at- 
titude frequently  and  this  has  materially  reduced 
the  growth  of  the  Fund  but  the  1948  general  assets 
were  |14,000,  and  as  of  August  31,  1949,  we  are 
pleased  to  report  $15,000  as  such  assets. 

Another  condensed  idea  of  the  growth  of  the 
corpus  of  the  Fund  is  seen  in  the  balance  of  income 
on  hand  at  the  close  of  August  26,  1949,  as  $195.45. 

Since  the  fee  for  the  Trust  Company  is  based  on 
assets,  the  charge  of  $24.33  for  the  period  ending 
8-3-49  reflects  the  same  increase. 

One  item  of  interest  in  this  year’s  history  was  a 
contribution  of  $443.80  from  The  Physician’s  Good- 
Will,  Incorporated,  a local  Denver  organization  with 
no  official  connection  to  the  Denver  Medical  Society. 

WALTER  W.  KING,  M.D. 

The  report  of  the  Executive  Office  Staff  was 
presented  as  printed,  following  which  Mr.  Seth- 
man  presented  to  the  House  Mr.  Ralph  Marshall 
of  Albuquerque,  recently  appointed  Executive 
Secretary  of  the  New  Mexico  Medical  Society, 
visiting  this  annual  meeting. 

The  next  order  of  business  was  the  annual  re- 
ports of  committees.  All  committee  reports  were 
presented,  in  order,  as  printed  in  the  Handbook, 
with  supplemental  reports  by  several,  as  follows: 

Public  Policy:  Dr.  K.  C.  Sawyer,  Chairman, 
supplemented  his  committee  report  as  follows: 

Recommendations  of  the  Tuberculosis  Control  Com- 
mittee on  two  matters  concerning  the  Colorado 
Tuberculosis  Society  were  approved  and  are  reported 
in  that  committee’s  Supplementary  Report. 

With  the  removal  of  the  plan  to  make  use  of 
the  confidential  cancer  registry,  this  committee  has 
approved  the  occupational  cancer  survey  in  Colo- 
rado, under  direciton  of  Dr.  Princi  at  the  Medical 
Center. 

The  matter  of  research  on  the  Papanicolau  test 
at  the  Medical  School  is  still  being  studied  by  the 
Liaison  Committee  to  the  Medical  School. 

The  question  of  raise  in  rates  of  malpractice 
insurance  as  proposed  by  the  Aetna  Life  Insurane 
Company  is  under  study  by  this  committee  and  it 
is  our  recommendation  that  the  incoming  Public 
Policy  Committee,  together  with  the  Society  Legal 
Counsel,  delve  further  into  this  subject  in  the  coming 
year. 

I would  like  again  to  thank  the  members  of 
the  committee  for  their  faithful  attendance  at  meet- 
ings and  for  their  work.  The  committee  in  turn 
wishes  to  thank  its  subcommittees  for  the  way  they 
have  carried  on  their  duties  throughout  the  year, 
and  we  are  especially  grateful  to  Mr.  Nordlund, 
our  legal  counsel,  and  to  the  Executive  Office  Staff 
for  their  loyalty  and  the  tiemendous  amount  of  help 
they  have  given  us.  We  also  wish  to  recognize 
and  thank  Dr.  George  Curry,  admitting  officer  at 
Colorado  General  Hospital,  for  his  recent  efforts  to 
define  aims  and  policies  at  that  institution. 


Report  of  Medicolegal  Committee 

The  Mediocolegal  Committee  has  held  eight  meet- 
ings during  the  past  Society  year.  Twenty  claims 
against  members  were  on  the  calendar,  a few  of 
these  being  carry-overs  from  the  preceding  year. 
Six  of  the  pending  cases  were  closed  during  the 
year,  leaving  fourteen  cases  pending  at  this  time. 

R.  W.  ARNDT,  Chairrnan; 
GEORGE  B.  PACKARD, 

K.  D.  A.  ALLEN, 

C.  S.  BLUEMEL, 

LYMAN  W.  MASON, 

HARRY  C.  HUGHES. 

Industrial  Health:  In  discussion  of  this  report. 
Dr.  D.  H.  Winternitz  requested  that  the  com- 
mittee consider  asking  the  State  Industrial  Com- 
mission for  an  upward  revision  of  the  State 
Workmen’s  Compensation  Fee  Schedule.  Dr.  W. 
C.  Herold  asked  that  in  such  a study  the  matter 
of  industrial  dermatoses  be  considered  for  clari- 
fication in  the  schedule.  These  requests  were 
referred  to  the  Reference  Coirunittee  on  Public 
Health. 

Tuberculosis  Control:  Dr.  John  Zarit,  Chair- 
man, supplemented  his  committee’s  report  as 
follows: 

The  Tuberculosis  Control  Committee  in  meeting 
on  November  6 discussed  at  length  the  Colorado 
Tuberculosis  Association’s  mass  x-ray  programs,  and 
the  report  of  the  Reference  Committee  on  public 
health  to  the  House  of  Delegates  in  1948  session, 
which  report  was  subsequently  adopted.  The  report 
of  the  Reference  Committee  stated:  “Your  committee 
isn’t  taking  any  stand  on  the  advisability  and  neces- 
sity nor  the  need  for  extensive  mass  chest  x-ray 
programs,  but  if  any  of  you  will  give  it  a little 
thought  you  will  see  either  you  have  to  have  a 
community  mass  program  under  the  facilities  avail- 
able, or  you  don’t  have  any  program.”  The  House 
also  deleted  the  phrase  "for  indigent  patients  only,” 
with  respect  to  the  14x17  x-rays. 

The  Tuberculosis  Control  Committee  does  not  ob- 
ject to  mass  survey  by  micro-film — on  the  contrary, 
the  committee  feels  this  screening  should  be  en- 
couraged. The  committee  does  feel,  however,  that 
the  14x17  film  should  only  be  taken  on  recommen- 
dation of  a private  physician  and  that  the  physician 
should  determine  indigency.  It  is  up  to  the  private 
physician  to  decide  whether  the  patient  should 
have  the  x-ray  taken  in  his  office,  be  referred  to 
a radiologist  or  referred  to  the  welfare  department 
or  Tuberculosis  Association. 

This  recommendation  was  made  to  the  Public 
Policy  Committee  and  approved  by  them.  Subse- 
quent to  the  report  of  the  Tuberculosis  Control 
Committee,  as  published  in  the  Handbook,  the  Colo- 
rado Tuberculosis  Society  asked  for  state-wide  ap- 
proval of  the  manner  of  conducting  the  mass  x-ray 
survey  in  other  sections  of  the  state  following  pol- 
icies laid  down  by  Denver  County  Medical  Society. 
The  Tuberculosis  Control  Committee  recommended 
to  the  Public  Policy  Committee,  which  committee 
approved  the  recommendation,  that  the  determina- 
tion of  how  mass  x-ray  surveys  should  be  conducted 
be  left  to  the  County  Medical  Societies,  and  that 
the  Denver  County  Society  outline  of  program  be 
sent  to  the  counties  for  information  only 

The  Colorado  Tuberculosis  Society  also  asked  for 
suggestions  for  their  work  program  for  the  coming 
year.  Since  the  current  year’s  progam  is  pretty 
well  outlined,  the  committee  recommended,  and  Pub- 
lic Policy  Committee  concurred  in  that  recommenda- 
tion, that  the  incoming  Tuberculosis  Control  Com- 
mittee communicate  with  the  Tuberculosis  Society 
asking  that  their  Work  Program  Committee  meet 
with  the  Medical  Society’s  Tuberculosis  Control 
Committee  well  in  advance  of  formulation  of  next 
year’s  program  in  order  to  incorporate  suggestions 
before  the  final  program  is  fixed.  The  committee 
also  recommended  that  if  any  points  or  suggestions 
for  the  current  year’s  program  be  made,  that  they 
be  forwarded  to  the  Tuberculosis  Society  for  in- 
corporation in  the  present  year's  program. 

The  first  section  of  the  Supplemental  Report  just 
submitted,  through  an  oversight,  was  omitted  from 
the  original  report  as  published  in  the  Handbook. 
The  second  section  thereof  was  action  taken  fol- 
lowing publication  of  the  report  in  the  Handbook. 

JOHN  I.  ZARIT,  M.D.,  Chairman. 

A.M.A.  Educational  Campaign:  Dr.  John  S. 
Bouslog,  Chairman,  supplemented  his  printed  re- 
port as  follows: 


1042 


Rocky  Mountain  Medical  Journal 


FULFILLING  EVERY 


REQUIREMENT  OF  EFFECTIVENESS 
AND  PATIENT-ACCEPTANCE 


TRAOEMABK  BtO  U S PAT  OFT. 

VAGINAL  JELLY^ 

O Immobilizes  sperm  in  the 
fastest  time  recognized 
under  the  Brown  and 
Gamble  technique 

Occludes  the  cervix  for  as  long  as 
1 0 hours— effecfivebarr/eracfion 

Cb  Nonirritating  and  nontoxic 

— safe  for  continued  use 

^ Crystal  clear,  nonstaining,  delicately 
fragrant— esthetically  agreeable 

^ Will  not  liquefy  at  body  tempera* 
ture — not  excessively  lubricating 


FOR  ECONOMY  TO  YOUR  PATIENTS 
SPECIFY  THE  LARGE  FIVE-OUNCE  SIZE 


gynecological  division 

JULIUS  SCHMID,  INC. 

423  West  55th  $t..  New  York  19,N.Y. 
quality  first  since  1883 


"Active  IngrecJieftts:  Dodecqethyleheglycol 
Monolourcjte  5%;  Boric  Acid  Alcohol  5*^. 


for  December,  1949 


1043 


It  is  with  much  pleasure  that  I report  today  that 
our  educational  campaign  is  beginning  to  move  for- 
ward after  a summer  vacation  period  of  understand- 
able inactivity. 

All  details  of  the  forthcoming  Organization  Con- 
ference on  October  7 have  been  completed.  Every- 
thing is  in  readiness  for  a splendid  conference  and 
you  will  be  interested  to  know  that  we  have  already 
had  acceptances  from  most  of  the  official  repre- 
sentatives invited  to  attend.  I would  like  to  urge 
every  member  of  the  State  Society  to  attend  this 
meeting  if  possible. 

In  cooperation  with  Dr.  Fred  A.  Humphrey,  who 
will  be  our  new  President,  we  are  making  plans  to 
resume  official  visits  to  County  Societies.  These 
contacts  are  very  important  and,  you  may  recall, 
were  terminated  in  March  due  to  the  illness  of 
President  Casper  F.  Hegner  and  the  pressing  duties 
of  the  newly  inaugurated  educational  campaign.  It 
is  our  hope  that  representatives  of  the  committee 
can  accompany  Dr.  Humphrey  and  the  President- 
elect on  many  of  the  County  Society  visits. 

Our  County  CAP  Chairmen  have  been  urged  to 
encourage  contacts  with  U.  S'.  Senators  and  Con- 
gressmen whenever  possible  and  the  El  Paso  County 
Medical  Society  was  the  first  to  hold  a special  din- 
ner meeting  for  its  representatives.  Their  guest 
speaker  the  night  of  September  14  was  Congressman 
John  H.  Marsalis  of  the  Third  District  and  he 
certainly  enjoyed  meeting  with  the  doctors  at  Colo- 
rado Springs.  He  talked  on  pending  health  leg- 
islation. 

The  Executive  Office  is  preparing  to  assist  the 
committee  with  correspondence  and  the  mailing  of 
campaign  materials  to  our  members  as  the  cam- 
paign tempo  increases.  We  are  ready  for  the  Wash- 
ington planners  this  time  and  I assure  you  that 
Colorado’s  strong  campaign  organization  will  do  the 
job  you  expect  of  it. 

I want  this  House  to  know  that  we  have  a success- 
ful organization  in  Colorado  because  we  have  had 
the  finest  cooperation  from  our  County  Societies. 
Thanks  are  due  to  our  office  force  who  have  aided 
in  this  campaign,  and  especially  Mr.  Edwards,  whom 
the  Board  of  Trustees  assigned  to  aid  the  com- 
mittee. Without  his  help  we  could  not  have  ac- 
complished the  achievements  that  we  are  reporting 
to  you.  I want  again  to  express  my  thanks  to  our 
CAP  chairmen  and  others  for  their  excellent  work. 

Advisory  Committee  to  the  U.M.W.  Health  and 
Welfare  Fund:  Dr.  W.  W.  Haggart,  after  ex- 
pressing appreciation  for  the  honor  previously 
conferred  upon  him  at  this  meeting,  asked  and 
received  permission  to  address  the  House  in 
executive  session,  supplementing  the  report  of 
his  committee.  Following  his  address  and  dis- 
cussion of  it  by  several  delegates  in  executive 
session,  the  supplemental  report  was  referred 
to  the  Reference  Committee  on  Public  Relations. 

Liaison  Council  on  Graduate  Education:  Dr. 
L.  R.  Safarik,  Chairman,  pointed  out  a serious 
typographical  error  in  the  printed  report  of  the 
Council,  where  the  word  “no”  had  been  omitted 
from  the  fourth  line  of  the  second  paragraph  of 
the  report  near  the  bottom  of  Page  66  of  the 
Handbook.  The  line  should  read:  “and  it  now 
seems  that  there  is  no  need  for  the  Liaison 
Council.”  . . . 

Election  of  Nominating  Committee 

Upon  completion  of  the  annual  reports,  the 
Secretary  announced  that  there  was  no  un- 
finished business  remaining  from  the  last  annual 
meeting.  Under  New  Business,  Acting  Presi- 
dent Ward  called  for  election  of  a Nominating 
Committee.  The  following  five  delegates  were 
elected  to  the  Nominating  Committee,  there 
being  no  contest  for  any  of  the  five  positions. 

Dr.  Jesse  W.  White,  Pueblo  County; 

Dr.  D.  H.  Winternitz,  El  Paso  County; 

Dr.  E.  R.  Phillips,  Delta  County; 

Dr.  Bradford  Murphey,  Denver  County; 

Dr.  E.  H.  Kuykendall,  Weld  County. 

Acting  President  Ward  called  upon  the  Ex- 
ecutive Secretary  to  certify  the  names  of  any 
persons  nominated  by  component  societies  for 
positions  on  the  Board  of  Supervisors.  The  fol- 
lowing were  nominated. 


Dr.  E.  A.  Elliff,  by  Northeast  Colorado  Medi- 
cal Society. 

Dr.  K.  F.  Krausnick,  by  the  Prowers  County 
Medical  Society. 

Dr.  Charles  L.  Mason,  by  the  San  Juan  Basin 
Medical  Society. 

Dr.  Ira  L.  Howellj  by  the  San  Luis  Valley 
Medical  Society. 

Under  the  order  of  additional  New  Business, 
Dr.  R.  L.  Davis,  La  Junta,  presented  the  follow- 
ing letter,  which  was  referred  to  the  Reference 
Committee  on  Public  Relations: 

Dr.  R.  L.  Davis,  Delegate, 

Otero  County  Medical  Society: 

The  Otero  County  Medical  Society  hereby  instructs 
you  to  present  to  the  House  of  Delegates  of  the 
1949  meeting  of  the  Colorado  State  Medical  Society 
the  following  plan: 

That  the  duly  appointed  representatives  of  the 
Colorado  State  Medical  Society  contact  the  in- 
surance carriers  for  health  and  accident  policies 
in  the  State  of  Colorado  asking  them  to  place, 
upon  the  face  of  checks  made  in  payment  to 
patients  for  physician’s  services,  the  name  of 
both  the  patient  and  the  physician  concerned. 

OTERO  COUNTY  MEDICAL  SOCIETY, 

G.  H.  VANDIVER,  Secretary. 

Dr.  W.  C.  Herold  asked  that  the  Reference 
Committee  on  Public  Relations  consider  any 
means  toward  seeking  income  tax  deductions 
for  the  cost  of  employing  household  assistance 
in  the  case  of  nurses  who  must  employ  house- 
keepers in  order  to  be  able  to  work  to  support 
themselves  and  their  families. 

The  House  adjourned  for  the  day  and  Ref- 
erence Committee  meetings  were  called. 


SECOND  MEETING—September  21,  1949 

Acting  President  Ward  called  the  House  to 
order  at  5:00  p.m.  Chairman  Buck  of  the  Cre- 
dentials Committee  read  a report  from  the  Sec-« 
retary  of  the  Prowers  County  Medical  Society, 
correcting  an  error  in  that  Society’s  previous 
report,  and  seating  Dr.  H.  E.  McClure  as  dele- 
gate, E.  C.  Likes  as  alternate,  instead  of  E.  C. 
Likes  as  delegate  and  G.  S.  Williams  as  alter- 
nate. The  Credentials  Committee  urged  the 
Prowers  County  Society  to  be  more  careful  in 
the  future  in  submitting  annual  reports,  and 
pointed  out  that  the  State  Society  By-Laws 
must  be  strictly  adhered  to. 

The  roll  was  called,  showing  59  accredited 
delegates  present,  more  than  a quorum. 

The  Credentials  Committee  report  was  then 
adopted.  By  unanimous  consent,  the  House 
dispensed  with  reading  minutes  of  yesterday’s 
meeting.  There  being  no  further  annual  re- 
ports, the  order  of  business  was  reports  of 
Reference  Committees. 

Report  of  Reference  Committee  on  Board  of  Trustees 
and  Executive  Office 

We  approve  the  entire  report  of  the  Board  of 
Trustees  and  make  the  following  recommendations: 

(a)  First,  that  the  site  of  the  Annual  Session  of 
the  Colorado  State  Medical  Society  be  selected  two 
years  in  advance, 

(b)  Second,  that  action  be  taken  as  soon  as  pos- 
sible to  assure  collection  of  the  special  assessment 
voted  by  the  A.M.A.  from  the  members  now  in 
arrears. 

(c)  Third,  that  the  Committee  on  Arrangements 
be  empowered  to  arrange  for  the  A.M,A.  Clinical 
Session  to  be  held  in  Denver,  November  28,  1950, 
through  December  1,  1950,  and  that  the  coinmittee 
determine  the  cost  thereof,  which  shall  be  financed 
by  a special  assessment  on  all  members  of  the 
Colorado  State  Medical  Society. 

(d)  Fourth,  that  the  Annual  Session  of  the  Colo- 
rado Medical  Society  for  1950  in  Colorado  Springs 
be  conducted  in  the  usual  manner. 


1044 


Rocky  Mountain  Medical  Journal 


id-  €tf 


Anotlier  product  adapted  to  a variety  of  uses  is  short- 
acting  Nembutal.  Clinical  reports  now  numbering  more 
than  500  review  over  44  conditions  in  which  it  is  being 
effectively  used.  See  list  at  right. 

Ad'usted  doses  of  short-acting  Nembutal  can  provide 
any  degree  of  cerebral  depression — from  mild  sedation 
to  deen  hynnosis.  Dosage  required  is  only  about  one-half 
that  of  manv  other  barbiturates.  Small  dosage  has  several 
advantages:  less  drug  to  be  inactivated,  less  possibility 
of  "hangover,”  shorter  duration  of  effect,  greater  safety 


44 

4 NEMBUTAI’S 
CLINICAL  USES 

SEDATIVE 

Cardiovascular 

Hypertension 
Coronary  disease 
Angina 

Decompensotion 
Peripheral  vascular  disease 

Endocrine  Disturbances 

Hvperthyroid 

Menopause 

Nausea  and  Vomiting 

Functional  or  organic  disease 
(acute  gastrointestinal  and 
emotional) 

X-ray  sickness 
Pregnancy 
Motion  sickness 

Gastrointestinal  Disorders 

Cardiospasm 

Pyiorospasm 

Spasm  of  biliary  tract 

Spasm  of  colon 

Peptic  ulcer 

Colitis 

Biliary  dyskinesia 

Allergic  Disorders 

Irritability 

To  combat  stimulation  of 
ephedrine  alone,  etc. 

Irritability  Associated 
With  Infections 

Restlessness  and 
Irritability  With  Pain 

Central  Nervous  System 

Paralysis  agitans 

Chorea 

Hysteria 

Delirium  tremens 
Mania 

Anticonvulsant 

Traumatic 

Tetanus 

Strychnine 

Eclampsia 

Status  epilepticus 

Anesthesia 

OBSTETRICAL 
Nausea  and  Vomiting 
Eclampsia 
Amnesia 


and  definite  economy  to  the  patient. 

Short-acting  Nembutal  is  available  as  Nembutal  sodium, 
Nembutal  calcium  and  Nembutal  Elixir,  all  in  easily 
administered  small-dosage  sizes.  For  the  tab-indexed 
booklet,  ”44  Clinical  Uses  for  Nembutal,”  write  to 
ABBOTT  LABORATORIES,  North  Chicago,  Illinois. 


HYPNOTIC 
Induction  of  Sleep 

SURGICAL 

Preoperative  Sedation 
Basal  Anesthesia 
Postoperative  Sedation 


In  equal  oral  doses,  no  other  barbiturate  combines 


QUICKER,  BRIEFER, 

MORE  PROFOUND  EFFECT  than  . . . 


PEDIATRIC 
Sedation  for: 

Special  examinations 
Blood  transfusions 
Administration  of  parenteral 
fluids 

Reactions  to  immunization 
procedures 
Minor  surgery 


(Pentobarbital,  Abbott)  Preoperative  Sedation 


for  December,  1949 


1045 


(e)  Fifth,  that  the  streamlining-  of  committees  be 
expedited  by  the  proper  authorities  with  the  goal 
that  all  duplication  of  activities  or  superfluous 
committees  be  eliminated. 

(f)  We  approve  the  Budget  for  the  fiscal  year 
beginning  September  1,  1949,  and  ending  August 
31,  1950. 

(g)  We  approve  the  annual  issuance  of  a wall 
type  certificate  of  membership  as  suggested  by  the 
Board  of  Trustees. 

(h)  We  recommend  that  the  two  component  so- 
cieties change  their  election  dates  to  coincide  with 
the  election  of  the  State  Society. 

(i)  We  approve  the  entire  report  of  the  Executive 
Office  Staff  and  make  the  following  recommenda- 
tions: 

First,  that  the  Executive  Office  Staff  be  com- 
mended for  their  splendid  work  and  conduct  of 
their  office  during  the  past  years. 

(J)  Second,  that  the  Board  of  Trustees  explore 
the  possibility  of  limiting  the  demands  made  upon 
the  executive  office  for  extra  curricular  activities 
on  behalf  of  organizations  which  are  not  a definite 
part  of  the  Colorado  State  Medical  Society. 

(k)  Third,  that  the  Board  of  Trustees  carefully 
scrutinize  the  program  activities  of  specialty  groups 
which  are'  tending  to  form  scientific  sections  of 
the  Society  without  the  required  authority  from  the 
House  of  Delegates.  It  should  be  noted  that  the 
Constitution  of  our  Society  definitely  limits  the 
formation  of  sections  to  those  which  have  been 
previously  authorized  by  the  House  of  Delegates. 

(l)  Fourth,  that  no  change  be  made  in  the  clas- 
sification of  membership  as  revised  by  the  House 
of  Delegates  at  previous  Annual  Sessions. 

(n)  We  approve  the  entire  report  of  the  Advisory 
Committee  to  Women’s  Auxiliary  and  make  the 
following  recommendations: 

First,  that  we  commend  the  members  of  the 
Women’s  Auxiliary  for  their  sincere,  intelligent  and 
never  tiring  activities  for  the  benefit  of  The  Colo- 
rado State  Medical  Society. 

(o)  Second,  we  further  compliment  them  for  their 
splendid  work  in  aiding  our  C.A.P.  Committee  to 
make  the  National  Education  Program  a success. 

(p)  Third,  we  commend  the  Women’s  Auxiliary 
for  the  efficient  manner  in  which  they  have  han- 
dled the  preliminary  arrangements  for  the  banquet. 

(q)  Fourth,  that  we  urge  the  State  Medical  So- 
ciety and  its  component  societies  to  encourage  the 
cooperative  and  friendly  relationship  between  the 
two  organizations  for  the  advancement  of  medicine 
in  the  State  of  Colorado. 

(m)  We  approve  the  entire  report  of  the  Foun- 
dation Advocate. 

F.  H.  ZIMMERMAN,  Pueblo,  Chairman. 

L.  CDARK  HEPP,  Denver. 

W.  C.  HEROLD,  El  Paso. 

C.  L.  MASON,  San  Juan. 

LUMIR  R.  SAFARIK,  Denver. 

KENNETH  C.  SAWYER,  Denver. 

W.  A.  SCHOEN,  SR.,  Weld. 

The  report  of  the  Reference’  Committee  on 
Board  of  Trustees  and  Executive  Office  was 
adopted,  section  by  section  and  as  a whole,  as 
above,  without  dissent. 

Report  of  Reference  Committee  on  Scientific  Work 

Your  committee  agrees  to  the  report  of  the  Com- 
mittee on  Scientific  Work.  We  recommend  that  it 
be  accepted  and  that  they  be  commended  for  theii 
good  work  and  particularly  with  reference  to  get- 
ting the  television  here  for  this  meeting. 

We  recommend  that  the  report  of  the  Committee 
on  Medical  Education  and  Hospitals  be  accepted  as 
printed  in  the  Handbook. 

We  believe  that  the  report  of  the  Committee  on 
Library  and  Medical  Literature  should  be  accepted 
as  published  in  the  Handbook. 

We  agree  with  the  report  of  the  Mid-Winter  Post- 
graduate Clinics  Committee  and  agree  with  its 
feeling  that  the  J5  fee  should  'oe  retained  until 
these  clinics  are  solvent. 

We  recommend  that  the  report  of  the  Repre- 
sentative to  the  Belle  Bonfils  Memorial  Blood  Bank 
be  accepted  as  printed  in  the  Handbook. 

We  believe  that  the  repoit  of  the  Liaison  Council 
on  Graduate  Education  should  be  accepted  as  printed 
in  the  Handbook.  We  agree  with  them  that  there 
seems  to  be  no  reason  why  the  committee  should 
not  be  disbanded  at  this  time. 

J.  L.  McDonald,  E1  Paso,  Chairman. 

M.  L.  CRAWFORD,  Northwestern. 

JAMES  S.  HALEY.  Boulder. 

FRANK  B.  McGLONE,  Denver. 

The  report  of  the  Reference  Committee  on 
Scientific  Work,  above,  was  adopted,  section  by 
section  and  as  a whole,  without  dissent. 


Report  of  Rcfereace  Committee  on  Public  Relations 

Attention  of  the  House  of  Delegates  is  called  to 
that  part  of  the  report  of  the  Public  Policy  Com- 
mittee appearing  at  the  top  of  Page  26  of  the  Hand- 
book, pertaining  to  the  establishment  of  a state- 
wide medical  investigation  facility. 

In  the  light  of  the  obvious  increase  of  crime 
within  the  state  and  recent  experiences  in  the 
solution,  or  attempted  solution  of  violent  crimes, 
it  is  recommended  that  the  Colorado  State  Medical 
Society  and  all  component  societies  assume  leader- 
ship in  demanding  the  establishment  of  a state- 
wide program  of  scientific  crime  investigation.  We 
also  recommend  that  the  Public  Policy  Committee 
Report  be  adopted  as  printed. 

Your  Reference  Committee  considered  the  report 
of  the  Sub-Committee  for  the  formation  of  a state 
health  council,  and  recommends  its  acceptance. 

With  regard  to  the  report  of  the  Committee  on 
Health  Education,  this  committee  recommends  its 
acceptance  and  a continuation  of  their  operations. 

We  wish  to  report  acceptance  on  the  report  of 
the  Committee  on  Medical  Service  Plans,  plus  a 
comment  of  our  committee.  The  Reference  Com- 
mittee recommends  acceptance  of  this  report  with 
the  several  suggestions.  We  feel  that  the  material 
presented  in  the  first  two  paragraphs — and  we 
ask  you  to  please  refer  to  your  Handbook  at  Page 
33 — comprises  a rather  weak  handling  of  the  prob- 
lem. Therefore,  we  suggest  that  the  incoming 
committee  consider  the  possibilities  of  exerting  more 
pressure  on  sub-standard  health  and  accident  com- 
panies by  whatever  means  may  seem  best,  as  through 
the  Underwriters  Association,  or  by  some  stamp 
of  approval  or  disapproval  by  the  State  Society. 
It  is  further  desirable  in  this  connection  that  the 
insurance  company  reports  be  made  more  brief;  and, 
secondly,  that  the  claim  checks  to  policyholders 
carry  the  physician’s  name.  The  question  of  a 
raise  in  life  insurance  examination  fees  is  in  the 
hands  of  the  American  Medical  Association.  Every 
pressure  possible  should  be  exerted  to  facilitate 
action  by  the  American  Medical  Association. 

Your  committee  recommends  acceptance  of  the 
report  of  the  American  Medical  Association  Educa- 
tion Campaign  Committee. 

In  connection  with  the  report  of  the  Committee 
on  Rehabilitation  we  make  this  statement: 

Your  Reference  Committee  on  Public  Relations 
recommends  the  acceptance  of  the  report  of  the 
Rehabilitation  Committee  and  rejection  of  the  State- 
ment of  Policy  appended  thereto.  In  this  connec- 
tion is  is  recommended  that  the  Statement  of  Policy 
be  deleted  from  the  committee’s  report  and  from 
the  Minutes  of  the  House  of  Delegates,  as  being 
too  controversial  for  official  publication  by  the 
Society.  Your  Reference  Committee  recommends 
that  the  incoming  President  appoint  a committee 
to  consider  the  whole  question  of  chronic  diseases 
and  rehabilitation  as  a community  problem  in  which 
the  medical  profession  is  vitally  interested  and 
willing  to  assume  constructive  leadership,  laying 
particular  emphasis  on  evaluation  and  rehabilita- 
tion. 

We  recommend  acceptance  of  the  report  of  the 
Advisory  Committee  to  the  Goodwill  Industries’  Re- 
habilitation Program. 

We  recommend  the  acceptance  of  the  report  of 
the  Special  Committee  Advisory  to  Sewall  House. 

We  recommend  acceptance  of  the  report  of  the 
Rural  Health  Commission. 

We  recommend  acceptance  of  the  report  of  the 
Special  Committee  on  Day  Organization  Standards, 
and  recommend  that  the  House  of  Delegates  abolish 
the  committee. 

Your  Reference  Committee  on  Public  Relations 
recommends  acceptance  of  the  report  of  the  Ad- 
visory Committee  to  the  United  Mine  Workers 
Welfare  and  Retirement  Fund  as  published,  and 
the  supplementary  report  presented  for  the  com- 
mittee in  Executive  Session  by  Dr.  Haggart.  Your 
Reference  Committee  recommends  that  the  House  of 
Delegates  go  on  record  as  being  unalterably  opposed 
to  abuses  of  the  United  Mine  Workers  Welfare  Plan 
by  excessive  fees  or  through  subterfuge  of  any  type. 
In  keeping  with  this  statement  of  policy,  it  is 
recommended  that  the  House  of  Delegates  inform 
the  Administrative  Director  of  the  United  Mine 
Workers  Welfare  Fund  that  all  cases  of  , abuse  in 
which  the  service  fails  to  reconcile  differences  with 
the  physicians  involved  be  reported  directly  to  the 
Board  of  Supervisors  of  the  Colorado  State  Medical 
Society  for  investigation  and  appropriate  action. 
It  is  further  recommended  that  the  House  of  Dele- 
gates use  its  influence  with  the  trustees  of  the 
welfare  fund  and  the  medical  societies  of  other 
states  in  establishing  comparable  control  of  abuses 
in  those  states  in  which  similar  situations  do  or 
may  exist. 

We  recommend  acceptance  of  the  report  of  the 
Representatives  to  the  Rocky  Mountain  Radio  Coun- 


1046 


Rocky  Mountain  Medical  Journal 


✓ 

If  she  is  one 
of  your  patients 


...Your  help  now  may  spell  the  difference  between  unprovided-for  old  age 
and  economic  security. 

Women  in  business  who  ore  nervous,  emotionally  unstable  and  generally 
distressed  by  symptoms  of  the  climacteric  almost  inevitably  experience 
a reduction  in  efficiency  as  well  as  earning  power. 

'’^Premarin''  offers  a solution.  Many  thousand  physicians  prescribe  this 
naturally-occurring,  oral  estrogen  because... 

1 .  Prompt  symptomatic  improvement  usually  follows  therapy. 

2.  Untoward  side-effects  are  seldom  noted. 

3.  The  sense  of  well-being  so  frequently  reported  tends  to 

quickly  restore  the  patient's  confidence  and  normal  efficiency. 

4.  This  "Plus"  (the  sense  of  well-being  enjoyed  by  the  patient) 
is  conducive  to  a highly  satisfactory  patient-doctor 
relationship. 

I 5.  Four  potencies  provide  flexibility  of  dosage:  2.5  mg., 

1 .25  mg.,  0.625  mg.  and  0.3  mg.  tablets;  also  in  liquid 
form,  0.625  mg.  in  each  4 cc.  (1  teaspoonful). 


While  sodium  estrone  sulfate  is  the  principal  estrogen 
in  "Premarin,"  other  equine  estrogens  ...  estradiol, 
equilin,  equilenin,  hippulin  . . . are  probably  also  pres- 
ent in  varying  amounts  as  water-soluble  conjugates. 


ESTROGENIC  SUBSTANCES  (WATER-SOLUBLE) 
also  known  as  CONJUGATED  ESTROGENS  (equine) 


Ayerst,  McKenna  & Harrison  Limited  22  East  40th  Street,  New  York  16,  New  York 
for  December,  1949  1047 


ciJ  and  suggest  commendation  for  their  very  ex- 
cellent work. 

Your  committee  considered  the  question  raised  by 
Dr.  Herold  of  Colorado  Springs,  concerning  indus- 
trial dermatoses.  This  committee  recommends  the 
continued  cooperation  of  the  Legislative  Committee 
and  Dr.  Bell  working  for  a broader  industrial  cov- 
erage bill. 

Another  question  brought  up  by  Dr.  Herold  was 
the  question  of  tax  exemption  for  nurses  for  care 
of  their  children.  Frankly,  we  were  unable  to  see 
how  we  were  to  function  in  that  direction,  no 
matter  how  desirable  it  might  be.  We  have  taken 
no  action  on  it  although  we  did  consider  it. 

HERMAN  C.  GRAVES,  Chairman. 

K.  D.  A.  ALLEN,  Denver. 

J.  Ek  A.  CONNELL,  Pueblo. 

E.  A.  ELLIFF,  Northwest. 

A.  B.  GJELLiUM,  San  Luis  Valley. 

I.  E.  HENDRYSON,  Denver. 

WILLIAM  A.  LIGGETT,  Denver. 

G.  C.  MILLIGAN,  Arapahoe. 

D.  H.  WINTERNITZ,  El  Paso. 

The  report  of  the  Reference  Committee  on 
Public  Relations,  above,  was  adopted  section  by 
section  and,  as  a whole,  unanimously. 

Report  of  Reference  Committee  on  Public  Healtb 

Your  Reference  Committee  wishes  to  submit  the 
following  regarding  the  reports  of  the  various  public 
health  committees: 

1.  We  recommend  the  adoption  of  the  report  of 
the  General  Committee  on  Public  Health.  We  sug- 
gest that  the  problem  of  diphtheria  and  undulent 
fever  be  referred  to  the  respective  local  health 
units  for  solution. 

2.  We  recommend  the  adoption  of  the  report  of 
the  Committee  on  Cancer  Control.  We  feel  that 
this  committee  should  be  commended  for  the  re- 
fresher courses  that  were  held  in  various  parts  of 
the  state  and  hope  that  this  work  will  be  continued. 

3.  We  recommend  the  adoption  of  the  report  of 
the  Committee  on  Crippled  Children  and  especially 
are  they  to  be  commended  for  their  policy  in  re- 
stricting services  offered  to  those  referred  by  pri- 
vate physicians.  We  heartily  agree  that  rheumatic 
fever  patients  should  not  be  included  in  the  crip- 
pled children’s  program. 

4.  We  recommend  the  adoption  of  the  report  of 
the  Committee  on  Industrial  Health.  We  also  feel 
that  the  lejgislative  subcommittee  of  the  Public 
Policy  Comirtittee  should  work  out  a satisfactory 
bill,  to  be  submitted  at  the  next  session  of  the  State 
Legislature,  that  would  more  adequately  cover  oc- 
cupational diseases.  We  also  feel  that  the  Public 
Policy  Committee  should  appoint  a subcommittee 
to  study  the  insurance  carrier  fees  and  the  present 
committee  should  carry  on  its  good  work  for  upward 
revision  in  some  instances. 

5.  We  recommend  the  adoption  of  the  report  of 
the  Committee  on  Local  Health  Units.  We  agree 
with  the  committee  that  the  lack  of  cooperation 
between  the  local  stfCieties  and  the  local  health 
units  and  the  failure  of  the  local  societies  to  more 
closely  scrutinize  the  activities  of  the  health  units 
is  a serious  matter  and  is  one  more  step  in  the 
direction  of  state  medicine.  Realizing  the  need  of 
public  health  personnel  in  epidemiology,  immuniza- 
tion programs,  etc.,  we  still  feel  that  there  is  a 
great  field  for  education  of  the  population  in  re- 
gards to  their  health  needs,  and  that  more  effort 
should-be  expended  in  this  direction  by  local  health 
units.  ^ 

6.  We  recommend  the  adoption  of  the  report  of 
the  Committee  on  Maternal  and  Child  Health.  .We 
feel  there  is  a great  need  for  practical  nurses  as  a 
result  of  the  present  nursing  education  program. 
The  committee  to  be  appointed  for  the  ensuing  year 
should  further  study  the  possibility  of  approving 
practical  nurses.  We  would  also  recommend  that 
the  President  of  the  Society  appoint  a committee 
to  study  the  present  nurses’  education  program 
which  we  feel  is  inadequate,  and  which  is  not  pro- 
ducing the  quantity  or  quality  of  nurses  suitable 
for  patient  care.  The  present  nursing  education 
program  is  designed  for  specialized  fields  such  as 
public  health,  obstetrics,  etc.,  and  to  produce  nurs- 
ing supervisors  and  teachers.  This  program  is  not 
producing  sympathetic  nurses  who  are  willing  to 
care  for  the  sick.  It  is  this  program  which  has 
produced  the  present  dearth  of  nurses  and  neces- 
sitates the  training  of  good  practical  nurses.  No 
comment  is  made  about  the  handling  of  patients  in 
the  maternal  and  child  health  set-up  as  this  is 
covered  fully  by  the  report  of  the  Committee  for 
the  Study  of  Maternal  and  Child  Welfare  Clinics  in 
Colorado. 

7.  We  recommend  the  adoption  of  the  report  of 
the  Special  Committee  for  the  Study  of  Maternal 
and  Child  Welfare  Clinics  in  Colorado.  We  thank 


this  committee  for  its  study  and  we  recommend 
its  discontinuance  because  it  was  appointed  for  only 
one  year.  We  particularly  commend  the  summary 
of  this  committee  as  seen  on  Page  59  of  the  Hand- 
book, especially  items  2 and  3 in  which  it  is  em- 
phasized that  the  maternal  and  child  health  activi- 
ties of  public  health  nurses  should  be  controlled 
and  supervised  by  local  medical  societies  and/or 
individual  physicians  practicing  in  the  communities, 
and  item  3,  the  need  for  well  baby  clinics  and  im- 
munization programs  for  low  economic  groups,  but 
not  for  the  general  public. 

8.  We  recommend  the  adoption  of  the  report  of 
the  Committee  on  Mental  Hygiene. 

9.  We  recommend  the  adoption  of  the  report  of 
the  Committee  on  Milk  Control. 

10.  We  recommend  the  adoption  of  the  report  of 
the  Committee  on  New  Hospital  Construction.  We 
suggest  that  the  Denver  County  Medical  Society 
investigate  the  University  of  Denver  Student  Health 
Program  with  reference  to  the  referral  of  patients. 
Especially  are  we  concerned  about  the  treatment 
of  those  students  who  are  residents  of  Denver  and 
who  already  have  a private  physician.  We  feel 
that  a good  portion  of  the  student  body  at  Denver 
University  is  composed  of  Denverites.  We  recom- 
mend that  referrals  from  the  Student  Health  Cen- 
ter be  handled  through  the  Information  and  Service 
Center  of  the  Denver  County  Medical  Society. 
We  further  recommend  that  the  Medical  Society  of 
the  City  and  County  of  Denver  be  informed  of  our 
recommendations  and  that  they  act  accordingly. 

11.  We  recommend  the  adoption  of  the  report  of 
the  Committee  on  Public  Water  Supplies.  This  is 
a problem  in  which  every  practicing  physician  has 
a vital  interest  and  is  a fertile  field  for  good  public 
relations.  Medical  societies  should  continue  to  take 
an  active  interest  in  the  subject  covered  by  this 
report. 

12.  We  recommend  the  adoption  of  the  report  and 
the  supplementary  report  of  the  Committee  on  Tu- 
berculosis Control.  We  especially  wish  to  emphasize, 
as  is  brought  out  in  the  supplementary  report,  that 
free  14x17  x-ray  plates  should  be  taken  only  of 
indigent  patients,  and  that  people  who  are  able  to 
pay  should  certainly  have  their  x-ray  by  a private 
physician. 

13.  We  recommend  adoption  of  the  report  of  the 
Committee  on  Venereal  Disease  Control. 

(Section  13  of  the  Reference  Committee  re- 
port, immediately  above,  was  amended  before 
adoption  in  this  form,  a sentence  being  stricken 
from  the  report  by  aye  and  no  vote.  The  section 
as  amended  was  then  adopted,  with  several  “no” 
votes  recorded.) 

In  closing  this  report,  let  us  remind  you  that  free 
venereal  disease  treatment,  free  maternal  and  child 
welfare  clinics,  public  health  units,  even  though  in- 
dividually small,  can  all  grow  until  we  are  sur- 
rounded by  various  small  units  which  together 
would  give  us  state  medicine. 

L.  D.  BUCHANAN,  Washington-Yuma, 
Chairman. 

HARRY  C.  HUGHES,  Denver. 

W.  A.  H.  RETTBERG,  Denver. 

JESSE  W.  WHITE,  Pueblo. 

M.  E.  SNYDER,  El  Paso. 

PC.  J.  VON  DETTEN,  Denver. 

A.  M.  COCHRANE,  Garfield. 

H.  E.  HAYMOND,  Weld. 

The  report  of  the  Reference  Committee  on 
Public  Health,  above,  was  adopted  section  by 
section,  and  as  a whole,  as  amended.  Dissenting 
votes  were  recorded  on  several  sections  of  the 
report. 

Report  of  Reference  Committee  on  Professional 
Relations 

The  report  of  the  Board  of  Councilors  is  approved 
as  it  appears  on  page  12  of  the  Handbook.  The 
report  of  the  Board  of  Supervisors  is  approved  as 
it  appears  in  the  Handbook  on  pages  13,  14,  and  15. 
The  committee  wishes  to  commend  the  Board  of 
Supervisors  for  their  untiring  work  for  the  State 
Society.  The  report  of  the  Delegates  of  the  A.M.A. 
is  approved  as  printed  on  pages  15  and  16  of  the 
Handbook.  The  report  of  the  Committee  on  Rocky 
Mountain  Medical  Conference  is  approved  as  printed 
on  page  46  of  the  Handbook.  The  report  of  the 
Liaison  Committee  to  Colorado  State  Nurses’  Asso- 
ciation is  approved  as  printed  on  page  63  of  the 
Handbook.  The  report  of  the  Liaison  Committee 
to  the  Colorado  Bar  Association  is  approved  as 
printed  on  page  63  of  the  Handbook.  The  report 
of  the  Medical-Dental  Liaison  Committee  is  ap- 


1048 


Rocky  Mountain  Medical  Journal 


for  POSTOPERATIVE 
and  POSTPARTUM 

NEEDS 


Basic  design  and  the  unique  sys- 
tem of  adjustment  make  a large 
variety  of  Camp  Scientific  Sup- 
ports especially  useful  as  post- 
operative aids.  Surgeons  and 
physicians  often  prescribe  them 
as  assurance  garments  and  con- 
sider them  essential  after  op- 
eration upon  obese  persons, 
after  repair  of  large  herniae,  or 
when  wounds  are  draining  or 
suppurating.  A Camp  Scientif- 
ic Support  is  especially  useful  in 
the  postoperative  patient  with 
undue  relaxation  of  the  abdom- 
inal wall.  Obstetricians  have 
long  prescribed  Camp  Post- 
operative Supports  for  post- 
partum use.  Physicians  and 
surgeons  may  rely  on  the  Camp- 
trained  fitter  for  precise  execu- 
tion of  all  instructions. 

If  you  do  not  have  a copy  of  the 
Camp  “Reference  Book  for  Phy- 
sicians and  Surgeons’’,  it  will 
. be  sent  on  request. 


c/yyv,p 

clentific  ^uppci 


THIS  EMBLEM  is  displayed  only  by  reli- 
able merchants  in  your  community.  Camp 
Scientific  Supports  are  never  sold  by  door- 
to-door  canvassers.  Prices  are  based  on 
intrinsic  value.  Regular  technical  and 
ethical  training  of  Camp  fitters  insures 
precise  and  conscientious  attention  to  your 
recommendations. 


S.  H.  CAMP  AND  COMPANY,  JACKSON,  MICHIGAN 

World’s  Largest  Manufacturers  of  Scientific  Supports 
Offices  io  New  York  • Chicago  • Windsor,  Ontario  • London,  England 


for  December,  1949 


. ^ OF  THE 

lullege  of  physicians 

rur  DTJTT  ArnTT  pma 


1049 


proved  as  printed  on  page  63  of  the  Handbook.  The 
report  of  the  Medicolegal  Committee  is  approved 
as  submitted.  The  supplementary  report  of  the 
Board  of  Supervisors  on  recommended  changes  in 
the  purposes  and  procedures  of  the  Board  of  Super- 
visors of  the  Colorado  State  Medical  Society  is 
approved  in  principle  bat  the  committee  requests 
that  the  Board  of  Councilors  seek  the  advice  of 
the  Society’s  attorney  before  the  final  revision  is 
adopted.  The  committee  also  approves  the  pro- 
posed amendment  to  the  By-Laws  as  submitted  and 
refers  this  to  the  Committee  on  Constitution  and 
By-Laws. 

The  report  of  the  Delegates  to  the  Colorado  Inter- 
professional Council  is  approved  as  printed  on  page 
67  of  the  Handbook.  Your  committee  recommends 
that  interprofessional  relations  be  encouraged  and 
expanded  through  the  activities  of  this  Council. 

FREDERICK  H.  GOOD,  Chairman. 
WILLIAM  B.  CONDON, 

MORGAN  A.  DURHAM, 

PAUL  R.  HILDEBRAND, 

JAMES  M.  LAMME,  SR., 

JOHN  G.  RYAN, 

RALP;H  M.  STUCK. 

The  report  of  the  Reference  Committee  on 
Professional  Relations,  above,  was  adopted  sec- 
tion by  section  and  as  a whole,  unanimously. 

Report  of  the  Nominating  Committee 

Your  Committee  on  Nominations  elected  Dr. 
Jesse  W.  White,  Pueblo,  as  its  chairman  and 
respectfully  submits  the  following  ticket  of  nom- 
inations for  this  Annual  Session: 

FoT  President-Elect,  Dr.  Ervin  A.  Hinds  of 
Denver. 

The  niembers  of  the  House  will  note  that  our 
nomination  of  a Denver  member  for  President- 
elect is  in  line  with  the  expressed  wishes  of  a 
majority  of  the  delegates  for  a new  custom 
whereby  the  presidency  hereafter  should  alter- 
nate annually  between  Denver  and  the  re- 
mainder of  the  state,  instead  of  alternating  bi- 
annually  as  it  has  in  recent  years. 

For  Vice  President,  Dr.  A.  B.  Gjellum  of 
Del  Norte. 

For  Trustee  for  a three-year  term  to  succeed 
Dr.  Ervin  A.  Hinds  of  Denver,  Dr.  Cyrus  W. 
Anderson  of  Denver. 

For  Trustee  for  a three-year  term  to  succeed 
himself.  Dr.  E.  H.  Munro  of  Grand  Junction. 

For  Councilor  for  District  No.  6,  for  one  year 
to  fill  a vacancy  in  a three-year  term  caused 
by  the  moving  of  the  present  Councilor,  Dr.  L. 
E.  Thompson,  away  from  the  District,  Dr.  C. 
Rex  Fuller  of  Salida. 

For  Cormcilor  for  District  No.  7,  for  a three- 
year  term,  to  succeed  Dr.  A.  L.  Burnett  of 
Durango,  Dr.  Leo  W.  Lloyd  of  Durango. 

For  Councilor  for  District  No.  8,  for  a three- 
year  term,  to  succeed  Dr.  Lawrence  L.  Hick  of 
Delta,  Dr.  Arch  H.  Gould  of  Grand  Junction. 

For  Councilor  for  District  No.  9,  for  a three- 
year  term,  to  succeed  Dr.  William  W.  Sloan  of 
Hayden,  Dr.  Marvel  L.  Crawford  of  Steamboat 
Springs. 

For  tjie  six  positions  on  the  Boabd  of  Super- 
visors which  become  vacant  in  this  Annual  Ses- 
sion, each  for  a two-year  term,  your  committee 
transmits  to  you  with  its  recommendation  the 
four  nominations  previously  made  by  component 
societies,  as  follows: 

Dr.  Edgar  A.  Elliff,  Sterling,  of  the  North- 
eastern Medical  Society. 

Dm.  Keith  F.  Krausnick,  Lamar,  of  the  Prowers 
County  Medical  Society. 

Dr.  Charles  L.  Mason,  Durango,  of  the  San 
Juan  Basin  Medical  Society. 

Dr.  Ira  L.  Howell,  Alamosa,  of  the  San  Luis 
Valley  Medical  Society. 

For  the  other  two  of  the  six  positions  your 


committee  nominates  Dr.  Howard  H.  Heuston, 
Boulder,  representing  the  Boulder  County  Medi- 
cal Society;  and  Dr.  George  M.  Myers,  Pueblo, 
of  the  Pueblo  County  Medical  Society. 

For  Delegate  to  the  American  Medical  Asso- 
ciation for  a two-year  term  beginning  next 
January  1,  to  succeed  himself.  Dr.  George  A. 
Unfug  of  Pueblo. 

For  Alternate  Delegate  to  the  American  Med- 
ical Association  for  a two-year  term  beginning 
next  January  1,  to  succeed  himself.  Dr.  Herman 
C.  Graves  of  Grand  Junction. 

For  Foundation  Advocate  to  succeed  himself. 
Dr.  Walter  W.  Kling  of  Denver. 

Your  committee  concurs  in  the  previous  ac- 
tions taken  by  the  Board  of  Trustees  in  recom- 
mending that  the  80th  Annual  Session  be  held 
in  Colorado  Springs  in  September,  1950,  with 
headquarter^  at  the  Broadmoor  Hotel;  and  makes 
this  as  its  formal  nomination.  In  this  connec- 
tion your  committee  notes  that  with  the  in- 
creased size  of  the  Annual  Session  and  until 
such  time  as  additional  hotel  facilities  are  avail- 
able elsewhere,  there  are  only  two  cities  in  the 
state  which  can  adequately  accommodate  our 
meeting,  namely  Denver  and  Colorado  Springs. 

We  concur  in  the  recommendation  of  the  Board 
of  Trustees  that  the  Society  must  choose  its 
meeting  place  and  meeting  dates  approximately 
two  years  in  advance  while  this  situation  ob- 
tains. We  therefore,  recommend  that  by  adop- 
tion of  this  report  the  House  of  Delegates  em- 
power the  Board  of  Trustees  to  act  for  the 
House  in  selecting  a meeting  place  and  dates 
for  the  annual  session  to  be  held  in  1951. 

JESSE  W.  WHITE,  Pueblo.  Chairman. 

D.  H.  WINTERNITZ,  El  Paso. 

Ei  R.  PHILLIPS,  Delta. 

BRADFORD  MURPHEIY,  Denver. 

E.  H.  KUYKENDALL,  Weld. 

The  report  of  the  Nominating  Committee, 
above,  was  received  and  filed,  subject  to  later 
nominations  from  the  floor  prior  to  the  time 
for  election  of  officers. 

Report  of  Refercnee  Committee  on  Constitution 
and  By-Laws 

Your  committee  on.  Constitution  and  By-Laws  has 
considered  the  proposal  to  change  the  date  of  in- 
stallation of  Members  to  the  House  of  Delegates. 

We  approved  this  proposal,  with  a change  of  date. 
As  originally  proposed  yesterday  the  date  of 
installation  of  Delegates  was  made  as  April  1.  The 
only  change  we  have  made  is  suggesting  the  date 
of  January  1,  to  make  it  universal  for  all  component 
societies. 

This  would  require  the  following  change  in  our 
By-Laws: 

Amend  Section  2 of  Chapter  IV  of  the  By-Laws 
by  striking  the  first  sentence  thereof  and  sub- 
stiuting  therefor  the  following  provision: 

‘‘Members  of  the  House  of  Delegates  shall  be 
elected  for  terms  of  two  years  and  shall  assume 
office  on  January  1 of  the  year  next  succeeding 
their  election,  provided  that  Incumbent  dele- 
gates at  the  date  of  adoption  of  this  provision 
shall  serve  until  the  expiration  of  their  term 
and  until  their  successors  are  elected  and  assume 
office:  elections  to  fill  vacancies  shall  be  for 
the  unexpired  term.”  • 

The  above  proposal  of  the  Reference  Com- 
mittee was  discussed  at  length  by  several  of- 
ficers and  delegates,  at  the  conclusion  of  which 
it  was  moved,  seconded,  and  carried  without 
dissent  that  the  words  “January  1 of  the  year” 
in  the  proposed  amendment  be  deleted  and  the 
word  and  figure  “February  1”  be  inserted  in- 
stead. This  section  of  the  Reference  Committee 
report  was  then  adopted  as  amended,  without 
dissent,  and  on  motion  of  the  Reference  Com- 
mittee the  By-Laws  of  the  Society  were  so 
amended. 


1050 


Rocky  Mountain  Medical  Journat. 


NOT  IN  THE  SENSE  OF  CUSTOM 
ONLY,  BUT  WITH  GENUINE  APPRE- 
CIATION OF  OUR  PLEASANT  ASSO- 
CIATIONS, WE  EXTEND  TO  YOU  OUR 
BEST  WISHES,  AND  MAY  THE  HAP- 
PINESS AND  GOOD  CHEER  OF  THE 
HOLIDAY  SEASON  BE  YOURS 
THROUGHOUT  THE  NEW  YEAR. 

☆ 

GEO.  BERBER!  & SONS,  INC., 
and  ASSOCIATES 

1524  Court-  Place 
Denver  2,  Colorado 


for  December,  1949 


1051 


This  committee  also  approves  the  adoption  of  the 
proposed  amendment  referred  to  us  by  the  Reference 
Committee  on  Professional  Relations,  which  in- 
creases the  power  of  the  Board  of  Supervisors.  The 
necessary  chang-e  is  as  follows: 

Amend  Chapter  VII,  Section  11,  as  the  same  ap- 
pears on  Page  20  of  the  1948  publication  of  the  Con- 
stitution and  By-Laws  by  striking  the  last  sentence 
of  the  section  and  inserting  in  lieu  thereof  the  fol- 
lowing: 

■‘The  board  shall  have  power  to  adopt  rules 
to  govern  matters  within  its  jurisdiction,  and 
said  rules  after  approval  of  the  Board  of  Coun- 
cilors shall  be  published  in  the  official  journal 
of  the  Society  and  shall  be  binding  upon  all 
members  of  the  Society  ten  days  after  said  pub- 
lication.” 

E.  R.  PHILLIPS,  Delta,  Chairman. 

W.  BERNARD  TEGGE,  Denver. 

J.  ALAN  SHAND,  Otero. 

The  second  section  of  the  Reference  Commit- 
tee report,  above,  was  adopted  without  dissent 
and  on  motion  of  the  committee  the  By-Laws 
were  so  amended.  The  Reference  Committee 
report  was  then  adopted  as  a whole,  as  amended, 
without  dissent. 

There  being  no  unfinished  business.  Acting 
President  Ward  called  for  new  business.  Dr. 
S.  R.  Denzler,  Fremont  County,  presented  the 
following  resolution  and  moved  its  adoption, 
which  motion  was  seconded  and  carried  unani- 
mously. 

Resolution 

During  the  past  several  months  while  the  Colorado 
medical  profession  has  been  devoting  its  time  and 
energy  toward  safeguarding  the  rights  of  the  people 
as  regards  their  health  and  medical  care,  it  has  been 
most  heartening  to  have  had  the  increasing  support 
of  lay  groups  and  individuals  throughout  our  state. 

It  becomes  more  apparent  daily  that  these  indi- 
viduals and  lay  groups  are  aware  of  the  threat  to 
their  individual  freedom,  their  health  and  their 
privacy,  contained  in  the  government’s  proposal  for 
political  medicine. 

Today  they  are  side  by  side  with  us  in  our  educa- 
tional campaign  to  inform  the  people,  even  to  the 
extent  of  financial  contributions. 

The  support  of  the  lay  public  consists  not  only  in 
action  by  organized  groups,  but  of  support  from 
men  and  women  from  all  walks  of  life,  who  have 
joined  forces  with  us. 

We,  the  members  of  the  Colorado  State  Medical 
Society,  therefore  express  to  our  lay  friends  in  Colo- 
rado our  heartfelt  thanks  and  deepest  appreciation 
for  their  admirable  assistance  and  we  bespeak  their 
continued  help. 

Dr.  D.  H.  Winternitz,  El  Paso  County,  an- 
nounced the  favorable  outcome  of  a city  election 
held  in  Colorado  Springs  the  previous  day  re- 
garding municipal  ownership  of  the  city  hos- 
pital, in  which  the  County  Medical  Society  had 
taken  a vigorous  part.  Mr.  Sethman  read  a tele- 
gram received  by  the  House  from  the  El  Paso 
County  Druggists  Association  congratulating  the 
medical  society  on  its  election  victory  and  pay- 
ing especial  tribute  to  the  work  of  Dr.  Winter- 
nitz. The  announcements  were  applauded. 

There  being  no  further  new  business,  Acting 
President  Ward  asked  for  estimates  of  the, 
amount  of  work  remaining  for  the  House,  and 
upon  receiving  them,  asked  for  and  obtained 
unanimous  consent  to  cancel  the  regularly  sched- 
uled third  meeting  of  the  House,  which  therefore 
adjourned  to  its  scheduled  fourth  meeting. 


THIRD  MEETING— September  22,  1949 

Meeting  cancelled,  see  above. 


FOURTH  MEETING— September  23,  1949 

Acting  President  Ward  called  the  House  to 
order  at  8:30  a.m.  The  Credentials  Committee 
had  no  further  report.  The  roll  was  called,  dis- 


closing 53  accredited  delegates  present,  more 
than  a quorum. 

Minutes  of  the  second  meeting  of  the  House 
were  read  and  approved. 

The  next  order  of  business  was  the  election 
of  officers.  Acting  President  Ward  directed  the 
Secretary  to  re-read  the  report  of  the  Nominat- 
ing Committee  as  presented  at  the  second  meet- 
ing of  the  House,  and  then  called  for  nomina- 
tions from  the  floor  for  the  position  of  President- 
elect. There  being  none,  it  was  moved,  seconded, 
and  unanimously  carried  that  the  Secretary 
be  instructed  to  cast  the  ballot  of  the  House 
for  Dr.  Ervin  A.  Hinds,  Denver,  as  President- 
elect of  the  Society.  Dr.  Hinds'  was  declared 
elected. 

Acting  President  Ward  appointed  Past  Presi- 
dents E.  R.  Mugrage  and  J.  S.  Bouslog  to  find 
Dp.  Hinds  and  escort  him  to  the  rostrum.  Upon 
his  appearance  before  the  House,  Dr.  Hinds 
addressed  the  delegates  as  follows: 

“I  consider  this  a great  honor  and  I also 
realize  that  there  is  considerable  responsibility 
involved  in  this  position.  If  and  when  I take 
over,  I expect  to  do  my  best  to  carry  on  the 
good  work  of  my  predecessors.  Most  of  you 
know  that  I have  some  connections  with  a rail- 
road, and  I suspect  that  there  must  have  been 
a good  deal  of  ‘railroading’  in  this  maneuvering! 
I do  thank  you,  very  much.” 

The  House  then  proceeded  to  elect,  by  sep- 
erate  actions  in  each  instance,  nominees  for 
the  remaining  offices  as  shown  by  the  report 
of  the  Nominating  Committee.*  In  each  in- 
stance, after  waiting  a reasonable  time  for  fur- 
ther nominations  from  the  floor,  and  obtaining 
no  response,  the  Chair  declared  nominations 
closed,  or  a motion  for  closing  them  carried; 
then  a separate  motion  directing  the  Secretary 
to  cast  the  unanimous  ballot  of  the  House  for 
the  nominee  presented  by  the  Committee  on 
Nominations  carried  and  the  Chair  declared  the 
man  elected. 

A motion  was  then  adopted  unanimously,  ap- 
proving and  adopting  that  section  of  the  report 
of  the  Nominating  Commttee  dealing  with  the 
time  and  place  of  future  Annual  Sessions  of 
the  Society. 

Supplemental  Report  of  Reference  Committee  on 
Public  Relations 

RESOLVED,  That  the  Colorado  Medical  Society 
express  its  appreciation  and  gratitude  to  the  mem- 
bers of  the  Retail  Drug  Trade  in  Denver  who  at 
their  own  expense  and  through  their  own  efforts 
brought  Representative  Clyde  Harness  to  Colorado 
to  speak  against  the  compulsory  health  bill. 

Not  as  a formal  report,  but  merely  as  an  ex- 
planation, this  Reference  Committee  wishes  to  clar- 
ify one  thing  which  we  reported  previously.  You 
will  remember  our  report  concerning,  the  report  of 
the  Medical  Service  Plans  Committee  in  which  we 
stated:  ‘‘We  feel  that  the  material  presented  in 

the  first  two  paragraphs  comprise  a rather  weak 
handling  of  the  problem.”  Well,  that  is  mathe- 
matically correct,  because  they  referred  it  to  the 
Health  and  Accident  Insurance  Underwriters  Asso- 
ciation which  handles  that  type  of  business.  That 
does  not  mean  that  we  think  the  committee  did 
too  little  work  on  that  thing.  It  is  just  that  we 
do  not  know  that  there  is  any  satisfactory  answer. 
Our  legal  advisor  tells  us  we  cannot  with  legal 
safety  put  a stamp  of  approval  on  any  regular 
insurance  company’s  health  policy.  So  that  seems 
to  be  out.  The  Industry  of  the  Medical  Service 
Plans  Committee,  v^hose  Chairman  is  Dr.  Fred  Good, 
and  the  amount  of  work  that  they  did  on  these 
problems  is  known  to  all  of  us.  Our  statement 
was  not  intended  to  indicate  criticism  of  that  com- 
mittee. We  still  hope  that  something  better  than 
this  can  be  worked  out.  W'e  do  not  know  how. 
We  think  work  on  it  should  continue,  but  we  do  not 
wish  to  leave  you  with  any  misunderstanding  of 


1052 


See  Report  of  Nominating  Committee,  Page  1050. 

Rocky  Mountain  Medical  Journal 


BLAIR  X-RAY  SUPPLY 

20  East  9th  Avenue 
Denver,  Colorado 


Ansco  Solutions 
We  Mix  Em 


X-RAY  MACHINES 
We  Fix  Em 


for  December,  1949 


1053 


the  committee’s  work.  The  result,  by  their  own 
statement  to  us,  has  not  been  effective.  The  Under- 
writers Association  has  not  been  effective,  and  I 
don’t  know  of  anyone  who  can  do  it. 

HERMAN  C.  GRAVES,  Mesa,  Chairman. 

The  above  supplemental  report  of  the  Ref- 
erence Committee  on  Public  Relations  ■was 
adopted  unanimously. 

Supplemental  Report  of  Standing;  Committee  on 
Public  Policy 

Dr.  Kenneth  C.  Sawyer,  Chairman,  reported  in- 
formally that  on  the  previous  day  the  Public  Policy 
Committee  had  approved  a request  for  State  Society 
participation  in  Diabetes  Week,  had  received  and 
acted  upon  a request  of  the  Colorado  Pharmacal 
Association  for  Society  disapproval  of  coded  pre- 
scriptions and  secret  remedies  in  connection  with 
physician-owned  pharmacies,  and  had  received  but 
found  no  means  for  acting-  upon  a series  of  news- 
paper clippings  from  Northwestern  Colorado  which 
dealt  with  cult  practice  in  a Veterans  Administration 
Hospital.  Dr.  Sawyer’s  supplemental  report  was 
adopted,  without  dissent. 

Report  of  Reference  Committee  on  Military  Affairs 
and  Miscellaneous  Rusiness 

Your  Reference  Committee  recommends  that  the 
report  and  all  recommendations  made  by  the  Medical 
Disaster  Commission  as  printed  in  the  Handbook  be 
approved  by  the  House  of  Delegates 

BLAIR  ADAMS,  Larimer,  Chairman. 

CHARLES  G.  FREED,  Denver. 

R-  L.  DAVIS,  Otero. 

The  above  report  of  the  Reference  Committee 
was  adopted,  without  dissent. 

Dr.  William  R.  Lipscomb,  Chairman,  reported 
informally  for  the  committee  which  had  called 
on  President  Hegner  on  behalf  of  the  House. 
It  was  announced  that  President  Hegner  would 
be  permitted  by  his  physicians  to  visit  the  An- 
nual Session  briefly,  later  this  same  day,  at  the 
time  of  the  installation  of  new  officers. 

Under  the  order  of  unfinished  business  Execu- 
tive Secretary  Sethman  read  telegrams  from  the 
Colorado  State  League  of  Nursing  Education 
and  the  Colorado  State  Nurses  Association  re- 
questing representation  on  the  committee  which 
the  House  two  days  ago  ordered  to  study  the 
problems  of  nursing  education  in  Colorado.  Fol- 
lowing discussion.  Acting  President  Ward  by 
unanimous  consent  referred  the  matter  to  the 
Board  of  Trustees  for  action  according  to  the 
Board’s  judgment. 

The  next  order  was  New  Business,  and  Acting 
President  Ward  reminded  the  House  that  favor- 
able action  by  two-thirds  of  all  registered  dele- 
gates is  necessary  for  consideration  of  new  busi- 
ness on  this,  the  last  day  of  an  Annual  Session. 
There  being  unanimous  consent  for  its  intro- 
duction, a motion  was  made,  seconded,  and 
carried  unanimously  that  suitable  letters  of 
thanks  be  forwarded  to  Smith,  Kline  and  French 
Laboratories,  Inc.,  and  to  the  Columbia  Broad- 
casting System  for  their  cooperation  in  demon- 
strating color  television  before  this  Annual  Ses- 
sion, it  being  the  first  time  in  history  that 
color  television  of  medical  and,  surgical  pro- 
cedures has  been  demonstrated  before  any  state 
medical  society. 

There  was  no  further  new  business,  and  after 
routine  announcements  the  Secretary  reported 
his  desk  clear.  Acting  President  Ward  then  de- 
clared the  House  of  Delegates  adjourned  with- 
out day. 

Respectfully  submitted, 

HARVEY  T.  SETHMAN, 

Executive  Secretary. 


Obituaries 

CHARLES  A.  DAVLIN,  M.D. 

Dr.  Charles  A.  Davlin,  well-known  San  Luis 
Valley  physician,  died  October  22,  1949,  in 
Evanston,  Illinois,  of  injuries  sustained  in  Ala- 
mosa, Colorado. 

Dr.  Davlin  was  born  in  Rush  Lake  Junction, 
Wisconsin,  in  1878.  He  attended  the  University 
of  Wisconsin  at  Madison  and  the  Wisconsin  Col- 
lege of  Physicians  and  Surgeons.  The  next  three 
years  were  spent  at  the  University  of  Pennsyl- 
vania, where  he  graduated  in  1905. 

Dr.  Davlin  came  to  Colorado  in  1906  and 
practiced  medicine  in  Pitkin,  Colorado,  for  two 
years  and  then  returned  to  Chicago  and  took 
his  second  internship  at  Michael  Reese  Hospital. 
Upon  finishing  his  work  in  Chicago  he  returned 
to  Colorado  and  in  1911  began  practice  in  Ala- 
mosa, Colorado,  where  he  continued  until  his 
death.  For  two  years  Dr.  Davlin  was  Mayor  of 
Alamosa,  a member  of  the  Masonic  Lodge,  Scot- 
tish Rite,  Knights  Templar  and  Royal  Arch 
chapter  of  A1  Kaly  Shrine.  He  was  elected  vice 
president  of  the  Colorado  Municipal  League  for 
two  terms,  one  of  the  few  men  to  receive  this 
honor. 

Dr.  Davlin  served  on  the  Board  of  Councilors 
of  the  Colorado  State  Medical  Society  in  1932 
and  again  in  1945  through  1947. 


ROSCOE  GENUNG  LELxAND 

Officers  of  the  Colorado  State  Medical  Society 
and  older  members  who  knew  Dr.  R.  G.  Leland 
were  saddened  last  month  to  learn  of  his  death 
October  17  at  his  Chicago  home.  Dr.  Leland 
was  an  Honorary  Member  of  the  Colorado  State 
Medical  Society,  elected  by  the  House  of  Dele- 
gates in  1936. 

Dr.  Leland  was  a native  of  Michigan  and  a 
1903  graduate  of  the  University  of  Michigan 
Department  of  Medicine.  He  practiced  in  Michi- 
gan until  World  War  I,  during  which  he  served 
overseas.  After  the  war,  entered  public  health 
work  with  the  Ohio  State  Health  Department, 
and  after  several  years  in  that  state  joined  the 
staff  of  the  American  Medical  Association  as 
assistant  director  of  the  Bureau  of  Health  and 
Public  Instruction.  He  became  Director  of  the 
A.M.A.’s  Bureau  of  Medical  Economics  in  1931 
and  in  succeeding  years  authored  a multitude 
of  economic  studies  and  reports  which  history 
may  well  credit  as  the  foundation  of  voluntary 
health  insurance  in  the  United  States.  He  was 
an  admirer  of  Western  people  and  gave  gener- 
ously of  his  time  and  energy  to  projects  of  the 
Colorado  State  Medical  Society  during  the  years 
of  its‘  studies  toward  eventual  formation  of  the 
hospital  and  medical  service  plans  now  known 
as  Blue  Cross  and  Blue  Shield  in  this  and  other 
parts  of  the  nation. 

Throughout  the  second  World  War  “Ross”  Le- 
land was  the  active  head,  so  far  as  the  A.M.A. 
was  concerned,  of  the  Procurement  and  Assign- 
ment Service  which  endeavored  to  obtain  proper 
placement  of  physicians  in  the  military  services. 
Ill  health  forced  his  retirement  from  active  work 
toward  the  end  of  the  war. 


1054 


Rocky  Mountain  Medical  Journal 


DOROTHY 


Phone 

Lakewood 

1922 


s 

A 

N 

A 

T 

0 
R 

1 

U 

M 


1625  Simms  Street 
Denver  14,  Colo. 


OLSSEN’S 


DEAR  DOCTOR: 

We  know  that  you  want  the  best  for  your  aged  patients.  We 
sincerely  believe  we  have  the  most  Beautiful  Convalescent  Home 
in  the  Rocky  Mountain  Region.  BeautifuUy  decorated  rooms, 
with  new  and  modern  equipment,  and  the  most  modern  and 
sanitary  kitchen. 

Your  patients  will  get  excellent  care  under  the  best  of  condi- 
tions. We  have  had  years  of  experience  in  this  field  and  invite 
your  inspection  at  any  time.  We  are  proud  of  our  institution  and 
the  individual  care  given  our  patients.  Truly  an  exclusive  home 
for  the  aged  and  infirm.  No  Contagious  or  MENTAL  Cases. 

Nurses  on  duty  24  hours  daily.  Moderate  rates. 

Very  sincerely, 

Dorothy  B.  Olssen 


DICILANID 

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SUPPLIiD — Tablets,  Ampuls,  Suppositories  and  Liquid 

Literature,  Samples  and  Bibliography  on  Request 

SANDOZ  PHARMACEUTICALS 

West  Coast  Office  — - 450  Sutter  Street  San  Francisco  8,  California 


for  December,  1949 


1055 


COLORADO 

State  Health  Department 

Excellent  progress  has  been  made  in  the  con- 
struction of  needed  hospital  facilities  under  the 
Hill-Burton  Act  in  accordance  with  the  State 
Plan  as  developed  by  the  State  Department  of 
Public  Health  with  the  advice  of  the  State  Ad- 
visory Hospital  Council. 

Seven  new  hospitals  are  actually  under  con- 
struction and  a contract  for  an  eighth  will  prob- 
ably have  been  signed  before  this  article  goes 
to  press.  The  following  table  lists  the  institutions 
under  contract  and  gives  some  statistical  infor- 
mation regarding  them. 


No.  Const.  Estimated  Federal 

Location  Beds  Contract  Total  Cost  Share 


Grand  Jet.  __130  $1,854, 757.00  $2,180,595.00  $701,487.42 

Montrose  __  50  352,711.00  468,160.00  154,886.62 

Delta  28  180,648.00  225,679.00  59,893.15 

Craig- 20  174,392.00  223,417.00  74,389.00 

Ju'lesburg-  __  23  197,208.00  247,568.00  106,629.70 

Akron  24  209,026.00  255,426.00  85,142.00 

'Greeley  _J__220  *269,600.00  2,950,607.00  983,535.00 


*This  project  is  being-  built  in  three  stages.  An 
initial  contract  for  foundations  at  a cost  of  $268,- 
963.91  was  completed  in  June,  1949,  without  Federal 
aid.  The-  present  contract  for  $269,600.00  is  for  the 
reinforced  concrete  framework  of  the  super-struc- 
ture. When  this  is  completed  early  in  1950,  a con- 
tract will  be  let  for  the  balance  ot  the  construction. 


Bids  were  opened  on  November  22  for  the  con- 
struction of  a 40-bed  hospital  to  be  built  in  Love- 
land. The  estimated  cost  of  construction  is  $563,- 
000.  Estimated  total  cost  is  $656,000. 

In  addition  to  the  above,  preliminary  approval 
has  been  given  to  projects  for  construction  of 
facilities  in  Durango  (48  beds  and  housing  for 
San  Juan  Basin  Health  Department);  Fort  Mor- 
gan _(40  beds);  Dillon  (six-bed  Community 
Clinic);  and  La  Jara  (28  beds). 

The  first  hospital  to  be  completed  in  Colorado 
under  the  Federal  aid  program,  the  Delta  Me- 
morial Hospital,  was  dedicated  on  November 
27.  The  hospital  in  Montrose  is  scheduled  for 
completion  in  late  December  and  will  be  dedi- 
cated in  early  January,  1950. 

The  hospital  construction  program  was  given 
added  impetus  with  the  enactment  of  P.  L.  380 
(81st  Congress)  on  October  25,  1949.  This  new 
law  amends  the  Hill-Burton  Act  to  double  the 
amount  of  the  authorized  Federal  appropriation 
for  hospital  construction;  extends  the  program 
through  1955;  increases  the  allowable  percentage 
of  the  “Federal  share”  and  delegates  to  the  state 
the  authority  to  establish  the  Federal  percentage 


for  projects  within  the  state  with  a minimum  of 
33%  per  cent  and  a maximum,  in  Colorado,  of 
47.6  per  cent. 

Colorado’s  allotment  of  Federal  Funds  for  the 
current  fiscal  year  is  $1,022,875.00,  and  in  accord- 
ance with  the  provisions  of  the  act,  the  State  » 
Board  of  Health  has  established  431/3  per  cent  as 
the  Federal  share  of  the  projects  approved  dur- 
ing this  fiscal  year. 

UTAH 

State  Medical  Association 


Obituary 

ORIN  A.  OGILVIE,  M.D. 

1895-1949 

Dr.  Orin  A.  Ogilvie,  54,  prominent  Salt  Lake 
physician  and  pathologist,  died  Tuesday,  Novem- 
ber 8,  1949,  of  a heart  ailment. 

Dr.  Ogilvie  was  immediate  Past  President  of 
the  Utah  State  Medical  Association  and  was 
President  of  the  Salt  Lake  County  Medical  So- 
ciety two  years  ago.  He  was  founder  of  the 
Wasatch  Laboratories,  which  he  directed  from 
1923  until  time  of  his  death  and  at  one  time 
was  professor  of  bacteriology  and  pathology  at 
the  University  of  Utah  College  of  Medicine.  Re- 
cently he  had  served  on  the  clinical  staff  of 
the  college  as  associate  clinical  professor  of 
pathology. 

Dr.  Ogilvie  was  born  on  May  29,  1895,  at 
Richfield,  Utah.  He  was  a graduate  of  the  Uni- 
versity of  Utah  and  received  his  M.D.  degree 
from  the  University  of  Pennsylvania  in  1927.  He 
was  a member  of  Alpha  Omega  Alpha,  honorary 
medical  society. 

Returning  to  the  University  of  Utah  after  his 
graduation.  Dr.  Ogilvie  became  associate  pro- 
fessor of  bacteriology  and  in  1932  was  made  a 
full  professor.  He  later  was  appointed  head  of 
the  department  of  bacteriology  and  pathology 
in  the  medical  school,  serving  until  March,  1944, 
when  he  resigned.  For  eight  years  he  served 
as  pathologist  at  the  Salt  Lake  General  Hos- 
pital and  later  served  for  several  years  as 
pathologist  at  Holy  Cross  and  St.  Mark’s  Hos- 
pitals. He  made  extensive  cancer  studies  and 
in  1947  received  recognition  from  the  American 
Cancer  Society  for  twelve  consecutive  years  of 
service  to  the  organization. 

Dr.  Ogilvie  was  a member  of  the  Church  of 
Jesus  Christ  of  Latter  Day  Saints.  He  belonged 
to  the  Alta  Club  and  the  Aztec  Club  of  the 
University  of  Utah. 

Dr.  Ogilvie  is  survived  by  his  wife,  one  daugh- 
ter and  two  doctor  sons. 


St.  Anthony  Hospital 

Write  or  Phone  Registrar  for  Information 

West  16th  Ave.  and  Quitman  ALpine  1761 

Denver,  Colorado 


1056 


Rocky  Mountain  Medical  Journal 


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In  the  interest  of  public  health,  the  Deep  Rock  Water 
Company,  bottlers  of  Denver’s  purest  water,  will  spon- 
sor a radio  program,  "Doctor’s  Orders,”  on  station  KLZ, 
Denver,  from  9:45  P.M.  to  10:00  P.M.  every  Sunday. 
Each  broadcast  consists  of  a human  interest  drama  and 
is  followed  by  a medical  interview,  an  authentic  state- 
ment of  fact  of  health  and  disease  in  language  any 
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infant  feeding.  It  is  fortified  (from  the  natural  source)  with  400  U.S.P. 
units  vitamin  D and  2000  U.S.P.  units  vitamin  A per  reconstituted  quart. 


MORNIIMG  MILK 


for  December,  1949 


1057 


New  Books  Received 

Diseases  of  the  Aorta;  Diagnosis  and  Treatment: 

By  Nathaniel  E.  Reich,  M.D.,  F.A.C.P.,  Associate  in 
Medicine,  Long  Island  College  of  Medicine;  Attend- 
ing Cardiologist,  Harbor  Hospital,  Brooklyn,  N.  Y.; 
Associate  Attending  Physician,  Kings  County  Hos- 
pital, Brooklyn,  N.  Y. ; Senior  Cardologist,  Veterans’ 
Administration,  Biooklyn,  N.  Y.  The  Macmillan 
Company,  New  York,  1949.  Price,  $7.50. 


The  Physician's  Business;  Practical  and  Economic 
Aspects  of  3Iedicine:  By  George  D.  Wolf,  M.D., 
Assistant  Clinical  Professor  Otolaryngology,  New 
York  Medical  College;  Fellow,  New  York  Academy 
of  Medicine;  Fellow,  American  Medical  Associa- 
tion. Foreword  by  Harold  Rypins,  A.B.,  M.D., 

F.A.P.C.  Third  Edition,  96  Illustrations.  J.  B.  Lip- 
pincott  Company,  Philadelphia,  London,  Montreal. 
Price,  $10.00. 


Operations  of  General  Surgery:  By  Thomas  G.  Orr, 
M.D.,  Professor  of  Surgery,  University  of  Kansas 
School  of  Medicine,  Kansas  City,  Kansas.  Second 
Edition  with  1,700  step-by-step  Illustrations  on 
721  figures.  W.  E.  Saunders  Company,  Philadelphia 
and  London,  1949. 


Fundamentals  of  Otolaryngology;  A Textbook  of 
Ear,  Nose  and  Throat  Diseases:  By  Lawrence  R. 
Boies,  M.D.,  Clinical  Professor  of  Otolarynology, 
Director  of  Division  of  Otolaryngology,  University 
of  Minnesota  Medical  School.  And  Associates: 
Charles  E.  Connor  M.D.,  Anderson  C.  Hilding,  M.D., 
Jerome  A.  Hilger,  M.D.,  John  J.  Hochfilzer,  M.D., 
Conrad  J.  Holmberg,  M.D.,  Kenneth  A.  Phelps, 
M.D.,  Robert  E.  Priest,  M.D.,  George  M.  Tangen, 
M.D.  W.  B.  Saunders  Company,  Philadelphia  and 
London,  1949. 


Marihuana  in  Latin  America,  The  Threat  It  Consti- 
tutes: By  Pablo  Osvaldo  Wolff,  M.D.,  Ph.D.,  M.A., 
Buenos  Aires,  Argentina,  Member  of  Expert  Com- 
mittee on  Habit  Forming  Drugs  of  the  World 
Health  Organization,  sponsored  by  Washington  In- 
stitute of  Medicine,  published  by  The  Linacre  Press, 
Inc.,  Washington  6,  D.  C.  $1.50. 


A Textbook  of  Neuropathology  With  Clinical,  Ana- 
tomical and  Technical  Supplements:  By  Ben  W. 

Lichtenstein,  B.S.,  M.S.,  M.D.,  Associate  Professor 
Neurology,  University  of  Illinois  College  of  Medi- 
cine; State  Neuropathologist,  Illinois  Neuropsy- 
chiatric Institute;  Attending  Neurologist,  Cook 
County  Hospital;  Professor  of  Neurology,  the  Cook 
County  Graduate  School  of  Medicine;  Attending 
Neuropsychiatrist,  Mount  Sinai  Hospital,  Chicago. 
Illustrated.  W.  B.  Saunders  Company,  Philadelphia, 
London,  1949. 


Blakiston’s  New  Gould  Me«lical  Dictionary:  A mod- 
ern comprehensive  dictionary  of  the  terms  used  in 
all  branches  of  medicine  and  allied  sciences,  in- 
cluding medical  physics  and  chemistry,  dentistry, 
pharmacy,  nursing,  veterinary  medicine,  zoology 
and  botany,  as  well  as  medicolegal  terms;  with  il-. 
lustrations  and  tables.  Editors,  Harold  Wellington 
Jones,  M.D.,  Normand  L.  Hoerr,  M.D.,  Arthur  Osol, 
Ph.D.,  with  the  cooperation  of  an  Editorial  Board 
and  80  contributors.  252  illustrations  on  45  plates, 
129  in  color.  First  edition.  The  Blakiston  Com- 
pany, Philadelphia,  Toronto,  1949.  $8.50. 


Stedman’s  Medical  Dictionary:  Of  words  used  in 
medicine  with  their  derivations  and  pronuncia- 
tion including  Dental,  Veterinary,  Chemical.  Bo- 
tanical, Electrical,  Life  Insurance  and  Other  Special 
Terms:  Anatomical  tables  of  titles  in  general  use, 
the  terms  sanctioned  by  the  basle  anatomical  con- 
vention; the  new  British  Anatomical  nomeclature; 
pharmaceutical  preparations  official  in  the  U.  S. 
and  British  pharmacopoeias  or  contained  in  the 
national  formulary;  and  comprehensive  lists  of 


synonyms;  biographical  sketches  of  the  principal 
figures  in  the  history  of  medicine.  Seventeenth 
Revised  Edition  with  Etymologic  and  Orthographic 
Rules.  Edited  by  Normand  Burke  Tavlor,  M.D., 
P.R.S.C.,  F.R.C.S.  (Edin.),  F.R.C.P.  (Can.),  M.R.C.S. 
(Lori.),  University  of  Western  Ontario  and  former- 
ly of  the  University  of  Toronto.  In  collaboration 
with  Allen  Ellsworth  Taylor,  D.S.O.,  M.A.  The  Wil- 
liams & Wilkins  Company,  Baltimore,  1949.  With 
thumb  index,  $8.50;  without  thumb  index,  $8.00. 


Cltniesil  Biochemistry:  By  Abraham  Cantarow,  M.D., 
Professor  of  Biochemistry,  Jefferson  Medical  Col- 
lege; formerly  Associate  Professor  of  Medicine, 
Jefferson  Medical  College  and  Assistant  Physician, 
The  Jefferson  Hospital,  Philadelphia;  and  Max 
Trumper,  Ph.D.,  Commander,  H(S),  USNR,  Lec- 
turer in  Clinical  Biochemistry  and  Basic  Science 
Coordin-ator,  Naval  Medical  School,  National  Naval 
Medical  Center,  Bethesda,  Md.  Four  Edition.  W.  B. 
Saunders  Company,  Philadelphia  and  London,  1949. 


Text-Book  of  Ophthalmology:  By  Sir  W.  Stewart 
Duke-Elder,  K.C.V.O.,  M.A.,  D.Sc.  (St.  And.),  Ph.D. 
(Lond),  M.D.,  Ch.B.,  F.R.C.S.,  Hon.  D.Sc. (Northwest- 
ern). Surgeon  Oculist  to  H.M.  the  King:  Knight  of 
Grace,  Order  of  St.  John;  Consulting  Ophthalmic 
Surgeon  to  the  British  Army  and  the  Royal  Air 
Force:  Director  of  Research,  Institute  of  Oph- 
thalmology, University  of  London;  Fellow,  Univer- 
sity College,  London;  Consulting  Surgeon,  Moor- 
fields  Westminster  and  Central  Eye  Hospital;  Oph- 
thalmic Surgeon,  St.  George’s  Hospital,  London.  Vol. 
IV.  The  Neurology  of  Vision  Motor  and  Optical 
Anomalies,  with  1081  Illustrations,  including  71 
in  Color.  The  C.  V.  Mosby  Company,  St.  Louis, 
1949.  Price,  $20.00. 


Atla.s  of  Obstetric  Technic:  By  Paul  Titus  M.D.,  Ob- 
stetrician-Gynecologist to  the  St.  Margaret  Me- 
morial Hospital,  Pittsburgh;  Secretary,  American 
Board  of  Obstetrics  and  Gynecology.  Illustrations 
by  E.  M.  Shackelford,  formerly  Medical  Illustra- 
tor, John  C.  Oliver  Memorial  Research  Foundation, 
St.  Margaret  Memorial  Hospital,  Pittsburgh.  The 
C.  V.  Mosby  Company,  St.  Louis,  1949.  Second  Edi- 
tion. Price,  $7.50. 


Life  Among  the  Doctors:  By  Paul  De  Kruif  in 
collaboration  with  Rhea  De  Kruif.  To  paint  na- 
ture here,  as  everywhere,  you  must  have  lived  in 
it  a long  time,  Vincent  Van  Gogh.  Harcourt,  Brace 
and  Company,  New  York.  Price,  $4.75. 


Bone  and  Joint  Radiology:  By  Emerik  Merkovitis, 
M.D.,  formerly  Scientific  Collaborator  of  the  Cen- 
tral Radiologic  Institute  of  the  General  Hospital 
(Holzknecht-Institute),  Vienna;  Head  of  the  Ra- 
diologic Department  of  Elizabeth  Hospital  of  the 
City  of  Budapest;  Postgraduate  Lecturer  at  the 
Central  Radiologic  Institute  of  the  University  of 
Budapest;  Radiologist  of  the  Steiner  Cancer  Clinic, 
Atlanta,  Ga.  The  MacMillan  Company,  New  York, 
1949.  . Price,  $20.00. 


Atlas  of  Surgical  Operations,  Second  Edition:  By 

Elliott  C.  Cutler,  late  Mosley  Professor  of  Sur- 
gery, Harvard  University,  and  Chief  Surgeon, 
Peter  Bent  Brigham  Hospital;  formerly  Briga- 
dier General,  U.  S.  Army  Medical  Corps,  Chief 
Consultant  in  Surgery,  European  Theater  of 
Operations;  formerly,-  Professor  of  Surgery,  West- 
ein  Reserve  University,  and  Director  of  Surgery, 
Lakeside  Hospital;  and  Robert  M.  Zollinger,  Pro- 
fessor and  Chairman  of  the  Department  of  Sur- 
g-ery,  Ohio  State  University  College  of  Medicine, 
and  Chief  of  the  Surgical  Service,  University  Hos- 
pitals, Ohio  State  University;  formerly.  Assistant 
Professor  of  Surgery,  Harvard  University,  and  Sur- 
geon at  the  Peter  Bent  Brigham  Hospital;  for- 
merly Colonel,  U.  S.  Army  Medical  Corps,  Senior 
Consultant  in  Surgery,  European  Theater  of  Op- 
erations. Illustrated  by  Mildred  B.  Codding,  A.B., 
M.A.  The  MacMillan  Company,  New  York,  1949. 
Price,  $9.00. 


A Textbook  of  Surgery:  By  American  Authors, 
Edited  by  Frederick  Christopher,  B.S.,  M.D., 

F.A.C.S.,  Professor  of  Surgery,  Northwestern  Uni- 
versity Medical  School;  Chief  Surgeon,  Evanston 
(Illinois)  Hospital.  1,465  Illustrations  on  742  fig- 
ures, Fifth  Edition.  W.  B.  Saunders  Company, 
Philadelphia  and  London,  1949. 


1058 


Rocky  Mountain  Medical  Journai 


y\/lercy  J-Lospital 

Conducted  by  the  Sisters  of  Mercy 
School  of  Nursing  in  Connection 

A General  Hospital  Scientifically  Equipped 

1619  Milwaukee  St.,  Denver  FRemont  2771 


H.  C.  Stapleton  Drug  Company 

Service  Wholesalers  for  the  Prescription  Department 
rapid— INTELLIGENT— SERVICE 

1252-54  Arapahoe  St.,  Denver,  Colo.  Phone  MAin  4152 


Presbyteman  Hospital 

Nineteenth  Avenue  and  Gilpin  Street,  Denver,  Colorado 

A General  Hospital  for  Surgical,  Medical  or  Maternity  Cases 

One  hundred  sixty  beds  and  twenty-five  bassinets.  Fireproof.  Telephone  service  to  every 
bed.  Hot  and  cold  running  water  and  toilet  service  in  every  room.  Complete  laboratory 
and  x-ray  facilities,  including  x-ray  therapy.  Inquiries  welcomed. 


LIVERMORE  SANITARIUM 


• The  Hydropathic  Department 
devoted  to  the  treatment  of  gen- 
eral diseases,  excluding  surgical 
and  acute  infectious  cases.  Special 
attention  given  functional  and  or- 
ganic nervous  diseases.  A well 
equipped  clinical  laboratory  and 
modern  X-ray  Department  are  in 
use  for  diagnosis. 


* The  Cottage  Department  (for 
mental  patients)  has  its  own  fa- 
cilities for  hydropathic  and  other 
treatments.  It  consists  of  small 
cottages  with  homelike  surround- 
ings, permitting  the  segregation  of 
patients  in  accordance  with  the 
type  of  psychosis.  Also  bungalows 
for  individual  patients,  offering 
the  highest  class  of  accommoda- 
tions with  privacy  and  comfort. 


1.  Climatic  advantages  not  excelled  in  United  States.  Beautiful  grounds  and  attractive  surrounding  country. 

2.  Indoor  and  outdoor  gymnastics  under  the  charge  of  an  athletic  director.  An  excellent  Occupational  Department. 

3.  A resident  medical  staff.  A large  and  well-trained  nursing  staff  so  that  each  patient  is  given  careful  individual  attention. 

Information  and  circulars  upon  request.  CITY  OFFICES ' 

Address:  O.  B.  JENSEN,  M.D. 

Superintendent  and  Medical  Director  Sak  FRANCISCO  OAKLAND 

Livermore,  California  450  Sutter  Street  1624  Franklin  Street 

Telephone  313  GArfield  1-5040  GLencourt  1-5988 


GENERAL  FEATURES 


1059 


for  December,  1949 


I 


Neoplasms  of  the  Dog:  By  R.  M.  Mulligan,  M.D., 
Professor  of  Pathology  in  the  University  of  Colo- 
rado Medical  Center  School  of  Medicine.  The  Wil- 
liams & Wilkins  Company,  Baltimore,  1949.  Price, 
$4.00. 


A Descriptive  Atlas  of  Radiographs;  An  Aid  to  Mod- 
ern Clinical  Methods:  By  A.  P.  Bertwistle,-  M.B., 
Ch.B.,  F.R.C.S.  Ed.  Seventh  Edition,  revised  and 
enlarged  with  980  Illustrations.  The  C.  V.  Mosby 
Company,  St.  Louis,  1949. 


A Textbook  of  Physiology:  Orginally  by  William 
H.  Howell,  M.D.,  Edited  by  John  F.  Fulton,  M.D., 
Sterling  Professor  of  Physiology,  Yale  University 
School  of  Medicine.  With  the  collaboration  of 
Donald  H.  Barron,  John  R.  Brobeck,  Robert  W. 
Clarke,  George  R.  Cowgill,  Paul  F.  Fenton,  Wil- 
liam U.  Gardner,  Samuel  Gelfan,  David  I.  Hitch- 
cock, David  P.  C.  Lloyd,  Leslie  F.  Nims,  Theodore 
C.  Ruch,  Jane  A.  Russell.  Sixteenth  Edition, 
Illustrated.  W.  B.  Saunders  Company,  Philadel- 
phia and  London,  1949. 


Diagnosis  and  Treatment  of  Brain  Tumors  and  Care 
of  the  Neurosurgical  Patient:  By  Ernest  Sachs, 
A.B.,  M.D.,  Research  Associate  in  Physiology,  Yale 
University,  New  Haxen;  formerly  Professor  of 
Clinical  Neurological  Surgery,  Washington  Uni- 
versity School  of  Medicine,  St.  Louis.  Three  hun- 
dred forty-eight  illustrations  and  ten  color  plates. 
Second  Edition.  The  C.  V.  Mosby  Company,  St. 
Louis,  1949.  Price,  $15.00. 


An  Atlas  of  Amputations:  By  Donald  B.  Slocum, 
M.D.,  M.S.,  Orthopaedic  Surgeon,  Sacred  Heart 

General  Hospital,  Eugene,  Oregon;  Member  of 
American  Academy  of  Orthopaedic  Surgeons:  Mem- 
ber of  the  American  Society  for  Surgery  of  the 
Hand;  Branch  Consultant  in  Orthopaedic  Surgery, 
U.  S.  Veterans  Administration;  formerly  Chief  of 
the  Amputation  Section,  Walter  Reed  Hospital, 
Washington,  D.  C.  With  564  Illustrations.  The 
C.  V.  Mosby  Company,  St.  Louis,  1949.  Price,  $20.00. 


Medicine  of  the  Year:  Editorial  Direction,  John  B. 
Youmans,  M.D.,  Dean,  College  of  Medicine,  Uni- 
versity of  Illinois.  J.  B.  Lippincott  Company, 
Philadelphia,  London,  Montreal.  First  issue  1949. 


An  Atlas  of  the  Blood  and  Bone  Marrow;  By  R. 

Philip  Custer,  M.D.,  Director,  Laboratories  of  the 
Presbyterian  Hospital  in  Philadelphia;  Assistant 
Professor  of  Pathology,  The  University  of  Pennsyl- 
vania School  of  Medicine;  Consultant  of  the  Armed 
Forces  Institute  of  Pathology.  285  Illustrations, 
42  in  color.  W.  B.  Saunders  Company,  Philadel- 
phia and  London,  1949. 


Normal  Values  in  Clinical  Medicine:  By  F.  William 
Sunderman,  M.D.,  Ph.D.,  Professor  of  Eixperi- 
mental  Medicine  and  Clinical  Pathology,  University 
of  Texas  Postgraduate  School  of  Medicine;  Chief 
of  The  Department  of  Clinical  Pathology  and  Di- 
■ rector  of  Clinical  Research,  M.  D.  Anderson  Hos- 
pital for  Cancer  Research,  Houston,  Texas;  and 
Frederick  Boerner,  V.M.D.,  late  Associate  Profes- 
sor of  Clinical  Bacteriology,  Graduate  School  of 
Medicine,  University  of  Pennsylvania,  and  Assist- 
ant Professor  of  Bacteriology,  The  School  of  Medi- 
cine, University  of  Pennsylvania;  Bacteriologist, 
The  Graduate  Hospital  of  Philadelphia;  Advanced 
Bacteriologist,  Pennsylvania  Department  of  Health. 
Illustrated.  W.  B.  Saunders  Company,  Philadel- 
phia and  London,  1949 


The  Eye  and  Its  Diseases:  By  92  International  Au- 
thorities. Edited  by  Conrad  Berens,  M.D.,  F.A.C.S., 
Managing  Diiector  of  The  Ophthalmological  Foun- 
dation, Inc.;  President,  Snyder  Ophthalmic  Founda- 
tion; President,  American  Academy  of  Ophthalmol- 
ogy and  Otolaryngology;  Diplomate  and  former 
Member,  American  Board  of  Plastic  Surgeons; 
President,  Pan  American  Association  of  Ophthal- 
mology; formerly  President  of  the  Section  on 
Ophthalmology  of  the  American  Medical  Associa- 
tion: Fellow  of  the  American  Ophthalmological 
Society;  Fellow  of  the  American  Illuminating  En- 
gineering Society;  Fellow  of  the  Aero-Medical  As- 
sociation; Vice  President,  National  Society  for  the 
Prevention  of  Blindness;  Vice  President,  Interna- 
tional Society  for  the  Prevention  of  Blindness. 
Second  Edition,  with  435  Illustrations,  eight  in 
Color.  W.  B.  Saunders  Company,  Philadelphia  and 
London,  1949. 


1060 

i 


Book  Reviews 

Fundamentals  of  Internal  Medicine:  By  Wallace 
Mason  Yater,  A.B.,  M.D.,  M.S.  (in  Med.),  F.A.C.P.; 
Director,  Yater  Clinic,  Washington,  D.  C. ; for- 
merly Professor  of  Medicine  and  Director  of  the 
Department  of  Medicine,  Georgetown  University 
School  of  Medicine;  Physician-in-Chief,  George- 
town University  Hospital;  Physician-in-Chief,  Gal- 
linger  Municipal  Hospital,  Washington,  D.  C.;  and 
Fellow  in  Medicine,  The  Mayo  Foundation.  Third 
Edition.  Appleton-Century-Crofts,  Inc.,  New  York. 
Price,  $12.00. 

The  author  states  in  the  preface  that  this 
volume  is  designed  to  make  readily  available  in 
simple  and  concise  form  the  essentials  of  internal 
medicine.  The  book  is  written  primarily  for  stu- 
dents and  general  practitioners,  and  is  in  its 
third  edition,  the  first  having  been  published 
in  1938. 

The  1,451  pages  and  twenty-six  chapters  in- 
clude, in  addition  to  the  usual  subjects  of  in- 
ternal medicine,  chapters  on  diseases  of  the  skin, 
eye,  and  a section  on  dietetics.  There  are  nu- 
merous illustrations  throughout  the  book,  most 
of  which  are  of  good  quality. 

In  the  section  on  diseases  of  the  heart,  well 
over  one-third  of  it  is  taken  up  by  a detailed 
discussion  of  electrocardiography,  which  seems 
to  be  out  of  place  in  a book  supposedly  simple 
and  concise. 

The  chapter  on  dietetics  is  good;  besides  various 
dietetic  tables,  there  are  a number  of  sample 
diets  which  are  used  in  the  treatment  of  dif- 
ferent diseases. 

There  is  a section  on  chemotherapy  and 
therapy  with  antibiotics  which  is  up  to  date. 
Properties,  potency  and  assay,  actions,  absorp- 
tion, distribution,  excretion,  administration,  toxic 
effects,  indications,  and  dosage  are  presented  for 
the  sulfonamides  and  antibiotics.  In  another 
chapter,  many  other  drugs  are  discussed  in  con- 
nection with  symphomatic  and  supportive  treat- 
ment. Incidentally,  the  trade  names  of  most 
drugs  are  mentioned  as  well  as  their  official 
names  throughout  the  book  when  treatment  is 
being  discussed. 

This  volume  is  recommended  as  a practical 
and  accessible  reference  for  use  in  everyday 
medical  practice. 

ALBERT  M.  PATTEN. 


Atlas  of  Koentgenograpliic  Positions:  By  Vinita 
Merrill  while  Educational  Director,  Picker  X-Ray 
Corporation.  In  two  volumes;  Volume  I.  The  C. 
V.  Mosby  Company,  St.  Louis,  1949. 

Atlas  of  Roentgenographic  Positions;  By  Vinita 
Merrill  while  Educational  Director,  Picker  X-Ray 
Corporation.  In  two  volumes:  Volume  II.  The  C. 
V.  Mosby  Company,  St.  Louis,  1949.  Price,  $30.00. 

This  is  a well  presented  and  profusely  il- 
lustrated treatise  of  radiographic  technic  pro- 
viding adequate  replacement  and  substitute  of 
the  out-of-print  tome,  “Positioning  in  Radi- 
ography,” by  the  English  author,  K.  C.  Clark. 

The  work  is  in  two  volumes,  each  volume  hav- 
ing a short,  “rapid-reference”  index  on  its  front 
cover,  in  addition  to  the  very  complete  con- 
ventional index  in  the  usual  location.  The  il- 
lustrations with  accompanying  explanation  re- 
ferring to  patient-part  positioning  and  direction 
of  the  central  ray  of  the  x-ray  beam  are  clear 
and  precise,  rendering  reduplication  by  the  in- 
telligent x-ray  technician  relatively  simple.  Sev- 
eral choices  of  patient-tube  positioning  are  pre- 

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A group  of  outstanding  men  will  present  an  excellent  scientific  program. 

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sented  covering  the  more  difficult  and  unusual 
radiographic  procedures.  Each  body  section  (up  - 
per extremity,  pelvic  girdle,  shoulder,  skull, 
paranasal  sinuses,  digestive  system,  etc.)  has  an 
adequate  gross  anatomical  prologue  to  help  the 
technician’s  understanding  the  rationale  of  his 
work  and  the  whyfor  of  meticulous  technic. 

An  extensive  and  valuable  bibliography  of 
world  literature  on  radiographic  technic  is  ad- 
dended  to  Volume  II. 

The  two  volumes  form  a valuable  addition  to 
the  radiologist’s  library  and  laboratory;  they 
will  prove  very  helpful  in  the  office  of  the  “oc- 
casional radiographer.’’ 

It  is  noted  that  radiologic  technical  factors 
such  as  kilovoltage,  milliampere-seconds,  etc., 
have  been  omitted.  This  is  wise  because  such 
data  depend  on  film  and  screen  speeds  which 
vary  according  to  brand,  and  the  progress  of 
the  manufacturer;  such  data  become  absolescent 
almost  at  the  time  of  their  printing.  This  omis- 
sion anticipates  the  ultimate  use  of  the  auto- 
matic timing  device,  the  Hodges  meter. 

THOMAS  J.  KENNEDY. 


Cancer  of  the  Esophagns  and  Gastric  Cardia:  Edited 
by  George  T.  Pack,  B.S.,  M.D.,  New  York,  N.  Y., 
Clinical  Professor  of  Surgery,  New  York  Medical 
College;  Attending  Surgeon,  the  Memorial  Hospital 
for  Cancer  and  Allied  Diseases.  Illustrated.  192 
pages.  The  C.  V.  Mosby  Company,  St.  Louis,  1949. 
Price,  $5.00. 

This  book  is  a compendium  of  thirteen  papers 
originally  written  for  a symposium  on  this  sub- 
ject which  appeared  in  the  June,  1948,  issue  of 
Surgery.  Each  paper  is  represented  in  the  book 
by  a chapter  in  which  the  authors  discuss  their 
experience  with  certain  phases  of  cancer  in  this 
area.  Typical  chapter  titles  are:  “Roentgen  Diag- 
nosis;” “Pre-  and  Post-operative  Management;” 
“Cancer  of  the  Cervical  Esophagus;”  etc.  Natural- 
ly, with  so  many  well  qualified  surgeons  report- 
ing their  experience,  there  is  some  degree  of 
repetition.  However,  each  chapter  brings  to  light 
new  and  original  observations  which  will  stimu- 
late all  those  who  have  occasion  to  care  for 
patients  with  cancer  of  the  esophagus  and  upper 
stomach. 

This  reviewer  felt  that  the  most  intereseting 
and  valuable  chapters  were  those  written  by  Dr. 
Richard  Sweet  of  Boston,  and  by  Drs.  George  T. 
Pack  and  Gordon  McNeer  of  New  York.  Dr. 
Sweet’s  chapter,  entitled  “The  Treatment  of 
Carcinoma  of  the  Esophagus  and  Cardiac  End 
of  the  Stomach  by  Surgical  Extirpation,”  is  a 
very  lucidly  presented  experience  with  203  re- 
sected cases.  This  comprehensive  paper  is  ex- 
cellently illustrated  with  tables  and  diagrams, 
which  outline  the  technical  details,  pre-  and 
post-operative  management,  and  operative  re- 
sults of  cancer  in  the  different  areas  of  the 
esophagus  and  upper  stomach. 

The  chapter  by  Drs.  Pack  and  McNeer,  en- 
titled “Surgical  Treatment  of  Cancers  of  the 
Gastric  Cardia,”  deals  exclusively  with  prob- 
lems of  high  gastric  cancer.  The  historical  out- 
line of  the  surgical  procedures  used  in  this  area 
is  excellent,  and  further  emphasizes  the  truly 
dramatic  progress  which  has  been  made  in  sur- 
gery in  the  last  ten  years. 

The  less  comprehensive  papers  included  an  ex- 
cellent discussion  of  roentgen  diagnosis  of  cancer 
of  the  cardiac  region  of  the  stomach  by  Dr.  Rob- 
ert W.  Sherman  of  The  Memorial  Hospital,  New 
York  City.  Pre-operative,  operative,  and  post- 


operative care  in  esophageal  resections  is  dis- 
cussed by  Herbert  C.  Maier.  Dr.  Maier  gives 
special  attention  to  the  prevention  and  treatment 
of  cardio-vascular  complications  which  occur  so 
frequently  in  esophageal  resection.  His  approach 
to  the  problem  is  stimulating  and  logical,  and  is 
well  worth  careful  study  by  anyone  doing  major 
surgery  in  this  age  group.  A paper  dealing  ex- 
clusively with  cancer  of  the  cervical  esophagus 
is  presented  by  William  L.  Watson  and  John  L. 
Poole  of  New  York’s  Memorial  Hospital.  This 
paper  only  reaffirms  the  statistically  poor  prog- 
nosis of  patients  having  a neoplasm  in  the  cer- 
vical segment.  One  of  the  pioneers  of  esoph- 
ageal surgery,  Dr.  John  Garlock,  reports  on 
surgical  progress  in  this  field.  Contrary  to  Dr. 
Sweet,  Dr.  Garlock  does  not  favor  extensive  pal- 
liative resection,  in  view  of  the  high  mortality 
associated  therewith.  The  Mayo  Clinic  expe- 
rience with  esophogo-gastric  cancer  is  reported 
by  Clagett,  et  al.,  who  explored  129  cases.  Of 
these,  sixty-two  were  resected,  with  a mortality 
of  16  per  cent,  chiefly  due  to  pulmonary  com- 
plications and  sepsis.  Ochsner  and  DeBakey  re- 
port two  cases  of  subtotal  esophagectomy  with 
primary  esophago-gastric  anastomosis.  The  prob- 
lem of  incision  is  discussed  by  Macmanus,  who 
suggests  a left  abdominal  and  right  thoracic  in- 
cision for  upper  esophageal  lesions.  Reynolds  and 
Young,  of  the  University  of  Illinois  Medical  Col- 
lege, present  their  experience  with  the  Roux  Y 
anastomosis.  Although  no  mention  is  made  of 
Yudin,  this  sounds  very  much  like  the  technic 
described  by  the  master  surgeon  of  Russia. 

HUGH  A.  MacMILLAN,  JR. 


Oiiei-ative  Surg-ery:  By  Frederick  C.  Hill,  B.A,  M.S. 
(Surg. ),  M.D.,  Associate  Professor  of  Surgery,  The 
Creighton  University  School  of  Medicine,  Omaha, 
Nebraska.  Foreword  by  Charles  W.  Mayo,  B.A., 
M.S.  (Surg.),  M.D.,  Section  on  Surgery,  Mayo 
Clinic,  Rochester,  Minnesota.  New  York,  Oxford 
University  Press,  1949.  Oxford  Medical  Publica- 
tions. 

In  Operative  Surgery,  the  author  has  written 
a single  volume  work  on  general  surgery  technic. 
The  operations  described  are  those  that  Dr.  Hill 
has  found  to  be  most  satisfactory  on  the  basis 
of  his  own  experience  in  surgery.  The  various 
procedures  are  well  described  and  in  an  easily 
readable  manner.  On  the  whole,  the  book  is 
rather  well  illustrated  and  shows  the  main 
steps  in  the  more  important  operations  de- 
scribed. 

This  book  will  prove  most  useful  to  the  intern, 
resident,  and  less  experienced  surgeon. 

JOHN  G.  HEMMING,  JR. 


Human  Biochemistry:  By  Israel  S.  Kleiner,  Ph.D., 
Professor  of  Biochemistry  and  Director  of  the 
Department  of  Physiology  and  Biochemistry,  New 
York  Medical  College,  Flower  and  Fifth  Avenue 
Hospitals:  Formerly  Associate,  The  Rockefeller 
Institute  for  Medical  Research,  New  York.  With 
seventy-seven  text  illustrations  and  five  color 
plates.  Second  edition.  649  pages.  The  C.  V.  Mosby 
Company,  St.  Louis,  1948.  $7.00. 

This  is  an  excellent  book,  covering  the  various 
aspects  of  Human  Biochemistry  and  presented 
in  a very  readable  manner.  The  majority  of 
the  errors  and  criticisms  of  the  previous  edition 
have  been  corrected.  The  coverage  of  material 
is  good  and  it  is  not  difficult  to  understand.  The 
authors  have  attempted  wherever  possible  to  in- 
troduce the  clinical  applications  of  the  material 
covered,  which  will  make  it  of  greater  value  to 


1062 


Rocky  Mountain  Medical  Journal 


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for  December,  1949 


1063 


the  clinician.  There  are  many  good  charts  and 
illustrations,  the  latter  in  many  instances  depict- 
ing clinical  material  and  cases. 

This  book  is  used  as  a textbook  in  freshman 
biochemistry.  The  only  criticism  I have  heard 
from  those  studying  biochemistry  is  that  the 
author  does  not  make  full  use  of  chemical  equa- 
tions and  formulae.  However,  because  of  this,  the 
clinician  who  wishes  to  use  it  for  reference  or 
review  may  find  it  of  greater  value  than  other 
texts  in  biochemistry. 

JOSEPH  H.  HOLMES. 


Manual  of  Clinical  liaboratoi^  Methods:  By  Opal 
E.  Hepler,  Ph.D.,  M.D.,  Associate  Professor  of  Path- 
ology, Northwestern  University  Medical  School; 
Director  of  the  Clinical  Laboratories  of  the  Mont- 
gomery Ward  Clinics  and  Passavant  Memorial 
Hospital;  Consultant  in  Clinical  Pathology  at  Chil- 
dren’s Memorial  Hospital,  Chicago,  Illinois.  With 
a Foreword  by  James  P.  Simonds,  Ph.D.,  M.D. 
Fourth  Edition.  Charles  C.  Thomas,  Publisher, 
Springfield,  Illinois.  U.  S,  A. 

This  book  in  the  previous  editions  gained  con- 
siderable use  because  it  seemingly  filled  a need 
which  was  not  supplied  by  any  of  the  text- 
books in  the  field  of  clinical  pathology.  The 
author,  who  has  taught  in  the  field  of  clinical 
laboratory  methods  for  some  years,  is  qualified 
and  this  book  is  the  outcome  of  trial  and  error 
of  the  many  tests  which  are  advocated  in  the 
different  fields  of  clinical  laboratory  procedures. 

The  book  expresses  the  views  of  the  author 
in  the  selection  of  a few  tests  for  the  different 
procedures  and  this  edition,  which  has  been 
rewritten  and  enlarged,  can  be  of  material  as- 
sistance to  medical  technologists  in  particular 
and  also  to  others  who  are  interested  in  labora- 
tory technic.  The  procedures  covered  are  mainly 
those  which  are  carried  out  in  routine  work 
in  the  several  fields.  Because  of  the  clarity  of 
description  and  outline,  the  writer  can  sincerely 
recommend  this  book  to  the  medical  profession 
and  particularly  to  those  actively  engaged  in 
the  work  of  the  clinical  laboratory. 

E.  R.  MUGRAGE. 


Atlas  of  Peripheral  Nerve  In.1uries:  By  William  R. 
Lyons,  Pb.D.,  Associate  Professor  of  Anatomy, 
University  of  California  Medical  School;  and 
Barnes  Woodhall,  M.D.,  Professor  of  Neurosurgery, 
Duke  Medical  School,  Durham,  North  Carolina. 
W.  B.  Saunders  Company,  Philadelphia  and  Lon- 
don, 1949. 

War  offers  a unique  opportunity  for  the  study 
of  peripheral  nerve  injuries.  In  World  War  II, 
for  the  first  time,  the  scientific  and  professional 
resources  of  the  nation  were  enlisted  for  a well 
coordinated  and  comprehensive  approach  to  the 
problem.  Not  the  least  important  step  was  the 
routine  microscopic  examination  of  the  portions 
of  nerves  which  were  resected  at  the  time  of 
surgical  repair.  From  the  knowledge  thus 
gained,  surgeons  learned  to  recognize  alterations 
in  the  nerve  trunk  near  the  site  of  injury  which 
would  preclude  proper  regeneration.  It  proved 
necessary  not  only  to  excise  the  obvious  neuroma 
but  to  extend  the  resection  until  reasonably 
normal  neural  architecture  was  encountered. 
The  atlas  is  an  outgrowth  of  this  particular 
phase  of  the  study.  With  the  aid  of  photographs 
showing  both  gross  specimens  and  microscopic 
sections,  many  of  which  are  in  color,  all  types 
of  injury  to  peripheral  nerves  are  beautifully 
illustrated.  The  accompanying  text  is  adequate 
and  quite  readable,  the  section  on  combined  in- 
juries to  nerves  and  blood  vessels  being  espe- 
cially informative. 

This  work  should  be  of  interest  not  only  to 


neurosurgeons  and  neurologists  but  to  all  who 
care  for  the  injured.  One  of  the  facts:  brought 
out  should  in  particular  be  more  generally 
known;  i.e.,  that  even  when  a nerve  is  not  actu- 
ally severed  the  injured  portion  may  be  so 
permeated  by  scar  tissue  that  recovery  of  func- 
tion is  impossible  unless  it  is  resected  and  the 
cut  ends  are  accurately  approximated.  All  too 
often  the  serious  nature  of  a nerve  injury  is  not 
appreciated  until  the  optimal  period  for  surgical 
treatment  has  passed. 

LUMAN  E.  DANIELS. 


Campbell’s  Operative  Orthopedics:  Editor,  J.  S. 
Speed,  M.D. ; Associate  Editor,  Hugh  Smith,  M.D., 
Memphis',  Tenn.  Second  Edition  with  1,141  iiius- 
trations  including  two  color  plates.  Volume  I,  835 
pages.  The  C.  V.  Mosby  Company,  St.  Louis,  1949. 
$30. 

Caiiipbell’.s  Operative  Orthopedics:  Editor,  J.  S. 
Speed,  M.D. ; Associate  Editor,  Hugh  Smith,  M.D., 
Memphis',  Tenn.  Second:  Edition  with  1,141  illus- 
trations including  two  color  plates.  Volume  II,  801 
pages.  The  C.  V.  Mosby  Company,  St.  Louis,  1949. 
$30. 

The  second  edition  of  this  basic  book  has  been 
enlarged  to  the  extent  that  two  large  volumes 
are  required.  This  edition  was  written  primarily 
for  the  resident  in  Orthopedic  Surgery  but  the 
two  volumes  will  be  extremely  useful  and  in- 
formative to  everyone  practicing  in  this  field, 
as  there  is  no  single  book  available  at  present 
covering  the  vast  amount  of  material  and  recent 
advances. 

Added  to  the  accumulated  material  from  the 
recent  published  literature,  there  are  the  sound 
clinical  experiences  of  men  who  are  actually  in 
active  practice.  Under  these  circumstances,  most 
of  the  usual  didactic  and  controversial  material 
is  excluded. 

Several  new  sections  have  been  added.  The 
opening  chapter  of  Preoperative  and  Postopera- 
tive Care,  written  by  Dr.  J.  F.  Hamilton  outlines 
simply  the  procedures  followed  by  the  clinic 
and  the  staff.  Two  new  sections  on  Ruptured 
Intervertebral  Disc  and  Peripheral  Nerve  In- 
juries by  Dr.  Frances  Murphy,  a neuro-surgeon, 
are  excellent;  the  material  having  been  obtained 
from  a very  wide  and  extensive  clinical  practice 
comprising  over  two  thousand  operated  disc  cases 
alone.  A concise,  well-written  chapter  is  pre- 
sented by  Dr.  M.  N.  Smith-Peterson  on  Mold 
Arthroplasties  of  the  Hip  and  the  subject  of 
Amputations  is  covered  by  Dr.  D.  B.  Slocum. 
There  are  fifty-four  pages  in  the  enlarged 
chapter  on  Surgical  Approaches  and  the  informa- 
tion contained  in  them  is  exceeded  by  few  if  any 
books  written  on  this  specific  subject.  The  prob- 
lems, indications,  and  the  many  technics  of  bone 
grafts  axe  covered  thoroughly.  Here  again  the 
experience  of  the  staff  at  Campbell  Clinic  and 
the  extensive  material  from  the  recent  literature 
are  recorded. 

Illustrations  are  very  profuse  and  in  many 
instances  are  reproduced  from  the  original  ar- 
ticle published  in  the  various  'journals  or  re- 
drawn from  them.  Proper  credit  has  been  given 
to  the  originators  of  the  various  technical  pro- 
cedures. A very  extensive  authors’  index  has 
been  added  to  this  edition  and.  the  bibliography 
and  references  are  very  complete,  especially  as 
regards  to  American  and  English  publications. 
Unfortunately,  very  little  of  the  recent  foreign 
literature  is  included. 

The  new  edition  is  highly  recommended  as  a 
valuable  and  useful  addition  to  the  libraries'  of 
all  who  are  interested  in  the  practice  of  Ortho- 
pedic Surgery. 

WILLIAM  NELSON. 


1064 


Rocky  Mountain  Medical  Journal 


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in  the 

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Attending  Physicians 
FREDERICK  LEMERE,  M.D. 

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jor  December,  1949 


1065 


AdveriisemenI 


From  where  I sit 
Joe  Marsh 


Clam  Chowder  Can 
Be  Dynamite! 

If  Smiley  Roberts  is  a friend  of 
yours,  like  he  is  mine,  and  if  you 
want  to  keep  his  friendship,  like  I 
do,  don’t  let  him  hear  you  say  that 
good  clam  chowder  can  he  made  with- 
out cream. 

In  New  England,  where  Smiley 
comes  from,  friendships  have  been 
broken  over  tomatoes  versus  cream 
in  clam  chowder.  Experts  say  that 
south  of  Boston  the  tomato  reigns 
supreme,  but  north  of  Boston  it’s 
cream — or  else! 

From  where  I sit,  whether  it  should 
have  cream  or  tomatoes  is  simply  a 
matter  of  taste.  This  is  plain  to 
anyone  who  doesn’t  come  from  clam 
chowder  country. 

What  a great  world  this  would  be 
if  we  could  all  see  that  most  prejudices 
are  matters  of  taste  only.  Some  like 
hot  coffee.  Some  like  it  iced.  Some 
people  like  a temperate  glass  of  beer. 
Others  prefer  ice-cold  lemonade.  My 
grandmother  used  to  say,  “Prejudice 
that  sees  only  what  it  pleases,  cannot 
see  very  plain.” 


Copyright,  19^9,  United  States  Brewers  Foundation 


! 

JuberculosLs  Abstracts 

Issued  Monthly  by  the  National  Tuberculosis 
Association 

A ol.  XXII  NOVEMBER,  1949  No.  11 

There  is  a great  need  for  a trustworthy  set  oi  rules 
to  protect  the  people  in  contact  with  tuberculosis  pa- 
tients and  an  even  greater  need  /or  a more  general 
application  of  existing  methods  in  sanatoriums,  in  hos- 
pitals, and  in  homes. 


A CRITICAL  ANALYSIS  OF  ASEPTIC 
TECHNIC  FOR  TUBERCULOSIS 
The  Essentials  of  Asepsis 

“Aseptic  technic”  is  a routine  for  protecting  the 
contacts  of  tuberculous  patients.  It  consists  of  a num- 
ber of  logical  methods  to  prevent  the  spread  of  infec- 
tion which  are  applied  to  the  patient,  to  his  contacts, 
and  to  his  environment.  It  involves  facilities  for  isola- 
tion, placement  of  the  patient,  and  care  of  the  patient. 
According  to  the  circumstances,  the  routine  may  be 
limited  to  a few  obvious  essentials,  or  include  a com- 
plete list  of  all  possible  methods. 

The  usual  source  of  infectious  material  is  the  res- 
piratory tract.  Contamination  may  occur  in  three 
ways — -direct,  by  contact  with  the  patient;  indirect,  by 
the  handling  of  contaminated  materials,  and  air-borne. 
The  newer  analyses  of  air-borne  transmissions  have 
shown  that  bacilli  may  travel  by:  droplets,  larger  than 
0.2  mm,  which  quickly  clear  from  the  air  by  gravity: 
droplet  nuclei,  less  than  0.1  mm,  which  quickly  evap- 
orate, continue  to  float,  and  are  a dangerous  cause  of 
infection;  and  dust  which  may  contain  dried  droplets. 

Isolation  technic  is  not  the  only  means  for  control 
of  tuberculosis  in  general  hospitals.  Other  approaches 
include  x-ray  examinations  of  all  patients  and  per- 
sonnel to  uncover  all  active  cases  of  tuberculosis  and 
the  provision  of  facilities  for  the  care  and  isolation 
of  ca.ses  of  tuberculosis  when  found. 

Principles  of  Protection 

The  ways  to  avoid  contamination  are  to  reduce  the 
number  of  bacilli  expelled  by  the  patient,  to  reduce 
contact  between  attendants  and  patients,  and  to  apply 
a routine  of  aseptic  precautions.  One  must  plan  to: 
immobilize  the  bacilli  near  their  source,  collect  the 
secretions,  protect  the  contacts,  and  cleanse  the  en- 
vironment by  appropriate  means. 

Education  and  training  must  reach  not  only  the 
patient  and  his  visitors  but  the  staff  and  all  employed 
personnel  in  the  hospital  whose  duties  bring  them  into 
contact  with  the  patient  or  with  material  contaminated 
by  his  secretions.  A detailed  routine  must  be  arranged 
for  their  care  and  protection,  and  carried  out  without 
deviation. 

Excessive  Hazards 

There  are  a number  of  places  in  a precautionary 
routine  where  the  hazard  of  contamination  or  the  chance 
of  non-observance  is  greater  than  others.  In  part 
these  hazards  are  due  to  the  nature  of  illness,  but  in 
part  to  human  failings.  TTiey  include:  lapses  in  self- 
care  by  the  patient,  personnel,  or  visitors,  and  the 
uncovered  cough,  sneezing,  laughing,  talking,  and 
throat-clearing. 

Some  of  the  hazards  are  relatively  unimportant,  but 
a few  of  them  represent  notable  flows  or  weak  spots. 
The  habits  of  the  patient  are  probably  the  most  im- 
portant factor  in  an  aseptic  routine.  The  patient  must 
understand  the  theory  of  contamination;  he  must  be 
willing  to  help;  he  is  responsible  for  catching  the 
bacilli  near  their  source  and  disposing  of  them;  he 
must  practice  the  methods  until  habits  are  formed:  and 
the  habits  must  be  constant  and  invariable. 


1066 


Rocky  Mountain  Medical  Journal 


The  respiratory  tract  of  persons  in  contact  with  the 
patient  must  be  considered  exceptionally  vulnerable. 
Since  attendants  must  care  for  the  patient  and  also 
must  breathe,  the  entry  of  bacilli  should  be  prevented 
by  all  possible  means.  Tbe  correct  wearing  of  masks, 
and  their  construction  and  composition,  are  of  utmost 
importance. 

The  uncertain  value  of  several  antiseptics  and  meth- 
ods is  a weak  spot  in  the  technic.  Among  the  anti- 
septics only  the  alcohols,  cresols,  and  formaldehyde 
have  any  appreciable  effect  on  the  tubercle  bacillus, 
and  only  the  first  two  are  practical.  The  value  of 
cresol  compounds  is  at  present  a matter  of  dispute. 
They  are  being  tested  by  modern  methods  in  order 
to  determine  their  efficiency  and  limitations. 

Whether  soap  is  simply  an  aid  to  ablution  or  is 
bacteriostatic  is  not  known.  Detergents  (including 
soaps)  are  used  for  cleaning  of  rooms,  yet  they  are 
not  considered  to  be  antiseptic  for  tubercle  bacilli  by 
authorities.  Hand-washing  is  a standby  in  aseptic 
technic.  In  the  washing  of  clothes,  soap  acts  only  as 
a remover  of  dirt.  Sterilization  depends  upon  the  re- 
current exposure  of  white  clothes  to  temperatures  above 
140°  F.  for  a total  of  at  least  thirty  to  forty  minutes. 
This  formula  is  generally  used  in  standard  laundry 
practice. 

Vacuum  cleaners  have  recently  been  suggested  for 
cleaning  rooms  containing  tuberculous  patients  but 
have  not  been  sufficiently  tested  for  efficiency. 

Face  masks  have  not  been  completely  studied.  They 
have  two  uses — for  the  patient  and  for  the  person  in 
contact.  Masking  of  those  in  intimate  contact  with  pa- 
tients is  necessary,  especially  when  they  are  grossly 
infectious,  liable  to  cough,  or  careless. 

The  disinfecting  value  of  ultra-violet  light  is  in 
dispute,  chiefly  due  to  the  variation  in  sources,  in- 
tensities, and  tbe  quality  of  contaminated  surfaces. 


New  and  Valuable  Methods 

Several  methods  and  material  have  only  recently 
been  proved  valuable  and  put  into  use.  The  use  of 
oil  to  reduce  the  dust,  and  the  use  of  alcohol  as  a 
skin  antiseptic  are  the  most  notable.  Certain  "odor- 
less cresols”  (which  actually  are  phenols)  have  shown 
promise  and  are  being  tested. 

Summary  and  Conclusions 

The  majority  of  protective  methods  and  materials 
are  good.  They  are  logical,  efficient,  and  can  be 
easily  applied.  There  are  several  valuable  new  pro- 
cedures. A limited  and  incomplete  application  is  the 
greatest  deficiency  which  has  been  noted.  A correction 
should  not  wait  imtil  perfection  of  the  precautions:  it 
should  be  made  now,  in  every  hospital  and  sanatorium, 
and  pushed  to  wide  usage  in  the  care  of  patients  at 
home. 

A Critical  Analysis  o/  Aseptic  Technic  [or  Tuber- 
culosisi  William  H.  Oatway,  Jr.,  M.D.,  Arizona  Medi- 
cine, May,  1949. 


Vol.  XXII  DECEMBER,  1»49  No.  12 

As  the  mortality  horn  tuberculosis  continues  its  down- 
ward trend  the  question  of  whether  or  not  it  will 
finally  be  eradicated  becomes  less  speculative  and  more 
practical.  This  question  was  asked  and  answered  by 
Wade  Hampton  Frost  in  1937  and  his  answer  now  has 
been  reviewed  with  the  added  experience  of  the  last  ten 
eventful  years. 


IS  AREA  ERADICATION  OF  TUBERCULOSIS 
POSSIBLE? 

Wade  Hampton  Frost  in  1937  presented  a thought- 
ful appraisal  of  the  question  "How  Much  Control  of 
Tuberculosis?”  After  marshalling  the  available  evidence. 


GRADUATE  AND  POSTGRADUATE  MEDICINE 

COURSE  IN  THE  SCIENCES  FUNDAMENTAL  TO 
MEDICAL  AND  SURGICAL  SPECIALTIES  AT 
UNIVERSITY  OF  COLORADO  MEDICAL  SCHOOL 
Denver,  Colorado 

Winter  Quarter — |anuary  3 to  March  18,  1950 
Spring  Quarter — March  27  to  June  10,  1950 

These  courses  are  designed  to  orient  the  graduate  student  in  the  basic 
sciences  required  for  certification  by  the  various  American  Specialty  Boards, 
except  Otolaryngology  and  Ophthalmology.  Attendance  on  a full-time  or 
part-time  basis  may  be  arranged  according  to  individual  needs. 

Winter  Quarter  includes  symposia  and  seminars  covering  the  various 
clinical  phases  of  physiology,  biochemistry,  pharmacology,  pathology  and 
bacteriology  closely  correlated  with  patient  problems  as  related  to  the 
clinical  specialties.  (Emphasis  is  placed  upon  medical  subjects.) 

Spring  Quarter  includes  anatomy  of  the  surgical  specialties,  experi- 
mental surgery,  gross  and  microscopic  pathology,  neuropathology,  neuro- 
anatomy and  radiophysics.  (Emphasis  is  placed  on  surgical  subjects.) 

University  credit  is  granted.  Tuition  is  $110.00  per  quarter. 

Apply  to  Director  of  Graduate  and  Postgraduate  Medical  Education, 
University  of  Colorado  Medical  Center,  Denver  7,  Colorado. 


for  December,  1949 


1067 


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DOWNING  and  ALAMEDA 


he  concluded  that  in  this  country  we  had  already  reached 
a stage  at  which  the  biological  balance  was  against  the 
survival  of  the  tubercle  bacillus  and  that  eventually  this 
disease  would  disappear. 

A British  opinion  of'  the  same  year  was:  “It  is  idle 
to  speak  of  the  conquest  of  tuberculosis;  tuberculosis 
has  not  been  and  so  far  as  one  can  see  never  will  be 
conquered.”  This  opinion  was  endorsed  recently  by 
Medlar  who  found  many  tuberculous  pulmonary  lesions 
unrecognized  during  life  in  persons  in  the  older  age 
groups  coming  to  autopsy  in  New  York  City. 

The  question  of  the  validity  of  Frost’s  thesis  is  of 
great  practical  as  well  as  theoretical  importance.  His 
reasoning  was  briefly  this:  There  were  many  and  sound 
reasons  for  doubting  that  the  rapid  decline  in  tuber- 
culosis in  the  preceding  half  centurv  had  been  due 
principally  to  the  measures  which  had  been  taken  for 
the  purpose  of  preventing  infection.  Without  question 
the  factors  lumped  together  under  the  terms  “advancing 
civilization  and  better  living  conditions”  has  played  an 
important  role.  There  was  reason  to  believe,  however, 
that  the  decline  was  due  in  some  part  to  the  efforts 
made  to  control  the  disease. 

The  direct  attack  has  proved  to  he  a more  formidable 
undertaking  than  was  at  first  realized,  but  in  Frost’s 
words:  “If  the  effective  control  of  tuberculosis  re- 

quired complete  isolation  of  all  open  cases,  . . . the 
present  (i.e.,  1937)  status  could  not  be  considered  en- 
couraging, for  . . . (many)  such  cases  are  discovered 
in  a fairly  advanced  stage,  and  the  isolation  even  of 
cases  known  to  the  authorities  is  probably  less  than  50 
per  cent  complete.  However,  for  the  eventual  eradica- 
tion of  tuberculosis,  it  is  not  necessary  that  transmis- 
sion be  immediately  and  completely  prevented  but  only 
that  the  rate  of  transmission  be  held  permanently  below 
the  level  at  which  a given  number  of  infection-spreading 
cases  succeed  in  establishing  an  equivalent  number  (of 
‘open’  cases)  to  carry  on  the  succession.  If  the  num- 
ber of  infectious  hosts  is  continuously  reduced,  the  end 
result  . . . must  be  extermination  of  the  tubercle 
bacillus.” 

He  placed  a single  qualification  upon  his  conclusion 
that  “As  to  the  maintenance  of  this  balance,  favorable 
to  us,  unfavorable  to  the  tubercle  bacillus,  there  are,  of 
course,  elernents  of  uncertainty,  among  them  uncertainty 
as  to  the  stability  of  our  civilization.” 

Only  twelve  years  have  passed — too  short  a period  upon 
which  to  base  inferences  in  regard  to  long-time  trends — 
during  which  the  very  existence  of  civilization  has  been 
threatened.  The  world  has  undergone  one  of  the  great- 
est military,  social,  and  economic  upheavels  in  history. 
It  is,  therefore,  pertinent  to  review  the  experience  of 
this  decade  and  inquire  whether  the  Frost  thesis  is  still 
tenable. 

Despite  their  limitations,  mortality  rates  provide  the 
best  available  index  of  the  biological  balance  over  long 
periods  of  time.  During  the  war  years,  mortality  from 
tuberculosis  increased  in  most  of  the  western  Europe 
nations  involved  in  the  conflict,  while  those  countries 
that  escaped  the  rigors  of  war  were  little  affected.  In 
western  Germany  the  rate  is  still  higher  than  in  1938. 
In  Belgium  and  the  Netherlands,  as  in  England  and 
France,  the  rate  rose  during  the  war,  but  by  1946  was 
already  down  to  or  below  the  1938  level.  In  Denmark, 
Sweden,  Switzerland  and  the  United  States,  mortality 
continued  downward  during  the  war. 

It  appears,  therefore,  that  the  disturbances  due  to  the 
war  have  been  insufficent  to  effect  more  than  a tem- 
porary setback  in  declining  death  rates.  It  would  appear 
then  that,  where  civilization  is  relatively  advanced,  the 
biological  balance  is  still  against  survival  of  the  tubercle 
bacillus. 


1068 


Rocky  Mountain  Medical  Journal 


WANTADS 


FOR  sale; 

PORTABLE  MODEL.  DICTAPHONE  purchased  in 
August,  1948,  used  only  twice.  Price  $525.00.  Box 
14,  Rocky  Mountain  Medical  Journal. 


FOR  SAI.E 

DR.  CONANT,  502  MacJj;  Bldg.,  plans  to  retire  from 
practice  on  or  before  January  1,  1950.  Treatment 
tables,  instruments  and  other  supplies  for  E.E.N.T. 
specialty  are  offered  for  sale;  also  office  desk, 
chairs,  bookcase,  wall  clock,  wall  cupboards  and 
medium-sized  iron  safe. 


FOR  SALE 

MOUNTAIN  CABIN  10  miles  from  Idaho  Springs. 
Fine  construction,  roomy,  completely  furnished. 
Stream  on  property,  fishing  lake  close,  caretaker, 
telephone.  $4,800.  Includes  Association  membership 
and  lovely  guest  house.  H.  W.  Tabor,  2331  South 
Jackson. 


SHIRLEY- SAVOY 
HOTEL 

At  Your  Service 

New  Lincoln  Auditorium 
and 

Private  Dining  Room 

J.  Edgar  Smith,  President 

Ed  C.  Bennett,  Manager 

Ike  Walton,  Managing  Director 

BROADWAY  and  EAST  17th  AVE. 
Denver,  Colo.  TAbor  2151 


WHEATRfDCE  FARM  DAIRY 

COMPLETE  LINE  OF  GRADE  A 
DAIRY  PRODUCTS 
Special  Milk  for  Babies 
DELIVERED  TO  YOUR  DOOR 
We  Have  Our  Own  Cows 
8000  West  44th  Ave. 

GL.  1719  ARVADA  220 


W.D.RocL 

Ambulance 
Service 

Prompt,  Careful  and  Courteous 
Serving  Denver  25  Years 

Approved  by  Phy«iciaiui  OonorAlly 

18th  Ave.  at  Gilpin  St.,  Phone  EA.  7733 


I’o  what  extent  this  is  due  to  indirect  socio-economic 
causes  or  indirectly  to  control  measures  is  still  a difficult 
question  to  answer.  In  the  United  States,  progress  has 
been  made  toward  more  effective  measures  ot  control 
despite  the  war.  In  the  field  of  specific  therapy  the 
most  important  contribution  was,  of  course,  the  dis- 
covery of  streptomycin  which  is  now  receiving  ex- 
tensive clinical  trial.  Experience  with  it  thus  far  gives 
hope  that  eventually  an  antibiotic  may  be  discovered 
which  will  suppress  growth  ot  the  microorganism  in  the 
tissues  and  rapidly  terminate  the  infectious  state  in  pul- 
monary tuberculosis.  With  such  an  agent,  the  seedbed 
of  the  disease  could  be  more  rapidly  reduced. 

The  search  for  a practical  and  effective  method  of 
artificial  immunization  has  progressed.  The  technics 
related  to  the  use  of  BCG  vaccine  have  been  improved 
and  its  safety  established.  Critical  trials  support  the 
judgment  that  this  procedure  affords  some  protection 
against  post-primary  tuberculous  lesions  for  at  least  a 
limited  period.  Its  long-range  effect  in  reducing  the 
incidence  of  pulmonary  tuberculosis  has  yet  to  be 
determined.  In  the  United  States,  BCG  is  still  under 
investigation. 

Thus,  the  past  ten  years  have  brought  forth  no  really 
new  principle  of  prevention.  The  main  objective  is  still 
avoidance  of  exposure,  and  the ’strategy  is  still  that  ot 
a frontal  assault  on  discoverable  sources  of  infection. 
Progress  has  also  been  made  in  “case  finding”  and  isola- 
tion. The  tools  used  in  diagnosis  have  undoubtedly  been 
sharpened. 

While  there  are  still  manifest  deficiencies  in  the 
preventive  program,  it  is  better  than  it  was  a decade  ago 
There  are  reasons  for  believiing  it  is  progressively  reduc- 
ing the  frequency  of  transmission  from  infected  to  non- 
infected  individuals. 

Granting  continuation  or  strengthening  of  control 
efforts  in  addition  to  favorable  socio-economic  develop- 
ments in  a world  at  peace,  it  would  seem  not  unrea- 
sonable to  expect  that  the  balance,  favorable  to  us, 
unfavorable  to  the  tubercle  bacillus,  will  be  maintained 
and  that  the  decline  in  mortality  from  tuberculosis  will 
be  sustained,  even  to  the  point  of  disappearance  from 
some  areas.  There  is  nothing  in  the  record  up  to  date 
that  is  inconsistent  with  Frost’s  thesis. 


Is  Area  Eradication  of  Tuberculosis  Possible?  Edi- 
torial, American  Journal  of  Public  Health,  June,  1949. 


A TELEPHONE  SERVICE 
THAT’S  INVALUABLE 
TO  PROFESSIONAL  MEN 

The  Physicians  & Surgeons  Exchange 
965  Gas  & Electric  Bldg:.  KE.  8173 

We  take  your  phone  calls — get  them 
to  you.  On  the  job  24  hours  every  day. 


NEWTON  OPTICAL  COMPANY 

GUILD  OPTICIANS 

V.  C.  NORWOOD,  Managsr 

309-16th  Street  Denver 

Phone  KEystone  0806 

Catariag  to  Madicol  Proiawion  Patronag* 


for  December,  1949 


1069 


To  our  many  friends  who  have 
contributed  to  our  progress  through 
the  years... our  sincere  appreciation. 

May  the  future  witness  a 
continuation  of  this  confidence. 


THE  J.  HURBIN  SURGICAL  SUPPLY  CO. 

1625  COURT  PLACE  • DENVER  2,  COLORADO  • KE  5287-88 


1070 


Rocky  Mountain  Medical  Journal 


☆ 

“Sincere  congratulations  to  the  J.  Dur- 
bin Surgical  Supply  Company  on  their 
seventy-fifth  anniversary. 

Congratulations  to  THE  J.  DURBIN 

SURGICAL  SUPPLY  CO.  on  their  75th 

☆ 

anniversary,  and  our  best  wishes  for 

their  continued  success  and  prosperity. 

Continental  Hospital 

Service,  Inc. 

☆ 

Cleveland,  Ohio 

Fred  Haslam  & Co., 

☆ 

Inc. 

“Manufacturers  of  the  Continentalair 

83  Pulaski  Street 

Brooklyn,  New  York 

iceless  oxygen  tent  and  the  Infantair  for 

infant  care.” 

products  of  Quality 


ETHYL  CHLORIDE  U.S.P. 

Professionally  preferred  for  local  anesthesia 
for  more  than  40  years.  The  amber  glass 
bottle,  with  self-sealing  dispenseal  cap,  is 
practical  and  convenient  in  handling.  Avail- 
able in  choice  of  fine,  medium  or  coarse 
spray.  Also  available  in  metal  tubes  with 
regulating  spray. 


S.S.  SPRAY 

FOR  SOAP 
SENSITIVE 
PATIENTS 

Especially  valuable  to  soap  sen- 
sitive patients.  This  soapless 
detergent  is  sprayed  from  the 
bottle  forming  a creamy,  soft 
lather  that  quickly  removes  dirt 
and  grease  without  irritation. 


TANNIC  SPRAY 

A cooling,  soothing  relief 
when  applied  to  sunburn  or 
in  the  prompt  treatment  of 
minor  burns. 

ALCO  SPRAY 

Alco  Spray  applied  to  edge 
of  adhesive  bandage  quick- 
ly loosens  its  grip,  changes 
its  "stick"  to  "slick,"  per- 
mitting removal  of  bandage 
quickly,  painlessly. 

P.M.C.  SPRAY 

This  penetrating  spray  is 
especially  valuable  as  a 
fungicidal  and  bacteriacldal 
solution  in  the  treatment 
of  tinnea. 

THE  GEBAUER 
CHEMrCAL  CO. 

CLEVELAND,  OHIO 


for  December,  1949 


1071 


‘^'^hung  from  the 
shoulders” 


An  Important 


The  Improved 

MATERNITY 

SUPPORT 


Exclusive  for  the 

NEW  Mother 
NURSING  BRASSIERE 


with 

Zipper 

Cups 


Obstetricians  have  long  realized  the 
ideal  pre-natal  garment  must  pro- 
vide correct  uplift  for  the  abdomen 
with  no  constriction  or  binding.  Nu- 
lift  is  that  garment,  firm  in  its 
placement  yet  perfectly  assisted  by 
shoulder  suspension. 


TWO-IN-ONE  Feature 

After  the  baby  arrives,  the  post- 
partum front  replaces  the  obstetrical 
front,  converting  the  maternity  gar- 
ment to  a post-partum  support. 

Nu-Lift 

Supportive  Girdle 

Designed  for  effective  post-partum, 
post-operative  and  sacro-iliac  sup- 
port. 


It  carries  a load  of  uses. 

Nursery  and  teo  apron 

Knitting  bag.  Shopping  bag. 


1.  Scientifically  designed  zip- 
per cups. 

2.  Bust  is  supported  by  inner 
medial  half  cups. 

3.  Cup  size  adjustable  with 
dart  features. 

4.  1"  tubular  shoulder  straps 
prevent  "cutting-in"  dis- 
comfort. 

5.  Ribbon  loops  inside  cups  to 
hold  pads  in  case  of  leak- 
age or  need  of  medication. 


For  every  mother  . . . amaz- 
ing serviceability.  For  every 
baby  shower  shopper  . . . the 
ideal  gift.  Of  gay  plaid  rayon 
gabardine,  the  bag  unzips  to 
an  attractive  apron.  RE- 
VERSED— it  becomes  all  baby's 
needs. 


IT'S  REVERSIBLE/ 


OVER  ARM  UTILITY 
ZIPPER  APRON  BAG 


BABY 


BAGGAGE 


The  Apron 
That  Closes 


to  Carry 


Manufactured  by 

NU-LIFT  COMPANY,  INC. 

1021  N.  Les  Palmas,  Hollywood  38,  Calif. 


FOR  J.  DURBIN 

SURGICAL 
SUPPLY  COMPANY 


1072 


Rocky  Mountain  Medical  Journal 


Best  Wishes  From 

Best  Wishes  From 

THE  MASSILLON 

RUBBER  COMPANY 

DAVIS  & CECK,  INC. 

Massillon,  Ohio 

^^Makers  of  MATEX” 

Sterile  Surgical  Sutures 

Congratulations  to 

J.  Durbin  Surgical  Supply  Company 

Congratulations  to  Durbin’s 

on  Their  75th  Year 

r 

Serving  the  Rocky  Mountain  Territory 

L/yendrvri 

Detect-o  Scales,  Inc. 

Brooklyn,  N.  Y. 

PERRYSBURC,  OHIO 

Best  W ishes 

- 

DENVER  TOWEL 

to  Durbin’s 

SUPPLY  CO. 

on  Their 

☆ 

75th  Anniversary 

1730  Speer  Blvd.  TAbor  3276 
Denver,  Colorado 

☆ 

(Attention  . . . 

DENVER  PHYSICIANS 

Z.  L.  SNYDER,  Representative 

‘Vatronize  Your 

THE  CINCINNATI  TRUSS  CO. 

Denver  Advertisers 

for  December,  1949 


1073 


NURSES 

OFFICIAL 

REGISTRY 

Established  to  Meet  the  Community’s 
Every  Need  for  Nursing  Care 

★ + + 

GRADUATE  REGISTERED  NURSES 

Hourly  Nursing  Service  Positions 
Filled — Information  on  All 
Nursing  Service 

This  registry  is  endorsed  by  the 
Colorado  State  Graduate  Nurses’ 
Association  and  American  Nurses’ 
Association 

♦ -It 

Undergraduates  and  Practical  Nurses 
Furnished  Upon  Request 

KEystone  0168 

ARGONAUT  HOTEL 


f^roduction  •Si 


eruLce 


ELECTROTYPES 

MATRICES 

STEREOTYPES 

PRINTING 

TYPOGRAPHY 

lAJedtern  lf}ew6pcLpep  Idnion 

Denver - 1830  Curtis  St. 

New  York  - - - - 310  East  45th  St. 
Chicago  - - - - 210  So.  Desplaines  St. 

And  33  Other  Cities 


4“ 


SPECIALISTS  IN  THERAPY  FOR 

CHRONIC  ALCOHOLISM 


BY  THE  CONDITIONED  REFLEX  AND  ADJUVANT  METHODS 


7106  35th  Ave.,  S.  W.,  Seattle  6,  Wash.  WEst  7232 
Recognized  by  the  American  Medical  Association 
Member  of  the  American  Hospital  Association 


for  December,  1949 


1075 


RELIABLE  DRUGGISTS 

PATRONIZE  DENVER’S  INDEPENDENT  DRUGGISTS 


WE  RECOMMEND 

COUNTRY  CLUB 
PHARMACY 

PRESCRIPTION  SPECIALISTS 

1700  E.  6th  Ave.  EAst  7743 

Denver,  Colorado 

We  Recommend 

KincaicPs  Pharmacy 

JESS  L.  KINCAID,  Prop. 

Prescriptions,  Biologicals 
and  Fine  Cosmetics 

7024  W.  Colfax  Ave. 

Phone  Lakewood  436 

LAKEWOOD,  COLORADO 

ROBERTS  PHARMACY 

East  23rd  Ave.  at  Onedia  St. 

Phones:  EAst  7783-EAst  7784 

D.  Lyall  Roberts,  Prop. 

East  Denver's  Newest  Neighborhood  Drug  Store 
Takes  Pleasure  to  Fill  the  Needs  of  Your  Pa- 
tients. 

Prompt  Free  Delivery  Service 

Our  Prescription  Stock  Is  Complete 

We  Recommend 

EARIVEST  DRUG  COMPANY 

T.  H.  BRAYDEN,  Prop. 

PRESCRIPTION  SPECIALISTS 
Prompt  Delivery  Service 

1699  Broadway  Phone  KEystone  7237 

Denver,  Colorado 

"Conveniently  Located  for  the  Doctor" 

HYDE’S  PHARMACY 

ACCURATE  PRESCRIPTIONS 

Chas  W.  Hyde,  Prop. 

Rocky  Mountain  Distributor  for  Sherman 
Biologicals  and  Pharmaceuticals 

Free  Deliveries 

629  16th  St.  (Mack  Bldg.)  KE.  4811 

Doyle's  Pharmacy 

Particular  ^bru^^Ut" 

East  17th  Ave.  at  Grant  KE.  5987 

21  Years  in  the  Heart  of  North  Denver 

GUIDO  SHUMAKE  DRUGS 

(Formerly  Otto  Drug  Co.) 

PRESCRIPTIONS  ACCURATELY 
COMPOUNDED 

Free  Delivery  Service 

West  38th  Ave.  and  Clay  Denver,  Colo. 

Phone  GRand  9934 

We  Recommend 

BONNIE  BRAE 

DRUG  COMPANY 

Alfred  C.  Andersen,  Owner  and  Manager 
Prescriptions  Accurately  Compounded 

Drugs Sundries 

FREE  IMMEDIATE  DELIVERIES 

ON  EMERGENCY  PRESCRIPTIONS 

763  South  University  Boulevard 

Phone  RAce  2874  — Denver,  Colorado 

WE  RECOMMEND 

Whittaker’s  Pharmacy 

“The  Friendly  Store” 

PRESCRIPTION  SPECIALISTS 

West  32nd  and  Perry,  Denver,  Colo. 
Phone  GLendale  2401 

22  Years  in  North  Denver 

OTTO  DRUG  COMPANY 

TRY  US  FIRST 

Prescriptions  Accurately  Compounded 

Free  Delivery  Service 

(New  Location) 

5070  Federal  Boulevard  Denver,  Colorado 

Phone  GRond  9832 

1076 


Rocky  Mountain  Medical  Journal 


RELIABLE  DRUGGISTS 


PATRONIZE  DENVER’S  INDEPENDENT  DRUGGISTS 


WALTERS  DRUG  STORE 
801  COLORADO  BLVD. 
Denver,  Colorado 

Telephone  FRemont  5391 


lAJhg  to  at  lAJeidd 

WEISS  DRUG 

PRESCRIPTION  SPECIALISTS 


Colfax  and  Elm  Denver,  Colorado 

Phone  EAst  1814 


We  Recommend 

VAN'S  PHARMACY 

THOS.  A.  VANDERBUR 

Frescrlptions,  Drnss,  Cosmetics,  Magazines 
Sundries  Excellent  Fountain  Service 

2859  Umatilla  St.,  Cor.  29th  Ave.  at  Umatilla 
GRand  7944  Denver,  Colo. 


Dansberry’s  Pharmacy 
"New  Ultra  Modern  Prescription  Service” 
JAMES  F.  DANSBERRY 
Owner  and  Manager 

Champa  at  14th  Street  Denver,  Colorado 
Phone  KEystone  469 


WE  RECOMMEND 

LAKEWOOD  PHARMACY 

R.  W.  Hoitgren,  Prop. 
PRESCRIPTION  SPECIALISTS 

West  Colfax  at  Wadsworth 
Lakewood  Colorado 

Phone  Lakewood  65 


Downing  Street  Pharmacy 

GEORGE  M.  HILL,  Prop. 

PROFESSIONAL  PHARMACIST 

901  Downing  St.  Denver,  Colo. 

Phone  ALpine  4465 

Complete  Merchandise  Line 
Free  Delivery  on  Prescriptions 


East  Denver’s  Prescription  Drug  Store 


Bert  C.  Corgan,  Prop. 

3401  FRANKLIN  STREET 
KEystone  7241 


OVERSTAKE’S  PHARMACY 

Gail  E.  Overstake 
Prescription  Specialists 

DRUGS  — SUNDRIES  — 
COSMETICS  — CANDIES 

We  Deliver 

1000  So.  Gaylord  — RAce  4401 


Harl  Cleveland,  Owner 

CLEVELAND  PHARMACY 

W.  29tli  Ave.  at  Speer  Ph.  GL.  9272 

Modem  Prescription  Department 
Registered  Pharmacist 

Drugs  — Sundries  — Soda  Fountain 

HOURS:  Week  Days,  8 a.m.  to  10  p.m. 

Sundays.  10  am.  to  1 p.m..  5 p.m.  to  9 p.m. 

Prescriptions  Delivered  Promptly 


PROFESSIONAL  MEN  RECOMMEND 


D.  MALCOLM  CAREY,  Pharmacist 

Phone  AComa  3711 

224  Sixteenth  Street  Denver,  Colorado 


for  December,  1949 


1077 


Cook  County  Graduate 
School  of  Medicine 

ANNOUNCES  CONTINUOUS  COURSES 

SURGERY — Intensive  Course  in  Surgical  Technique, 
Two  Weeks,  starting  January  23,  February  20.  Sur- 
gical Technique,  Surgical  Anatomy  and  Clinical 
Surgery,  Four  Weeks,  starting  February  6,  March 
(1.  Surgery  of  Colon  and  Rectum,  One  Week,  start- 
ing March  6.  Esophageal  Surgery,  One  Week,  start- 
ing June  5.  Breast  and  Thyroid  Surgery,  One 
Week,  starting  June  26.  Thoracic  Surgery.  One 
Week,  starting  June  12.  Gallbladder  Surgery,  Ten 
Hours,  starting  June  19.  Fractures  and  Traumatic 
Surgery,  Two  Weeks,  starting  April  17. 

GYNECOLOGY — Intensive  Course.  Two  Weeks,  start- 
ing February  20.  Vaginal  Approach  to  Pelvic  Sur- 
gery, One  Week,  starting  March  6. 

OBSTETRICS — Intensive  Course,  Two  Weeks,  start- 
ing March  6. 

PEDIATRICS — Intensive  Course,  Two  Weeks,  start- 
ing April  3. 

MEDICINE — Intensive  General  Course,  Two  Weeks, 
starting  April  24.  Gastroscopy,  Two  Weeks,  start- 
ing March  6. 

DERMATOLOGY — Formal  Course,  Two  Weeks,  start- 
ing May  8.  Informal  Clinical  Course  every  two 
weeks. 

ROENTGENOLOGY — Diagnostic  and  Lecture  Course 
First  Monday  of  every  month.  Clinical  Course  Third 
Monday  of  every  month.  X-Ray  Therairy  every 
two  weeks. 

UROLOGY — Intensive  Course,  Two  Weeks,  starting 
April  17.  Cystoscopy,  Ten  Day  Practical  Course, 
every  two  weeks. 

GENERAL,  INTENSIVE  AND  SPECIAL  COURSES 
IN  ALL  BRANCHES  OF  MEDICINE,  SURGERY 
AND  THE  SPECIALTIES 

TEACHING  FACULTY— ATTENDING  STAFF  OF 
COOK  COUNTY  HOSPITAL 
ADDRESS:  REGISTRAR,  427  SOUTH  HONORE 
STREET,  CHICAGO  12,  ILLINOIS 


ACCIDENT  - HOSPITAL  - SICKNESS 

INSURANCE 

For 


Physicians,  Surgeons,  Dentists  Exclusively 


...  / PHYSICIANSX 

ALL  f \ 

ALL 

> PREMIUMS  _ 

SURGEONS 

CLAIMS  < 

COME  FROM 

V DINTISTS  / 

GO  TO 

$5,000.00  accidental  death 

$25.00  weekly  indeiDDliy.  accident  and  sickness 

$10,000.00  accidental  death 

$50.00  weekly  indemnity,  accident  and  sickness 

$15,000.00  accidental  death 

$75.00  weekly  Indemnity,  accident  and  sickness 

$20,000.00  accidental  death 

$100.00  weekly  Indemnify,  accident  and  sickne>4s 

$8.00 

Qiiirterly 

$16.00 

fpiarterly 

$24.00 

Quarterly 

$32.00 

Quarterlj 

Cost  has  never  exceeded  amounts  shown. 

ALSO  HOSPITAL  EXPENSE  FOR  MEMBERS,  WIVES  & CHILDREN 


85c  out  of  each  $1.00  gross  income  used  for 
members’  benefit 

$3,700,000.00  ^5,700,000.00 

INVESTED  ASSETS  PAID  FOR  CLAIMS 

$200,000.00  deposited  with  State  of  Nebraska  (or  protection  of  our  memben. 
iM.'sability  n- t-u  hmi  i»h  ii«  ui  ied  in  lint*  of  duty — 
benefits  fioin  tlie  bepmnin^  day  of  disabiliiy 

PHYSICIANS  CASUALTY  ASSOCIATION 
PHYSICIANS  HEALTH  ASSOCIATION 

47  ycors  under  the  same  management 
4I>0  K(r*«f  IV2lti4»nnl  Hi  k Hiifliliiiu.  Oiniiliii  U.  .\eiiraMk.a 


ZJL 

BROWN  SCHOOLS 

For  Exceptional  Children 

Four  distinct  units.  Tiny  Tots  through 
the  Teens.  Ranch  for  older  hoys.  Spe- 
cial attention  given  to  educational  and 
emotional  difficulties.  Speech,  Music, 
Arts  and  Crafts.  Full  time  Psychologist. 
Under  the  daily  supervision  of  a Certi- 
fied Psychiatrist.  Registered  Nurses. 
Private  swimming  pool,  fireproof 
building.  View  Book.  Summer  Camp. 
Approved  hy  State  Division  of  Special 
Education. 

BERT  P.  BROWN 

President 

Paul  L.  White,  M.D.,  F.A.P.A., 
Medical  Director 

P.  0.  Box  4008,  Austin,  Texas 


1078 


Rocky  Mountain  Medical  Journal 


Index  to  Advertisers 


Page 

Abbey  Rents  1074 

Abbott  Laboratories  1045 

Alba  Dairy  1061 

American  Medical  and  Dental 
Association  1000 


Ayerst,  McKenna  & Harrison  1047 

Berber!  & Sons,  Inc.,  George  1051 

Blair  X-Ray  Supply 1053 

Bonita  Pharmacy  1063 

Bonnie-Brae  Drug 1076 

Brown  School  1078 

Burroughs  Wellcome  & Co._1005 

Cambridge  Dairy  996 

Camel  Cigarette  997 

Camp,  S.  H.  & Co 1049 

Capital  Chevrolet  1078 

Cascade  Laundry 1068 

Chicago  Medical  Society 1061 

Children’s  Hospital  Assn 1080 

Cincinnati  Truss  Company — 1073 

City  Park  Dairy 100? 

Cleveland  Pharmacy  1077 

Colburn  Hotel  1068 

Colorado  Springs  Psycho- 
pathic Hospital  1063 

Colvin  Medical  Books 1074 

Continental  Hospital  Service, 

Inc.  - _ _ 1071 

Cook  County  Graduate 

School  of  Medicine 1078 

Country  Club  Pharmacy 1076 

Cutter  Laboratories  1037 

Dansberry’s  Pharmacy  1077 

Davis  & Geek,  Inc. 1073 

Deep  Rock  Water 1057 

Denver  Oxygen  Co. 1004 

Denver  Surgical  Supply 1061 

Denver  Towel  Supply  Co 1073 

Detecto  Scales,  Ihc. 1073 

Dorothy  Olssen’s  Sanatorium  1055 

Dorr  Optical  Co 1006 

Downing  Street  Pharmacy — 1077 

Doyle’s  Pharmacy 1076 

Durbin,  J.,  Surgical  Supp'ly 
Company,  The 1070 


Page 

Earnest  Drug  Company 1076 

Ehret  Ehgraving  Co 1004 

Fairfax  Sanitarium  1065 

Fairhaven  Maternity 

Hospital  996 

Fleet,  C.  B.,  Company 1007 

Franklin  Drug  Company 1077 

Gebauer  Chemical  Company, 

The  1071 

Glockner  Penrose  Hospital  . 1065 
Gendron  1073 

Haslam,  Fred  & Co.,  Inc 1071 

Hyde’s  Pharmacy  1076 

Jackson’s  Cut  Rate  Drug 1068 

Karg  Paint  Co 1068 

Kendrick-Bellamy  Co.  994 

Kincaid’s  Pharmacy 1076 

Lakewood  Pharmacy 1077 

Lederle  Laboratories 1003 

Lilly,  Eli  & Co. 

Insert  Between 1008-1009 

Livermore  Sanitarium  105JJ 

Luzier’s  Cover  III 

Malone  Drug  Store , 1063 

Massillon  Rubber  Company, 

The  1073 

Mead,  Johnson  & Co Cover  IV 


Medical  Center  Pharmacy 1061 

Mercy  Hospital  _• 1059 

Morning  Milk  1057 

Nepera  Chemical  Co.,  Inc 10  41 

Nestle  Company,  Inc.,  The 1039 

Newton  Optical  Company 1069 

Nu-Lift  Company,  Inc 1072 

Nurses  Official  Registry 1074 

Otto  Drug  Company 1076 

Overstake’s  Pharmacy  1077 

Park  Floral  Company 1004 

Parke,  Davis  & Co. .Cover  11-993 


Page 

Physicians  and  Surgeons 

Telephone  Service  Exch._.1069 

Physicians  Casualty  Assn. 1078 

Presbyterian  Hospital  1059 

Professional  Pharmacy 1077 

Restaurant  240  1068 

Roberts  Pharmacy  1076 

Roche  Ambulance  Service 1069 

Roedel’s  Prescription  Drug 1063 

St.  Anthony  Hospital 1056 

Sandoz  Pharmaceuticals 1055 

Scherlng  Corporation 999 

Schmid,  Julius,  Inc 1043 

Searle,  G.  D.  & Co. 103'5 

Shade!  Sanitarium  1075 

Shadtord-Fletcher  Optical  Co. 1002 

Shidley-Savoy  Hotel  1069 

Shumake  Drug,  Guido 1076 

Stapleton,  H.  C.,  Drug  Co 1059 

Stodghill’s  Imperial 

Pharmacy  1074 

Telephone  Answering  Service  996 

Thornton,  George  R 994 

Tours-  Hotel  1061 

' United  States  Brewing 

Industry 1066 

Univ.  of  Colo.  Medical  School  1067 
Upjohn  Company 1001 

Van's  Pharmacy 1077 

Walter’s  Drug  Store 1077 

Wander  Company,  The 1008 

Wantads  1069 

Weiss  Drug 1077 

Weiss,  Paul  1065 

Westei’n  Electric 

Hearing  Aids  1065 

Western  Newspaper  Union 1074 

Wheatridge  Farm  Dairy 1069 

Whittaker’s  Pharmacy 1076 

Winthrop-Stearns,  Inc. 995 

Woodcroft  Hospital  1080 

York  Pharmacy  1063 


for  December,  1949 


1079 


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Rocky  Mountain  Medical.  Journal 


AUTHOR  INDEX,  VOLUME  XL  VI 


Allen,  Kenneth  D.  A.,  Isotopes  and  the  New  Alchemy. 
931. 

Almas,  David  J.,  Primary  Lymphosarcoma  of  the 
Appendix  Vermiformis,  567. 

Bacon,  Harry  E.,  Anterior  Resection  or  Abdomino- 
perineal Proctosig'moidectomy  for  Carcinoma  of 
the  Rectum,  716. 

Baker,  George  E.,  Prevention  and  Treatment  of 
Rocky  Mountain  Spotted  Fever,  812. 

Barber,  Edgar  W.,  Management  of  Acute  Cholecyst- 
itis, 293. 

Barglow,  David  R.,  Ethylene  Dlsulfonate  and  Hemo- 
lytic Disease  of  the  Newborn,  938. 

Barnacle,  Clarke  H.,  Psychosomatic  Aspects  of  Gas- 
tro-Intestinal  Disorders,  642. 

Baskin,  M.  J.,  Further  Experience  With  Methergine 
as  an  Oxytocic,  304. 

Bauerlein,  T.  C.,  The  Combined  Procedure  of  Vagot- 
omy and  Partial  Gastric  Resection  in  the  Treat- 
ment of  Peptic  Ulcer,  460. 

Baum,  Martin  D.,  Colorado  Veterinary  Public  Health 
Program,  923. 

Beebe,  N.  L.,  Obstruction  of  the  Bowel  Due  to  Gall- 
stone, 940. 

Benson,  Grant  Lee,  Jr.,  Severe  Bleeding  of  an  Esoph- 
ageal Varlx  Controlled  by  Oxycel,  546. 

Black,  B.  Marden,  Changing  Conceptions  in  the 
Management  of  Carcinoma  of  the  Left  Portion  of 
the  Colon,  726. 

Bond,  Douglas  D.,  Anorexia  Nervosa,  1012. 

Brown,  J.  Mackenzie,  Recent  Advances  in  the  Care 
of  the  Deafened,  1020. 

Castleton,  Kenneth  B.,  Carcinoma  of  the  Colon,  119. 

Chapman,  Edward  N.,  The  Medical  Care  of  Tubercu- 
losis by  the  State  of  Colorado,  115. 

Childs,  Samuel  B.,  Surgical  Diseases  of  the  Thyroid 
Gland,  734. 

Clapper,  Merle  M.,  The  Distribution  of  Physicians 
and  Physicians’  Services  in  Colorado  in  1S48,  296. 

Cleere,  Roy  L.,  Present  Administrative  Organization 
and  New  Programs,  918. 

Coakley,  Leo  P.,  The  Allergic  Nasa;i  Syndrome,  125. 

Condon,  William  B.,  Chronic  Empyema,  Present  Con- 
cepts of  Treatment,  206. 

Coppinger,  W.  R.,  Surgical  Gastro-Ilestomy,  306. 

Crago,  F.  H.,  Hemochromatosis  With  Aplastic  or 
Refractory  Anemia,  32. 

Cragun,  W.  E.,  Acute  Intussusception  Due  to  Tor- 
sion of  Meckel’s  Diverticulum,  291. 

Crisp,  William  H.,  The  Psychology  of  the  Poor 
Reader,  833. 

Darley,  Ward,  The  Distribution  of  Physicians  and 
Physicians’  Services  in  Colorado  in  1948,  296. 

DeCosta,  Edwin  J.,  Prolonged  Labor,  371. 

Dodge,  H.  J.,  The  Distribution  of  Physicians  and 
Physicians’  Services  in  Colorado  in  1948,  296. 

Dolowitz,  David  A.,  Severe  Bleeding  of  an  Esopha- 
geal Varix  Controlled  by  Oxycel,  546. 

Downs,  Robert  A.,  Some  Phases  of  the  Program  of 
Public  Health  Dentistry,  921. 

Duffy,  B.  J.,  Jr.,  The  Chemotherapy  of  Cancer,  284. 

Ebaugh,  Franklin  G.,  A Psychiatrist'  Looks  at  Com- 
pulsory Health  Insurance,  364. 

English,  O.  Sturgeon,  Psychological  Factors  in  Ev- 
eryday Practice,  21. 

Fltz,  Reginald,  Speculum  Medici,  908. 

Forsee,  James  H.,  Extrapleural  Thoracoplasty  Early 
in  Caseopneumonic  Tuberculosis,  452. 


Freedman,  Robert  J.,  Unusual  Metastatic  Manifesta- 
tions of  Silent  Gastric  Carcinoma,  210. 

Freudenberger,  C.  B.,  Surgical  Treatment  of  Herma- 
phroditism, 1024. 

Fuller,  Harold  W.,  Review  of  Management  of  Per- 
sistent Occiput  Posterior  Positions,  1027. 

Gamble,  Clarence  J.,  Protective  Sterilization  in  the 
Rocky  Mountain  States,  564. 

Geever,  Erving  F.,  Fatal  Chronic  Peptic  Ulcer  in 
the  Aged,  553. 

Generelli,  Joseph  A.,  Remote  Recording  of  Physio- 
logical Data  by  Radio,  74'7. 

Gillaspie,  John  D.,  The  Treatment  of  Status  Asth- 
maticus  With  Intravenous  Ethyl  Alcohol,  547. 

Goldman,  Harold  I.,  Clinical  Investigation  of  Oen- 
ethyl  Mucate,  220. 

Gordon,  Harry  H.,  Colorado  Premature  Infant  Care 
Program,  650. 

Hall,  Earl  L.,  Review  of  Management  of  Persistent 
Occiput  Posterior  Positions,  1027. 

Hannett,  J.  W.,  Some  Observations  Relating  to  Re- 
cently Proposed  Legislation  in  the  Congress  of 
the  United  States,  448. 

Harmston,  G.  J.,  Acute  Intussusception  Due  to  Tor- 
sion of  Meckel’s  Diverticulum,  291. 

Hatch,  F.  F.,  The  Combined  Procedure  of  Vagotomy 
and  Partial  Gastric  Resection  in  the  Treatment 
of  Peptic  Ulcer,  460. 

Hildebrand,  Eugene,  Hemochromatosis  With  Aplas- 
tic or  Refractory  Anemia,  32. 

Holmes,  C.  L.,  Fluid,  Electrolyte  and  Protein  Bal- 
ance in  the  Surgical  Patient,  377. 

Holter,  Norman  J.,  Remote  Recording  of  Physio- 
logical Data  by  Radio,  747. 

Humphrey  Fred  A.,  Presidential  Address,  828. 

Humphrey,  Fred  A.,  The  Rural  Health  Program,  638. 

Ingraham,  C.  B.,  Certain  Aspects  of  the  Uterine 
Cervix  Cancer  Problem  in  Colorado,  214. 

Ireland,  P.  M.,  Surgical  Gastro-Ileostomy,  306. 

Jeppson,  E.  M.,  Familial  Leg’  Ache  in  Children,  288. 

Johnson,  Alexander  C.,  The  Use  and  Abuse  of  Spinal 
Puncture  and  Cerebrospinal  Fluid  Studies,  730. 


Johnson,  Delmer 
740. 

E., 

Botulism 

in  Human 

Beings, 

Johnson,  Marvin 

E., 

Chronic 

Empyema, 

Present 

Concepts  of  Treatment,  206. 

King,  J.  A.,  The  Sanitation  Program  in  Colorado, 
924. 

LaBarge,  Oza  J.,  Unusual  Metastatic  -Manifestations 
of  Silent  Gastric  Carcinoma,  210. 

Laff,  Herman  I.,  Otology  in  General  Practice,  914. 

Layne,  John  A.,  Hemochromatosis  With  Aplastic  or 
Refractory  Anemia,  32. 

Learned,  Leland  O.,  A General  Review  of  Nitrous 
Oxide  Anesthesia,  201. 

Lichty,  John  A.,  Colorado  Premature  Infant  Care 
Program,  650. 

Lig’gett,  Robert  S.,  Incidence  of  Homologous  Serum 
Jaundice  in  Recipients  of  Blood  Products  Prom 
the  Belle  Bonfils  Memorial  Blood  Bank,  845. 

Loder,  Roland  H.,  Local  Health  Departments  and 
the  Physician,  926. 

Lowell,  E.  J.,  Jr.,  Surgical  Significance  of  the  Non- 
Functioning  Gall  Bladder,  1033. 

Mahan,  Thomas  K.,  Carcinoma  of  the  Skin,  38. 

Maternal  and  Child  Welfare'  Committee  of  the  Mon- 
tana State  Medical  Association  and  the  Maternal 
and  Child  Health  Division  of  the  Montana  State 
Board  of  Health,  Maternal  Deaths  in  Montana, 
836. 


McBride,  Earl  D.,  Low  Back  Pain,  631. 

McPhail,  Frank  L.,  Review  of  Management  of  Per- 
sistent Occiput  Posterior  Positions,  1027. 

iMiddleton,  William  S.,  Current  Therapeutic  Proce- 
dures in  Coronary  Disease,  27. 

Miller,  Joseph  H.,  A Simple  Bedside  Method  for  the 
Determination  of  Plasma  Salicylate,  544. 

Morflt,  H.  Mason,  Perspective  in  Cancer  Research, 
5i59. 

Mundt,  Raymond,  Inversion  of  the  Uterus,  3 6. 

Nelson,  Woodrow,  The  Combined  Procedure  of  Va- 
gotomy and  Partial  Gastric  Resection  in  the 
Treatment  of  Peptic  Ulcer,  460. 

Ogilvie,  Oron  A.;  Surgical  Treatment  of  Hermaph- 
roditism, 1024. 

Overton,  Lewis  M.,  Colles’  Fracture,  842. 

Patton,  John  F.,  Bladder  Neck  Obstruction  in  Women 
and  Children,  540. 

Ramer,  Samuel  M.,  Jejuno-Ileal  Diverticula,  301. 

Rosenblum,  Philip,  Cancer  in  Infancy  and  Child- 
hood, 109. 

Rymer,  Marion  R.,  Incidence  of  Homologous  Serum 
Jaundice  in  Recipients  of  Blood  Products  From 
the  Belle  Bonfils  Memorial  Blood  Bank,  845. 

Sawyer,  Kenneth  C.,  Massive  Resection  of  the  Small 
Intestine  Due  to  Volvulus  With  Multiple  Diver- 
ticula of  the  Jejunum,  223. 

Sears,  Thad  P.,  Isotopes  and  the  New  Alchemy,  931. 

Shields,  Claude  L.,  Malignancy  Records,  43. 

Shields,  Claude  L.,  Surgical  Treatment  of  Hermaph- 
roditism, 1024. 

Slnton,  Eleanor,  Certain  Aspects  of  the  Uterine 
Cervix  Cancer  Problem  in  Colorado,  214. 

Smith,  G.  Paul,  A Clinical  Study  of  Auricular  Flut- 
ter, 130. 

Smith,  Lloyd,  Unusual  Metastatic  Manifestations  of 
Silent  Gastric  Carcinoma,  210. 

Soland,  Louis  W.,  Massive  Resection  of  the  Small 
Intestine  Due  to  Volvulus  With  Multiple  Diver- 
ticula of  the  Jejunum,  223. 

Stampfli,  Wendell  J.,  General  Principles  in  the 
Treatment  of  Superficial  Carcinoma,  647. 

Stevenson,  Thomas  W.,  Surgical  Treatment  of  X-Ray 
Burns,  198. 

Stiles,  Geo.  W.,  Botulism  in  Human  Beings,  740. 


Stiles,  Geo.  W.,  The  Brucellosis  Problem,  124. 

Stubben,  Owen  B.,  The  Hospital  Administrator’s 
Appraisal  of  Current  Nursing  Problems,  197. 

Swan,  Henry,  Congenital  Tracheo-Esophageal  Fis- 
tula, 221. 

Sweet,  William  H.,  Recent  Impressions  of  Medical 
Practice  in  Great  Britain,  307. 

Swiigert,  William  B..  “Eleoma”  of  the  Rectum,  739. 

Taylor,  E.  Stewart,  Certain  Aspects  of  the  Uterine 
Cervix  Cancer  Problem  in  Colorado,  214. 

Thompson,  Harold  Clark,  Trauma  as  Alleged  Cause 
of  Appendicitis  in  Compensation  Cases,  367. 

Thorek,  Philip,  Intestinal  Obstruction,  627. 

Trimpi,  Howard  D.,  Anterior  Resection  or  Abdomino- 
perineal Proctosigmoidectomy  for  Carcinoma  of 
the  Rectum,  716. 

Van  Allen,  M.  W.,  Extradural  Hemorrhage,  549. 

Walker,  William  C.,  Severe  Bleeding  of  an  Esopha- 
geal Varix  Controlled  by  Oxycel,  546. 

Warren,  Shields,  Biologic  Aspects  of  Atomic  Energy, 
937. 

Warren,  Shields,  Medicolegal  Aspects  of  Radiation 
Injury,  936. 

Watts,  Randolph  E.,  Jejuno-Ileal  Diverticula,  301. 

Weaver,  J.  A.,  Jr.,  Acute  Diffuse  Interstitial  Fibro- 
sis of  the  Lung,  751. 

Weaver,  J.  A.,  Jr.,  Pneumatic  Rupture  of  the  Bowel, 
218. 

Weiker,  Alax  L.,  Improvement  in  Patients’  General 
Condition  After  Application  of  Skin  Test  for  Bru- 
cellosis, 649. 

Welden,  Joseph  E.,  A Clinical  Study  of  Auricular 
Flutter,  130. 

Whitehead,  Richard  W.,  A Simple  Bedside  Method 
for  the  Determination  of  Piasma  Salicylate,  544. 

Wills,  C.  B.,  The  Use  of  Nisulfazole  in  the  Treatment 
of  Ulcerative  Colitis,  743. 

Witham,  Ray  G.,  Massive  Resection  of  the  Small  In- 
testine Due  to  Volvulus  With  Multiple  Diverticula 
of  the  Jejunum,  223. 

Woltman,  Henry  W.,  The  Different  Diagnosis  of 
Poliomyelitis,  620. 

Wright,  F.  Howell,  Purulent  Meningitis  in  Child- 
hood, 718. 

Young,  Raymond  L.,  Trichomoniasis  in  the  Male, 
928. 


SUBJECT  INDEX,  VOLUME  XLVI 


Acute  Diffuse  Interstitial  Fibrosis  of  the  Lung: 
Case  Report  (Weaver),  751. 

Acute  Intussusception  Due  to  Torsion  of  Meckel’s 
Diverticulum  (Harmston  and  Cragun),  291. 

Allergic  Nasal  Syndrome,  the  (Coakley),  125. 

American  War  Hospitals  in  England'  (editorial),  IS. 

Anemia,  Hemochromatosis  With  Aplastic  or  Re- 
fractory (Hildebrand,  Crago  and,  Layne),  32. 

Anesthesia,  A General  Review  of  Nitrous  Oxide 
(Learned),  201. 

Anorexia  Nervosa  (Bond),  1012. 

Anterior  Resection  or  Abdominoperineal  Procto- 
sigmoidectomy for  Carcinoma  of  the  Rectum 
(Bacon  and  Trimpi),  716. 

Appendicitis  in  Compensation  Cases,  Trauma  as 
Alleged  Cause  of  (Thompson),  367. 

Appendix  Vermiformis,  Primary  Lymphosarcoma  of 
the:  Case  Report  (Almas),  567. 

Asthmaticus  With  Intravenous  Ethyl  Alcohol,  The 
Treatment  of  Status  (Gillaspie),  547. 

Atomic  Energy,  Biologic  Aspects  of:  Abstract  (War- 
ren), 937. 

Atomic  Energy  (edtiorial),  446. 

Auricular  Flutter,  A Clinical  Study  of  (Simith  and 
Welden),  130. 

Belle  Bonfils  Memorial  Blood  Bank,  Incidence  of 
Homologous  Serum  Jaundice  in  Recipients  of 
Blood  Products  From  the  (Liggett  and  Rymer), 
845. 

Better  Than  We  Could  Do  It  (editorial),  105. 

Biologic  Aspects  of  Atomic  Energy:  Abstract  (War- 
ren), 937. 

Bladder  Neck  Obstruction  in  Women  and  Children 
(Patton),  540. 

Board  of  Supervisors  of  the  Colorado  State  Medical 
Society,  Revised  Rules  of  the,  944. 


Book  Notices 

Amesse,  John  W.,  History  of  the  Children's  Hospital 
of  Denver,  Colo.,  72. 

Anderson,  W.  A.  D.,  Pathology,  137. 

Barrow,  David  Woolfolk,  The  Cinical  Management 
of  Varicose  Veins,  114. 

Carling,  Ernest  Rock,  Sir,  British  Surgical  Practice, 
Volume  I,  46'8. 

Carling,  Ernest  Rock,  Sir,  British  Surgical  Practice, 
Volume  III,  768. 

Committee  on  Dietetics  of  the  Mayo  Clinic,  Mayo 
Clinic  Diet  Manual,  32'6. 

Crile,  George,  Jr.,  Practical  Aspects  of  Thyroid  Dis- 
ease, 774. 

Dunbar,  Flanders,  Synopsis  of  Psychosomatic  Diag- 
nosis and  Treatment,  205. 

Gordon,  Maurice  Bear,  Aesculapius  Comes  to  the 
Colonies.  The  Story  of  the  Early  Days  of  Medi- 
cine in  the  Thirteen  Original  Colonies,  468. 

Hepler,  Opal  E.,  Manual  of  Clinical  Laboratory  Meth- 
ods, 1064. 

Hill,  Frederick  C.,  Operative  Surgery,  1062. 

Judovich,  Bernard,  Pain  Syndromes,  Treatment  by 
Paravertebral  Nerve  Block,  770. 

Kleiner,  Israel  S.,  Human  Biochemistry,  1062. 

Licbt,  Sidney,  Occupational  Therapy  Source  Book, 


Luisada,  Aldo  A.,  Heart:  A Physiologic  and  Clinical 
Study  of  Cardiovascular  Diseases,  240. 

Lyons,  William  R.,  Atlas  of  Peripheral  Nerve  In- 
juries, 1064. 


Marshall,  James,  The  Skin  Disease,  A Manual  for 
Practitioners  and  Students,  137. 

Merrill,  Vinita,  Atlas  of  Roentgenological  Positions, 
Volumes  I and  II,  1060. 

Pack,  George  T.,  Cancer  of  the  Esophagus  and  Gas- 
tric Cardia,  1062. 

Rubenstein,  I.  H.,  Contemporary  Religious  Juris- 
prudence, 766. 

Sadler,  William  S.,  A Doctor  Talks  to  Teen-Agers. 
A Psychiatrist’s  Advice  to  Youth,  240. 

Sadler,  William  S.,  Adolescence  Problems.  A Hand- 
book for  Physicians,  Parents  and  Teachers,  240. 

Shands,  Alfred  Rives,  Jr.,  Handbook  of  Orthopedic 
Surgery,  488. 

Smith,  Philip  E.,  Bailey’s  Text-Book  on  History,  72. 

Speed,  J.  S.,  Campbell’s  Operative  Orthopedics,  Vol- 
umes 1 and  2,  1064. 

Sutton,  Richard  L.,  Handbook  of  Diseases  of  the 
Skin,  490. 

Truex,  Raymond  C.,  Detailed  Atlas  of  the  Head,'  and 
Neck,  246. 

Turner,  C.  E.,  Personal  and  Community  Health,  242. 

Turner,  Donnel,  General  Endocrinology,  72. 

’(''aughan,  Warren  T.,  Practice  of  Allergy,  72. 

Yater,  Wallace  Mason,  Fundamentals  of  Internal 
Medicine,  1060. 

760,  827,  1056. 

48,  138,  226,  310,  384,  482,  570,  654,  756,  850,  944,  1036. 

Botulism  in  Human  Beings  (Johnson  and  Stiles),  740. 

Bowel,  Pneumatic  Rupture  of  the  (Weaver),  218. 

British  National  Health  Service,  the  (editorial),  906. 

Brucellosis,  Improvement  in  Patients’  General  Con- 
dition After  Application  of  Skin  Test  for  (Weiker), 
649. 

Brucellosis  Problem,  the  (Stiles),  124. 

Burns,  Surgical  Treatment  of  X-Ray  (Stevenson), 
198. 

Cancer  Consciousness  (editorial),  106. 

Cancer  in  Infancy  and  Childhood  (Rosenblum),  109. 

Cancer  Problem  in  Colorado,  Certain  Aspects  of  the 
Uterine  Cervix  (Ingraham,  Taylor  and  Sinton), 
214. 

Cancer  Research,  Perspective  in  (Morfit),  559. 

Cancer,  The  Chemotherapy  of  (Duffy),  284. 

Carcinoma,  General  Principles  in  the  Treatment  of 
Superficial  (Stampfli),  647. 

Carcinoma  of  the  Colon  (Castleton),  119. 

Carcinoma  of  the  Left  Portion  of  the  Colon,  Chang- 
ing Conceptions  in  the  Management  of  (Black), 
726. 

Carcinoma  of  the  Rectum,  Anterior  Resection  or 
Abdominoperineal  Proctosigmoidectomy  for  (Ba- 
con and  Trimpi),  716. 

Carcinoma  of  the  Skin  (Mahan),  38. 

Carcinoma,  Unusual  Metastatic  Manifestations  of 
Silent  Gastric  (Smith,  Freedman  and  LaBarge), 
210. 

Certain  Aspects  of  the  Uterine  Cervix  Cancer  Prob- 
lem in  Colorado  (Ingraham,  Taylor  and  Sinton), 
214. 

Challenge  We  Must  Meet,  the  (editorial),  194. 

Changing  Conceptions  in  the  Management  of  Car- 
cinoma of  the  Left  Portion  of  the  Colon  (Black), 
726. 

Chemotherapy  of  Cancer,  the  (Duffy),  284. 

Cholecystitis,  Management  of  Acute  (Barber),  293. 

Chronic  Empyema,  Present  Concepts  of  Treatment 
(Condon  and  Johnson),  206. 

Clear  Speaking  Better  Than  Debates  (editorial),  361. 


Clinical  Investigation  of  Oenethyl  Mucate  (Gold- 
man), 220. 

Clinical  Study  of  Auricular  Flutter,  a (Smith  and 
Welden),  130. 

Colitis,  The  Use  of  Nisulfazole  in  the  Treatment  of 
Ulcerative  CWill.s),  743. 

Colles’  Fracture  (Overton),  842. 

Colon,  Carcinoma  of  the  (Castleton),  119. 

Colon,  Changing  Conceptions  in  the  Management  of 
Carcinoma  of  the  Left  Portion  of  the  (Black),  726. 

Colorado  Hospital  Association,  62. 

Colorado  Medical  School  Notes,  58,  392,  758,  950. 

Colorado  Premature  Infant  Care  Program  (Gordon 
and  Lichty),  650. 

Colorado  State  Health  Department,  390,  486,  572,  674, 
760,  827,  1056. 

Colorado  State  Medical  Society;  Organization  News 
48,  138,  226,  248,  310,  384,  482,  570,  654,  756,  850, 
944,  1036. 

Colorado  Veterinary  Public  Health  Program  (Baum), 
923. 

Combined  Procedure  of  Vagotomy  and  Partial  Gas- 
tric Resection  in  the  Treatment  of  Peptic  Ulc6r, 
the  (Hatch,  Nelson  and  Baueriein),  460. 

Compulsory  Health  Insurance,  A Psychiatrist  Looks 
at  (Ebaugh),  364. 

Congenital  Tracheo-Esophageal  Fistula:  Case  Report 
(Swan),  221. 

Coronary  Disease,  Current  Therapeutic  Procedures 
in  (Middleton),  27. 

Correspondence,  20,  107,  539,  942. 

Current  Therapeutic  Procedures  in  Coronary  Diseases 
(Middleton),  27. 

Deafened,  Recent  Advances  in  the  Care  of  the 
(Brown),  1020. 

Deaths:  See  List  of  Deaths  at  End  of  Letter  D. 

Differential  Diagnosis  of  Poliomyelitis,  the  (Wolt- 
man),  620. 

Disaster  Needs  Educated  Doctors  (editorial),  447. 

Distribution  of  Physicians  and  Physicians’  Services 
in  Colorado  in  1948,  the  (Dodge,  Clapper  and  Dar- 
ley),  296. 

Diverticula,  Jejuno-Ileal  (Watts  and  Ramar),  301. 

Diverticula  of  the  Jejunum,  Massive  Resection  of 
the  Small  Intestine  Due  to  Volvulus  With  Multiple: 
Case  Report  (Sawyer,  Soland  and  Witham),  223. 

Diverticulum,  Acute  Intussusception  Due  to  Torsion 
of  Meckel’s  (Harmston  and  Cragun),  291. 


Deaths 

Amesse,  John  W.,  852. 
Apperson,  Edwin  L.,  950. 
Bingham,  William  J.,  484. 
Boutelle,  Louise  E.,  58. 

Brown,  Robert  Osgood,  230. 
Canby,  Henry  S.,  950. 

Cannon,  William  T.,  576. 
Currigan,  Martin  D.,  570. 
Davis,  John  B.,  142. 

Davlin,  Charles  A.,  1054. 
Epler,  Crum,  228. 

Feld,  David  D.,  756. 

Gerber,  Charles  W.,  866. 
Gilmore,  George  B.,  54. 


Good,  Brooks  D.,  54.  ; 

■ [ 

Groves,  Dale  O.,  54. 

Hagan,  John  Waldo,  986.  • i 

Hick,  Lawrence  A.,  756. 

Hills,  Willard  K.,  484. 

Jaffa,  Bertram  B.,  142. 

Kirtley,  Howard  Pendleton,  486. 

Krueger,  Edward  H.,  570. 

Lannon,  Arthur  R.,  386. 

Lawrence,  David  Henry,  54. 

Leland,  Roscoe  Genung,  1054. 

« 

Lilia,  Robert  S.,  54. 

Marsh,  Donald  Burr,  954. 

McHugh,  Frank  M.,  58. 

Monaco,  Donat  F.,  954. 

Morrison,  Robert  G.,  570. 

Ogilvie,  Orin  A.,  1054. 

Rothwell,  Augusta,  852. 

St.  Clair,  Charles  A.,  952. 

Seidner,  M.  J.,  758. 

Singer,  William  F.,  54. 

Spicer,  Charles  M.,  312. 

Starr,  Roert  P.  E.,  54. 

Stevens,  John  L.,  852. 

Stratton,  Mary  Reed,  386. 

Wherritt,  W.  R.,  60. 

Wilson,  Edwin  M.,  230. 

Wohlauer,  Franz  F.,  852. 

“Eleoma”  of  the  Rectum  (Swigert),  739. 

Empyema,  Chronic,  Present  Concepts  of  Treatment 
(Condon  and  Johnson),  206. 

Esophageal  Varix  Controlled  by  Oxycel,  Severe 
Bleeding  of  an  (Dolowitz,  Walker  and  Benson), 

546. 

Ethylene  Disulfonate  and  Hemolytic  Disease  of  the 
Newborn;  Case  Report  (Barglow).  938. 

Extradural  Hemorrhage  (Van  Allen),  549. 

Extrapleural  Thoracoplasty  Early  in  Caseopneumonic 
Tuberculosis  (Forsee),  452. 

Familial  Leg'  Ache  in  Children  (Jeppson),  288. 

Fatal  Chronic  Pej^tic  Ulcer  in  the  Aged  (Geever),  553. 

Fate  of  Damaged  Mammary  Ducts  (editorial),  714. 

Find  That  Diabetic!  (editorial),  809. 

First-hand  Information  (editorial),  617. 

Fishbein  Era  Draws  to  a Close,  the  (editorial),  537. 

Fluid,  Electrolyte  and  Protein  Balance  in  the  Sur- 
gical Patient  (Holmes),  377. 

Fourteenth  Annual  Midwinter  Clinics  (editorial). 

281. 

Further  Experience  With  Methergine  as  an  Oxytocic 
(Baskin),  304. 

Gall  Bladder,  Surgical  Significance  of  the  Non- 
Funcioning  (Dowell),  1033. 

Gallstone,  Obstruction  of  the  Bowel  Due  to:  Case 
Report  (Beebe),  940. 

Gastro-Ilestomy,  Surgical:  Case  Report  (Coppinger 
and  Ireland),  306. 


1 


Gastro-Intestinal  Disorders,  Psychosomatic  Aspects 
of  (Barnacle),  642. 

General  Principles  in  the  Treatment  of  Superficial 
Carcinoma  (Stampfli),  647. 

General  Review  of  Nitrous  Oxide  Anesthesia,  a 
(Learned),  201. 

Hermaphroditism,  Surgical  Treatment  of  (Shields, 
Freudenberger  and  Ogilvie),  1024. 

Hemochromatosis  With  Aplastic  or  Refiactory 
Anemia  (Hildebrand,  Crago  and  Layne),  32. 

Hemolytic  Disease  of  the  Newborn,  Ethylene  Di- 
sulfonate and:  Case  Report  (Barglow),  938. 

Hemorrhage,  Extradural  (Van  Allen),  549. 

Henry  Sewall  Memorial  Lecture,  the  (editorial),  195. 

Homologous  Serum  Jaundice  in  Recipients  of  Blood 
Products  From  the  Belle  Bonfils  Memorial  Blood 
Bank,  Incidence  of  (Liggett  and  Rymer),  845. 

Hospital  Administrator’s  Appraisa,!  of  Current  Nurs- 
ing Problems,  the  (Stubben),  197. 

“I  Am  the  State”  (editorial),  905. 

Improvement  in  Patient’s  General  Condition  After 
Application  of  Skin  Test  for  Brucellosis  (Weiker), 
649. 

Incidence  of  Homologous  Serum  Jaundice  in  Re- 
cipients of  Blood  Products  From  the  Belle  Bonfils 
Memorial  Blood  Bank  (Liggett  and  Rymer),  845. 

Incidence  of  Poliomyelitis  (editorial),  619. 

Indemnity  Plans  (editorial),  362. 

Infant  Care  Program,  Colorado  Premature  (Gordon 
and  Lichty),  650. 

Interim  Session,  Montana  State  Medical  Association, 
142. 

Intestinal  Obstruction  (Thorek),  627. 

Inversion  of  the  Uterus  (Mundt),  36. 

Isotopes  and  the  New  Alchemy  (Sears  and  Allen), 


It’s  Time  to  Buy  Christmas  Seals  (editorial),  1099. 

Jejuno-Ileal  Diverticula  (Watts  and  Ramer),  301. 

Labor,  Prolonged  (DeCosta),  371. 

Legislation  in  the  Congress  of  the  United  States, 
Some  Observations  Relating  to  Recently  Proposed 
(Hannett),  448. 

Let’s  Go  to  Washington!  (editorial),  907. 

Local  Health  Departments  and  the  Physician  (Lo- 
der),  926. 

Logical  and  Totally  Selfish  Deduction,  a (editorial), 
281. 

Low  Back  Pain  (McBride),  631. 

Lung,  Acute  Diffuse  Interstitial  Fibrosis  of  the: 
Case  Report  (Weaver),  751. 

Malignancy  Records  (Shields),  43. 

Management  of  Acute  Cholecystitis  (Barber),  293. 

Massive  Resection  of  the  Small  Intestine  Due  to 
Volvulus  With  Multiple  Diverticula  of  the  Je- 
junum: Case  Report  (Sawyer,  Soland  and  With- 
am),  223. 

Maternal  Deaths  in  Montana  (Maternal  and  Child 
Welfare  Committee  of  the  Montana  State  Medical 
Association  and  the  Maternal  and  Child  Health 
Division  of  the  Montana  State  Board  of  Health). 

fi  O C * * 


Medical  Care  of  Tuberculosis  by  the  State  of  Colo- 
rado, the  (Chapman),  115. 

Medical  Radio  Programs  (editorial),  194. 

Medical  Reporting  in  the  Lay  Press  (editorial),  713. 

Medical  Service  Bureau  of  the  Utah  State  Medical 
Association  Summary  of  the  Minutes  of  the  An- 
nual Stockholders  Meeting,  146. 


Medical  Service  to  the  Armed  Forces  (editorial),  282. 

Medicolegal  Aspects  of  Radiation  Injury:  Abstract 
(Warren),  936. 

Medicine  Through  a Knot  Hole  (editorial),  538. 

Meningitis  in  Childhood,  Purulent  (Wright),  718. 

Methergine  as  an  Oxytocic,  Further  Experience  With 
(Baskin),  304. 

Minutes  of  the  Annual  Stockholders  Meeting,  Sum- 
mary of.  Medical  Service  Bureau  of  the  Utah  State 
Medical  Association,  146. 

Minutes  of  the  House  of  Delegates,  Fifty-Fifth  An- 
nual Meeting,  Utah  State  Medical  Association,  972. 

Minutes  of  the  House  of  Delegates,  Seventy-first  An- 
nual Session,  Montana  State  Medical  Association, 
866,  954. 

Minutes  ot  the  House  of  Delegates,  Seventy-ninth 
Annual  Session,  Colorado  State  Medical  Society, 
1036. 

Minutes  of  the  House  of  Delegates,  Sixty-seventh 
Annual  Session,  New  Mexico  Medical  Society,  854. 

Minutes  of  the  Interim  Meeting,  House  of  Dele- 
gates, Montana  State  Medical  Association,  392. 

Mismanagement  of  Burns  (editorial),  446. 

Montana,  Maternal  Deaths  in  (Maternal  and  Child 
Welfare  Committee  of  the  Montana  State  Medical 
Association  and  the  Maternal  and  Child  Health 
Division  of  the  Montana  State  Board  of  Health), 
836. 

Montana  State  Medical  Association:  Organization 
News,  142,  230,  392,  866,  954. 

Nasal  Syndrome,  The  Allergic  (Coakley),  125. 

National  Affairs:  Organization  News,  384,  482,  944. 

New  Mexico  Looks  to  the  Future  (editorial),  445. 

New  Mexico  Medical  Society:  Organization  News, 
142,  230,  314,  390,  756,  854,  954. 

New  Style  for  Medical  Publications,  a (editorial), 
618. 

Nitrous  Oxide  Anesthesia,  A General  Review  of 
(Learned),  201. 

Now  That  Vacation  Days  Are  Over  (editorial),  714. 

Nursing  Problems,  The  Hospital  Administrator’s  Ap- 
praisal of  Current  (Stubben),  197. 

Obstruction  of  the  Bowel  Due  to  Gallstone:  Case 
Report  (Beebe),  940. 

Otology  in  General  Practice  (Laff),  914. 

Perspective  in  Cancer  Research  (Morfit),  559. 

Perverted  Emotional  Outlets  (editorial),  1011. 

Plasma  Salicylate,  A Simple  Bedside  Method  for  the 
Determination  of  (Miller  and  Whitehead),  544. 

Pneumatic  Rupture  of  the  Bowel  (Weaver),  218. 

Poliomyelitis,  the  Differential  Diagnosis  of  (Wolt- 
man),  620. 

Present  Administrative  Organization  and  New  Pro- 
grams (Cleere),  918. 

Presidential  Address  (Humphrey),  828. 

Prevention  and  Treatment  of  Rocky  Mountain 
Spotted  Fever  (Baker),  812. 

Primary  Lymphosarcoma  of  the  Appendix  Vermi- 
formis:  Case  Report  (Almas),  567 

Program,  Colorado  State  Medical  Society,  Seventy- 
ninth  Annual  Session,  654. 

Program,  New  Mexico  Medical  Society  Convention, 
314. 

Program,  Preliminary,  Fourteenth  Annual  Midwinter 
Postgiaduate  Clinics  of  the  Colorado  State  Medical 
Society,  138. 

Program,  Rocky  Mountain  Medical  Conference,  469. 


Program,  Second  Rocky  Mountain  Anesthesiological 
Conference,  850. 

Program,  The  Rocky  Mountain  Radiological  So- 
ciety, 568. 

Program,  The  Second  Cancer  Symposium,  Salt  Lake 

' City,  Utah,  318. 

Program,  Utah  State  Medical  Association,  Fifty- 
fourth  Annual  Meeting,  668. 

Program,  Western  Colorado  Springs  Clinics,  226. 

Program,  Wyoming  State  Medical  Society,  Forty- 
sixth  Annual  Meeting,  670. 

Prolonged  Labor  (DeCosta),  371. 

Protective  Sterilization  in  the  Rocy  Mountain  States 
(Gamble),  564. 

Psychiatrist  Looks  at  Compulsory  Health  Insurance, 
a (Ebaugh),  364. 

Psychological  Factors  in  Everyday  Practice  (Eng- 
lish), 21. 

Psychology  of  the  Poor  Reader,  the  (Crisp),  833. 

Psychosomatic  Aspects  of  Gastro-Intestinal  Disor- 
ders (Barnacle),  642. 

Public  Health  Dentistry,  Some  Phases  of  the  Pro- 
gram of  (Downs),  921. 

Public  Health  Progress  in  Colorado:  A Symposium 
(Cleere,  Downs,  Baum,  King  and  Loder),  918. 

Publication  Policies,  a Reminder  (editorial),  193. 

Purulent  Meningitis  in  Childhood  (Wright),  718. 

Radiation  Injury,  Medicolegal  Aspects  of:  Abstract 
(Warren),  936. 

Recent  Advances  in  the  Care  of  the  Deafened 
(Brown),  1020. 

Recent  Impressions  of  Medical  Practice  in  Great 
Britain:  Abstract  (Sweet),  307. 

Rectum,  Anterior  Resection  of  Abdominoperineal 
Proctosigmoidectomy  for  Carcinoma  of  the  (Bacon 
and  Trimpi),  716. 

Rectum,  “Eleoma”  of  the  (Swigert),  739. 

Remote  Recording  of  Physiological  Data  by  Radio 
(Holter  and  Generelli),  747. 

Report  From  London  (editorial),  618. 

Review  of  Management  of  Persistent  Occiput  Pos- 
terior Positions  (Puller,  Hall  and  McPhail),  1027. 

Ringworm  of  the  Scalp  (editorial),  905. 

Rocky  Mountain  Medical  Conference,  Program  469. 

Rocky  Mountain  Spotted  Fever,  Prevention  and 
Treatment  of  (Baker),  812. 

Rural  Health  Program,  the  (Humphrey),  638. 

Sanitation  Program  in  Colorado,  the  (King),  924. 

Severe  Bleeding  of  an  Esophageal  Varix  Controlled 
by  Oxycel  (Dolowitz,  Walker  and  Benson),  546. 

Short  Scientific  Papers  (editorial),  811. 

Silhouettes  from  the  A.M.A.  House  of  Delegates,  19, 
106,  196,  282,  363,  538,  619,  715. 

Simple  Bedside  Method  for  the  Determination  of 
Plasma  Salicylate,  a (Miller  and  Whitehead),  544. 

Some  Observations  Relating  to  Recently  Proposed 
Legislation  in  the  Congress  of  the  United  States 
(HJannett),  448. 

Some  Phases  of  the  Program  of  Public  Health  Den- 
tistry (Downs),  921. 

Speculum  Medici  (Fitz),  908. 

Spinal  Puncture  and  Cerebrospinal  Fluid  Studies, 
The  Use  and  Abuse  of  (Johnson),  730. 


Sterilization  in  the  Rocky  Mountain  States,  Pro- 
tective (Gamble),  564. 

Sudden  Social  Change — A National  Catastrophe  (ed- 
itorial), 1009. 

Surgical  Diseases  of  the  Thyroid  Gland  (Childs),  734. 

Surgical  Gastro-IIestomy : Case  Report  (Coppinger 
and  Ireland),  306. 

Surgical  Significance  of  the  Non-Functioning  Gall 
Bladder  (Lowell),  .1033. 

Surgical  Treatment  of  Hermaphroditism  (Shields, 
Freudenberger  and  Ogilvie),  1024 

Surgical  Treatment  of  X-Ray  Burns  (Stevenson), 
198. 

Talc  Granuloma  (editorial),  539. 

This  Is  the  Month  to  Be  Generous  (editorial),  809. 

This  Is  Worth  Memorizing  (editorial),  17. 

Thyroid  Gland,  Surgical  Diseases  of  the  (Childs), 
734. 

Time  to  Stand  Up  and  Be  Counted!  (editorial),  445. 

Total  Socialization  in  England  (editorial),  17. 

Tracheo-Esophageal  Fistula,  Congenital:  Case  Re- 
port (Swan),  221. 

Trauma  as  Alleged  Cause  of  Appendicitis  in  Com- 
pensation Cases  (Thompson),  367. 

Treatment  of  Status  Asthmaticus  With  Intravenous 
Ethyl  Alcohol,  the  (Gillaspie),  547. 

Tribute  (editorial),  194. 

Trichomoniasis  in  the  Male  (Young),  928. 

Tuberculosis  Abstracts,  66,  236,  322,  406,  492,  578, 
676,  762,  880,  1066. 

Tuberculosis  by  the  State  of  Colorado,  the  Medical 
Care  of  (Chapman),  115. 

Tuberculosis,  Extrapleural  Thoracoplasty  Early  in 
Caseo-Pneumonic  (Forsee),  452., 

Twenty-five  Dollar  Assessment,  the  (editorial),  105. 

Ulcer  in  the  Aged,  Fatal  Chronic  Peptic  (Geever), 
553. 

Ulcer,  The  Combined  Procedure  of  Vagotom.y  and 
Partial  Gastric  Resection  in  the  Treatment  of 
Peptic  (Hatch,  Nelson  and  Bauerlein),  460. 

Unusual  Metastatic  Manifestations  of  Silent  Gastric 
Carcinoma  (Smith,  Freedman  and  LaBarge),  210. 

Use  and  Abuse  of  Spinal  Puncture  and  Cerebrospinal 
Fluid  Studies,  the  (Johnson),  730. 

Use  of  Nisulfazole  in  the  Treatment  of  Ulcerative 
Colitis,  the  (Wills),  743. 

Utah  Medical  School  Notes,  60,  986. 

Utah  State  Medical  Association:  Oranization  News, 
58,  146,  232,  318,  390,  486,  574,  668,  758,  972,  1056. 

Uterine  Cervix  Cancer  Problem  in  Colorado,  Certain 
Aspects  of  the  (Ingraham,  Taylor  and  Sinton),  214. 

Uterus,  Inversion  of  the  (Mundt),  36. 

Vagotomy  and  Partial  Gastric  Resection  in  the 
Treatment  of  Peptic  Ulcer,  The  Combined  Pro- 
cedure of  (Hatch,  Nelson  and  Bauerlein),  460. 

Veterinary  Public  Health  Program,  Colorado  (Baum), 
923. 

Washington  Front,  the  (editorial),  810. 

We  Suffer  a Major  Loss  (editorial),  106. 

Woman’s  Auxlliarv:  Colorado,  56,  140,  228,  312,  386, 
484,  570,  664,  952. 

Wyoming  State  Medical  Society:  Organization  News, 
60,  320,  488,  670. 


LUZIER'S  ETHICAL  COSMETIC  SERVICE 

Luzier’s  Fine  Cosmetics  and  Perfumes,  as  advertised  in  publications  of  the 
American  Medical  Association,  are  made  available  to  the  public  by  Cosmetic 
Consultants  who  assist  with  the  selection  of  suitable  shades  and  variations  of 
Luzier  products  and  suggest  how  the  various  preparations  should  be  applied  to 
obtain  the  best  results. 


What  amounts  to  a case  history  is  kept  for  each  patron,  so  that  when  there 
is  a history  or  suspicion  of  allergy,  detailed  information  is  available  to  doctors 
concerning  the  formulas  selected  for  the  individual,  and  in  specific  cases,  raw 
materials  may  be  obtained  for  testing. 

When  it  is  demonstrated  that  the  subject  is  sensitized  to  normally  harm- 
less ingredients  in  Luzier  preparations,  formulas  are  modified  when  possible  to 
eliminate  the  offenders.  This  service  (the  modification  of  formulas)  is  made 
available  to  Luzier  patrons  without  extra  charge. 

Luzier’s  Service  includes  a comprehensive  range  of  cosmetic  preparations 
for  facial  care,  body  care,  hair  and  scalp  care  and  the  care  of  the  hands;  also  a 
few  choice  perfumes  and  colognes. 


LUZIER  S FINE  COSMETICS  AND 


PERFUMES 


Distributed  in  Colorado  by: 


CECELIA  JENKINS 
P.  0.  Box  177 
Aguilar 


BAKER  & BAKER 
346  Palmer  St. 
Delta 


ELIZABETH  HASKIN 
649  Adams  St. 
Denver 


CECILE  ARMSTRONG 
1352  Jasmine  St. 
Denver 


FUNDERBURK  & FUNDERBURK 
324  So.  7th  St. 

Grand  Junction 


JOYCE  KILGORE 
250  Collins 
Pueblo 


SELMA  SOLLEE 
1426  Grand  Ave. 
Pueblo 


Distributed  in  Montana  and  Wyoming  by: 


MR.  W.  M.  HENLEY 
739  Burlington  Ave. 
Billings,  Montana 


PHIL  & FERN  PLILEY 
P.  O.  Box  902 
Laramie,  Wyoming 


WHITNEY  & WHITNEY 
1086  East  21st  So. 

Salt  Lake  City 
Phone  8-5810 


INEZ  L.  SCHULTZ 
256  E.  3rd  So. 

Apt.  213 
Salt  Lake  City 


WINNIE  BAIRD 
227  E.  1st  North 
Provo 

Phone  873-W 


Distributed 

CAROL  HOLT 
936  So.  1 2th  East 
Salt  Lake  City 
Phone  5-8633 


EDWARD  M. 
WILKINSON 
Box  209 
Cedar  City 


BLANCHE  G.  HALES 
Box  233 
Spanish  Fork 
Piione  106-J-4 


in  Utah  by: 

LUCILLE  LOVEWELL 
2690  Dearborn  St. 
Salt  Lake  City 
Phone  8-0521 


MAE  FARMER 
97  North  Grant  St. 
Midvale 
Phone  436-W 


ANNIS  B.  TRIBE 
734-23rd  St. 
Ogden 

Phone  2- 1 820 


RUTH  R.  THATCHER 
2293  Claybourne  St. 
Salt  Lake  City 
Phone  8-3751 

ALICE  QUINN 
248-5th  Ave. 

"•rice 


FRANK  C.  WHITE 

Box  908 

Ogden 

Phone  4-07 1 7 


■(' 


FOR  AN  INDIVIDUALIST 


PHYSICIANS  concerned  with  infant  feeding 
have  found  that  the  exceptional  flexibil- 
ity-nf-use  offered  by  Dextri-Maltose*  is  an 
important  advantage  in  adapting  formulas 
to  the  individual  requirements  of  the  baby. 

By  the  inclusion  of  Dextri-Maltose  in  ap- 
propriate amount,  the  caloric  value  and  car- 
bohydrate content  of  a formula  can  easily  be 
ad  justed. to  the  infant’s  special  needs. 

Sinc.e  the  physician  has  S forms  of  Dextri- 
Maltose  available,  an  individual  infant’s  for- 
mula may  be  changed  according  to  various 
clinical  or  physiologic  indications  without 
disturbance  of  his  routine. 

Being  a mixture  of  carbohydrates,  Dextri- 
Maltose  offers  special  qualities  of  digestibil- 
ity and  slowness  of  absorption.  Hence  it  is 
an  ideal  carbohydrate  for  use  m diarrhea  and 
other  gastrointestinal  disturbances. 


Dextri-Maltose  dissolves  rapidly  in  water  or 
milk.  It  can  be  used  in  your  preferred  method 
of  formula  preparation.  *T.M.Reg.U.S.Pat.O{f. 


DIRECTORY 

of 

DHEMBERS 


The  Colorado  State  Medical  Society 
The  Montana  State  Medical  Association 
The  New  Mexico  Medical  Society 
The  Utah  State  Medical  Association 
The  Wyoming  State  Medical  Society 


Supplement  to  Issue  of 

FEBRUARY 

1949 


I 


Directory  Price:  $1.50 


MEDICAL  SERVICE 

REPRESENTATIVES 

SOCIETY  OF  COLORADO 

Abbott  Laboratories  

SP.  0515 

Abbott  Laboratories 

J.  C.  Halasz 

SP.  2821 

Abbott  Laboratories 

FR.  9062 

Abbott  1 obomtoriAs 

Vjr  Y#»ngpr 

i.-ini  Holly  .';t. 

DE.  3002 

Ames  Co.,  Inc 

E.  M.  Kincaid 

Pine,  Colorado 

Armour  Laboratories  

E.  J.  Sierks 

CH.  0989 

Ayerst,  McKenna  & 

. 

Harrison,  Ltd 

F.  j,  prA^tnn 

SP.  8182 

Breon,  Geo.  A.  & Company... 

Claude  H*  Watson 

438  East  14th  Avenue 

MA.  5597 

Burroughs  Wellcome  & Co 

David  Brown 

1223  Milwaukee  St 

FR.  7851 

Burroughs  Wellcome  & Co 

. r F.  'Ihnft 

Eng.  2848-J 

Ciba  Pharmaceutical 

Products,  Inc 

.Aurora  1 1 25-J 

Carroll  Dunham  Smith 

Pharmacol  Co 

Lee  K.  Foster 

2960  Eudora  St 

FR.  7516 

Cole  Chemical  Co 

PE.  2288 

Flint,  Eaton  & Company 

M.  C.  Race 

2244  Ivy  St 

EA.  1334 

Harrower  Laboratory,  Inc 

GR.  2423 

Hoffmon-LaRochA 

EA.  5565 

Hoffman-LaRoche  

2000  So.  Kino Westwood  1152-J 

Kremers-Urban  Co. 

1310  Leyden  St,,  Apt.  306, 

DE.  9009 

Lakeside  Laboratories,  Inr. 

1371  Verbena  

DE.  2300 

Lakeside  Laboratories,  Inc, 

2250  Dahlia  St 

FR.  2085 

Lederle  Laboratories  Div 

4675  Osceola 

GL.  4980 

Lederle  Laboratories  Div 

....W.  Van  Anderson 

2432  So.  Clayton 

SH.  0773 

American  Cyanamid  Co. 

Lilly,  Eli  and  Company 

Fronk  M.  Fo^ntn 

1460  Jasmine  

DE.  9234 

Lilly,  Eli  and  Company 

....H.  L.  Harper 

EA.  3408 

Lilly,  Eli  and  Cnmpnny 

829  Fillmore  St 

DE.  4646 

Lilly,  Eli  and  Company 

....Russell  M.  Mead 

959  So.  York  St 

PE.  9172 

Lilly,  Eli  and  Company 

2540  Hudson  St 

FR.  4374 

Maltine  Company 

Lookout 

R.D.  3,  Golden,  Colorado.... 

3424 

.4n6.S  Field  Drive  . . 

....Arvada  1372 

Merrell,  Wm.  S.  Co 

....G.  L.  Patterson 

SP.  2027 

977  Krameria  

DE.  6184 

642  Birch  St 

FR.  2591 

3744  Eliot  St 

GL.  2838 

.S9.S  High  .Street 

EA.  1569 

Parke,  Davis  & Co 

....E.  E.  Kidder 

FR.  8108 

Parke,  Davis  & Co 

1555  South  Josephine 

PE.  3574 

4660  Montview  Boulevard... 

FR.  4655 

Pitman-Moore  Co 

....H.  A.  Hargreaves 

2180  South  Josephine 

SP.  4770 

Robins,  A.  H.  Company 

....  N.  E.  Megenity 

2675  Oneida  Street 

FR.  6419 

....Charles  J.  Eldredoe 

GR.  3015 

Sandoz  Pharmaceuticals  

....Harold  L.  Swanson 

690  South  Race  Street 

PE.  4872 

Schenley  Laboratories,  Inc 

Robert  W.  Moore 

1 908  Hanover  St.,  Aurora... 

...Aurora  188-R 

Schering  Corp 

....Don  Rush  

1415  E.  9th  Ave.,  Apt.  1.... 

CH.  6952 

125  E.  1 1th  Ave 

CH.  2867 

Searle,  G.  D.  and  Co 

....Wayne  H.  Hales 

1395  South  Steele  St 

SP.  5040 

Sharpe  & Dohme,  Inc 

....R.  L.  Burgess 

1 1 49  South  Cook  St 

PE.  2539 

Sharpe  & Dohme,  Inc 

....Maxwell  V.  Lewark.... 

1420  Vine  St 

EA.  2130 

Sharpe  & Dohme,  Inc 

....Hugh  L.  Taylor 

1 340  South  Vine  St 

RA.  2094 

Sharpe  & Dohme,  Inc 

....Phil  T.  Wiley 

1525  Wynkoop  St 

TA.  5117 

1047  Cook  St 

EA.  1331 

5635  E,  6th  Ave 

FR.  3219 

Smith-Dorsey  Co.,  the 

....B.  W.  Chiappini 

RA.  4189 

Smith-Dorsey  Co.,  the 

Harry  E.  Rosenbaum.... 

1350  Fillmore  St 

DE.  9677 

Smith, Kline  and  French 

Laboratories  

Jack  W,  Warner 

FR.  7914 

Squibb,  E.  R.  & Sons 

Rob.  S.  Brannon 

SP.  9449 

1095  Jasmine  St 

EA.  9246 

Harold  A.  Soanaler.... 

DE.  1323 

Squibb,  E.  R.  & Sons 

Harry  A.  Stirling 

455  South  York  St 

SP.  9683 

2785  W.  Archer  

SP.  3477 

Upjohn  Co.,  the 

W.  P.  Ford 

DE.  6290 

Upjohn  Co.,  the 

....H.  E.  Urton 

FR.  0487 

Warner,  Wm.  R.  & Co.,  Inc... 

Glynn  A.  Beord 

45361/2  Tennyson  St 

GR.  6935 

White  Laboratories,  Inc 

S.  C.  Reynolds 

AL.  5703 

Winthrop  Stearns,  Inc 

....R.  C.  Bishop 

4317  Eliot  St 

GL.  5091 

Winthrop  Stearns,  Inc 

....Alva  Proctor 

2895  Birch  St 

DE.  6473 

Winthrop  Stearns,  Inc 

M.  R.  Smidt 

PE.  0881 

. K.  D.  Bassett 

RA.  2128 

Wyeth,  Inc 

....John  A.  Miller 

2830  Vine  St 

TA.  4606 

Wyeth,  Inc 

Ward  C.  Tillotson 

731  Dexter  St 

EA.  9349 

EXPLANATION  OF  LISTINGS  AND  SYMBOLS 


Information  concerning  each  member  of  the  five 
State  Medical  Societies  and  Associations  is  pre- 
sented in  the  following  sequence: 

Surname,  Given  Name  or  Initials:  Office  Address: 
Office  Telephone  Number;  City  or  Town  (with  post 
office  zone  numbers  for  Denver  and  Salt  Lake  City 
if  zone  numbers  were  reported  to  the  Editors): 
Symbol  indicating  specialty;  Symbol  or  words  in 
parentheses  ( ) indicating  Field  of  Practice. 

NAMES! — Names  of  all  members  (regardless  of 
type  of  membership  such  as  active,  honorary,  asso- 
ciate, etc.)  are  included  as  they  appear  on  the 
official  roster  of  membership  kept  by  the  five 
respective  state  secretaries.  Members’  names  are 
included  even  if  they  failed  to  return  a Directory 
Information  Card. 

ADDRESSES — Office  addresses  rather  than  resi- 
dence addresses  are  listed  except  in  cases  where  a 
member  maintains  no  office  or  combines  his  office 
and  residence.  In  smaller  towns  where  street  or 
building  addresses  are  not  used,  or  if  the  detailed 
local  address  was  not  reported,  the  name  of  the 
town  is  repeated. 

TELEPHONE  NUMBERS — These  are  office  tele- 
phone numbers  as  supplied  by  the  members  on  the 
Directory  Information  Cards.  If  a member  failed 
to  return  his  card,  his  last-known  office  telephone 
number  from  the  most  recent  telephone  directory 
is  given.  The  name  of  the  telephone  exchange 
precedes  the  number.  In  Denver,  the  telephone 
dial  system  requires  dialing  the  first  two  letters 
of  the  exchange  name,  therefore  the  letters  to 
be  dialed  are  both  capitalized,  thus;  CHerry  5521. 
In  Salt  Lake  City,  Albuquerque,  and  some  other 
localities,  the  telephone  exchanges  are  numbered 
rather  than  named,  thus:  3-9137.  In  most  cities 
and  towns  where  there  is  but  one  exchange,  not 
named,  only  the  number  is  given.  In  others,  the 
name  of  the  town  is  the  name  of  the  exchange 
and  is  so  given,  thus;  Pueblo  7880'  . 

CITY  OR  TOWN,  AND  POST  OFFICE  ZONES— 
The  name  of  the  city  is  repeated  with  the  post 
office  zone  number  of  the  member’s  address  in 
the  cases  of  Denver  and  Salt  Lake  City,  unless  the 
member  failed  to  report  his  zone  number  on  the 
Directory  Information  Card.  In  other  cities  and 
towns  where  building  or  street  addresses  are  given, 
the  name  of  the  city  or  town  is  repeated  only 
where  it  is  believed  necessary  for  clarity. 

SPECIALTY  AND  FIELD  OF  PRACTICE — Despite 
clear  Instructions  on  the  Directory  Information 
Card  from  which  information  pertaining  to  “Spe- 
cialty” and  “Field  of  Practice”  was  obtained,  many 
members  listed  more  than  one  specialty.  Others 
stated  they  “limited”  their  practice  to  one  specialty 
and  in  addition  gave  “special  attention”  to  an- 
other. Others  stated  they  were  “certified”  by  two 
or  more  specialty  boards  and  “limited”  their  prac- 
tice to  these  two  or  more  specialties.  Still  others 
listed  two  or  more  full-time  fields  of  practice  and 
stated  that  they  were  devoting  fqll-time  to  each. 

By  order  of  the  Editorial  Board  and  the  Board 
of  Trustees,  only  one  specialty  and  only  one  Field 
of  Practice  are  listed  for  any  member.  If  a member 
listed  more  than  one  specialty,  the  one  he  named 
first  or  highest  in  his  list  is  carried  in  this  Di- 
rectory. If  he  stated  that  he  was  engaged  in 
Private  Practice  and  also  stated  he  was  devoting 
“full-time”  to  some  other  field,  he  is  listed  as  in 
private  practice.  If  he  stated  he  was  not  in 
private  practice  but  was  devoting  “full-time”  to 
two  or  more  full-time  fields  of  practice,  the  first 
such  field  listed  by  him  on  his  card  is  represented 
by  the  appropriate  symbol. 

IP  NO  SYMBOL  APPEARS — If  no  symbols  appear 
for  either  Specialty  or  Field  of  Practice,  the  member 
failed  to  return  a Directory  Information  Card  in 
spite  of  repeated  requests.  The  Editors  were  in- 
structed to  enter  such  symbols  only  upon  the  author- 
ity of  an  information  card  signed  by  the  member. 
If  one  appears  without  the  other  (i.e.,  either  Special- 
ty or  Field  of  Practice)  it  is  because  the  member 
completed  only  part  of  his  card,  or  because  he  listed 
as  his  specialty  one  which  is  not  so  recognized  by 
the  American  Medical  Association. 

SYMBOLS — Symbols  indicate  limitation  of  prac- 
tice to  a specialty,  or  special  interest  without 


limitation  of  practice,  according  to  the  following 
list  as  used  and  recognized  by  the  American  Medi- 
cal Association  in  its  Directories: 


GP 

— General  Practice 

I* 

— Internal  Medicine 

S 

— Surgery 

A 

— Allergy 

Pr 

— Proctology 

C 

— Cardiovascular 

NS 

— Neurological  Surgery 

Disease 

Or 

— Orthopedic  Surgery 

GE 

— Gastroenterology 

PI 

— Plastic  Surgery 

T 

— Tuberculosis 

Anes 

— Anesthesiology 

Pd 

— Pediatrics 

Ob 

— Obstetrics 

P 

— Psychiatry 

Gyn 

— Gynecology 

N 

— Neurology 

ObG 

— Obstetrics  and 

PN 

— Psychiatry  and 

Gynecology 

Neurology 

Oph 

— Ophthalmology 

Path 

— Pathology 

ALR 

• — Otology, 

CP 

— Clinical  Pathology 

Laryngology, 

Bact 

— Bacteriology 

Rhinology 

R 

— Roentgenology, 

OALR 

— Ophthalmology, 

Radiology 

Otology,  Laryn- 

PH* 

— Public  Health 

gology,  Rhinology 

Ind 

— Industrial  Practice 

D 

— Dermatology 

HA 

• — Hospital  Admin- 

U 

— Urology 

istration 

*The  asterisk  indicates 

that  practice  is  limited 

to  that  specialty:  the  symbol  without  an  asterisk 
indicates  special  attention  to,  and  interest  in,  that 
specialty  without  limitation  of  practice.  Symbols 
for  Internal  Medicine  and  for  Public  Health  are 
used  only  when  the  member  stated  that  he  limits 
his  practice. 

Symbols  or  words  in  parentheses  ( ) indicate 

the  member’s  Field  of  Practice  as  follows: 

(PP)  Engages  in  the  PRIVATE  PRACTICE  of  medi- 
cine (either  full-time  or  part-time). 

(Intern)  Engaged  full-time  in  an  internship  or 
externship. 

(PG  Res)  Engaged  full-time  in  a post-graduate 
hospital  residency. 

(PG)  Engaged  full-time  in  post-graduate  study, 
but  not  as  a hospital  resident. 

(Research)  Engaged  full-time  in  scientific  research. 
(Armed  Forces)  On  full-time  Active  Duty  with 
the  medical  department  of  the  United  States 
Army,  Navy,  Air  Force,  Marine  Corps,  or  Coast 
Guard. 

(PH)  — Engaged  full-time  in  one  of  the  state,  dis- 
trict, county,  or  city  public  health  departments, 
not,  however,  with  the  United  States  Public 
Health  Service. 

(USPHS)  On  full-time  Active  Duty  with  the  United 
States  Public  Health  Service. 

(Gov)  Engaged  full-time  in  a federal  governmental 
medical  activity  otlier  than  the  Armed  Forces 
and  the  U.  S.  Public  Health  Service;  includes 
the  Veterans  Administration,  Indian  Service,  etc. 
(Med.  School)  Engaged  full-time  on  the  faculty 
of  a medical  school. 

(Student  Health  Service)  Engaged  full-time  by  the 
established  Student  Health  Service  of  a uni- 
versity or  other  institution  of  higher  learning. 
(School  Health  Service)  Engaged  full-time  by  the 
health  service  of  a primary  or  secondary  public 
school  system. 

(Exec)  Engaged  full-time  in  an  executive  capacity. 
(Ind)  Engaged  full-time  in  industrial  medicine  or 
surgery  by  an  industrial  firm. 

(Hosp)  Engaged  full-time  by  a hospital. 

(State  Hosp)  Engaged  full-time  by  a state-operated 
hospital. 

(Ret)  Retired  from  Practice. 

(Associate  member,  not  a physician)  Denotes  mem- 
bers of  allied  professions  who  have  been  granted 
associate  membership  by  certain  county  medical 
societies. 

TYPOGRAPHICAL  ERRORS — Every  effort  has 
been  made  to  present  a complete  and  accurate 
Directory  of  Members,  as  the  membership  of  each 
Society  and  Association  stood  on  December  31,  1948. 
But  editors  and  typographers  and  proof  readers  are 
human  and  we  have  no<  doubt  that  some  errors  will 
be  found.  Each  member  is  requested  to  verify  his 
own  listing  and  to  notify  the  Rocky  Mountain 
Medical  Journal  of  any  error  so  that  future  issues 
of  the  Directory  will  be  even  better.  Each  member 
is  reminded,  however,  that  the  Editors  are  not  per- 
mitted to  create  new  specialty  symbols  or  to  list 
specialties  or  fields  of  practice  other  than  within 
the  rules  referred  to  above. 


Rocky  Mountain  Medical  Journal  Supplement 


1 


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Rocky  Mountain  Medical  Journal  Supplement 


1 


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Rocky  Mountain  Medical  Journal  Supplement 


3 


THE  COLORADO  STATE  MEDICAL  SOCIETY 

Next  Annual  Session:  Shirley-Savoy  Hotel,  Denver;  Sept.  20,  21,  22,  23,  1949 


OFFICERS 

Terms  of  Officers  and  Committees  ejEpire  at  the  Annual  Session 
in  the  year  indicated.  Where  no  year  is  indicated,  the  term 
is  for  one  year  only  and  expires  at  the  1949  Annual  Session. 

President;  Casper  F.  Hegner,  Denver. 

President-elect:  Fred  A.  Humphrey,  Fort  Collins. 

Vice  President:  Lester  L.  Ward,  Pueblo. 

Constltatisnal  Secretary  (three  years) : George  B.  Buck,  Denver,  1951. 
Treasurer  (three  years):  Geoi^e  C.  Shivers,  Colorado  Springs,  1930. 

Additional  Trustees  (three  years):  Ervin  A.  Hinds,  Denver,  1949;  E.  H. 
Munro,  Grand  Jurction,  1949;  S.  P.  Newman,  Denver,  1950;  Claude  D. 
Bonham,  Boulder,  1951. 

(The  above  nine  officers  compose  the  Board  of  Trustees  of  which  Dr. 
Ervin  A.  Hinds  is  the  1948-1949  Chairman.) 

Board  of  Councilors  (three  years):  District  No.  1:  Clemens  F.  Eaklns, 
Brush,  1951;  No.  2:  Ella  A.  Mead,  Greeley,  1951;  No.  3:  L.  G.  Crosby, 
Denver,  1951;  No.  4:  Lansing  E.  Likes,  Lamar,  1950;  No.  5:  Guy  H. 
Hopkins,  Pueblo,  1950;  No.  6:  Lester  E.  Thompson,  Salida,  1950;  No.  7; 
A.  L.  Burnett,  Durango,  1949;  No.  8:  Lawrence  L.  Hick,  Delta,  1949; 
No.  9:  W.  W.  Sloan,  Hayden,  1949  (Chairman  of  Board  for  1948-49). 

Board  of  Supervisors  (two  years):  A.  B.  Gjellum,  Del  Norte,  1949;  L.  W. 
Lloyd,  Durango,  1949;  B.  G.  Howlett,  Golden,  1949;  Scott  A.  Gale, 
Pueblo,  1949;  L.  D.  Dickey,  Fort  Collins,  1949;  N.  A.  Madler,  Greeley, 
1949  (Chairman  of  Board  for  1948-49);  L.  D.  Buchanan,  Wray,  1950; 
W.  P.  Deal,  Craig,  1950;  0.  C.  Cary,  Grand  Junction,  1950;  W.  A. 
Campbell.  Colorado  Springs,  1950;  Ralph  S.  Johnston,  Sr.,  La  Junta, 
1950;  William  A.  Liggett,  Denver,  1950. 

Delegates  to  American  Medical  Association  (two  years):  George  A.  Dntug, 
Pueblo,  1949  (Alternate:  Herman  C.  Graves,  Grand  Junction,  1949): 
William  H.  Halley.  Denver,  1950  (Alternate:  Kenneth  C.  Sawyer.  Denver. 
1950). 

Foundation  Advocate:  Walter  W.  King,  Denver. 

Executive  Office  Staff:  Mr.  Harvey  T.  Sethman,  Executive  Secretary: 
Miss  Helen  Kearney,  Assistant  Executive  Secretary;  Mr.  Evan  A.  Edwards, 
Field  Secretary;  Miss  Mary  E.  McDonald,  Committee  Secretary:  835  Ke- 
pubHc  Building,  Denver  2,  Colo.,  Telephone  CHerry  5521. 

General  Counsel:  Mr.  J.  Peter  Nordlund,  Attorney-at-Law,  Denver. 

STANDING  COMMITTEES 
Credentials:  George  K.  Buck,  Denver,  Chairman,  ex-officio;  others  to 
be  appointed. 

Public  Policy:  Kenneth  C.  Sawyer,  Denver,  Chairman;  McKinnie  L. 
Phelps.  Denver,  Vice  Chairman;  John  S.  Boaslog,  Denver;  F.  R.  Calhoun, 
Denver;  Frank  B.  McGlone,  Denver;  T.  M.  Rogers,  Sterling:  Sidney  An- 
derson, Alamosa;  Richard  L.  Davis,  La  Junta;  Herman  C.  Graves,  Grand 
Junction:  .iohn  L.  McDonald,  Colorado  Springs;  George  E,  Rice,  Pueblo; 
John  D.  Gillaspie,  Boulder.  Ex-Offieio  members:  Casper  F.  Hegner,  Presi- 
dent; Fred  A.  Humphrey,  President-elect;  George  K.  Buck,  Constitutional 
Secretary. 

Sub-Committee  on  Leiisiatlon:  H.  I.  Barnard,  Denver,  Chairman;  others 
to  be  appointed. 

Health  Education  (two  years):  A.  C.  Sudan,  Denver,  Chairman,  1949; 

J.  D.  Bartholomew,  Boulder,  1949;  E.  J.  Savage,  Denver,  1949;  R.  T. 
Porter,  Greeley,  1949;  Robert  B.  Bradshaw,  Alamosa,  1949;  L.  W.  Bortree, 
Colorado  Springs,  1950;  F.  0.  Robertson,  Denver,  1950.;  J.  L.  Sadler,  Fort 
Collins,  1950;  Harold  T.  Low,  Pueblo,  1950;  John  H.  Amesse,  Denver, 
1950;  E.  H.  Munro,  Grand  Junction,  1950. 

Scientific  Work:  W.  B.  Condon,  Denver,  Chairman;  Robert  S.  Liggett, 
Karl  P.  Arndt,  Frank  T.  Joyce,  Marshall  G.  Nims,  Vincent  G.  Cedar- 
Wade,  all  of  Denver. 

Sub-Committee  on  Scientific  Exhibits:  Frank  C.  CampbeU,  Chairman; 
Nolle  Mnmey,  Edgar  W.  Barber,  E.  W.  Vines,,  all  of  Denver. 

Arranotments : To  be  appointed. 

Medicoieial  (two  years):  R.  W.  Amdt,  1950,  Chairman;  George  B. 
Packard,  Jr.,  1950;  K,  D.  A.  Allen,  1950.;  C.  S.  Bluemel,  1949;  Lyman 
W.  Mason,  1949;  Harry  C.  Hughes,  1949;  all  of  Denver. 

Medical  Education  and  Hospitals:  George  F,  Wollgast,  Denver,  Chairman; 
W.  W.  Sloan,  Hayden;  F.  R.  Kngrey,  Durango:  E.  R.  Mugrage.  Denver; 
D.  W.  McCarty,  Longmont:  A.  E.  Lubchenco,  Denver. 

Library  and  Medical  Literature:  A.  J.  Markley,  Denver,  Chairman;  T.  E. 
Beyer,  Denver;  J.  J.  Connor,  Delta;  H.  Dumont  Clark,  Denver. 

Medical  Service  Plans:  P.  H.  Good,  Denver,  Chairman;  C.  E,  Hoi^tein, 
Port  Collins;  James  R.  Blair,  Denver;  Vernon  L.  Bolton,  Colorado  Springs; 
Scott  A.  Gale,  Pueblo;  John  A.  Weaver,  Jr.,  Greeley;  John  E.  Hyland, 
Monte  Vista;  Thomas  K.  Mahan,  Grand  Junction. 

Neeroldiy:  W.  H.  Wilson,  Denver,  Chairman. 

PUBLIC  HEALTH  COMMITTEES 

General  Camniittee  on  Public  Health:  Consists  of  the  chairmen  of  the 
foDowing  eleven  public  health  subcommittees,  presided  over  by  Robert  W. 
Dickson,  Denver,  as  General  Chairman. 

Cancer  Control;  J.  C.  Mendenhall,  Denver,  Chairman:  John  B.  Grow, 
Denver:  S.  W.  Holley,  Greeley;  T.  Leon  Howard,  Denver;  James  B.  Mc- 
Naught,  Denver;  Roger  G.  Howlett,  Golden;  James  W.  McMullen,  Colorado 
Springs:  James  E.  Donnelly,  Trinidad;  Lanning  E.  Likes,  Lamar;  Thomas 

K.  Mahan.  Grand  Junction. 


Crippled  Children:  I.  E.  Hendryson,  Denver,  Chairman:  Mary  L.  Moore, 
Grand  Junction;  Richard  H.  Mellen,  Colorado  Springs;  Sidney  B.  Bland- 
ford,  Jr.,  Denver;  Paul  R.  Hildebrand,  Brush;  .Samuel  P.  Newman,  Denver. 

Industrial  Health:  R.  F.  Bell,  Louviers.  Chairman:  A.  R.  Woodbume, 
Denver;  Vincent  E.  Kelly,  Leadville;  D.  W.  Boyer,  Pueblo;  H.  G.  Harvey,  Jr., 
Denver;  Robert  Woodruff,  Denver;  Frank  J.  McDonough,  Grand  Junction. 

Local  Health  Units:  Monroe  R.  Tyler,  Denver.  Chairman;  Harold  B. 
Haymond.  Greeley;  R.  B.  Richards,  Port  Morgan;  Nicholas  S.  Sallba,  Wal- 
senburg;  Marvel  L.  Crawford,  Steamboat  Springs;  K.  Sherwln  Johnston,  Jr., 
La  Junta. 

Maternal  am)  Child  Health:  .John  R.  Evans,  Denver,  Chairman;  Joseph 
H.  Lyday,  Denver:  John  M.  Nelson,  Denver;  Tracy  D.  Peppers,  Greeley; 
J.  H.  Woodbridge,  Pueblo:  M.  E.  Snyder,  Colorado  Springs. 

Mental  Hygiene:  Bradford  Murphey,  Denver,  Chairman;  E.  James  Brady, 
Colorado  Springs;  Frank  H.  iiimmerman,  Pueblo;  Paul  A.  Draper,  Colorado 
Springs:  J.  P.  Hilton,  C.  S.  Bluemel,  John  M.  Lyon,  G.  H. , Ashley,  Lewie 
C.  Overholt,  Clarke  H.  Barnacle,  Harold  R.  Carter,  all  of  Denver. 

Milk  Control:  George  W.  Stiles.  Denver,  Chairman;  Max  M.  Ginsburg, 
Denver;  N.  J.  Miller,  D.V.M.,  Eaton;  Millard  P.  Schafer,  Colorado  Springs; 
Robert  W.  Vines,  Denver;  Mr.  Wendell  Vincent,  Denver. 

New  Hospital  Construction:  D.  B.  Collier,  Wheatridge,  Chairman: 
Henry  M.  Powell,  Colorado  Springs;  Mr.  John  R.  Peterson,  Port  Collins; 
Florence  R.  Sabin,  Denver;  Herbert  A.  Black,  Pueblo. 

Public  Water  Supplies:  E.  I.  Dobos,  Denver,  Chairman;  Robert  Barnard, 
Eagle;  William  C.  Shontz,  San  Luis;  Carl  W.  Maynard,  Pueblo:  W.  B. 
Crouch.  Colorado  Springs;  H.  D.  Palmer,  Denver;  E.  Robert  Orr,  Pniita. 

Tuberculosis  Control:  John  I.  Zarit,  Denver,  Chairman;  W.  J.  Hlnzel- 
man, 'Greeley;  H.  M.  Van  Der  Schouw,  Wheatridge;  John  P.  McGraw,  Pueblo; 
Arthur  Rest,  Denver;  H.  Calvin  Fisher,  Denver;  T.  D.  Cunningham,  Denver. 

Venereal  Disease  Control:  Sam  W.  Downii^,  Denver,  Chairman:  Paul  B. 
Stidham.  Grand  Junction;  H.  E.  Coakley,  Pueblo;  D.  E.  Newland,  Denver; 
Joseph  H.  Patterson,  Denver;  James  R.  McDowell,  Denver. 

SPECIAL  COMMITTTES 

Rocky  Mountain  Medieal  Conference  (five  years):  L.  Clark  Hepp,  Denver, 
1953;  G.  P.  Lingenfelter,  Denver,  1952,  Chairman;  Ward  Darley,  Denver, 
1951;  L.  W.  Bortree,  Colorado  Springs.  1950;  George  H.  Gillen,  Denver, 
1949. 

Advisory  to  Auxiliary:  Fred  A.  Humphrey,  Fort  Collins,  Chairman;  Ervin 
A.  Hinds.  George  R.  Buck,  Denver. 

Midwinter  Clinics:  Samuel  B.  Childs,  Jr.,  Chairman:  Raymond  C.  Chat- 
field,  E.  L.  Binkley,  Jr.,  A.  J.  Kauvar,  Terry  J.  Gromer,  aU  of  Denver. 

Rehabilitation:  W.  W.  Haggart,  Denver,  Chairman;  Atha  Thomas,  Den- 
ver; Lawrence  T.  Brown,  Denver;  J.  E.  A.  Connell,  I^eblo;  Thad  P.  Sears, 
Ft.  Logan;  Kenneth  C.  Sawyer,  McKlnnle  L.  Phelps,  deorge  R.  Buck, 
Bradford  Murphey,  all  of  Denver. 

Advisory  to  the  Goodwill  Industries’  Rehahilifation  Program;  Lewis  C. 
Overholt,  Chairman;  William  H.  Halley,  Maurice  Katzman,  Terry  J. 
Gromer.  Lorenz  W.  Frank,  William  R.  Lipscomb,  Indn  B.  Hendryson, 
all  of  Denver. 

Rural  Hdalth  Commission:  Leonard  N.  Myers,  Cheyenne  Wells,  Chairman; 
V.  V.  Anderson,  Del  Norte;  James  S.  Orr,  Fruita;  Keith  P.  Krausnlek, 
Lamar;  Robert  M.  Lee,  Fort  Collins.  Ex-officio  member:  Fred  A.  Hum- 
phrey, Fort  Collins. 

Medical  Disaster  Commission:  Foster  Matchett,  Denver,  Chairman;  Karl 
Arndt,  Denver,  Secretary;  Mark  S.  Donovan,  Harry  C.  Hughes,  Adolph  J. 
Kafka,  Roderick  J.  McDonald.  William  F.  Stanok,  Henry  Swan,  Karl  F. 
Sunderland,  K.  D.  A.  Allen,  all  of  Denver;  Lawrence  W.  Holden,  Boulder; 
Richard  H.  Mellen.  Colorado  Springs;  Richard  H.  Altmix,  Englewood;  Jacob 

O.  Mall,  Estes  Park;  Thad  P.  Sears,  Fort  Logan:  Donald  E.  Cowen,  Fort 
Morgan;  Kenneth  E.  Prescott,  Grand  Junction;  Walter  A.  Schoen,  Greeley; 
David  W.  McCarty,  Longmont;  David  W.  Boyer,  Pueblo;  J.  G.  Espey,  Craig; 
Leo  W.  Loyd,  Durango;  Keith  F.  Krausnick,  Lamar;  Robert  M.  Lee,  Ft.  Col- 
lins; George  H.  Lord,  Aurora;  J.  Gordon  Hedrick,  Wray;  James  P.  Rigg, 
Grand  Junction. 

Lay  Organization  Standards:  George  R.  Buck.  Fredrick  H.  Good,  Ken- 
neth C.  Sawyer,  Frank  B.  McGlone,  T.  D.  Cunningham,  Bradford  Murphey, 
Casper  F.  Hegner,  John  S.  Bouslog,  all  of  Denver. 

Study  of  Child  Welfare  Clinics:  Ralph  H.  Verploeg,  Denver,  Chairman; 
J.  W.  White,  Pueblo:  Jackson  L.  Sadler,  Fort  Collins;  L.  E.  Maurer, 
Boulder;  Harvey  M.  Tupper,  Grand  Junction;  Harvey  S.  Rusk,  Pueblo. 

Advisory  to  U.M.W.  Welfare  Fund  (Executive  Committee,  three-year 
terms;  others,  one-year)  : Executive:  W.  W.  Haggart.  1951,  Chairman; 

P.  H.  Good,  1951;  J.  S.  Bouslog,  1951,  all  of  Denver;  W.  H.  Halley, 
1950;  C.  F.  Hegner,  1950,  both  of  Denver;  R.  F.  Bell,  1950,  Louviers; 
McKinnie  Phelps.  1949,  Denver;  F.  A.  Humphrey,  1949,  Fort  ColUns; 
J.  M.  Lamme,  1949,  Walsenburg.  Other  members:  K.  C.  Sawyer,  A.  C. 
Sudan,  Bradford  Murphey,  all  of  Denver;  C.  D.  Bonham,  Boulder;  J.  W. 
Craighead,  Pueblo;  J.  E.  Donnelly,  Trinidad;  Ligon  Price,  Mt.  Harris;  M.  J. 
McCallum,  Erie. 

Liaison  to  Colwado  State  Nurses  Association:  John  R.  Evans,  Samuel  P. 
Newman,  Denver. 

Liaison  to  Colorado  Bar  Association:  W.  S.  Dennis,  Chairman;  A.  C. 
Sudan,  B.  W.  Amdt,  all  of  Denver. 

Medical-Dental  Liaison:  Guy  W.  Smith,  Denver,  Chairman;  George  B. 
Warner,  Denver;  Calvin  N.  Caldwell,  Pueblo. 

Representative  to  Rocky  Mountain  Radio  Council:  William  E.  Hay. 
Denver;  (Alternate:  Chauncey  A.  Hager,  Denver). 

Representative  to  Belle  Bonfils  Memorial  Blood  Bank:  0.  S.  Philpott, 
Denver. 

Representatives  to  Liaison  Council  on  Graduate  Education  (two  years) : 

L.  R.  Safarik,  Denver,  1949;  Harold  I.  Goldman,  Denver,  1950. 

Delegate  to  Colorado  Interprofessional  Council  (five  years);  K.  D.  A. 
•Lllen.  Denver,  1949;  (Alternate:  Carl  A.  McLauthlia,  Denver,  1949). 


Rocky  Mountain  Medical  Journal  Supplement 


5 


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6 


Rocky  Mountain  Medical  Journal  Supplement 


Directory  of  Members  — COLORADO 

(As  of  December  31,  1948) 

For  Explanation  of  listings  and  symbols,  see  Page  1. 


Aguilar  ... 

Merritt,  William  A.;  Aguilar;  Aguilar  661;  GP  (PP). 

Akron  ... 

Adams,  William  A.;  Akron;  Akron;  (Ret.). 

Keller,  Park  D.;  Akron;  Akron  246-W;  GP  (PP). 
Woblauer,  Valentin  E. ; 50  W.  Franklin  St.;  Akron 
3-W;  GP  (PP). 

Alamosa  ... 

Anderson,  Sidney;  810  Main  St.;  Alamosa  311;  ObG 
(PP). 

Bradshaw,  Robert  B.;  810  Main  St.;  Alamosa  311; 
GP  (PP). 

Davies,  John  D.;  823  Main  St.;  Alamosa  545;  OALR*. 
Davlin,  Charles  A.;  Physicians  Bldg.;  Alamosa  75; 
S (PP). 

Day,  Roy  J.;  Region  Bldg.;  Alamosa  627;  S (PP). 
Howell.  Ira  L. ; Physicians  Bldg.;  Alamosa  120; 
PN  (PP). 

Hurley,  James  R. ; 420  San  Juan  Ave.;  Alamosa  27; 
GP  '(PP). 

Johnson,  Delmer  E.;  420  San  Juan  Ave.;  Alamosa  474; 
S (PP). 

Miller,  Alvin  P. ; 402  San  Juan  Ave.;  Alamosa  790; 
Pd*  (PP). 

Stong,  Elliott  S.;  Masonic  Bldg.;  Alamosa  72;  S (PP). 

Antonito  ... 

Davis,  George  R.;  Antonito;  Antonito  110;  GP  (PP). 

Arvada  ... 

Fee,  Edward  P. ; 5613  Wadsworth  Ave,;  Arvada  177; 
GP  (PP). 

Poster,  Edwin  D. ; 238  E.  Grandview  Ave.;  Arvada  24; 
Pd. 

Markham,  Allen  M. ; 5612  Wadsworth  Ave.;  Arvada 
198;  GP  (PP). 

Thorn,  Thomas  R.;  5618-20  N.  Wadsworth  Ave.;  Ar- 
vada 216;  GP  (PP). 

Aspen  . . . 

Cochrane,  Allen  M.;  505  E.  Hyman  Ave.;  Aspen  4911; 
GP  (PP). 

Lewis,  Robert  C.,  Jr.;  223  E.  Hallam;  Aspen  2541; 
GP  (PP). 

Mahony,  Frederick  S. ; Box  511;  (Associate  Member; 
Not  a Physician). 

Ault  ... 

Anderson,  Andreas  A.;  Ault;  Ault  57;  (Ret.). 

Aurora  ... 

Carson,  Paul  C. ; 9701  E.  Colfax  Ave.;  Aurora  1060; 
CP  (PP). 

Esposito,  Salvatore  P. ; 934  0 E.  Colfax  Ave.;  PRemont 
4422;  GP  (PP). 

Porsee,  James  H. ; Pitzsimons  Gen.  Hosp. ; Aurora  460, 
Ext.  208;  S*  (Armed  Forces). 

Gersh,  Malcolm;  9525  E.  Colfax  Ave.;  Aurora  920; 
GP  (PP). 

Gordon,  James  H.;  Pitzsimons  Gen.  Hosp.;  Aurora  460. 
Hill,  Thurman  K. ; Pitzsimons  Gen.  Hosp.;  Box  6038; 

Aurora  460;  I*  (Armed  Forces). 

Johnson,  Richard  P. ; Pitzsimons  Gen.  Hosp.;  Aurora 
460;  I*  (Armed  Forces). 

Kellogg,  Douglas  S. ; Pitzsimons  Gen.  Hosp.;  Box 
6277;  Aurora  460,  Ext.  249;  R*  (Armed  Forces). 
Kendall,  Charles  B.;  Pitzsimons  Gen.  Hosp.;  Aurora 
460;  I*  (Armed  Forces). 

Kuraner,  Heinz;  Pitzsimons  Gen.  Hosp.;  Aurora  460. 
Lord,  George  H. ; 9360  E.  Colfax  Ave.;  PRemont  8232. 
McShane,  Patrick  I.;  Pitzsimons  Gen.  Hosp.;  Aurora 
460;  I*  (Armed  Forces). 

Raulston,  John  W. ; Pitzsimons  Gen.  Hosp.;  Aurora 
460;  (Armed  Forces). 


Roper,  William  H.;  Pitzsimons  Gen.  Hosp.;  Box  6027; 

Aurora  460,  Ext.  246;  I*  (Research). 

Sayler,  John  A.;  Pitzsimons  Gen.  Hosp.;  Aurora  460, 
Ext.  237;  S*  (Armed  Porces). 

Scantland,  Willard  A.;  9360  E.  Colfax  Ave.;  Aurora 
37;  GP  (PP). 

Slagle,  DeRoy  W.  H. ; 1902  Havana  St.;  Aurora  1182; 
GP  (PP). 

Steer,  Arthur;  Pitzsimons  Gen.  Hosp.;  Aurora  460. 
Webb,  Miles  L.;  9513  E.  Colfax  Ave.;  Aurora  3;  GP. 

Berthoud  ...  ' 

Arndt,  Donald  A.;  307  Mountain  Ave.;  Berthoud  145; 
GP  (PP). 

Fickel,  Helen  McCarty;  645  7th  St.;  Berthoud  16-J3; 
(Ret.). 

Hardesty,  Willis  B.;  344  Mountain  Ave.;  Berthoud  48; 
GP  (PP). 

Boulder  . . . 

Alexander,  Harry  A.;  408  Pirst  Natl.  Bank  Bldg.; 
Boulder  164;  I*  (PP). 

Allison,  Olaf  W.;  Medical  Center;  Boulder  3600;  GP 
(PP). 

Bartholomew,  Jack  D. ; Medical  Center:  Boulder  3600; 

®*  (PP). 

Bonham,  Claude  D.;  Medical  Center;  Boulder  3600; 
ObG*  (PP). 

Bowen,  Albert;  Community  Hospital;  Boulder;  R* 
(PP). 

Cattermole,  George  H.;  605  Pine  St.;  Boulder  (PP). 
Cowgill,  Joseph  S.;  Medical  Center;  Boulder  3600; 
ObG  (PP). 

Duerkson,  Edward  C. ; Boulder;  Boulder. 

Duhon,  S.  Crawford;  2111  14th  St.;  Boulder  1848; 
GP  (PP). 

Farrington,  Paul  R.;  2006  Broadway;  Boulder  246; 
S (PP). 

Giffen,  Glenn  O. ; .Student  Health  Service;  Univ.  of 
Colo.;  Boulder  3700,  EIxt.  274;  Ind*  (Student  Health 
Service). 

Gillaspie,  John  D.;  Medical  Center;  Boulder  3600;  A* 
(PP). 

Gilman,  Carl  J. ; Medical  Center;  Boulder  3600;  S* 
(PP). 

Graf,  Carl  H. ; Physicians  Bldg.;  Boulder  232;  GP. 
Hanson,  Russell;  Boulder-Colorado  San.;  Boulder 
1800;  GP. 

Houston,  Howard  H.;  Medical  Center;  Boulder  3600; 
GP  (PP). 

Holden,  Lawrence  W. : Univ.  of  Colo.;  Boulder  3700; 

I*  (iStudent  Health  Service). 

Lilly,  Lewie  J. ; Boulder-Colorado  San.;  Boulder  1800; 
S*  (PP). 

Martin,  Christopher  H. ; Medical  Center;  Boulder  3600; 
S (PP). 

Maurer,  Lawrence  E. ; Medical  Center:  Boulder  3600; 
Pd  (PP). 

McCabe,  Fordyce  G. ; 205  First  Natl.  Bank  Bldg.; 
Boulder  383;  ObG  (PP). 

McCabe,  Fordyce  H.;  First  Natl.  Bank  Bldg.;  Boulder 
384;  GP  (PP). 

McDonald,  John  G. ; Medical  Centei';  Boulder  3600; 
GP  (PP). 

Messenheimer,  Myron  Gifford;  Student  Health  Serv- 
ice, Univ.  of  o'o.:  Boulder  3700,  Ext.  71;  PN® 
(Student  Health  Service). 

Miles,  Martin  B. ; 200  First  Natl.  Bank  Bldg.;  Boulder 
399;  S (PP). 

Milton,  John  B.,  Jr.;  Physicians  Bldg. ; Boulder  142-W; 
GP  (PP). 

Morency,  H.  L. ; Citizens  Bldg.;  Boulder  192;  (As- 
sociate Member;  Not  a Physician). 

Page,  Donald  F. ; Boulder-Colorado  San.;  Boulder 
1800;  OALR*  (PP). 

Page,  Mabel  E. ; Boulder-Colorado  San.;  Boulder 
1800;  R*. 

Roberts,  C.  Oliver;  Physicians  Bldg'.;  Boulder  1708; 
GP  (PP). 

Shearer,  Margery  C. ; Student  Health  Service:  Univ. 
of  Colo.;  Boulder  3700;  (Student  Health  Service). 


Rocky  Mountain  Medical  Journal  Supplement 


7 


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8 


Rocky  Mountain  Medical  Journal  Supplement 


Boulder  . . . (Conlinued) 

Sikkema,  Stella  Hazen;  Univ.  of  Colo.  Student 
Health  Service:  Boulder  1700,  Ext.  71,  78;  (Student 
Health  Service). 

Smith,  Russell  T.;  Boulder-Colorado  San.;  Boulder 
1800,  Ext.  20;  HA  (PP). 

Spencer,  Frank  R.;  2111  14th  St.;  Boulder  22;  OALR* 
(PP). 

Sturges,  Harold  J. ; Boulder-Colorado  San.;  Boulder 
1800;  S. 

Takahashi,  William  Y. ; 1325  Broadway;  Boulder 

1236;  Pd*  (PP). 

Welker,  Max  L. ; 209  First  Natl.  Bank  Bldg.; 

Boulder  1419-W:  C (PP). 

Wolfe,  Roy  E.;  2111  14th  St.;  Boulder  1848;  GP 
(PP). 

Brighton  ... 

Koschalk,  Joseph;  167  Bridge  St.;  Brighton  514;  GP. 
Peer,  Walter  F. : 119  Bridge  St.;  Brighton  104;  GP 
(PP). 

Brush  ... 

Eakins,  Clemens  F. ; 403  Farmers  State  Bank  Bldg.; 
Brush  62-J:  GP  (PP). 

Hildebrand,  Paul  R. ; Farmers  State  Bank  Bldg.; 
Brush  17;  GP  (PP). 

Lus'by,  Luther  C.;  323  Clayton  St.;  Brush  6-J:  GP 
(PP). 

Rechnitz,  Fred  A.;  First  Natl.  Bank  Bldg.;  Brush 
125- W:  GP  (PP). 

Burlington  . . . 

Beethe,  Raymond  C. ; Wilson  Bldg.;  Burlington  5; 
GP  (PP). 

Bergen,  Frank  L. ; Burlington:  Burlington  1;  GP 
(PP). 

Courtnev,  Roy  F.;  Burlington;  Burlington  61;  S (PP). 
Currie,  Norman  L.;  Box  476;  Burlington  7;  GP  (PP). 
Platt,  G.  S.;  Burlington;  (Associate  Member;  Not  a 
Physician). 

Hayes,  Harold  M.;  Main  St.;  Burlington  5;  GP  (PP). 

Byers  ... 

Reed,  Charles  W. ; Byers;  Byers  13. 

Canon  City  . . . 

Christie,  George  C. ; 116  N.  5th  St.;  Canon  City  1080- J; 
GP  (PP). 

Denzler,  S.  Russ;  602  Macon  Ave. ; Canon  City  1250; 
ObG  (PP). 

Flanagan,  Eiarl  B.,  Jr.;  Harrison  Bldg.;  Canon  Citv 
348-W:  GP  (PP). 

Grabow,  Henr  y C. : 120  N.  7th  St.;  Canon  City  142;  GP 
(PP). 

Hinshaw,  Jonathan  D. ; 631  Rudd  Ave.;  Canon  City 
943-J;  (Ret.). 

Lynch,  Elwood  B. ; 431  Main  St.;  Canon  City  388-W; 
GP  (PP) 

Robinson,  James  M.;  425  Main  St.;  Canon  City  923; 
OALR  (PP). 

Shoun,  David  A.;  Apex  Bldg.;  Canon  City  475;  GP. 
Shoun,  James  G.;  Apex  Bldg.;  Canon  City  475;  S. 
Wyatt,  Kon;  215  N.  5th  St.;  Canon  City  286-J;  GP 
(PP). 

Castle  Rock  ... 

Keller,  Charles  J.;  Castle  Rock;  Castle  Rock  27;  GP. 

Cedaredge  . . . 

Frey,  Charles  T.;  Cedaredge;  Cedaredge  376;  C (PP). 
Pounden,  John  C.;  250  Main  St.;  Cedaredge  6;  GP. 

Center  ... 

Coleman,  John  M.;  Center;  Center  4;  GP  (PP). 

Cheyenne  Wells  ...  c,-, 

Keefe,  Jerome  L. ; Box  347;  Cheyenne  Wells. 

Myers,  Leonard  N.;  Fenner  Ave.  and  3rd  St.;  Cheyenne 
Wells  100;  S (PP). 

Climax  ... 

Ruddy,  James;  Climax  Molybdenum  Hosp.;  Climax  26; 
GP  (Ind.). 

Smiley,  Richard  H. ; Climax  Molybdenum  Hosp.;  Cli- 
max 26;  GP  (Ind.). 


Collbran  ... 

Zeigel,  Henry  H.;  Plateau  Valley  Congregational 
Hosp.;  Collbran  41;  GP  (PP). 

Colorado  Springs  . . . 

Adams,  Ralph  W. ; 209  S.  Nevada  Ave.;  Main  9700; 
I*  (PP). 

Ainsworth,  H.  Smith;  301  Burns  Bldg.;  Main  10255; 
ALR>^  (PP). 

Allen,  Lloyd  R. ; 327  Ferguson  Bldg.;  Main  1820;  Anes. 
Anderson,  Roland  R. ; 707  N.  Cascade;  Main  1999;  R*. 
Arnn,  Edward  T.;  1206  Cheyenne  Blvd.;  Main  3515; 
Anes*  (PP). 

Baker,  Fred  R.;  18  N.  Tejon  St.;  Main  4477;  GP  (PP). 
Bancroft,  George  W. ; 18  N.  Tejon  St.;  Main  2259;  S. 
Beadles,  Robert  O.,  Jr.;  209  S.  Nevada  Ave.;  Main 
9700;  U*  (PP). 

Beck,  Levi  H. ; 2425  N.  Tejon  St.;  Main  7188:  (Ret.). 
Bernstein,  Phineas;  First  Natl.  Bank  Bldg.;  Main 
8541;  ObG. 

Billingsley,  Lindsey  F. ; 311  E.  Pikes  Peak  Ave.; 
Main  4805:  Anes  (PP). 

Bolton,  Vernon  L. ; ®t.  Francis  Hosp.;  Main  7344, 
Ext.  73;  R*  (PP). 

Bortree,  Leo  W.;  104  E.  St.  Vrain  St.;  Main  4160;  I* 
(PP). 

Bowling,  Franklin  L. ; Rt.  3,  15th  Air  Force;  Main 
8380;  Oph  (Armed  Forces). 

Bradley,  John  W. ; 209  Burns  Bldg.;  Main  454;  ALR* 

(PP). 

Brady,  E.  James;  Colorado  Springs  Psychopathic 
Hosp.;  Main  1356;  PN*  (PP). 

.Brobeck,  Von  H. ; 312  Ferguson  Bldg.;  Main  126;  Oph* 
(PP). 

Brown,  James  H.;  218  Burns  Bldg.;  Main  45;  I*. 
Brown,  Louis  Gordon;  707  N.  Cascade  Ave.;  Main 
1999;  (Ret.). 

Brown,  Samuel  H. ; 312  Ferguson  Bldg.;  Main  126; 
Oph*  (PP). 

Bryan,  Harry  C. ; 462  First  Natl.  Bank  Bldg.;  Main 
1095;  S (PP). 

Campbell,  William  A.;  700  Exchange  Natl.  Bank 
Bldg.-  Main  104;  S (PP). 

Chandler,  Gilbert  B.;  Independence  Bldg.;  Main 
6940;  S (PP). 

Chapman,  Edward  N.;  124  W.  Columbia  St.;  Main 
7476;  T*  (Exec.). 

Chapman,  Katherine  H. ; 304  Burns  Bldg.;  Main 

8910;  Oph*  (PP). 

Chapman,  S.  Jefferson;  400  Burns  Bldg.;  Main 
781;  ALR* 

Close,  Harland  T. ; 2431  W.  Colorado  Ave.;  Main  4774; 
ALR  (PP). 

Corlett,  Thomas  G. : 215  First  Natl.  Bank  Bldg.;  Main 
753;  GP  (PP). 

Crouch.  John  B. ; 316  Ferguson  Bldg.;  Main  4160;  T 
(PP). 

Crouch,  Winthrop  B.;  316  Ferguson  Bldg.;  Main  4160; 
ObG  (PP). 

Davis,  Robert  W. ; Colorado  Springs  Psychopathic 
Hosp.;  Main  1356;  PN*  (PP). 

Draper.  Paul  A.;  316  Ferguson  Bldg.;  Main  4160; 
PN*  (PP). 

Drea.  William  F. ; 410  Burns  Bldg.:  Main  961;  R (PP). 
Drendel,  Edward  P. ; 218  Burns  Bldg.;  Main  45:  GP 
(PP). 

duBois,  Paul.  G. ; 209  S.  Nevada  Ave.;  Main  9700; 
Pd*  (PP). 

Einstein,  Otto;  Cragmor  San.;  Main  122;  T (PG  Res.). 
Ellis,  Aller  G. ; Elm  Ave.  and  4th  St.;  Broadmoor; 
Main  7074;  (Ret.). 

Fawcett,  Newton  W. ; 349  First  Natl.  Bank  Bldg.; 
Main  669;  S (PP). 

Forster  Alexius;  Cragmor  San.;  Main  122;  T*  (Exec.). 
Geever,  Erving  F. ; 2200  N.  Tejon  St.;  Main  184;  Path* 
(PP). 

Giese,  Charles  O. ; 316  Ferguson  Bldg.;  Main  4160; 
T (PP). 

Gilbert,  G.  Burton;  214  E.  San  Rafael  St.;  Main  213; 
(Ret.). 

Gloss,  Kenneth  E.;  2431  W.  Colorado  Ave.;  Main 
4774;  ObG  (PP). 

Goodson,  Harry  C. : 619  Exchange  Natl.  Bank  Bldg,; 
Main  150:  T (PP). 

Greiner,  David  J.;  712  Exchange  Natl.  Bank  Bldg.; 
Main  193;  ObG  (PP). 

Gydesen,  Carl  S. ; 301  Ferguson  Bldg.;  Main  3712; 
I*  (PP). 

Haney.  J.  Rowan;  211  Ferguson  Bldg.;  Main  450; 
S (PP). 

Haney,  Lawrence  O. ; Ferguson  Bldg.;  Main  450;  S 
(PP). 

Hanford,  Peter  O. ; 720  N.  Nevada  St.;  Main  1151;  S*. 
Hartwell,  John  B.;  328  Burns  Bldg.;  Main  218;  S* 
(PP.) 

Herold,  Walter  C. ; 412  Burns  Bldg.;  Main  8100; 
D*  (PP). 

Hill,  James  N.;  324  Burns  Bldg.;  Main  724;  Pd*  (PP). 


Rocky  Mountain  Medical  Journal  Supplement 


9 


Essential  Automobiles  Given  Priority — 

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Featuring 

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Including — Body,  Fender  and  Paint  Work 

CAPITAL  CHEVROLET  COMPANY 

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Phone:  TAbor  5191  Denver,  Colorado 

Catering  to  the  Patronage  of  the  Medical  Profession 


BURT'S  MOTOR  SALES 

BURT  BLANOT,  Owner 

☆ 

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Complete  Motor  Rebuilding 

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Dodge  Plymouth 

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24-Hour  Tow  Service 

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Phone  KEystone  8448 

We  Do  Welding 


Alpine  Electric 
Company 

F R.  Webster  J.  F.  Legge 

☆ 

Electrical  Contracting 

Repairing  and  Maintenance  Work 

☆ 

Fluorescent  Lighting 

Sales  and  Service 

629  Santa  Fe  Drive  Denver 

Phone  CHerry  5958 

We  W^elcome  the  Business  of  the 
Medical  Profession 


10 


Rocky  Mountain  Medical  Journal  Supplement 


Colorado  Springs  ...  (Continued) 

Hills,  Willard  K.;  232  Ferguson  Bldg.;  Main  665; 
ObG  (PP). 

Hoebel,  Frederick  C.;  209  S.  Nevada  Ave. ; Main  9700; 
S*  (PP). 

Holcomb.  William  D.;  1619  S.  Tejon  St.:  Main  4244; 
GP  (PP). 

Houf,  Harry  W.,  Jr.;  224  Burns  Bldg.;  Main  4507; 
GP  (PP). 

Johnston,  J.  Harvey;  209  S.  Nevada  Ave.;  Main  9700; 
I*. 

Karabin,  John  E.;  209  S.  Nevada  Ave.;  Main  9700; 
S*  (PP). 

Kennedy,  James  R. ; 322  Burns  Bldg.;  Main  6350; 
ObG*  (PP). 

Kennedy,  Louis  J. ; 322  Burns  Bldg.;  Main  8172;  S* 
(PP). 

Kerr,  Richard  K. ; 209  S.  Nevada  Ave.;  Mam  9700; 
ObG*  (PP). 

Kettelkamp,  Fred  O. ; 301  Ferguson  Bldg.;  Main  267; 
ALR*  (PP). 

Kibler,  Bh'ancis  E. ; 408  Burns  Bldg.;  Main  207;  S* 
(PP). 

Knowles,  Tom  R. : 600  Exchange  Natl.  Bank  Bldg.; 
Main  78;  S (PP). 

Kuhlman,  William  K. ; 209  S.  Nevada  Ave.;  Main  9700; 
Oph*  (PP). 

Labowskl,  Peter  J.;  206  Burns  Bldg.;  Main  8882; 
Pd*  (PP). 

Lamberson,  Harry  H. ; 344  First  Natl.  Bank  Bldg.: 
Main  44 ; U*  (PP). 

Lamberson,  William  H. ; 468  First  Natl.  Bank  Bldg.; 
Main  1360;  OALR*  (PP). 

Landon,  F.  Rodman;  327  E.  Platte  Ave.;  Main  9164; 
Pd*  (PP). 

Larimer,  Craig-  W. ; 327  Ferguson  Bldg.;  Main  1820; 
Anes*  (PP). 

Lewis,  James  W. ; 209  S.  Nevada  Ave.;  Main  9700; 
R*  (PP). 

Liddle,  Edward  B. ; 202  Burns  Bldg.;  Main  392;  U* 
(PP). 

Loomis.  P.  A.;  Ferguson  Bldg.;  Main  4160. 

Low,  William  G. ; 460  First  Natl.  Bank  Bldg.;  Main 
416;  Pd  (PP). 

Mahoney,  Joseph  J.;  464  First  Natl.  Bank  Bldg.;  Main 
305;  I*  (PP). 

Maly,  Henry  W. ; 344  First  Natl.  Bank  Bldg.;  Main 
6735;  I*  (PP). 

Marbourg,  Edgar  M.;  1823  N.  Cascade  Ave.;  Main 
1239;  Oph*  (Ret.). 

McClanahan,  Zenas  H.;  Exchange  Natl.  Bank  Bldg.; 
Main  150;  S. 

McClellan,  Charles  W.;  215  First  NatT  Bank  Bldg.: 
Main  753;  I*  (PP). 

McConnell.  John  F.;  316  Ferguson  Bldg.;  Main  4160; 
I*  (PP). 

McCrossin,  William  P.,  Jr.;  206  Bums  Bldg.;  Main 
444;  S (PP). 

McDonald,  John  L.;  412  Burns  Bldg.;  Main  1221; 
C*  (PP). 

McMullen,  James  W. ; 2200  N.  Tejon;  Main  184;  R* 
(PP). 

Mellen,  Richard  H.;  416  Burns  Bldg.;  Main  9766; 
Or*  (PP). 

Mihalick,  John;  Ferguson  Bldg.;  Colorado  Springs. 
Morrison,  Charles  S. ; 2512%  W.  Colorado  Ave.;  Main 
965;  GP  (PP). 

Mullett,  Aidan  M.;  400  Burns  Bldg.;  Main  671;  I* 
(PP). 

Nelson,  Fritz;  1117  N.  Tejon;  Main  6443;  Oph*  (PP). 
Nicks,  Frank  I.;  224  Burns  Bldg.;  Main  4507;  GP. 
O'Brien,  Edward  J. ; Etxchange  Natl.  Bank  Bldg.; 
Main  243;  GP  (PP). 

O’Donnell,  Francis  A.;  Rt.  1,  Box  47;  Main  1356;  PN* 
(PP). 

Pattee,  James  J.;  7%  E.  Bijou  St.;  Main  9751;  GP 
(PP). 

Powell,  Henry  M.;  309  Bums  Bldg.;  Main  4547;  I* 
(PP). 

Prior,  Frank  H.;  720  No.  Tejon  St.;  Colorado  Springs. 
Ralston,  John  D.;  411  Burns  Bldg.;  Main  8977;  I* 
(PP). 

Rand,  Ellis  D. ; 402  Burns  Bldg.;  Main  9766;  Or*  (PP). 
Rothrock,  Francis  B. ; 422  E.  Pikes  Peak  Ave.;  Main 
322;  GP. 

Ryder,  Charles  T.;  1626  Wood  Ave.;  Main  4626; 
(Ret.). 

Schafer,  Millard  F.;  28  B.  Boulder;  Main  7577;  PH* 
(PH). 

Schwab,  Irving  H.;  462  First  Natl.  Bank  Bldg.;  Main 
1095;  ObG. 

Schwer,  Carl;  Colorado  Springs  Psychopathic  Hosp.; 

Main  1356;  PN*  (PG  Res.). 

Service,  William  C.;  414  Burns  Bldg.;  Main  5775; 
A*  (PP). 

Sevier,  Charles  E. ; Broadmoor  Hotel;  Main  4180;  Or* 
(PP). 


Sevier,  John  A.;  Broadmoor  Hotel;  Main  4180;  I* 
(PP). 

Shivers,  George  C. ; 235  Ferguson  Bdg. ; Main  8500; 
S (PP). 

Shivers,  Marcus  O.;  1431  N.  Tejon  St.;  Main  793; 
S*  (Ret.). 

Smith,  Gerald  H. ; 391  Ferguson  Bldg.;  Main  3712; 
I*  (PP). 

Smith,  Robert  H. ; 209  St  Nevada  Ave.;  Main  9700; 
I*  (PP). 

Smith,  Willard  A.;  Ferguson  Bldg,;  Main  3711. 
Snyder,  Maurice  E. ; 113  E.  St.  Vrain  St.;  Main  1612; 
Pd*  (PP). 

Staines,  Minnie  E.;  407  Burnsi  Bldg.;  Main  1212;  CP*. 
Stine,  George  H.;  304  Burns  Bldg.;  Main  5090;  Oph* 
(PP). 

Stone,  William  F.  316  Ferguson  Bldg.;  Main  4160; 
T (PP). 

Stough,  Charles  F.;  316  Ferguson  Bldg.;  Main  4160; 
S*  (PP). 

Taylor,  Gwendolyn  E. ; 1006  W.  Pikes  Peak  Ave.;  Main 
7574;  Anes*  (PP). 

Tice,  Frederick  G. ; 412  Burns  Bldg.;  Main  9044;  D* 
(PP). 

Timmons,  Elmer  L. ; 712  Exchange  Natl.  Bank  Bldg.; 
Main  193;  Pd  (PP). 

Tyner,  Bernice;  416'  Burns  Bldg.;  Main  9549;  GP 
(PP). 

Vanderhoof,  Don  A.;  601  N.  Tejon  St.;  Main  75; 
ALR  (Ret.). 

Vincent,  Edward  H. ; 325  Burns  Building;  Main  661; 
Si*  (PP). 

Wallace,  William  S.;  501  N.  Tejon  St.;  Main  6811; 
R*  (PP). 

Whitney,  Roger  S.;  20  E.  San  Rafael  St.;  Main  9599; 
I*  (PP). 

Williams,  Lester  L.;  202  Burns  Bldg.;  Main  392; 
U*  (PP). 

Williams,  Walter  S.;  407  Burns  Bldg.;  Main  1212; 
I*  (PP). 

Winternitz,  David  H. ; 412  Burns  Bldg.;  Main  1173;  S 
(PP)  . 

Woodward,  Harry  W.;  Ferguson  Bldg.;  Main  4160; 
S (PP). 

Woodward,  Stillman;  Union  Printers’  Home;  Main 
2817,  Ext.  17;  GP. 

Cortez  ... 

Calkins,  Royal  W.;  Cortez;  Cortez  77;  OALR  (PP). 
Griffith,  Elden  R.;  808  Grand:  St.;  Cortez;  (Associate 
Member;  Not  a Physician). 

Kirkeeng,  M.  J. ; 200  W.  Main  St.;  Cortez  22;  OALR 
(PP). 

Maxwell,  Irwin  E.;  200  W.  Main  St.;  Cortez  22;  S* 
(PP). 

Parmley,  Clifford  Ec  200  W.  Main  St.;  Cortez  22;  GP. 
Rasor,  Harry  R.;  117  N.  Elm;  Cortez  165-W'  GP  (PP). 
Speck,  Richard  T.;  510  E.  Main  St.;  Cortez  6;  GP 
(PP). 

Craig  ... 

Bliss,  Chester  H.;  530  Yampa  Ave.;  Craig  530;  GP 
(PP). 

Deal,  William  F.;  Craig;  Craig  148;  GP  (PP). 

Bspey,  James  G.,  Jr.;  560  Yampa  Ave.;  Craig  375; 
GP  (PP). 

Cripple  Creek  ... 

Hassenplug,  William  F.;  Cripple  Creek;  Cripple 
Creek  17;  (Ret.). 

Del  Norte  ... 

Anderson,  Vetalls  V.;  Del  Norte;  Del  Norte  30; 
S (PP). 

Gjellum,  Arthur  B.;  Del  Norte;  Del  Norte  200; 
S (PP). 

Vickers,  Charles  W.;  820  Spruce  St.;  Del  Norte  4422; 
GP  (PP). 

Delta  ... 

Cleland,  Winfield  S.;  Cook  Bldg.;  Delta  102-W; 
GP  (PP). 

Connor,  Joseph  J.;  345  Meeker;  Delta  293;  GP  (PP). 
Erich,  Augustus  F.;  Delta;  (Ret.). 

Hick,  Lawrence  A.;  Delta;  (Ret.). 

Hick,  Lawrence  L.;  345  Meeker;  Delta  29-3;  S (PP). 
Phillips,  Edward  R. ; Medical  Bldg.;  Delta  240- W; 
S (PP). 

Underwood.  Robert  A.;  327  Meeker;  Delta  341;  S 
(PP). 


Rocky  Mountain  Medical  Journal  Supplement 


11 


PROFESSIONAL  LIABILITY  INSURANCE 


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Does  it  contain  the  word  “NEGUGENCE”  ? 

Does  it  contain  the  words  “PROPERTY  DAMAGE”? 

If  not,  phone  us  for  an  appointment  and  let  us  explain  the 

Policy  issued  by  the 

UNITED  STATES  FIDELITY  & GUARANTY  COMPANY 

and  approved  by 

The  Colorado  State  Medical  Society 


MORGAN,  LEI6MAN  & HICKEY,  Agents 

Gas  & Electric  Bldg.  Denver  Phone  TAbor  1395 


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The  Drug  Store  Complete 

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We  Use  Lilly  Pharmaceutical  and 
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DRUGS  . . . SUNDRIES 

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Imported  Wines — Fountain — Luncheonette 

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Owner  and  Manager 

Champa  at  14th  Street 

Phone  KEystone  4269 

Denver  ' Cbibrado 


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☆ 

PRESCRIPTION 
DRUG  STORE 

Drugs  and  Sundries 

☆ 

2200  Kearney  St.,  Denver,  Colorado 
Phone  EAst  1 823 


12 


Rocky  Mountain  Medical  Journal  Supplement 


Denver  ... 

Abrums,  William  W. ; 4120  Federal  Blvd. ; GLendale 
4762;  Denver  11;  S*  (PP). 

Adland,  Samuel  A.;  1509  Marion  St.;  MAin  0881;  Den- 
ver 6;  I*  (PP). 

Afton;  William  E. ; 330"  Republic  Bldg.;  TAbor  1053; 
Denver  2;  GP  (PP). 

Aiello,  Serge  A.;  1765  Sherman  St.;  TAbor  8181;  Den- 
ver 2;  I*  (PP). 

Akers.  David  R.;  777  Ash  St.;  DExter  3813;  Denver  7: 
S*  OPG  Res.). 

Albers,  A.  Lee;  520  Metropolitan  Bldg.;  KEystone 
7623;  Denver  2;  S (PP). 

Albi,  Piero;  3456  W.  1st  Ave. ; SPruce  9480;  Denver 
4;  Or  (PP). 

Albi,  Roger  V.;  768  Santa  Fe  Drive;  KEystone 

3598;  Denver  4;  ObG  (PP). 

Albi,  Rudolph;  325  Mack  Bldg.;  KEystone  7703; 
Denver  2;  I*. 

Alexander,  Martin  M.‘;  709  Republic  Bldg.;  MAin 
5820;  Denver  2;  (PP). 

Allen,  Kenneth  D.  A.;  452  Metropolitan  Bldg.; 

TAbor  4208;  Denver  2;  R*  (PP). 

Allen,  Philip  C.  C. ; 224  Republic  Bldg.;  MAin  2235; 
Denver  2;  Anes*. 

Allen,  Robert  P. ; Children’s  Hosp. ; MAin  1261;  R* 
(PP). 

Altieri,  John  A.;  3655  Tejon  St.;  GRand  3732;  Denver 
11;  GP  (PP). 

Ambler,  John  V.;  910  Republic  Bldg.;  ALpine  2887; 
Denver  2;  D*  (PP). 

Amesse,  John  H. ; 624  Metropolitan  Bldg.;  TAbor 

0181;  Denver  2;  GP  (PP). 

Amesse,  John  W. ; 1675  Kearney  St.;  EAst  4917; 
Denver  7;  Pd*  (Ret.). 

Anderson,  Cyrus  W. ; 224  Republic  Bldg.;  MAin 

2235;  Denver  2;  ObG  (PP). 

Anderson,  Leighton  L. ; Colorado  General  Hosp.; 

EAst  7771;  Denver  7;  I*.  (Med.  School). 

Argali,  Albert  J. ; 928  Metropolitan  Bldg.;  KEystone 
5304;  ALR*  (PP). 

Arndt,  Karl  F. ; 208  Republic  Bldg.;  TAbor  8227; 
Denver  .2;  I*  (PP). 

Arndt,  Rudolph  W. ; 208  Republic  Bldg.;  TAbor  8227; 
Denver  2;  I*  (PP). 

Arnei'll,  James  Rae;  1765  Sherman  St.;  TAbor  8181; 
Denver  5;  I*. 

Arneill,  James  Rae,  Jr.;  1765  Sherman  St.;  TAbor 
8181;  Denver  5;  S*. 

Ashe,  S.  M.  Prather;  1056  E.  19th  Ave.;  MAin  1261: 

Denver  6;  Path*  (PG  Res.). 

Ashley,  Glaister  H. ; 432  Republic  Bldg.;  TAbor  8044; 
Denver  2;  PN*  (PP). 

Ashmun,  David  R.;  609  Republic  Bldg.;  ALpine  2488; 
Denver  2;  (PP). 

Ashmun,  Raymond  V.;  4430  Federal  Blvd.;  GRand 
3400;  Denver  11;  GP  (PP). 

Attwood.  A.  De  Forest;  4635  W.  38th  Ave.;  GLendale 
0127;  Denver  12. 

Auer,  Eugene  S.;  638  Republic  Bldg.;  KEystone 

6201;  Denver  2;  ObG*  (PP). 

Badger,  Edward  B.;  Denver  Gen.  Hosp.;  TAbor  1331: 
Denver  4. 

Bagot,  William  S. ; Denver  Club,  500  17th  St.;  TAbor 
3221;  Denver  2;  (Ret.). 

Baker,  William  Gi;  820  Metropolitan  Bldg.;  KEy- 
stone 3124;  Denver  2;  GP  (PF). 

Balajty,  George;  509  Republic  Bldg.;  TAbor  0033; 
Denver  2;  I*  (PP). 

Balkin,  Gilbert;  1003  Republic  Bldg.;  MAin  0813; 
Denver  2;  S*  (PP). 

Bane,  William  M. ; 1005  Republic  Bldg.;  AComa  0025; 
Denver  2:  Oph*  (PP). 

Barbato,  L«owis;  Student  Health  Service,  Denver 
Cniversity;  2040  S.  Josephine  St.;  RAce  2891;  Den- 
ver 10;  PN*  (Student  Health  Service). 

Barber,  Edgar  W.;  632  Metropolitan  Bldg.;  KEystone 
0i70j4:  Denver  2;  S*  (PP). 

Barber,  Wilford  W. ; 624  Metropolitan  Bldg.;  TAbor 
0181;  Pd*  (PP). 

Bard,  Eli;  326  Republic  Bldg.;  AComa  1010;  Denver 
2;  Oph*  (PP). 

Barker,  Mary  L. ; 4200  E.  9th  Ave.;  EAst  7771;  Den- 
ver 7. 

Barnacle,  Clarke  H. ; 756  Metropolitan  Bldg:  KEy- 
stone 2711;  Denver  2;  PN*  (PP). 

Barnard,  Hamilton  I.;  1707  E.  18th  Ave.;  FRemont 
8877;  Denver  6;  Or*  (PP). 

Barneyr^j;  Murray;  206  Steel  Bldg.;  TAbor  2541; 
Denver  2;  GP. 

Barra,  R.  Louis,  733  Republic  Bldg.;  KEystone  4279: 
Denver  2;  OALR*  (PP). 

Baskin.  Morris  J.;  822  Republic  Bldg.:  MAin  4371: 
Denver  2;  ObG*  (PP). 

Bassow,  Solomon  H. ; 703  Republic  Bldg.;  KEvstone 
6767;  Denver  2;  U*  (PP). 


Bates,  Mary  E. ; 220  Majestic  Bldg.;  KEystone  7314; 
Denver  2;  (Ret.). 

Battock,  Benjamin  H. ; 832  Republic  Bldg;  TAbor 
6309;  Denver  2;  Anes*  (PPL 
Baughman,  Jack  L. ; Denver  General  Hosp.;  TAbor 
1331;  Denver  4;  I*  (Med.  School). 

Baum,  Harry  L. ; 510  Republic  Bldg.;  TAbor  2954; 
Denver  2;  ALR*  (Ret.). 

Beaghler,  Amos  L.;  414  14th  St.;  TAbor  7151,  Ext. 

361;  Denver  2;  PH*  (School  Health  Service). 

Beall,  Walter  C.;  3525  W.  49th  Ave.;  GLendale  1438; 
Denver  11;  (Ret.). 

Becker,  Harold  C.;  832  Republic  Bldg.;  TAbor  7765; 
Denver  2;  GP  (PP). 

Bell,  James  C.;  4200  E.  9th  Ave.;  EAst  7771;  Den- 
ver 7. 

Benner,  Miriam  Crowell,  254  Metropolitan  Bldg.: 

CHerry  2919;  Denver  2;  (PP). 

Bennion,  Ben  W.;  1765  Sherman  St.;  TAbor  8181; 
Denver  5:  GP  (PP). 

Benwell,  John  S.;  506  Metropolitan  Bldg.;  ALpine 
4675;  Denver  2;  S*  (PP). 

Berris,  Robert  F. ; 822  Republic  Bldg.;  MAin  4371; 
Denver  2;  I*  (PP). 

Berry.  John  W.;  4200  E.  9th  Ave.;  EAst  7771;  Denver 
7;  I*  (Med.  .School). 

Bershof,  Edward:  707  Republic  Bldg.;  TAbor  1594; 
Denver  2;  I*  (PP). 

Best,  Thomas  E.;  718  Mack  Bldg.;  MAin  3457;  Den- 
ver 2;  GP  (PP). 

Beyer,  Theodore  E. ; 920  Metropolitan  Bldg.;  TAbor 
3800:  Denver  2;  ALR*  (PP). 

Billings,  Edward  G. ; 1820  Gilpin  St.;  DExter  1161; 
Denver  6:  PN*  (PP). 

Bingham,  WSlliam  J.;  2281  Ivy  St.;  EAst  7357; 

Denver  7:  (Ret.). 

Binkley,  Edward  L.,  Jr.;  1767  Franklin  St.;  ALpine 
1940;  Denver  6;  Pd*  (PP). 

Birkenmayer,  Wilson  C. ; 250  Metropolitan  Bldg.; 

KEystone  5077;  Denver  2;  GP  (PP). 

Black,  William  C.;  St.  Luke’s  Hosp.;  TAbor  3241; 
Denver  5:  Path*  (Hosp.). 

Blair,  James  R.,  Jr.;  920  Metropolitan  Bldg.;  TAbor 
3800;  Denver  2;  ALR*  (PP). 

Blanchard,  Winthrop  E.;  601  Republic  Bldg.:  MAin 
3609;  Denver  2;  S*. 

Blandford,  Sidney  E.,  Jr.;  612  Metropolitan  Bldg.; 

TAbor  2303;  Denver  2;  S*  (PP). 

Blevins,  Jason  L. ; 600  Metropolitan  Bldg.;  KEystone 
1725;  Denver  2;  GP  (PP). 

Block,  Leon;  624  Majestic  Bldg.;  TAbor  5593;  Denver 
2;  OALR*  (PP). 

Bluemel.  Charles  S. ; 1205  Clermont  St.;  EAst  1805; 
Denver  7;  PN*  (HA). 

Boehm,  William;  536  Republic  Bldg.;  TAbor  4934; 
Denver  2;  S*  (PP). 

Bograd,  Michel;  1938  S.  Broadway:  PEarl  6866; 
Denver  10;  GP. 

Botha,  Eleanor;  2100  S.  University  Blvd.;  Denver  10. 
Bouslog,  John  S. ; 304  Republic  Bldg.;  KEystone 

2301:  Denver  2;  R*  (PP). 

Bowers,  Abern  E.;  1013  Republic  Bldg.:  TAbor  8800; 
Denver  2;  OALR*  (PP). 

Bradford,  H.  Alexander;  203  Metropolitan  Bldg.; 

MAin  3185;  Denver  2;  I*  (PP). 

Bradford,  Henry  Rollie;  1690  Milwaukee  St.;  DExter 
7447;  Denver  6;  GP  (PP). 

Bramley,  Howard  F. ; 1809  E.  18th  Ave.;  FRemopt 
2731;  Denver  6;  S*  (PP). 

Bramley,  J.  Gilbert;  423  Majestic  Bldg.;  MAin  5746; 
Denver  2;  GP  (PP). 

Bramley,  James  R. ; 423  Majestic  Bldg.;  MAin  5746; 
Denver  2;  GP  (PP). 

Brandenburg,  Harmon  P. ; 155  Metropolitan  Bldg.; 

KEystone  0523;  Denver  2;  R*  (PP). 

Bricker,  John  W. ; 1809  E.  18th  Ave.;  FRemont  2731; 
Denver  6;  I*  (PP). 

Brinkhaus,  Norman  E.;  5030  Stuart  St.;  GRand  0122; 
Denver  12. 

Brinton,  William  T.;  406  Republic  Bldg.;  KEystone 
8231;  Denver  2;  Oph*  (PP). 

Bronson,  Howard  A.;  818  Majestic  Bldg.;  MAin  6488; 
Denver  2;  GP  (PP). 

Brown,  Harry  C. ; 330  Republic  Bldg.;  TAbor  1053; 
Denver  2;  Ob  (PP). 

Brown,  Lawrence  T. ; 623  Republic  Bldg.;  KEystone 
3629;  Denver  2;  Ob*  (PP). 

Brown,  Robert  K.;  806  Metropolitan  Bldg.;  MAin 
8295;  Denver  2;  S*  (PP). 

Bryson,  Margaret  E. ; 1370  Race  St.:  EAst  7840; 

Denver  6;  (Ret.). 

Buchanan,  Archibald  R. ; 4200  E.  9th  Ave.;  EAst 
7771:  Denver  7:  (Med.  School). 

Buchanan,  Daniel  H.,  Jr.;  550  Metropolitan  Bldg.; 

TAbor  5428;  Denver  2;  I*  (PP). 

Buchtel,  Henry  A.;  1224  Republic  Bldg.;  TAbor 

1224;  Denver  2;  U*  (PP). 

Buck,  George  R. ; 721  Republic  Bldg.;  TAbor  2545: 
Denver  2;  Pr*  (PP). 

Bundsen,  Charles  A.;  2040  Eudora  St.:  EAst  5355: 
Denver  7;  T (PP). 


Rocky  Mountain  Medical  Journal  Supplement 


13 


Cruises 

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Agents  for  ALL  Steamship  Companies — Airlines — Railroads 

Members  of  the  American  Society  of  Travel  Agents 
One  of  America’s  Oldest  Travel  Agencies — 45  Years  of  Service 

E.  D.  WHITLEY  Steamship  and  Tourist  Agency,  Inc. 

648  17th  St.  (Security  Bldg.)  Denver,  Colo.  Phone  AComa  2828 


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14 


Rocky  Mountain  Medical  Journal  Supplement 


Denver  ...  (Continued) 

Burdick,  Elands  D.;  Student  Health  Center,  2040  S. 

Josephine  St.;  Denver  10;  I*  (PP). 

Burling-ame,  Robert  M. ; 732  Republic  Bldg-. ; KEy- 
stone  4465;  Denver  2;  S*  (PP). 

Burnett,  Clough  T. ; 550  Metropolitan  Bldg.;  TAbor 
5428;  Denver  2;  I*  (PP). 

Bush,  Stuart  K.;  4200  E.  9th  Ave.;  EAst  7771;  Den- 
ver 7;  P*  (Med.  School). 

Butterfield,  Olin  J. ; 646  Metropolitan  Bldg.;  KEy- 
stone  6422;  S*. 

Byington,  LeGrand  B.;  304  New  Custom  House;  KEy- 
stone  4151,  Ext.  8356;  Denver  2;  PH*  (U.S.P.H.S.). 
Calhoun,  Frederick  R. ; 416  Metropolitan  Bldg.; 

KEystone  5976;  Denver  2;  I*  (PP). 

Campbell,  Frank  C.;  1750  E.  19th  Ave.;  DExter  5471; 
Denver  6;  (PP). 

Campbell,  Horace  E.;  537  Republic  Bldg.;  MAln 

5524;  Denver  2;  S (PP). 

Campbell,  J.  Lawrence;  806  Republic  Bldg.;  KEy- 
stone 3153;  Denver  2;  Anes*  (PP). 

Campbell,  Winona  G. ; 4200  E.  9th  Ave.;  EAst  7771; 

Denver  7;  Pd*  (Med  School). 

Carlson,  Robert  G. ; 1205  Clermont  St.;  EAst  1805; 
Denver  7;  P*  (PP). 

Carpenter,  Fred  H. ; 1218  Republic  Bldg.;  MAin 

4798;  Denver  2;  S*. 

Carter,  Harold  R.;  550  Metropolitan  Bldg.;  TAbor 
3218;  Denver  2;  PN*  (PP). 

Cash,  AEneas  P. ; U.  S.  Vet.  Adm.  Reg.  Office;  1108 
15th  St.;  KEystone  4151;  Denver  2;  GP  (PP). 
Castellano,  Stephen  A.;  St.  Anthony's  Hosp. ; TAbor 
1103;  Denver  4. 

Cattermole,  George  S. ; 712  Metropolitan  Bldg.; 

CHerry  6030;  Denver  2;  S (PP). 

Catterson,  Alden  D.;  652  Metropolitan  Bldg.;  KEy- 
stone 8408;  Denver  2;  Gyn  (PP). 

Cecchlni,  Augustine  S. ; 208  Republic  Bldg.;  TAbor 
8227;  Denver  2;  GP. 

Cedarblade,  Vincent  G. ; 3705  EL  Colfax  Ave.;  KEy- 
stone 0907;  Denver  6;  S*  (PP).  * 

Chadwick,  Ward  L;  Denver  (General  Hosp.;  TAbor 
1331;  Denver  4;  Fd*  (PH). 

Chambers,  Karl;  812  Republic  Bldg.-;  TAbor  0620; 
Denver  2;  ALR  (PP). 

Chambers,  William  W. ; 610  Republic  Bldg.;  KEy- 
stone 7728;  Denver  2;  S (PP). 

Chapman,  Edward  N. ; 460  State  Capitol  Annex; 

MAin  0283;  Denver  3;  T*  (Exec.). 

Charles,  Robert  L;  564  Metropolitan  Bldg;  KEystone 
7023;  Denver  2;  Anes*  (PP). 

Charney,  Leon  J. ; U.  S.  Veterans  Administration, 
1108  15th  St.;  KEystone  4151;  Denver  2;  T*  (Gov.). 
Chatfield,  Raymond  C. ; 1809  E.  18th  Ave.;  DExter 
8458;  Denver  6;  ObG*  (PP). 

Chernyk,  Maurice;  404  Republic  Bldg.;  MAin  6448; 
Denver  2;  I*  (PP). 

Chessen,  James;  510  Republic  Bldg.;  TAbor  2954; 
Denver  2;  ALR*  (PP). 

Childs,  Samuel  B.,  Jr.;  1731  Gilpin  St.;  FRemont 
4220;  Denver  6;  S*  (PP). 

Clark,  H.  Dumont;  1731  Gilpin  St.;  DEXter  1597; 
Denver  6;  I*  (PF). 

Clark,  Paul  M. ; 509  Republic  Bldg.;  KEystone  3807; 
Denver  2;  I*  (PP). 

Cleere,  Roy  L;  414  State  Office  Bldg.;  ALpine  1466; 
Denver  3;  PH*  (PH). 

Cochems,  Fhank  N. ; 401  Westwood  Drive;  EAst 

7408;  Denver  6. 

Cohen,  Edmond  F. ; 804  Republic  Bldg.;  TAbor  5557; 
Denver  2;  Pr*  (PP). 

Cohen,  Haskell  M. ; 709  Republic  Bldg.;  MAin  5820; 
Denver  2;  S*. 

Cohen,  R.  Robert;  438  Republic  Bldg.;  TAbor  5605; 
Denver  2;  PN*  (PP). 

Collier,  Mary  Marr;  806  Republic  Bldg.;  KEystone 
3153;  Denver  2;  Anes*. 

Collins,  Edward  Welles;  1578  Humboldt  St.;  MAin 
2555;  Denver  6:  ALR*  (PP). 

Conant,  Edgar  F.;  502  Mack  Bldg.;  MAin  2512; 

Denver  2;  OALR*. 

Condit,  Edwin  G. ; 1001  Ogden  St.;  CHerry  3389; 

Denver  3. 

Condon,  William  B. ; 1008  Republic  Bldg.;  ALpine 
2889;  Denver  2;  S*  (PP). 

Conway,  Leo  A.;  1024  Republic  Bldg.;  KEystone 
3665;  Denver  2;  I*  (PP). 

Cooper,  Clyde  J. ; 309  Republic  Bldg.;  TAbor  0094; 
Denver  2;  S (PP). 

Cooper,  Kemp  G. ; 652  Metropolitan  Bldg.;  MAin 

2922;  Denver  2;  ALR*  (PP). 

Corper,  Harry  J.;  3800  E.  Colfax  Ave.;  EAst  1881; 
Denver  6;  I*  (Research). 

Covode,  William  M. ; 202  Metropolitan  Bldg.;  TAbor 
2985;  Denver  2;  U*  (PP). 

Crary,  Richard  H. ; St.  Luke’s  Hosp.;  TAbor  3241; 

Denver  5;  Path*  (PG  Res.). 

Cremer,  John  Alfred;  4400  E.  Iliff  Ave.,  Bethesda 
San.;  RAce  2841;  Denver  7;  S. 


Crisp,  William  H. ; 1276  Emerson  St.;  KEystone  1513; 
Denver  3;  Oph*  (PP). 

Crosby,  Leonard  G. : 366  Metropolitan  Bldg.;  TAbor 
5141;  Denver  2;  R*  (PP). 

Cullyford,  James  S.;  2660  Kearney  St.;  EAst  6284; 
Denver  7. 

Cunningham,  T.  -Donald;  932  Republic  Bldg.;  MAin 
4204;  Denver  2;  J*  (PP). 

Curfman,  George  H.,  Jr.;  1820  Gilpin  St.;  DExter 
1654;  Denver  6;  I*  (PP). 

Currigan,  Martin  D. ; 432  Republic  Bldg.;  TAbor 
2857;  Denver  2;  Ind  (PP). 

Curtis,  Selvie  J. ; 891  S.  Race  St.;  PEarl  5190;  Denver 
9;  I*  (PP). 

Curtis,  William  S. ; 304  Republic  Bldg.;  KEystone 
2301;  Denver  2;  R*  (PP). 

Dahl,  LaMeta  F. ; 4200  E.  9th  Ave.;  EAst  7771,  Ext. 

299;  Denver  7;  Pd*  (Med.  School). 

Dailey,  Clifford  L. ; 1445  S.  Garfield  St.;  RAce  3907; 
Denver  10;  Anes*  (PP). 

Danahey,  Lawrence  K. ; 679  Grant  St.;  ALpine  6343; 
Denver  3;  GP  (PP). 

Daniels,  Luman  E. ; 1227  Republic  Bldg.;  KEystone 
5037;  Denver  2;  N*  (PP). 

Danielson,  Ralph  W. ; 324  Metropolitan  Bldg.;  MAin 
2332;  Denver  2;  Oph*  (PP). 

Darley,  Ward;  4200  El  9th  Ave.;  EAst  7771;  Denver 
7;  I*  (Exec.). 

Davis,  Charles  L.;  517  Custom  House  Bldg.;  Denver 
2;  (Associate  Member;  Not  a Physician). 

Davis,  E.  Keith;  3937  Tennyson  St.;  GLendale  8905; 
Denver  12;  GP  (PP). 

Davis,  John  A.;  2525  So.  Downing  St.;  PEarl  3721; 
Denver  10;  GP  (PP). 

Davis,  William  S. ; 2045  E.  18th  Ave.;  DExter  5493; 
Denver  6;  Pd*  (PP). 

Daywitt,  Alvin  L;  910  Central  Savings  Bank  Bldg.; 

KEystone  4151;  Denver  2;  (Gov.). 

Deeds,  Douglas;  700  Metropolitan  Bldg.;  AComa 
2628;  Denver  2;  I*  (PP). 

Deems,  Myers  B.;  1765  Sherman  St.;  TAbor  8181; 
Denver  5;  ALR*  (PP). 

Delehanty,  Edward,  Sr.;  327  Majestic  Bldg.;  KEy- 
stone 2916;  Denver  2;  N*  (PP). 

Delehanty,  Edward  J.,  Jr.;  327  Majestic  Bldg.;  KEy- 
stone 2916;  Denver  2;  PN*  (PP). 
del  Junco,  Gerard  W. ; 2025  E.  18th  Ave.;  FRemont 
2704;  Denver  6;  ObG*  (PP). 

Dennis,  Wilfred  S.;  1834  Gilpin  St.;  EAst  6443;  Den- 
ver 6;  I*  (PP). 

DeRoos,  James  J. ; 2150  S.  Pearl  St.;  RAce  3819; 
Denver  10;  Si*  (PP). 

Dickman,  Paul  A.;  1901  Emerson  St.;  TAbor  3000; 
Denver  5;  GP  (PP). 

Dickson,  Logan  M. ; 1565  Pearl  St.;  KEystone  9525; 
Denver  5;  GP  (PP). 

Dickson,  Robert  W. ; 810  Republic  Bldg.;  CHerry 
4531;  Denver  2;  U*  (PP). 

Dillon,  Henry  J.;  2239  E.  Colfax  Ave.;  FRemont  3517; 
Denver  6;  I*  (PP). 

Dinken,  Harold;  4200  E.  9th  Ave.;  EAst  7771;  Denver 
7:  (Med.  School). 

Dixson,  Ira:  1765  Sherman  St.;  TAbor  8181;  Denver 
5;  I*  (PP). 

Dobos,  Emeric  I.;  St.  Joseph’s  Hosp.;  MAin  6121; 
Denver  6;  Path*. 

Donovan,  Mark  S. ; 306  Majestic  Bldg.;  KEystone 
7020;  Denver  2;  R*  (PP). 

Dorsey,  George  H. ; 810  Republic  Bldg.;  CHerry  4531; 
Denver  2;  U*  (PP). 

Dov.rning,  Sam  W.;  1940  E.  18th  Ave.;  DExter  2302; 
Denver  6;  II*  (PP). 

Drinkwater,  Ray  L.;  804  Republic  Bldg.;  TAbor  7066; 
Denver  2;  S (PP). 

Dubin,  Frank  I;  316  Majestic  Bldg.;  ALpine  5276; 
Denver  2;  I*  (PP). 

Dumm,  Byron  I.;  732  Republic  Bldg.;  KEystone  8071; 
Denver  2;  S (PP). 

Durbin,  Edgar;  1809  E.  18th  Ave.;  DExter  4293; 
Denver  6;  C (PP). 

Durham,  Harry  B.,  Jr.;  610  Republic  Bldg.;  CHerry 
1058;  Denver  2;  GP  (PP). 

duRoy,  Robert  M. : 2282  Bellaire  St.;  FRemont  7943; 
Denver  7;  S (PG  Res.). 

Dwyer,  Paul  K.;  830  Metropolitan  Bldg.;  MAin  3508; 
Denver  2;  ObG*  (PP). 

Earhart,  Henry  T. ; 516  Republic  Bldg.;  MAin  4393; 
Denver  2;  S*  (PP). 

Barley,  Arthur  H. ; 1204  Republic  Bldg.;  KEystone 
0680;  Denver  2;  Pr*  (PP). 

Eastlake,  A.  Chesmore;  816  Republic  Bldg.;  MAin 
5761;  Denver  2;  I*  (PP). 

Ebaugh,  Franklin  G. ; 4200  E.  9th  Ave.:  EAst  7771; 

Denver  7:  PN*  (Med.  School). 

Echternacht,  Evan  E.;  46  S.  Broadway;  RAce  2773; 
Denver  9;  GP  (PP). 

Edwards,  John  A.;  1117  Republic  ,Bldg.;  CHerry 

5569;  Denver  2;  GP  (PP). 

Egan,  John  A.;  1765  Sherman  St.;  TAbor  8181;  Den- 
ver 5;  Oph*  (PP). 


Rocky  Mountain  Medical  Journal  Supplement 


15 


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Huntington,  W.  Vo. 


Kansas  City,  Mo. 

Los  Angeles,  Calif. 
Milwaukee,  Wis. 
Minneapolis,  Minn. 
Newark,  N.  J. 
Oklahoma  City,  Okla. 


Winston-Salem,  N.  C. 


16 


Rocky  Mountain  Medical  Journal  Supplement 


Denver  . . . (Continued) 

Elder,  Charles  S.;  333  E.  16th  Ave.;  KEystone  0715; 
Denver  5;  (Ret.). 

Ellis,  George  Dale;  850  Metropolitan  Bldg.;  TAbor 
8348;  Denver  2;  S*  (PP). 

Elrick,  Leroy;  1024  Republic  Bldg'.;  KEystone  0464: 
Denver  2;  T (PP). 

Emerv,  George  ,de  L. : ''2')  Republic  Bldg.:  JIAi.i 

7147;  Denver  2;  R*  (PP). 

Enos,  Clinton;  829  Majestic  Bldg.;  MAin  1633;  Den- 
ver 2;  GP. 

Esserman,  Arthur  L. ; 1575  Gilpin  St.;  FRemont  8801; 
Denver  6;  Pd*  (PP). 

Evans,  Albert  E.;  806  Republic  Bldg.;  KEystone  3153; 
Denver  2;  Anes*  (PP). 

Evans,  Frank  J.;  410  Mack*  Bldg.;  TAbor  7538;  Den- 
ver 2;  S*  (PP). 

Evans,  John  R. ; 1119  Republic  Bldg.;  TAbor  4205; 
Denver  2;  ObG*  (PP). 

Evans,  Russell  J. ; 999  S.  Broad'way;  PEarl  2411; 
Denver  9;  I*  (PP). 

Faust,  Louis  S. ; 1731  Gilpin  St.;  DExter  1597;  Den- 
ver 6;  I*  (PP). 

Fieman,  Sidney  F.;  620  Metropolitan  Bldg.;  CHerry 
1226;  Denver  2;  ALR*  (PP). 

Filmer,  Burnett  A.;  1331  So.  Marion  St.;  PEarl  8486; 
Denver  10;  (Ret.). 

Filmer,  George  A.;  324  Metropolitan  Bldg.;  MAin 
3065;  Denver  2;  Oph*  (PP). 

Fisher,  G.  Robert;  1901  Clarkson  St.;  CHerry  5431; 
Denver  5;  Pd*  (PP). 

Fisher,  H.  (Calvin;  1008  Republic  Bldg.;  ALpine  2889; 
Denver  2;  S*  (PP). 

Flax,  Leo  J.;  1575  Vine  St.;  DExter  5448;  Denver  6; 
Pd*  (PP). 

Florio,  Lloyd;  4200  E.  9th  Ave.;  EAst  7771;  Denvei 
7;  PH*  (Med.  School). 

Foley,  Thomas  H. ; 1934  E.  18th  Ave.:  DExter  7287; 
Denver  6;  ObG*  (PP). 

Forbes,  Burton  L. ; 525  Mack  Bldg.;  KEystone  8453; 
Denver  2;  GP  (PP). 

Fortin,  Virgil  R.;  2123  Gaylord  St.;  EAst  8892; 

Denver  5. 

Foster,  John  M.;  504  Republic  Bldg.;  KEystone  0294; 
Denver  2;  S*  (PP). 

Fo'wler,  Harmon  L. ; 232  Mack  Bldg.;  TAbor  8186; 
Denver  2. 

Fo'wler,  O.  S. ; 940  Metropolitan  Bldg.;  TAbor  3663; 
Denver  2;  S*  (PP). 

Fowler,  William  G. ; 1501  W.  Alameda;  SPruce  8953; 
Denver  9;  GP  (PP). 

Frangos,  Pete  G. ; 1475  Ivy  St.;  FRemont  4004;  Den- 
ver 7;  GP  (PP). 

Frank,  L.  Scott;  1773  Williams  St.;  EAst  7705;  Denver 
6;  GP  (PP). 

Frank,  Lorenz  W.;  1834  Gilpin  St.;  EAst  5025;  Den- 
ver 6;  I*  (PP). 

Frankenburger,  Louise  B. ; 526  Metropolitan  Bldg.; 

CHerry  3915;  Denver  2;  GP  (PP). 

Fianklin,  Daniel;  999  S.  Broadway;  PEarl  7141; 
Denver  9;  OALR*  (PP). 

Franz,  Elmer  M. ; 1750  Race  St.;  DExter  4218;  Denver 
6;  OR*  (PP). 

Fraser,  M.  Ethel  V.;  737  Republic  Bldg.;  TAbor  2672; 
Denver  2;  Gyn  (PP). 

Fraser,  Robert  W. ; 536  Majestic  Bldg.;  KEystone 
0846:  Denver  2. 

Freed,  Charles  G. ; 550  Metropolitan  Bldg.;  TAbor 
3218;  Denver  2;  NS*  (PP). 

h'reeman,  Leonard,  Jr.;  1809  E.  18th  Ave.;  EAst  0375; 
Denver  6;  S*  (PP). 

Freshman,  A.  W. ; 23  4 Metropolitan  Bldg.;  ALpine 
0427;  Denver  2;  Path*. 

Friedland,  Joseph  D.:  1134  Republic  Bldg.;  AComa 
4815;  Denver  2;  I*  (PP). 

Friedman,  Elmanuel;  326  Republic  Bldg.;  MAin 
1943;  Denver  2;  Pd*  (PP). 

Friedman,  Gerald  H. ; 801  Majestic  Bldg.;  CHerry 
8509;  Denver  2;  S*  (PP). 

Friedman,  H.  Harold;  438  Republic  Bldg.;  TAbor 
7386;  Denver  2;  I*  (PP). 

Friesch,  Wenzel;  625  Republic  Bldg.;  MAin  6829; 
Denver  2;  S (PP). 

Frumess,  Gerald  M. ; 210  Republic  Bldg.;  KEystone 
3219;  Denver  2;  D*  (PP). 

Fujisaki,  Charles  K.;  2421  W.  33rd  Ave.;  GLendale 
3538;  Denver  11;  GP. 

Gale,  M.  Jean;  73'7  Republic  Bldg.;  TAbor  2672;  Den- 
ver 2;  Oph*  (PP). 

Garden,  John  E. ; 1325  Milwaukee  St.;  FRemont  1517; 
Denver  6. 

Gardner,  Mariana;  1850  Gilpin  St.;  FRemont  8821; 
Denver  6;  Pd*  (PP). 

Gauss,  Harry;  535  Republic  Bldg.;  TAbor  5723;  Den- 
ver 2;  GE*  (PP). 

Gen.genbach,  Franklin  P.;  1850  Gilpin  St.;  FRemont 
;>o21;  Denver  6;  Pd*  (PP). 

Gersh,  Isadore;  242  Metropolitan  Bldg.;  TAbor  1611; 
Denver  2;  U*  (PP). 


Geshell,  Stanley  W. ; Veterans  Adm.:  KEystone  4151, 
Ext.  554;  Denver  2;  P*  (Gov.). 

Giehm,  Rudolph  E.;  522  Majestic  Bldg.;  KEystone 
3431;  Denver  2;  S (PP). 

Gilbert,  Howard  P.;  2035  E.  18th  Ave.;  DExter  4281; 
Denver  6;  PN*  (PP). 

■ Gillen,  George  H.;  1773  Williams  St.;  EAst  7705; 
Denver  6;  S (PP). 

Gilman,  Harold  E.;  312  Majestic  Bldg.;  CHerry  8840; 
Denver  2;  GP  (PP). 

Ginsburg,  Max  M. ; 1575  Vine  St.;  DExter  5448;  Den- 
ver 6;  Pd*  (PP). 

Glaser,  Joseph  L. ; 1114  Republic  Bldg.;  TAbor  5600; 
Denver  2;  S*  (PP). 

Goldhammer,  Samuel  S.;  727  Republic  Bldg.;  MAin 
4695;  Denver  2;  Oph*. 

Goldman,  Harold  I.;  1'0'24  Republic  Bldg.;  KEystone 
5004;  Denver  2;  A (PP). 

Good,  Albert  H.;  1261  So.  Corona  St.;  PEarl  6444; 
Denver  lOl  GP  (PP). 

Good,  Fredrick  H.;  730  Republic  Bldg.;  CHerry  5411; 
Denver  2;  S*  (PP). 

Goodman,  Nelson;  3920  Tennyson  St.;  GRand  7600; 
Denver  12';  GP  (PP). 

Goodv/in,  Aurel;  Central  Savings  Bank  Bldg.;  KEy- 
stone 4151;  Denver  2;  (Gov.). 

Gootee,  Joseph  E. ; 4200  E.  9th  Ave.;  EAst  7771;  Den- 
ver 7;  (PG  Res.). 

Gordon,  Harry  H.;  4200  E.  9th  Ave.;  EAst  7771,  Ext. 

299;  Denver  7;  Pd*  (Med.  School). 

Gordon.  Robert  W.;  1820  Gilpin  St.;  EAst  7741;  Den- 
ver 6;  I*  (PP). 

Gottschalk,  Robert  H.;  1750  E.  19th  Ave.;  DExter 
5471;  Denver  6;  ObG*  (PP). 

Gottesfeld,  M.  Ray;  624  Republic  Bldg.;  KEystone 
5055;  Denver  2;  ObG*. 

Govan,  Clifton  D.,  Jr.;  2830  Niagara  St.;  DExter 
2360;  Denver  7. 

Graham,  Emmett  V.;  1205  Republic  Bldg.;  TAbor 

2456;  Denver  2;  GP  (PP). 

Greene,  Laurence  W. : 1237  Republic  Bldg.;  KEystone 
8600;  Denver  2;  ALR*  (PP). 

Greenhalgh,  Charles  R.,  Jr.;  774  Eudora  St.;  DExter 
8108;  Denver  7;  (PG  Res.). 

Greig,  William  M. ; 628  Majestic  Bldg.;  MAin  0424; 
Denver  2;  S (PP). 

Grey,  Leslie;  407  Mack  Bldg.;  CHerry  8347;  Denver 
2;  Gyn  (PP). 

Griffin,  John  G. ; 1809  E.  18th  Ave.;  Denver  6;  FRe- 
mont 2734;  NS*  (PP). 

Gromer,  Terry  J. ; 110  Metropolitan  Bldg.;  MAin  4133; 
Denver  2;  ALR*  (PP). 

Grossman,  Bernard  E. ; 1202  Republic  Bldg.;  TAbor 
0508;  Denver  2;  S*  (PP). 

Grew,  John  B. ; 3705  E.  Colfax  Ave.;  CHerry  2609; 
Denver  6;  S*  (PP). 

Guggenheim,  Albert  H. ; 1218  Republic  Bldg.;  KEy- 
stone 7755;  I*  (PP). 

Guthrie.  Ewing  C. ; 206  Steel  Bldg.;  TAbor  2541; 

Denver  2;  GP. 

Gwinn,  Lawrence  M.,  Jr.;  4200  E.  9th  Ave.;  EAst  7771; 
Denver  7;  S*  (PG  Res.). 

Hager,  Chauncey  A.;  1750'  E.  19th  Ave.;  DExter  5471; 
Denver  6;  S*  (PP). 

Haggart,  William  W. ; 1236  Republic  Bldg.;  ALpine 
2059;  Denver  2;  S*  (PP). 

Haig,  Henry  W. : 738  Metropolitan  Bldg.;  TAbor  2265; 
Denver  2;  S (PP). 

Haley,  A.  T.;  1620  Gaylord  St.;  DExter  4071;  Den- 
ver 6;  ObG  (PP). 

Hall,  Lewis  L. ; 629  Majestic  Bldg.;  TAbor  0771;  Den- 
ver 2;  ObG*  (PP). 

Hall,  Robert  F. ; Denver  General  Hosp. ; TAbor  1331; 
Or*  (PG  Res.). 

Hall,  Robert  M. ; 608  Metropolitan  Bldg.;  CHerry 

2511;  GP  (PP). 

Halley,  William  H. ; 220  Metropolitan  Bldg.;  TAbor 
6715;  Denver  2;  S'*  (PP). 

Halsted,  Frederick  S. ; 736  Metropolitan  Bldg.;  TAbor 
2248;  Denver  2;  OALR*  (PP). 

Hammer,  Donna  Lea;  1578  Humboldt  St.;  TAbor  3234; 
Denver  6;  ObG  (PP). 

Hansen.  Fitch  P. ; 506  Mack  Bldg.;  TAbor  5915; 

Denver  2;  GP. 

Hargreaves.  Oliver  C. ; 3700  W.  32nd  Ave.;  GLendale 
2210;  Denver  11;  GP. 

Harper,  Fred  R. ; 1008  Republic  Bldg.;  ALpine  2889; 
Denver  2:  S*  (PPl. 

Harrington,  John  F. ; 1850  Williams  St.;  EAst  1897; 
Denver  6;  GP  (PP). 

Harrington,  Robert  B.;  3415  Franklin  St.;  MAin 
2830;  Denver  5;  GP  (PP). 

Harris,  Allen  H.;  935  Detroit  St.;  FRemont  8511; 
Denver  6. 

Hartendorp,  Paulus  V.  H.;  622  Republic  Bldg.;  KEy- 
stone 0027;  Denver  2;  I*  (PP). 

Hartley,  John  E.;  1224  Republic  Bldg.;  TAbor  1224; 
Denver  2;  U*  (PP). 

Hartshorn,  Fred  H.;  418  Republic  Bldg.;  KEystone 
5289;  Denver  2;  Or*  (PP). 


Rocky  Mountain  Medical  Journal  Suppiement 


17 


NOTICE!  MEMBERS  OF  THE  MEDICAL  PROFESSION 

Margaret  Kay  Stewart  Travel  Service 

Furnishing  Prompt,  Experienced  World-Wide  Travel  Service.  No  Fees 


☆ 


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Hotel  - Resort  - Ranch 


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Call  Us  for  Reservations  and  Information 
1953-55  Broadway  Denver,  Colo.  AComa  2511 

Offices  also  located  in  Greeley,  Fort  Morgan  and  Longmont,  Colo. 


JOT  IT  DOWN] 
WRITE  IT  DOWN! 
CALL  IT  DOWN! 

Ch-5548 

Ch-5549 

For  direct  contact  with  our 
prescription  department — 

Dial:  Ch-5548 
Ch-5549 

Only  registered  pharmacists  answer 
these  ’phones. 

(These  ’phones  are  not  listed  in  the 
directory^  they  are  for  the  Doctors’ 
use  exclusively.) 

And  of  Course  — KE-5377 
in  addition! 

REPUBLIC  DRUG  CO. 

Lobby  Republic  Bldg. 

1600  TREMONT  ST. 

New  Fast  Delivery  Service 
to  All  Parts  of  the  City 


SixSe 


serviced 

THAT  MEET  EVERY 


TELEPHONE  SECRETARIAL 
NEED 


one  lA 


The  Nationwide  PHYSICIANS  & SUR- 
GEONS EXCHANGE  has  been  serviced 
in  Denver  by  the  Telephone  Secretarial 
Bureau  for  more  than  12  years.  The 
PHYSICIANS  & SURGEONS  EX- 
CHANGE answers  and  processes  over 
3,000  telephone  calls  a month  for  its  sub- 
scribers. In  addition,  the  PHYSICIANS 
& SURGEONS  EXCHANGE  is  called  on 
the  average  of  4 times  daily  by  new- 
comers to  Denver  and  others  who  depend 
on  us  to  recommend  and  get  a doctor  for 
them  at  anytime,  day  or  night. 


Telephone  Secretarial  Bureau 
Gas  & Electric  Bldg.,  TA.  1609 


18 


Rocky  Mountain  Medical  Journal  Supplement 


Denver  ...  (Continued) 

Harvey,  Edward  L. ; 635  Republic  Bldg.;  KEystone 
1373:  Denver  2;  Ob*  (PP). 

Harvey,  Horace  G.,  Jr.;  632  Republic  Bldg.;  TAbor  ' 
5366;  Denver  2;  Gyn  (PP). 

Hausmann,  Gertrude  S. ; 434  Mack  Bldg.;  KEystone 
2489;  Denver  2;  Oph*  (PP). 

Hay,  William  E.;  424  Metropolitan  Bldg.;  MAin  8527; 
Denver  2;  I**(PP). 

Hayes,  Robert  E. ; St.  Joseph’s  Hosp.;  MAin  6121; 
Denver  6;  (PG  Res.). 

Hazel,  Woodrow  S. ; 2341%  E.  Evans  Ave. ; PEarl 
3660;  Denver  10;  I*  (PP). 

Hazlett,  Joseph  D.;  615  Republic  Bldg.;  KEystone 
2714;  Denver  2;  GP  (PP). 

Hegner,  Casper  F. ; 724  Metropolitan  Bldg.;  KEystone 
7'913;  Denver  2;  S»  (PP). 

Hemming,  John  G.,  Jr.;  436  Majestic  Bldg.;  Cherry 
4220;  Denver  2;  S*  (PP). 

Henderson,  Harold  B.;  1019  Republic  Bldg.;  TAbor 
4033;  Denver  2;  ObG*  (PP). 

Hendryson,  Irvin  E.;  1750  Race  St.;  DExter  4218; 
Denver  6;  Or*  (PP). 

Henschel,  Egbert  J. ; 210  Republic  Bldg.;  KEystone 
3219;  Denver  2;  D*  (PP). 

Hepp,  L.  Clark;  223  Republic  Bldg.;  KEystone  1020; 
Denver  2;  ObG*  (PP). 

Hickey,  Harold  L. ; 934  Republic  Bldg.;  KEystone 
1742;  Denver  2;  ADR*  (PP). 

Hicks,  Alfred  II;  1172  Monaco  Parkway;  DExter 
5626;  Denver*  7;  (PG  Res.). 

Higbee,  Daniel  R. ; 1117  Republic  Bldg.;  CHerry  556'9; 
Denver  2;  U*  (PP). 

Hill,  Edward  C.;  2410  E.  7th  Ave.;  DExter  1109; 
Denver  6;  (Ret.). 

Hill,  Kenneth  A.;  530  Metropolitan  Bldg.;  CHerry 
8329;  Denver  2;  S (PP). 

Hilton,  Jack  Palmer;  711  Republic  Bldg.;  KEystone 
5542;  Denver  2;  PN*  (PP). 

Hinds,  Ervin  A.;  445  Equitable  Bldg.;  CHerry  8845; 
Denver  2;  S*  (PP). 

Hines,  William  A.;  1820  Gilpin  St.;  DExter  1654; 
Denver  6;  I*  (PP). 

Hirschberg,  J.  Cotter;  4200  E.  9th  Ave.;  EAst  7771; 

Denver  7;  P*  (Med.  School). 

Hix,  Ivan  E.;  1138  Republic  Bldg.;  KEystone  8421; 
Denver  2;  OADR*  (PP). 

Hoch,  Peter  C.;  858  Metropolitan  Bldg.;  AComa  2835; 
Denver  2;  Pd*  (PP). 

Hodges,  Dean  W. ; 416  Republic  Bldg.;  TAbor  6433; 
Denver  2;  ObG. 

Holmes,  Joseph  H.;  4200  E.  9th  Ave.;  EAst  7771; 

Denver  7:  I*  (Med.  School). 

Homstad,  Joseph  E. ; 223  Republic  Bldg.;  TAbor  7816; 
Denver  2;  GP  (PP). 

Hopkins,  Hugh  J.;  3211  Dowell  Blvd.;  GRand  7677; 
Denver  11;  GP  (PP). 

Hopkins,  John  R.;  602  Mack  Bldg.;  MAin  2755;  Den- 
ver 2;  GP  (PP). 

Horsky,  Brooke:  655  So.  Downing  St.;  RAce  3682; 

Denver  9;  (Not  in  Practice). 

Howard,  T.  Deon;  1224  Republic  Bldg.;  TAbor  1224; 
Denver  2;  U*  (PP). 

Hoyle,  Dewis  H.;  304  New  Custom  House;  KEystone 
4151,  Ext.  8400;  Denver  2;  PH*  (USPHS). 

Hoyt,  Charles  G. ; 1765  Sherman  St.;  TAbor  8181; 
Denver  5;  I*  (PP). 

Hoyt,  Ralph  W.;  404  Republic  Bldg.;  KEystone  5517; 
Denver  2;  S*. 

Hudston,  Ranulph;  418  S.  Vine  St.;  PEarl  2389;  Den- 
ver 9;  (Public  School  Health  Service). 

Hughes,  Harry  C. ; 1750  Race  St.;  DExter  4218;  Den- 
ver 6;  Or*  (PP). 

Humphries,  Jesse  H.;  Denver  Gen.  Hosp.;  TAbor 
1331;  Denver  4. 

Hunter,  Carol;  1410  Vine  St.;  Denver  6. 

Hunter,  Harriot;  4200  E.  9th  Ave.;  EAst  7771,  Ext. 

250;  Denver  7;  P*  (Med.  School). 

Hunter,  Richard  T.;  999  S.  Broadway;  PEarl  6060; 
Denver  9;  S*. 

Hurst.  Allan;  3800  E Colfax  Ave.;  EAst  1881;  Denver 
6;  T*  (HA). 

Hutchison,  James  E. ; 216  Republic  Bldg.;  KEystone 
1624;  Denver  2;  S (PP). 

Huxhold,  August  F. ; 1726  Welton  St.;  KEystone  2256; 
Denver  2;  GP  (PP). 

Huyler,  Washington  C.;  Mercy  Hosp.;  FRemont  2771; 
Denver  7;  R*  (Hosp.). 

Imbro,  Eva  Arbini;  4670  Brighton  Blvd.;  TAbor  5591; 
Denver  16;  GP  (PP). 

Ingraham,  Clarence  B. ; 509  Republic  Bldg.;  TAbor 
0033;  Denver  2;  ObG*  (PP). 

Irwin,  Robert  SI;  460  Metropolitan  Bldg.;  MAin  5515; 
Denver  2;  I*  (PP). 

Isbell,  N.  Paul;  604  Republic  Bldg.;  KEystone  5523; 
Denver  2;  ObG*  (PP). 

Ivers,  William  M. ; 1224  Republic  Bldg.;  TAbor  1224; 
Denver  2;  U*  (PP). 


Jackson,  A.  Page,  Jr.;  716  Republic  Bldg.;  KEystone 
1073;  Denver  2;  R*  (PP). 

Jackson,  Taylor  W. ; 634  Mack  Bldg.;  KEystone  6587; 
Denver  2;  GP  (PP). 

Jacobs,  John  T.;  400  Metropolitan  Bldg.;  KEystone 
6336;  Denver  2;  Or*  (PP). 

Jacques,  Thomas  F. ; 502  Majestic  Bldg.;  TAbor  4869; 
Denver  2;  Pr  (PP). 

Jamison,  John  H.;  452  Metropolitan  Bldg.;  TAbor 
4208:  Denver  2;  R*  (PP). 

Jankovsky,  Kenneth  A.;  1886’  Humboldt  St.;  MAin 
7709;  Denver  6;  S (PG  Res.). 

Jelstrup,  Gunnar;  1019  Republic  Bldg.;  TAbor  2334; 
Denver  2;  ObG*  (PP). 

Jobe,  Merrill  C.;  606  Metropolitan  Bldg.;  MAin  4543: 
Denver  2;  S*  (PP). 

-Tciinson,  Amil  J.;  340  Metropolitan  Bldg.;  CHerry 
4251;  Denver  2;  GP  (PP). 

Johnson,  F.  Craig;  1901  E.  20th  Ave.;  DExter  4241; 
Denver  5:  Pd*  (PP). 

Johnson,  Marvin  E.;  4200  E.  9th  Ave.;  EAst  7771; 
Denver  7;  S*  (PG  Res.). 

Johnston,  Robert  P. ; 1449  Pennsylvania  St.;  KEystone 
3508;  Denver  3;  S (PP). 

Jones,  W.  Wiley;  810  Metropolitan  Bldg.;  KEystone 
2601;  Denver  2;  Pd*  (PP). 

Josephson,  Carl  J. ; 203  Metropolitan  Bldg.;  MAin 
3185;  Denver  2;  I*  (PP). 

Joyce,  Frank  T.;  640  Metropolitan  Bldg.;  KEystone 
5060;  Denver  2;  A*  (PP). 

Kafka.  Adolph  J.;  1820  Gilpin  St.;  EAst  2069:  Denver 
6;  OADR*  (PP). 

Kaplan,  Max;  1575  Gilpin  St.;  FRemont  8801;  Den- 
ver 6;  Pd*  (PP). 

Kaplan,  Morris;  807  Republic  Bldg.;  KEystone  1691; 
Denver  2;  Oph*  (PP). 

Katz,  George;  404  Republic  Bldg.;  MAin  5531;  Denver 
2;  PN*  (PP). 

Katzman,  Maurice;  412  Republic  Bldg.;  KEystone 
0411;  Denver  2;  C (PP). 

Kauvar,  Abraham  J.;  1104  Republic  Bldg.;  TAbor 
0209;  Denver  2;  I*  (PP). 

Kauvar,  Solomon  S. ; 1104  Republic  Bldg.;  TAbor 
0209;  Denver  2;  I*  (PP). 

Keiser,  Alvin  F.;  2035  E.  18th  Ave.;  FRemont  7'76’6: 
Denvei'  6;  GE  (PP). 

Kellar,  G.  Richard;  600  E.  Alameda  Ave.;  RAce  6433; 
Denver  9;  C (PP). 

Kemper,  Constantine  F. ; 708,  Metropolitan  Bldg.; 

ADpine  4588;  Denver  2;  I*  (PP). 

Kennedy,  Thomas  J. ; 452  Metropolitan  Bldg.;  TAbor 
4208;  Denver  2. 

Kent,  George  B.;  516  Republic  Bldg.;  MAin  4393'; 
Denver  2;  S*  (PP). 

King,  W.  W.;  738  Metropolitan  Bldg.;  TAbor  2265; 
Denver  2;  Gyn  (PP). 

Xingry,  Charles  B.;  305  Republic  Bldg.;  TAbor  5464; 
Denver  2;  CP*  (PP). 

Knoch,  Norbert  H.;  522  Majestic  Bldg.;  KEystone 
3431;  Denver  2;  .Si*. 

Kobayashi,  Thomas  K.;  1227  27th  St.;  KEystone  4590; 
Denver  5:  GP  (PP). 

Koscove,  Sarah  K. ; 3333  Federal  Blvd.;  GDendale 
3661;  Denver  11;  GP  (PP). 

Kramish,  David;  1401  Jackson  St.;  Florida  0014;  Den- 
ver 5’;  S*  (PP). 

Kraus,  Daniel  M. ; 326  Republic  Bldg.;  MAin  1943; 
Denver  2;  PG. 

Kretschmer,  Otto  S. ; 325  Republic  Bldg.;  ADpine  2071; 
Denver  2;  Path*. 

Krohn,  Morris  J.;  608'  Mining  Exchange  Bldg.;  KEy- 
stone 8517;  Denver  2;  GP  (PP). 

Krueger,  Edward  H.;  2100  E.  28th  Ave.;  CHerry  0101; 
Denver  2;  GP. 

Kunitomo,  Nobuya;  2421  W.  33rd  Ave.;  GDendale 
3528;  Denver  11;  GP  (PP). 

Kurland,  Stanley  K. ; 234  Metropolitan  Bldg.;  ADpine 
0427;  Denver  2;  Path*  (PP). 

Daff,  Herman  I;  620  Metropolitan  Bldg.;  CHerry  1226; 
Denver  2;  ADR*  (PP). 

Dannon,  Arthur  R.;  311  Republic  Bldg.;  TAbor  4008; 
Denver  2;  U*  (PP). 

Dapi,  Angelo:  Denver  General  Hosp.;  TAbor  1331; 
Denver  4;  Path*  (PH). 

Dauvetz,  Frank  R.;  216  Republic  Bldg.;  KEystone 
1624;  Denver  2;  ObG  (PP). 

Dawson,  James  B.;  500  Downing  St.;  SPruce  2689; 

Denver  3;  Pd*  (PP). 

Deder,  Max  M.;  2880  Elm  St.;  Denver  7. 

I,ee,  George  H.;  330  Metropolitan  Bldg.;  KEystone 
4323;  Denver  2;  S (PP). 

Dee,  Douis  W.;  223  Republic  Bldg.;  TAbor  7816, 
Denver  2;  GP  (PP). 

DeFevre,  Harry  W.,  Jr.;  2035  E.  18th  Ave.;  DExter 
6262;  Denver  6;  Pr*  (PP). 

Dehrburger,  Henry;  438  Republic  Bldg.;  TAbor  8715; 
Denver  2;  GP  (PP). 

Deight,  Sidney  B.;  3838  W.  38th  Ave.;  GDa*1ale  3432; 
Denver  11;  GP  (PP). 


Rocky  Mountain  Medical  Journal  Supplement 


19 


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20 


Rocky  Mountain  Medical  Journal  Supplement, 


Denver  ...  (Continued) 

Lentz,  Jack  R.;  520  Metropolitan  Bldg.;  TAbor  2443; 
Denver  2;  S (PP). 

Ijevin,  Oscar  S.;  2239  E.  Colfax  Ave.;  EAst  3603; 
Denver  6;  T (PP). 

Levisohn,  Leonard  W. ; 310  Republic  Bldg.;  CHerry 
372’6;  Denver  2;  GP  (PP). 

Levy,  Maurice:  709  Republic  Bldg.;  MAin  0633;  Den- 
ver 2;  I*  (PP). 

Lewins,  Naum;  431  Mack  Bdg.;  MAin  6363;  Denver 
2;  (PP). 

Lewis,  George  B.:  726  Metropolitan  Bldg.;  TAbor 
5788;  Denver  2;  Anes*. 

Lewis,  Robert:  231  Majestic  Bldg.;  TAbor  3890;  Den- 
ver 2;  GP  (PP). 

Leyda,  James  H. ; 946  Metropolitan  Bidg.;  KEystone 
3768;  Denver  2:  ALR*  (PP). 

Lich.ty,  John  A.;  4200  E.  9th  Ave.;  EAst  7771;  Den- 
ver 7;  Pd*  (Med.  School). 

Lief,  Philip  Alfred;  4200  E.  9th  Ave.;  EAst  7771; 
Denver  7. 

Liggett,  Robert  S. ; 4200  E.  9th  Ave.;  EAst  7771;  Den- 
ver 7;  I*  (Med.  School). 

Liggett,  William  A.;  203  Metropolitan  Bldg.;  MAin 
3185;  Denver  2;  I*  (PP). 

Lincoln,  Cicero  L. ; 820  Metropolitan  Bldg.;  TAbor 
1762;  Denver  2. 

Lingenfelter,  George  P.;  910  Republic  Bldg-.;  ALpine 
2887;  Denver  2;  D*  (PP). 

Dipan,  Edward  M. ; 1024  Republic  Bldg.;  KEystone 
0464;  Denver  2;  S*  (PP). 

Lipscomb,  John  M. ; 1224  Republic  Bldg.;  TAbor  1224; 
Denver  2;  U*  (PP). 

Lipscomb,  William  R. ; 1809  E.  18th  Ave.;  FRemont 
2734 ; Denver  6;  NS*  (PP). 

Livingston,  Wallace  H.;  1104  Republic  Bldg.;  TAbor 
0209;  Denver  2;  I*  (PP). 

Lof,  A.  J.  O. ; 836  Metropolitan  Bldg.;  KEystone  4000: 
Denver  2;  GP. 

Lombardi,  James  C. ; 5005  W.  33rd  Ave.;  GRand  3722; 

Denver  13;  ObG*  (PG  Res.). 

Long,  John  C.;  324  Metropolitan  Bldg.;  MAin  2332; 
Denver  2;  Oph*  (PP). 

Long,  Margaret:  2070  Colorado  Blvd.;  FRemont  8441; 
Denver  7:  (Ret.). 

I.ongeway,  Walter  J. ; 520  Metropolitan  Bldg.;  KEy- 
stone 7623;  Denver  2;  Ind  (PP). 

Longwell,  Freeman  H. ; 629  Majestic  Bldg.;  TAbor 
0771;  Denver  2;  ObG*  (PP). 

Lorber,  Milton  B.;  438  Republic  Bldg.;  TAbor  7386; 
Denver  2;  Anes*  (PP). 

I,ove,  Tracy  R. ; 730  Metropolitan  Bldg.;  KEystone 
6650;  Denver  2;  I*  (PP). 

Lowell,  Edward  J.,  Jr.;  6820  E.  4th  Ave.;  FRemont 
4277:  Denver  7:  (PG  Res.). 

Lowry,  Hope;  4200  E.  9th  Ave.;  EAst  7771;  Denver 
7;  I*  (Med.  School). 

IiOv.rther.  Ray  R. ; 945  Washington  St.;  CHerry  0013; 
Denver  3;  Bact*  (PH). 

Lubchenco,  Alexis  E. ; Presbyterian  Hosp.;  KEystone 
2311:  Denver  6;  CP*  (PP). 

Lubchenco,  Lula  O. ; 42'00  E.  9th  Ave.;  EAst  7771; 

Denver  7:  Pd*  (Med.  School). 

Lyday,  Joseph  H. : 858  Metropolitan  Bldg.;  AComa 
2835-  Denver  2;  Pd*  (PP). 

Lyon,  John  M.;  42-00  E.  9th  Ave.;  EAst  7771,  Ext.  250; 
Denver  7;  P*  (Med.  School). 

Mackey,  John  F.;  725  Republic  Bldg.;  CHerry  5105; 
Denver  2;  S*  (PP). 

MacMillan.  Hugh  A.,  Jr.;  1765  Sherman  St.;  TAbor 
8181:  Denver  5:  S*  (PP). 

Macomber,  Douglas  W.;  1820  Gilpin  St.;  DExter  2313; 
Denver  6;  PI*  (PP). 

Macomber,  Harold  G.;  809  Republic  Bldg.;  KEystone 
7733;  Denver  2;  GP  (PP). 

Mahony,  Thomas  H.,  Jr.;  2900  Locust  St.;  Denver  7; 
I*  (PG  Res.). 

Maier.  F.  Julian;  1123  Republic  Bldg.;  TAbor  2341; 
Denver  2;  I*  (PP). 

Manganero,  Carl  J. ; 1809  E.  18th  Ave.;  EAst  2101; 
Denver  6;  GP  (PP). 

Manly,  Wilbur  F.;  406  Metropolitan  Bldg.;  TAbor 
8133;  Denver  2;  ObG*  (PP). 

Manns,  John  A.;  722  Republic  Bldg.;  KEystone  7001; 
Denver  2;  GP  (PP). 

Marcove,  Maurice  E. ; 526  Republic  Bldg.;  MAin  5416; 
Denver  2;  Oph*  (PP). 

Maresh,  Gerald  S. ; 366  Metropolitan  Bldg.:  TAbor 
5141;  Denver  2;  R*  (PP). 

Markel,  Casper;  631  Majestic  Bldg.;  MAin  4942;  Den- 
ver 2;  I*  (PP). 

Markley,  A.  J.;  434  Metropolitan  Bldg.;  CHerry -5526; 
Denver  2;  D*  (Ret.). 

Marvin,  Horace  P. ; 168-5  Steele  St.;  EAst  9377;  Den- 
ver 6;  (Ret.). 

Marx,  Johann  R.;  Old  Custom  House  Bldg.;  KEy- 
stone 4151,  Ext.  554;  Denver  2;  P*  (Gov.). 


.Mason,  Lyman  W. ; 1214  Republic  Bldg.;  MAin  2344; 
Denver  2;  ObG*  (PP). 

-tlatchett,  Foster;  1727  Gilpin  St.;  FRemont  8853; 
Denver  6;  Or*  (PP). 

Matson,  James  A.;  804  Republic  Bldg.;  TAbor  7066; 
Denver  2;  GP  (PP). 

Maul,  Herman  S.;  2704  W.  32nd  Ave.;  GLendale  9692; 
Denver  11;  GP  (PP). 

Maul,  Kester  V. ; 2239  E.  Colfax  Ave.,  Room  312; 

DExter  2912;  Denver  6;  GP  (PP). 

Maul,  Robert  F. ; 227  Mack  Bldg.;  KEystone  5341; 
Denver  2;  GP. 

Maul,  Robert  M. ; 227  Mack  Bldg.;  KEystone  5341; 
Denver  2;  GP  (PP). 

Mayer,  Alvin  W.,  Jr.;  612  Metropolitan  Bldg.;  TAbor 
230.3;  Denver  2;  S*  (PP). 

Maytum,  Helen  E. ; 910  Metiopolitan  Bldg.;  KEystone 
8377;  Denver  2;  ObG  (PP). 

McAfee,  John  C. ; 806  Republic  Bldg.;  KEystone  3153; 
Denver  2;  Anes*  (PP). 

McCal'lin,  Paul  F.;  4200  E.  9th  Ave.;  EAst  7771;  Den- 
ver 7:  ObG*  (PG  Res.). 

McCloskey,  Joseph  B. ; 5027  E.  28th  Ave.;  FRemont 
1741;  Denver  7;  GP  (PP). 

McCormick,  Wm.  Holt,  Jr.;  1017  Republic  Bldg.; 

TAbor  1428;  Denver  2;  GP  (PP). 

McDonald,  Roderick  J.,  Jr.;  626  Republic  Bldg.; 

TAbor  7747;  Denver  2;  Pd*  (PP). 

McEndaffer,  Donald  M. ; 903  Republic  Bldg.;  MAin 
5770;  Denver  2,  GP  (PP). 

McGill,  Joseph  J. ; 432  Republic  Bldg.;  TAbor  3811; 
Denver  2;  S. 

McGlone,  Prank  B.;  1820  Gilpin  St.;  DExter  1654; 
Denver  6;  GE  (PP). 

McGuire,  James  A.;  822  Majestic  Bldg.;  KEystone 
6840;  Denver  2;  D*  (PP). 

McKeen,  Harold  R.,  Sr.;  532  Republic  Bldg.;  CHerry 
5487;  Denver  2;  9*  (PP). 

McKeen.  Harold  R.,  Jr.:  530  Republic  Bldg.;  CHerry 
5487;  Denver  2;  S (PP). 

McKelvey,  Samuel  R. ; P.  O.  Box  1273;  No  telephone; 
Denver  1;  (Ret.). 

McKenna,  Daniel  S. ; 904  Republic  Bldg.;  TAbor  4321; 
Denver  2;  Or*  (PP). 

McLauthlin,  Carl  A.;  532  Republic  Bldg.;  TAbor  1067; 
Denver  2;  S (PP). 

McLauthlin,  Carl  Herbert;  4200  E.  9th  Ave.;  EAst 
7771;  Denver  7;  S*  (PG  Res.). 

McMahon,  B.  Thomas;  402  Republic  Bldg.;  TAbor 
5961;  Denver  2;  I*  (PP). 

McMahon,  Jean  Louis;  1767  Franklin  St.;  KEystone 
6400;  Denver  6;  Pd*  (PP). 

McNaught,  James  B. ; 4200  E.  9th  Ave.;  EAst  7771, 
Ext.  255;  Denver  7;  Path*  (Med.  School). 

McVicker,  John  H. ; 2852  Sheridan  Blvd.;  GRand  7254; 
Denver  12;  S. 

Meader,  Charles  N.;  519  Majestic  Bldg.;  TAbor  0914; 
Denver  2;  I*  (PP). 

Mechler,  Emmett  A.;  2025  E.  18th  Ave.;  FRemont 
2704;  Denver  6;  ObG*  (PP). 

Meister,  Edward  J.;  3 66  Metropolitan  Bldg.;  TAbor 
5141;  Denver  2;  R*  (PP). 

Mendenhall,  John  -C.;  932  Republic  Bldg.;  MAin  4204; 
Denver  2;  I*  (PP). 

Menkel,  Herman  C. ; 37-33  Sheridan  Blvd.;  GLendale 
1658;  Denver  12:  GP  (PP). 

Metcalf,  Albert  W.,  Jr.;  820  Metropolitan  Bldg.; 

KEystone  3124;  Denver  2;  S (PP). 

Metz,  C.  Walter;  806  Republic  Bldg.;  KEystone  3153; 
Denver  2;  Anes*  (PP). 

Miller,  Arnold  H. ; 485()  Morrison  Road;  Westwood 
498-  Denver  9;  GP. 

Miller,  Earl  G.;  1850  Williams  St.;  EAst  1897;  Den- 
ver 7;  S. 

Miller,  Edward  S. ; 1104  Republic  Bldg.;  TAbor  0209; 
Denver  2;  I*  (PP). 

Miller,  Eli  A.;  26-6  Metropolitan  Bldg.;  TAbor  4289; 
Denver  2;  TJ*  (PP). 

Miller,  Lewis  I.;  266  Metropolitan  Bldg.;  TAbor  4289; 
Denver  2;  S*  (PP). 

Miller,  Simon  I.;  332  Republic  Bldg.;  CHerry  4421; 
Denver  2;  GP  (PP). 

Mills,  Frances  McConnell:  Denver  General  Hosp.; 

TAbor  1331:  Denver  4;  CP*  (PH). 

Mills,  Robert  J.;  St.  Luke’s  Hosp.;  TAbor  3241;  Den- 
ver 5. 

Minnig,  Arnold;  638  Metropolitan  Bldg.;  KEystone 
1571;  Denver  2;  I*  (PP). 

Mitchel,  Duane  H. : 1765  Sherman  St.;  TAbor  8181; 
Denver  5. 

Mizer,  Floyd  Robert;  932  Republic  Bldg.;  MAin  420-4; 
Denver  2;  I*  (PP). 

Mogan,  William  E.;  423  Republic  Bldg.;  MAin  1847; 
Denver  2;  S*  (PP). 

Monaghan,  Daniel  G. ; 806  Metropolitan  Bldg.;  ALpine 
3551;  Denver  2;  I*  (PP). 

Moody,  R.  Wlayne;  1776  Vine  St.;  DExter  4231;  Den- 
ver 6 ; I*  (PP). 

Moon,  Arlie  L.;  2525  S.  Downing  St.;  PEarl  3721; 
Denver  10;  S (HA). 


Rocky  Mountain  Medical  Journal  Supplement 


21 


Members  of  the  Colorado 
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22 


Rocky  Mountain  Medical  Journal  Supplement 


Denver  ...  (Continued) 

Morfit,  H.  Mason;  1735  Gilpin  St.;  EAst  4740;  Den- 
ver 6;  GP. 

Morian,  Clarence  H.;  510  Mack  Bldg.;  TAbor  2473; 
Denver  2;  GP  (PP). 

Morning,  James  F.;  1300  Josephine  St.;  PRemont 
7373;  Denver  6;  CP  (PP). 

Mosko,  Joel;  4563  Washington  St.-  KEystone  5536; 
Denver  16;  ObG  (PP). 

Mossberger,  Joseph  I.;  4200  E.  9th  Ave. ; EAst  7771; 

Denver  7;  Path*  (Research). 

Mousel,  Claude  M. ; 1381  Niagara;  FRemont  8198; 
Denver  7. 

Mozer.  Borah;  83  S.  Brpadway;  PEarl  7255;  Denver 
9;  GP  (PP). 

Mugrage,  Edward  R.;  4200  E.  9th  Ave.;  EAst  7771; 

Denver  7;  CP*  (Med.  School). 

Muir,  Bennett  W. ; 920  Republic  Bldg.;  TAbor  6279; 
Denver  2;  Oph*  (PP). 

Mumey,  Nolie;  1133  Republic  Bldg.;  KEystone  1335; 
Denver  2;  S (PP). 

Munsell,  Donald  W. ; 4200  E.  9th  Ave.;  EAst  7771; 
Denver  7;  (PG  Res.). 

Murphey,  Bradford;  814  Republic  Bldg.;  KEystone 
7787;  Denver  2;  PN*  (PP). 

Murphy,  Rex  D. ; 110  Metropolitan  Bldg.;  MAin  4133; 
Denver  2;  ADR*  (PP). 

Musman,  David  J. ; 1024  Republic  Bldg.;  TAbor  4388; 
Denver  2;  D*  (PP). 

Nelson,  Eli;  926  Republic  Bldg.;  MAin  2911;  Den- 
ver 2;  Ind  (PP). 

Nelson,  John  M.;  1558  Humboldt  St.;  TAbor  6621; 
Denver  6;  Pd*  (PP). 

Nelson,  William;  413  Mack  Bldg.;  KEystone  1528; 
Denver  2;  Or*  (PP). 

Ness,  Ragnar  J. ; 354  Metropolitan  Bldg.;  KEystone 
4472;  Denver  2;  Ind. 

Neubuerger,  Karl  T.;  4200  E.  9th  Ave.;  EAst  7771; 

Denver  7;  Path*  (Med.  School). 

Neubuerger,  Katharina;  2090  CJherry  St.;  FRemont 
4415;  Denver  7;  PH*  (School  Health  Service). 
Newcomb,  C.  A.;  424  Majestic  Bldg.;  KEystone  7426; 
Denver  2;  GP. , 

Newcomer,  Elizabeth  H.;  306  Republic  Bldg.;  KEy- 
stone 8563;  Denver  2;  R*. 

Newcomer,  Nathan  B.;  306  Republic  Bldg.;  KEystone 
8563;  Denver  2;  R*. 

Newland,  Donald  E.;  915  Republic  Bldg.;  KEystone 
8480;  Denver  2;  U*  (PP). 

Newman,  Samuel  P.;  1840  E.  18th  Ave.;  EAst  1053; 
Denver  6;  Or*  (PP). 

Nilsson,  Martin  M. ; 226  Republic  Bldg.;  TAbor  0882; 
Denver  2;  OALR*. 

Nims,  Marshall  G.;  781  Magnolia  St.;  FRemont  8292; 
Denver  7:  C (PP). 

Noonan,  George  M.;  261  S.  Williams  St.;  PEarl  6603; 
Denver  9;  (Ret.). 

O’Dea,  N.  Joseph;  269  S.  Downing;  RAce  5373;  Den- 
ver 9;  GP  (PP). 

Ogura,  George  I.;  Denver  Gen.  Hosp.;  TAbor  1331; 
Denver  4;  Path*  (Hosp.). 

Ohmart,  Walter  A.;  1102'  Republic  Bldg.;  MAin  6941; 
Denver  2;  Oph*  (PP). 

O’Rourke,  Donald  H.;  920  Republic  Bldg.;  TAbor 
6279;  Denver  2;  Oph*  (PP). 

Orsborn,  George  E. ; 428  Majestic  Bldg.;  MAin  0971; 
Denver  2;  S (PP). 

Orsborn,  George  E.,  Jr.;  3919  W.  38th  Ave.;  GLendale 
9361;  Denver  12;  GP  (PP). 

Osborne,  Dale;  460  Metropolitan  Bldg.;  TAbor  1832; 
Denver  2;  S (PP). 

Overholt,  Lewis  C.,  Jr.;  212  Metropolitan  Bldg.; 

ALpine  2191;  Denver  2;  PN*  (PP). 

Oxman,  Albert  C. ; 1218  Republic  Bldg.;  KEystone 
3417;  Denver  2;  I*  (PP). 

Ozamoto,  Isamu;  1130  16th  St.;  TAbor  1596;  Den- 
ver 2;  S (PP). 

Packard,  George  B.;  764  Metropolitan  Bldg.;  CHerry 
5575;  Denver  2;  S*  (PP). 

Packard,  Robert  G.;  1707  E.  18th  Ave.;  FRemont 
8877;  Denver  6;  Or*  (PP). 

Pallas,  William  C. ; 4200  E.  9th  Ave.;  EAst  7771; 
Denver  7. 

Palmer,  Harold  D.;  Children’s  Hospital;  MAin  1261; 
Denver  5;  CP*. 

Parkhurst,  Frederick  B.;  508  Metropolitan  Bldg.; 

MAin  4266;  Denver  2;  Pd*  (PP). 

Pate,  Charles  E.;  730  Metropolitan  Bldg.;  KEystone 
1839;  Denver  2;  GP  (PP). 

Pattee,  George  L.;  612  Republic  Bldg.;  MAin  7069; 
Denver  2;  ADR*  (PP). 

Patten,  Albert  M. ; 1123  Republic  Bldg.;  TAbor  2341; 
Denver  2;  I*  (PP). 

Patterson,  Joseph  H. ; 738  Metropolitan  Bldg.;  TAbor 
2265;  Denver  2;  U*  (PP). 

Peck,  Mordant  E. ; Denver  General  Hosp.;  TAbor 
1331;  Denver  4;  S*  (Med.  School). 


Pedigo,  Myron  B.;  726  Metropolitan  Bldg.;  TAbor 
5788;  Denver  2;  Anes*  (PP). 

Penix,  Dex  L. ; 25  E.  Iowa  Ave.;  RAce  2897;  Denver 
10;  S (PP). 

I’erkins,  Earl  J.;  958  Metr'opolitan  Bldg.;  CHerry 
4525;  Denver  2;  S*  (PP). 

Perkins,  Georgia  B. ; 999  S.  Broadway;  PEarl  2411; 
Denver  9;  Pd*  (PP). 

Perkins,  J.  Meredith;  958  Metropolitan  Bldg.;  CHerry 
4525;  Denver  2;  GP  (PP). 

Perrott,  Edwin  W.,  Jr.;  2398  Colorado  Blvd.;  FRe- 
mont  0404;  Denver  7;  (Ret.). 

Peterson,  Harold  R. ; 903  Republic  Bldg.;  KEystone 
6969;  Denver  2;  GP  (PP). 

Phelps,  McKinnie  D. ; 80'6  Republic  Bldg.;  KEystone 
3153;  Denver  2;  Anes*  (PP). 

Philippus,  Theodore  C. ; 803  Central  Savings  Bank 
Bldg.;  KElystone  4151;  Denver  2;  I*  (Gov.). 
Philpott,  Ivan  W. ; 806  Metropolitan  Bldg.;  TAbor 
8931;  Denver  2;  ADR*  (PP). 

Philpott,  James  A..;  202  Metropolitan  Bldg.;  TAbor 
2985;  Denver  2;  U*  (PP). 

Philpott.  Osgoode  S. ; 434  Metropolitan  Bldg.;  CHerry 
5526;  Denver  2;  D*  (PP). 

Pinto,  Sherman  S.;  1022  First  Natl.  Bank  Bldg.; 

CHerry  5355;  Denver  2;  Ind*. 

Plank,  J.  Raymond;  1840  E.  18th  Ave.;  FRemont  2018; 
Denver  6;  S*  (PP). 

Plattner,  Edward  B.;  1575  Gilpin  St.;  FRemont  8801; 
Denver  6;  Pd*  (PP). 

Pollice,  John  A.;  3520  Newton  St.;  GLendale  9642; 
Denver  11;  S (PP). 

Pollock.  Louis  A.;  204  Republic  Bldg.;  KEystone 
5088;  Denver  2;  I*  (PP). 

Porter,  Victor  W.;  1785  Ivy  St.;  No  telephone;  Den- 
ver 7;  (Ret.). 

Porter,  Whitney  C. ; 320  Republic  Bldg.;  TAbor  5075; 
Denver  2;  Oph*  (PP). 

x*ostma,  George  S. ; 1590  S.  Pearl  St.;  SPruce  3044; 
Denver  10;  S*  (PP). 

Powell,  Cuthbert;  1578  Humboldt  St.;  TAbor  3234; 
Denver  6;  ObG*  (PP). 

Pratt,  Elsie  Seelye;  737  Republic  Bldg.;  TAbor  2672; 
Denver  2;  Pd  (PP). 

Prenzlau,  Werner  S. ; 310'  Republic  Bldg.;  CHerry 
3726;  Denver  2;  T (PP). 

Prey,  Duval;  504  Republic  Bldg.;  KEystone  0294; 
Denver  2;  S*  (PP). 

Princi,  Prank;  4200  E.  9th  Ave.;  EAst  7771,  Ext.  289; 

Denver  7;  Ind*  (Med.  School). 

Prinzing,  J.  Frederic;  1011  Republic  Bldg.;  KEystone 
5713;  Denver  2;  S (PP). 

PrOckter,  Walter  H. ; 1809  E.  18th  Ave.;  FRemont 
2734;  Denver  6;  NS*  (PP). 

Purcell,  James  W. ; 3788  Walnut  St.;  KEystone  6911; 
Denver  5;  GP  (Ret.). 

Ramo,  Leon;  2550  W.  44th  Ave.;  GRand  8272;  Den- 
ver 11;  T (PP). 

Ramsey,  Russell  T.;  2373  Albion  St.;  EAst  1264; 
Denver  7 ; GP. 

Ravin,  Abe.;  425  Republic  Bldg.;  MAin  5127;  Denver 
2;  C*  (PP). 

Ravin,  Rose  Steed;  425  Republic  Bldg.;  MAin  5127; 
Denver  2;  D*  (PP). 

Reckler,  Sidney  M. ; 1114  Republic  Bldg.;  TAbor 

5600;  Denver  2;  S*  (PP). 

Rest,  Arthur;  1401  Jackson  St.;  DExter  6939;  Den- 
ver 6;  I*. 

Retallack,  Louis  L.;  604  Republic  Bldg.;  KEystone 
6655;  Denver  2;  GP  (PP). 

Rettberg,  William  A.  H.;  203  Metropolitan  Bldg.; 

MAin  3185;  Denver  2;  I*  (PP). 

Reynolds,  Edna  M.;  208  Metropolitan  Bldg.;  KEy- 
stone 1444;  Denver  2;  Oph*. 

Reynolds,  F.  Henry;  1010  Republic  Bldg.;  KEystone 
3792;  Denver  2;  Pd*  (PP). 

Reynolds,  Levi  E. ; 4200  E'.  9th  Ave.;  EAst  7771;  Den- 
ver 7;  S*  (PG  Res.). 

Rhodes,  Paul  H.;  608  Metropolitan  Bldg.;  CHerry 
2511:  Denver  2;  Pd*  (PP). 

Rice,  Paul  M.;  1765  Sherman  St.;  TAbor  8181;  Denver 
3:  ObG*  (PP). 

Richard,  Warren  E.;  999  S.  Broadway;  PEarl  6060; 
Denver  9;  GP  (PP). 

Richards,  Daniel  F. ; 804  Republic  Bldg.;  TAbor 

4761;  Denver  2;  GP  (PP). 

Ritterspach,  Fred  J. ; 1445  Bellaire  St.;  FRemont  7247; 
Denver  7;  (Ret.). 

Robb,  Guel  G. ; 104  Broadway;  PEarl  0404;  Denver 
9;  GP  (PP). 

Robbins,  Harry  E. ; 620  Republic  Bldg.;  TAbor  8531- 
Denver  2;  S (PP). 

Robinson,  E.  F.;  Albany  Hotel;  KEystone  5211; 
Denver  2. 

Robertson,  Frank  O. ; 2040  S.  Josephine  St.;  PEarl 
3711;  Denver  10;  I*  (Student  Health  Service). 
Robinson,  Arthur;  1575  Vine  St.;  DExter  2957-  Den- 
ver 6;  Pd*  (PP). 


Rocky  Mountain  Medical  Journal  Supplement 


23 


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Denver  ...  (Continued) 

Robinson,  Lloyd  W. ; 1834  Gilpin  St.;  EiAst  3818;  Den- 
ver 6:  I*  (PP). 

Rodriquez,  Rene  A.;  2266  Broadway;  TAbor  0725: 
Denver  2;  ObG  (PP). 

Rogers,  Frank  E. ; 350  Metropolitan  Bldg.;  MAin 
1506;  Denver  2;  S*  (PP). 

Rosenberg,  Fritz;  8000  Montview  Blvd. ; FRemont 
8828;  Denver  7;  T*  (PP).  . 

Rothwell,  William  D.,  Jr.;  1010  Republic  Bldg.; 

TAbor  3981;  Denver  2;  Pd*  (PP). 

Ruegnltz,  Louis  H.;  1717'  Downing  St.;  TAbor  5369; 
Denver  5. 

Bussell,  James  Earl,  Jr.;  1010  Republic  Bldg.; 

KEystone  3792;  Denver  2;  Pd*. 

Russell,  Ruth  Kenyon;  1777  Krameria  St.;  DE'xter 
0382;  Denver  7;  (Not  in  Practice). 

Rutledge,  Enid  K.;  4200  B.  9th  Ave.;  EAst  7771; 

Denver  7;  Path*  (Med.  School). 

Ryan,  James  L.;  3465  W.  44th  Ave.;  GRand  7'961;  Den- 
ver 11;  ObG  (PP). 

Ryan,  John  G. ; 725  Mack  Bldg.;  MAin  0834;  Denver 
2;  I*  (PP). 

Ryan,  Michael  P. ; 5412  W.  Colfax  Ave.;  KEystone 
4411;  Denver  14;  S (PP). 

Ryder,  Frances  B.  Dworak;  3420  W.  34  th  Ave.; 

GLendale  7068;  Denver  11;  (Ret.). 

Rymer,  Charles  A.;  230  Majestic  Bldg.;  CHerry 

7615;  Denver  2;  P*  (PP). 

Sabin,  Florence  R. ; 1333  E.  lOth  Ave.;  CHerry  7191; 
Denver  3;  PH*  (PH). 

Safarik,  Lumir  R. ; 1032  Republic  Bldg.;  KEystone 
8507;  Denver  2;  I*  (PP). 

Savage,  Raymond  J.;  1820  Gilpin  St.;  DExter  1252; 
Denver  6;  I*  (PP). 

Sawyer,  Kenneth  C.;  1820  Gilpin  St.;  EAst  3378; 

, Denver  6;  S*  (PP). 

Scannell,  Raymond  C. ; 2035  E,  18th  Ave.;  EJAst  0140; 
Denver  6;  S*  (PP). 

Schachet,  Reuben;  3604  Morrison  Road;  Westwood 
416;  Denver  9;  GP  (PP). 

Schick,  Walter  R. ; 326  Republic  Bldg.;  AComa  4001; 
Denver  2;  Pd*  (PP). 

Schless,  James  M. ; 204  Republic  Bldg.;  KEystone 
5088;  Denver  2;  I*  (PP). 

Schmidt,  Kennith  W.;  1820  Gilpin  St.;  DExter  1141; 
Denver  6;  Pd*  (PP). 

Schmitt,  Oscar  J. ; 227  Mack  Bldg.;  KEystone  5341; 
Denver  2;  S (PP). 

Scott,  Stephen  C. ; 2321  E.  Ohio  St.;  RAce  3646; 
Denver  9;  GP  (PP). 

Steott,  Walter  S.;  291  Garfield  St.;  EAst  9344;  Denver 
6;  S*. 

Scott,  William  C.;  4200  E.  9th  Ave.;  EAst  7771;  Den- 
ver 7;  ObG*  (PG  Res.). 

Sells,  Virgil  B.;  2239  E.  Colfax  Ave.;  FRemont  8209: 
Denver  6. 

Shankel,  Harry  W. ; 1005  Republic  Bldg.;  AComa  0025; 
Denver  2;  Oph  * (PP). 

Shattuck,  Robert  Cl.:  406  Republic  Bldg.;  KEystone 
8231;  Denver  2;  ALR*  (PP). 

Shepard,  Charles  A.;  450  So.  Marion  St.;  PEarl  4611; 
Denver  9;  C (PP). 

Sherberg,  Ralph  O. ; 500  Downing  St.;  SPruce  2689; 
Denver  3;  Pd*. 

Sherbok,  Bernard  C.;  713  Republic  Bldg.;  CHerry 
3030;  Denver  2;  Or*  (PP). 

Shere,  Norbert  L.;  204  Republic  Bldg.;  KEystone 
5516;  Denver  2;  FN*  (PP). 

Sherman,  Leon  H.;  1080  Logan  St.;  TAbor  2650; 
Denver  3. 

Sheridan,  Edward  Paul;  1776i  Vine  St.;  DExter  4231; 
Denver  6;  I*  (PP). 

Shields,  James  M. ; 264  Metropolitan  Bldg.;  TAbor 
4594;  Denver  2;  Oph*  (PP). 

Shinn,  Carrol  C.;  30  E.  Dakota  Ave.;  SPruce  0016; 
Denver  9;  GP  (PP). 

Shmugar,  Meyer;  4248  Tennyson  St.;  GLendale  2641; 
Denver  12 ; GP. 

Shumsky,  Nathan  S. ; 204  Republic  Bldg.;  KEystone 
3650;  Denver  2;  S*  (PP). 

Shwayder,  Aaron  J. ; 2958  Welton  St.;  CHerry  7775; 
Denver  5;  P (PP). 

Shwayder,  Montimore  C. ; 824  Majestic  Bldg.;  KEy- 
stone 3545;  Denver  2;  Oph*  (PP). 

Simmons,  Jack  M.,  Jr.;  638  Republic  Bldg.;  KElystone 
6201;  Denver  2;  ObG*  (PP). 

Simon,  Saling;  838  Republic  Bldg.;  KEystone  3417; 
Denver  2;  C. 

Simpson,  Russell  E.,  Jr.;  1401  Madison  St.;  Denver  6. 
Sitton,  Joseph  D.;  3738  Walnut  St.;  TAbor  7343; 
Denver  5;  GP  (PP). 

Smernoff,  Meyer  E,;  3937  Morrison  Road;  PEarl  6572; 
Denver  9;  S (PP). 

Smith,  Charles;  300  Metropolitan  Bldg.;  TAbor  5136; 
Denver  2;  I*  (PP). 

Smith,  Guy  W. ; 1014  Republic  Bldg.;  TAbor  4739; 
Denver  2;  ALR*  (PP). 


Smith,  Lawson  F. ; 1502  Quince  St.;  DExter  2601; 
Denver  7 ; GP. 

Snider,  Bernard  H.;  704  Republic  Bldg.;  MAin  6884; 
Denver  2;  GP  (PP). 

Snyder,  Harvey  W. ; 832  Republic  Bldg.;  TAbor 

6309;  Denver  2;  S (PP). 

Sorensen,  Regnar;  Denver  General  Hospital;  TAbor 
1331;  Denver  4. 

Sparer,  Phineas  J. ; 4000  E.  6th  Ave.;  DExter  1468; 
Denver  7;  I*  (PG  Res.). 

Spicer,  Charles  M. ; 1111  Republic  Bldg.;  KEystone 
2571;  Denver  2;  Or*. 

Staeck,  Felix  C.;  3135  W.  44th  Ave.;  GRand  3331; 
Denver  11;  GP  (PP). 

Stahl,  Arthur  W.;  690  So.  Clay  St.;  PEarl  9111;  Den- 
ver 9;  A. 

Stampfli,  Wendel  P.;  St.  Luke’s  Hosp.;  TAbor  3241; 
Denver  5;  R*. 

Stander,  Theodore  C. ; 1765  Sherman  St.;  TAbor  8181; 
Denver  5;  S (PP). 

Stander,  Thomas  R. ; 733  Republic  Bldg.;  KEystone 
4279;  Denver  2;  OALR*  (PP). 

Stanek,  William  F.;  1727  Gilpin  St.;  FRemont  8853; 
Denver  6;  Or*  (PP). 

Stanfield,  Clyde  El;  3705  E.  Colfax  Ave.;  DExter  8291; 
Denver  6;  PN*  (PP). 

Stanley,  George  B. ; Veterans  Administration,  Cen- 
tral Savings  Bank  Bldg.;  KEystone  4151;  Denver 
2;  (Gov.). 

Stapleton,  James  A.;  1840  E.  18th  Ave.:  FRemont 
2018;  S*  (PP). 

Stark,  Merritt  M.;  1750  E.  19th  Ave.;  DExter  5471; 
Denver  6;  Pd*  (PP). 

Starr,  Arthur  G.;  730  Milwaukee  St.;  DExter  3088; 
Denver  6. 

Staunton,  Archibald  G.;  1445  Downing  St.;  FRemont 
2018;  Denver  6. 

Stein,  Hermann  B.;  310  Republic  Bldg.f  MAin  7570; 
Denver  2;  Anes*  (PP). 

Stephenson,  Frank  B. ; Children’s  Hosp.;  MAin  1261; 
Denver  5;  R*  (Hosp.). 

Sterling,  Robert;  3705  E.  Colfax  Ave.;  TAbor  5483; 
Denver  6;  Oph*  (PP). 

Stevens,  John  L.;  932  S.  Franklin  St.;  Denver  9; 
(Ret.). 

Stewart,  Robert  J.;  3705  E.  Colfax  Ave.;  ALpine  8592; 
Denver  6;  ObG  (PP). 

Stiles,  George  W. ; 430  State  Office  Bldg.;  ALpine 
1466;  Denver  2;  Path*  (PH). 

Stonlngton,  Oliver  G. ; 1765  Sherman  St.;  TAbor  8181; 
Denver  5. 

Strakosch,  Ernest  A.;  207  Republic  Bldg.;  CHerry 
4453;  Denver  2;  D*  (PP). 

Strong,  James  C.,  Jr.;  617  Majestic  Bldg.;  TAbor 
3635;  Denver  2;  Oph*  (PP). 

Struthers,  John  E.;  1004  Republic  Bldg.;  MAin  0813; 
Denver  2;  S*. 

Stuck,  Ralph  M. ; 632  Republic  Bldg.;  TAbor  4403; 
Denver  2;  NS*  (PP). 

Stuck!,  John  C. ; 820  Metropolitan  Bldg.;  TAbor  1481; 
Denver  2;  ObG  (PP). 

Stuver,  Edna  L. ; 2036  Emerson  St.;  KEystone  0043; 
Denver  5;  GP  (PG  Res.). 

Stuver.  Henry  W.;  324  Majestic  Bldg.;  MAin  1968; 
Denver  2;  GP  (PP). 

Sudan,  Archer  C. ; 430  B.  11th  Ave.;  ALpine  5958; 
Denver  3;  GP  (PP). 

Suenaga,  Howard;  830  18th  St.;  TAbor  2642;  Denver 
2;  GP  (PP). 

Summers,  William  B. ; 632  Republic  Bldg.;  KEystone 
7573;  Denver  2;  S (PP). 

Sunderland,  Karl  F.;  705  Republic  Bldg.;  MAin 

0560;  Denver  2;  S*  (PP). 

Sunderland,  William  E. ; 705  Republic  Bldg.;  MAin 
0560;  Denver  2;  S (PP). 

Swan,  Henry;  4200  E.  9th  Ave.;  EAst  7771;  Denver 
7;  S*  (Med.  School). 

Swanson,  Howard  B. ; 1578  Humboldt  St.;  CHerry 
8013;  Denver  6;  ALR*  (PP). 

Swigert,  J.  Leonard:  320  Republic  Bldg.;  TAbor 
2724;  Denver  2;  Oph*  (PP). 

Swigert,  William  B. ; 1035  Republic  Bldg.;  TAbor 
0477;  Denver  2;  Pr*  (PP). 

Thkeno,  M.  George;  830  18th  St.;  TAbor  0783; 
Denver  2;  GP  (PP). 

Tannenbaum,  Philip  D. ; 701  Majestic  Bldg.;  KEy- 
stone 5921;  Denver  2;  ObG  (PP). 

Tanner,  Gordon  W. ; 700  S.  Pearl  St.:  SPruce  1000; 
Denver  9;  GP  (PP). 

Taylor,  Edward  E^;  505  Republic  Bldg.;  MAin  3014; 
Denver  2;  S*  (PP). 

Taylor,  E'.  Stewart;  4200  E.  9th  Ave.:  EAst  7771; 

Denver  7;  ObG*  (Med.  School). 

Taylor,  Ray  R.,  Jr.;  4200  E.  9th  Ave.;  EAst  7771; 
Denver  7;  Pd*  (PG  Res.). 

Tepley  Leo  V. ; 804  Republic  Bldg.;  TAbor  2008; 
Denver  2;  PN*  (PP). 

Thode,  Henry  P.,  Jr.;  4200  E.  9th  Ave.;  EAst  7771; 
Denver  7;  (PG  Res.). 


Rocky  Mountain  Medical  Journal  Supplement 


25 


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26 


Rocky  Mountain  Medical  Journal  Supplement 


Denver  ...  (Continued) 

Thomas,  Atha:  418  Republic  Bldg.;  KEystone  5289; 
Denver  2;  Or*  (PP). 

Thomas,  James  D.;  3500  E.  17th  Ave. ; DExter  8044; 
Denver  6;  I*  (PP). 

Thompson,  Nathaniel  A.;  946  Metropolitan  Bldg.; 

MAin  2232;  Denver  2;  S*  (PP). 

Threlkeld,  Richard  L. ; 3028  W.  Clyde  Place;  GLen- 
dale  4666;  Denver  11;  GP  (PP).' 

Towbin,  Samuel;  2257  W.  32nd  Ave.;  GLendale 
1155;  Denver  11,  GP  (PP). 

Triplett,  Thomas  A.;  1441  Josephine  St.;  EAst  5862; 
Denver  6;  P. 

Tucker,  Warren  W. ; 1820  Gilpin  St.;  FRemont  2812; 
Denver  6;  ObG*  (PP). 

Tuteur,  Richard;  332  Metropolitan  Bldg.;  MAln  5812; 
Denver  2;  I*  (PP). 

Twombly,  (jeorge  C. ; 4200  E.  9th  Ave.;  EAst  7771; 
Denver  7;  (PG  Res.). 

Tyler,  Monroe  R. ; 730  Republic  Bldg.;  CHerry  5411; 
Denver  2;  S*  (PP). 

Tyor,  Joseph  C. : 2833  E.  16th  Ave.;  FRemont  0285; 
Denver  6;  (PG  Res.). 

Ulmer,,  Herbeirt  D. ; 402  Mack  Bldg.;  TAbor  6632; 
Denver  2;  GP. 

Underwood,  Earl;  4343  W.  44th  Ave.;  GRand  4142; 
Denver  12;  GP  (PP). 

Van  Bergen,  Thomas  M. ; 264  Metropolitan  Bldg.; 

TAbor  4594;  Denver  2;  Oph*  (PP). 

Vanden  Bosch,  Marvin  P. ; 2090  S.  Downing  St.; 

SPruce  1618;  Denver  10;  ObG  (PP). 

Van  Stone,  Leonard  M. ; 1578  Humboldt  St.;  CHerry 
2326;  Denver  6;  I*. 

Van  Stone,  W.  D.;  1578  Humboldt  St.;  TAbor  3234: 
Denver  6:  ObG*  (PP). 

Van  Zant,  (jharles  B.;  1205  Ogden  St.;  CHerry  0304; 
Denver  3;  (Ret.). 

Verploeg,  Ralph  H.;  1901  E.  20th  Ave.:  DExter  4241; 
Denver  5;  Pd*  (PP). 

Vest,  Walter  E.,  Jr.;  1820  Gilpin  St.;  EAst  7741; 
Denver  6;  I*  (PP). 

Vines,  Robert  W. ; 1234  Republic  Bldg.;  KEystone 
6429;  Denver  2;  I*  (PP). 

Von  Detten,  Harold  J. ; 711  Republic  Bldg.;  KEy- 
stone 8808;  Denver  2;  Ob*  (PP). 

Waddell,  Myron  C. ; 610  Republic  Bldg.;  CHerry 

1058;  Denver  2;  ObG  (PP). 

Waggener,  William  R. ; 220  Metropolitan  Bldg.; 

MAln  0351;  Denver  2;  Ind*. 

Wagschal,  Ferdinand;  40S  Mack  Bldg.;  MAin  2680; 
Denver  2;  GP  (PP). 

Wagschal,  Rolf;  431  Mack  Bldg. ;' KEystone  0569; 
Denver  2;  GP  (PP). 

Wahl,  David  L. ; 1575  Gilpin  St.;  EAst  6347;  Denver 
6:  GP  (PP). 

Walker,  Charles  E.;  1732  High  St.;  FRemont  7615; 
Denver  6. 

Waring,  James  J. ; 4200  Ei  9th  Ave.:  EAst  7771; 

Denver  7;  I*  (Med.  School). 

Warner,  George  R. ; 1206  Republic  Bldg.;  AComa 
3818;  Denver  2;  Dental  Radiology  (PP). 

Wasson,  W.  Walter;  304  Republic  Bldg.;  KEystone 
2301:  Denver  2;  R*  (PP). 

Watson,  Oscar  M.,  Jr.;  1408  E.  47th  Ave.;  AComa 
0171;  Denver  16. 

Wear,  Harry  H. ; 1080  Sherman  St.;  TAbor  0098;  Den- 
ver 2;  U*  (Ret.). 

Wearner,  Arthur  A.;  806  Republic  Bldg.;  KEystone 
3153;  Denver  2;  Anes*  (PP). 

Weatherford,  James  E.;  2239  E.  Colfax  Ave;  EAst 
3478;  Denver  6. 

Weaver,  Robert  H. : Children’s  Hosp. ; MAin  1261; 
Denver  5:  Pd*  (PG  Res.). 

Weeks,  Paul  R.;  520  Republic  Bldg.;  MAin  7147; 
Denver  2;  R*  (PP). 

Wheelock,  Seymour  E. ; 1850  Gilpin  St.;  FRemont 
8821;  Denver  6;  Pd*  (PP). 

Weiker,  Justin;  803  Majestic  Bldg.;  TAbor  5678; 
Denver  2;  GP  (PP). 

Weinstein,  Louis  J. ; 1035  Republic  Bldg.;  TAbor 
7702;  Denver  2;  Pr  (PP). 

Weiss,  Joseph  H.;  Denver  General  Hosp.;  TAbor 
1331;  Denver  4;  R*  (Hosp.). 

Wherry,  Franklin  P. ; 999  So.  Broadway;  PEarl  2411; 
Denver  9;  I*  (PP). 

Wherry,  Harry  L.;  4200  B.  9th  Ave.;  EAst  7771;  Den- 
ver 7;  GP  (PG  Res.). 

Whitaker,  Harry  L.;  910  Republic  Bldg.;  MAin 

2759;  Denver  2;  ADR*. 

AA^ite,  Stanley  M. ; 4200  E.  9th  Ave.;  EAst  7771; 
Denver  7;  I*  (PG  Res.). 

Whitehead,  Richard  W. ; 4200  E.  9th  Ave.;  EAst 
7771;  Denver  7;  (Med.  School). 

Whiteley,  Philip  W. ; 920  Metropolitan  Bldg.;  CHerry 
3855;  Denver  2;  ObG*  (PP). 

Whitmore,  John  D.;  1119  Republic  Bldg.;  TAbor 

4205;  Denver  2;  ObG*  (PP). 

Wierman,  William  H. ; 1008  Republic  Bldg.;  ALpine 
2889:  Denver  2;  S*  (PP). 


Wikle,  Walter  T.;  4200  E.  9th  Ave.;  EAst  7771;  Den- 
ver 7;  Path*  (Med.  School). 

Wilkoff,  Myron;  3441  Tennyson  St.;  GLendale  3330; 
Denver  12;  GP  (PP). 

Williams,  Aubrey  H. ; 1630  Adams  St.;  EAst  1686; 
Denver  6:  (Ret.). 

Williams,  Ben  C.;  3500  E.  17th  Ave.;  FLorida  0212; 
Denver  6;  ObG*  (PP). 

Williams,  Edwin  T. ; 1850  Gilpin  St.;  FRemont  8821; 
Denver  6*  Pd*  (PP). 

Williams,  Francis  J.;  2739  W.  Alameda  Ave.;  SHer- 
man  0278;  Denver  9;  GP  (PP). 

Williams,  Sherman,  350  Metropolitan  Bldg.;  MAin 
1506;  Denver  2;  D (PP). 

Williams,  Theodore  L. ; 1650  Lawrence  St.;  TAbor 
6131;  Denver  2;  Ind*  (Exec.). 

Willis,  Charles  H.;  51st  and  Bannock;  KEystone  1123; 
Denver  16;  Ind.  (PP). 

Wills,  Charles  B. ; 506  Republic  Bldg.;  KEystone 
1275;  Denver  2;  Pr*  (PP). 

Wilson,  A.  Lawrence;  1203  Republic  Bldg.;  KEystone 
4707;  Denver  2;  GP  (PP). 

Wilson,  William  H. ; 903  Republic  Bldg.;  KEystone 
6684;  Denver  2;  ALR*  (PP). 

Winemiller,  Lee  H.;  404  Republic  Bldg.;  KEystone 
4812;  Denver  2;  GP  (PP). 

Witham,  Ray  G.;  1820  Gilpin  St.;  EAst  3378;  Denver 
6;  S (PP). 

Wlollenweber,  Louis  C. ; 808  Republic  Bldg.;  KE^?^- 
stone  8443;  Denver  2;  Pd  (PP). 

Wollgast,  George  F. ; 1120  S'.  Broadway;  SPruce 

5353;  Denver  10;  S*  (PP). 

Woodburne,  Arthur  R. ; 434  Metropolitan  Bldg.; 

CHerry  5526;  Denver  2;  D*  (PP). 

Woodruff,  Robert:  406  Metropolitan  Bldg.;  TAbor 
8133;  Denver  2;  S*  (PP). 

Workman,  Cloyd  W. ; 1078  S.  Gaylord  St.;  PEarl 
6690;  Denver  9;  GP  (PP). 

Yegge,  W.  Bernard;  908  Metropolitan  Bldg.;  MAin 
6168;  Denver  2;  I*  (FP). 

Young,  Howard  B. ; 330  Republic  Bidg. ; TAbor  1062; 
Denver  2;  Ob  (PP). 

Zarit,  John  I.;  212  Republic  Bldg.;  KEystone  3434; 
Denver  2;  I*  (PP). 

Zarlengo,  Ernest  P. ; 656  Metropolitan  Bldg.;  MAin 
1422;  Denver  2;  S (PP). 

Zarlengo,  Frank  N. ; 656  Metropolitan  Bldg.;  MAin 
1442;  Denver  2;  I*. 

Zarlengo,  Roland  J. ; 2846  W.  25th  Ave.;  GRand 

6564;  Denver  11;  GP  (PP). 

Zwemer,  Theodore  W. ; 2090  So.  Downing  St.;  SPruce 
1618;  Denver  10;  GP  (PP). 

Dolores  ... 

Lefurgey,  Herbert  C. : Dolores;  Dolores  40;  GP. 
Merritt,  Edward  G. ; Dolores;  Dolores  40;  (3P  (PP). 

Durango  ... 

Burnett,  Alta  L.;  102  E.  8th  St.;  Durango  212;  S (PP). 
Callaway,  Sam  E.;  873  2nd  Ave.;  Durango  30;  GP 
(PP). 

Clark,  James  W.;  873  2nd  Ave.;  Durango  30;  GP  (PP). 
Darling,  John  C. ; 868  Main  Ave.;  Durango  60;  GP 
(PP). 

Downing,  Robert  L. ; Penney  Bldg.;  Durango  161. 
Elliott,  Wordsworth  M.;  946  Main  St.;  Durango  322; 
OALR*. 

Koplowitz,  Joseph  B. ; 203  Penney  Bldg.;  Durango 
162;  Oph*. 

Lloyd,  Leo  W. ; Burns  Bank  Bldg.;  Durango  79;  GP 
(PP). 

Mason,  Charles  L, ; Burns  Bank  Bldg.;  Durango 
122;  GP  (PP). 

McKinley,  Joseph  G.;  Penney  Bldg.;  Durango  340; 
GP  (PP). 

Pingrey,  Fergus  R. ; 1020  Main  Ave.;  Durango  400; 
GP  (PP). 

Rensch,  Otto  B.;  207  Century  Bldg.;  Durango  441; 
Ob  (PP). 

Eagle 

Barnard,  Robert;  Eagle  Theater  Bldg.;  Eagle  9;  GP 
(PP). 

Eaton  ... 

Holden,  Eugene  G.;  Eaton;  (Ret.). 

Kuykendall,  Fred  D.;  123  1st  St.;  Eaton  8;  GP  (PP). 

Edgewater  ... 

Hiemer,  Allen  D.;  5366  W.  25th  Ave.;  GLendale 

4900;  Denver  14;  I*  (PP). 

Stein.  Meivin;  5366  W.  25th  Ave.;  GLendale  4900; 
Denver  14. 

Sunderland,  Orla  R.;  1605  Sheridan  Blvd.;  CHerry 
5252;  Denver  14;  GP  (PP). 


Rocky  Mountain  Medical  Journal  Supplement 


27 


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28 


Rocky  Mountain  Medical  Journal  Supplement 


Elbert  ... 

Denney,  Robert  H.;  Elbert;  Elbert  24;  GP  (PP). 

Englewood  ... 

Alldredge,  Hugh  H.,  35'33  S.  Broadway;  Englewood 
T-W;  GP  (PP). 

Altmix,  Richard  H.;  351'5  S.  Broadway;  Englewood 
2024;  GP  (PP). 

Catron,  Homer  B. ; 3600  S.  Broadway;  Englewood  22; 
GP  (PP). 

Crawford,  Velma  G.;  3439%  S.  Broadway;  Engle- 
wood 1953;  GP  (PP). 

Dahl,  Alvin  E.;  3515  S.  Broadway;  Englewood 

1233-W;  Anes  (PP). 

Dart,  Merrill  O.;  3191  S.  Broadway;  Englewood  160; 
OALR*  (PP). 

Darwin,  D.  W.;  3485  S.  Broadway:  Englewood  86; 

S*. 

Elgler,  Charles  O.;  3425  S.  Broadway;  Englewood 
1206;  OAL.R*. 

Hogan,  Paul  W.;  3485  S.  Broadway;  Englewood  6; 
GP  (PP). 

John,  Grant  H.;  2815  S.  Broadway;  Englewood  238; 
(Ret.). 

Lilienthal,  Samuel  C.;  3485  S.  Broadway;  Englewood 
18;  GP  (PP) 

Maerckleln,  Wallace  W. ; 2929  S.  Broadway;  Engle- 
wood 203;  GP  (PP). 

Miller,  Edgar  W. ; 3109  S.  Cherokee  St.;  Englewood 
1185-W:  (Ret.). 

Milligan,  Gatewood  C.;  3485  S.  Broadway;  Englewood 
6;  GP  (PP). 

Simon,  John;  3345  S.  Broadway:  Englewood  192; 
Ob  (PP). 

Simon,  John  Jr.;  2866  S.  Broadway;  Englewood  58; 
GP  (PP). 

Wiedenmann,  John  C.;  3498  S.  Broadway;  Engle- 
wood 200;  GP  (PP). 

Erie  . . 

McCallum,  Marion  J.;  Erie;  Erie  22R1;  GP  (PP). 

Estes  Park  ... 

Mall,  Jacob  O. ; Elkhorn  Ave. ; Box  516;  Estes  Park 
150;  GP  (PP). 

Reid,  Henry  S.;  Baird  Bldg.;  Estes  Park  89;  GP 
(PP). 

Wiest,  Roy  F.;  Estes  Park;  Estes  Park  41;  GP  (PP). 

Evergreen  ... 

Hunt,  John  R.;  Evergreen;  Evergreen  110;  GP  (PP). 

Ilagler  ... 

McBride,  William  L.;  Flagler;  Flagler  27;  GP  (PP). 
Straub,  John  C.,  Jr.;  Flagler;  Flagler  30:  GP  (PP). 

Florence  ... 

Atkinson,  George  S. ; 105  E.  Main  St.;  Florence 

102;  S (PP). 

Waroshill,  Alexander  D. ; 112  N.  Pikes  Peak  Ave.; 
Florence  218;  S. 

Fort  Collins  ... 

Adams,  Blair;  215  State  Bldg.;  Ft.  Collins  112;  GP 
(PP). 

Allison,  Miss  Inga  M.  K. ; 120  Garfield  St.;  Ft. 

Collins  1361;  (Associate  Member;  Not  a Physician). 
Anderson,  N.  Paul  E. ; 132  S.  College  Ave.;  Ft. 

Collins  2462;  Pd  (PP). 

Beebe,  Nathan  L. ; 605  S.  College  Ave.;  Ft.  Collins 
44;  S (FP). 

Betts,  Frank  A.;  131  N.  College  Ave.;  Ft.  Collins 
424-W;  GP  (PP). 

Bliss,  Robert  J. ; 403  S.  College  Ave.;  Ft.  Collins 
556;  GP  (PP). 

Brown,  George;  125  S.  College  Ave.;  Ft.  Collins  810; 
OALR*  (PP). 

Brownell,  William  F. ; 156  S.  College  Ave;  Ft.  Collins 
433;  OADR*. 

Carey,  James  D.;  •f’oudre  Valley  Natl.  Bank  Bldg.; 
Ft.  Collins  204. 

Carroll,  Charles  A.;  112  W.  Oak  St.;  Ft.  Collins  669- 
W;  GP  (PP). 

Cram,  Victor  E.;  919  Woodford  Ave.;  Ft.  Collins 
1048:  GP. 

Dickey,  Lawrence  D. ; 109  W.  Olive  St.;  Ft.  Collins 
2205:  U (PP). 

Dickey,  Olive  L.  S. ; 109  W.  Olive  St.;  Ft.  Collins  2205; 
ObG  (PP). 


Garrison,  George  E. ; 156  S.  College  Ave.;  Ft.  Collins 
442;  OALR*  (PP). 

Gleason,  Roy  L.;  137'  W.  Oak  St.;  Ft.  Collins  440-W; 
S (PP). 

Hartshorn,  Duane  F. ; 230  Remington  St.;  Ft.  Col- 
lins 321;  GP  (PP). 

Hoffman,  James  F. ; 316  S.  College  Ave.;  Ft.  Collins 
704;  Pd  (PP). 

Honstein,  Clyde  Ei;  Central  Bldg.;  Ft.  Collins  786; 
GP  (PP). 

Humphrey,  Fred  A.;  115  S.  College  Ave.;  Ft.  Collins 
560:  GP  (PP). 

Lee,  Robert  M.;  156  S.  College  Ave.;  Ft.  Collins  149; 
S (PP). 

Little,  Lowell,  112  W,.  Oak  St.;  Ft.  Collins  669-W; 
GP  (PP). 

Morrill,  E.  Miner;  151  S.  College  Ave.;  Ft.  Collins 
1818;  GP  (PP). 

Munroe,  Allan  B.;  605  S.  College  Ave.;  Ft.  Collins  44; 
Pd  (PP). 

Sadler,  Jackson  L. ; 109  W.  Olive  St.;  Ft.  Collins  2205; 
Pd  (PP). 

Schmidt,  Robert:  132  S.  College  Ave.:  Ft.  Collins 
2244-W:  GP  (PP). 

Stewart,  James  D. ; 312  S.  College  Ave.:  Ft.  Collins 
181;  Or*  (PP). 

Taylor,  T.  Clarkson;  Physicians  Bldg.;  Ft.  Collins 
400-W;  GP  (PP). 

Van  Der  Schouw,  Martin  G. ; Poudre  Valley  Bank 
Bldg.;  Ft.  Collins  204;  GP  (PP). 

Fort  Logan  ... 

Bigelow,  Eugene  V.;  Veterans  Hosp. ; RAce  2881. 
Boyd,  Walter  M.;  Veterans  Hosp.;  RAce  2881,  Ext. 
201;  S*  (Gov.). 

Cook,  Robert  C. ; Veterans  Hosp.;  RAce  2881,  Ext.  1; 
HA*  (Gov.). 

Gibbens,  Murray  E.;  Veterans  Hosp. ; RAce  2881;  Or* 
(Gov.). 

Goldner,  Martin  G. ; Veterans  Hosp.;  RAce  2881;  I* 
(Gov.). 

Ingersoll,  Charles  F.;  Veterans  Hosp.;  RAce  2881, 
Ext.  20S;  R*  (Gov.). 

Ireland,  Paul  M. ; Veterans  Hosp.;  RAce  2881,  Ext. 
201;  S*  (Gov.). 

Leder,  Max  Morris;  Veterans  Hosp.;  RAce  2881; 
I*  (PG  Res.). 

Novota,  Otto  J. : Veterans  Hosp.;  RAce  2881,  BIxt.  46; 
I*  (PG  Res.). 

Sears,  Thad  P.;  Veterans  Hosp.;  RAce  2881;  I* 
(Gov.). 

Stevenson,  Chester  P.;  Veterans  Hosp.;  RAce  2881; 
I*  (Gov.). 

Fort  Lupton  ... 

Pearson,  Ernest  R. ; 229  Denver  Ave.;  Ft.  Lupton 
148;  GP  (PP). 

Soland,  Louis  W.;  329  Denver  Ave.;  Ft.  Lupton  6; 
GP  (PP). 

Fort  Lyon  ... 

Jackson,  Benjamin  F.;  Fort  Lyon;  Las  Animas  82; 
P*  (Gov.). 

Wells,  Benjamin  S. ; Veterans  Hospital;  Fort  Lyon. 

Fort  Morgan  ... 

Cowen,  D.  Eugene;  525  State  St.;  Ft.  Morgan  646; 
GP  (PP). 

Dawson,  W.  A.;  Times  Bldg.;  Ft.  Morgan  47;  Anes 
(PP). 

Olsen,  Arthur  R. ; 316%  Main  St.;  Ft.  Morgan  690-W: 
GP  (PP). 

Richards,  Robert  B.;  Times  Bldg.;  Ft.  Morgan  47; 
GP  (PP). 

Roark,  Frank  E. ; Times  Bldg.;  Ft.  Morgan  47: 
GP  (PP). 

Williams,  Arthur  F.;  220  Eu  Beaver  Ave.;  Ft. 

Morgan  18;  S (PP). 

Woodward,  Paul  E.;  220  E.  Beaver  Ave.:  Ft.  Morgan 
18;  GP  (PP). 

Fowler  ... 

Van  Der  Schouw,  George  E.;  202  8th  St.;  Fowler 
50,  GP  (Ret.). 

Frederick  ... 

Ashbaugh,  Guy  A.;  Frederick;  Frederick  2421;  GP. 


Rocky  Mountain  Medical  Journal  Supplement 


29 


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30 


Rocky  Mountain  Medical  Journal  Supplement 


Fruita  ... 

Orr,  Edwin  R.;  Bank  Bldg.;  Pruita  4;  GP  (PP). 

Orr,  James,  S.;  Bank  Bldg.;  Fruita  4;  S (PP). 

Gm  . . . 

Warren,  Charles  B. ; Gill;  (Ret.). 

Gilman  ... 

Kehoe,  John  M. ; Gilman;  Redcliff  421;  GP. 

Glenwood  Springs  ... 

Games,  Wilmer  D.;  Glenwood  Hot  Springs  Clinic; 

(Associate  Member;  Not  a Physician). 

E,vans,  Webster  W. ; Napier  Bldg.;  Glenwood  Springs 
444;  GP  (PP). 

Hopkins,  Granville  A.;  803  Bennett  Ave. ; Glenwood 
Springs  63- J;  GP  (PP). 

Livingston,  Robert  R. : Glenwood  Springs  Clinic; 

Glenwood  Springs  101;  GP  (PP). 

Nutting,  Burtis  E.;  First  Natl.  Bank  Bldg.;  Glen- 
wood'Springs  25;  S (PP). 

Shull,  Clarence  W. ; First  Natl.  Bank  Bldg.;  Glen- 
wood Springs  21-W;  S (PP). 

Stevens,  William  H. ; Address  unknown. 

White,  Paul  J. ; Glenwood  Springs  Clinic;  Glenwood 
Springs  101;  S*  (PP). 

Golden  ... 

Garvin,  Galen  D. ; 1120%  Washington  Ave.;  Golden 
62;  Pd  (PP). 

Hewlett,  Roger  G. ; 1317  Wlashington  Ave.;  Golden 
99;  S (PP). 

Hewlett,  Lewis  U.;  1317  Washington  Ave.;  Golden 
99;  GP. 

Kemble,  Earl  W. : 1205  Washington  Ave.;  Golden  6; 
GP  (PP). 

Robinovitch,  Louise  G. ; c/o  Mrs.  M.  F.  Coolbaugh; 
(Ret.). 

Wright,  W.  Lloyd;  819  13th;  Golden  649;  GP  (PP). 

Grand  Junction  . . . 

Beaver,  Margaret  E.  Nelson;  618  Rood  Ave.;  Grand 
Junction  2427;  PH*  (PH). 

Beaver,  William  C.;  521  Rood  Ave.;  Grand  Junction 
80;  OALR*  (PP). 

Bull,  Heman  R. ; First  Natl.  Bank  Bldg.;  Grand 
Junction  790;  S (PP). 

Cary,  Guy  C. ; United  States  Bank  Bldg.;  Grand 
Junction  1520;  OALR*  (PP). 

Crook,  Guy  H. ; 416  White  Ave.;  Grand  Junction  40  ; 
ObG  (PP). 

Gould,  Arch  H.;  1055  N.  12th  St.;  Grand  Junction 
1804;  GP  (PP). 

Graves,  Herman  C. ; 26  DeMerschman  Gardens: 

Grand  Junction  8;  I*  (PP). 

Groom,  Robert  J. ; 416  White  Ave.;  Grand  Junction 
649-W;  Pd  (PP). 

Holmes,  James  B.;  130  S.  5th  St.;  Grand  Junction 
512-W;  GP  (PP). 

Taros,  Ernest  A.;  Cinco  Bldg.;  Grand  Junction  403; 
GP  (PP). 

Jefferson,  Benjamin  L.;  Colorado  State  Home  for 
Mental  Defectives;  Grand  Junction  47;  (Exec.). 
Mahan,  Thomas  K. ; 531  Rood  Ave.;  Grand  Junction 
3384;  R*  (PP). 

Marasco,  Paul  B. ; 131  So.  6th  St.;  Grand  Junction 
3348;  ObG  (PP). 

McDonough,  Frank  J.;  115  N.  5th  St.;  Grand  Junc- 
tion 284;  S (PP). 

Merkley,  Harold  EL;  227  N.  5th  St.;  Grand  Junction 
3348;  ObG  (PP). 

Moore,  Mary  Louise;  Room  43,  Canon  Bldg.;  Grand 
Junction  29;  GP. 

Munro,  Everett  H. ; Canon  Bldg.;  Grand  Junction 
839;  S (PP). 

Olsen,  Prank  B.;  1850  N.  8th  St.;  Grand  Junction  714; 
GP  (PP). 

Orr,  Walame  M. ; N.  7 th  St.;  (Associate  Member; 
Not  a Physician). 

Parker,  Joseph  J. ; First  Natl.  Bank  Bldg.;  Grand 
Junction  253;  GP  (PP). 

Prescott,  Kenneth  Ei.;  1115  Main  St.;  Grand  Junction 
2206;  GP  (PP). 

Raso,  Roland  A.;  Room  5,  Canon  Bldg.;  Grand 
Junction  210;  GP  (PF). 

Rigg,  James  P. ; 521  Rood  Ave.;  Grand  Junction  80; 
OALR*  (PP). 

Saccomano,  Geno;  St.  Mary’s  Hosp.;  Grand  Junction 
115;  Path*. 


Slckenberger,  Jess  U. ; 115  N.  5th  St.;  Grand  Junction 
42;  S*. 

Smith,  G.  Paul;  1163  Ouray  Ave.;  Grand  Junction  32; 
I*  (PP). 

Stidham,  Paul  B. ; 531  Hood  Ave.;  Grand  Junction 
2892;  U*  (PP). 

Taylor,  Arthur  G. ; 113  S.  5th  St.;  Grand  Junction 
333-W;  GP  (PP). 

Tupper,  Harvey  M. ; 115  S.  4th  St.;  Grand  Junction 
101;  S (PP). 

Waldapfel,  Richard;  De  Merschman  Gardens;  Grand 
Junction  146;  OALR*  (PP). 

White,  Plarry  W.;  1259  Rood  Ave.;  Grand  Junction 
936;  ^Ret.). 

Grand  Lake 

Mahon,  Nathan  H.;  Grand  Lake;  GP  (PP). 

Murphey,  Edward  S. ; Box  34;  Grand  Lake  110;  Gl 
(PP). 

Grand  Valley  ... 

Miller,  Fred  H. ; Grand  'Valley;  Grand  Valley  25;  GP. 

Greeley  ... 

Adams,  Bert  L. ; 812%  8th  St.;  Greeley  680;  OALR* 
(PP). 

Allely,  James  W. ; Greeley  Natl.  Bank  Bldg.;  Greeley 
380-W;  GP  (PP). 

Atkinson,  Thomas  E-. ; 209  Coronado  Bldg.;  Greeley 
862;  OALR*  (PP). 

Barber,  Donn  J. ; Greeley  Bldg.;  Greeley  52;  Pd 
(PP). 

Darst,  John  H.;  1002  9th  St.;  Greeley  147;  ObG*  (PP). 
Di'oegenmueller,  William  H. : Coronado  Bldg.;  <3-ree- 
ley  65;  Oph*  (PP). 

Dyde,  Charles  B. ; 221  Park  Place  Bldg.;  Greeley 
61-W;  C (PP). 

Fezer,  Florence;  1622  13th  Ave.;  Greeley  1944;  (Ret.). 
Haskell,  Edward  E. ; 1002  9th  St.;  Greeley  147;  S 
(PP). 

Haymond,  Harold  E. ; 215  Greeley  Bldg.;  Greeley  1550; 
S (PP). 

Heinz,  'Theodore  E. ; 1002  9th  St.:  Greeley  147;  I* 
(PP). 

Helm,  Albert  J.;  1717  14th  Ave.;  Greeley  2914;  Anes* 
(PP). 

Hlbbert,  Russell  W.,  Jr.;  821%  9th  St.;  Greeley 
486-W:  GE  (PP). 

Hinzelman,  Willy  J. ; 1602  11th  Ave.;  Greeley  305; 
I*  (PP). 

Holley,  Sion  W. ; Weld  County  Hosp.;  Greeley  2400; 
Path*  (PP). 

Lehan,  James  W. ; Park  Place  Bldg.;  Greeley  28- W. 
Levine,  Solon  J. ; 816  8th  St.;  Greeley  112;  GP. 
Loder,  Roland  HJ.;  Weld  Co.  Health  Dept.,  Court 
House;  Greeley  951;  PH*  (PH). 

Lux,  Leo  L. ; 209  Greeley  Bldg.;  Greeley  107-W: 
GP  (PP). 

Madler,  Nicholas  A.;  804  8th  Ave.;  Greeley  52;  S (PP). 
Marsh,  John  W. ; 1002  9th  St.;  Greeley  147;  OALR* 
(PP). 

McCaw,  Willliam  W. ; Weld  County  Hosp.;  Greeley 
.2400,  Ext.  18;  R*  (PP). 

Mead.  Ella  A.;  210  Coronado  Bldg.;  Greeley  91; 

GP  (PP). 

Montg'omery,  Eugene  P. ; 1646  8th  Ave.;  Greeley 
727-W;  I*. 

Muhs,  El.  O. ; 202  Coronado  Bldg.;  Greeley  814-W; 
S (PP). 

Peppers.  Tracy  D.;  1008  9th  Ave.;  Greeley  703;  Pd* 
(PP). 

Peterson,  Arthur  E.,  218  Greeley  Bldg.;  Greeley 

3360  S (PP). 

Porter,  Robert  T. ; 1002  9th  St.;  GreelCv  147;  C (PP). 
Roukema,  Frederick  J.  T.;  204  Greeley  Bldg.; 

Greeley  1061-W:  GP  (PPJ. 

Rupert,  Harley  S.:  802  8th  Ave.;  Greeley  3000;  U (PP). 
Russell,  Henry  M.,  Jr. ; 1002  9th  St.;  Greeley  147; 
Pd*  (PP). 

Schoen,  Walter  A.;  206  Greeley  Bldg.;  Greeley 

935-W;  Pd  (PP). 

Shwayder,  Reynold  I.;  816  8th  St.;  Greeley  112;  GP 
(PP). 

Swanson,  Roy  A.  L.;  320  Greeley  Bldg.;  Greeley  52; 
ObG  (PP). 

Weaver,  John  A.;  1405  9th  Ave.:  Greeley  70;  (Ret.). 
Weaver,  John  A.,  Jr.;  220  Park  Place  Bldg.;  Greeley 
15;  S. 

Webster,  William  W. ; 1012  9th  Ave.;  Greeley  36; 
S.  (PP). 

Widney,  Samuel  E. ; 'Coronado  Bldg.:  Greeley  65; 
OALR*. 

Wlege,  Eugene;  1002  9th  St.;  Greeley  147;  S*. 


Rocky  Mountain  Medical  Journal  Supplement 


31 


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Rocky  Mountain  Medical  Journal  Supplement 


Gunnison  ... 

Cumming’s,  Benjamin  F. ; 505  N.  Pine  St.:  Gunnison 
118;  GP. 

Light,  Mason  M.;  212  N.  Main;  Gunnison  77;  GP 
(PP). 

McDonough,  John  F.;  233  N.  Main  St.;  Gunnison 
147:  GP  (PP).  ^ 

Michalo,  Adam,  Jr.:  212  Main  St.:  Gunnison  32- J 
GP  (PP). 

Peterson,  Donald  M.;  700  N.  Taylor;  Gunnison  147: 
GP  (PP). 

Haxtun  ... 

Kinzie,  John  W.;  Box  336;  Haxtun  105-R3:  GP  (PP). 

Hayden  ... 

Basinger,  Alan  A.;  Hayden;  Hayden  61;  GP  (PP). 
Sloan,  William  W. ; Gibbony.  Bldg.;  Hayden  61;  S 

(PP) 

HoUy  . . . 

Fitzgerald,  Dennie  L. ; Holly;  Holly  37-W;  GP  (PP). 
Fox,  Melvin  R.;  Holly:  Holly  99-W:  GP. 

Holyoke  ... 

Dille,  Frank  M.;  Holyoke  Hosp.;  Holyoke  107;  S (PP). 
Means,  Frank  M.;  Holyoke;  Holyoke  14;  GP. 
Ralston,  Robert  J.;  508  Interocean  Ave.;  Holyoke 
3100;  GP  (FP). 

Hugo  ... 

Beeler,  Robert;  Hugo;  (Associate  Member;  Not  a 
Physician). 

Gloeckler,  Bernhardj  B.;  First  Natl.  Bank  Bldg.; 
Hugo  14;  GP  (PP). 

■Idaho  Springs  ... 

Durham,  Morgan  Allen;  1503  Miner  St.;  Idaho 
brings  230;  GP  (PP). 

Fowler,  Freeman  D. ; 1500  Colorado;  Idaho  Springs 
. 63;  GP. 

Johnstown  ... 

Jones,  Glenn  A.;  Johnstown:  Johnstown  57-W;  GP. 

Julesburg  ... 

Linton,  Hersell  P.;  White  Bldg.;  Julesburg  17;  GP 
(PP). 

Lundgren,  John  C. ; Citizen’s  Bank  Bldg.;  Jules- 
burg 215;  GP  (FP). 

Kersey  ... 

Olson,  David  G.;  Kersey;  Greeley  092-R5:  GP  (PP). 

Kremmling  ... 

Ceriani,  Ernest  G.;  Middle  Park  Hosp.;  Kremmling 
3;  GP  (PP). 

Lafayette  ... 

Gordon,  Leon  L.;  401  E.  Cleveland;  Lafayette  63; 
GP  (PP). 

La  Jara  ... 

Wittenberg,  Ernst;  La  Jara;  La  Jara  18;  ObG  (PP). 

La  Junta  ... 

Calonge,  Guy  E.;  McNeen  Bldg.;  La  Junta  186; 
S (PP). 

Cooper,  Thomas  J.;  321  Colorado  Ave.;  La  Junta  84; 
GP  (PP). 

Davis,  Richard  L.;  317  Santa  Fe  Ave.;  La  Junta  29; 
GP  (PP). 

Farnsworth,  Morton  A.;  Opera  House  Apts.;  La 
Junta  115:  OALR*. 

Johnston,  Ralph  S. ; 505  Bellview  Ave.;  La  Junta 
J-959;  S (PP). 

Johnston,  R.  Sherwin,  Jr.;  A.  T.  & S.  F.  Hosp.;  La 
Junta  210;  D (PP). 

Ringle,  Charles  A.;  Box  454;  La  Junta;  (Ret.). 
Shand,  J.  Alan;  A.  T.  & S.  F.  Hosp.;  La  Junta  210; 
GP  (PP). 


Sisson,  William  R.;  615  Carson  Ave.;  La  Junta; 
(PG  Res.). 

Stickles,  Albert  L.;  221  Belleview  Ave.;  La  Junta  143; 
A (PP). 

Vandiver,  Gordon  H.;  214  W.  3rd  St.;  La  Junta 
1352-W:  GP  (PP). 

Weber,  Clayton  C.;  505  Belleview;  La  Junta  959; 
GP  (PP). 

Lakewood  ... 

Bailey,  George  P. ; 1445  Wadsworth  Ave.;  TAbor 
8655;  Denver  15;  GP  (PP). 

Kallay,  Stephen  L. ; 7004  W.  Colfax  Ave.;  MAin 
7304;  Denver  15;  (IP  (PP). 

Kraemer,  Willis  F.;  1661  Wadsworth  Ave.;  Lakewood 
1661;  Denver  15;  GP  (PP). 

Leonard,  Joseph  A.;  7340  W.  Colfax  Ave.;  Lake- 
wood  400;  Denver  15;  GP  (PP). 

Mason,  George  E. ; 8580  W.  Colfax  Ave.;  Lakewood  9; 
Denver  15;  GP  (PP). 

Souder,  Byron  M.;  5571  W.  27th  Ave.;  Lakewood 
352-W;  Denver  14;  GP  (PP). 

Lamar  ... 

Knuckey,  Clyde  T. ; 200)^  S.  Main  St.;  Lamar  92; 
GP  (PP). 

Krausnick,  Keith  F.;  201  W.  Olive;  Lamar  177; 
R (PP). 

Likes,  Edwin  C.;  800  S.  Main  St.;  Lamar  305;  GP  (PP). 
Likes,  Lanning  E,,  800  S.  Main  St.;  Lamar  305;  S*. 
McClure,  Harlan  B.;  202  S.  5th  St.;  Lamar  35;  GP 
(PP). 

Nienhuis,  John  E. ; 223  S.  Main  St.;  Lamar  2-W;  GP 
(PP). 

Williams,  George  S.,  Jr.;  409  S.  Main;  Lamar  56; 
GP  (PP). 

La  Salle  ... 

Wilkinson,  Walter  L.;  La  Salle:  La  Salle  18;  GP 
(FP). 

Las  Animas  ... 

Desmond,  William  M. ; 625  Carson  St.;  Las  Animas 
348-W:  Or  (PP). 

Hageman,  Silas  V.;  216  6th  St.;  Las  Animas  9;  GP. 
Lapan,  Charles  H.;  540  Carson  Ave.;  Las  Animas  63; 
GP  (PP). 

Sanford,  Lawrence  R.;  216  6th  St.;  Las  Animas  9; 
GP  (PP). 

Leadville  ... 

Kelly,  Vincent  E.;  206  E.  7th  St.;  Leadville  8;  GP 
(PP). 

Lanebeck,  Franklin  B.;  146  E.  6th  St.;  Leadville 
44;  GP  (PP). 

McDonald,  Franklin  J.;  Bank  Annex;  Leadville  31; 
GP. 

Limon  ... 

Clanln,  James  O.;  Limon:  Limon  117;  GP  (PP). 
Harvey.  Robert  P.;  Limon;  (PP). 

Pershing,  Darroll  R.;  Limon;  (Associate  Member; 
Not  a Physician). 

Littleton  ... 

Berg,  Edward:  171  Santa  Fe  Ave.;  Littleton. 
Mackenzie,  Ralph  W. ; 159  N.  Sherman  Ave.;  Little- 
ton 564-W:  Ob  (PP). 

Moore,  G.  Cooper;  105  N.  Nevada;  Littleton  132-W; 
GP  (PP). 

Nuttail,  Leonard  W.;  106  N.  Nevada;  Littleton  132-W; 

S*. 

Otte,  Joseph  E. ; Suite  5,  Coors  Bldg.;  Littleton 
10-W;  S (PP). 

Wood,  Wilbur  D.;  159  N.  Sherman  Ave.;  Littleton 
564-W;  GP  (PP). 

Longmont  ... 

Bixler,  Clarence  W.;  651  4th  Ave.;  Longmont;  (Ret.). 
Cooke,  Myron  W.;  412  Coffman  St.;  Longmont  676; 
S. 

Dietmeier,  Homer  R.;  Longmont  Hosp.;  Longmont 
1350;  S. 

Gibson,  Janet  Clarke;  . 429  Terry  St.;  Longmont 
672-J;  GP  (PP). 

Hageman,  George  R.;  518  Main  St.;  Longmont  157- J; 
OALR»  (PP). 


Rocky  Mountain  Medical  Journal  Supplement 


33 


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Rocky  Mountain  Medical  Journal  Supplement 


• Longmont  . . . (Contimied) 

Haley,  James  S.;  351  Coffman  St.;  Longmont  1350; 
S (PP). 

Jernigan,  Virgil  J.;  615  4th  Ave.;  Longmont  247. 
Jones,  Harry  D. ; Longmont  Hosp'. ; Longmont  1350; 
S (PP). 

McCann,  Joseph  W.;  303  Coffman  St.;  Longmont  640; 
I (PP). 

McCarty,  Havid  Wm.;  Longmont  Hosp.;  Longmont 
1035;  S. 

Nelson,  Harry  H. ; 750  4th  Ave.;  Longmont  314; 

GP  (PP). 

Peterson,  Birger  E.;  662  4th  Ave.;  Longmont  74;  GP 
(PP). 

Sidwell,  Clarence  E. ; 608  4th  Ave.;  Longmont  200-J , 
OALR*. 

Tramblie,  William  G. ; 714  Main  St.;  Longmont. 
White,  Willard  J.;  662  4th  Ave.;  Longmont  50; 

GP  (PP). 

Wiley,  Clare  C. ; 351  Coffman  St.;  Longmont  1350; 
GP  (PF). 

Woods,  Wilfrid  P. ; 414  Coffman  St.;  Longmont  51; 
GP  (PP). 

Louisville  . . . 

Bock,  Walter  W.;  1005  LaEarge  St.;  Louisville  175; 
GP  (PP). 

Cassidy,  Lucius  F. ; Louisville;  Louisville  24;  GF 
(PP). 

Louviers  . . . 

Bell,  Robert  F.;  Louviers;  Ind  (PP). 

Loveland  . . . 

Datz,  Louis  A.;  Masonic  Temple  Bldg.;  Loveland 
241-W:  GP  (PPj. 

Gasser,  William  P. ; 428  Lincoln  Ave.;  Loveland 
656;  GP  (PP). 

Grosboll,  Ashley  N. ; 232  W.  4th  St.;  Loveland  850; 
GP  (PP). 

Patterson,  Robert  B.;  433  Lincoln  Ave.;  Loveland 
933-W";  GP  (PP). 

Romans,  Carl  F.;  Masonic  Temple  Bldg.;  Loveland 
599;  ObG  (PP).  , 

Stewart,  Magnus  J.;  770  Wiashington  Ave.;  Love- 
land 805;  GP. 

Tramp,  Paul  E.;  644  Cleveland  Ave.:  Loveland  26; 
S (PF). 

Waldner,  John  L. ; 200  Masonic  Temple  Bldg.; 

Loveland  92-W;  S (PP). 

Mancos  ... 

Gardner,  Vincent  E. ; Post  Office  Bldg.;  Mancos  1; 
GP  (PP). 

Manitou  Springs  ... 

Min,  Henry  M. ; 210  Manitou  Ave.;  Hyland  98;  GP 
(PP). 

Meeker  ... 

Brewer.  Malcolm  I.;  Oldland  Bldg.;  Meeker  61-W, 
GP  (PP). 

Farthing,  Charles  H. ; Room  22,  Oldland  Bldg.; 

Meeker  101;  GP  (PP). 

Taylor,  Walter  E. ; Meeker;  Meeker  2;  GP. 

Milliken  ... 

Fuson,  Carl  C. ; Milliken:  Milliken  16-lV. 

Monte  Vista  . . . 

Burkhart,  Edwin  D.;  Monte  Vista;  (Ret.). 

Cassidy,  Charles  A.;  604  3rd  St.;  Monte  Vista  15;  S 
(PP). 

Hyland,  John  E.  P. ; Medical  Arts  Bldg.;  Monte  Vista 
99;  GP  (PP). 

Ley,  Albert  P. ; Monte  Vista;  Monte  Vista  25;  GP 
(PP). 

Roth,  Herman  W.;  604  3rd  Ave.;  Monte  Vista  15, 
GP  tPP). 

Taylor,  Roscoe  D.;  924  1st  Ave.;  Monte  Vista  22-W; 
GP  (PP). 

Montrose  . . . 

Albright,  Charles  W. ; 510  S.  2nd;  Montrose;  (Asso- 
ciate Member;  Not  a Physician). 


Brandt,  Shirley  P. : 43  0 So.  5th  St.;  (Associate  Mem- 
ber; Not  a Physician). 

Brethouwer,  Norman  A.;  Brethouwer  Bldg.;  Mont- 
rose 399:  S (PP). 

Gidrickson,  Fredolph  G. ; 602  Main  St.;  Montrose  29. 
Foechterle,  Edward  T.;  615  So.  3rd  St.;  (Associate 
Member;  Not  a Physician). 

Good,  William  O.;  Brethouwer  Bldg.;  Montrose  399; 
PI  (PP). 

Knott,  Isaiah,  Jr.;  Nye  Bldg.;  Montrose  99- J;  GP, 
Lockwood,  Charles  E. ; 845  Main  St.;  Montrose  137; 
(Ret.). 

Luther,  Ross  D.;  Keller  Bldg.;  Montrose  202-W;  GP 
(PP). 

MacTavish,  Mary  B.;  Box  216;  (Associate  Member; 
Not  a Physician). 

McKinnon,  Raymond  A.;  203  So.  Uncompahgre;  (As- 
sociate Member;  Not  a Physician). 

McKinnon,  William  A.;  729  N.  4th;  Montrose;  (As- 
sociate Member,  Not  a Physician). 

Plummer,  Thomas  O.;  20  N.  Cascade  Ave.;  Mont- 
rose 107;  GP  (PP). 

Rig’g’,  Robert  R. ; 329  Main  St.;  Montrose  55;  GP 
(PP). 

Santarelli,  Helen;  515  S.  4th;  Montrose;  (Associate 
Member,  Not  a Physician). 

Spring,  John  A.;  502  Main  St.;  Montrose  29;  GP. 
Welsh,  Nola  K. ; 1211  No.  1st  St.;  (Associate  Member; 
Not  a Physician). 

Mount  Harris  ... 

Price,  Ligon;  Mount  Harris;  Hayden  92-J3;  Ind. 

Oak  Creek  ... 

Morrow,  Ernest  L.;  Oak  Creek;  Oak  Creek  29; 
GP  (PP). 

Ordway  ... 

McDonough,  John  A.;  120  W.  3rd  St.;  Ordway  5533; 
GP  (PP). 

Ouray  ... 

Bourland,  Anna  B.;  Box  243;  Ouray;  (Associate 
Member;  Not  a Physician). 

Spangler,  Edtvard  L. ; Ouray  Hosp.;  Ouray  26;  Ind 
(PP). 

Ovid  . . . 

Hilderman,  Frederick  J.;  Ovid;  Ovid  2181;  GP  (PP). 

Pagosa  Springs  ... 

Button,  John  J. ; Pagosa  Springs;  Pagosa  Springs 
48;  GP  (PP), 

Paonia  ... 

Brown,  Woodrow  E.;  Paonia;  Paonia. 

Long,  Charles  E, ; Kennedy  Bldg.;  Co-op  132;  GP 
(PP). 

Milne,  A.  Howard;  Paonia:  Co-op  34;  GP  (PP). 

Platte\'ille  ... 

Kern,  Beverly  F. ; Platteville:  Platteville  58-W: 
GP  (PP). 

Scheldt,  John  H. ; Platteville:  Platteville  8.  GP  (PP). 

Portland  ... 

Davis,  Thomas  A.;  Portland;  Florence  186- J3:  GP. 

Pueblo  ... 

Ackerly,  Roscoe  H. ; Corwin  Hosp.;  Pueblo  7880;  I* 
(PP). 

Adams,  Francis  S. ; Corwin  Hosp.;  Pueblo  7880; 
Pr*  (PP). 

Baker,  William  N.;  702  N.  Main  St.;  Pueblo  6000;  S 
(PP). 

Baker,  William  T.  H. ; 702  N.  Main  St.'  Pueblo 
6000;  GP. 

Barwick.  John  T.  F. : 203  W.  19th  St.;  Pueblo. 

Black,  Herbert  A.;  702  N.  Main  St.;  Pueblo  6000;  S. 
Boyer,  David  W. ; Corwin  Hosp.;  Pueblo  7880;  Or* 
(PP). 

Bramer,  Clifford  F.;  702  N.  Main  St.;  Pueblo  6000; 
GP  (PP). 

Brown,  Wilbert  O. : Corwin  Hosp.;  Pueblo  7880; 
Path*  (PF). 

Caldwell,  Calvin  N. ; 320  Colorado  Bldg.;  Pueblo 

4755;  GP  (PP). 


Rocky  Mountain  Medical  Journal  Supplement 


35 


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36 


Rocky  Mountain  Medical  Journal  Supplement 


Pueblo  ...  (Continued) 

Clyman,  Irving;  522  Thatcher  Bldg.;  Pueblo  1500; 
GP  (PP). 

Coakley,  Harry  E.;  629  Thatcher  Bldg.;  Pueblo 

402;  U*  (PP). 

Connell,  Jos.  B.  A.;  Convin  Hosp.;  Pueblo  7880; 
S*  (PP). 

Corry,  Earl  H. ; Corwin  Hosp.;  Pueblo  7880;  D*  (PP). 
Craighead,  Joseph  W. ; Corwin  Hosp.;  Pueblo  7880; 
I*  (PP). 

Crozier,  Rufus  B.;  432  Broadway;  Pueblo  2189;  GP 
(PP). 

Curless,  Grant  R.;  416  Court  St.;  Pueblo  532;  I*  (PP). 

Bail,  Oran  C. ; 403  Colorado  Bldg.;  Pueblo  6878; 
OAX,R*  (PP). 

Earnest,  Clarence  E, ; 414  Thatcher  Bldg.;  Pueblo 
45;  OALR*  (PP). 

Farley,  John  B.;  530  Thatcher  Bldg.;  Pueblo  483; 
S (PP). 

Finney,  Royal  H.;  Corwin  Hosp.;  Pueblo  7880;  A 
(PP). 

Fowler,  James  Ray;  412  Thatcher  Bldg.;  Pueblo 
5898;  GP. 

Gale,  Scott  A.;  Corwin  Hosp.;  Pueblo  7880;  ObG* 
(PP). 

Gallavan,  Ella  Mae;  Colorado  State  Hosp.;  Pueblo 
3451;  Path*. 

Gardner,  John  W.;  Corwin  Hosp.;  Pueblo  7880;  I* 
(PP). 

Geissinger,  John  D.;  702  N.  Main  St.;  Pueblo  6000; 
Pd*. 

Grant,  William  D.;  240  Colorado  Bldg.;  Pueblo  174; 
OALR*  (PP). 

Hawlick,  Garfield  F.;  325  Colorado  Bldg.;  Pueblo 
9049;  Pd*  (PP). 

Hawthorn,  Henry  M.;  C.  F.  & I.  Dispensary;  Pueblo 
130;  GP. 

Hooper,  Clifford  L.;  326  N.  Prairie  Ave.;  Pueblo 
6104;  Anes*  (PP). 

Hopkins,  Guy  H.;  702  N.  Main  St.;  Pueblo  6000;  Oph*. 
Jackson,  Eugene  S. ; 418  W.  Abriendo  Ave.;  Pueblo 
7925;  GP  (PP). 

Johnston,  Walter  S. ; 650  Thatcher  Bldg.;  Pueblo 
400;  GP  (PP). 

Lassen,  Fritz;  702  N.  Main  St.;  Pueblo  6000;  ALB* 
(PP). 

Ley,  Eugene  B.;  329  Colorado  Bldg.;  Pueblo  8408; 
S*  (PP). 

Low,  Harold  T.;  629  Thatcher  Bldg.;  Pueblo  402; 
U*  (PP). 

Lowe,  Wilbur;  308  Colorado  Bldg.;  Pueblo  1936;  Pr*. 
Maynard,  Carl  W.;  702  N.  Main  St.;  Pueblo  6000;  CP* 
(PP). 

McBarney,  James  W.;  Corwin  Hosp.;  Pueblo  7880; 
ObG*  (PP). 

McBrayer,  Benjamin  E.;  Corwin  Hosp.;  Pueblo  7880; 
Anes*  (PP). 

McDonnell,  James  J. ; 111  Broadway;  Pueblo  232;  GP. 
McGonigle,  James  P.;  200  E.  Abriendo;  Pueblo  8494; 
GP  (PP). 

McGraw,  John  P. ; 316  Colorado  Bldg.;  Pueblo  383; 
R*. 

Mcllroy,  Richard  H. ; 416  Colorado  Bldg.;  Pueblo  7650; 
S (PP). 

Myers,  George  M. ; 702  N.  Main  St.;  Pueblo  6000; 
U*  (PP). 

Nelson,  Samuel;  212  Colorado  Bldg.;  PuOblo  1871; 
GP  (PP). 

Nethery,  Raymond  A.;  Corwin  Hosp.;  Pueblo  7880; 
ObG*  (PP). 

Nicoletti,  Frank  A.;  314  Colorado  Bldg.;  Pueblo 

988-W;  GP  (PH). 

Norman,  J.  Sims;  539  Thatcher  Bldg.;  Pueblo  1918; 
Or*  (PP). 

Pollard,  James  E.;  539  Thatcher  Bldg.;  Pueblo  1918; 
Or*  (PP). 

Potter,  Samuel  Bert;  Corwin  Hosp.;  Pueblo  7880; 
S*  (Exec.). 

Rice,  George  E.;  702  N.  Main  St.;  Pueblo  6000;  S 
(PP). 

B.>o''ardson,  R.  Calvin;  Corwin  Hosp.;  Pueblo  7880; 
Oph*  (PP). 

Rorenbloom,  Julius  Lee;  Colorado  State  Hosp.; 

Pueblo  3451;  PN*  (State  Hosp.). 

Rusk,  Harvey  S. ; Colorado  Bldg.;  Pueblo  174;  OALR. 
Schilling,  Robert  D. ; 702  N.  Main  St.;  Pueblo  6000; 
A (PP). 

Schwer,  John  L. ; Corwin  Hosp.;  Pueblo  282;  Pd*  (PP). 
Senger,  William;  Corwin  Hospital;  Pueblo  7880;  S*. 
Shaw,  Dwight  B. ; 702  N.  Main  St.;  Pueblo  6000;  S 
(PP). 

Shontz,  William  C. ; Colorado  State  Hosp.;  Pueblo 
3451*  S*  (PG  Res.). 

Snedec,  Joseph  F. ; 650  Thatcher  Bldg.;  Pueblo  400;  S. 


Steinhardt,  Ernest  H.;  C.  F.  & I.  Dispensary;  Pueblo 
5800;  GP  (PP). 

Stewart,  Ellen;  321  Michigan  Ave.;  Pueblo  4780. 
Stjernholm,  Thomas;  Corwin  Hosp.;  Pueblo  7880;  I* 
(PP). 

Swartz,  Carl  W.,  Jr.;  422  Thatcher  Bldg.;  Pueblo  587; 
GP  (PP). 

Taylor,  Ray  R.;  422  Thatcher  Bldg.;  Pueblo  587; 
ObG  (PP). 

Terry,  Howard  L.;  Colorado  State  Hospital;  Pueblo 
3451;  PN*  (State  Hosp.). 

Tipple,  Albert  McC.;  Corwin  Hosp.;  Pueblo  7880; 
ALR*  (PP). 

Unfug,  George  A.;  316  Colorado  Bldg.;  Pueblo  383; 
R*  (PP). 

Van  Camp,  Wesley;  702  N.  Main  St.;  Pueblo  6000; 
I*  (PP). 

Waggener,  Karl  J.;  Woodcroft-  Hosp.;  Pueblo  84; 
PN*  (PP). 

Ward,  Lester  L.;  316  Colorado  Bldg.;  Pueblo  383; 
S (PP). 

Weiler,  Reginald  B.;  403  Colorado  Bldg.;  Pueblo 
784;  I*  (PP). 

White,  Jesse  W.;  702  N.  Main  St.;  Pueblo  6000;  S 
(FP). 

Wingett,  Wendell  T.;  Woodcroft  Hosp.;  Pueblo  84; 
PN*  (PP). 

Wise,  Oliver  C.;  517  Thatcher  Bldg.;  Pueblo  142; 
OALR*  (PP). 

Wolf,  p John  G.;  320  Colorado  Bldg.;  Pueblo  153; 

Woodbrldge,  Jahleel  H.;  650  Thatcher  Bldg.;  Pueblo 
400;  GP  (PP). 

Zimmerman,  Prank  H.;  Colorado  State  Hosp.;  Pueblo 
3451;  P*  (HA). 

Rangely  . . . 

Meens,  David  P.;  P.  O.  Box  173;  Rangely  0193 -Jl; 


Ridge  . . . 

LaMoure,  Howard  A.;  Ridge;  Arvada  133;  PN* 
(Exec.). 

Ridgeway  . . . 

Fisher,  Jean  T.;  Ridgeway;  (Associate  Member;  Not 
a Physician). 

Rifle  ... 

Clagett,  Oscar  F.;  208  E.  3rd  St.;  Rifle  63-W;  GP. 
Williamson,  Tom  L.;  Penney  Bldg.;  Rifle  75;  GP 
(PP). 

Rocky  Ford  . . . 

Baker,  George  M.;  511  S.  9th  St.;  Rocky  Ford  318; 
GP  (PP). 

Blotz,  B.  Franklin;  Blotz-Daring  Bldg.;  Rocky  Ford 
100;  GP. 

Blotz,  Byron  B. ; 923  Elm  Ave.;  Rocky  Ford  100;  S. 
Fenton,  Ward  C. ; Cover  Bldg.;  Rocky  Ford  680; 
GP  (PP). 

Lawson,  John  A.;  913  Elm  Ave.;  Rocky  Ford  80- J; 
GP. 

Shlma,  Raymond  T. ; 306  N.  10th  St.;  Rocky  Ford 
610-W;  GP  (PP). 

Saguache  ... 

Keyting,  Walter  S. ; Medical  Center;  Saguache  6-W; 
GP. 


Salida  ... 

Bender,  Alva  J.;  124  E,  2nd;  Salida  27;  GP. 

Budd,  Edward  C.;  109%  E.  1st  St.;  Salida  621-J;  GP 
(PP). 

Fuller,  C.  Rex;  233  E.  1st  St.;  Salida  80;  S (PP). 
Hoover,  Robert  A.;  415  E.  1st  St.;  Salida  707;  Or  (PP). 
Larimer,  Guy  W.;  134%  F St.;  Salida  146;  GP. 
Leonard!,  Leo  J.;  233  E.  1st  St.;  Salida  426-W;  GP 
(PP). 

Smith,  Howard  D.;  216  E.  St.;  Salida  175;  GP  (PP). 
Thompson,  Lester  E. ; Woolworth  Bldg.;  Salida 
133;  OALR*. 

Silverton  ... 

Holt,  Frank;  Silverton;  Silverton. 


Rocky  Mountain  Medical  Journal  Supplement 


37 


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Rocky  Mountain  Medical  Journal  Supplement 


Springfield  . . . 

Duffy,  Gerald  A.;  Main  St.;  Spring-field  60;  Pr  (PP). 
Hamilton,  David  D.;  Springfield;  Springfield  24-W; 
GP  (PP). 

Hamilton,  Lester  L. ; Springfield;  Springfield  24-W; 
GP  (PP). 

Patterson,  Robert  F.;  Springfield;  Springfield  45; 
GP. 

Steamboat  Springs  ... 

Crawford,  Marvel  L. ; Steamboat  Springs;  Steamboat 
Springs  51-W;  GP  (PP). 

Mayer,  Ben  H.,  Jr.;  Hubbard  Bldg.;  Steamboat 
Springs  .3  0;  GP  (PP). 

Willett,  Frederick  E.;  Steamboat  Springs;  Steam- 
boat Springs  44;  GP  (PP). 

Sterling  . . . 

Anderson,  Lloyd  W.;  203  N.  Division  Ave. ; Sterling 
468-W;  GP  (PP). 

Beebe.  Kenneth  H.;  108  N.  3rd  St.;  Sterling  693-W; 
Pd  (PP). 

Daniel,  James  H. ; 12  Henderson  Bldg.;  Sterling 

242-W;  R. 

Elliff,  Edgar  A.;  216  N.  3rd  St.;  Sterling  993; 

OALR*  (PP). 

Hummel,  Edward  P.;  108  N.  3rd  St.;  Sterling  501-W; 
GP  (PP). 

Latta,  Clarence  J.;  203  N.  Division  St.;  Sterling 

468-W;  GP. 

Lubchenco,  Portia  McKnight;  212  Foote  Bldg.;  Ster- 
ling 330;  GP  (PP). 

McKnight,  James  H. ; 212  Foote  Bldg.;  Sterling  330; 
GP  (PP). 

Naugle,  John  E.,  Jr.;  327  Ash  St.;  Sterling  355;  S 
(PP). 

Naugle,  Johnson  E.;  327  Ash  St.;  Sterling  355;  GP 
(PP). 

Palmer,  Frank  E.;  123  N.  3rd  St.;  Sterling  327-W; 
OALR*  (PP). 

Perrin,  .1.  Burris;  125  Commercial  Bank  Bldg.;  Ster- 
ling 889;  PH*  (PH). 

Tripp,  Clifford  I.;  218  N.  3rd  St.;  Sterling  178-W; 
GP  (PP). 

Stratton 

Johnson,  Samuel  ' G.;  Stratton;  (Associate  Member; 
Not  a Physician). 

Telluride  ... 

Balderston,  George  C. ; American  Legion  Community 
Hosp. ; Telluride  40;  GP  (PP). 

Wilson,  Frank  B.;  Telluride;  (Associate  Member; 
Not  a Physician). 

Trinidad  . . . 

Abrums,  Horatio  E. ; 105  E.  Main  St.;  Trinidad  82; 
GP  (PP). 

Barglow,  David  R.;  312  E.  Main  St.;  Trinidad  282;  C. 
Beshoar,  Ben  B.;  615  S.  Maple;  Trinidad  162;  GP  (PP). 
Beuchat,  Lee  J. ; 602  E.  2nd  Ave.;  Trinidad  384;  NF 
(PP). 

Carmichael,  Earle  K.;  216  E.  Main;  Trinidad  346; 
GF  (PP). 

Clark,  Morris  H. ; 505  First  Natl.  Bank  Bldg.;  Trinidad 
1812;  OALR*  (PP). 

Donnelly,  James  E. ; 402  W.  Main  St.;  Trinidad 

624;  S (PP). 

Duncan,  David  R.  L. ; 723  Arizona  Ave.;  Trinidad; 
PH*  (PH). 

Bspey,  James  G.,  Sr.;  Main  and  Animas;  Trinidad  2; 
(Ret.). 

McClure,  Charles  O. ; 100  E.  Main;  Trinidad  733- J; 
GP. 

Newburn,  Walter  L. ; First  Natl.  Bank  Bldg.;  Trini- 
dad 660. 

Pfile,  Eugene  F.;  300  W.  Main  St.;  Trinidad  514; 
GP  (PP). 

Smith,  Millard  F. ; First  Natl.  Bank  Bldg.;  Trinidad 
660;  S. 

Victor  ... 

Denman,  A.  Campbell;  408  Diamond  St.;  Cripple. Creek 
99;  GP  (PP). 


Vona  ... 

Hewitt,  Virgil  M.;  Vona;  Vona  11;  GP  (PP). 

Walsenburg  ... 

Chapman,  Walter  S. ; 136  E.  5th  St.;  Walsenburg 
175-W;  Ind  (PP). 

Lamme,  James  M.,  Sr.;  104  E.  7th  St.;  Walsenburg 
178;  OALR  (PP). 

l.amime,  James  M.,  Jr.;  104  E.  7th  St.;  Walsenburg 
178;  S (PP). 

Mathews,  Paul  (J.;  134  E.  5th  St.;  Walsenburg  92-W; 
GP  (PF). 

Saliba,  Nicholas  S.;  119  E.  5th  St.;  Walsenburg  324; 
GP  (PP). 

Westminster 

Bishop,  Calmes  P. ; Westminster;  Arvada  0624- J3. 

Wheatridge  ... 

Collier,  Douglas  R. ; 4020  Wadsworth  Ave.;  GLen- 
dale  5695;  GP  (PP). 

Edwards,  G.  Murray;  6901  W.  32nd  Ave.;  GLendale 
6211;  GP  (PP). 

Van  Der  Schouw,  Harold  M. ; Lutheran  Sanitarium; 
GLendale  4796;  T*  (Hosp.). 

Wiley  ... 

Housel,  Charles  L. ; Wiley;  Wiley  541. 

Windsor  . . . 

Deisher,  Joseph  B.,  Jr.;  424  Main  St.;  Windsor  78-W; 
GP  (PP). 

Sabin,  Clarence  W.;  208  5th  St.;  Windsor  225;  GP 
(FP). 

Wray  . . . 

Bauer,  Wesley  W. : 319  Adams  St.;  Wray  233;  GP 
(PP). 

Buchanan,  Lawrence  D.;  517  Adams  St.;  Wray  138; 
GP  (PP). 

Hedrick,  J.  Gordon;  517  Adams  St.;  Wray  138;  S (PP). 
Larson,  John  H. ; 517  Adams  St.;  Wray  138;  GP  (PP). 

Yuma  ... 

Bennett,  Clayton  J. ; Yuma;  Yuma  282;  S (PP). 

Ham,  John  P. ; 218  S.  Main;  Yuma  187-W;  GP  (PP). 
Waski,  Albert  T. ; Chrismer  Bldg.;  Yuma  92-W;  GP 
(PP). 

Members  Out  of  State  . . . 

Bailey,  Bayard  M. ; Box  531;  La  Jolla,  California. 
Benell,  Otto  E. ; Newark  City  Hospital;  Newark,  New 
Jersey;  R*  (PG  Res.). 

Bennett,  Everett  E. ; 818  Lockford;  Lodi,  California. 
Bondurant,  Alpheus  J.;  O’Reilly  Veterans  Hospital; 

Springfield,  Missouri;  T*  (Gov.). 

Boucher,  Adlore  L. ; Tulare  General  Hosp.;  Tulare, 
California. 

Burden,  Harold  G. ; White  Memorial  Hosp.;  Los  An- 
geles, California;  ObG*  (PG  Res.). 

Davis,  Leo  L. ; Kadlec  Hospital;  Richland,  Washing- 
ton; Richland  600;  Oph*  (Gov.). 

Day,  William;  72  Sheldon,  S.E. ; Grand  Rapids,  Mich- 
igan; Grand  Rapids  6-8521;  Pr*  (PG  Res.). 
Drewyer,  Glenn  E.;  V.  A.  Center;  Bay  Pines,  Florida; 

Bay  Pines  78281,  Exch.  206;  I*  (Gov.). 

Emerson,  Paul  Waldo;  422  East  19th;  Cheyenne,  Wyo- 
ming; Cheyenne  4915;  Pd*  (PP). 

Finer,  Morris  J. ; L.  D.  S.  Hospital;  Salt  Lake  City, 
Utah;  Anes*  (PG  Res.). 

Fulwider,  Robert  M.;  602  Poplar  St.;  Hot  Springs, 
New  Mexico;  Hot  Springs  86;  A (Ret.). 

Gerber,  William  F.;  3801  University  St.;  Montreal, 
Canada;  PI  1251;  NS*  (PG  Res.). 

Hall  Aza  Z.;  19420  Valerio  St.;  Reseda,  California; 
(Ret.). 

Henderson,  William  C.;  215  W.  45th  St.;  Los  Angeles 
37,  California;  GP. 

Houchins,  Edward  K. ; Las  Vegas  State  Hosp.;  Las 
Vegas,  New  Mexico. 

Howell,  William  C. ; General  Delivery;  Panama  City, 
Florida. 

Kestle,  Charles  W. ; Box  1170;  Stockton,  California. 
Kennison,  Warren  S. ; 2504  Geddes  Ave.;  Ann  Arbor, 
Michigan. 


Rocky  Mountain  Medical  Journal  Supplement 


39 


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Rocky  Mountain  Medical  Journal  Supplement 


Members  Out  of  State  . . . (Continued) 

Kozak,  Walter  H.;  918  Wallace;  Vandergrift,  Penn- 
sylvania. 

Kraus,  Daniel  M. ; Univ.  of  111.  College  of  Medicine, 
835  Polk  St.;  Chicago  12,  Illinois. 

La  Force,  Richard  F.;  1434  W.  53rd  St.;  Los  Angeles, 
California;  (PG  Res.). 

Lamme,  SI  Julian;  Madrid,  New  Mexico;  GP  (PP). 

Le  Rossignol,  Walter  J.;  1917  Berkeley  Ave.;  Pomona, 
California;  Pomona  2-5964;  (Ret.). 

Lewin,  Julian  R. ; Department  of  Radiology,  Temple 
University  Hosp.;  Philadelphia  40,  Pennsylvania; 
RA  5-6663,  R*  (Med.  School). 

Lewis,  William  B.,  Jr.;  Letterman  General  Hosp.; 
San  Francisco,  California;  Or*  (PG  Res.). 

Logan,  Robert  W.;  804  North  29th;  Billings,  Mon- 
tana; OALR*  (Gov.). 

McGill,  Earl  D. ; Lock  Box  283;  Midway  City,  Cali- 
fornia; Oph  (Ret.). 

Miner,  Sabin  S. ; 1424  Willshlre  Blvd.,  Apt.  412;  Los 
Angeles  5,  California;  GP. 

Murphy,  Robert  E.;  St.  Joseph's  Hosp.;  Omaha,  Ne- 
braska; (Intern). 

Netherton,  George  F. ; Cameron,  Missouri;  S (PP). 

New,  Mary  Woo;  Rt.  2,  Box  359;  Mt.  View,  California; 
GP  (PP). 

North,  Francis  S. ; 500  Arguel'lo  St.;  Redwood  City, 
California;  I*  (PP). 

Owens,  Robert  L.;  Box  1343;  Levelland,  Texas. 

Perkins,  Carter  C. ; 190  E.  Marathon  Rd. ; Altadena, 
California. 

Pretz,  James  B. ; 602  Huron  Bldg.;  Kansas  City  10, 
Kansas;  (Intern). 

Regehr,  John  K.;  Arsenal  Base  Dispensary  and  Hos- 
pital, Arsenal,  Arkansas;  Arsenal  204;  GP  (Gov.). 

Richardson,  Darwin  L.;  502  Circle  Drive;  Cody,  Wyo- 
ming; GP  (PP). 


Rogers,  Thurman  M. ; 400  29th  St.;  Oakland,  Califor- 
nia; S (PP). 

Schoen,  Walter  A.,  Jr.;  84  B Ingalls  Road;  Port  Mon- 
roe, Virginia. 

Shea,  John;  Veterans  Hosp.;  Albuquerque,  New 
Mexico. 

Smith,  Bryce  D.;  1217  Elm  St.;  Manchester,  New 
Hampshire. 

Stanley,  Abram  P. ; County  Court  House;  Harrison, 
Arkansas;  Harrison  296;  PH*  (PH). 

Temple,  Herbert  V.;  P.  O.  Box  278;  Moab,  Utah;  GP 
(PP). 

Thompson,  John  W. ; 803  Harvard  Road;  San  Mateo, 
California;  Shn  Mateo  4-3634;  OALR*  (PP). 
Vonburg,  Vernon  R. ; Medical  Arts  Bldg.;  Mitchell, 
South  Dakota;  Or*  (PP). 

Vonden  Steinen,  Edward;  3708  South  Lundy  Ave.; 
Tucson,  Arizona;  (Ret.). 

Weber,  Frederick  H. ; 2500  East  Van  Buren  St.; 
Phoenix,  Arizona;  (Ret.). 

Wilcox,  Henry  W. ; 1821  Anacapa  St.;  Santa  Barbara, 
California;  (Ret.). 

Wohlauer,  Frank  F. ; Los  Angeles  Sanitarium; 

Duarte,  California;  Monrovia  15001;  R*  (Hosp.). 
Work,  Philip;  Box  564;  Reno,  Nevada. 


Honorary  Members  Out  of  State  ... 

Bierring,  Walter  L.;  406  6th  Ave.;  Des  Moines  9, 
Iowa;  Des  Moines  44518;  I*  (PH). 

Hawley,  Paul  R.;  330  S.  Wells,  Chicago,  Illinois. 
Leland,  R.  G.;  Chicago,  Illinois;  (Ret.). 

Tyndale,  William  Robert;  1720  Brockton  Ave.;  Los 
Angeles,  California;  Arizona  9-0916;  (Ret.). 
Whedon,  Earl;  304  S.  Main;  Sheridan,  Wyoming; 
Sheridan  723;  (JALR*  (Ret.). 


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Rocky  Mountain  Medical  Journal  SuppIiEment 


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Fender  Repairs 

Automobile  Painting 

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Denver,  Colorado 

Phone:  KEystone  5109 

PHONE  ALpine  2308 

24-HOUR 

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CITY  AND  DISTANCE  CALLS 

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and  Lunch  Service 

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PHYSICIANS’  BUSINESS 

1 880  High  Street  Denver,  Colo. 

ALWAYS  WELCOME 

42 


Rocky  Mountain  Medical  Journal  Supplement 


MONTANA  STATE  MEDICAL  ASSOCIATION 


OFFICERS 

Terms  of  Officers  and  Committees  expire  at  the  Annual  Session 
In  the  year  indicated.  Where  no  year  Is  Indicated,  the  term  is 
for  one  year  only  and  expires  at  1949  Annual'  Session. 

President:  Thomas  L.  Hawkins,  Helena. 

President-elect:  Thomas  F.  Walker,  Great  Falls. 

Vice-President:  R.  G.  Johnson,  Harlowton. 

Secretary-Treasurer:  Herbert  T.  Caraway,  Billings. 

Delegate  to  American  Medical  Association:  Raymond  F.  Peterson,  Butte, 
1950;  Alternate,  Thomas  B.  Moore,  KaMspeU,  1950. 


STANDING  COMMITTEES 

Executive  Committee;  T.  L.  Hawkins,  Helena,  Chairman;  T.  F.  Walker, 
Great  Falls;  H.  T.  Caraway,  Billings;  L.  W.  Allard,  BllUnp;  M.  A. 
ShlUlngton,  Glendive. 

Economics  Committea:  J.  C.  Shields,  Butte,  Chairman;  C.  P.  Brooke,  St. 
Ignatius;  R.  B.  Dumln,  Great  Falls;  Leland  G.  Russell,  Billings;  S.  D. 
Whetstone,  Cut  Bank. 

Legislativa  Committee:  J.  M.  FHnn,  Helena,  Chairman;  F.  D.  Hurd, 
Gnat  Falls;  P.  E.  Kane,  Butte;  J.  C.  MacGregor,  Great  Falls;  Claude 
M.  Hears,  Helena. 

Necrology  and  History  of  Medicine  Committee;  L.  W.  Brewer,  Missoula, 
Chairman;  I.  J.  Bridenstine.  Missoula;  J.  H.  Irwin,  Great  Falls;  Claude 
M.  Mears,  Helena;  J.  P.  Bitehey,  Missoula. 

Public  Relations  Committee:  H.  W.  Gregg,  Butte,  Chairman;  W.  L.  DuBois, 
Cut  Bank;  R.  V.  Morledge,  Billings;  W.  H.  Stephan,  Dillon;  Dora  Walker, 
Great  Falls. 

Legal  Affairs  and  Malpractice  ConiRiitteos  J.  C.  MacGr^or,  Great  Falls, 
Chairman;  Raymond  Eck,  Lewlstown;  W.  1.  Harris,  Livingston;  John  E. 
Hynes,  BilMngs;  B.  D.  Knapp,  Wolf  Point. 

Program  Committee:  C.  H.  Fredrickson,  Missoula,  Chairman;  H.  T. 
Caraway,  BiUlngs;  H.  W.  Gregg,  Butte;  J.  J.  McCabe,  Helena;  K S. 
Murphy.  Missoula. 

Interprofessional  Relationship  Committee:  L.  W.  AUard,  Billings,  Chair- 
man; C.  R.  Canty,  Butte;  S.  A.  Cooney,  Helena;  S.  N.  Preston,  Missoula; 
F.  I.  Sabo,  Bozeman. 


Nominating  Committee:  H.  H.  James,  Butte,  Chairman;  E.  L.  Anderson, 
Fort  Benton;  R.  D.  Harper,  Sidney;  J.  J.  Malee,  Anaconda;  W.  B.  Mc- 
Elwee,  Townsend. 

Auditing  Committee:  K.  H.  Lindstrom,  Helena,  Chairman;  F.  H.  Crago, 
Great  FaUs;  R.  D.  Harper,  Sidney;  G.  W.  Setzer,  Malta;  R.  G.  Johnson, 
Harlowton. 

Cancer  Committee:  Mary  E.  Martin,  Billings,  Chairman;  W.  F.  Cauh- 
more,  Helena;  C.  H.  Fredrickson,  Missoula;  R.  F.  Peterson,  Butte;  W.  C. 
Robinson,  Shelby. 

Maternal  and  Child  Welfare  Committee;  F.  L.  McPhall,  Great  FaUs, 
Chairman;  L.  W.  Brewer,  Missoula;  P.  L.  Eneboe,  Bozeman;  Maude  M. 
Gerdes,  Billings;  D.  L.  Gillespie,  Butte;  A.  L.  Gleason,  Great  Falls:  E-  !<• 
Hall,  Great  FaUs;  D.  S.  MacKenzie,  Jr.,  Havre;  R.  E.  Mattison,  BllHngs; 
0.  M.  Moore,  Helena;  F.  W.  Paul,  Kalispell;  C.  W.  Pemberton,  Butte; 
S.  N.  Preston,  Missoula;  A.  E.  Bitt,  Great  FaUs. 

Tuberculosis  Committee:  F.  I.  Terrill,  Galen,  Chairman;  C.  B.  Craft, 
Bozeman;  E.  A.  Dolan,  Anaconda;  A.  R.  Kintner,  Missoula;  J.  A.  Layne, 
Great  Falls. 

Fracture  and  Orthopedic  Committee;  J.  K.  Colman,  Butte,  Chairman;  L.  C. 
Allard,  Billings;  W.  H.  Hagen.  Billings;  S.  L.  Odgers,  Butte;  J.  C.  Wol- 
gamot.  Great  FaUs. 

Rural  Health  Committee:  B.  C.  Farrand,  Jordan,  Chairman;  B.  A. 
Benke,  Kalispell;  W.  A.  Lacey,  Havre;  W.  G.  TangUn,  Poison;  J.  H. 
Williams,  Culbertson. 

Industrial  Welfare  Committee:  R.  B.  Richardson,  Great  Falls,  Chairman; 
M.  A.  Gold,  Butte;  P.  E.  Logan,  Great  Falls;  D.  S.  MaeKcnzle,  Jr.,  Havre; 
R.  E.  Walker,  Livingston. 

Rheumatic  Fever  and  Heart  Committee:  F.  B.  Schemm,  Great  FaUs, 
Chairman;  D.  T.  Berg,  Helena;  H.  W.  Gregg,  Butte;  A.  E.  Kintner,  Mis- 
soula; P.  E.  Logan,  Great  FaUs;  F.  H.  Lowe,  Missoula;  J.  J.  Malee, 
.Anaconda;  0.  M.  Moore,  Helena;  H.  W.  Power,  Conrad:  B.  E.  SmaUey, 
Billings. 

SPECIAL,  COMMITTEES 

Emergency  Medical  Service  Committee:  R.  F.  Peterson,  Butte,  Chairman; 
Paul  J.  Gans,  Lewlstown;  J.  J.  McCabe,  Helena;  S.  A.  Olson,  Glendive; 
L.  G.  RusseU,  Billings. 

lAB  Fee  Schedule  Committee:  H.  H.  James,  Butte,  Chairman;  E.  H. 
Lindstrom,  Helena;  J.  J.  Malee,  Anaconda;  D.  S.  McKenzie,  Jr.,  Havre; 
F.  K.  Waniata,  Great  FaUs. 


We  Welcome  the  Business  of  the  Doctors  and  the  Hospitals 


Doose  & Lintner 
Construction  Company 

General  Contractors  tor  All  Types  of  Buildings 

Residential  — Apartments  — Clinics 
Repairs  and  Remodeling 

4835  Grove  Street  Denver,  Colorado 

Phone  CLendale  4627 


Rocky  Mountain  Medical  Journal  Supplement 


43 


A Brand  New 

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OF  THE 

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Place  near  16th  Street  intersection 

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Motor  Tune-Up 

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Tires  — Tubes  — Accessories 

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800  Birch  Street  Phone  EAst  4766 

MEMBER  FEDERAL  DEPOSIT  INSURANCE  CORP. 

Denver 

Complete  Automobile  Repairs 

Welcome  Members  of  the  Medical 
Profession  at 

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Specialists  on  Wheel  Alignment, 
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Axles  and  Frames  Straightened  Cold  in 
Car — Body  and  Fender  Work — 

Auto  Painting 

We  Also  Handle  Auto  Wrecks 

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Complete  Bar  Service 

Choice  Steaks  Fried  Chicken 

Original  Mexican  Dinners 

1125  California  Street  Denver 

Phone  CHerry  6313 

SATISFACTION  OR  MONEY  BACK 

A 

Dancing  Every  Evening 

8975  E.  Colfax  Ave.  Aurora,  Colo. 
Phone  FRemont  5814 

44 


Rocky  Mountain  Medical  Journal  Supplement 


Directory  of  Members  — MONTANA 

(As  of  December  31,  1948) 

For  Explanation  of  listings  and  symbols,  see  Page  1. 


Absarokee  ... 

Blackstone,  A.  V.;  Absarokee;  GP. 

Anaconda  ... 

Dolan,  Edward  A.:  124  Oak  St.;  23-W:  GP  (PP). 
Donich,  George  M.;  507  E.  Park  St.;  tSO-W;  S (PP). 
Dunlap,  Lawrence  Glen;  101  Main  St.;  220;  OALR*. 
Kargacin,  Tom  J. ; Anaconda;  Anaconda. 

Long,  'William  E.;  16  Main,  Anaconda;  S. 

Malee,  John  J.;  101  Main  St.;  35- W:  S (PP). 
O’Rourke,  Joseph  L.;  Daly  Bank  Bldg.;  19;  GP  (PP). 
Trobough,  George  E. ; 507  E.  Park  St.;  553-W;  GP 
(PP). 

Baker  ... 

Blakemore,  W.  H.;  Baker;  Baker;  (Ret.). 

Hogeboom,  C.  F.;  Bank  of  Baker  Bldg.;  141;  GP  (PP). 
■Weeks,  S.  A.;  Baker;  Baker  219-W;  GP  (PP). 

Big  Timber  ... 

Baskett,  Lindsay  W. ; Montana  Power  Bldg.;  Big  Tim- 
ber 31-K;;  GP  (PP). 

Claiborn,  Drura;  1-2  Budd  Blk. ; Big  Timber  31-K2; 
GP  (PP), 

Billings  ... 

Allard,  L.  Clayton;  217  Electric  Bldg.;  5158;  Or* 
(PP). 

Allard,  Louis  W.;  217  Electric  Bldg.;  5158;  Or*  (PP). 
Barrow,  Leonard  A.;  Hart-Albln  Bldg.;  3194;  ObG* 
(PP). 

Benson,  Raymond  E. ; Hart-Albin  Bldg.;  8095;  S 
(PP). 

Biehn,  Ralph  H.;  217  Electric  Bldg.;  5158;  I (PP). 
Bridenbaugh,  John  H.;  400  Hart-Albin  Bldg.;  3194; 
R. 

Brogan,  Richard  E.;  Airport  Rd.  at  12th  Ave. ; 8646; 
S (PP). 

Caraway,  Herbert  T. ; 217  Electric  Bldg.;  5158; 

S (PP). 

Chappie,  Richard  R.;  Hart-Albin  Bldg.;  9-1772;  GP 

(PP). 

Drew,  Harry  O.;  202  Hart-Albin  Bldg.;  6787;  S (PP). 
Farr,  Eri  Madison;  222  Hart-Albin  Bldg.;  4525; 
Ind  (PP). 

Fulton,  Alfred  M. ; 400  Hart-Albin  Bldg.;  3194;  I* 
(PP). 

Gerdes,  Maude  M.;  407  Hart-Albin  Bldg.;  6727;  ObG* 

(PP). 

Gibbs,  Edward  W.;  400  Hart-Albin  Bldg.;  3194;  S* 

(PP). 

Gordon,  Wayne;  208  N.  Broadway;  3194;  I*  (PP). 
Griffin;  Phillip  E. ; 244  Hart-Albin  Bldg.;  6400; 
GP  (PP). 

Hagen,  Walter  H. ; 208  N.  Broadway;  3194  Or*  (PP). 
Hagmann,  Edward  A.;  Hart-Albin  Bldg.;  3194;  Pd* 
(PP). 

Hammerel,  Ambrose  L.;  339  Hart-Albin  Bldg.;  3422; 
OALR. 

Hammerel,  John  J. ; 334  Hart-Albin  Bldg.;  9-1288; 
OALR*  (PP). 

Hodges,  D.  Ernest;  333  Hart-Albin  Bldg.;  8676;  U* 
(PP). 

Hynes,  John  E.;  208  Hart-Albin  Bldg.;  9-1544;  ObG* 
(PP). 

Irwin,  Charles  E.;  400  Hart-Albin  Bldg.;  3194;  I*. 
Kronmiller,  Eugene  V.;  311  N.  28th  St.;  6969;  GP  (PP). 
Kronmiller,  Leslie  H.;  311  N.  28th  St.;  6969;  GP  (PP). 
Large,  Henry  R.;  IT  Alderson  Ave.;  6758';  Oph* 
(PP). 

Larson,  Keith  D.;  122  N.  30th  St.;  9-1398;  I*  (PP). 
Larson,  Roger  A.;  412  N.  Broadway;  4121;  I*  (PP). 
MacDonald,  Donald  J. ; Hart-Albin  Bldg.;  6977;  S 
(PP). 

Marks,  Frederic  S.;  Billings;  Billings. 

Martin,  Mary  E.;  St.  Vincent’s  Hosp.;  2121;  Path* 
(PP). 


Mattison,  Robert  E.;  202  Treasure  State  Bldg.;  3847; 
ObG  (PP). 

McIntyre,  Harold  E.;  1T5  N.  28th  St.;  5158;  I*  (PP). 
Morledge,  Roy  V.;  Hart-Albin  Bldg.;  2322;  OALR. 
Morrison,  James  D. ; 208  N.  28th  St.;  4863;  Oph*. 
Movius,  Arthur  J.,  Jr.;  400  Hart-Albin  Bldg.;  3194;  S 
(PPL 

Nelson,  Cedric  H. ; 202  Treasure  State  Bldg.;  3847; 
ObG  (PP). 

Peterson,  Mrs.  H.  W. ; Billings;  Billings. 

Raitt,  Grant  P. ; 203  Treasure  State  Bldg.;  9-3213;  R* 
(PP). 

Rathman,  Omer  C. ; 217  Electric  Bldg.;  5158;  ObG* 
(PP). 

Richards,  William  G. ; Billings;  I*  (Ret.). 

Ruona,  Martin  A.;  820  Division  S't.,  Suite  5;  7966; 
PN*  (PP). 

Russell,  Leland  G. ; 203  Treasure  State  Bldg.;  7576; 
S (PP). 

Shaw,  John  A.;  400  Hart-Albin  Bldg.;  3194;  U*  (PP). 
Smalley,  Raymond  E.;  120  N.  30th  St.;  9-3565;  I*  IPP). 
Soltero  Harry  R,;  Annex  No.  2,  Stapleton  Bldg.; 
9-1353;  GP  (PP). 

Soltero,  Julio  R.;  Stapleton  Bldg.  Annex;  9-1353; 
S (PP). 

Unsell,  David  H.;  400  Hart-Albin  Bldg.;  3194;  S (PP). 
Vye,  Theodore  R.;  412  N.  Broadway;  4121;  S (PP). 
Weedman,  Walter  F.;  835  Lewis  Ave.;  2279;  (Ret.). 
Werner,  Samuel  L.;  Hart-Albin  Bldg.;  7525. 
Wernham,  James  I.;  208  N.  28th  St.;  5553;  S. 

Boulder 

Pallister,  Philip  D. ; Boulder;  Boulder  2541;  GP 
(PP). 

Bozeman  ... 

Bole,  W.  S.;  507  So.  8th  St.;  Bozeman;  (Ret.). 

Clark,  Chester  A.;  Montana  State  College;  2073;  PH* 
(Student  Health  Service). 

Craft,  Charles  B.;  19  W.  Babcock;  21-W;  GP  (PP). 
Eneboe,  Paul  L.;  28  N.  Black;  282;  ObG. 

Epler,  Deane  C.;  28  N.  Black;  387;  I*  (PP). 
Farnsworth,  Ray  B. ; 14  N.  Tracy;  Bozeman;  OALR* 
(PP). 

Grigg,  Elmer  R.;  405  Commercial  Natl.  Bank  Bldg.; 
205;  OALR*  (PP). 

Hammer,  Carl  W.;  Montana  State  College;  147;  PH* 
(Student  Health  Service). 

Heetderks,  B.  J. ; 310  Commercial  Natl.  Bank  Bldg.; 
52-W;  S. 

Kearns,  Edmund  J.;  28  N.  Black;  261-W;  GP. 

Keeton,  Roland  (1.;  Ill  S.  Tracy;  Bozeman;  GP. 
Pickett,  Frank  J.;  28%  E.  Main;  1261-W;  GP  (PP). 
Sabo,  F.  I.;  Commercial  Natl.  Bank  Bldg.;  Bozeman 
492;  GP  (PP). 

Scherer,  Roland  G.;  310  Commercial  Bank;  52-W;  U 
(PP). 

Seerley,  Clement  C.;  28  N.  Black;  118-W;  GP  (PP). 
Sigler,  R.  R.;  Bozeman;  Bozeman;  (Ret.). 

Seitz,  Roy  E. ; Lovelace  Bldg.;  121-'W;  GP  (PP). 

Smith,  Charles  S,;  28  N.  Black;  460;  S. 

Whitehead,  C.  E.;  Bozeman;  Bozeman. 

Williams,  R.  A.;  Commercial  Bank  Bldg.;  Bozeman; 
GP. 

Butte  ... 

Atkins,  Donald  A.;  9 W.  Granite  .St.;  5474;  I*  (PP). 
Brancamp,  Joseph  H. ; Mayer  Bldg.;  8225;  Ob  (PP). 
Burton,  F.  Hanly;  415  Phoenix  Bldg.;  2-4628;  OALR* 
(PP). 

Canty,  Charles  R. ; 658  Phoenix  Bldg.;  2-2266;  GP. 
Casebeer,  Harvey  L. ; 140  Penn  Bldg.;  6539;  OALR* 

(PP). 

Casebeer,  R.  Lawrence;  140  Penn  Bldg.;  6539;  OALR* 
(PP). 

Colman,  John  K. ; 129  W.  Park;  8320;  Or*  (PP). 
Duchesneau,  Fernand  P.;  416  Metals  Bank  Bldg.; 
3408;  GP  (PP). 

Frisbee,  John  B.;  658  Phoenix  Bldg.;  2-2266;  I*  (PP). 
Gangner,  E.  T. ; 225  Rialto  Bldg.;  6659;  GP  (PP). 
Garvey,  James  EL;  206  Mayer  Bldg.;  2-4141;  GP 
(PP). 


Rocky  Mountain  Medical  Journal  Supplement 


45 


REED^S  AMBULANCES 

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PHARMACY 

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Auto  Blinds  — ■ House  Trailer  Blinds 

Dealers  in  “Remov-A-Slat  Blinds 

Prescription 

Drapery  Rods  — Window  Shades 

Specialists 

Every  Kind  of  V enetian  Blind 
Repairs  or  Supplies 

DRUGS  — SUNDRIES  — 

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Free  Estimates  Convenient  Terms 

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Rocky  Mountain  Medical  Journal  Supplement 


Butte  . . . (Continued) 

Gillespie,  Donald  L.;  9 W.  Granite  St.;  5474;  Pd* 
(PP). 

Gold,  Morris  Alan;  210  Mayer  Bldg.;  6161;  I*  (PP). 
Gregg,  Harold’ W>.;  318  Mayer  Bldg.;  8611;  I*  (PP). 
Horst,  Carl  H.;  321  Owsley  Blk.;  7272;  U (PP). 

James,  Herbert  H.;  9 W.  Granite  St.;  5474;  Gyn*  (PP). 
Kane,  Joseph  J.;  Butte;  Butte;  R. 

Kane,  Patrick  E. ; 403  Lewisolm  Blk.;  4190;  S (PP). 
Kane,  Richard  C. ; Butte;  Butte;  GP. 

Kroeze,  R.  G.;  214  Mayer  Bldg.;  5379;  S (PP). 
Lapierre,  J.  Charles;  511  Phoenix  Bldg.;  5952; 
OALR*  (PP). 

Lhotka,  John  P. ; Owsley  Blk.;  Butte;  GP. 
MacPherson,  G.  T.;  9 Granite  St.;  5474;  S*  (PP). 
Matthews,  Vida  J. ; 619  Metals  Bank  Bldg.;  8500;  I* 
(PP). 

McGill,  Caroline;  58  Wu  Quartz;  4862;  I*  (PP). 
McMahon,  Edmund  S. ; 4 So.  Main;  6131;  S. 

Monahan,  Richard  C. : Hennessy  Bldg.;  4565;  GP. 
Mondloc'h,  J.  Li.;  3250  Owsley  Blk.;  3420;  T. 

Odgers,  Stephen  I.;  9 W.  Granite  St.;  5474;  Or*  (PP). 
ci'Keefe,  Neil  J. ; 28  YV.  Granite  St.;  Butte;  S. 
Pemberton,  Charles  W.;  9 W.  Granite  St.;  5474;  ObG* 
(PP). 

Peterson,  Raymond  F.;  9 W.  Granite  St.;  5474;  CP* 
(PP). 

Plett,  John  B.;  9 W.  Granite  St.;  Butte. 

Roter,  Leopold  P. ; Butte;  Butte. 

Saam,  Thomas  'W. ; 9 W.  Granite  St.;  5474;  U*  (PP). 
Schwartz,  Harold;  58  W.  Quartz;  4862;  S (PP). 
Shields,  James  C.;  658  Phoenix  Bldg.;  2-2266;  S*  (PP). 
Sievers,  Arthur  R.;  303  Lewisohn  Bldg.;  7401;  U (PP). 
Spurck,  Peter  T.;  St.  James  Hosp. ; R*. 

Ungherini,  V.  O.;  217  Mayer  Bldg.;  2-3322;  Ob  (PP). 
Webb,  Margaret  A. ; 9 W.  Granite  St.;  5471;  I*  (PP). 
Wilking,  S.  V.;  402  Phoenix  Bldg.;  4225;  Ob  (PP). 

Chester  . . . 

Simmonds,  Harry  N. ; Chester;  Chester  89;  GP  (PP). 

Chinook  ... 

Hoon,  Arthur  S. ; Chinook:  Chinook  73;  GP  (PP). 
Leeds.  Robert  H.;  72  4th  St.;  Chinook  165;  GP  (PP). 
McCannel.  Wilfred  A.;  128  Indiana  Ave.;  Chinook  9;  S 
(PP). 

Choteau  ... 

Bateman,  Howard  W.;  Choteau;  GP. 

Circle 

Rundle,  Bennet  S. ; Drawer  14;  Circle;  GP  (PP). 

Columbia  Falls 

Mitschke,  John  J.,  Jr.;  1st  Ave.  W.  and  5th  St.;  Colum- 
bia Falls  28;  GP  (PP). 

Columbus  ... 

Neville,  John  V.  H.;  Columbus;  Columbus  12;  S.  (PP). 
Smith,  W.  P. ; Columbus;  Columbus. 

Conrad  ... 

Cannon,  Porter  S. ; First  Natl.  Bank  Bldg.;  Conrad  25; 
GP  (PP). 

DuBois,  W.  L. ; First  Natl.  Bank  Bldg;  Conrad  25; 
GP. 

Paterson,  William  F.;  Conrad;  Conrad  19;  GP  (PP). 
Power,  Harry  W.;  Conrad;  Conrad;  GP. 

Power,  Thomas  C. ; Conrad;  Conrad  2000;  GP. 

Culbertson 

Williams,  Joseph  H. ; Searchlight  Bldg.;  Culbertson 
131;  GP  (PP). 

Cut  Bank  ... 

Neraal,  Paul  O.;  Cut  Bank;  Cut  Bank  12;  GP. 

Olsen,  N.  A.;  Cut  Bank;  Cut  Bank  94- W;  GP. 
Waller,  George  D.;  Bank  Bldg.;  Cut  Bank  460;  GP 
(PP). 

Whetstone,  S.  D.;  Cut  Bank;  Cut  Bank  670;  GP  (PP). 


Deer  Lodge  ... 

Anderson,  Gordon  A.;  504  Main  St.;  Deer  Lodge 

271;  GP  (PP). 

Beasley,  Warren  A.'.  Tuberculosis  Sanitarium;  Deer 
Lodge;  T*. 

Benjamin,  L.  M.;  Deer  Lodge;  Deer  Lodge. 

Terrill,  Frank  I.;  R.F.D.  1;  Deer  Lodge;  S*  (Gov.). 
Unmack,  Frank  L. ; Masonic  Temple  Bldg.;  Deer 
Lodge  21;  GP  (PP). 

Dillon  ... 

Bell,  Robert  F.;  30  S.  Montana  St.;  Dillon  437-W;  GP 
(PP). 

Routledge,  George  L. ; 6 Telephone  Bldg.;  Dillon  22; 
S. 

Stanchfield,  Harve  A.;  7 E.  Bannock  St.;  36-W; 

GP  (PP). 

Stephan,  W.  H.;  Poindexter  Bldg.;  Dillon  125;  R. 

Ekalaka  ... 

Sandy,  Benj.  B. ; Ekalaka;  Ekalaka  23:  GF  (PP). 

Emigrant 

Townsend,  George  A.;  Emigrant;  Emigrant:  GP  (PP). 

Fairfield 

Crary,  L.  S. ; Fairchild;  Fairchild. 

Fishtail  ... 

Dunkle,  Frank;  Fishtail;  Absarokee  348;  (Ret.). 

Forsyth  ... 

Brabec,  Paul  F.;  Forsyth;  Forsyth;  OALR*  (PP). 
Tarbox,  Byron  R.;  Forsyth;  Forsyth  237;  GP  (PP). 

Fort  Benton  ... 

Anderson,  Evon  L. ; Front  St.;  Fort  Benton  96;  GP 
(PP). 

McDede,  J.  Searle;  Fort  Benton;  Fort  Benton  96: 
GP  (PP). 

Fort  Harrison  . . 

Campbell,  Robert  M. ; V.A.C. ; Fort  Harison  1560; 
Anes*  (Gov.). 

Levitt,  Louis;  Fort  Harrison;  Fort  Harrison  1560; 
(Gov.). 

Fort  Shaw  ... 

Russell,  Rosannah;  Fort  Shaw;  Fort  Shaw;  GP  (PP). 

Fromberg  ... 

Benson,  Theo.  J.;  Fromberg;  Fromberg;  GP. 

Galen  . . . 

Enochs,  Robert  J. ; Galen;  Galen;  T*. 

Glasgow  ... 

Agneberg,  N.  O. ; Glasgow;  Glasgow. 

Gregory,  David;  502  2nd  Ave.  S. ; Glasgow  16;  ObG 
(PP). 

Knierim,  Frederick  Mattherv;  First  Natl.  Bank  Bldg.; 

Glasgow  445;  OALR*  (PP).  • 

Smith.  Alfred  N.;  502  2nd  Ave.  S.:  Glasgow  16;  GP 
(PP). 

Smith,  Philip  A.;  502  2nd  Ave.  S;  Glasgow  16;  GP 
(PP). 

Glendive  ... 

Anderson,  Robert  H. ; N.  P.  Hosp.;  Glendive  490; 
Ob  (PP). 

Danskin,  Melville  G. ; First  Natl.  Bank  Bldg.;  Glen- 
dive 27;  GP  (PP). 

Olson,  Stuart  A.;  N.  P.  Hosp.;  Glendive  490;  S (PF). 
Shillington,  Maurice  A.;  N.  P.  Hosp.;  Glendive  490: 
I*  (PP). 

Great  Falls  ... 

Allred,  Ivan  A.;  503  1st  Ave.  N.;  7676;  S (PP). 
Anderson;  C.  E.;  311  Medical  Arts  Bldg.;  7456; 

ObG  (PP). 


Rocky  Mountain  Medical  Journal  Supplement 


47 


Great  Falls  ...  (Continued) 

Arthur,  Tj.  Milton;  409  Medical  Arts  Bldg.;  2-3302; 
U*  (PP). 

Atkinson,  A.  Kearney;  410  Central  Ave.;  3273;  I* 
(PP). 

Beans,  Robert  B. ; Deaconess  Hosp. ; 6521;  Anes* 

(PP). 

Bresee,  Charles  J.;  208  Medical  Arts  Bldg.;  2-2346; 
Pr*  (PP). 

Bulger,  James  J. ; 208  Medical  Arts  Bldg.;  2-2346;  P 
(PP). 

Crago,  Felix  H.;  Strain  Bldg.;  3273;  I*  (PP). 

Davis,  Robert  C.;  505  Strain  Bldg.;  6233;  S*. 
Durnin,  R.  B. ; Strain  Bldg.;  3273;  I*. 

Fuller,  Harold  W.;  Strain  Bldg.;  ObG^*  (PP).  ' 

Gibson,  Harry  V.;  Civic  Center;  7664;  Ph*  (PH). 
Gilson,  Betty;  Strain  Bldg.;  3273;  I*  (PP). 

Gilson,  John  S.;  Strain  Bldg.;  3273;  I*  (PP). 

Gleason,  Archie  Leland;  Strain  Bldg.;  3273;  Pd*  (PP). 
Greaves,  J.  P. ; Great  Falls;  Great  Falls. 

Hall,  Cecil  M.;  Strain  Bldg.;  6586;  Oph*  (PP). 

Hall,  Earl  L.;  Strain  Bldg.;  3273;  ObG*. 

Hanley,  John  C.;  306  Medical  Arts  Bldg.;  4268;  GP 
(PP). 

Hlckes.  John  M.;  401  Medical  Arts  Bldg.;  4303; 

I*  (PP). 

Hildebrand,  Eugene;  Strain  Bldg.;  3273:  Path*  (PP). 
Hitchcock,  Ernest  D.;  Strain  Bldg.;  3273;  R*. 
Holzberger,  Robert  J.;  214  Medical  Arts  Bldg.;  7468; 
OADR*  (PP). 

Howard,  Laurence  L. ; Strain  Bldg.;  3273;  S*  (PP). 
Hurd,  Fritz  D.;  309  Medical  Arts  Bldg.:  4257;  OAL.R* 
(PP). 

Irwin,  James  H. ; 401  Medical  Arts  Bldg.;  4303;  S* 
(PP). 

Johnson,  Alf  C.;  Strain  Bldg.;  3273;  I*  (PP). 

Keenan,  F.  Edward;  210  Medical  Arts  Bldg.;  7676; 
S (PP). 

Keenan,  Maurice  E. ; 210  Medical  Arts  Bldg.;  7676; 
GP. 

Keenan.  Thomas  M.;  210  Medical  Arts  Bldg.;  7676; 
GP  (PP). 

Kendall,  Rodney  F.;  Strain  Bldg.;  3273;  D*  (PP). 
Larson,  E.  Martin;  Strain  Bldg.;  3273;  S*. 

Layne,  -John  A.;  Strain  Bldg.;  3273;  I*  (PP). 

Little,  Charles  F.;  503  1st  Ave.  N.;  6533;  I*  (PP). 
Logan,  P.  E.;  305  Medical  Arts  Bldg.;  5889;  GP  (PP). 
Lord,  Bertram  E.;  401  Medical  Arts  Bldg.;  4303; 
GP  (PP). 

MacBurney,  L.  R. ; Great  Falls;  Great  Falls. 
MacGregor,  James  C. ; 401  Medical  Arts  Bldg.;  4303; 
S (PP). 

Magner,  Charles  E. ; 505  Strain  Bldg.;  6233;  GP  (PP). 
Maillet,  Laurence  L. ; 505  Strain  Bldg.;  6233;  GP 
(PP). 

McGregor,  Harry  J. ; Ford  Bldg.;  3255;  S. 

McGregor,  John  F. ; Ford  Bldg.;  3255;  S (PP). 
McGregor,  Robert  J. ; Ford  Bldg.;  3255;  ObG  (PP). 
McPhail,  Frank  L.;  Strain  Bldg.;  3273;  ObG*  (PP). 
Nagel,  Charles  E.;  307  Medical  Arts  Bldg.;  2-2535; 
S*. 

Northrop,  Arthur  K.,  Jr.;  314  Medical  Arts  Bldg.; 
6533;  S*  (PP). 

Richardson,  R.  B. ; Strain  Bldg.;  3273;  S. 

Ritt,  Arnold  E.;  314  Medical  Arts  Bldg.;  6533;  ObG* 
(PP). 

Roberts,  Wyman  J. ; Strain  Bldg.;  3273;  ALR*  (PP). 
Schemm,  Ferdinand  R. ; Strain  Bldg.;  3273;  C (PP). 
Sexton,  George  A.;  314  Medical  Arts  Bldg.;  6533; 
S*  (PP). 

Strain,  Earle;  410  Central  Ave.;  Great  Falls. 
Templeton,  Charles  V.;  800  5th  Ave.  N.;  3398;  GP  (PP). 
Walker,  Dora  V.  H. ; 206  Medical  Arts  Bldg.;  2-1434; 
R*  (PP). 

Walker,  Thomas  F.;  206  Medical  Arts  Bldg.;  2-1434; 
Path*. 

Waniata,  Frank  K.;  North  Montana  Clinic;  Great 
Palls. 

Welsgerber,  Arthur  L.;  410  Central  Ave.;  6586; 

OALR*. 

Wolgamot,  John  C. ; Strain  Bldg;;  3273:  Or*  (PP). 

Hamilton  ... 

Gordon,  Donald  A.;  202  S.  3rd  St.;  Hamilton  202;  GP 
(PP). 

Hayward,  Herbert;  Medical  Arts  Bldg.;  Hamilton 
155;  S (PP). 


Meis,  Armon  M. ; Medical  Arts  Bldg.;  Hamilton  155: 
GP  (PP). 

Peterson,  Richard  L. ; 202  S.  3rd  St.;  Hamilton  102; 
GP  (PP). 

Tefft,  C.  C.;  104  S.  3rd  St.;  Hamilton;  GP. 

Willis,  Park  W.,  Jr.;  215  Main  St.;  Hamilton  445-W: 
S (PP). 

Har'din  ... 

jl’Jjderson,  Murl  O. ; Hardin;  Hardin  242:  GP  (PP). 
Yeatts,  Roy  O;  Sullivan  Block;  Hardin  344;  GP 
(PP). 

Harlem  ... 

Rapp,  Val  W. ; Ft.  Belknap  Hosp.;  Harlem  5-J3;  GP 
(Gov.). 

Harlowton  ... 

Gans,  Edward  M. ; Graves  Hotel  Bldg.;  Harlowton 
17-W:  GP  (PP). 

Johnson,  Raymond  G. ; Harlowton;  Harlowton  99; 
GP. 


Havre  ... 

Almas,  David  J.;  315  2nd  St.;  Havre  903:  S (PP). 
Aubln,  Francis  W.;  213  Masonic  Temple  Bldg.; 

Havre  438;  GP  (PP). 

Axley,  Albert  W.;  315  2nd  St.;  Havre  903;  C (PP). 
Forster,  Walter  L.;  Clinic  Bldg.;  Havre  45;  OALR* 
(PP). 

Hamilton,  William  F.;  Medical  Bldg.;  Havre  175; 
GP  (PP). 

Houtz,  Charles  S. ; Havre;  Havre.  e 

Jestrab,  George  A.;  Havre;  Havre;  GP. 

Lacey.  William  A.;  126  3rd  Ave.;  Havre  1000;  GP 
(PP). 

Lawson,  Chester  W.;  315  2nd  St.;  Havre  903:  ObG 
(PP). 

MacKenzie,  D.  S.;  Havre  Clinic;  Havre. 

MacKenzle,  D.  S.,  Jr,;  Havre  Clinic;  Havre;  GP. 
Spicher,  Robert  W. ; 213  Masonic  Temple  Bldg.;  Havre 
438;  GP  (PP). 

Helena  ... 

Berg,  David  T.;  107  N.  Jackson  St.;  98-W;  S (PP). 
Cashmore,  William  F. ; 403  First  Natl.  Bank  Bldg.; 
601;  GP  (PP). 

Cogswell,  W.  F. ; Helena:  Helena. 

Cooney,  Sidney  A.;  214  Power  Blk. ; 567;  GP. 

Cooney,  Theodore  W. ; 214  Power  Blk.;  567;  GP  (PP). 
Flinn,  James  M. ; 19  Kohrs  Blk.;  855;  GP. 

Gallivan,  Edward  L. ; 214  Power  Blk.;  567;  GP  (PP). 
Hawkins,  Thos.  L. ; 850  Helena  Ave.;  226;  S (PP). 
Kilbourne,  B.  K.;  State  Board  of  Health;  1274;  PH* 
(PH). 

Klein,  Otto  G.;  401  First  Natl.  Bank  Bldg.;  601;  S 
(PP). 

Lewis,  Ravmond  O. ; 205  Power  Bldg.;  1968;  OALR* 
(PP). 

Lindstrom,  Everett  H.;  850  Helena  Ave.;  226;  S 

(PP). 

Little,  Amos  R.,  Jr.;  850  Helena  Ave.;  226;  S (PP). 
Lull,  Lyon  J.;  State  Board  of  Health;  1274;  PH* 
(PH). 

McCabe,  James  J.;  19  Kohrs  Blk.;  855;  GP  (PP). 
Mears,  Claud  M.;  214  Power  Blk.;  567;  GP  (PP). 
Monserrate,  Domingo  N. ; 146  E.  6th  Ave.;  811;  S (PP). 
Moore,  Orville  M. ; 850  Helena  Ave.;  226;  Pd*  (PP). 
Morgan,  Robert  M. ; 205  Power  Block:  1968;  OALR* 
(PP). 

Morris,  R.  Wynne;  629  Helena  Ave.;  634;  Ob  (PP). 
Nichols,  Dean;  Gold  Blk.;  4040;  D*  (PP). 

Hinsdale  ... 

Cockrell,  Thomas  L. ; Hinsdale;  Hinsdale  441;  GP 
(PP). 

Hot  Springs 

Kinser,  W.  C. ; Hot  Springs;  Hot  Springs. 

Huntley  "... 

DeMers,  Joseph  J.;  Huntley;  Huntley;  GP. 


Jordan  ... 

Farrand,  B.  C.;  Jordan;  Jordan;  GP  (PP). 


Rocky  Mountain  Medical  Journal  Supplement 


49 


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50 


Rocky  Mountain  Medical  Journal  Supplement 


Kalispell  * . . 

Benke,  Robert  A.;  130  7th  St.  East;  1110;  GP. 
Brassett,  Albert;  Kalispell;  Kalispell;  GP. 

Brewer,  A.  D.;  Rt.  3;  Kalispell;  (Ret.). 

Cockrell,  Eugene  P. ; Buffalo  Block;  136;  GP  (PP). 
Dodge,  Albert  A.;  14  Conrad  Bank  Bldg.;  426;  GP. 
Perree,  Virgil  D.;  221  1st  Ave.  E.;  1174;  S (PP). 
Griffis,  Lawrence  G. ; Whipp’s  Block;  194;  GP. 
Higgins,  Eaner  P. ; 221  1st  Ave.  E. ; 1175;  GP  (PP). 
Huggins,  H.  D. ; Kalispell;  Kalispell;  OADR. 

Leitch,  Neil  M.;  203  Buffalo  Block;  633;  U*  (PP). 
Moore,  T.  B. ; 21  Whipp’s  Block;  468’;  S'  (PP). 

Paul,  F.  W. ; Kalispell;  Kalispell. 

Ross,  F.  B. ; Ross  Medical  Bldg.;  Kalispell;  GP  (Ret.). 
Towne.  Ralph  L. ; Noffsinger  Bldg.;  253;  S. 

Weed.  Vernon  A.;  224  Buffalo  Block;  980;  OALR’" 
(PP). 

Wright,  G.  B.;  704  S.  Main  St.;  163;  C. 

Laurel  ... 

Calvert,  Matthew  W. ; Vye  Clinic;  Laurel  100;  ObG 
(PP). 

Hall,  Earl  C.;  Wold  Bldg.;  Laurel  3;  GP. 

Leeper,  D.  D.;  Laurel;  Laurel. 


Lewistown  ... 

Dion,  Robert  H. ; 315  Montana  Bldg.;  Lewiston  801; 
S (PP). 

Eck,  Raymond  L. ; 612  Montana  Bldg.;  Lewistown 
305;  S (PP). 

Gans,  Paul  J.;  612  W.  Main  St.;  Lewistown  99; 

S (PP). 

Hanson,  O.  Lyman;  612  Montana  Bldg.;  Lewistown 
305;  GP  (PP). 

Herring,  James  H. ; 103  4th  Ave.  N.;  Lewistown  25; 
OALR*  (PP). 

Mueller.  James  A.;  407  Montana  Bldg.;  Lewistown 
37;  ObG  (PP). 

Schubert,  John  W. ; 515  Montana  Bldg.;  Lewistown 
63;  GP. 

Welden,  E.  A.;  Lewistown;  Lewistown. 

Libby  ... 

Seifert,  Paul  J.,  Jr.;  613  Mineral  Ave.;  Libby  242; 
. GP  (PP). 

Livingston  ... 

Clemons,  Thomas  R. ; Park  Hospital;  Livingston  287; 
GP  (PP). 

Harris,  William  E.;  114  N.  2nd;  Livingston  95;  GP 
(PP). 

Larson,  Eloise  M. ; Krohne-O’Connor  Bldg.;  Living- 
ston 2;  GP  (PP). 

Lueck,  Alfred  M. ; Park  Hosp.;  Livingston  287;  S* 
(PP). 

Means,  Robert  R. ; 117  E.  Callender;  Livingston  1165; 
GP  (PP). 

Pearson,  John  A.;  121  S.  3rd  .St.;  Livingston  287;  GP 
(PP). 

Walker,  Robert  E. ; 114  N.  2nd;  Livingston  95;  GP 
(PP). 

Malta  ... 

Setzer,  George  W. ; Malta;  Malta  146;  S. 

Williams,  Wm.  T. ; Malta;  Malta  210;  GP  (PP). 

Miles  City  ... 

Brogan,  Horace  E.;  6 N.  7th  St.;  Miles  City  102;  GP 
(PP). 

Garberson,  John  H. ; 6 N.  7th  St.;  Miles  City  102;  S* 
(PP). 

Harlowe,  H.  D.;  6 N.  7th  St.;  Miles  City  102;  OALR*. 
Howard,  Elna  M. ; 6 N.  7th  St.;  Miles  City  102;  ObG. 
Lindeberg;  Sadie  B. ; Medical  Arts  Bldg.;  Miles  City 
888;  ObG*. 

Polk,  Raymond  W. ; Medical  Arts  Bldg.;  Miles  City 
888;  I*  (PP). 

Pratt,  Sidney  C.;  6 N.  7th  St.;  Miles  City  102;  S*  (PP). 
Randall,  Ray  R. ; Miles  City;  Miles  City;  ObG. 
Rowen,  Ernest  H. ; Miles  City;  Miles  City;  OALR. 
Thompson,  James  R. ; Medical  Arts  Bldg.;  Miles 
City  888;  S*  (PP). 

Winter,  Malcolm  D.;  6 N.  7th  St.;  Miles  City  102;  I* 
(PP). 


Missoula  ... 

Alderson,  L.  R.;  501  W.  Broadway;  2168;  Pd*. 
Babcock,  Daniel  W. ; Missoula;  6423;  S (PP). 
Barmeyer,  George  H. ; 501  W.  Broadway;  2168;  Pd* 
(PP). 

Blegen,  Halward  M. ; 501  W.  Broadway;  2168;  S*  (PP). 
Bourdeau,  C.  L.;  305  Montana  Blk.;  4782;  S (PP). 
Brewer,  Leonard  W. ; 212  N.  Higgins  Ave.;  6423; 
S (PP). 

Bridenstine,  I.  J.;  121  First  Natl.  Bank  Bldg.;  5430; 
GP  (PP). 

Campbell,  Harry  B.;  501  W.  Broadway;  2168;  ObG* 
(PP). 

Carmichael,  Glenn  A.;  518  Evans  Ave.;  7524;  ObG* 
(PP). 

Coakley,  Leo  P. ; 501  W.  Broadway;  2168;  ALR. 

Cox,  Walter  B.;  501  W.  Broadway;  2168;  R*  (PP). 
Foss,  Allen  R.;  1421  Jackson  St.;  2654;  I*  (Ret.). 
Fredrickson,  Clyde  H.;  501  W.  Broadway;  2168;  S* 
(PP). 

George,  E.  K.;  201  Montana  Bldg.;  6300  GP. 

Hall,  Horace  J. ; N.  P.  Hospital;  Missoula;  S. 
Harris,  William  E.;  201  Montana  Bldg.;  6300;  GP 
(PP). 

Honeycutt,  Charles  F. ; 501  W.  Broadway;  2168;  S* 
(PP). 

Hulla,  Grover;  117  W.  Broadway;  6294;  Pd*  (PP). 
Johnson,  Melvin  J. ; North  2nd  and  Rose  St.;  2193; 
GP  (PP). 

Key,  Roy  W. ; 413  Montana  Bldg.;  5995;  OALR*  (PP). 
Kintner,  Arthur  R. ; 501  W.  Broadway;  2168;  I*. 
Kress,  J.  E.;  501  W.  Broadway;  2168;  I*  (PP). 

Kuffel,  Leonard  E.;  N.P.B.A.  Hosp.;  2193;  Ind  (PP). 
Lanphier,  Vernard  A.;  201  Union  Bldg.;  89'31. 

Lovell,  Ernest  M. ; 117  W.  Broadway;  6294;  GP 

(PP). 

Lowe,  Fred  H.;  201  Montana  Bldg.;  6300;  S. 

Lyons,  Charles  R.;  Montana  State  Univ.;  7626;  HA* 
(Student  Health  Service). 

Marshall,  William  J. ; 401  Montana  Bldg.:  2565; 

OALR*  (PP). 

McPhail,  W.  Neil;  44  Higgins  Bldg.;  7878;  C (PP). 
Minckler,  John  fe.;  501  W.  Broadway;  2168;  I*  (PP). 
Morrison,  William  F. ; N.  P.  Hosp.;  2193;  GP  (PP). 
Murphy,  Edward  S. ; 216  Dixon  Bldg.;  6637;  Oph* 
(PP). 

Nelson,  John  M.;  205  Higgins  Bldg.;  2318;  GP. 

Pease,  F.  D. ; Missoula;  Missoula;  (Ret.). 

Preston,  Stephen  N.;  501  W.  Broadway;  2168:  ObG* 
■ (PP). 

Quinn,  James  H.;  216  Dixon  Bldg.;  6638;  Oph*  (PP). 
Ritchey,  John  P.;  407  Montana  Bldg.;  2345;  I*  (PP). 
Sale,  George  G.;  216  Dixon  Bldg.;  6637;  OALR*  (PP). 
Spottswood,  E.  W.;  Missoula;  Missoula;  (Ret.). 

Svore,  C.  R. ; 117  W.  Broadway;  6294;  S (PP). 
Thornton,  C.  R.;  Missoula;  Missoula;  (Ret.). 
Trenouth,  Stanley  M.;  501  W.  Broadway:  2168:  I* 
(PP). 

Turman,  George  F.:  Missoula;  Missoula. 

Turner,  Allan  P.;  344  Higgins  Blk.;  7878;  GP  (PP). 
Weber,  Richard  D.;  501  W.  Broadway;  2168;  I*  (PP). 
Wirth,  Rudolph  E. ; Missoula;  2088;  GP  (PP) 

Yuhas,  J.  L.;  401  Wilma  Bldg.;  7332;  S. 

Philipsburg  ... 

Nesbit,  L.  R.;  Philipsburg;  Philipsburg  33-W;  GP 
(PP). 


Plentywood  ... 

Benson,  O.  G. ; Plentywood;  Plentywood;  GP. 

Pronin,  Arthur;  Main  St.;  Plentywood  22;  GP  (PP). 

Poison  ... 

Dimon,  John;  Poison;  Poison  33-K;  GP. 

Tanglin,  Walter  G.;  Poison;  Poison  104;  GP  (PP). 

Red  Lodge  ... 

Adams,  Edwin  M. : Red  Lodge;  Red  Lodge;  GP. 

Beal,  Robert  L.;  9 N.  Broadway:  Red  Lodge  40;  GP 
(PP). 

Karward,  Thomas  G. ; 9%  N.  Broadway;  Red  Lodge 
40;  GP  (PP). 

Ronan  ... 

Brooke,  Joseph  M.;  Ronan;  Ronan;  GP. 

Roundup  ... 

Bennett,  Arthur  A.;  204  Main  St.;  Roundup  211;  GP. 
Crouse,  Sheridan  A.;  Wall  Bldg.;  Roundup  32;  GP. 
O’Neill,  Robert  T.;  Wall  Bldg.;  Roundup  70;  GP  (PP). 


Rocky  Mountain  Medical  Journal  Supplement 


51 


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52 


Rocky  Mountain  Medical  Journal  Supplement 


Ryegate  ... 

Fouts,  Edwin  R.;  Court  House;  Ryegate  25;  GP  (PP). 

St.  Ignatius  ... 

Brooke,  Charles  P.;  1st  St.  West;  St.  Ignatius  18;  S 
(PP). 

Shelby  ... 

Robinson,  William  C.;  Box  564;  Shelby  160;  GP  (PP). 

Sheridan  ... 

Rossiter,  Henry  D. ; Sheridan;  Sheridan;  GP  (PP). 

Sidney  ... 

Beagle,  John;  S. ; Sidney;  Sidney;  GP. 

Benson,  Ross  D. ; Rich  Natl.  Bank  Bldg.;  Sidney 
37;  GP. 

Harper,  R.  D. ; Roxy  Bldg.;  Sidney  111;  S (PP). 

Hyde,  Robert  A.;  203  E.  Morrill;  Sidney  697;  GP  (PP). 
Pennepacker,  J.  S. ; Roxy  Bldg.;  Sidney  111;  GP. 

Stanford  ... 

Freed,  Hazel;  First  Natl.  Bank  Bldg.;  Stanford 
26;  GP  (PP). 

Stevensville  . . 

Quinn,  James  W.;  Stevensville;  Stevensville  160;  GP 
(PP). 

Superior  ... 

Doyle,  William  J. ; Superior;  Superior;  GP. 

Trayner,  Hampton  H.;  Superior;  Superior  2341;  GP 
(PP). 

Terry  . 

Tenny,  A.  Cass;  Terry;  Terry  1;  GP  (PP). 

Thompson  Falls  ... 

Rosdahl,  C.  EJ.;  Thompson  Palls;  Thompson  Falls  8; 
GP  (PP). 

Townsend  ... 

Bayles,  R.  G.;  Townsend;  Townsend  98;  GP  (PP). 
McElwee,  William  R. ; Broadwater  Hosp.;  Townsend 
98;  GP  (PP). 

Nash,  Francis  P.;  Townsend;  Townsend  98;  S (PP). 

Twin  Bridges  ... 

Seidensticker ; Twin  Bridges;  Twin  Bridges  40; 
GP  (PP). 

Wilson,  Edwin  M. ; Twin  Bridges;  Twin  Bridges; 
(Ret.). 

Warm  Springs  ... 

Holmes,  Gladys  V.;  Warm  Springs;  Warm  Springs  36; 
P*  (State  Hosp.). 

Pampel,  Byron  L.;  Montana  State  Hospital;  Warm 
SI>rings;  GP. 

Place,  B.  A.;  Montana  State  Hosp.;  Warm  Springs; 
PN*  (State  Hosp.). 


Washoe  ... 

Beltzer,  Charles  E.;  Washoe;  Washoe  0-55R1;  GP. 

Whitefish  ... 

Lees,  Alfred  T.;  211  Central  Ave.;  Whitefish  44; 
GP  (PH). 

Lockridge,  T.  Leon;  First  Natl.  Bank  Bldg.;  White- 
fish  63;  GP  (PP). 

Simons,  John  B.;  First  Natl.  Bank  Bldg.;  Whitefish 
63;  GP  (PP). 

Stewart,  Robert  M. ; 525  3rd  St.;  Wlhitefish  225; 
GP  (PP). 

Taylor,  William  W. ; Whitefish;  Whitefish;  (Ret.). 
Whalen,  John  T.;  Britell  Bldg.;  Whitefish  225;  GP 
(PP). 

Whitehall  ... 

Hill,  Robert  J.;  Whitehall;  Whitehall  73;  S (PP). 
Packard,  Lawrence  R. ; Whitehall;  Whitehall  12; 
GP  (PP). 

White  Sulphur  Springs 

White,  Horace  L.;  Johnson  Bldg.;  White  Sulphur 
Springs  2221;  GP. 

Willow  Creek 

Bradbury,  J.  T.;  Willow  Creek;  Willow  Creek; 
(Ret.). 

Wolf  Point  ... 

Knapp,  Robert  D.;  Flynn  Bldg.;  Wolf  Point  89;  GP 
(PP). 

Krogstad,  Lorance  T. ; Huxsol  Bldg.;  Wolf  Point 
21;  GP  (PP). 


Members  Out  of  State  ... 

Carey,  Walter  R. ; Rosebud  Indian  Hosp.;  Rosebud, 
S.  Dak.;  ObG  (Gov.). 

De  Canio,  John;  Sisseton,  So.  Dak. 

Farabaugh,  C.  L. ; 208  Grand  St.;  Newburgh,  N.  T. ; 
Newburgh  4824;  OALR*  (PP). 

French,  E.  J.;  10721  Sask.  Drive;  Edmonton,  Alta, 
Canada. 

Gans,  Edward  W.;  280  MacArthur  Blvd.  West;  Oak- 
land, Calif.;  Humboldt  3-5720;  ALR*  (PG  Res.). 

Graham,  J.  H. ; 705  Seville  Way;  San  Mateo,  Calif.; 
(Ret.). 

Huene,  M.  J.;  1600  N.  Colfax  St.,  Apt.  22;  Portland 
13.  Ore. 

King,  E.  Erwin;  Koldridge,  Nebr. 

Labbitt,  L.  H.;  906  N.  17th  St.;  McAllen,  Texas;  GP. 

Movius,  Arthur  J.;  7759  Herschel  Ave.;  LaJolla, 

Calif.;  Glencove  5-6242;  S (PP). 

Steffens,  Laverne  C. ; St.  Joseph’s  Hosp.;  Lexington, 
Ky.;  S*  (PG  Res.). 

Thompson,  Prank  M. ; 521  E.  Van  Buren  St.;  Co- 
lumbia City,  Ind.;  Columbia  City  678;  I*  (PP). 

Van  Veen,  F.  L. ; Univ.  of  Pennsylvania;  Philadel- 
phia 4,  Pa. 

Witherspoon,  T.  Casey;  10518  Helena  St.;  Los  An- 
geles, Calif.  (Ret.). 


CQ} 


Rocky  Mountain  Medical  Journal  Supplement 


53 


UNITED  STATES  FIDELITY 
fir  GUARANTY  COMPANY 

(U.  S.  F.  & G.) 

Asset’s  Over  $120,000,000.00 

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Denver  1,  Colorado 

Carries  professional  liability  insurance  un- 
der group  policies  for  many  of  the  individual 
members  of  the  Colorado,  New  Mexico  and 
Wyoming  State  Medical  Societies. 

Please  write  for  rates  and  other  details. 
Also  will  take  care  of  your  needs  for  the 
following: 

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Public  Liability  and 
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We  Appreciate  the  Patronage 
of  the  Members  of  the 
Medical  Profession 

CAPITOL 
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We  Welcome  the  Business  of  the  Doctors 
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54 


Rocky  Mountain  Medical  Journal  Supplement 


NEW  MEXICO  MEDICAL  SOCIETY 

Next  Annual  Session:  Roswell,  May  5,  6.  7,  1949 


OFFICERS  — 1948-1949 

President:  P.  L.  Travers.  Santa  Fe. 

President-Elect:  J.  W.  Hannett,  Albuquerque. 

Vice  President:  I.  J.  Marshall.  Roswell. 

Secretary-Treasurer:  H.  L.  January,  Albuquerque. 

Cooneilors  (3  years):  W.  D.  Dabbs,  Clovis;  A.  C.  Shuler,  Carlsbad. 
Councilors  (2  years):  R.  0.  Brown,  Santa  Fe;  C.  H.  Gellentblen,  Valmora. 
Councilors  (1  year):  Carl  Mulky,  Albuquerque;  L.  S.  Evans.  Las  Ouces. 

COMMITTEES  1948-1949 

Basic  Science;  W.  E.  Nlssen,  Albuquerque,  Chairman ; Le  Grand  Ward, 
Santa  Fe:  Vincent  Accardl,  Gallup. 

Rural  Medical  Serica  Service:  Stuart  W.  Adler,  Albuquerque,  Chairman: 
W.  B.  Cantrell,  Hot  Springs;  Samuel  R.  Zeigler,  Espanola;  A.  T.  Gordon, 
Tucumcari;  L.  G.  Foster,  Reserve. 

Cancer:  Murray  M.  Friedman,  Santa  Fe,  Chairman:  Van  A.  Odle,  Roswell; 
J.  R.  Van  Atta,  Albuquerque;  J.  W.  Grossman,  Albuquerque;  R.  W.  Maher, 
Albuquerque. 


Venereal  Disease  Control:  Sam  Jelso,  Albuquerque,  Chairman;  V.  E. 
Berchtold.  Santa  Fe;  L.  M.  Miles,  Albuquerque;  L.  S.  Evans,  Las  Cruce*; 
H.  L.  January,  Albuquerque. 

Legislative;  Albert  Lathrop,  Santa  Fe,  Chairman;  W.  0.  Connor,  Albu- 
querque; W.  R.  Lovelace,  II,  Albuquerque;  Walter  A.  Stark,  Las  Vegas; 
George  k Morrison,  Roswell;  B.  0.  Brown,  Santa  Fe. 

Public  Relations;  D.  A.  McKinnon,  Jr.,  Albuquerque,  Chairman;  James 
L.  McCrory,  Santa  Fe;  H.  M.  Mortimer,  Las  Vegas;  Frank  W.  Parker,  Jr., 
Gallup. 

Tuberculosis:  B.  0.  Brown,  Santa  Fe,  Chairman;  C.  H.  GeUentblen, 
Valmora;  D.  0.  Shields,  Albuquerque;  H.  S.  A.  Alexander,  Santa  Fe. 

Advisory  Committee  on  Ins.  Compensation:  Eugene  W.  Flske,  Santa  Fe, 
Chairman;  John  F.  Conway,  Clovis;  A.  C.  Shuler,  Carlsbad;  E.  E.  Forbls, 
Albuquerque. 

Committee  on  National  Emergency  Medical  Service:  A.  E.  Reymont,  Sants 
Fe,  Chairman:  C.  M.  Thompson,  Albuquerque;  L.  0.  Rice,  Albuquerque; 
Walter  A.  Stark,  Las  Vegas. 


Directory  of  Members  — NEW  MEXICO 

(As  of  December  31,  1948) 

For  Explanation  of  listings  and  symbols,  see  Page  1. 


Alamogordo  ... 

Simms,  Eugene  P. ; 412  10th  St.;  Alamogordo  8;  Pd. 


Albuquerque  ... 

Aberle,  S.  D.;  223  N.  14th  St.;  2-0329:  GP. 

Adler,  Eleanor  L.;  817  E.  Central  Ave.;  3-0721;  Pd* 
(PP). 

Adler,  Stuart  W. ; 817  E.  Central  Ave.:  6881;  Pd* 
(FP). 

Ballenger,  Irby  B. ; 424  First  Natl.  Bank  Bldg.; 

4402;  S (PP). 

Bartolucci,  R.  J.;  106  S.  Girard;  2-5673;  GP  (PP). 
Bass,  Hugh  L.:  924  Park  Ave.;  2-4190:  S (PP). 
Beaudette,  Robert  D. ; 221  W.  Central  Ave.;  8871; 
Oph*  (PP). 

Beck,  Harold  J.;  106'  S.  Girard:  4248;  U*  (PF). 
Bivings,  Charles  K. ; 1406  W.  Central:  9109;  S (PP). 
Bowers  Leroy  J.;  319  First  Natl.  Bank  Bldg.;  8871; 
ObG*. 

Brehmer,  Harrison  L. ; 623  First  Natl.  Bank  Bldg.; 
4210;  Oph*  (PP). 

Brentan,  Emanuel;  1111  E'.  Central  Ave.;  9629;  GP 
(PP). 

Brock,  C.  LeRoy;  715  W.  Gold  Ave.;  6265;  GP. 

Byrd,  Wallace;  221  W.  Central  Ave.;  8871;  I*. 

Clark,  Lenna  Emelyn  Jones;  215  N.  7th  St.;  7353; 
Gyn. 

Clauser,  Alvin  R. ; 109  S.  Elm  St.;  7558;  Ob  (PP). 
Cohenour,  Leo  B.;  422  First  Natl.  Bank  Bldg.; 

3-5284;  S (PP). 

Cohenour,  W.  E. ; 422  First  Natl.  Bank  Bldg.;  3-5284. 
(i'onnor,  Wesley  O.,  Jr.;  106  S.  Girard:  9472;  ObG* 
(PP). 

Cornell,  H.  M.;  323  S.  Amherst  Ave.;  2-0597;  (Ret.). 
Cornish,  P.  G. ; First  Natl.  Bank  Bldg.;  2-1333; 
S (PP). 

Courville,  Albert  L. ; 623  First  Natl.  Bank  Bldg.; 
6759;  ALR*  (PP). 

Cramer,  Oliver  S. ; 221  W.  Central  Ave.;  8871:  I* 
(PP). 

Elliott,  L.  F.;  First  Natl.  Bank  Bldg.;  2-1197. 
Fishback,  Charles  F. ; 221  W.  Central  Ave.;  8871;  Pd* 
(PP). 

Folllngstad,  Alvin  H.;  206  N.  Dartmouth;  2-0692; 
S (PP). 

Forbls,  R.  E.;  106  S.  Girard;  2-3532;  Or*  (PP). 
Freedman,  Harold  L.;  7208  E.  Central  Ave.;  2-7187; 
GP  (PP). 

Freeman,  J. ; Veterans  Hosp. ; Albuquerque. 
Priedenberg,  Robert;  2929  Monte  Vista  Blvd.;  2-7449; 

I*  (PP). 

Friable,  Evelyn  P.;  426  First  Natl.  Bank  Bldg.; 

4785;  ObG  (PP). 

Garduno,  J.  Lopez;  922  W.  Tijeras  Ave.;  9112;  GP 

(PP). 

Gore,  G.  J.,  Jr.;  403  W.  Harwood;  Albuquerque. 
Grossman,  J.  W. ; 221  W.  Central  Ave.;  8871;  R*  (PP). 
Hagood,  E.  C. : 907  W.  Bridge;  2-0560;  Fr. 
Hannett,  J.  W. ; 515  First  Natl.  Bank  Bldg.;  3-2251;  S. 


Harris,  J.  E.  Jackson;  221  W.  Central  Ave.;  4147; 
T (PP). 

Hart,  George  A.;  221  W.  Central  Ave.;  . 6295;  ObG* 
(PP). 

Jacobson,  Alan;  514  First  Natl.  Bank  Bldg.;  2-2352; 
PN*  (PP). 

January,  Harold  L. ; First  Natl.  Bank  Bldg.;  8871; 
I*  (PP). 

Jelso,  Samuel:  106  S.  Girard;  2-4619;  D*  (PP). 
Jernigan,  Henry  C.;  106  S.  Girard;  2-5003;  T*  (PP). 
Kempers,  Bert;  706  First  Natl.  Bank  Bldg.;  2-3807; 
S (PP). 

Kircher,  Theodore  E. ; 109  S.  Elm  St.;  6467;  A (PP). 
Kling,  Herman  E: ; 109  S.  Elm  St.;  3-2228;  Pr*  (PP). 

Leeds,  A.  B.;  109  S.  Elm  St.;  3-2226;  I*. 

Lovelace,  William  R. ; 221  W.  Central  Ave.;  8871;  S* 
(PP). 

Lovelace,  W.  Randolph,  IT:  221  W’".  Central  Ave.; 
8871:  S*  (PP). 

Lyle,  E.  H.;  109  S.  Elm  St.;  3-2226;  OALR*  (PP). 
Maher,  Robert  W.;  800  E.  Central  Ave.;  8829;  S* 
(PP). 

Maisel,  Albert  L.;  109  S.  Elm  St.;  3-0792;  I*  (PP). 
Mclntire,  R.  W.;  106  S.  Girard;  2-3532;  Or*  (PP). 
McKinnon,  D.  Angus,  Jr.;  221  W.  Central  Ave.;  8871; 
S*  (PP). 

McRae,  Louis  A.,  Jr.;  2929  Monte  Vista  Blvd.;  2-2511; 
ObG*. 

Mendelsqn,  Ralph  W.;  1016  Parkland  Place;  7566; 
(Ret.). 

Miles,  Lee  M. ; 221  W.  Central  Ave.;  8871;  ObG*  (PP). 
Milner,  Virginia  Voorhies;  704  Laguna  Blvd.;  3-1865. 
Montani,  Anthony  C. ; 310  S.  Dartmouth;  Albu- 

querque. 

Mulky,  Carl;  First  Natl.  Bank  Bldg.;  4320;  T*  (PP). 
Myers,  John  W. ; 514  First  Natl.  Bank  Bldg.;  2-2352; 
■ NP*  (PP). 

Nlssen,  Wallace  Ei;  First  Natl.  Bank  Bldg.;  3-2251; 
S (PP). 

Overton,  Lewis  M.;  221  W.  Central  Ave.;  8871;  Or* 
(PP). 

Parnall,  Edward;  324  S.  Yale  Ave.;  2-4228;  Or*  (PP). 
Peck,  Howard  B.;  106  S.  Girard;  2-0271;  Oph*. 
Pollard,  Milton;  1109  E.  (Central  Ave.;  2-3764;  Oph* 
(PP). 

Price.  Arthur  L.;  109  S.  Elm  St.;  3-2226;  U*  (PP). 
Prieto,  Alfonso  G.;  115%  S.  2nd;  3-5280;  R (PP). 
Rice,  Lucien  G.;  611  E.  Central:  4992. 

Roberts,  Bennett  F. ; 800  E.  Central  Ave.;  2-0239; 
OALR*  (PP). 

Robertson,  Roy  R. ; 106  S.  Girard;  2-5821;  C (PP). 
Rood,  Albert  C.;  523  First  Natl.  Bank  Bldg.;  2-1333; 
GP. 

Rosenbaum,  Myron  G.;  404  W.  Lead  Ave.;  7879; 
Or*  (PP). 

Rowe,  Frank  A.;  109  S.  Elm  St.:  3-2226;  GP  (PP). 
Royer,  Emmett  E. ; 611  First  Natl.  Bank  Bldg.;  8418; 
Ob  (PP). 

Schilling,  Harold  James;  106  S.  Girard  St.;  8672;  S 
(PP). 


Rocky  Mountain  Medical  Journal  Supplement 


55 


BLAIR  SURGICAL  SUPPLY,  Inc 

Rocky  Mountain  Distributors 

Offices : 

Albuquerque 
Denver 
Phoenix 
Tucson 


Blair  Surgical  Supply 
20  E.  9th  Ave., 
Denver  3,  Colo. 


Date 


Gentlemen 


Please  have  your  representative  demonstrate  the 
“Bandmaster”  in  my  office. 


Dr 


Street 


State 


Federal 

Communications 
Commission 
Approved  No,  D-474 

An  important  advance  in  Dia- 
thermy apparatus . . . 

• CRYSTAL  CONTROL  . . . 
Assures  accurate  frequency 
stability  for  the  life  of  the  unit. 

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• SIMPLICITY . . . Control  of 
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safeguard  against  mistakes  in 
treatment  and  eliminate  abuse 
or  damage  to  the  equipment. 

• POWER  PLUS  . . . Power 
Output  is  more  than  adequate 
for  treatment  of  any  part  of 
the  body.  Deep  heat ...  to  large 
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accurate  and  easy  control. 

• ECONOMY . . . Simple  rug- 
ged construction  assures  mini- 
mum maintenance  . . . initial 
cost  is  surprisingly  low. 


56 


Rocky  Mountain  Medical  Journal  Supplement 


Albuquerque  ...  (Continued) 

Shields,  Delmar  O.;  106  S.  Girard;  2-5003:  I*  (PP). 
Simms,  A.  G.,  II;  Albuquerque;  Albuquerque. 
Simonds,  Hamilton;  106  S.  Girard;  2-3532;  Or*  (PP). 
Speed,  Henry  Kirven;  2001  E.  Gold  Ave.;  2-2376;  GP 
(PP). 

Spitz,  Theodore;  109  S.  Elm  St.;  3-2226;  Anes. 
Stewart,  A.  B.;  225  First  Natl.  Bank  Bldg.;  2-2861; 
PN*  (PP). 

Stiles,  Waldo  W.;  200  N.  Walter  St.;  3-5300;  S*  (PP). 
Tanny,  Alfred  J. ; 109  S.  Elm  St.;  2-1822;  S*  (PP) 
Tanny,  Michael  A.;  109  S.  Elm  St.;  2-1822;  GP  (PP). 
Teague,  Hubert  R. ; 424  First  Natl.  Bank  Bldg.; 

4402:  GP  (PP). 

Thearle,  William  H. ; 221  W.  Central  Ave.;  8871;  I* 
(PP). 

Thompson,  Charles  M. ; 617  First  Natl.  Bank  Bldg.; 
3-2229;  R*  (PP). 

Trombley,  Robert  A.;  106  S.  Girard;  4922;  Pd*  (PP). 
Van  Atta,  John  R. ; First  Natl.  Bank  Bldg.;  3-2229; 
R*  (PP). 

Vergara,  Lautaro  G.;  1203  S.  4th;  2-3553;  GP. 
Werner,  By;  513  First  Natl.  Bank  Bldg.;  2-3141;  Pd* 
(PP). 

Werner,  Walter  I. ; First  Natl.  Bank  Bldg.;  2-5921; 
I*  (PP). 

Wiggins,  James  W. ; 800  E.  Central  Ave.;  8829;  ObG 
(PP). 

Williams,  Guy;  2001  E.  Gold  Ave.;  3-0191;  OALR. 
Woolston,  William  H. ; First  Natl.  Bank  Bldg.; 
8644;  S*  (PP). 

Wright,  William  B.,  Jr.;  201  S.  Arno  St.;  2-1161; 
Oph*. 

Wylder,  Meldrum  K.;  627  First  Natl.  Bank  Bldg.; 
6440;  Pd  (PP). 

Anthony  ... 

Preston,  T.  K.;  Anthony;  Anthony. 

Artesia  ... 

Bunch,  C.  Pardue;  405  S.  2nd  St.;  Artesia  480;  Pd 
(PP). 

Cressman,  Frederic  E. ; 102  S.  2nd  St.;  Artesia  973; 
OAXR*  (PP). 

Derbyshire,  R.  C;  108  S.  2nd  St.;  Artesia  395;  S* 
(PP). 

Hamilton,  Louis  F.;  210  S.  Roselawn;  Artesia  255; 
GP  (PP). 

Russel,  Chester  R.;  307  Washington;  Artesia  135; 
GP  (PP). 

Starr,  Pete  J.;  701  W.  Main  St.;  Artesia  400;  C (PP). 
Stroup,  H.  Austin;  113  S.  Roselawn;  Artesia  67;  GP. 

Bayard  ... 

Grenfell,  N.  P. ; Bayard;  Bayard. 

Wilkinson,  Wylie  S. ; Box  727;  Bayard;  GP. 

Belen  ... 

Bessette,  Adelard  E.;  520  Dalles  Ave.;  Belen  3271; 
S (PP). 

Heffner,  Edward  A.;  300  Becker  Ave.;  Belen  2931; 
GP  (PP). 

Parkison,  Wallace  M.;  511  N.  3rd  St.;  Belen  5111; 
GP  (PP). 

Sheeley,  Faye  G.;  511  N.  3rd  St.;  Belen  5111;  GP  (PP). 
Wier,  David  T.;  300  Becker;  Belen  2931;  ObG  (PP). 

Bernalillo  ... 

Hemmings,  Lincoln  S.;  Main  Ave.;  Bernalillo  411;  Ob 
(PP). 

Carlsbad  ... 

Bohannen,  Frank  C. ; 408  W.  Mermod  St.;  890;  I* 
(PP). 

Brown,  Roderick  F. ; 108%  S.  Canal  St.;  704;  GP  (PP). 
Cavanaugh,  J.  L. ; Bank  Bldg;  217. 

Doepp,  Frederick  F.;  108  S.  Canal  St.;  30;  GP  (PP). 
Gwinn,  Clay;  110  N.  Canyon  St.;  727;  OALR*  (PP). 
Hillsman,  Joseph  W. ; 408  W.  Mermod  St.;  223;  S 
(PP). 

Hogsett,  Glade  C.;  102  W.  Fox;  919;  GP. 

Pate,  Henry  D.;  Carlsbad;  Carlsbad. 

Pate.  Louis  H. ; 122  N.  Canyon  St.;  21;  S (PP). 
Puckett,  Owen  E. ; Dept,  of  Health,  Court  House:  246; 
PH*  (PH). 

Rose,  William  A.;  114  N.  Canyon  St.;  900;  GP  (PP). 


Shuler,  Ashley  C.;  701  N.  Canal  St.;  37;  GP  (PP). 
Smith,  Warren  G. ; 114  W.  Mermod;  Carlsbad;  GP. 
Womack,  C.  L. ; 701  N.  Canal  St.;  37;  S (PP). 

Carrizozo  ... 

Turner,  James  Paul;  Carrizozo:  Cairizozo  58-  GP 
(PP). 

Chama  .... 

Dunham,  James  I.;  Chama;  Chama;  GP. 

Cimarron  ... 

Posey,  G.  O. ; Cimarron:  Cimarron  10-W;  GP  (PP). 

Clayton  ... 

Daniel,  D.  C.;  Clayton;  Clayton  256;  GP  (PP). 
Winchester,  J.  M.;  103  Oak  St.;  Clayton  192;  GP. 

Clovis  ... 

Conway,  John  F.;  121  W.  5th  St.;  500;  S*  (PP). 

Cox,  Vincent  C.;  516  Mitchell  St.;  35;  GP  (PP). 

Curry,  Roy  L. ; 600  Mitchell  St.;  1053;  OALR*  (PP). 
Dabbs.  Walter  D.;  602  Mitchell  St.;  235;  S (PP). 
Erdlitz,  Prank  J.;  A.T.&S.F.  Hosp.;  Clovis;  T (HA). 
Hale,  P.  E.;  600  Mitchell  St.;  155;  GP. 

Johnson,  V.  Scott;  419  Mitchell  St.;  274;  GP  (PP). 
Kieve,  Rudolph;  209  E.  7th  St.;  606;  PN*  (PP). 
Lancaster,  D.  D.;  1517  Wallace  St.;  247- J. 

Lancaster,  W.  M.;  413  Mitchell  St.;  157;  Ob*. 

Martin,  Wallace  P. ; 407  Pile  St.;  1540;  GP  (PP) 
Miller,  H.  A.;  319  W.  Grand  Ave.;  1600  (PP). 

Newman,  Howard  D.;  Court  House,  700  Main  St.;  895; 
PH*  (PH). 

^■iiegler,  Joel;  417  Mitchell  St.;  1269;  GP  (PP). 

Dawson 

Hart,  Crozier  S. ; Dawson;  Dawson;  GP. 

Doming  ... 

Marsh,  Donald  B. ; 213  W.  Spruce  St.;  Deming  15;  GP 
(PP). 

Rodgers.  Bradford  D.;  421  W.  Pine  St.;  Deming  72; 
GP  (PP)-. 

Whittaker,  Leon  J. ; 300  S.  Copper;  Deming:  GP  (PP). 

Des  Moines  ... 

Wellman,  J.  M.;  Des  Moines;  Des' Moines  39-J;  GP. 

Dexter  ... 

Hubbard,  E.  J. ; Box  128;  Dexter  2161;  GP  (PP). 

El  Rito  ... 

Calkins,  S.  Boyd;  N.N.M.N.S. ; El  Rito;  GP. 

Embudo  ... 

Bowen.  Sarah;  Embudo  Presbyterian  Hosp.;  Embudo 
3;  GP. 

Espanola  ... 

Espinosa,  Tobias;  Box  128;  Espanola  26-R2;  GP  (PP). 
Nesbitt,  Orval  I.;  Box  646;  Espanola  23:  GP  (PP). 
Ziegler.  Samuel  R.;  Box  W;  Espanola  54;  S (PP). 

Estancia  ... 

AViggins,  James  H.;  Estancia;  Estancia  8;  GP. 

Eunice  ... 

Barzune,  Benjamin;  Box  403;  Eunice  1;  Ind  (PP). 

Farmington  ... 

Moran,  M.  D.;  Farmington;  Farmington  80;  GP  (PP). 
Peacock,  W.  H. ; Farmington;  Farmington. 

Fort  Bayard 

Wharton,  John  L;  Fort  Bayard;  Fort  Bayard  131; 
T*  (Gov.). 


Rocky  Mountain  Medical  Journal  Supplement 


57 


Where  You  Are  Always 
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58 


Rocky  Mountain  Medical  Journal  Supplement 


Gallup  ... 

Accardi,  Vincent;  202  W.  Hill  St.;  Gallup  774;  S. 
Anthony,  William  Dodd;  208  E.  Logan  Ave. ; Gallup 
601;  GP  (PP). 

Beaver,  Edgar  B.;  McKinley  County  Health  Dept.; 
Gallup  510;  PH*  (PH). 

Center,  W.  B.;  Medical  Arts  Bldg.;  Gallup  488;  S 
(PP). 

Dineen,  John  B. ; 200  W.  Hill  Ave.;  Gallup  620; 

OALR*. 

Keney,  Charles  W.;  Medical  Arts  Bldg.;  Gallup  855; 
GP  (PP). 

Kettel,  C.  F. ; Gallup;  Gallup. 

Loe,  Fred;  202  W.  Hill  St.;  Gallup  774;  OALR*. 
Monaco,  Donat  F.;  Allison  Bldg.;  Gallup  633;  S*. 
Parker,  Frank  W, ; Medical  Arts  Bldg.;  Gallup  981; 
ObG  (PP). 

Pousma,  R.  H.;  200  W.  Hill;  Gallup  181;  ObG  (PP). 
Watson,  H.  T. ; 120-122  Medical  Arts  Bldg,;  Gallup  4; 
GP  (PP), 


Gi*ants  ... 

Harrington,  V.  D.;  Grants;  Grants. 

Molholm,  Clifford  E. ; Jones  Bldg.;  Grants  26;  GP 
(PP). 

Hanover  ... 

Reeser,  Wayne;  Hanover;  Hanover  054-R3;  Ind  (PP). 

Hatch  ... 

steel,  James  A.;  Hatch;  Dial  2161;  GP  (PP). 

Hobbs  ... 

Badger,  Demarious  C. ; 200  N.  Dalmont;  630;  Pd*  (PP). 
Badger,  William  E.;  200  N.  Dalmont;  630;  S (PP). 
Cohen,  Herman  S. ; Hobbs;  Hobbs;  GP. 

Heffner,  Edward  A.;  P.  O.  Box  172;  823-W;  Oph* 
(PP). 

Hodde,  Henry  W. ; 303  E.  Taylor  St.;  725;  GP  (PP). 
Jenson,  Alfred  J.;  319  E.  Cain  St.;  773;  GP  (PP). 
McBee,  A.  V.;  Hobbs;  Hobbs. 

Morgan,  Thomas  L. ; 107  E.  Taylor  St.;  770;  OALR* 
(PP). 

Niehuss,  Charles  E.;  601  N.  Shipp;  Hobbs;  Ob. 

Stone,  Coy  Smith;  317  E.  Cain  St.;  462;  S*  (PP). 

Hot  Springs  ... 

Cantrell,  William  B. ; 111  Clancy;  Hot  Springs  136; 
GP  (PP). 

Hubble  Ellsworth  E. ; 403  Main;  Hot  Springs  308; 
GP  (PP). 

Johnson,  Hanson  B.;  430  W.  Broadway;  HOt  Springs 
103:  GP  (PP). 

McCorvex,  N.  B. ; Hot  Springs;  Hot  Springs. 

Minear,  William  L. ; Carrie  Tingley  Hosp.;  Hot 
Springs;  Or*  (Exec.). 

White,  A.  C. ; Hot  Springs;  Hot  Springs. 

Williams,  Thomas  B. ; Hot  Springs;  Hot  Springs; 
OALR  (PP). 

Las  Cruces  ... 

Allison,  Dwight;  119  E.  May  Ave.;  330;  I*. 

Daubs,  W.  H.;  1248  W.  Picacho;  1023;  GP  (PP). 
Daviet,  Leslie  L;  128  W.  Griggs;  45;  S (PP). 

DeNeen,  DeEnna  D.;  326  W.  Mountain;  152;  Glyn  (PP). 
Evans,  Leland  S. ; 217  W.  Court  Ave.;  141;  Ob  (PP). 
Maddox,  A.  D.;  217  W,  Court  Ave.;  141;  (PP). 
Sedgwick,  James  C. ; 122  W.  Hadley  St.;  73;  GP  (PP). 
Sedgwick,  William  D.;  122  W.  Hadley;  73;  GP  (PP). 

Las  Vegas  ... 

Beattie,  James  W.;  608  University  Ave.;  1070;  S (PP). 
Butterfield,  E.  T.;  Las  Vegas;  Las  Vegas;  Oph. 
Cheney,  Volney  S. ; 817  Seventh  St.;  643- J;  (Ret.). 
Dellinger,  E.  H.;  615  University  Ave.;  154;  S*. 

Evans,  Junius  A.;  Rm.  15,  Crockett  Bldg.;  935;  D 
(PP). 

McCreary,  Marcellus;  Box  1181;  Hot  Springs  Blvd. ; 
1020;  S*  (Ret.). 

Minas,  Vaughn  N. ; Crockett  Bldg.;  146;  Oph*. 
Ivlortimer,  H.  M. ; 720  University  Ave.;  197;  GP  (PP). 
Peavy.  I.  L.;  214  N.  Plaza;  Las  Vegas;  PH*  (PH). 
Stark,  Walter  A.;  720  University  Ave.;  287;  GP  (PP). 
Wright,  J.  R.;  Court  House;  62;  PH*  (PH). 


Logan  ... 

Thompson,  M.  M.;  Logan;  Tucumcari  3;  GP. 

Lordsburg  ... 

DeMoss,  Edwin  C.;  408  E.  3rd  St.;  Lordsburg  39;  GP 
(PP). 

Los  Alamos 

Blaney,  Loren  F.;  Los  Alamos  Hospital;  511;  I* 
(Gov.). 

Forbes,  Gilbert  B. ; Los  Alamos;  Los  Alamos. 
Natoli,  William  J.;  Hospital;  3722;  ObG*  (Gov.). 
Oakes,  William  R. ; Los  Alamos  Hospital;  511;  S* 
(Gov.). 

White,  William  C.;  Los  Alamos  Hospital;  511;  HA 
(Gov.). 

Los  Lunas 

Wittwer,  W.  F.;  Los  Lunas;  Los  Lunas  451;  GP  (PP). 

Magdalena  ... 

Evans,  Arthur  John;  Magdalena;  Magdalena  15;  GP 
(PP). 

Melrose 

Cotnam,  John  F. ; Melrose;  Melrose. 

Parkview  ... 

Becker,  J.  N, ; Parkview;  GP. 

Pecos  ... 

Fitzgerald,  Leslie  M. ; Pecos;  Pecos;  GP  (PP). 

Portales  ... 

Brasell,  Hugh  T.;  204  Colorado;  Portales  3;  GP. 
Lehman,  Herman  O. ; 222  S.  E.  Colorado;  Portales 
94;  GP  (PP). 

Raton  ... 

Adams,  Victor  K.;  220  Cook  Ave.;  153;  GP. 

Elliott,  Carey  B.;  220  Cook  Ave.;  153;  S (PP). 
Floersheim,  Milton,  Jr.;  Boyle  Bldg.;  9-W;  GP. 
Fuller,  Richard  L;  Wiison  Bldg.;  387;  GP. 

Hubbard,  Lamont  A.;  Gardiner  Hosp.;  091  Jl;  GP 
(PP). 

Pavletich,  Louis  M. ; Rm.  1,  Boyle  Bldg.;  9-W: 
GP  (PP). 

Whitcomb,  Orin  J.;  Raton;  Raton;  (Ret.). 

Reserve  . . . 

Foster,  L.  G.;  Reserve;  Reserve;  GP  (PP). 

Roswell  ... 

Baldwin,  Harvey  C.;  612  N.  Main  St.;  2150;  GP  (PP). 
Boice,  Robert  R.;  113  S.  Kentucky;  428;  OALR* 

(PP). 

Fall,  Hugh  V.:  210  W.  3rd  St.;  290;  S (PP). 
Griswold,  G.  W.;  211  W.  3rd  St.;  600;  OALR*  (PP). 
Haire,  Robert  D.,  Jr.;  706  W.  2nd  St.;  2275;  GP  (PP). 
Lander,  Ernest  Wc  211  W.  3rd  St.;  600;  Ob  (PP). 
Latimore,  Earl  A.;  215  W.  3rd  St.;  30;  GP  (PP). 
Malone,  Earl  L. ; 113  N.  Kentucky:  2263;  GP  (PP). 
Marshall,  I.  J.;  401  N.  Penn;  30;  S (PP). 

Marshall,  Ulysses  S.;  401  N.  Penn;  30;  (jp  (PP). 
Morrison.  George  S. ; 113  S.  Kentucky;  428;  OALR* 
(PP). 

Odle,  Van  A.;  506  N.  Richardson;  932;  R*  (PP). 
Philips.  William  W.;  Health  Dept.,  Court  House; 
130;  GP  (USPHS). 

Service,  Allen  C.;  406  North  Penn;  Roswell;  Pd* 

(PP). 

Snow,  Wister  C.;  115  W.  Walnut;  293;  I*  (PP). 
Waggoner,  Richard  P,;  504  N.  Richardson;  208:  S* 
(PP). 

Williams.  J.  P.;  211  W.  3rd  St.;  600;  GP. 

Roy  ... 

Self,  Thomas  F. ; Roy;  Roy  59;  GP. 

Ruidoso  ... 

English,  Frank  A.;  Ruidoso:  Ruidoso  2-12;  GP. 
Sutton,  Robert  S.;  Ruidoso;  Ruidoso  45-03;  GP  (PP). 


Rocky  Mountain  Medical  Journal  Supplement 


59 


PIERRE  ROOFERS 

DECORATORS  - INTERIOR  AND  EXTERIOR 
EXPERT  SPRAYING  OR  BRUSH  PAINTING 
PAPER  HANGING  - TEXTURING 
CONTRACTORS 

Budget  Payments  if  Desired 

C.  j.  ST.  PETER,  Contractor 

Roof  Repairing  Roof  Painting — Spray  or  Brush 

Lathing  Plastering 


PIERRE  ROOFING  COMPANY 

1453  Pontiac  Street  Phones  DExter  5321  - DExter  3869 

Residence  Phone:  CRand  5894 


Free  Estimates 

Wood  Shingles 
Composition  Roofs 


METHERCINE 

A New  and  Effective  Oxytocic 


Methergine  is  a partial  synthetic  ergot  called  (C20H23O2N3)  . Experimentally 
and  clinically  it  was  found  to  be  a safe  and  reliable  oxytocic  in  the  manage- 
ment of  the  third  stage  of  labor. 

Methergine  reduces  normal  blood  loss  and  shortens  the  third  stage  of  labor 
and  in  many  instances,  it  has  proven  more  effective  than  natural  ergonovine. 

Supplied  in  ampuls,  tablets  and  liquid 
Bibliography  and  samples  on  request 


S A N D O Z 


450  Sutter  Street 


PHARMACEUTICALS 

West  Coast  Office 

San  Francisco  8,  Calif. 


60 


Rocky  Mountain  Medical  Journal  Supplement 


Santa  Fe  . . . 

Alexander,  Henry  S.  A;  209  Coronado  Bldg.;  1142; 
Ob 

Auerbach,  Sidney;  Don  Miguel  Annex  No.  3;  2104; 
GP  (PP). 

Barton,  William  C.;  813  Don  Gaspar  Ave.;  (Ret.). 
Berchtold,  Victor  E. ; 206  Coronado  Bldg.;  922;  U* 
(PP). 

Brown,  Robert  O. ; 125  E.  Palace  Ave.;  341;  I*  (PP). 
Campbell,  Nancy  D. ; Coronado  Bldg.;  24;  ObG*  (FP). 
Coombs,  Ralph  B. ; 110  Coronado  Bldg.;  2010;  ObG. 
Corbusier,  Harold  D. ; Box  868;  696-W;  Or*  (PP). 
Douthirt,  Cranford  H. ; 406  Don  Gaspar  Ave.;  48; 
PH*  (PH). 

Drummond,  Alan  M.;  10  Sena  Plaza;  140;  PN*  (PP). 
Egenhofer,  Albert  M. ; Coronado  Bldg.;  1996;  Oph* 
(PP). 

Ellis,  Herbert  B.,  Jr.;  131  Nusbaum;  Santa  Fe. 
Ferret,  Andres;  221  Coronado  Bldg.;  31;  S*  (PF). 
Fiske,  Eugene  W. ; 223  E.  Palace  Ave.;  540;  S. 
Friedman,  Anita  S. ; 111  Coronado  Bldg.;  1646;  D* 
(PP). 

Friedman,  Murray  M. ; Coronado  Bldg.;  2762;  R*. 
Gibbs,  Meyler  D;  1008  Canyon  Rd.;  902-W;  GP. 
Gonzalez,  S.  M. ; Don  Miguel  Bldg.;  2094;  S (PP). 
Hamilton,  William  L.;  636  E.  Garcia  St.;  2373;  S 
(PP). 

Hausner,  Eric  P. ; Coronado  Bldg.;  1912-W;  I*. 
Hotopp,  Marion;  Dept,  of  Public  Health;  262;  PH* 
(PH). 

Johnson,  Eric  G. ; Indian  Hosp. ; 3117;  GP  (Gov.). 
Jones,  Charlotte;  Coronado  Bldg.;  Santa  Fe. 

Lathrop,  Albert  S. ; 141  E.  Palace  Ave.;  249;  Pd* 
(PP). 

McCrory,  James  L. ; Coronado  Bldg.;  Santa  Fe. 
McGoey,  Charles  J. ; 219  Coronado  Bldg.;  31;  I*  (PP). 
McIntyre,  Elroy  F. ; 203  Public  Welfare  Bldg.;  262; 
PH*  (PH). 

Mera,  Frank  E.;  431  Las  Animas;  209;  (Ret.). 
Miskowiec,  Adalbert;  25  Laughlin  Bldg.;  938;  GP 
(PP). 

Payne,  Harry;  Rm.  203  County  Court  House;  480; 
PH*  (PH). 

Radford,  Molly;  Box  1702;  805;  Anes*. 

Renkoff,  Herman;  Laughlin  Bldg.;  1081;  OALR* 
(PP). 

Reymont,  Anthony  E. ; 231  Washington  Ave.;  2430; 
I*  (PP). 

Rife,  Dwight;  219  E.  Palace  Ave.;  2272;  S* 

Scott,  James  R.;  Department  of  Public  Health;  262; 
PH*  (PH). 

Seitz,  Howard  M. ; 214  Coronado  Bldg-.;  2630;  ALR* 
(PP). 

Soldow,  Fred;  218  Coronado  Bldg.;  2750  GP  (PP). 
Travers,  Philip  L. ; 202  Coronado  Bldg.;  1766;  S*. 
Ward,  LeGrand;  141  Palace  Ave.;  5;  S. 

Young,  Raymond  L. ; 207  E.  Palae'e?Ave. ; Santa  Fe; 
ObG*  (PP). 


Santa  Rosa 

Funk,  Z.  E.;  Santa  Rosa;  Santa  Rosa. 

Silver  City  ... 

Allen,  Fredrick  Ward,  Jr.;  505  College  Ave.;  61;  GP 
(PP). 

Frazin,  Nathan  D. ; 204  W.  Market  St.;  49- W;  Ind. 
Gill,  Arthur  E.;  313  10th  St.;  Silver  City  196;  OALR*. 
Lane,  Russell  C.:  610  W.  6th  St.;  Silver  City  86; 
OALR*  (PP). 


Mitchell,  John  C. ; Box  469;  Silver  City  121;  PH* 
(PH). 

Ramer,  Samuel  M. ; 101  N.  Cooper  St.;  Silver  City  567; 
A (PP). 

Slusser,  Gerald  A.;  101  N.  Cooper  St.;  Silver  City 
567;  S*  (PP). 

Spencer,  R.  T. ; 803  6th  St.;  Silver  City  805;  GP  (PP). 
Watts,  R.  E. ; 101  N.  Cooper  St.;  Silver  City  567; 
S (PP). 

Springer  ... 

Blakely,  H.  Garth;  Springer;  Springer;  GP  (PP). 
'I’hompson,  Leland  A.;  Springer;  Springer  29;  GP 
(PP). 

Taos  ... 

Nicholson,  Ruth  L.;  Taos;  Taos  49;  Pd  (PP). 
Onstine,  Warner  A.;  Taos;  Taos  45;  GP. 

Pond,  Ashley;  S.  Plaza;  Taos  49;  GP  (PP). 

Rosen,  Albert  M. ; Theatre  Bldg.;  Taos  49;  GP  (PP). 

Tucumcari  ... 

Brown,  Ormiston  E.;  203  S.  2nd  St.;  Tucumcari  78; 
Ind. 

Goodall,  R.  George;  Tucumcari;  Tucumcari. 

Gordon,  A.  T.;  314  S.  2nd  St.;  Tucumcari  74;  GP 
(PP). 

Hoover.  Thomas  B.;  315  S.  2nd  St.;  Tucumcari  30;  GP. 
Thaxton,  William  M. ; 300  S.  2nd  St.;  Tucumcari  50;  S. 

Tyrone  ... 

Kaufman,  Cloid  E.;  Tyrone;  Tyrone  0818-F3;  GP 
(PP). 

Valmora  ... 

Gellenthien,  Carl  H.;  Valmora  Sanatorium;  Valmora; 
I*  (PP). 

Members  Out  of  State  ... 

Allen,  Jerry  H.  Jr.;  Barnes  Hosp.;  St.  Louis  10,  Mo.; 
FO  6400;  S*  (PG  Res.). 

Caylor,  Robert  N. ; 40  H McAlister  Place;  New 

Orleans  18,  La. 

Crane,  Roland  F.;  Higgins,  Texas;  Higgins  114;  GP. 
Hanks,  Samuel  J.;  Redlands,  Calif.;  Redlands  227-12; 
(Ret.). 

Harper,  Robert  W. ; 6828  Morgan  Ave.  South;  Min- 
neapolis, Minn.;  (PG  Res.). 

Jackson,  D.  O. ; 1310  Lincoln  St.;  Topeka,  Kans. 
Johnson,  Broor  A.;  Mare  Island  Naval  Shipyard; 

Vallejo,  Calif.  (Armed  Forces). 

Johnson,  John  J.  Sr.;  2500  E.  Van  Buren,  Phoenix, 
Arizona;  GP  (PP). 

Johnson,  John  J.,  Jr.;  Phoenix,  Ariz. 

Maldonado,  Jose;  Box  1142;  Corpus  Christie,  Texas. 
Monat,  Seymour;  5367  Pershing  Ave.;  St.  Louis,  Mo. 
Neal,  Lovell  A.;  3344  W.  Prairie;  Maltoon,  Illinois; 
ObG. 

Pate,  Rupert  H. ; 6536  Bandua;  Dallas  4,  Texas;  (PG 
Res.). 

Stoltz,  H.  F. ; 1619.  N.  Treat;  Tucson,  Ariz. 

Withers,  Martin  S. ; 14  Davenport  Ave.;  New  Haven, 
Conn.;  Pd*. 

Zeigler.  Paul;  100  4th  St.;  Petaluma,  Calif.;  Peta- 
luma 2368;  GP  (PP). 


oa) 


Rocky  Mountain  Medical  Journal  Supplement 


61 


PROKSsionm  nidi’s  pnoGimni 

A PLAN  OF 

INCOME  PROTECTION  WITH  LIFETIME  BENEFITS 

* MEDICAL  * DENTAL  'LEGAL  Professions 

Summary  of  Combined  Benefits  Provided  in  Policy  Form  UG  20N  of  United  Benefit  and  PG  20N  of  Mutual  Benefit 


r ■ 

Regular  Monthly 

Benefit 

<400.00 

y 

f ^ 

Double  Monthly  Benefits 
for  Specified  T ravel  Accidents 

<800.00 

V J 

r ^ 

Accidental 

Death  Benefit 

<10,000.00 

^ ' J 

f \ 

Double  Accidental  Death  Benefit 
for  Specified  Travel  Accidents 

<20,000.00 

V ' J 

NEW  HOME  OFFICE  • OMAHA,  NEBRASKA 
Separate  Policies  Underwritten  By 

myryiiL  boefii  hfalth  s flcciDEiu  flssocmTion 

THE  UVRGEST  EXCLUSIVE  HEALTH  & ACCIDENT  COMPANY  IN  THE  WORLD 

and 

yniTFD  e£y£Fii  life  lysuyyycF  coyipyyy 

ONE  OF  AMERICA’S  FOREMOST  LIFE  INSURANCE  COMPANIES 
For  Complete  Information,  Write  to: 


L.  V.  POTHAST,  GENERAL  MANAGER 
Colorado  State  Office 

ROCKY  MOUNTAIN  DIVISION 
Security  Building 

Denver  2,  Colorado.  AComa  3619  - AComa  3610 


62 


Rocky  Mountain  Medical  Journal  Supplement 


THE  UTAH  STATE  MEDICAL  ASSOCIATION 


OFTICBR-S  1948-1949 
President:  0.  A.  Ogilne,  Salt  Lake  City. 

President-elect:  C.  H.  Jenson,  Ogden. 

Past  President:  J.  C.  Hubbard,  Price. 

Honorary  President;  0.  W.  French,  Coalrille. 

First  Vice  President:  J.  G.  McQuarrie,  Bichfield. 

Second  Vice  President;  Ezra  Cragun,  Lewiston. 

Third  Vice  President:  R.  W.  Farnsworth,  Cedar  City. 

Secretary:  Ray  T.  Woolsey,  Salt  Lake  City. 

Executive  Secretary:  Mr.  W.  H.  Tibbals,  Salt  Lake  City. 

Treasurer:  L.  B.  White,  Salt  Lake  City. 

Councilor  First  District:  J.  G.  Olson,  Ogden. 

Councilor  Second  District:  V.  L.  Rees,  Salt  Lake  City. 

Councilor  Third  District;  L.  W.  Oaks,  Provo. 

Delegate  to  A.M.A.,  1948:  James  P.  Kerby,  Salt  Lake  City. 

Alternate  Delegate  to  A.M.A..  1948:  J.  J.  Weight,  Provo. 

Editor  of  the  Utah  Section  of  the  Rocky  Moonnain  Medical  Journal: 
R.  P.  Middleton,  Salt  Lake  City. 

STANDING  OOMMITTEBS 
Rocky  Mountain  Medical  Conference  Continuing  Committee;  E.  P.  Mid- 
dleton. Chairman,  Salt  Lake  City,  1949;  K.  B.  Castleton,  Salt  Lake  City, 
1960;  Clark  Rich,  Ogden,  1951;  Noall  Z.  Tanner,  Layton,  1952;  T.  R. 
Seager,  Vernal,  1953. 

Scientific  Program  Committee:  Ray  T.  Woolsey,  Chairman,  Salt  Lake 
City;  Drew  M.  Peterson,  Ogden;  Stanley  N.  Clark,  Provo;  P.  M.  Howard. 
Salt  Lake  City;  V.  P.  White,  Salt  Lake  City;  L.  V.  Broadbent,  Cedar 
City;  Paul  A.  Pemberton.  Salt  Lake  City. 

Pablic  Policy  and  Legislation  Committee:  F.  B.  King,  Chairman,  Price, 
1951;  Jesse  J.  Weight,  Provo,  1949;  M.  L.  Crandall,  Salt  Lake  City, 
1949;  V.  L.  Stevenson,  Salt  Lake  City,  1949;  N.  F.  Hicken,  Salt  Lake 
City,  1950;  Omar  Bu^e,  Logan,  1950;  John  Coletti,  Salt  Lake  City,  1950; 
W.  B.  West,  Ogden,  1951;  R.  V.  Larson.  Roosevelt,  1951. 

Medical  Defense  Committee:  W.  J.  Thomson,  Chairman,  Ogden,  1949; 
B.  W.  Owens.  Salt  Lake  City,  1949;  J.  L.  Hansen,  Vernal,  1949;  Homer 
Smith,  Salt  Lake  City,  1950;  L.  N.  Ossman,  Salt  Lake  City,  1950;  Erwin 

D.  Zeman,  Ogden.  1950;  Charles  W.  Woodruff,  Salt  Lake  City,  1951; 

James  Westwood,  Provo,  1951;  L.  H.  Merrill,  Hiawatha,  1951. 

Medical  Education  and  Hospitals  Committee:  I.  Bruce  McQuarrie,  Chair- 
man, Ogden.  1949;  L.  J.  Paul,  Salt  Lake  City,  1949;  0.  A.  Ogilvie, 
Salt  Lake  City,  1949;  G.  G.  Richards,  Salt  Lake  City,  1950.;  Bay  T. 
Woolsey,  Salt  Lake  City,  1950;  T.  B.  Robinson,  Salt  Lake  City,  1950; 

Seth  K Smoot,  Provo,  1951;  George  H.  Curtis,  Salt  Lake  City.  1951; 

B.  0.  Porter,  Logan,  1951;  R.  H.  Young,  Ex-Otflcio,  Salt  Lake  City. 

Medical  Economics  Committee:  Russell  Smith,  Chairman,  Provo,  1949; 
A.  B.  Denman,  Helper,  1949;  W.  T.  Ward,  Salt  Lake  City,  1950;  W.  R. 
Merrill,  Brigham  City,  1951;  Balph  Pendleton.  Salt  Lake  City,  1951. 


Public  Health  Committee:  John  R.  Bourne,  Chairman,  Roosevelt,  1949; 
F.  D.  Spencer,  Salt  Lake  City,  1950;  Ralph  Ellis,  Ogden,  1951. 

Military  Affairs  and  National  Emergency  Committee:  Chrles  Woodruff, 
Chairman,  Salt  Lake  City;  L.  J.  Paul,  Salt  Lake  City;  Mazel  Skolfleld, 
Salt  Lake  City;  W.  M.  Gorlshek,  Standardvllle  L.  R.  Cullimore,  Orem; 

Ray  H.  Barton,  Magna;  D.  T.  Madson,  Price;  Riley  G.  Clark,  Provo; 

Willis  Hayward,  Logan;  Dean  Tanner,  Ogden. 

Tuberculosis  and  Cardiovascular  Diseases  Committee:  Elmer  M.  Kil- 
patrick. Chairman,  Salt  Lake  City;  Bay  Rumel,  Salt  Lake  City;  D.  0.  N. 
Lindberg,  Ogden;  W.  C.  Walker,  Salt  Lake  City;  Donald  M.  Moore,  Ogden; 
Don  C.  Merrill,  Provo. 

Cancer  Committee:  0.  A.  Ogllvle,  Chairman,  Salt  Lake  City;  S.  W. 

Fennemore,  Price;  E.  D.  Zeman,  Ogden;  W.  G.  Noble,  Richmond;  Harold 

Austin,  Provo;  Stanley  G.  Rees,  Gunnison;  Paul  K.  Edmunds,  Cedar  City; 
P.  G.  Eskelson,  Vernal;  K.  B.  Castleton,  Salt  Lake  City. 

Fraeture  Committee:  A.  M.  Okelberry,  Chairman.  Salt  Lake  City;  Clark 
Rich,  Ogden;  Roy  H.  Robinson,  Kenilworth;  S.  M.  Budge.  Logan;  Norman 
R.  Beck,  Salt  Lake  City;  Louis  Perry,  Ogden;  J.  G.  McQuarrie,  Richfield; 
D.  C.  Evans,  Fillmore. 

Necrology  Committee:  W.  T.  Easier,  Chairman,  Provo;  L.  A.  Stevenson, 
Salt  Lake  City;  Jos.  A.  Phipps,  Salt  Lake  City. 

Industrial  Health  Committee:  Paul  S.  Richards,  Chairman,  Bingham 
Canyon;  L.  J.  Taufer,  Salt  Lake  City;  Frank  Gorlshek,  Helper:  Byron  Daynes, 
Salt  Lake  City;  E.  B.  Kuhe,  Salt  Lake  City;  D.  C.  Barker,  Ogden. 

Advisory  Committee  to  the  Woman’s  Auxilfary:  Vernal  Johnson,  Chair- 
man, Ogden;  0.  P.  Heninger,  Provo;  L.  G.  Moench,  Salt  Lake  City;  James 

K.  Palmer.  Salt  Lake  City. 

Public  Relations  Commitfee:  K.  P.  Middleton,  Chairman,  Salt  Lake  City; 

Louis  P.  Matthel,  Ogden;  R.  W.  Farnsworth,  Cedar  City;  Quinn  A.  Whit- 
ing, Price;  Clyde  J.  Daines,  Logan;  Ray  E.  Spendlove,  Vernal;  H.  I. 

Goodwin,  Salt  Lake  City;  Gilbert  Wright,  Salt  Lake  City;  Roy  B.  Hammond, 
Provo. 

Inter-Professional  Committee:  J.  Leroy  Kimball,  Chairman,  Salt  Lake 
City;  C.  C.  Hetzel,  Jr.,  Ogden;  T.  E.  Bauman,  Park  City;  Paul  Clayton, 
Salt  Lake  City;  Ralph  G.  Rigby,  Salt  Lake  City. 

Mental  Hygiene  Committee:  Roy  A.  Darke,  Chairman,  Salt  Lake  City: 

L.  G.  Moench,  Salt  Lake  City;  Wm.  D.  Pace,  Salt  Lake  City;  George  Cochran, 
Salt  Lake  City;  E.  L.  Weimers,  Provo. 

Fee  Schedule  Committee:  K.  B.  Castleton,  Chairman,  Salt  Lake  City; 
Howard  K.  Belnap,  Ogden;  J.  E.  Trowbridge,  Bountiful;  U.  R.  Bryuer, 
Salt  Lake  City;  W.  Leroy  Smith,  Salt  Lake  City;  J.  R.  Wherritt.  Hcber 
City;  0.  W.  Budge,  Logan. 

Speelal  Committee  to  Study  Dues:  H.  R.  Reiehman,  Chairman,  Salt 
Lake  City:  Eliot  Snow,  Salt  Lake  City;  Ezra  Cragun,  Lewiston. 

Rural  Health  Committee:  J.  J.  Weight,  Chairman,  Provo;  J.  G.  McQuarrie, 
Richfield;  J.  P.  Burgess,  Hyrum;  Noall  Z.  Tanner,  Layton. 


We  Welcome  Members  of  the 

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We  Appreciate  the  Business  of  the 
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Rocky  Mountain  Medical  Journal  Supplement 


63 


€lMcl 

Kremers-Urban  parenteral,  oral,  and  topical  drug  preparations 

Kremers-Urban  Company  has  had  over  fifty  years  of  fruitful  experi- 
ence in  the  development  and  manufacture  of  ethical  pharmaceuticals. 

An  established  program  of  continuing  research  and  product  development 
provides  a constantly  expanding  line  of  clinically  proved  medicinals, 
including  both  standard  therapeutic  agents  and  distinctive  specialties 
embodying  new  advances  in  drug  therapy.  The  name  Kremers-Urban 
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,he  advantages  of  parenteral  therapy  at  no  greater  eost  than  oral  nted^ 
ication.  Single  injection  provides  both  raptd  aetion  from  the 
estrogen  and  prolonged  effect  front  the  undissolved  portion -benefits 
may  persist  for  as  long  as  a month. 

(1)  Reduces  number  of  office  visits  required,  yet  allows 
control  of  ffierapy  to  remain  in  hands  of  physician.  (2)  Gradual  drop 
of  estrogen  level  permits  physiological  adjustment  to  low  Premeno- 
pausal hormone  levels.  (3)  Minimal  likelihood  of  withdrawal  bleeding 
(4)  Freely  syringeable  through  22-gauge  needle.  (5)  Syringes  easily 

5-cc  multiple-dose  vials.  Also  available  — ESTRUGEN- 
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Established  1894 


Box  2038 MILWAUKEE  1,  WISCONSIN 


Directory  of  Members  UTAH 

(As  of  December  31,  1948) 

For  Explanation  of  listings  and  symbols,  see  Page  1. 


American  Fork  ... 

Houston,  Vernon  F. ; 8 N.  Center;  American  Fork  111; 
GP  (PP). 

Noyes.  Kenneth  E. ; 15  N.  1st  East;  American  Pork 
6?:9-W;  GP  (PP). 

Ramsay,  Hubert  H.;  Box  8;  American  Fork  214; 
P*  (State  Hosp.). 

Richards,  Guy  A.;  Peonies  State  Bank  Bldg.;  Ameri- 
can Fork  135;  GP  (PP). 

Richards,  Guy  S(:  Peoples  State  Bank  Bldg.;  Ameri- 
can Fork  135;  GP  (PP). 

Beaver  City  ... 

McQuarrie,  Edward  S. ; Tolton  Bldg.;  Beaver  City 
50;  GP. 

Bingham  Canyon  ... 

Frazier,  Russell  G. ; 430  Main  St.;  Bingham  Canyon 
72;  GP  (PP). 

Hyde,  Charles  C. ; Bingham  Canvon;  Bingham  Can- 
yon 4;  GP  iPP). 

Jenkins,  Harold  C.:*430  Main  St.;  Bingham  Canyon 
72;  GP  (PP). 

Kane,  Cari  L. ; Brigham  Canyon;  Brigham  Canyon. 
Richards,  Paul  S.;  457  Main  St.;  Bingham  Canyon 
4;  Or  (PP). 

Straup,  Fred  E. ; 457  Main  St.;  Bingham  Canyon  4; 
GP. 

Bountiful  ... 

Christensen,  Chester  H.;  7 N.  Main  St.;  Bountiful 
552;  GP  (PP). 

Diumenti,  (Jeorge  S. ; Bountiful;  Bountiful  552-  GP. 
Stocks,  John  C. ; 257  S.  Main;  Bountiful  100;  GP. 
Trowbridge,  Juel  E.;  Bountiful;  Bountiful  552;  S 
(PP). 

Brigham  City  ... 

Felt,  J.  Gordon;  7 W.  Forest  St.;  Brigham  City  50; 
GP  (PP). 

Merrell,  W R. ; Cooley  Memorial  Hosp.;  Brigham 
City  45;  ObG  (PP). 

Moskowitz,  Simon  L,.;  124  W.  Forest  St.;  Brigham 
City  646;  R (PP). 

Pearse,  Harper  E. ; 127  W.  Forest  St.;  Brigham  City 
1'51;  GP  (PP). 

Rasmussen,  J.  Howard;  Eddy  Bldg.;  Brigham  City 
700;  GP  (PP). 

Weymuller,  Ernest  A.;  137  E.  Forest  St.;  Brigham 
City  108;  (PP). 

Castle  Dale  ... 

Turman,  Benjamin;  Castle  Dale;  Castle  Dale  15-Y; 
GP  (PP). 

Castle  Gate  ... 

Dong,  Edwin  V.;  Castle  Gate;  19-Rll;  GP  (PP). 

Cedar  City  ... 

Broadbent,  Deroy  V.;  55  N.  Main;  Cedar  City  70; 
S (PP). 

Edmunds,  Paul  K. ; Bank  Bldg.;  Cedar  City  70;  GP 
(PP). 

Farnsworth,  Reed  W.;  55  N.  Main;  Cedar  City  70; 
Pd  (PP). 

Graff,  A.  L. ; 66  S.  Main;  Cedar  City  66;  S (PP). 
Prestwich,  James  S. ; 39  N.  Main;  OADR. 

Williams,  Rymal  G.;  Cedar  City;  Cedar  City  66; 
S (PP). 

Clear  Creek  ... 

Hardy,  O.  W.;  Clear  Creek  Hosp. 

Clearfield  . . . 

Peterson,  Ralph  C. ; 204  Smith  Bldg.;  Kaysville 

302-R3;  GP  (PP). 

Coalville  ... 

French,  Oscar  W.;  Coalville;  Coalville  2146;  GP. 
Oldham,  Ernest  W.;  Coalville;  Coalville  3451;  GP 
(PP). 


Delta  ... 

Adams,  R.  Paul:  Delta  1771;  GP  (PP. 

Bird,  M.  E.;  Delta;  Delta  352. 

Devil’s  Slide  ... 

High,  Harlan  T. ; Devil’s  Slide;  Devil’s  Slide  193-Rl; 
GP  (PP). 

Dragerton  ... 

Colombo,  E.  V. : Dragerton;  Dragerton  10;  Ind. 
Monnette,  G.  A.;  Dragerton  Hospital;  Dragerton 
10;  GP  (PP). 

Starley,  S.  Paul;  Dragerton;  Dragerton  10;  GP  (PP). 

Draper  ... 

Sorenson,  J.  Toccoy;  Draper;  Midvale  0087-Rl;  GP 
(PP). 

Duchesne  ... 

Hamilton,  Dorin  D. ; Duchesne;  Duchesne  8162;  GP 
(PP). 

Ephraim  ... 

Anderson,  A.  J.;  Ephraim;  Ephraim  466. 

Eureka  ... 

Bailey,  Steele,  Jr.;  Elks  Bldg.;  Eureka  65;  GP. 

Fairview  ... 

Rigby,  .S'.  B.;  108  N.  Main;  Fairview  2537;  GP. 

Farmington  ... 

Jenson,  Harold  S. ; Box  613;  Farmington  6;  S (PP). 

Fillmore  ... 

Evans,  Dean  C.;  Fillmore;  Fillmore  311;  GP  (PP). 
Freeman,  Ralph  W. ; Fillmore;  Fillmore  741;  GP. 

Garfield  ... 

Chase,  Philips  M.;  c/o  Kennecott  Copper  Corp.; 
Magna  2.311;  Ind. 

Newman,  Milton  A.;  129  Washington  Ave.;  Magna 
6541;  GP  (PP). 

Garland  ... 

Wardleigh,  Claude  E.;  Garland  Bank  Bldg.;  Garland 
17-W;  OADR  (PP). 

Gunnison  ... 

Hagan,  J.  A.;  Gunnison;  Gunnison  2514;  GP  (PP). 
Rees,  G.  Stanford:  E.  Center  St.;  Gunnison  H-162; 
GP  (PP). 

Heher  City  ... 

Draper,  Willard  J. : Heher  City. 

Nielsen,  Karl  O.;  Heher  City;  Heher  City  38- J;  GP 
(PP). 

Wright,  Eldred  G.;  Heher  City;  Heher  City  24- J; 
GP  (PP). 

Helper  . . . 

Demman,  A.  R. ; 131  Main  St.;  Helper  SO-W;  GP  (PP). 
Gonzalez,  Pablo  M.;  Helper  State  Bank  Bldg.;  Helper 
153-W:  GP  (PP). 

Gorishek,  Prank  J. ; 143  S.  Main  St.;  Helper  99;  GP 
(PP). 

Hiawatha  ... 

Merrill,  DaVille  H. ; Hiawatha;  Hiawatha  3R2;  Ind 
(PP). 

Holladay  ... 

Root,  Frank  K. ; 4694  Holladay  Blvd.;  Holladay  210; 
(Ret.). 


Rocky  Mountain  Medical  Journal  Supplement 


65 


Hurricane  ... 

McIntyre,  E.  Clark;  Hurricane;  Hurricane  2121;  GP 
(PP). 

Hyrum  . . . 

Burg-ess,  J.  Paul;  5 E.  Main;  Hyrum  14;  GP  (PP). 

Kamas  ... 

Bingham,  L.  John;  Kamas;  Kamas  262;  GP  (PP). 

Kanab  ... 

Aiken,  George  R.;  Room)  11,  Watson  & By  bee  Bldg.- 
Kanab  109;  OABR.  (PP). 

Covington,  Fen  H.;  Kanab:  ObG*  (PG  Res.). 
H^^es^^eorge  T.;  30  North  Main;  Kanab  166; 

Kaj'sville  ... 

Clark  Stephen  H.;  Kaysville;  Kaysville  280;  GP. 
Rutledge,  Guy  D.;  Kaysville;  Kaysville  13;  GP. 

Kenilworth  ... 

R(^ins^  Roy  W.;  Kenil-worth;  Kenll-worth  9-R5: 
(PI*). 

Layton  . . . 

Tanner,  Joseph  B.;  Layton;  Kaysville  680;  GP  (PP). 
Tanner,  Noall  Z.;  Box  335;  Kaysville  680;  GP  (PP). 

Lehi  ... 

Eddington,  Elmo;  206  State  St.;  Lehi  22;  GP  (PP). 

1301^  W.  Main  St.;  Lehi  332;  GP 


Lewiston  ... 

Cragun,  W.  Ezra.;  Box  16;  Le-wiston  44-W;  GP  (PP). 

Logan  . . . 

^^(*P^  N. ; 3 N.  Main  St.;  Logan  22;  Pd* 

Budge,  Omar  S. ; 3 N.  Main  St.;  Logan  22;  I*  (PP) 
Budge,  O.  Wendell;  3 N.  Main  St.:  Logan  22;  S*  (PP) 
Budge,  Scott  M.;  3 N.  Main  St.;  Logan  22-  S* 
Dames,  Clyde  J.;  271  Blvd.;  Logan  54 
Gasser,  C^orge  W.:  3 N.  Main  St.;  Logan  22. 
Hanson,  E.  L.;  52  N.  1st  East;  Logan  54-  U 
Harmston,  Gordon  J. ; 225  Blvd.:  Logan’  ' 
Hayward,  J.  C.;  3 N.  Main  St.;  Logan  22 ■ I*. 
Hayward,  J.  Clare;  3 N.  Main  St.;  Log-an  *22 ■ I*  (PP) 
Hayward,  ^seph  William:  Box  422;  Logan  (Ret  )' 
(PP)  ’ ® H.;  3 N.  Main  St.;  Logan  22;  Ob(j* 

McGee,  Harry  R. ; Box  286;  Logan;  (Ret.). 

Paulson,  Niels  P.;  31  W.  1st  North:  Logan  863;  Si*. 
^TpiO  East;  Logan  54;  OALR* 

E.  Center;  Logan  71. 

C.;  52  N.  1st  East;  Logan  54-  S 
Rees,  George  LeRoy;  3 N.  Main  St.;  Logan  22;  AnesL 
^*(PP)^*^^^^  ^ Logan  22;  OALR* 


Magna  . . . 

^Tpp”’  Hunter,  Jr.;  Magna;  Magna  6521;  S 

wit"!’  2314  So.  9100  West;  Magna. 

Keese,  Owen  G. ; Magna. 


Manti  ... 

Sears,  George  L.;  Manti;  Manti  135;  GP 

21  S.  Main  St.;  Manti  165; 

Sear^  Richard  H.;  16  W.  Union  St.;  Manti  153;  GP 


Marysville 

Jenkins,  Kurt  L. ; Marysville:  Marysville. 

Midvale  ... 

Alley,  John  S.;  47  E.  Center  St.;  Midvale  204-  S* 
Graham,  Oscar  J.;  69  N.  Holden;  Midvale  672-W- 
Ind  (PP). 

Ho^er,  Andrew  J.;  2 Si  Main  St.;  Midvale  209;  S* 

Jones,  j.  O.;  47  E.  Center  St.;  Midvale  204;  Ob  (PP) 
Lindsay,  A.  Van;  2 S.  Main  St.;  Midvale  209;  OALR 

Young,  Harold  E.;  Midvale;  Midvale  209;  GP  (PP). 


Milford  . 

Fowler,  H.  B.;  Milford;  Milford  210;  GP  (PP). 

Moab  ... 

Allen,  I.  W.;  Moab;  Moab  13 -Rl. 

Temple,  H.  V.;  Moab;  Moab;  GP  (PP). 

Morgan  . . . 

Abbott,  E.  M. ; Morgan;  Morgan  40. 

Martineau,  John  R. ; Morgan;  Morgan;  Pd  (PP). 

Moroni  ... 

McAffee,  Don  B.;  Moroni;  Moroni  2181;  GP  (PP). 

Mt.  Pleasant  ... 

Madsen,  George  B.;  146  W.  Main  St.;  Mt.  Pleasant  7; 
GP  (PP). 

Murray  ... 

Argyle,  Emery  M. ; 138  E.  48th  South;  Murray  45; 
GP  (PP). 

Ball,  John  M.;  298  E.  48th  So.;  GP  (PP). 

Boggess,  Eldin  W.;  14014  E.  4800  South;  Murray  34; 
ObG  (PP). 

Challis,  Donald  W.;  140%  E.  4800  South;  Murray  34; 
GP  (PP). 

Christiansen,  Evan  L.;  140  E.  48th  South;  Murray  4; 
GP  (PP). 

Johnson,  Raymond  O.;  140  E.  48th  South;  Murray  4; 
S (PP). 

Morgan,  Sherman  M. ; 4620  So.  State  St.;  Murray; 
GP  (PP). 

Sundwall,  Olaf;  138  E.  48th  South;  Murray  45;  GP 
(PP). 

Sundwall,  Val;  118  E.  48th  South;  Murray  84;  GP 
(PP). 

Thone,  Frank  H. ; 120  E.  48th  South;  Murray  47-W; 
GP  (PP). 

Nephi  ... 

Beckstead,  Francis  H.;  Nephi;  Nephi  25;  GP  (PP). 
Steele,  John  G.;  34  S.  Main  St.;  Nephi  373;  GP  (PP). 

Ogden  ... 

Anderson,  Wesley  H.;  412  First  Security  Bank  Bldg.; 
2-1162;  Pd*  (PP). 

Barker,  D.  C. ; 727  Eccles  Bldg.;  Ogden  5597:  S (PP). 
Bartlett,  Frank  K. ; 412  First  Security  Bank  Bldg.; 
2-2813;  S (PP). 

Belnap,  Howard  K. ; 327  Kiesel  Bldg.;  2-7184;  Pr* 
(PP). 

Benson,  Leo  W.;  3930  Washington  Blvd.;  3-3474  S 
(PP). 

Brown,  W.  R. ; 412  First  Security  Bank  Bldg.;  6784; 
ObG  (PP). 

Budge,  Wallace  H. ; 2404  Washington  Blvd.;  8001; 
GP  (PP). 

Burdett,  Ray  E.;  First  Security  Bank  Bldg.;  Ogden; 
GP. 

Christensen,  Jerome  J.;  412  First  Security  Bank 

Bldg.;  7023;  GP  (PP). 

Conroy,  Francis  R.;  430  Eccles  Bldg.;  2-8271;  GP 
(PP). 

Curtis  Lindsey  R. ; 2279  Jackson  Ave. ; 5773;  ObG* 
(PP). 

Daines,  Orson  S.;  510  Eccles  Bldg.;  2-1713;  OALR*. 
De  Mars,  Harold  V.;  218  First  Security  Bank  Bldg.; 
2-7537;  ALR*  (PP). 

Draper,  Roscal  H;  Eccles  Bldg.;  7767;  S. 

Dumke,  E.  R.;  727  Eccles  Bldg.;  5597;  S (PP). 

Ellis,  Ralph  C.;  3000  Polk  Ave.;  4666;  Path*  (PP). 
Fister,  George  M. ; 710  Eccles  Bldg.;  9832;  U*  (PP). 
Goddard,  Edward  P. ; 604  First  Security  Bank  Bldg.; 
9300;  GP  (PP). 

Gudmundson,  Arthur  D.;  329  Eccles  Bldg.;  2-7411; 
GP  (PP). 

Hancock,  Heber  C. ; 607  Eccles  Bldg.;  4563;  S (PP). 
Harding,  Glen  F. ; 528  Eccles  Bldg.;  2-8181;  Oph* 
(PP). 

Hetzel,  Clarence  C.,  Sr.;  721  Eccles  Bldg.;  9118; 
OALR*  (PP). 

Hetzel,  C.  Charles,  Jr.;  721  Eccles  Bldg.;  9118; 
OALR*  (PP). 

Hirst,  R.  N.;  312  Eccles  Bldg.;  2-9573;  GP  (PP). 
Howe,  Rulon  F. ; 617  First  Security  Bank  Bldg.; 
5231;  S*  (PP). 

Imus,  A.  Austin,  Jr.;  578  24th  St.;  8251;  GP  (PP). 
Iriki,  Walter  K.;  578  23rd  St.;  4139;  GP  (PP). 

Jenson,  Conrad  H. ; 418  First  Security  Bank  Bldg.; 
9703;  S (PP). 


66 


Rocky  Mountain  Medical  Journal  Supplement 


Ogden  . . . (Continued) 

Johnson,  Vernal  H. ; 2279  Jackson  Ave. ; 5773;  ObG* 
(PP). 

Johnston,  Rich;  704  Eccles  Bldg.;  4511;  GP. 
Jorgensen,  C.  Louis;  2301  Eccles  Ave.;  2-6649;  ObG* 
(PP). 

Kato,  Hideo  H.;  965  28th  St.;  3-0262;  I*  (PP). 
Kearns,  Grant  F.;  2301  Eccles  Ave.;  2-9404;  GP 
(PP) 

Lindberg,  David  O.  N. ; Utah  State  Tuberculosis 
Sanitarium;  4636;  T*  (HA). 

Loomis,  W.  Prank;  727  Eccles  Bldg.;  5597;  S (PP). 
Lowe,  George  H.,  Jr.;  501  First  Security  Bank  Bldg.; 
3-0835;  S*  (PP). 

Lund,  Anthony  J.;  710  Eccles  Bldg.;  9832;  U*  (PP). 

Matthei,  Louis  P.;  3000  Polk  St.;  4666;  R»  (PP). 
McQuarrie,  I.  Bruce;  2400  Washington  Blvd.;  4312; 
S (PP). 

Merrill,  L.  S.;  518  First  Security  Bank  Bldg.;  2-2694; 
ObG  (PP). 

Mills,  Earnest  P. ; 516  First  Security  Bank  Bldg.; 
7947;  GP  (PP). 

Moesinger,  Gilbert  C;.  418  First  Security  Bank  Bldg.; 
Ogden  9703;  ObG  (PP). 

Moore,  Donald  M. ; First  Security  Bank  Bldg.;  Og- 
den; I*  (PP). 

Morrell,  Joseph  R.;  2533  Eccles  Ave.;  Ogden;  (Ret.). 
Moyes,  George  G.;  201  Eccles  Bldg.;  7969;  GP. 

Nelson,  Henry  W.;  712  Eccles  Bldg.;  7253;  ObG  (PP). 
Nelson,  L.  D. ; Ogden;  GP  (PP). 

Noall,  Wendell;  1097  27th  St.;  2-7158;  GP  (PP). 
Olson,  Don  Dee;  412  First  Security  Bank  Bldg.;  Og- 
den 2-2813;  I*  (PP). 

Olson,  J.  G.;  304  Eccles  Bldg.;  9583;  I*  (PP). 

Perry,  Louis  S.;  305  First  Security  Bank  Bldg.; 
7797;  Or*  (PP). 

Peterson,  Drew  M. ; 2404  Washington  Blvd.;  7797;  I* 
(PP). 

Pugmire,  LeRoy;  218  First  Security  Bank  Bldg.; 
2-7537;  Oph*  (PP). 

Pugmire,  Ralph  W.;  218  First  Security  Bank  Bldg.; 
2-7537;  Oph*  (PP). 

Rich,  Clark  L.;  302  First  Security  Bank.  Bldg.;  7797; 
S (PP). 

Rich,  Edward  I.;  2624  Taylor  Ave.;  Ogden;  (Ret.). 
Rich,  Homer  R.;  227  Kiesel  Bldg.;  Ogden  3-3131; 
Pd*  (PP). 

Rich,  Junior  E.;  521  Eccles  Bldg.;  2-2381;  S (PP). 
Rogers,  LaMar;  329  Eccles  Bldg.;  2-7391;  GP  (PP). 
Ross,  Aaron  B.;  3425  Riverside  Rd.;  Ogden  3-1170; 
GP  (PP). 

Se|dnen^M.  J.;  604  First  Security  Bank  Bldg.;  9300; 

Smith,  Eugene  H.;  714  Eccles  Bldg.;  8902;  Pd*. 

Simth,  Leslie  A.;  2404  Washington  Blvd.;  2-2634; 

Pd*. 

Stocks,  R.  C.;  Eccles  Bldg.;  Ogden. 

Stranquist,  Henry  C.;  801  Eccles  Bldg.;  4710;  GP. 
Stratford,  Keith;  617  First  Security  Bank  Bldg.; 
2-6791;  S. 

Sycamore,  Leland  S.;  821  Eccles  Bldg.;  2-6206;  GP 
(PP). 

Tanner,  Dean  W.;  405  First  Security  Bank  Bldg.;  S* 

(PP). 

Thomson,  Wendell  J.;  2404  Washington  Blvd.;  5213; 
S (PP). 

VanHook,  (Tloyd  D.;  617  First  Security  Bank  Bldg.; 
2-6791;  GP  (PP). 

Ward,  Vernon  L. ; 2279  Jackson  Ave.;  5773;  ObG* 
(PP). 

West,  Warren  B.;  828  Eccles  Bldg.;  2-6619;  R*  (PP). 
Wilson,  W.  J.;  407  ECcles  Bldg.;  9771;  S (PP). 
Zeman,  Erwin  D.;  2440  Harrison  Blvd.;  5521;  CP 

(PP). 

Orem  ... 

Allred,  E.  Wayne;  Orem;  Orem  0791J1;  GP  (PP). 
Cranney,  W.  Doyle;  Orem;  Orem  0688-Jl;  GP  (PP). 
Cullimore,  Leland  K.;  Orem;  Orem  0547 J2;  GP  (PP). 
Madsen,  Carlos  N. ; Orem;  Orem. 

Smoot,  Seth  E. ; Orem;,  Orem  0688 Jl;  GP  (PP). 

Panguitch  ... 

Duggins,  Sims  E.;  Panguitch;  Panguitch  192;  GP 
(PP). 

Park  City  ... 

Bauman,  Thomas  E.;  310  Main  St.;  Park  City  32; 
GP  (PP). 

Laffoon,  Clint  A.;  354  Main  St.;  Park  City  28;  GP. 


Payson  ... 

Curtis,  A.  L. ; 1st  E.  and  Utah  Ave.;  Payson  74;  S 
(PP). 

Curtis,  Emerson  C. ; 1st  E.  and  Utah  Ave.;  Payson 
74;  GP  (PP). 

Oldroyd,  Merrill  L.;  150  S.  1st  W. ; Payson  38;  GP. 
Stewart,  Max  W.;  Payson. 

Pleasant  Grove  ... 

Anderson.  Grant  T. ; 30  S.  Main;  Pleasant  Grove 
3551;  GP  (PP). 

Price  ... 

Anderson.  G<ale  W.;  17  S.  Carbon  Ave.;  466;  GP  (PP). 
Dorman,  J.  Eldon;  33  E.  Main  St.;  Price  799;  OALR* 
(PP). 

Fennemore,  Stanford  W.;  Price;  Price  465;  GP. 
Green,  Carl  R. ; First  Natl.  Bank  Bldg.;  Price  255; 
GP  (PP). 

Hubbard,  John  (Tlark;  303  Electric  Bldg.;  Price 
246-J;  S. 

King,  F.  R.;  304  Eastern  Utah  Electric  Bldg.;  Price 
473;  GP  (PP). 

Madsen,  Daniel  T. ; Silvagni  Bldg.;  Price  31;  GP 
(PP). 

Whiting,  Quinn  A.;  20’  N.  Carbon;  Price  510;  GP  (PP). 

Provo  ... 

Allen,  Glenn  L. ; 225  N.  University  Ave.;  132;  GP. 
Austin.  Harold;  225  N.  University  Ave.;  132;  ObG 

(PP). 

Bowen,  John  M.;  418  E.  Center;  3410;  GP  (PP). 
Clark,  Elden  D.;  22  E.  1st  North;  704-W;  OALR* 
(PP). 

Clark,  J.  Kyle;  192  S.  1st  East;  2614;  GP  (PP). 

Clark,  Riley  G.;  143  S.  1st  East;  2614;  GP  (PP). 
Clark,  Stanley  M. ; 225  N.  University  Ave.;  132;  S 
(PP). 

Clark,  Stanley  N. ; 225  N.  University  Ave.;  132:  GP 
(PP). 

Cullimore,  Lloyd  L.;  33  E.  2nd  South;  862;  (PP). 
Georges,  Samuel  W.;  47  S.  1st  East;  700;  GP  (PP). 
Hammond,  Roy  B.;  10  S.  2nd  East;  290;  GP  (PP). 
Hasler,  Walter  T.;  192  S.  1st  East;  2614;  OALR*. 
Heninger,  Owen  P.;  Utah  State  Hosp.;  295;  P*  (State 
Hosp.). 

Jorgenson,  Ralph  E.;  79  E.  3rd  North:  2808;  Oph* 
(PP). 

Kelly.  Philemon  M. ; 192  S.  1st  East;  2614;  (Ret.). 
Merrill,  Don  C.;  10  S.  2nd  East;  290;  GP  (PP). 

Nixon,  James  W.;  192  S.  1st  East;  2614;  GP. 

Oaks,  L.  Weston;  33  E.  2nd  South;  864;  Oph*  (PP). 
Ostler.  David  Ei;  169  N.  University  Ave.;  670;  C>ALR* 
(PP). 

Rees,  H.  David;  Utah  Valley  Clinic;  Provo;  S*  (PP). 
Smith,  Charles  M.;  146  E Center  St.;  148;  GP  (PP). 
Smith,  J.  Russell;  218  N.  University  Ave.;  2805;  S 
(PP). 

Taylor,  Fred  W.;  147  S.  University  Ave.;  383;  (Ret.). 
Thomas,  Rex  T. ; 418  E.  Center  St.;  3410;  S'  (PP). 
Wakefield,  R.  H. ; 410  N.  University  Ave.;  3320;  Pd* 
(PP). 

Wallick,  D.  L. ; 855  N.  University  Ave.;  671-W;  GP. 
Webster,  J.  W. ; 33  E.  2nd  South;  862;  Provo. 
Weight,  Jesse  J.;  81  E.  Center;  254-W;  GP  (PP). 
Westwood,  James  B.;  65  E.  2n(i  South;  2371;  Ob 

(PP). 

Wiemers,  Eugene  L.;  Utah  State  Hosp.;  295;  PN* 
(State  Hosp.). 

Richfield  • • • 

Dewey,  H.  Asa;  108  N.  Main  St.;  Richfield  77:  GP 

(PP). 

Gledhill  Thomas  R. ; 108  N.  Main  St.;  Richfield  99; 
GP  (PP). 

Malouf,  R.  N. ; Commercial  Bank  Bldg.;  Richfield 
260:  GP  (PP). 

McQuarrie,  John  G.;  108  N.  Main  St.;  Richfield  17; 
S (PP). 

Miles,  Wyatt  W. ; 206  Commercial  Bank  Bldg.;  Rich- 
field 1;  GP. 

Wilson,  Roy  H. ; Health  District  No.  5;  Richfield 
511;  PH*  (PH). 

Richmond  • • • 

Noble,  Willard  G.;  Richmond;  Richmond  66;  GP 
(PP). 


Rocky  Mountain  Medical’  Journal  Supplement 


67 


We,  Welcome  the  Business  of  the 
Medical  Fraternity 

MINIT-MAN  AUTO 
WASH 

YOUR  CAR  WASHED  IN  6 MINUTES! 

“At  the  Sign  of  the  Minute  Man” 

A Mechanical  Marvel  That  Does  Wash, 
Polish  and  Dry  Autos  Efficiently  at 
the  Rate  of  1 Car  Every  3 Minutes 

Power  Glazing 

Open  6 Days  a Week 
8;30  A.M.  to  5:30  P.M. 
Sundays  from  9 A.M.  to  2 P.M. 

1155  Welton  Street,  Denver,  Colorado 
Phone  AComa  3323 


We  Welcome  the  Business  of  the 
Medical  Fraternity 

J.  A.  JOHNSON  & SON 

GAS  AND  COAL  FIRED  FURNACES 
INSTALLED — AIR  CONDITIONING 

Repairs  for  All  Furnaces  — Furnaces 
Vacuum  Cleaned — Automatic  Humidi-' 
tiers — Gas  Conversion  Burners  Sold 
and  Installed 

SHEET  METAL  PRODUCTS 

No  Down  Payment — FHA  Budget 
Payment  Plan 

Guaranteed  W orkmanship 

W.  A.  JOHNSON,  Prop. 

Heating  Engineer 

709  East  6th  Ave.  Denver 

Phone  KEystone  4031 
If  No  Answer  to  Above  Call  PE.  7398 


We  Welcome  the  Business  of  the 
Doctors  and  the  Hospitals 

☆ 

Kelly  Electric 
Company 

Electrical  Contractors 
Commercial  and  Residential  Wiring 

“LET  US  PLAN  YOUR  LIGHTING” 

1036  Champa  Street  Denver,  Colo. 
Phones:  MAin  4980 — FRemont  5133 


We  Welcome  the  Business  of  the 
Medical  Profession 

piETCHEl^ 

Construction  Company 

ARVADA,  COLORADO 
5990 

Wadsworth 

ARVADA 

172 

Complete  Planning  and  Building 
Service — Commercial  or  Residential 

“BUILDERS  OF  BETTER 
BUILDINGS” 

GEO.  B.  FLETCHER 

5990  Wadsworth  Arvado  172 

FRED  R.  SORENSON 

6240  Wadsworth  Arvada  690R 


68 


Rocky  Mountain  Medical  Journal  Supplement 


Roosevelt  ... 

Bourne,  John  R. ; Room  103,  Swain  Bldg.;  Roosevelt 
50:  GP  (PP). 

Larson,  R.  V.;  Norling  Bldg.;  Roosevelt  192;  GP. 
Wyler,  Glenn  H.:  Roosevelt:  Roosevelt  9;  GP  (PP). 


Roy 

Flinders,  Arley;  Roy;  Roy  2-5952;  GP  (PP). 


St.  George  . . . 

McGregor,  Alpine  W.;  35  S.  100  East;  St.  George  265; 
GP  (PP). 

McGregor,  L.  W.;  35  S.  100  East;  St.  George  265;  S* 
(PP). 

Reichmann,  Wilford  J. ; 14  N.  Main  St.;  St.  George 
66:  GP  (PP). 

Woolf,  W.;  St.  George;  St.  George;  (Ret.). 


Salina  ... 

Baird.  Thomas  D. ; Salina  Hospital;  Salina  152;  GP 
(PP). 

Noyes,  Rae  E.;  Salina;  Salina  52;  GP. 


Salt  Lake  City  ... 

Alexander,  Robert  J. ; 902  Boston  Bldg.;  3-1341;  Salt 
Lake  City  1;  PI*. 

Allen,  D.  K.;  Boston  Bldg.;  4-6142;  Salt  Lake  City  1. 
Allen,  George  A.;  710  Boston  Bldg.;  3-2058;  Salt 
Lake  City  1;  GP  (PP). 

Allen.  Joseph  H. : 1011  Hollywood  Ave. ; Salt  Lake 
City  5;  Anes*  (PG  Res.). 

Allen,  M.  Lowry;  526  Judge  Bldg.;  3-6253;  Salt  Lake 
City  1;  R*  (PP). 

Allison,  R.  S.;  831  Boston  Bldg.;  3-7604;  Salt  Lake 
City  1;  GP  (PP). 

Alway,  Robert  H.;  Medical  School,  University  of 
Utah;  6-8771;  Pd*  (Med.  School). 

Anderson,  A.  A.;  First  Natl.  Bank  Bldg.;  3-4734; 
Salt  Lake  City  1. 

Anderson,  Howard  T. ; 401  Medical  Arts  Bldg.; 

3- 7875;  Salt  Lake  City  1;  I*  (PP). 

Anderson,  J.  Mercer;  509  First  Natl.  Bank  Bldg.; 

4- 2022;  Salt  Lake  City  1;  A (PP). 

Anderson,  John  A.;  Dept,  of  Pediatrics,  County 
Hosp.;  6-8771;  Pd*  (Med.  School). 

Anderson,  John  R.;  305  Medical  Arts  Bldg.;  3-5848. 

Ext.  7;  Salt  Lake  City  1;  GP  (PP). 

Anderson.  Rees  H. ; 701  Medical  Arts  Bldg.;  9-2037: 
Salt  Lake  City  1;  S (PP). 

Bailey,  Fuller  B. ; 718  Boston  Bldg.;  5-1100;  Salt 
' Lake  City  1;  I*  (PP). 

Barrett.  C.  Elmer;  618  Boston  Bldg.;  4-8041;  S^lt 
Lake  City  1;  I*  (PP). 

Barrett,  E.  L. ; 618  Boston  Bldg. ; ' 4-8041 ; Salt  Lake 
City  1;  I*  (PP). 

Bauerlein,  Theodore  C. ; 699  E.  South  Temple;  4-5673; 
I*  (PP). 

Bayles,  Wesley  L. ; Judge  Bldg.;  5-5331;  Salt  Lake 
City  1. 

Beck,  Norman  R. ; 220  Boston’  Bldg.;  4-8408;  Salt 
Lake  City  1;  Or*  (PP).  ^ 

Beech,  Robert  D.;  699  E.  South  Temple;  4-5673;  I* 
(PP). 

Behle,  Charles  F.;  991  So.  12th  E. ; 8-1110;  (Gov.). 
Belden,  Galen  O.;  410  Judge  Bldg.;  3-3314;  Salt  Liake 
City  1;  GP  (PP). 

Bennion,  William  H. ; 115  E.  So.  Temple:  9-3701: 
I*  (PP). 

Berman,  Harry;  1016  Medical  Arts  Bldg.;  5-8895; 

Salt  Lake  City  1;  OALR*  (PP). 

Bernson,  Donald  C.;  809  Medical  Arts  Bldg.;  5-2933; 
Salt  Lake  City  1;  N*. 

Bigelow,  W.  W.;  State  Capital;  Salt  Lake  City: 
PH*  (PH). 

Billeter,  Oscar  A.;  837  Boston  Bldg.;  9-0263;  Salt  Lake 
City  1;  PI*  (PP).  ■ 

Blood,  David  W. ; 1012  Medical  Arts  Bldg.';  4-3705; 

Salt  Lake  City  1;  I*  (PP). 

Blood,  Wilkie  H.;  1012  Medical  Arts  Bldg.;  4-3705; 

Salt  Lake  City  1;  Pd*  (PP). 

Brewerton,  Joseph  O.;  1086  E.  21st  South;  7-0262; 

Salt  Lake  City  6;  GP  (PP). 

Brinton,  Sherman  S. : 220  E.  South  Temple;  Salt  Lake 
City  2. 

Brooke,  Wallace  S. ; 711  Boston  Bldg.;  3-8967;  Salt 
Lake  City  1;  S*  (PP). 

Brown,  Archie  L.;  353  E.  Broadway;  3-1022;  Salt 
Lake  City  2;  GP. 

Brown,  Hugh  O. ; St.  Mark’s  Hosp.;  8-1806;  Anes* 
(PP). 

Brown,  John  Z. ; Medical  Arts  Bldg.;  5-5656;  Salt 
Lake  City  1;  S. 


Brown,  John  Z.,  Jr.;  1015  Medical  Arts  Bldg.;  5-8839; 

Salt  Lake  City  1;  ObG*  (PP). 

Bryner,  Ulrich  R. ; 413  Medical  Arts  Bldg.;  5-4654; 
Salt  Lake  City  1;  S (PP). 

Buck,  Robert  E.;  699  E.  South  Temple:  4-5673;  Salt 
Lake  City  1;  I*  (PP). 

Burnham,  P.  J. : First  Security  Bank  Bldg.;  4-3531; 
Salt  Lake  City  1:  S. 

Calderwood,,  W.  R.;  47  W.  South  Temple;  4-8401; 
Salt  Lake  City  1;  (Exec.). 

Callaghan,  Adlai  E.;  615  Boston  Bldg.;  4-8321;  Salt 
Lake  City  1;  OALR*  (PP). 

Canister,  A.  (jyril;  409  Medical  Arts  Bldg.;  4-6226; 
Salt  Lake  City  1;  PI  (PP). 


Callister,  Thomas  K. ; 407  Medical  Arts  Bldg.;  9-5175; 

Salt  Lake  City  1;  GP  (PP). 

Cannon,  J .Floyd;  115  E.  South  Temple;  9-3701;  Salt 
Lake  City  1;  I*  (PP). 

Cannon,  W.  T. ; 2043  E.  27th  South;  Salt  Lake  City; 
(Ret.). 

Capener,  E.  J.;  414  Medical  Arts  Bldg.;  3-7736; 

Salt  Lake  City  1;  GP  (PP). 

Carlquist,  John  H. : L.D.S.  Hospital;  3-5881;  Salt 
Lake  City  2;  Path*  (Hosp.). 

Castleton,  Kenneth  B.;  711  Boston  Bldg.;  3-8967;  Salt 
Lake  City  1;  S*  (PP). 

Christenson,  C.  John:  St.  Mark’s  Hosp.;  Anes. 
Christenson,  V.  A.;  699  E.  South  Temple;  4-5673; 
ObG*  (PP). 

Clark,  John  H.;  458  S.  Main  St.;  5-8224;  Salt  Lake 
City  1;  S*  (PP). 

Clark,  Vinton  J.;  Salt  Lake  City;  (Ret.). 

Clausen,  Fred  W.;  718  Boston  Bldg.;  5-1100;  Salt 
Lake  City  1;  I*  (PP). 

Clawson,  Thomasi  A.,  Jr.;  206  E.  South  Temple; 
4-2891  I*. 


Clayton,  Paul  A.;  1045  E.  1st  South;  4-8441;  Anes* 
(PP). 

Cleary,  James  A.;  1103  Boston  Bldg.;  9-1002;  Salt 
Lake  City  1;  ALR*  (PP). 


Clegg.  Reed  S.;  714  Medical  Arts  Bldg.;  3-2625.  Salt 
Lake  City  1;  Or*  (PP). 

Clinger,  Wallace  M.;  710  Medical  Arts  Bldg.;  5-9157; 
Salt  Lake  City  1;  I*. 

Cochran,  George  A.;  1001  Medical  Arts  Bldg.;  5-4702; 
Salt  Lake  City  1:1*. 

Coletti,  John  M.;  613  Judge  Bldg.;  5-5331;  Salt  Lake 
City  1:  GP  (PP). 

Colton,  Warren  A.;  Veterans  Adm.  Hosp.;  9-2011, 
Ext.  32;  Salt  Lake  City  3;  HA*  (Gov.). 

Condie,  Lvman  W. ; 305  Medical  Arts  Bldg.;  3-5848; 
GP  (PP). 

Coombs,  Morgan  S. ; 701  Judge  Bldg.;  4-6335;  Salt 
Lake  City  1;  ObG*  (PP). 

Coray,  Q.  B. ; 207  Medical  Arts  Bldg.;  5-4081;  Salt 
Lake  City  1 ; R*. 

Cornwall,  Charles  R. ; 909  Medical  Arts  Bldg.;  Salt 
Lake  City  1;  ObG  (PP). 

Cottam,  Alma  H.;  220  E.  South  Temple;  5-5355;  GP 
(PP). 

Cowan,  Leland  R. : 606  Medical  Arts  Bldg.;  5-3991; 
Salt  Lake  City  1. 

Crandall,  Alan  S.;  141  E.  Second  South;  4-3210;  Salt 
Lake  Clity  1;  Oph*  (PP). 

Crandall,  Myron  L. ; 608  Medical  Arts  Bldg..;  9-4663; 

Salt  Lake  City  1;  GP  (PP). 

Cockett,  Kenneth  A.;  115  E.  South  Temple:  9-3701; 
I*  (PP). 

Crowder,  Earl  R.;  325  8th  Avenue;  3-5881;  R*  (PP). 
Curtis  (George  H. : 1017  Medical  Arts  Bldg.;  5-0365; 

Salt  Lake  City  1;  I*  (PP). 

Curtis,  George  N.;  512  Judge  Bldg.;  4-1551;  Salt 
Lake  City  1;  GP. 

Cutler,  Frank  H.;  206  E.  South  Temple;  9-6011;  Salt 
Lake  City  1;  GP  (PP). 

Cutler,  Preston  R. : 807  Medical  Arts  Bldg.;  4-1091: 
Salt  Lake  City  1;  S*. 

Daines,  Laura  L. ; 141  E.  2nd  South:  5-9362;  ObG*. 
Dalrymple,  Robert  M. ; 1729  Harvard  Ave.;  Salt  Lake 
City. 

Darke,  Roy  A.;  512  Judge  Bldg.;  9-6012;  Salt  Lake 
City  1;  P*  (PP). 

Daughters,  Frank  F. ; 4694  Holladay  Blvd.;  Holladay 
210;  Salt  Lake  City  7;  GP  (PP). 

Davis,  James  Z.;  410  Judge  Bldg.;  3-3314;  Salt  Lake 
City  1;  I*  (PP). 

Davis,  Jean  Patricia;  555  E.  1st  South;  9-5470;  Pd* 
(PP). 

Davis,  Melvin  R. ; 3007  Highland  Drive;  8-1926;  Salt 
Lake  City  6;  GP  (PP). 

Day,  J.  Edward:  501  Judge  Bldg.;  5-1366;  Salt  Lake 
City  1;  GP  (PP). 

Daynes,  Byron  W.;  1106  Walker  Bank  Bldg.;  5-8611; 
Salt  Lake  City  1;  S (PP). 

Dean,  Leona  K.;  699  E.  South  Temple;  4-5673;  Salt 
Lake  City  2;  ObG*  (PP). 

Dieckmann,  Johanna  M. ; 147  E.  2nd  South;  3-5677; 
Salt  Lake  City  1;  CP*. 


Rocky  Mountain  Medical  Journal  Supplement 


69 


Salt  Lake  City  ...  (Continued) 

Dolowitz,  David  A.;  1152  Grilmer  Drive;  4-8514;  Salt 
Lake  City  5;  ALR*  (PP). 

Dowd,  J.  E.;  First  Natl.  Bank  Bldg.;  3-5170;  Salt 
Lake  City  1. 

Edmunds.  David  G. ; 608  Medical  Arts  Bldg.;  3-2568; 
Salt  Lake  City  1;  R*. 

Ershler,  Irving;  463  E.  South  Temple;  9-5920;  I* 
(PP). 

Evans,  Carvel  S.;  1002  Medical  Arts  Bldg.;  5-2119; 
Salt  Lake  City  1;  I*  (PP). 

Evans,  J.  O. ; Veterans  Administration;  Salt  Lake 
City. 

Fairbanks,  Bryce  Jay;  315  Medical  Arts  Bldg.; 

3-1681;  Salt  Lake  City  1;  OALR*  (PP). 

Fairbanks,  E.  B.;  315  Medical  Arts  Bldg.;  3-1681; 
Salt  Lake  (jity  1;  OALR*. 

Fellows,  N.  Miles;  Salt  Lake  City  General  Hospital; 

6-8771;  Salt  Lake  City  5;  S*  (Med.  School). 

Pelt,  J.  E.;  1001  First  National  Bank  Bldg.;  4-9824; 
Salt  Lake  City  1;  GP. 

Felt,  Walter  L. ; Miedical  Arts  Bldg.;  3-7197;  Salt 
Lake  City  1;  Pd*. 

Flagg,  Geddes  B.,  Jr.;  204  E.  South  Temple;  Salt 
Ij3/k©  C/itv  2 

Fowler,  J.  B.;  458  S.  Main;  5-8224;  ObG  (PP). 

Frazier,  Harry  O. ; 707  Medical  Arts  Bldg.;  3-4203; 
OALR*  (PP). 

Galllgan,  John  J. ; 730  Judge  Bldg.;  5-8989;  Salt 
Lake  City  1;  S (PP). 

Gibbs,  Richard  W.;  812  Medical  Arts  Bldg.;  5-5161; 

Salt  Lake  City  1;  GP  (PP). 

Goodwin,  Harold  I.;  902  Medical  Arts  Bldg.;  5-7808; 

Salt  Lake  City  1;  GP  (PP). 

Gottfredson,  David  B.;  115  E.  South  Temple;  9-3701; 
S (PP). 

Green,  Ray  E. ; 601  Judge  Bldg.;  3-7575;  Salt  Lake 
City  1;  GP  (PP). 

Gross,  Esther  S. ; 202  E.  South  Temple;  5-2941;  Salt 
Lake  City  2;  Pd»  (PP). 

Gross,  George  D. ; 202  E.  South  Temple;  5-2941;  Salt 
Lake  City  2;  I*  (PP). 

Gubler,  John  A.;  Veterans  Adm.  Hosp.;  9-2011;  Salt 
Lake  City  3;  S*  (Gov.). 

Gunn,  Francis  D.;  2033  S.  State  St.;  6-8771;  Salt  Lake 
City  5;  Path*  (Med.  School). 

Hall.  Eugene  T.:  141  E.  2ndi  South;  5-0362;  Salt 
Lake  City  1;  GP  (PP). 

Hardie,  Julian  C.;  2950  S.  5th  East;  7-6449;  Salt  Lake 
City  8;  GP. 

Harris,  John!  G.;  1111  S.  State  St.;  3-9994;  Salt  Lake 
City  4;  GP. 

Harrow,  Reed;  809  Medical  Arts  Bldg.;  5-2933;  Salt 
Lake  City  1;  NS*  (PP). 

Harvey,  Dean  A.;  174  B.  South  Temple;  4-1941;  Salt 
Lake  City  6;  Oph*. 

Hashimoto.  Edward  I.;  315*  12th  East;  5-2268;  GP 
(PP). 

Hatch,  Floyd  F.;  699  E.  South  Temple;  4-5673;  S* 
(PP). 

Hicken.  N.  Frederick:  511  Medical  Arts  Bldg.;  4-8459; 
Salt  Lake  City  1;  S*. 

Hoenes,  Andrew  J.;  815  E.  21st  South;  6-9908;  Salt 
Lake  City  6;  (Ret.). 

Holbrook.  Von  G.;  220  E.  South  Temple;  5-5355; 
ObG*  (PP). 

Holley.  Edward  B. ; 1020  Boston  Bldg.;  4-5551;  Salt 
Lake  City  1;  Pd*  (PP). 

Holmstrom,  Emil  G.;  2033  S.  State  St.;  6-8771,  Ext. 

98;  Salt  Lake  City  5;  ObG*  (Med.  School). 

Horne,  Lyman  M.;  220  E.  South  Temple;  5-5355; 
ObG*  (PP). 

Horton,  W.  H.;  602  Medical  Arts  Bldg.;  3-2555;  Salt 
Lake  City  1;  S (PP). 

Howard,  Philip  M. ; 9 Exchange  PI.;  5-8110;  Salt  Lake 
City  1;  S*  (PP). 

Howells,  T.  J.;  1360  Thornton;  3-3313;  GP  (PP). 
Hruska,  Edward  J.;  L.D.S.  Hospital;  5-1477;  Salt  Lake 
City  3;  Anes*  (PP). 

Huether,  A.  L. ; 220  Boston  Bldg.;  Salt  Lake  City  1; 

Or*.  ■ ' 

Hunter,  John  P. ; 3007  Highland  Drive;  Salt  Lake 
City. 

Jackson,  H.  Myrthan;  699  E.  South  Temple;  4-5673; 
Salt  Lake  City  2;  S (PP). 

Jackson,  Newton  R.;  201  Medical  Arts  Bldg.; 

3- 7088;  Salt  Lake  City  1;  Gyn. 

Jager,  Blair  V. ; Salt  Lake  General  Hospital;  6-8771; 

Salt  Lake  City  5;  I*  (Med.  School). 

Jellison,.  Robert  T.;  1200  First  Natl.  Bank  Bldg.; 

4- 3531;  Salt  Lake  City  1;  I*. 

Jenkins,  Joseph  D.;  35  F St.;  5-8143;  A (PP). 
Jeppson,  Edward  M.;  604  Judge  Bldg.;  3-9226;  Salt 
Lake  City  1;  GP  (PP). 


Johns,  Richard  E.;  115  E.  South  Temple;  9-3701; 

Salt  Lake  City  1;  ObG*  (PP). 

Jones,  John  H. ; 720  Boston  Bldg.;  4-6690;  Salt  Lake 
City  1;  ObG*. 

Jones,  Scott  A.;  523  Judge  Bldg.;  8-2174;  Salt  Lake 
City  1;  GP  (PP). 

Jones,  William  J. ; 699  E.  South  Temple:  Salt  Lake 
City  2. 

Kahn,  Sol.  G. ; 821  Boston  Bldg.;  3-8525;  Salt  Lake 
City  1;  GP  (PP). 

Kerby,  James  P.;  343  S.  Main  St.;  4-4359;  R*  (PP). 
Kesler,  Joseph  P. ; 440  E.  1st  South;  Salt  Lake  City  2. 
Kilpatrick,  Elmer  M.;  141  E.  2nd'  South;  3-7959; 

Salt  Lake  City  1;  I*  (PP). 

Kimball,  F.  Heber;  912  Medical  Arts  Building;  9-0648; 

Salt  Lake  City  1;  GP  (PP). 

Kimball,  James  Leroy;  610  Medical  Arts  Bldg.; 

9-0648;  Salt  Lake  City  1;  I*  (PP)- 
Kirtley,  Howard  P.;  807  Medical  Arts  Bldg.;  3-2102; 

Salt  Lake  City  1;  Gyn*  (PP). 

Kuhe,  Emil  B.;  First  Security  Bank  Bldg.;  4-3531; 
Salt  Lake  City  1;  S (PP). 

Landenberger,  J.  C. ; 2122  Hubbard  Ave. ; Salt  Lake 
City;  (Ret.). 

Lawrence,  Edwin  A.;  Salt  Lake  General  Hospital: 

6-8771;  Salt  Lake  City  5;  S*  (Med.  School). 
LeCompte,  Edward  D.;  University  Club;  5-3456;  Salt 
Lake  City  1;  (Ret.). 

Lee,  Grant  W.;  2951  S.  20th  East;  7-3627;  Salt  Lake 
City  6;  S*  (PP). 

Lee,  Tunnie  F. ; Salt  Lake  General  Hospital;  6-8771; 

Salt  Lake  City  5;  Anes*  (PP). 

Leonard,  A.  N. ; Medical  Arts  Bldg.;  5-1012;  Salt  Lake 
City  1. 

Lindem,  Martin  C.;  818  Boston  Bldg.;  4-2781;  Salt 
Lake  City  1;  S*  (PP). 

Llewellyn,  John  R. ; 115  E.  South  Temple;  4-1941. 
Lund.  Herbert  Z.;  Medical  Arts  Bldg.;  3-1054;  Salt 
Lake  City  1. 

Macfarlane,  L.  Wayland;  718  Boston  Bldg.;  5-1100; 

Salt  Lake  City  1;  I*  (PP). 

Marshall,  H.  L. ; University  of  Utah;  4-1951;  PH* 
(Med.  School). 

Mason,  John  T.;  1021  E.  South  Temple;  4-2802;  Pd. 
Maw,  Raymond  B. ; 699  E.  South  Temple;  4-5673; 

Salt  Lake  City  2;  OALR*  (PP). 

McMain,  William  A.;  1202  E.  South  Temple:  5-7634; 
Pd*  (PP). 

McNeil,  Crichton:  Holy  Cross  Hosp.;  4-8441;  Path*; 
( Ex6C.  ) . 

McQuarrie,  Harlow  B. ; 204  E.  South  Temple;  9-2227; 

Salt  Lake  City  1;  Pr*  (PP). 

McQuarrie,  L.;  204  Ei  South  Temple;  4-7628;  Salt 
Lake  City  1;  GP  (PP). 

Meads,  Garner  B. ; 801  E.  South  Temple;  9-0242;  Salt 
Lake  City  2;  S (PP). 

Merrill,  Rowland  H. ; 1010  First  Natl.  Bank  Bldg.; 

9-2043;  Salt  Lake  City  1;  Oph*  (PP). 

Meyer,  Ralph  R. ; Holy  Cross  Hosp.;  Salt  Lake 
City  2;  4-8441;  R*  (PP). 

Middlemiss,  William  R.;  2046  S.  11th  East;  6-6244; 

Salt  Lake  City  5;  GP  (PP). 

Middleton,  Anthony  W.;  722  Boston  Bldg.;  3-4804; 

Salt  Lake  City  1;  U*  (PP). 

Middleton,  Richard  P.;  722  Boston  Bldg.;  3-4804; 

Salt  Lake  City  1;  U*  (PP). 

Miller,  James  Rex;  115  E.  South  Temple;  9-3701; 
I*  (PP). 

Milligan,  Paul  R;  115  E.  South  Temple;  9-3701;  Salt 
Lake  City  1;  Or*  (PP). 

Moench,  Louis'  G.;  115  E.  South  Temple:  9-3701; 

Salt  Lake  City  1;  P*  (PP). 

Moffat,  Dean  A.;  623  Judge  Bldg.;  3-5004;  Salt  L/ake 
City  1;  A*  (PP). 

Moore,  W.  Hlarvey;  308  Medical  Arts  Bldg.;  Salt  Lake 
City  1;  GP. 

Moretz,  William  H.;  2033  S.  State  St.;  Salt  Lake 
City;  S. 

Morginson,  William  J.;  141  E.  2nd  South:  3-8334; 

Salt  Lake  City  1;  D*  (PP). 

Morris,  Richard  P.;  830  Boston  Bldg.;  4-1553;  Salt 
Lake  City  1. 

Morton,  Thomas  F.  H.;  1007  Medical  Arts  Bldg.; 

5-5656;  Salt  Lake  City  1;  GP. 

Muir,  Everett  B.;  804  Boston  Bldg.;  3-9441;  Salt 
Lake  City  1;  Oph*  (PP). 

Muirhead,  R.  Mowatt;  213  Judge  Bldg.;  3-7916;  Salt 
Lake  City  1;  ALR*  (PP). 

Murphy,  Arthur  J. ; 601  Judge  Bldg.;  3-7575;  Salt 
Lake  City  1;  S (PP). 

Murphy,  Edwin  R. ; 701  Boston  Bldg.;  4-3095;  Salt 
Lake  City  1;  Pd*  (PP). 

Nebeker,  William  M.;  612  Medical  Arts  Bldg.; 

3-2595;  iSlalt  Lake  City  1;  ObG*. 

Neill,  Glenn  G.;  1086  E.  21st  South;  6-3337;  Salt 
Lake  City  5;  GP  (PP). 


70 


Rocky  Mountain  Medical  Journal  Supplement 


Salt  Lake  City  . . . (Continued) 

Kelson,  Mildred  N.;  905  Boston  Bldg.:  3-1331;  Salt 
Lake  City  1;  Ob  (PP). 

Nelson,  Woodrow;  Boston  Bldg.;  4567-3;  Salt  Lake 
City  1;  S*  (PP). 

Nemir,  Alma;  75  S.  Main;  5-2724;  Salt  Lake  City  1. 
Netolicky,  Stephen;  1786  Harrison  Ave. ; 8-0161; 

(Gov.). 

Nielson,  J.  Elmer;  606  Medical  Arts  Bldg.;  5-3991; 
Salt  Lake  City  1;  R (PP). 

Nyvall,  Clarence  A.;  414  Hooper  Bldg.;  5-3203; 

Salt  Lake  City  1;  GP  (PP). 

Ogilvie,  Orin  A.;  211  Medical  Arts  Bldg.;  3-2649; 
Salt  Lake  City  1;  Path*. 

Okelberry,  Alfred  M.;  115  E.  South  Temple;  9-3701; 

Salt  Lake  City  1;  Or*  (PP). 

Openshaw,  C.  R. ; 153  S.  9th  East;  5-2863;  S. 

Ossman,  Lawrence  N.;  601  Boston  Bldg.;  3-6944; 

salt  Lake  City  1;  Or*  (PP). 

Owens,  Russell  W.;  907  Boston  Bldg.;  3-9371;  Salt 
Lake  City  1;  S*. 


Pace,  Garland  H.;  508  Medical  Arts  Bldg.;  3-8108; 

Salt  Lake  City  1;  PN*  (PP). 

Pace,  William  D.;  508  Medical  Arts  Bldg.;  3-8108; 

Salt  Lake  City  1;  PN*  (PP). 

Palmer.  Bascom  W. ; 804  Boston  Bldg.;  3-9441;  Salt 
Lake  City  1;  Oph*  (PP). 

Palmer,  James  K. ; 415  Boston  Bldg.;  9-1447;  Salt 
Lake  City  1;  U*  (PP). 

Paul,  Leslie  J.;  612  Boston  Bldg.;  9-1508;  Salt  Lake 
City  1;  S. 

Paul,  Samuel  G.;  1216  E.  5th  South;  3-8372;  Salt 
Lake  City  2;  PH*  (PH). 

Pearsall,  Clifford  J.;  628  Boston  Bldg.;  3-4282;  Salt 
Lake  City  1;  D*  (PP). 

Peltzer,  Wesley  E. ; 414  Boston  Bldg.;  5-5355;  C* 
(PP). 

Pemberton,  Paul  A.;  220  Boston  Bldg.;  4-8151;  Salt 
Lake  City  1;  Or*  (PP). 

Pendleton,  Ralph  (i.;  613  Judge  Bldg.;  3-5744;  S*' 

(PP). 

Pepper,  Milton;  175  S.  Main  St.,  Suite  811;  3-4657; 
Salt  Lake  City  1;  S (PP). 

Peterson,  J.  Albert;  703  Boston  Bldg.;  3-3525;  Salt 
Lake  City  1;  GP  (PP). 

Phillips,  Earl  H.;  8 E.  3rd  South;  3-0533;  Salt  Lake 
City  1;  OALR*  (PP). 


Phipps,  J.  A.;  Medical  Arts  Bldg.;  3-5433;  Salt  Lake 
City  1;  GP  (PP). 

Plenk,  Henry  P. ; 2033  S.  State  St.;  6-8771;  Salt  Lake 
City  5;  R*  (Med.  School). 

Pomeroy,  Edward  S.;  628  Judge  Bldg.;  4-9143;  Salt 
Lake  City  1;  U*  (PP). 

Pond,  Vaughan  M. ; 115  E-.  South  Temple;  9-3701;  S. 
Powell,  Chester  B.;  220  Boston  Bldg.;  4-8408;  Salt 
Lake  City  1;  NS*  (PP). 

Price,  Phillip  B.;  2033  S.  State  St.;  6-8771;  Salt  Lake 
City  5;  S*  (Med.  School). 

Pugh,  Walter  N.;  First  Natl.  Bank  Bldg.;  4-3531 
Salt  Lake  City  1;  S*. 

Pugmire,  Adrian  S.;  504  First  Natl.  Bank  Bldg. 

3-6824;  Salt  Lake  City  1;  OALR*  (PP). 

Pugmire,  C.  C.  R.;  504  First  Natl.  Bank  Bldg. 
3-6824;  Salt  Lake  City  1;  OALR  (PP). 


Raile,  Henry;  411  Medical  Arts  Bldg.;  3-7957;  Salt 
Lake  City  1;  GP. 

Raley,  Franklin  H. ; 1115  Boston  Bldg.;  4-5924;  Salt 
Lake  City  1;  OALR*  (PP). 

Randall,  Nomma  Ellison;  246  S.  10th  East;  5-4415; 
Salt  Lake  City  2;  Pd*  (PP), 

Rasmussen,  L.  Paul;  1020  Boston  Bldg.;  4-5551 
Salt  Lake  City  1;  Pd*  (PP). 

Ray,  Charles  N. ; 1321  Harvard  Ave.;  3-3311;  Salt 
Lake  City  1;  GP. 

Rees,  Byron;  908  Medical  Arts  Bldg.;  3-2975;  Salt 
Lake  City  1;  GP. 

Rees,  Nephi  J.;  Medical  Arts  Bldg.;  3-8333-  Salt 
I^ake  City  1;  OALR*. 


Rees.  Vincent  L;  115  E.  South  Temple;  9-3701;  S* 

(PP). 

Reichman,  H.  R.;  705  Medical  Arts  Bldg.;  3-7492; 

Salt  Lake  City  1;  Pr*  (PP). 

Rich,  C.  O’Neal;  801  Medical  Arts  Bldg.;  3-3531- 
Salt  Lake  City  1;  D*  (PP). 

Richards,  G.  Gill;  115  E.  South  Temple;  9-3701;  Salt 
Lake  City  1;  I*. 

Richards.  Ralph  T.;  115  E.  South  Temple;  9-3701- 
Salt  Lake  City  1;  S*.  v 

Ridges,  Alvin  J.;  115  B.  South  Temple;  4-1941-  ALR* 
Rigby,  Ralph  G.;  837  Boston  Bldg.;  5-9400;  Salt 
Lake  City  1;  ALR*  (PP). 

Robbins,  Burtis  F.;  403  Medical  Arts  Bldg.;  4-8411; 
Salt  Lake  City  1;  S*. 

Robinson,  Robert  R,  Jr.;  141  E.  2nd  South;  3-7959; 
Salt  Lake  City  1;  PI*  (PP). 


Robinson,  T.  E.;  1086  E.  21st  South;  7-0262;  Salt 
Lake  City  5;  GP  (PP). 

Robinson,  W.  A.;  1106  Walker  Bank  Bldg.;  4-0353; 

Salt  Lake  City  1;  GP  (PP). 

Robison,  Benjamin  F. ; First  Natl.  Bank  Bldg.;  4-3531; 

Salt  Lake  City  1;  I*  (PP). 

Ross,  Orlindo  L.;  1016  Boston  Bldg.;  4-6725;  Salt 
Lake  City  1;  Pd*  (PP). 

Rothwell,  Robert  S. ; Boston  Bldg.;  5-5557;  Salt  Lake 
City  1;  Pd*  (PP). 

Ruggeri,  Charles;  1120  Boston  Bldg.;  9-4087;  Salt 
I^ake  City  1;  Oph*  (PP). 

Rumel,  William  R.;  807  Medical  Arts  Bldg.;  4-1091; 

Salt  Lake  City  1;  S*  (PP). 

Ryan,  Heber  H.,  Jr.;  Holy  Cross  Hosp. ; 4-8441;  Salt 
Lake  City  2;  Anes*  (PP). 


Sanders,  Mervyn  S'.;  115  E.  South  Temple;  4-1941; 
Salt  Lake  City  1;  ObG*. 

Sanders,  Sharp;  305  Medical  Arts  Bldg.;  Salt  Lake 
City  1;  S (PP). 

Saunders,  Leon  S. ; 703  First  Security  Bank  Bldg.; 

3-2912;  Salt  Lake  City  3;  OALR*  (PP). 

Scott,  H.  S.;  319  Utah  Oil  Bldg.;  3-0186;  Salt  Lake 
City  1.  GP. 

Sevy,  V.  M. ; 1014  Medical  Arts  Bldg.;  3-0524;  Salt 
Lake  City  1;  ObG  (PP). 

Sharp,  John  F.;  770  Ashton  Place;  6-1311;  Salt  Lake 
City  5;  (Ret.). 

Sheehy,  John  J. ; University  of  Utah;  Salt  Lake 
City  1. 

Shepherd,  Warren;  451  University  St.;  3-8238;  (Ret.). 
Shields,  Claude  L.;  613  Judge  Bldg.;  5-5331;  Salt 
Lake  City  1;  S*. 

Simonson,  Eric  E. ; Holy  Cross  Hosp.;  4-8441;  Salt 
Lake  City  2;  Anes*  (PP). 

Skidmore,  Demoivre  R. ; 703  Medical  Arts  Bldg.; 

3-4423;  Salt  Lake  City  1;  ObG  (PP). 

Skidmore,  Earl  L.;  54  E.  South  Temple;  3-4424;  Salt 
Lake  City  1;  S (PP). 

Skolfield,  M. ;,  809  Medical  Arts  Bldg.;  5-2933;  Salt 
Lake  City;  GP  (PP). 

Slopanskey,  Frank  R. ; 1427  S.  13th  East;  6-3961;  Salt 
Lake  City  5;  OALR*  (Ret.). 

Smith,  David  E.;  312  Medical  Arts  Bldg.;  3-1054; 
Salt  Lake  City  1;  ObG. 

Smith,  Homer  E. ; 1005  Medical  Arts  Bldg.;  5-9112; 

Salt  Lake  City  1;  Oph*  (PP). 

Smith,  Linwood;  824  Boston  Bldg.;  5-8008;  Salt  Lake 
City  1;  ObG*  (PP). 

Smith,  Rulon  E.;  701  Medical  Arts  Bldg.;  9-2037; 
Salt  Lake  City  1;  Or  (PP). 

Smith,  Scott  M.;  L.  D.  S.  Hosp.;  5-1477;  Salt  L.ake 
City,  Anes*  (PP). 

Smith,  Silas  S.;  220  E.  South  Temple;  5-5355;  Salt 
Lake  City  2;  S*  (PP). 

Smith,  ,S.  Wayne;  1086  E.  21st  South;  7-7711;  Salt 
Lake  City  6;  GP  (PP). 

Smith,  W.  Leroy;  1005  Medical  Arts  Bldg.;  5-2031; 
Salt  Lake  City  1;  OALR*. 

Snow,  Eliot;  115  E.  South  Temple;  9-3701;  Salt  Lake 
City  1;  S*  (PP). 

Snow,  Perry  G.;  501  Medical  Arts  Bldg.;  3-5209; 

Salt  Lake  City  1;  GP  (PP). 

Snow,  Robert  Gr.;  202  E.  South  Temple;  5-7756;  Salt 
Lake  City  2;  ALR*  (PP). 

Snow,  Spencer;  902  First  Security  Bank  Bldg.;  3-6033; 


Salt  Lake  City  1;  Pd*  (PP). 

Soffe,  George  W. ; 510  Medical  Arts  Bldg.;  3-8483; 
Salt  Lake  City  1;  GP. 

Sonntag,  Richard  Wl.;  1920  Yalerest  Ave.;  Salt  Lake 
City;  (PG  Res.). 

Spear,  Dean;  516  Boston  Bldg.;  5-4141;  Salt  Lake 
City  1;  Oph*  (PP).  „ „ . ^ , 

Spencer,  Frank  D.;  Boston  Bldg.;  3-7604;  Salt  Lake 
City  1*  S (PP). 

Stauffer,’  F.  Leaver;  707  Medical  Arts  Bldg.;  3-4203; 
Salt  Lake  City  1;  OALR*. 

Stevenson,  H.  S.;  903  Medical  Arts  Bldg.;  5-1012; 

Salt  Lake  City  1;  GP  (PP). 

Stevenson,  L.  A.;  5160  Highland  Dr.;  3-4366;  Salt 
Lake  City  7;  (Ret.). 


Stevenson,  Vernon  L. ; 511  Medical  Arts  Bldg.; 

4-8459;  Salt  Lake  City  1;  S*. 

Stobbe,  L.  H.  O.;  75  S.  Main  St.;  3-1788;  Salt  Lake 
City  1;  GP. 

Stookey,  W.  M.;  Medical  Arts  Bldg.;  4-4621;  Salt 
Lake  City  1. 

Tanner,  Richard  S.;  413  Medical  Arts  Bldg.;  5-4654; 

Salt  Lake  City  1;  GP  (PP). 

Taufer,  Louis  J.;  305  Medical  Arts  Bldg.;  3-5848;  Salt 
Lake  City  1;  S*  (PP). 

Taylor.  Maurice  J.;  916  Boston  Bldg.;  3-9251;  Salt 
Lake  City  1;  I*  (PP). 

Tedrow,  Jack  L. ; 141  E.  2nd  South;  3-2024;  Salt  Lake 
City  1;  PN*  (PP). 

Thurman  A.  C. ; 130  State  Capitol;  4-2515,  Ext.  416; 

PH*  (PH). 


Rocky  Mountain  Medical  Journal  Supplement 


71 


Salt  Lake  City  ...  (Continued) 

Toyota,  Toshika:  202  Atlas  Bldg-.;  4-2411;  Salt  Lake 
City  1;  GP  (PP). 

Vance,  Cyril  L.;  610  Medical  Arts  Bldg.;  9-6522;  Salt 
Lake  City  1;  ObG*  (PP). 

Viko.  Louis  E. ; 699  E.  South  Temple;  4-5673;  C 

(PP). 

Walker,  William  C. ; 830  Boston  Bldg.;  4-1553;  Salt 
Lake  City  1;  T (PP). 

Ward,  William  T. ; 1206  Yale  Ave. ; 3-8422;  Salt  Lake 
City  5;  S. 

Waren.ski,  Leo  C.;  612  Medical  Arts  Bldg.;  3-2595; 
Salt  Lake  City  1;  ObG*. 

Weaver,  Robert  G. ; 515  Medical  Arts  Bldg.;  4-9230; 
Salt  Lake  City  1;  U*  (PP). 

Weggeland,  T.  C.;  623  Judge  Bldg.;  3-5004;  Salt  Lake 
City  1;  GP  (PP). 

Wherritt,  J.  Russell;  699  E.  South  Temple;  4-5673; 

Salt  Lake  City  2;  ObG*  (PP). 

White.  Leslie  B.;  143  S.  Main  St.;  5-6011;  Salt  Lake 
City  1;  S (PP). 

White,  V.  P.;  Tribune-Telegram  Bldg.;  3-2608. 
Wight.  Earl  F.;  607  Judge  Bldg.;  9-1241;  Salt  Lake 
City  1;  (PP). 

Williams,  Ernest  B. ; 2168  Wyoming  St.;  8-0610;  C 
(PP) 

Wilson,  Angus  K.;  343  S,  Main  St.;  4-4350;  Salt 
Lake  City  1;  R*  (PP). 

Winget,  Frank  J. : 305  Medical  Arts  Bldg.;  3-5848; 
Salt  Lake  City  1;  S. 

Winter,  Irwin  F.:  463  E.  South  Temple;  Salt  Lake 
City;  R*  (PP). 

Wintrobe,  Maxwell  M.;  175  E.  21st  St.  South;  6-8771; 
I*  (Med.  School). 

Wood,  Eugene;  413  Medical  Arts  Bldg.;  5-4654;  Salt 
Lake  City  1;  ObG  (PP). 

Woodruff,  Charles  W.;  612  Boston  Bldg.;  5-9479; 

Salt  Lake  City  1;  S (PP). 

Woolley,  LeGrand;  205  Templeton  Bldg.;  4-8101; 
Salt  Lake  City  1;  U (PP). 

Woolsey,  Ray  T.;  710  Boston  Bldg.;  3-2932;  Salt 
Lake  City  1;  ObG*  (PP). 

Wright,  Gilbert  L.;  818  Boston  Bldg.;  4-2781;  Salt 
Lake  City  1;  S*  (PP). 

Wright,  Spencer;  308  Medical  Arts  Bldg.;  9-6671; 
Salt  Lake  City  1;  .S'*  (PP). 

Wright,  Stewart  A.;  310  Medical  Arts  Bldg.;  4-6341; 
Salt  Lake  City  1;  NS*  (PP). 

Young,  Clark;  814  Medical  Arts  Bldg.;  4-7435;  Salt 
Lake  City  1;  Ind. 

Young,  Richard  H. ; Medical  School,  University  of 
Utah;  4-1951,  Ext.  413;  I*  (Med.  School). 

Young,  William  R. ; 1202  E.  South  Temple;  5-6541; 
Salt  Lake  City  2;  Pd*  (PP). 

Sandy  ... 

Clark,  Thomas  E;  Sandy;  Midvale  104. 

.Jensen,  Clarence  C.;  Sandy;  Midvale  111:  (Ret.). 
Young,  Harold  E. ; Sandy. 

Santaquin  ... 

Cpenshaw,  Eli  Carlos:  Santaquin;  Santaquin  24-Jll: 
GP  (PP). 

Smithfield  ... 

Budge,  Edwin  C. : Smithfield;  Smithfield. 

Budge,  Robert  S. ; Smithfield;  Smithfield. 

Rees,  George  L. ; 119  N.  Main;  Smithfield  33;  GP. 

Spanish  Fork  ... 

Hagan,  J.  W. ; Creer  Bldg.;  Spanish  Fork  32:  GP. 
Hughes,  Preston;  195  W.  2nd  N. ; Spanish  Fork  74; 
GP  (PP). 

•Judd,  Thomas  R. ; 166  N.  Main  St.;  Spanish  Fork 
699-W:  GP  (PP). 

Moody,  Milo  C. : ’24  N.  1st  East;  Spanish  Fork  194; 
GP  (PP). 

Springville  ... 

Biesinger,  Wilford  G.;  Springfield  Bank  Bldg.; 
Springville  183-W;  GP  (PP). 


Judd,  Clair  W.:  197  S.  Main  St.;  Springville  29-W; 
GP  (PP). 

Orton,  Glen  B. ; 195  S.  Main  St.;  Springville  243;  GP 
(PP). 


Standardville  ... 

Gorishek,  William  M. ; Standardville  Hospital;  Stand- 
ardville 6-R4;  Ind. 

Sunnyside  ... 

Barrett,  William  W.,  Jr.;  Sunnyside;  Sunnyside 
28-J2:  GP  (PP). 

Spencei',  Orson  B.;  Sunnyside;  Sunnyside;  GP  (PP). 

Tooele  ... 

Aidous,  Tura  M.;  159  E.  Vine  St.;  Tooele  136;  GP 
(PP). 

Journay,  John  L.;  159  E.  Vine  St.;  Tooele  136;  GP 
(PP). 

Mayo,  Joseph  Lee;  154  S.  Main  St.;  Tooele  212;  GP 
(PP) 

Millburn,  J.  Herbert;  154  S.  Main  St.;  Tooele  212; 
GP  (PP). 


Tremonton  ... 

Ficklin,  George  C. ; The  Valley  Hospital;  Tremonton 
28;  GP  (PP). 

Mohr,  A.  J.;  Tremonton;  Tremonton  119;  GP. 

White,  Edgar  H.;  The  Valley  Hosp.;  Tremonton  91; 
GP  (PP). 

Vernal  ... 

Eskelson,  Farley  G.;  75  W.  Main;  Vernal  123;  GP. 
Franke,  J.  M. ; Vernal. 

Hansen,  Joseph  L. ; Uintah  State  Bank  Bldg.;  Vernal 
8;  GP  (PP). 

Piper,  Charles  L.;  Uintah  State  Bank  Bldg.;  Vernal 
8;  GP  (PP). 

Seager,  Tyrrell  R. ; 75  W.  Main  St.;  Vernal  123;  GP 
(PP). 

Spendlove,  Ray  E.;  75  W.  Main  St.;  Vernal  123;  GP. 

Wellsville  ... 

Francis,  Gilbert  S.;  Wellsville;  Hyrum  144-Rl;  GP 
(PP). 

Members  Out  of  State  ... 

Aird,  John  W. ; 4021  Cedar  AVe. ; Long  Beach  7,  Calif.; 
(Ret.). 

Behle,  Augustus  C.;  701  Sovereign  Apts.;  Long  Beach 
2,  (California;  Long  Beach  66-3333;  (Ret.). 
Boucher,  Francis  E.;  384  Myrtle;  Laguna  Beach, 

Calif.  (Ret.). 

Canister,  Cyril  T.;  68  Bickerstaff;  Lafayette,  Calif. 

Davis,  Donald  D. ; 407  7th  Ave.,  S.E.;  Minneapolis 
14,  Minn.;  (PG). 

Grose,  Edward  R, ; White  Memorial  Hospital;  312 
N.  Boyle  Ave.;  Los  Angeles  33,  Calif.;  ALR  (PG 
Res.). 

Hanson,  Albert  N.;  245  16th;  Santa  Monica.  Calif.; 
(Ret.). 

Hess,  Wallace  E. ; Kennedy  Hosp.;  Memphis,  Tenn. 
Horne,  Albert  M. ; 3501  Gaston  Ave.;  Dallas  4,  Texas; 
T3-1404;  R*  (PG  Res.). 

Hosmer,  John  A.;  300  Kelton  Ave.;  Los  Angeles  24, 
California;  (PG). 

Norris,  U.  H. ; 1344  Hill  St.;  Santa  Monica,  Cali- 
fornia; (Ret.). 

Pace,  John  W. : University  of  California  Hosp.;  San 
Francisco,  California;  Mo-4-3600;  NS*  (PG  Res.). 

Quick,  Roy  W. ; 5313  Franklin  Road;  Boise,  Idaho; 
(Ret.). 

Rose,  Kurt  E.;  Judge  Baker  Guidance  Center;  38 
Beacon  St.;  Boston  8,  Mass.;  P*  (PP). 

Schricker,  J.  Louis,  Jr.;  148  Sealrock  Drive;  San 
Francisco,  Calif. 

Tyndale,  W.  R. ; 1720  Brockton  Ave.;  Los  Angeles  25, 
Calif.;  Arizona  9-0916;  (Ret). 

Voss,  B.  J. ; Wadsworth  Gen.  Hosp.,  Vets.  Adm. 
Center;  Los  Angeles  25,  Calif. 


72 


Rocky  Mountain  Medical  Journal  Supplement 


THE  WYOMING  STATE  MEDICAL  SOCIETY 


OFFICERS 

President:  George  E.  Baker,  Casper. 

President-Elect:  DeWitt  Dominick,  Cody. 

Vice  President:  K.  E.  Krueger,  Rock  Springs. 

Treasurer:  F.  M.  Schunk,  Sheridan. 

Corresponding  Secretary:  George  H.  Phelps,  Cheyenne. 

Delegate  A M. A.:  E.  H.  Reeve,  Casper. 

Alternate  Delegate  A.M.A.:  W.  A.  Bunten,  Cheyenne. 

Executive  Secretary:  Mr.  Arthur  Ahhey,  Cheyenne. 

COMMITTEES 

Rocky  Mountain  Medical  Conference:  Earl  Whedon,  Chairman.  Sheridan; 
George  N.  Phelps,  Cheyenne;  H.  L.  Harvey.  Casper;  C.  W.  Jeffrey,  RawUn.s; 
L.  W.  Storey,  Laramie. 

Syphilis  Committee:  N.  E.  Morad,  Chairman,  Casper;  G.  M.  Groshart. 
Worland;  L.  H.  Wilmoth,  Lander;  L.  G.  Booth,  Sheridan;  F.  H.  Haigler, 
Midwest. 

Cancer  Committee;  Earl  Whedon,  Chairman,  Sheridan;  John  Gramllch, 
Cheyenne;  DeWitt  Dominick,  Cody;  J.  R.  Newman,  Kemmerer;  E.  W.  New- 
man, Cheyenne. 

Medical  Economics  Committee:  C.  L.  Rogers,  Chairman,  Sheridan;  Nels 
A.  Vlcklund,  Thermopolis;  R.  A.  Corhett,  Saratoga;  G.  R.  James,  Casper; 
S.  S.  Hellewell,  Evanston. 

Fracture  Committee:  Philip  Teal,  Chairman,  Cheyenne;  Silva  J.  Giovale, 
Cheyenne;  Robert  V.  Batterton,  Rawlins;  Lowell  D.  Kattenhorn,  Powell; 
Joseph  E.  Hoadley,  Gillette. 

Medical  Defense  Committee:  George  Baker,  Chairman,  Casper;  Andrew 
Bunten,  Cheyenne;  E.  W.  DeKay,  Laramie. 

Councillors:  Earl  Whedon,  Chairman,  Sheridan;  R.  J.  Boesel,  Cheyenne; 
E.  W.  DeKay,  Laramie;  George  Baker,  President,  Casper;  George  Phelps, 
Secretary,  Cheyenne. 

Advisory  to  Woman’s  Auxiliary:  John  R.  Bunch,  Chairman,  Laramie; 
Virgil  L.  Thorpe,  Newcastle;  H.  J.  Aldrich,  Sheridan;  G.  B.  Savory,  Chey- 
enne. 

Advisory  to  Workmen's  Compensation  Department:  J.  D.  Shingle,  Chair- 
man, Cheyenne;  G,  H.  Phelps,  Cheyenne;  W.  A.  Bunten,  Cheyenne;  R.  H. 
Reeve,  Casper;  Albert  T.  Sudman,  Green  River;  P.  M.  Schunk,  Sheridan. 


Industrial  Health  Committee:  K.  E.  Krueger,  Chairman,  Rock  Springs; 
Willard  Pennoyer,  Cheyenne;  Thomas  B.  Croft,  Lovell;  Eugene  Pelton. 
Laramie. 

Veterans’  Affairs  and  Military  Service  Committee;  A.  J.  AUegrettl,  Chair- 
man, Cheyenne;  Jack  Rowlett,  Laramie;  Everett  EUis,  Cheyenne;  Bernard 
Sullivan,  Laramie;  G.  W.  Koford,  Cheyenne;  Bernard  Stack,  Thermopolis; 
J.  W.  Sampson,  Sheridan;  DeWitt  Dominick,  Cody;  Paul  R.  Holtz,  Lander; 
George  E.  Baker,  President,  Casper;  George  Phelps,  Secretary,  Cheyenne. 

Blue  Cross  Hospital  Committee;  R.  I.  Williams,  Chairman,  Cheyenne,  1950; 
W.  A.  Bunten,  Cheyenne,  1949;  E.  W.  DeKay,  Laramie,  1951;  Cedric 
Jones,  Cody,  1952. 

Public  Policy  and  Legislation:  George  Phelps,  Chairman,  Cheyenne; 

Andrew  Bunten,  Cheyenne;  George  Baker,  President,  Casper;  G.  W.  Koford, 
Cheyenne;  E.  W.  DeKay,  Laramie;  G.  W.  Henderson,  Casper. 

National  Physicians  Committee:  George  Phelps,  Chairman,  Cheyenne; 

Andrew  Bunten,  Treasurer,  Cheyenne;  E.  W.  DeKay,  Laramie;  George  Baker, 
Casper. 

Poliomyelitis  Committee:  H.  L.  Harvey,  Chairman,  Casper;  N.  A.  Vicklund, 
Thermopolis;  Leo  Keenan,  Torrington;  DeWitt  Dominick,  Cody;  Philip  Teal, 
Cheyenne;  Franklin  Yoder,  Cheyenne;  F.  A.  Mills,  Rawlins. 

State  Institutions  Advisory  Committee;  J.  F.  Whalen.  Chairman,  Evans- 
ton; George  Phelps,  Cheyenne;  C.  W.  Jeffrey,  Rawlins;  Earl  Whedon,  Sheri- 
dan; G.  M.  Groshart,  Worland;  R.  H.  Kanable,  Basin. 

Necrology  Committee:  Earl  Whedon,  Chairman,  Sheridan;  John  B. 
Krahl,  Torrington;  Franklin  Yoder,  Cheyenne. 

Rural  Health  Committee:  Paul  Holtz,  Chairman,  Lander;  Andrew  Bun- 
ten, Cheyenne;  Samuel  Worthen,  Alton;  Wm.  K.  Bosene,  Wheatland;  Claude 
Raffl,  Basin. 

Public  Health  Department  Liaison  Committee:  E.  C.  Ridgeway,  Chair- 
man, Cody;  R.  P.  Fitzgerald,  Casper;  R.  V.  Batterton,  Rawlins;  J.  W. 
Sampson,  Sheridan;  R.  C.  Stratton,  Green  River;  Willard  Pennoyer, 
Cheyenne. 

Child  Health  Committee:  Paul  W.  Emerson,  Chairman,  Cheyenne;  John 
GramHch,  Cheyenne;  Thomas  Croft,  LoveU;  Bernard  Sullivan,  Laramie; 
Paul  R.  Holtz,  Lander;  Geo.  E.  Baker,  Casper;  A.  R.  Abbey,  Cheyenne. 

Council  on  National  Emergency  Medical  Service:  George  H.  Phelps, 
Chairman,  Cheyeixne;  R,  H.  Reeve,  Casper;  DeWitt  Dominick,  Cody;  E.  W. 
DeKay,  Laramie;  K.  S.  Krueger,  Rock  Springs;  P.  M.  Schunk,  Sheridan. 


Rocky  Mountain  Medical  Journal  Supplement 


73 


74 


Rocky  Mountain  Medical  Journal  Supplement 


Directory  of  Members  — WYOMING 

(As  of  December  31,  1948) 

For  Explanation  of  listings  and  symbols,  see  Page  1. 


Afton  ... 

Treloar,  Orson  U;  L.  D.  S.  Star  Valley  Hosp.  Bldg.; 
Afton  80;  GP  (PP). 

Worthen,  Samuel  H.;  Afton;  Afton  21;  S (PP). 

Basin  ... 

Kanable,  Russell  H.;  Basin;  Basin  103- W;  T*  (HA). 
Raffl,  Claude;  Pioneer  Bldg'.;  Basin  23;  S (PP). 

Buffalo  ... 

Smith,  Clifford  L.;  147  S.  Main;  84-W;  GP  (PP). 

Casper  ... 

Anderson,  Harlan  B. ; 332  Wyoming  Natl.  Bank  Bldg.; 
340;  Or  (PP). 

Arrasmith,  W.  W. ; 234  Wyoming  Natl.  Bank  Bldg.; 
756;  I*. 

Baker,  George  E.;  226  E.  2nd  St.;  372;  I*  (PP). 
Barrett,  La'wrence;  224  Wyoming  Natl.  Bank  Bldg.; 
484;  GP. 

Beach,  Glenn  O. ; 312  Wyoming  Natl.  Bank  Bldg.; 
312;  S (PP). 

Fitzgerald,  Richard  P. ; 226  E.  2iiu  5t. ; 3590;  Gl’ 
(PP). 

Hansard,  J.  R.;  260  So.  Elk  St.;  529R;  GP  (PP). 
Hart.  Wilbur;  135  W.  9th  St.;  3206;  GP  (PP). 
Harvey,  Herbert  L. ; 128  E.  2nd  St.;  61;  S. 

Henderson,  George  W.;  202  E.  2nd  St.;  1650;  S (PP). 
Henrich,  Melvin  C. ; 125  N.  Durbin  St.;  1806;  GP 
(PP). 

James,  George  R. ; 218  Wyoming  Natl.  Bank  Bldg.; 
2201;  Oph*  (PP). 

Knapp,  George  M.;  332  E.  2nd  St.;  4236;  S*  (PP). 
Lawton,  Latham  B. ; 231  Wyoming  Natl.  Bank  Bldg.; 
107;  GP  (PP). 

McI  ellan,  Allan;  Wyoming  Natl.  Bank  Bldg.;  90; 
Ini  (PP). 

Morad,  N.  B.;  137  S.  Wolcott  St.;  2344;  GP  (PP). 
Nelson,  John  R.;  218  Wyoming  Natl.  Bank  Bldg.; 
2 ,01:  ALR*  (PP). 

Platz,  C.  H.;  214  Wyoming  Natl.  Bank  Bldg.;  4151; 
Pd*  (PP). 

Platz,  (Jharles  P. ; 214  Wyoming  Natl.  Bank  Bldg.; 
781;  ObG*  (PP). 

Reeve,  Roscoe  H.;  311  Wyoming  Natl.  Bank  Bldg.; 
87;  S (PP). 

Riach,  Thomas  J. ; 210  E.  Second  St.;  1219;  P (PP). 
Stuckenhoff,  H.  E. ; 206  Wyoming  Natl.  Bank  Bldg.; 
316;  GP  (PP). 

Whiston,  Gordon  C. ; 332  Wyoming  Natl.  Bank  Bldg.; 
340;  Or*  (PP). 

W’ynne,  Walter  R. ; Wyoming  Natl.  Bank  Bldg.; 
'34;  R*. 

Cheyenne  ... 

Alder,  Verne  H.;  422  Hynds  Bldg.;  4882;  ALR*  (PP). 
Allegretti,  A.  J.;  522  Hynds  Bldg.;  6231;  GP. 
Andresen,  Marjory  I.;  1604  Capitol  Ave.;  5564;  CP 
(PP). 

Beck,  F.  L.;  1517  E.  18th  St.;  (Ret.). 

i ewis  C.;  Medical  Center,  United  Airlines; 
2-5260;  Ind*. 

Boesel,  R.  J. ; 321  Hynds  Bldg.;  4839;  S. 

Bunten,  Joseph  C.;  2815  Central  Ave.;  3326;  S (PP). 
Bunten,  W.  Andrew;  630  Boyd  Bldg.;  4493;  S (PP). 

Conyers,  Chester  A.;  220  Boyd  Bldg.;  6770;  GP  (PP). 
Cox.  A.  M.;  201  Hynds  Bldg.;  2-1801;  GF  (PP). 

Ellis,  Everett;  1730  Carey  Ave.;  4991. 

Emerson,  Paul  W. ; 422  E.  19th  St.;  4915;  Pd*  (PP). 

Flett,  David  M.;  1720  Carey  Ave.;  5765;  I*  (PP). 

Fox,  Galen  A.;  204  E.  22nd  St.;  (Ret.). 

Giovale,  Silvio  J.;  622  Central  Ave.;  8115;  GP  (PP). 
Goff,  Harry  L. ; Carey  Bldg.;  3511;  GP. 

Gramlich,  John  B. ; 2605  Capitol  Ave.;  9456;  S*  (FP). 
Gramlich,  Ralph  (j.;  2605  Capitol  Ave.;  9456;  Anes 
(PP). 


Harris,  William  D.;  630  Boyd  Bldg.;  4493;  Ob  (PP). 

Joder,  Glen  H.;  227  Hyndsi  Bldg.;  5732;  GP  (PP). 
Johnston,  George  P. ; 2018  Carey  Ave.;  3791;  GP. 

Kahn,  Ernest  A.;  200  Garlett  Bldg.;  3717;  GP  (PP). 
Ketchum,  Philip  V.;  315  W.  20th  St.;  8631;  PH*  (PH). 
Koford,  G.  W.;  2020  Carey  Ave.;  5600;  GP  (PP). 

Magrath,  F.  E. ; Hynds  Bldg.;  3200. 

McEnery,  Douglas:  W. ; State  Health  Dept.;  PH* 
(PH). 

McShane,  Kenneth  L. ; 1730  Carey  Ave.;  4991;  S (PP). 
Mylar,  Wilber  K.;  2520  Capitol  Ave.;  6631;  S*. 

Newman,  Erwin  W.;  408  Hynds  Bldg.;  4246;  Oph* 

(PP). 

Pennoyer,  Willard  H. ; 314  Hynds  Bldg.;  4131;  GP 
(PP). 

Phelps,  George  H. ; 522  Hynds  Bldg.;  6231;  S (PP). 

Savory,  G.  B.;  Boyd  Bldg.;  4122;  GP  (PP). 

Schmidt,  John  H. ; 2520  Capitol  Ave.;  6631;  GP  (PP). 
Shingle,  J.  D. ; 2020  Carey  Ave.;  5600;  S (PP). 
Shwen,  Ralph  O.;  319%  W.  18th  St.;  3633;  Pd  (PP). 
Stump,  Robert  B. ; 408  Hynds  Bldg.;  4246;  Oph* 
(PF). 

Teal,  Philip;  Boyd  Bldg.;  8011;  Or*  (PP). 

Wallin,  Stanley  P.;  2615  Capitol  Ave.;  3633;  ObG 
(PP). 

WSlliams,  Russel  I.;  422  Hynds  Bldg.;  4882;  ALR*. 
Yoder,  Franklin  D.;  Capitol  Bldg.;  5901;  PH*  (FH). 
Zuckerman,  Sam  S. ; Hynds  Bldg.;  5564;  CP*  (PP). 

Cody  ... 

Dacken,  Victor  R. ; Vogel  Bldg.;  43. 

Dominick,  DeWitt;  1301  Rumsey  St.;  600;  S (PP). 
Jones,  J.  Cedric:  1301  Rumsey  St.;  600;  Oph  (PP). 
Ridgway,  Eli  C.;  1301  Rumsey  St.;  600;  Pd  (PP). 
Williams,  Nathaniel  O.;  Vogel  Bldg.;  43;  S (PP). 

Dixon  ... 

Noyes,  Edmund  F. ; Dixon;  Dixon  18;  GP  (PP). 

Douglas  ... 

Gardner,  E.  W.;  313  E.  Center  St.;  Douglas  370;  GP. 
Hlnrichs,  William;  313  E.  Center  St.;  Douglas  370; 
GP  (PP). 

Johnson,  E.  George;  313  E.  Center  St.;  Douglas  370; 
GP  (PP). 


Evanston  ... 

Hellewell,  Joseph  S. ; 220  10th  St.;  Evanston  6;  GP 
(PP). 

Holland,  Josiah  H. ; 1025  Main  St.;  Evanston  97;  GP. 
Waters,  John  H. ; 1025  Main  St.;  Evanston  97;  GP 
(PP). 

Whalen,  Joseph  F. ; Wyoming  State  Hosp.;  Evanston. 

Fort  McKenzie 

Wright,  Eugene  O. ; Fort  McKefizie;  Fort  McKenzie; 
(Gov.). 

Gillette  ... 

Hoadley,  Joseph  B.;  Box  150;  Gillette  3;  S (PP). 
McHenry,  Junius  C.;  116  W.  2nd  St.;  55;  S (FP). 


Green  River  ... 

Stratton,  Richard  C.;  Green  River;  Green  River 
86;  GP  (PP). 

Sudman,  Albert  T. ; Green  River;  Green  River  84; 
GP  (PP). 

Greybull  ... 

Myre,  Stanley  L. ; Greybull;  Greybull  1;  GP  (PP). 


Rocky  Mountain  Medical  Journal  Supplement 


75 


Jackson  ... 

MacLeod,  Donald  G.;  Jackson;  Jackson  28;  GP  (PP). 

Kemmerer  ... 

Hummer,  Robert  O.;  313  Sapphire;  Kemmerer  2-W; 
GP  (PP). 

Newnam,  John  R.;  821  Pine  Ave.;  Kemmerer  11; 
S (PP). 

Wurtz,  R.  M.;  815  Pine  Ave.;  Kemmerer  97;  GP 

(PP). 

Lander  ... 

Bovenmyer,  Earl  S. ; Lander;  Landei'. 

Holtz,  Paul  R.;  317  W.  Main  St.;  Lander  89;  S (PP). 
Nylander,  Mary  Arlene;  Lander;  Lander  89;  GP  (PP). 
Rogers,  Fred  E.;  Baldwin  Bldg.;  Lander  420;  GP 
(PP). 

Smith,  W.  Francis;  Lander;  Lander  26. 

Wilmoth,  L.  Harmon;  Earl  Bldg'.;  Lander  77-W;  GP 
(PP). 

Laramie  ... 

Bunch,  John  R.;  209  Ivinson;  4884;  GP  (PP). 
DeKay,  E:.  W. ; 318  S.  2nd  St.;  2108;  GP  (PP). 

Evans,  Lloyd  R. ; Simpson  Bldg.;  2109;  I*  (PP). 
Ingersoll,  Winifred;  University  of  Wyoming;  Lara- 
mie; GP  (Student  Health  Service). 

Pavy,  Odra  S.;  408  Roach  Bldg.;  2621;  C (PP). 
Pelton,  Eugene  C. ; 15  Simpson  Bldg.;  3970;  GP 

(PP). 

Petri,  K.  N. ; Roach  Bldg.;  2116;  S. 

Pugh,  C.  G. ; 208  Grand  Ave.;  4304. 

Rowlett,  Jack;  Simpson  Bldg.;  2108;  S (PP). 
Storey,  Lee  W.;  318  S.  2nd  St.;  2108;  GP  (PP). 
Sullivan,  Bernard  J.;  318  S.  2nd  St.;  2109;  GP  (PP). 

Lingle  ... 

Patton,  John  E.;  Lingle;  Torrington  32-L2;  Oph 
(PP). 

Lovell  . . . 

Croft,  Thomas  B.;  470  Montana  Ave.;  Lovell  45;  GP. 
Horsley,  W.  W. ; 490  Montana  Ave.;  Lovell  45;  GP 
(PP). 

Lusk  . . . 

Reckling,  Walter  E.;  Lusk;  Lusk  8;  GP  (PP). 
Torkelson,  Oliver  E.;  Lusk;  Lusk  260-J;  GP  (PP), 

Midwest  ... 

Haigler,  Frederick  H. ; Midwest;  Midwest  2841;  GP. 

Monarch  . . . 

Pratt,  John  R. ; Monarch;  Monarch. 

Mountain  View 

McDill,  Wilson  F. ; Mountain  View;  Mountain  View; 
GP  (PP). 

Newcastle  ... 

Carlin,  E.  J. ; Newcastle;  Newcastle  23;  GP  (PP). 
Guilfoyle,  Edward  J.;  Newcastle;  Newcastle  274; 
GP  (PP). 

Thorpe,  Virgil  L.;  Newcastle;  Newcastle  274;  GP. 

Pine  Bluffs  ... 

Morris,  M.  L.;  Pine  Bluffs;  Pine  Bluffs. 

Pinedale  ... 

Leeman,  Judson  S.;  Pinedale;  Pinedale;  GP  (PP). 

Powell  ...  ' 

Allison,  Lester  F. ; 217  E.  1st  St.;  Powell  180;  GP 
(PP). 


Bridenbaugh,  Robert  N.;  595  Ave.  B. ; Powell  355; 
GP  (PP). 

Kattenhorn,  Lowell  D.;  267  N.  Bent  St.;  Powell  207; 
GP  (PP). 

Lukens,  Robert  G. ; 269  N.  Bent  St.;  Powell  207;  GP. 

Rawlins  . . • 

Baker,  Ranson  B. ; 7 Osborne  Bldg.;  Rawlins  133- W; 
GP  (PP). 

Cashman,  James  E^;  318  N.  5th  St.;  Rawlins  182; 
GP  (PP). 

Jeffrey,  Charles  W. ; 406  W.  Cedar  St.;  Rawlins 
606-W;  GP  (PP). 

Mills,  Frank  A.;  Rawlins;  300-W;  GP  (PP). 
Plummer,  Orby  E. ; 318  N.  5th  St.;  Rawlins  185;  GP 
(PP).  ' 

Reliance  ... 

Muir,  John  P.;  Reliance;  Reliance  015-J3;  Ind  (PP). 

Riverton  ... 

Ashbaugh,  Roy  Asquith;  Masonic  Temple  Bldg.; 
Riverton  162;  GP  (PP). 

Ashbaugh,  R.  Dale;  Masonic  Temple  Bldg.;  Riverton 
162;  GP  (PP). 

Cogswell.  John  G.;  Box  111;  Riverton  50;  GP  (PH). 

Rock  Springs  ... 

Arbogast,  H.  J.;  602  A St.;  Rock  Springs  75;  GP 
(PP). 

Bertoncel),  Frank  J.;  215  4th  St.;  Rock  Springs  14; 
GP  (PP). 

Harrison,  G.  Myron;  430  4th  St.;  Rock  Springs  2; 
-GP  (PP). 

Kos,  Paul  A.;  430  4th  St.;  Rock  Springs  2;  GF  (PP). 
Krueger.  Karl  E.;  430  4th  St.;  Rock  Springs  2;  GP. 
McCrann,  P.  M. ; 430  4th  St.;  Rock  Springs  2;  GP 
(PP). 

Prevedal,  Arthur  E. ; 430  4th  St.;  Rock  Springs  2; 
GP  (PP). 

Wanner,  Jay  G.;  219  4th  St.;  Rock  Springs  311; 
OALR*  (PP). 

Saratoga  ... 

Corbett,  Ray  A.;  Saratoga;  Saratoga  46;  GP  (PP). 

Sheridan  . . . 

Adams,  Herbert  V.;  7 Sheridan  Natl.  Bank  Bldg.; 
1952;  GP  (PP). 

Aldrich,  Herrick  J. ; 105  S.  Main  St.;  44;  I*  (PP). 
Anton,  Carleton  D.;  15  E.  Works  St.;  310;  Pd  (PP). 
Arnold,  Ralph  D.;  15  E.  Brundage  St.;  658;  GP  (PP). 
Booth,  Louis  G.;  Bank  of  Commerce  Bldg.;  524; 
GP  (PP). 

Carr,  John  E.;  49  N.  Main;  482;  GP  (PP). 

Crane,  Richard  E.;  134  S.  Main  St.;  276;  S (PP). 
Landis,  Walter  E. ; 50  N.  Main  St.;  71;  OALR*  (PP). 
Rogers,  Curtis  L. ; 49  S.  Main  St.;  380;  GP  (PP). 
Sampson,'  James  W.;  134  S.  Main  St.;  229;  S (PP). 
Schunk,  Peter  M.;-  105  S.  Main  St.;  44;  GP  (PP). 
Schunk,  William  F. ; Keenan  Bldg.;  44;  S (PP). 
Stewart,  J.  G.;  50  N.  Main  St.;  100;  GP  (PP). 
Veach,  Oscar  L. ; Whitney  Trust  Bldg.;  117;  OALR* 
(PP). 

Whedon,  Earl;  304  S.  Main  St.;  723;  OALR*  (Ret.). 

Shoshoni  ... 

Jewell,  E.  L.;  Bhoshoni;  Shoshoni  271;  (Ret.). 

Sundance  ... 

Clarenbach,  Julius  F.;  Sundance;  Sundance  27;  GP. 

Sunrise  . . . 

Arbogast,  Hoyle  J.;  Sunrise;  Sunrise;  GP. 

Superior  . . . 

Hanten,  Stephen  J.;  Box  L;  Superior  1450;  GP  (PP). 


76 


Rocky  Mountain  Medical  Journal  Supplement 


Thermopolis  ... 

Gitlitz,  Benjamin;  Klink  Bldg.;  Thermopolis  201; 
GP  (PP). 

Stack,  Bernard  D. ; Klink  Bldg.;  Thermopolis  276; 
GP  (PP). 

Vicklund,  Nels  A.;  712  Broadway;  Thermopolis  507; 
GP  (PP). 

Torrington  ... 

Krahl,  John  B.;  Bump  Bldg.;  Torrington  109;  GP 
(PP). 

Morgan,  Loran  B. ; Bump  Bldg.;  Torrington  109;  GP 
(PP). 

Rae,  Harold  B. ; 201  Eaton  Bldg.;  Torrington  265; 
Torrington;  GP  (PP). 

Reed,  Orville  C. ; Bump  Bldg.;  Torrington  141;  GP 
(PP). 

Sell,  Roger  K. ; Eaton  Bldg.;  Torrington  55;  GP 
(PP). 

Wheatland  ... 

Allison,  James  G. : Wheatland  General  Hosp. ; Wheat- 
land  75;  GP  (PP). 

Collins,  Walter  H. ; Wheatland;  Wheatland  120; 
Oph. 

Lunt,  Lawrence  K. ; Double  Four  Ranch;  Wheat- 
land;  P (PP). 

Rosene,  William  E. ; Hopwood  Bldg.;  Wheatland  85; 
GP  (PP). 


Winton  . . . 

Yedinak,  Paul  R.;  Winton;  Winton  012-R3;  GP. 

Worland  ... 

Anderson,  L.  S.;  P.  O.  Box  229;  Worland  42;  GP  (PP). 
Engelman,  A.  A.;  Swan  and  Henry  Bldg.;  Worland 
660-W;  GP  (PP). 

Groshart,  G.  M.;  Worland;  Worland  42;  GP  (PP). 
Hine,  Fred  B.;  Worland;  Worland  12. 

Members  Out  of  State  ... 

Batterton,  R.  V.;  3045  Dumas  St.;  San  Diego  6,  Calif.; 
GP. 

Bosshardt,  Orval  A.;  125  West  F St.;  Ontario,  Calif.; 
Ontario  611-06;  GP  (PP). 

Miner,  Paul  F. ; 411  Eastman  Bldg.;  Boise,  Idaho; 
Boise  166;  I*  (PP). 

Pawling,  Phillip  S. ; Sharpe  General  Depot;  Stockton, 
California;  Stockton  6-6001;  GP  (Armed  Forces). 

Richardsen,  Darwin  L.;  Okeene,  Oklahoma;  GP  (PP). 
Webb,  H.  Brook;  (Armed  Forces). 

Wood,  Lyle  L.;  Rt.  2;  Wadsworth,  Kansas;  (Gov.). 

Woodward,  Stillman;  Union  Printers  Home;  Colo- 
rado Springs,  Colo. 


Rocky  Mountain  Medical  Journal  Supplement 


77 


MEMORANDA 


V 


78 


Rocky  Mountain  Medical  Journal  Supplement 


MEMORANDA 


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Rocky  Mountain  Medical  Journal  Supplement 


Index  to  Advertisers 


Pag-e 


A and  B Sandwich  Shop 50 

Abbey  Rents  2 

Aladdin  Drug  Company 2 

Alpine  Electric  Company 10 

American  Ambulance 

Company 20 

American  Medical  and 

Dental  Association 6 

Armstrong  Equipment  and 

Supply  Company,  Inc 26 

Beatrice  Foods  Company 52 

Bennett,  Horace  W. 

and  Company Cover  III 

Berber!,  George  and  Sons 3 

Blair  Surgical  Supply 56 

Brecht’s  Candy  Company 40 

Built  Rite  Auto  Body 

Company 38 

Burt’s  Motor  Sales io 

Capital  Chevrolet  Company. _ 10 

Capitol  Sandwich  Company.  54 

Colorado  Artificial  Limb 

Company 20 

Colorado  Potato  Flake 

Manufacturing  Company 40 

Colorado  State  Bank 44 

Colorado  Thermoseal 

Company  30 

Columbian  Bifocal  Company  42 
Colvin  Medical  Books 38 

Cook,  M.  H.,  General 

Contractor  2 4 

Cooper,  Marie  A.,  Spencer 

Supports  36 

Dansberry’s  Pharmacy 12 

Denver  Catering  Company 22 

Denver  Tent  and  Awning 

Company  26 

Denver  Tramway 

Corporation  58 

Dictating  Recording 

Company  8 

Doose  and  Lintner 

Construction  Company 43 

Downing  Drug  Company 16 


Page 

Durbin,  J.  Surgical  Supply' 


Company 4 

Ernest  Drug  Company 52 

Evans,  Walter  W.,  General 

Contractor  28 

Pason  Films,  Jack 40 

Fletcher  Construction 

Company  68 


Floorite  Refinishing  Company'  54 
Harris,  Upham  and  Company  16 

Haven  Pharmacy  28 

Huppert’s,  Joe  Drug  Store 32 

Johnson,  J.  A.  and  Son, 

Furnaces  ^ 68 

Jonas  Brothers  14 

Kelly  Electric  Company 68 

Kincaid  Pharmacy  2 

Knight  Drug  Co.  12 

Kremers-Urban  Co.  64 

Lynch  Electric  Company 41 

Mail-Me-Monday  32 

IWecure  Auto  Service,  Floyd  63 
Medical  Service  Representa- 


tives Society  of 

Colorado  Cover  II 

Mercy  Hospital  20 

Midway  Cafe  74 

Minit-Man  Auto  Wash 68 


Morgan,  Leibman  and  Hickey  12 

Mountain  States  Telephone 

and  Telegraph  Company 26 

Mutual  Benefit  Health  and 


Accident  Association  62 

Nettie’s  Monroe  Buffet  58 

Oberg  and  Keller  Auto 

Repair  32 

Overstakes  Pharmacy 46 

Parise,  Carl  34 

Peters,  Writer  and 

Christensen,  Inc.  36 

Pfab  Pharmacy  2 

Pierre  Roofing  Company 60 

Pioneer  Window  Shade 

Factory  58 

Plains  Dairy  System 74 


Page 


Plaza  Hotel  63 

Presbyterian  Hospital  16 

Republic  Building 

Corporation  Cover  IV 

Republic  Drug  Company 18 

Restaurant  240  58 

Reed’s  Ambulance  Service 46 

Rexair,  Inc.  50 

Reynolds-Urling  24 

Rockmont  Flowers  52 

Roedel’s  Drug  Store 74 

Rose,  Arthur  Tailoring-,  Inc.  30 

R-X  Service  Station 44 

St.  Anthony’s  Hospital 2 

St.  Mary  Hospital 36 

Sandoz  Chemical  Works,  Inc.  60 

Shirley-Savoy  Hotel 50 

Short,  R.  C 5 4 

Smith-Dorsey  Company 48 

Spencer  Supports  36 

Stephenson,  J.  W.,  Auto 

Body  Repairing 42 

Stewart  Axle  and  Frame 

Service  44 

Stewart,  Margaret  Kay 

Travel  Service  — 18 

Telephone  Answering 

Service  24 

Telephone  Secretarial 

Bureau  18 

Udry,  Edward  G.  Agency 22 

University  Inn  38 

U.  S.  Fidelity  and 

Guaranty  Company  54 

Vandorbilts,  The 52 

Waco  Venetian  Blind 

Company  52 

Warren  Ambulance  Company  42 

Weiss  Venetian  Blind 

Company  46 

Whitley,  E.  D.  Steamship 

and  Tourist  Agency 14 

York  Pharmacy 38 

Yucca  Restaurant 44 


80 


Rocky  Mountain  Medical  Journal  Supplement 


METROPOLITAN  BUILDING 

A WELL  - KNOWN  ADDRESS 


At  Sixteenth  Street  and  Court  Place — in  Denver’s 
Medical  Center.  Exclusively  Medical  and  Dental 
occupancy.  Extensive  Medical  Library  available 
to  Medical  Society  Members. 


AGENTS 

HORACE  W.  BENNETT  & COMPANY 

235  Majestic  Building  Denver,  Colorado  TAbor  1271 


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Medical  and  Dental  Center 


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Designed  Exclusively 
for  the  Dental  and  Medical  Professions 


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